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Socket Shield Technique with and Without Implant Placement to Maintain Pink Aesthetics

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Socket Shield Technique with and Without Implant Placement to Maintain Pink Aesthetics Socket Shield Technique with and without Implant Placement to Dental examination (Figures 1-3) revealed that tooth number 23 was restored with a loose richmond crown Maintain Pink Aesthetics on a decayed root, teeth number 24 & 25 were decayed and non-restorable, tooth number 26 was decayed, non- Case Report vital and restorable, all teeth were asymptomatic. Periodontal examination revealed no pockets, no Haseeb H. Al-Dary inflammation, no gum recession, no bone resorption Private Practice, Amman – Jordan | [email protected] around teeth number 23, 24 & 25 teeth were healthy non mobile ones. Radiographic examination (Figure 4) revealed a root canal treated 23, 24, & 25, with no periapical lesions. (Fig. 4) Pre-operative Panoramic radiograph ABSTRACT Many treatment plans was discussed with the patient, Keeping the tune and the shape of the hard and soft tissues after tooth/teeth extraction happens to be an issue of a and due to financial reasons only one implant was Local anaesthesia was applied, richmond crown over great concern in aesthetic and restorative dentistry. accepted to be received by him. tooth number 23 was removed, then tooth sectioning The patient was educated about Socket Shield Technique was performed mesio-distaly, palatal fragment was Socket preservation was adopted by many clinicians to try to prevent the volumetric changes of the hard and soft and the Modified Socket Shield Technique and he accepted tissues, the thing that would lead to a satisfying aesthetic outcome after restoration. luxated then removed atraumatically, the buccal to have the procedures being done using these techniques. fragment was reduced at a bucco-lingual direction and Many socket preservation techniques were used starting from atraumatic extraction ending with bone augmentation to prepared to take a semilunar shape leaving the rest of keep the bone from being subjected to remodeling, but still keeping the tooth in the socket and maintaining the system the socket room for the implant to be inserted (Figure of periodontium seems to be the golden standard that would never be superimposed. 5), the remaining fragment was reduced from coronal to reach the gingival sulcus, osteotomy was performed, Root submergence then Socket techniques were suggested to keep the system of periodontium undisrupted the thing and a Euroteknica implant was inserted 2 millimeters that would keep the shape of the gum unchanged giving the optimal aesthetic results. bellow the coronal edge of the fragment and touching it, temporary abutment was then removed and replaced by In this case presentation the socket shield and a technique modified from the root submergence were used trying to a cover screw. (Figure 6) get the desired emergence profile. KEYWORDS Partial extraction, Buccal fragment, Socket shield, Modified socket shield. (Fig. 1) Pre-operative lateral view showing number tooth 23 crown unremoved & teeth 24,25 unrestored INTRODUCTION Many materials and methods have been mentioned in of the tooth in the pontic site, which in turn allows for 13 the literature to maintain or preserve the fresh extraction complete preservation of the alveolar bone frame. (Fig. 2) socket especially to support the relatively thin buccal Pre-operative frontal On the other hand instead of leaving the whole root in plate of the bone from getting collapsed, these include view of same site to Immediate implants after extraction protocol,1,2 also RST. The Buccal fragment of the remaining root is being give an idea about the (Fig. 5) Occlusal view of the site showing tooth 23 after bone substitute materials have been used,3-7 and/or left in socket shield technique after a root sectioning is soft tissue contour performing socket shield technique leaving buccal fragment barrier membranes,8,9 but those procedures have the performed from the mesial to distal side of the remaining of tooth 23 intact ability to maintain the ridge dimension to a certain root as to separate it into 2 fragments, Buccal and Palatal/ amount.5,10,11 Lingual. The buccal root fragment is being left while the rest of the tooth is being extracted,12 Leaving a space However, a complete preservation and/or entire to place the implant behind it. Or it can be left without regeneration of the extraction socket have not been placing an implant also, but the ridge would be saved documented yet.12 from being subjected to bone remodeling after extraction. The (Root Submergence Technique) RST was described CASE REPORT by Salama et al. By maintaining the root in the socket, A 60 years old male patient stepped into the office to a much greater amount of surrounding tissue may be restore teeth number 24 & 25, tooth number 23 was preserved than with the other commonly used socket restored