The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 20 , ISSUE 9 ( September, 2019 ) > List of Articles


Socket-shield Technique and Immediate Implant Placement for Ridge Preservation: Case Report Series with 1-year Follow-up

Rola Al Habashneh, Maher A Walid, Tahani Abualteen, Mohammad Abukar

Keywords : Immediate implant, Ridge preservation, Socket-shield technique

Citation Information : Habashneh RA, Walid MA, Abualteen T, Abukar M. Socket-shield Technique and Immediate Implant Placement for Ridge Preservation: Case Report Series with 1-year Follow-up. J Contemp Dent Pract 2019; 20 (9):1108-1117.

DOI: 10.5005/jp-journals-10024-2642

License: CC BY-NC 4.0

Published Online: 01-12-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: To evaluate the role of socket-shield technique for ridge preservation in immediate implant placement sites. Background: The socket-shield technique seems to be beneficial for ridge preservation despite its insufficient documentation. In this case report series, implants were placed immediately after extracting a hopeless teeth using this technique and then were followed up for 1 year to document functional and esthetic outcomes. Cases description: Five patients presented with a non-restorable teeth were treated using the socket-shield protocol and immediate implant placement. Roots were dissected in a mesiodistal direction along the long axis down to the apex; a periotome was later used to detach the palatal fragment of the root, while keeping the buccal one. Following sequential osteotomy drilling, implants were placed. The gap between the implant and the shield was filled with a synthetic bone grafting material. A customized healing abutment with an S-shaped emergence profile was prepared to support a coronal emergence profile of the tooth. Patients had follow-up visits after 6 weeks and 5 or 6 months before proceeding to prosthetic reconstruction phase. Screw-retained porcelain fused to metal crowns and titanium abutments were inserted intraorally with 35 N cm torque and screw-access holes were restored. Conclusion: The socket-shield technique along with immediate implant placement is a minimally invasive approach that can preserve the hard and soft tissue contour of the ridge and can be implemented in areas of high esthetic demands for better esthetic outcomes.

