An Up-to-date Technique for Preserving Alveolar Socket: Socket Shield Technique

Year 2021, Volume: 3 Issue: 3, 1 - 14, 31.10.2021

Ezgi Ceylan , Ezgi Gürbüz

Abstract

In maxillary anterior aesthetic region, adequate alveolar bone volume and appropriate bone architecture should be present for the treatment of tooth loss with dental implant-supported restoration. Therefore, a number of techniques such as atraumatic extraction, socket augmentation, guided bone regeneration, socket seal technique and immediate implantation are recommended in this region to prevent alveolar bone resorption and maintain bone dimensions for ideal functional and aesthetic rehabilitation. Although these techniques show significant effects in protecting the alveolar bone from resorption, a technique in which the alveolar socket can be fully protected is not yet available. Loss of periodontal ligament and associated vascular support is seen as a reason for resorption, and therefore, Socket Shield Technique has been defined in which some part of the periodontal ligament is protected by the root fragment left in the socket to avoid physiological bone resorption. According to the studies, it was concluded that this new technique can be used in the maxillary anterior aesthetic region to protect bone tissue and soft tissue. However, for its acceptance in clinical practice as conventional immediate implantation, prospective studies with large number of patients and long-term follow-ups are needed.

Keywords

Alveolar ridge preservation, Socket shield technique, Root membrane technique, Partial extraction therapies, Immediate implant placement

Alveoler Kreti Korumaya Yönelik Güncel Bir Teknik: Soket Kalkanı Tekniği

Abstract

Maksiller anterior estetik bölgede diş eksikliğinin dental implant destekli restorasyonlarla tedavisinde yeterli alveoler kemik hacminin ve uygun kemik mimarisinin olması gerekir. Dolayısıyla bu bölgede ideal fonksiyonel ve estetik rehabilitasyon için diş çekimi sonrası gelişen alveoler kemik rezorbsiyonunu engelleyecek ve kemik boyutlarını idame ettirebilecek birtakım teknikler (atravmatik çekim, soket ogmentasyonu, yönlendirilmiş kemik rejenerasyonu, soket seal tekniği ve immediat implantasyon gibi) önerilmektedir. Bu teknikler çekim sonrası alveoler kemiği rezorbsiyondan korumada belirgin etkiler gösterseler de alveoler soketin tamamen korunabildiği bir teknik henüz mevcut değildir. Diş çekimiyle birlikte periodontal ligament ve ilişkili vasküler desteğin kaybedilmesi rezorbsiyonun bir sebebi olarak görülür ve bu nedenle çekim sonrası tetiklenen fizyolojik kemik rezorbsiyonundan kaçınmak adına periodontal ligamentin bir kısmının soket içerisinde bırakılan kök fragmanı ile korunduğu Soket Kalkanı Tekniği tanımlanmıştır. Yapılan çalışmalara göre bu yeni tekniğin maksiller anterior estetik bölgede kemik dokusunu ve yumuşak dokuyu koruma amacıyla kullanılabileceği sonucuna varılmıştır. Ancak klinik pratikte geleneksel immediat implantasyon gibi kabul görmesi için hasta sayısının fazla olduğu, uzun dönem takipleri olan prospektif çalışmalara ihtiyaç vardır.

Keywords

Kret koruma, Soket kalkanı tekniği, Kök membran tekniği, Parsiyel ekstraksiyon terapileri, İmmediat implantasyon