with a loose crown. preservation techniques, which almost always leads to crestal bone resorption and thus reduction of the height of Medical history of the patient was taken, non-smoker, in the interdental papillae and width of the edentulous ridge. a good general condition, no systemic illness, not on a RST instead maintains the natural attachment apparatus regular medication. (Fig. 6) Occlusal view showing the implant being placed in (Fig. 3) Pre-operative occlusal view of same site the socket of tooth 23 | 16 | Smile Dental Journal | Volume 11, Issue 1 - 2016 Smile Dental Journal | Volume 11, Issue 1 - 2016 | 17 | Same procedure of socket shield was performed on teeth A root canal treatment was done on tooth number 26. root during implant placement does not appear to number 24 & 25 but without implant placement in the interfere with osseointegration and may be beneficial in resulting sockets (Figures 7-10). After more than 3 months has elapsed implant abutment preserving the buccal bone plate. was then attached to the implant (Figures 11,12) a 4 unit bridge connecting the implant and tooth number 26 was Hurzelur applied an enamel matrix derivate between the then fabricated to replace the missing 23,24,25 and to root and the implant which explain the newly formed restore tooth number 26 (Figures 13-15) cementum on the lingual side of root fragment and the surface of the implant on this side.12 Bauer et al. conducted a study in which they have separated the Buccal Tooth Segment -shield- and they have not used the enamel matrix derivate they concluded that the applied modification seems not to interfere (Fig. 14) Lateral view after the bridge is delivered with implant osseointegration and may still preserve the buccal plate. It may offer a feasible treatment option for vertically fractured teeth.18 (Fig. 7) Occlusal view showing teeth 24,25 after performing A draw back of Socket Shield Technique that it’s socket shield technique associated with certain risks, such as the formation of a peri-implant periodontal membrane19 or the development of peri-implant infections, as well as resorption associated (Fig. 11) Occlusal view showing implant abutment attached with the usual biological long-term complications that may to the implant, and healing of sockets of teeth 24,25 with occur. These occur especially in the presence of pre-exiting socket shield coronal tips before being reduced or developing periodontal or endodontic infections or inflammations of the retained tooth fragments.19 (Fig. 15) Panoramic radiograph after the delivery of the bridge On the other hand, root submergence technique needs a (Fig. 8) soft tissue grafting over the top of the submerged roots13 Post operative frontal DISCUSSION the thing that complicates the procedure, and needs view a donor site to take the soft tissue graft from, with the Giorgio Pagni et al. concluded that post-extraction possibility of soft tissue graft to fail, which exposes the alveolar ridge resorption is an inevitable process.14 root to the oral cavity environment with the possibility of (Fig. 12) In the literature, many techniques have been used to the tooth structure to get decayed. Frontal view showing overcome this negative consequence of tooth extraction that the soft tissue on the bony socket of teeth, like Immediate implant In socket shield technique without Implant placement the contour to compare it placement which does not stop the process of socket and shield acts same as root submergence technique but no with the frontal pre- ridge remodeling, and on its own, it proves problematic in need for soft tissue graft, the fragment is being covered operative one controlling alveolar bone resorption1,2 also graft materials by healing process of the socket and the exposed small have been used3-7 and/or barrier membranes,8,9 However, tip of the fragment may be reduced by round bur, (Fig. 9) a complete preservation and/ or entire regeneration of the reducing the possibility of caries. The removed richmond extraction socket have not been documented yet.12 crown and palatal teeth fragments after Salama et al. concluded that it’s safe to assume that Connecting Teeth to Implants was subjected to a great being extracted from implants will never surpass the natural tooth’s ability to debate by clinicians, due to differences in mobility teeth 23,24,25 preserve the surrounding bone and soft tissue height, this patterns between a tooth and an implant which could came up with the idea of (Root submergence technique) result in the tooth being depressed into the socket, of Salama which is leaving the root of a tooth in the which might cause the prosthesis to be cantilevered off socket to preserve bone and soft tissue dimensions13 the implant. Theoretically, this could increase stress on provided that the root is not infected or mobile because the implant and lead to both technical and biologic 20-22 it might be felt that the roots may act as a mobile foreign complications.
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