  1. Jemt T, Pettersson P. A 3-year follow-up on single implant treatment. J Dent 1993;21:203–208. DOI: 10.1016/0300-5712(93)90127-C.
  2. Henry PJ, Laney WR, et al. Osseointegrated implants for single-tooth replacement: A prospective 5-year multicenter study. Int J Oral Maxillofac Implants 1996;11:450–455.
  3. Jemt T. Modified single and short-span restorations supported by osseointegrated fixtures in the partially edentulous jaw. J Prosthet Dent 1986;55:243–246. DOI: 10.1016/0022-3913(86)90352-5.
  4. Goodacre CJ, Bernal G, et al. Clinical complications with implants and implant prostheses. J Prosthet Dent 2003;90:121–132. DOI: 10.1016/S0022-3913(03)00212-9.
  5. Palmer RM, Smith BJ, et al. A prospective study of Astra single tooth implants. Clin Oral Implants Res 1997;8:173–179. DOI: 10.1034/j.1600-0501.1997.080303.x.
  6. Buser D, Martin W, et al. Optimizing esthetics for implant restoration in the anterior maxilla: anatomic and surgical considerations. Int J Oral Maxillofac Implants 2004;19(Suppl):43–61.
  7. Martin W, Morton C, et al. Pre-operative analysis and prosthetic treatment planning in esthetic implant dentistry. Buser D, Belser U, et al. ITI Treatment Guide I: Implant Therapy in the Esthetic Zone: Single Tooth Replacements. New Malden, Surrey, UK: Publishing Co Ltd; 2007. pp. 9–24.
  8. Buser D, Halbritter S, et al. Early implant placement with simultaneous guided bone regeneration following single-tooth extraction in the esthetic zone: 12-month results of a prospective study with 20 consecutive patients. J Periodontol 2009;80:152–162. DOI: 10.1902/jop.2009.080360.
  9. Belser U, Buser D, et al. Consensus statements and recommended clinical procedures regarding esthetics in implant dentistry. Int J Oral Maxillofac Implants 2004;19(Suppl):73–74.
  10. Gapski R, Wang H-L, et al. Critical review of immediate implant loading. Clin Oral Implants Res 2003;14:515–527. DOI: 10.1034/j.1600-0501.2003.00950.x.
  11. Aparicio C, Rangert B, et al. Immediate/Early loading of dental implants: a report from the Sociedad Espanola de Implantes World Congress consensus meeting in Barcelona, Spain 2002. Clin Implant Dent Relat Res 2003;5:57–60. DOI: 10.1111/j.1708-8208.2003.tb00183.x.
  12. Attard NJ, Zarb GA. Immediate and early implant loading protocols: a literature review of clinical studies. J Prosthet Dent 2005;94:242–258. DOI: 10.1016/j.prosdent.2005.04.015.
  13. Vermylen K, Collaert B, et al. Patient satisfaction and quality of single-tooth restorations. Clin Oral Implants Res 2003;14:119–124. DOI: 10.1034/j.1600-0501.2003.140116.x.
  14. Tonetti MS, Cortellini P, et al. Immediate vs delayed implant placement after anterior single tooth extraction: the timing randomized controlled clinical trial. J Clin Periodontol 2017;44:215–224. DOI: 10.1111/jcpe.12666.
  15. Figliuzzi MM, Giudice A, et al. Postextractive implants in aesthetic areas: evaluation of perimplant bone remodeling over time. Ann Stomatol (Roma) 2015;6:29–34. DOI: 10.11138/ads/2015.6.1.029.
  16. Amler M, Johnson P, et al. Histologic and histochemical investigation of human alveolar socket healing in undisturbed extraction wounds. J Am Dent Assoc 1960;61:46–48. DOI: 10.14219/jada.archive.1960.0152.
  17. Araújo MG, Lindhe J. Dimensional change alterations following tooth extraction. An experimental study in the dog. J Clin Periodontol 2005;32:212–218.
  18. Schropp L, Wenzel A, et al. 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;23:313–323.
  19. Pietrokovski J, Massler M. Alveolar ridge resorption following tooth extraction. J Prosthet Dent 1967;17:21–27. DOI: 10.1016/0022-3913(67)90046-7.
  20. Buser D, Chappuis V, et al. Implant placement post extraction in esthetic single tooth sites: when immediate, when early, when late? Periodontology 2000 2017;73:84–102. DOI: 10.1111/prd.12170.
  21. Fu JH, Yeh CY, et al. Tissue Biotype and Its Relation to the Underlying Bone Morphology. J Periodontol 2010;81:569–574. DOI: 10.1902/jop.2009.090591.
  22. Van der Weijden F, Dell'Acqua F, et al. Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review. J Clin Periodontol 2009;36:1048–1058. DOI: 10.1111/j.1600-051X.2009.01482.x.
  23. Wang RE, Lang NP. Ridge preservation after tooth extraction. Clin Oral Implants Res 2012;23(suppl 6):147–156. DOI: 10.1111/j.1600-0501.2012.02560.x.
  24. Kotsakis G, Chrepa V, et al. Flapless alveolar ridge preservation utilizing the”socket-plug” technique: clinical technique and review of the literature. J Oral Implantol 2014;40:690–698. DOI: 10.1563/AAID-JOI-D-12-00028.
  25. Botticelli D, Berglundh T, et al. Hard tissue alterations following immediate implant placement in extraction sites. J Clin Periodontol 2004;31:820–828. DOI: 10.1111/j.1600-051X.2004.00565.x.
  26. Carmagnola D, Adriaens P, et al. Healing of human extraction sockets filled with Bio-Oss. Clin Oral Implants Res 2003;14:127–143. DOI: 10.1034/j.1600-0501.2003.140201.x.
  27. Lekovic V, Carmargo P, et al. Preservation of alveolar bone in extraction sockets using bioresorbable membranes. J Peirodontol 1998;69:1044–1049. DOI: 10.1902/jop.1998.69.9.1044.
  28. Vignoletti F, Sanz M. Immediate implants at fresh extraction sockets: from myth to reality. Periodontology 2000 2014;66:132–152. DOI: 10.1111/prd.12044.
  29. Donos N, Mardas N, et al. Clinical outcomes of implants following lateral bone augmentation: systematic assessment of available options (barrier membranes, bone grafts, split osteotomy). J Clin Periodontol 2008;35(8 suppl):173–202. DOI: 10.1111/j.1600-051X. 2008.01269.x.
  30. Studer SP, Lehner C, et al. Soft tissue correction of a singletooth pontic space: a comparative quantitative volume assessment. J Prosthet Dent 2000;83:402–411. DOI: 10.1016/S0022-3913(00)70034-5.