References

• Araujo MG, Lindhe J. Dimensional ridge alterations following tooth extraction. An experimental study in the dog. J Clin Periodontol. 2005;32(2):212-218.
• Cardaropoli G, Araujo M, Lindhe J. Dynamics of bone tissue formation in tooth extraction sites: an experimental study in dogs. J Clin Periodontol. 2003;30(9):809-818.
• Pietrokovski J, Massler M. Alveolar ridge resorption following tooth extraction. J Prosthet Dent. 1967;17(1):21-27.
• Schropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent. 2003;23(4):313-323.
• Pinho MN, Roriz VL, Novaes AB, Jr., Taba M, Jr., Grisi MF, de Souza SL, et al. Titanium membranes in prevention of alveolar collapse after tooth extraction. Implant Dent. 2006;15(1):53-61.
• Horvath A, Mardas N, Mezzomo LA, Needleman IG, Donos N. Alveolar ridge preservation. A systematic review. Clin Oral Investig. 2013;17(2):341-363.
• Wang H-L, Neiva RF. Socket augmentation: rationale and technique. In: El Askary Ael S, editor. Fundamentals of Esthetic Implant Dentistry. 1st ed., ABD: Wiley-Blackwell; 2008, p. 140-224.
• Iasella JM, Greenwell H, Miller RL, Hill M, Drisko C, Bohra AA, et al. Ridge preservation with freeze‐dried bone allograft and a collagen membrane compared to extraction alone for implant site development: A clinical and histologic study in humans. J Periodontol. 2003;74(7):990-999.
• Bartee BK. Extraction site reconstruction for alveolar ridge preservation. Part 2: membrane-assisted surgical technique. J Oral Implantol. 2001;27(4):194-197.
• Lekovic V, Camargo PM, Klokkevold PR, Weinlaender M, Kenney EB, Dimitrijevic B, et al. Preservation of alveolar bone in extraction sockets using bioabsorbable membranes. J Periodontol. 1998;69(9):1044-1049.
• Fickl S, Zuhr O, Wachtel H, Stappert CF, Stein JM, Hurzeler MB. Dimensional changes of the alveolar ridge contour after different socket preservation techniques. J Clin Periodontol. 2008;35(10):906-913.
• Fiorellini JP, Howell TH, Cochran D, Malmquist J, Lilly LC, Spagnoli D, et al. Randomized study evaluating recombinant human bone morphogenetic protein‐2 for extraction socket augmentation. J Periodontol. 2005;76(4):605-613.
• Froum S, Cho SC, Rosenberg E, Rohrer M, Tarnow D. Histological comparison of healing extraction sockets implanted with bioactive glass or demineralized freeze‐dried bone allograft: A pilot study. J Periodontol. 2002;73(1):94-102.
• Botticelli D, Berglundh T, Lindhe J. Hard-tissue alterations following immediate implant placement in extraction sites. J Clin Periodontol. 2004;31(10):820-828.
• Hurzeler MB, Zuhr O, Schupbach P, Rebele SF, Emmanouilidis N, Fickl S. The socket-shield technique: a proof-of-principle report. J Clin Periodontol. 2010;37(9):855-862.
• Siormpas KD, Mitsias ME, Kontsiotou-Siormpa E, Garber D, Kotsakis GA. Immediate implant placement in the esthetic zone utilizing the "root-membrane" technique: clinical results up to 5 years postloading. Int J Oral Maxillofac Implants. 2014;29(6):1397-1405.
• Guyer SE. Selectively retained vital roots for partial support of overdentures: A patient report. J Prosthet Dent. 1975;33(3):258-263.
• O'Neal RB, Ground T, Levin MP, Carlos E. Submergence of roots for alveolar bone preservation: I. Endodontically treated roots. Oral Surg Oral Med Oral Pathol. 1978;45(5):803-810.
• Malmgren B, Cvek M, Lundberg M, Frykholm A. Surgical treatment of ankylosed and infrapositioned reimplanted incisors in adolescents. Scand J Dent Res. 1984;92(5):391-399.
