The International Journal of Periodontics & Restorative Dentistry
The International Journal of Periodontics & Restorative Dentistry
The International Journal of Periodontics & Restorative Dentistry
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409
Complication Management of a
Socket Shield Case After
6 Years of Function
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410
Case Report
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411
a b
Fig 2 Occlusal view after (a) shield preparation and (b) implant placement. Fig 3 Emergence profile after 5 months of
healing.
a b
Fig 4 (a) Frontal and (b) occlusal views 1 year after implant crown placement.
around the implant in the maxillary height coronally with a diamond sutured with a 7/0 suture (Seralene
left incisor. The shield around the bur, allowing the subsequent re- DS 15, Serag-Weissner). The patient
buccal aspect of the implant was moval with a straight desmotome was instructed to refrain from clean-
mobile and a deep, 8-mm buccal (Deppeler). The remaining buccal ing in the surgical area and instead
probing depth could be detected. bone could be preserved, and the rinse three times daily with a 0.12%
The incisal edge of the implant defect was thoroughly cleaned using chlorhexidine liquid until removal
crown was in a lower position com- curettes and an airflow device with of the sutures. The healing process
pared to the adjacent tooth, sug- erythritol powder (Perioflow and Air- was uneventful, and the sutures were
gesting an ongoing vertical growth flow, EMS). Afterwards, the defect taken out 7 days later.
of the neighboring tooth (Fig 5a). was filled with bovine bone particles In 2019, 12 months after the cor-
It was decided to perform sur- (Bio-Oss, Geistlich Pharma) up to the rection, the patient was examined
gery to remove the shield with the top of the buccal wall. To thicken the and a stable situation was observed.
surrounding inflammation and fill the tissue and to achieve a more secure No inflammation or mobility was
defect with a bovine bone material coverage of the defect, an autoge- seen. The soft tissue around the im-
(Bio-Oss, Geistlich). At first a sulcu- nous connective tissue graft for cov- plant showed a recession, and the
lar incision was performed extend- erage was taken from the tuberosity. papilla adjacent to tooth 11 was re-
ing from tooth 11 to tooth 24 (FDI The graft was meticulously deepithe- duced in height. Scar tissue around
system). The papillae needed to be lialized using a blade and half split in the implant could be observed.
sharply dissected in order to gain the middle to achieve a better adap- Radiographs showed no irregu-
enough sight for the surgery and tation over the defect. These surgical larities around the implant, and the
carefully remove the mobile shield. steps are demonstrated in Figs 5b to patient did not report any complica-
The mobile shield was reduced in 5e. The flap was repositioned and tions (Fig 6).
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412
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413
a b
Fig 6 (a) Frontal, (b) occlusal, and (c) radiographic views 12 months after surgical intervention.
In the literature today, there is exactly follow the later-published Another overall successful case
only a small amount of data avail- concept of the socket shield tech- report of the socket shield technique
able for complications with the nique, the implications in terms of by Cherel and Etienne showed an
socket shield technique. Prior to development of complications are exposed dentine fragment in the
the first publication of the socket comparable to the complications in emergence profile when placing the
shield technique, Davarpanah and the socket shield technique. In their final crowns after 4 months of imme-
Szmukler-Moncler published a case case series of five patients, one pa- diate provisionalization and implant
series of five patients with a total of tient developed a small resorption placement.18 The dentine fragments
five implants, where the authors tried of the remaining dentine plate, but exhibited no signs of mobility or
to avoid the traumatic extraction of this did not affect the overall implant surrounding inflammation and thus
ankylosed teeth by leaving remnants success after a follow-up period of 49 were rated as a success.
of the root in place before placing months. The authors attributed the Siormpas et al reported one
the implant.32 Although they did not complication to an occlusal overload. failure in their retrospective analysis
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414
of 46 implants over a period of up clinical cases and a complication Except for the four studies re-
to 60 months.30 The patient initially rate of up to 83% (total: n = 58) in porting failures in the socket shield
presented with an extensive apical implants placed in animal studies. technique and the systematic lit-
defect in the maxillary central inci- At this point, it needs to be em- erature review by Gharpure and
sor that was treated by extracting phasized that the systematic review35 Bhatavadekar,35 there are no further
the tooth and placing an immedi- did not differentiate between the reports of complications in socket
ate implant with the socket shield originally published socket shield shield therapy. In the majority of the
technique. After a 3-year follow- technique and the T-Belt technique. cases, no additional treatment was
up, the apical defect radiographi- Out of 58 published failures of im- necessary, which was agreed on fol-
cally showed uneventful healing, plants in preclinical studies, 54 were lowing consequent follow-ups. In
but a 1.5-mm apical resorption of not treated with the original pub- one case, surgical intervention was
the shield was observed. The cone lished socket shield technique. The performed and a satisfactory es-
beam computed tomography scan failure rate in animal studies with the thetic result was achieved.34
at the 48-month follow-up revealed socket shield technique seems to be
no progress in resorption. The very low.
functional and esthetic implant suc- The 19 clinical studies in the Conclusions
cess was not impaired due to that review35 reported 33 out of 136 im-
event. plants as failures. A closer look at This case presentation shows that
In 2015, Lagas et al reported the underlying data reveals that 10 a long-term failure in the socket
in a case series of 16 patients (one out of the 26 implants had a bone shield technology can occur, but the
implant per patient) the failure of a loss of 1.3 ± 0.2 mm at 6 months. complications are manageable. It is
shield in one patient. The patient All of these implants come from the obvious that this is an evolving tech-
presented with a mobile dentine Troiano et al study31 and were not nique with a learning curve. To con-
shield, which was removed. In a placed with the socket shield tech- sistently apply this technique within
second surgical procedure, a con- nique but with the T-Belt technique. the implant therapy, more research
nective tissue graft was used to cor- The other 16 implants classified as a and more clinical control studies are
rect the defect, and a satisfactory failure of bone loss showed a bone needed in order to mitigate the risk
esthetic outcome was observed. loss of around 0.8 mm after 3 to 24 of possible failures. Identifying pos-
The authors attribute the complica- months. It remains a point of discus- sible risk factors and complications
tion to insufficient removal of res- sion whether this amount of bone with the socket shield technique is
toration material in the previously loss is to be classified as a failure. essential for its successful applica-
partially extracted tooth.34 Another 7 failed implants showed tion in today’s implant therapy.
A systematic literature review shield exposure, deep probing
by Gharpure and Bhatavadekar also depths, and deficiency of alveo-
had the intention to identify pos- lar ridge. Taking out the implants Acknowledgments
sible complications in the socket placed with the T-Belt technique,
shield technique.35 In their review, the complication rate is down to The authors declare no conflicts of interest.
four histologic studies and 19 clini- 17%, or 23 out of 136 implants.
cal studies were included, most of Gharpure and Bhatavadekar35
them case presentations with one also stated that a small number of References
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