Socket shield dental implant treatment
Socket shield is a technique for placing dental implants that is thought to possibly save facial or buccal bone by maintaining the PDL and it’s corresponding blood supply. The root fragment can be on the buccal, interproximal, or the entire circumferential coronal aspect of the tooth socket. Hurzeler was the first to use the term socket shield in 2010.
Socket shield technique and case selection
Obviously you want an area where there is a benefit to saying the buccal or facial architecture so an anterior dental implant on a patient with a high smile line. Ideally the tooth has no apical pathology according to Gluckman, is uninfected, and is periodontally healthy. According to this dt post Gluckman requires removal of all gutta percha. An implant that contacts an endodontically failing root can result in peri-implantitis.
Socket shield technique step by step
- Section the crown portion of the tooth to either slightly above, at, or slightly below the bone crest.
- Retain a 4-5 mm vertical section of tooth on the buccal
- The tooth section is ideally 1.5mm thick for strength and is immobile
- An optional 2mm cervical extension above the bone crest can support the papilla, this I find more risky. Most sources say up to 1mm above the bone ridge. Siormpas ID 2018
- No bone grafting
- Placement for healing abutment or immediate temporary
Socket shield research papers
A dog study has histology that shows this does work in dogs and also a case report on #9 that looks great. Others are trying these out and having success. Siormpas has a 10 year clinical study with success.
“This technique should not be used in routine clinical practice until a higher level evidence in the form of prospective clinical trials is available.” This quote is from the doctor, Dr. Hurzeler, who was the first to publish and discuss the technique so be aware.
Socket shield synonyms are abundant and the most common is partial extraction therapy
Socket shield, partial extraction therapy, root membrane, PDL-mediated ridge preservation for immediate implant placement and partial root retention (PRR) are all names that exist in the research. A circumferential socket shield goes by the name root-T-belt technique, although I can’t image that going over well with most dentists.
Root submergence technique
Root submergence technique is a procedure that involves root banking to save the bony architecture of the arch. Salama has a nice article on this technique. It may be of some use for those that extraction might be dangerous or traumatic for and I also see it from dentists touting it as a technique to help with esthetics. I personally can’t image too many cases where that really helps much. For instance this case of pontic site development and this one, I find foolish. However, Salama’s case looks fantastic.
Decoronation for ridge preservation
This technique is similar to the root submergence above and coronectomy of wisdom teeth. The difference is that this is done with teeth that have ankylosis and we expect the remaining tooth structure to resorb. The only use I have seen for this is when an anterior tooth has ankylosis as Malmgren JOE 2013 shows.