• Salama M, Ishikawa T, Salama H, Funato A, Garber D. Advantages of the root submergence technique for pontic site development in esthetic implant therapy. Int J Periodontics Restorative Dent. 2007;27(6):521-527.
• Buser D, Warrer K, Karring T. Formation of a periodontal ligament around titanium implants. J Periodontol. 1990;61(9):597-601.
• Buser D, Warrer K, Karring T, Stich H. Titanium implants with a true periodontal ligament: an alternative to osseointegrated implants? Int J Oral Maxillofac Implants. 1990;5(2):113-116.
• Parlar A, Bosshardt DD, Ünsal B, Çetiner D, Haytaç C, Lang NP. New formation of periodontal tissues around titanium implants in a novel dentin chamber model. Clin Oral Implants Res. 2005;16(3):259-267.
• Gray JL, Vernino AR. The interface between retained roots and dental implants: a histologic study in baboons. J Periodontol. 2004;75(8):1102-1106.
• Guarnieri R, Giardino L, Crespi R, Romagnoli R. Cementum Formation Around a Titanium Implant: A Case Report. Int J Oral Maxillofac Implants. 2002;17(5):729-732.
• Gluckman H, Salama M, Du Toit J. Partial Extraction Therapies (PET) Part 2: Procedures and Technical Aspects. Int J Periodontics Restorative Dent. 2017;37(3):377-385.
• Siormpas KD, Mitsias ME, Kotsakis GA, Tawil I, Pikos MA, Mangano FG. The Root Membrane Technique: A Retrospective Clinical Study With Up to 10 Years of Follow-Up. Implant Dent. 2018;27(5):564-574.
• Kher U. Surgical Technique for Socket Shield Procedure. In: Kher U, Tunkiwala A, editors. Partial Extraction Therapy in Implant Dentistry. 1st ed., Switzerland: Springer; 2020, p. 17-42.
• Gluckman H, Nagy K, Du Toit J. Prosthetic management of implants placed with the socket-shield technique. J Prosthet Dent. 2019;121(4):581-585.
• Gluckman H (editor). Past, Present and Future of Partial Extraction Therapies. Hungary: University of Szeged; 2019 (PhD thesis).
• Kumar PR, Kher U. Shield the socket: procedure, case report and classification. J Indian Soc Periodontol. 2018;22(3):266-272.
• Baumer D, Zuhr O, Rebele S, Schneider D, Schupbach P, Hurzeler M. The socket-shield technique: first histological, clinical, and volumetrical observations after separation of the buccal tooth segment - a pilot study. Clin Implant Dent Relat Res. 2015;17(1):71-82.
• Mitsias ME, Siormpas KD, Kontsiotou-Siormpa E, Prasad H, Garber D, Kotsakis GA. A Step-by-Step Description of PDL-Mediated Ridge Preservation for Immediate Implant Rehabilitation in the Esthetic Region. Int J Periodontics Restorative Dent. 2015;35(6):835-841.
• Tan Z, Kang J, Liu W, Wang H. The effect of the heights and thicknesses of the remaining root segments on buccal bone resorption in the socket‐shield technique: An experimental study in dogs. Clin Implant Dent Relat Res. 2018;20(3):352-359.
• Calvo-Guirado JL, Troiano M, López-López P, Ramírez-Fernandez MP, de Val JEMS, Marin JMG, et al. Different configuration of socket shield technique in peri-implant bone preservation: An experimental study in dog mandible. Ann Anat. 2016;208:109-115.
• Kulkarni S, Kumar T, Narayan T, Tunkiwala A. Errors and Complications in Partial Extraction Therapy. In: Kher, U. Tunkiwala A, editors. Partial Extraction Therapy in Implant Dentistry. 1st ed., Switzerland: Springer; 2020, p. 247-307.
• Du Toit J. The pontic-shield: partial extraction therapy for ridge preservation and pontic site development. Int J Periodontics Restorative Dent. 2016;36:417-423.
• Kan JY, Rungcharassaeng K. Proximal socket shield for interimplant papilla preservation in the esthetic zone. Int J Periodontics Restorative Dent. 2013;33(1):e24-e31.
• Glocker M, Attin T, Schmidlin PR. Ridge preservation with modified “socket-shield” technique: a methodological case series. Dent J. 2014;2(1):11-21.
• Schwimer CW, Gluckman H, Salama M, Nagy K, Du Toit J. The socket-shield technique at molar sites: A proof-of-principle technique report. J Prosthet Dent. 2019;121(2):229-233.
• Schwimer C, Pette GA, Gluckman H, Salama M, Du Toit J. Human Histologic Evidence of New Bone Formation and Osseointegration Between Root Dentin (Unplanned Socket-Shield) and Dental Implant: Case Report. Int J Oral Maxillofac Implants. 2018;33(1):e19-e23.
• Mitsias ME, Siormpas KD, Kotsakis GA, Ganz SD, Mangano C, Iezzi G. The Root Membrane Technique: Human Histologic Evidence after Five Years of Function. Biomed Res Int. 2017;2017:7269467.
• Abadzhiev M, Nenkov P, Velcheva P. Conventional immediate implant placement and immediate placement with socket-shield technique–which is better. Int J Clin Med Res. 2014;1(5):176-180.
• Bramanti E, Norcia A, Cicciu M, Matacena G, Cervino G, Troiano G, et al. Postextraction Dental Implant in the Aesthetic Zone, Socket Shield Technique Versus Conventional Protocol. J Craniofac Surg. 2018;29(4):1037-1041.
• Sun C, Zhao J, Liu Z, Tan L, Huang Y, Zhao L, et al. Comparing conventional flap-less immediate implantation and socket-shield technique for esthetic and clinical outcomes: A randomized clinical study. Clin Oral Implants Res. 2020;31(2):181-191.
• Mitsias MM, Bratos M, Siormpas K, Pikos MA, Kotsakis GA. Longitudinal Soft Tissue Changes During Periodontal Ligament-Mediated Immediate Implant Placement with the Root-Membrane Technique. Int J Oral Maxillofac Implants. 2020;35(2):379-385.
• Gluckman H, Salama M, Du Toit J. A retrospective evaluation of 128 socket-shield cases in the esthetic zone and posterior sites: Partial extraction therapy with up to 4 years follow-up. Clin Implant Dent Relat Res. 2018;20(2):122-129.
• Baumer D, Zuhr O, Rebele S, Hurzeler M. Socket Shield Technique for immediate implant placement - clinical, radiographic and volumetric data after 5 years. Clin Oral Implants Res. 2017;28(11):1450-1458.
• Xu Y, Huang H, Wang L, Wu Q, Fu G, Li J. Comparison of clinical effects of a modified socket shield technique and the conventional immediate implant placement. Hua Xi Kou Qiang Yi Xue Za Zhi. 2019;37(5):490-495 (in Chinese with English abstract).
• Gharpure AS, Bhatavadekar NB. Current evidence on the socket-shield technique: a systematic review. J Oral Implantol. 2017;43(5):395-403.
• Helsham RW. Some observations on the subject of roots of teeth, retained in jaws as a result of incomplete exodontia. Aust Dent J, 1959;5:70-77.
• Herd JR. The retained tooth root. Aust Dent J. 1973;18(3):125-131.
• Langer L, Langer B, Salem D. Unintentional Root Fragment Retention in Proximity to Dental Implants: A Series of Six Human Case Reports. Int J Periodontics Restorative Dent. 2015;35(3):305-313.
• Mourya A, Mishra SK, Gaddale R, Chowdhary R. Socket‐shield technique for implant placement to stabilize the facial gingival and osseous architecture: A systematic review. J Investig Clin Dent. 2019;10(4):e12449.
• Troiano M, Benincasa M, Sánchez P, Guirado JC. Bundle bone preservation with Root-T-Belt: case study. Ann Oral Maxillofac Surg. 2014;2(1):7-12.
• Blaschke C, Schwass DR. The socket-shield technique: a critical literature review. Int J Implant Dent. 2020;6(1):1-17.