  31. Troiano G, Zhurakivska K, et al. Combination of bone graft and resorbable membrane for alveolar ridge preservation: a systematic review, meta-analysis and trial sequential analysis. J Periodontol 2017; 1–17. DOI: 10.1902/jop.2017.170241.
  32. Filippi A, Pohl Y, et al. Decoronation of an ankylosed tooth for preservation of alveolar bone prior to implant placement. Dent Traumatol 2001;17:93–95. DOI: 10.1034/j.1600-9657.2001.017002093.x.
  33. Reames RL, Nickel JS, et al. Clinical, radiographic and histologic study of endodontically treated retained roots to preserve alveolar bone. J Endod 1975;1:367–373. DOI: 10.1016/S0099-2399(75)80212-3.
  34. Salama M, Ishikawa I, et al. Advantages of the root submergence technique for pontic site development in esthetic implant therapy. Int J Periodontics Restorative Dent 2007;27:521–527.
  35. Davarpanah M, Szmulker-Moncler S. Unconventional implant treatment I. Implant placement in contact with ankylosed tooth fragments. A series of five case reports. Clin Oral Implants Res 2009;20:851–856. DOI: 10.1111/j.1600-0501.2008.01653.x.
  36. Slagter KW, den Hartog L, et al. Immediate placement of dental implants in the esthetic zone: a systematic review and pooled analysis. J Periodontol 2014;85:e241–e250. DOI: 10.1902/jop.2014.130632.
  37. Lee EA, Gonzales MO, et al. Lingualized Flapless Implant Placement into Fresh Extraction Sockets Preserves Buccal Alveolar Bone: A Cone Beam Computed Tomography Study. Int J Periodontics Restorative Dent 2014;34:61–68. DOI: 10.11607/prd.1807.
  38. Kasugai S, Le B, et al. Effect of Buccal Gap Distance on Alveolar Ridge Alteration After Immediate Implant Placement. Implant Dent 2015;24:70–76. DOI: 10.1097/ID.0000000000000194.
  39. Kan J, Roe P, et al. Effects of implant morphology on rotational stability during immediate implant placement in the esthetic zone. Int J Oral Maxillofac Implants 2015;30:667–670. DOI: 10.11607/jomi.3885.
  40. Canullo L, Iannello G, et al. Impact of implant diameter on bone level changes around platform switched implants: preliminary results of 18 months follow-up a prospective randomized match-paired controlled trial. Clin Oral Implants Res 2012;23:1142–1146. DOI: 10.1111/j.1600-0501.2011.02297.x.
  41. Kan J, Rungcharassaeng K. Interimplant papilla preservation in the esthetic zone: a report of six consecutive cases. Int J Periodontics Restorative Dent 2003;23:248–259.
  42. Elian N, Cho SC, et al. A simplified socket classification and repair technique. Pract Proced Aesthet Dent 2007;19:99–104.
  43. Kan J, Rungcharassaeng K, et al. Facial gingival stability following immediate placement and provisionalization of maxillary anterior single implants: a 2- to 8- year follow-up. Int J Oral Maxillofac Implants 2011;26:179–187.
  44. Jemt T. Regeneration of gingival papillae after single-implant treatment. Int J Periodont Rest Dent 1997;17:327–333.
  45. Priest G. Predictability of soft tissue form around single-tooth implant restorations. Int J Periodont Rest Dent 2003;23:19–27.
  46. Cobb GW, Reeves GW, et al. Guided tissue healing for single-tooth implants. Compend Contin Educ Dent 1999;20:571–581.
  47. Grunder U. Stability of the mucosal topography around single-tooth implants and adjacent teeth: 1-year results. Int J Periodont Rest Dent 2000;20:11–17.
  48. Sclar AG. Soft tissue and esthetic considerations in implant therapy. Bywaters LC. Soft Tissue and Esthetic Considerations in Implant Therapy. Chicago, IL: Quintessence; 2003. pp. 144–163.
  49. Jemt T, Lekholm U. Measurements of buccal tissue volumes at single-implant restorations after local bone grafting in maxillas: a 3-year clinical prospective study case series. Clin Implant Dent Relat Res 2003;5:63–70. DOI: 10.1111/j.1708-8208.2003.tb00185.x.
  50. Chen ST, Darby IB, et al. A prospective clinical study of bone augmentation techniques at immediate implants. Clin Oral Implants Res 2005;16:176–184. DOI: 10.1111/j.1600-0501.2004.01093.x.
  51. Tarnow DP, Eskow RN, et al. Aesthetics and implant dentistry. Periodontology 2000 1996;11:85–94. DOI: 10.1111/j.1600-0757.1996.tb00186.x.
  52. Choquet V, Hermans M, et al. Clinical and radiological evaluation of the papilla level adjacent to single-tooth dental implants. A retrospective study in the maxillary anterior region. J Periodontol 2001;72:1364–1371. DOI: 10.1902/jop.2001.72.10.1364.
  53. Cooper LF, Raes F, et al. Immediate provisionalization of dental implants placed in healed alvelar ridges and extraction sockets: a 5-year prospective evaluation. Int J Oral Maxillofac Implants 2014;29(3):709–717. DOI: 10.11607/jomi.3617.
  54. Jemt T. Restoring the gingival contour by means of provisional resin crowns after single-implant treatment. Int J Periodont Rest Dent 1999;19:21–29.
  55. Henriksson K, Jemt T. Measurements of soft tissue volume in association with single-implant restorations: a 1-year comparative study after abutment connection surgery. Clin Implant Dent Relat Res 2004;6:181–189. DOI: 10.1111/j.1708-8208.2004.tb00034.x.
  56. Block M, Finger I, et al. Single tooth immediate provisional restoration of dental implants: technique and early results. J Oral Maxillofac Surg 2004;62:1131–1138. DOI: 10.1016/j.joms.2004.05.115.
  57. Harshakumar K, Deepthi VS, et al. Customized healing abutment for enhancing pink aesthetics in implants. J Dent Implants 2013;3: 172–176. DOI: 10.4103/0974-6781.118862.
  58. Stumpel LJ, Wadhwani C. A Customized Healing Abutment for Immediate and Delayed Implant Cases. Compend Contin Educ Dent 2017;38:672–678.
  59. Hurzeler MB, Zuhr O, et al. The socket-shield technique: a proof-of-principle report. J Clin Periodontol 2010;37:855–862. DOI: 10.1111/j.1600-051X.2010.01595.x.
  60. Baumer D, Zuhr O, et al. 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;17:71–82. DOI: 10.1111/cid.12076.
  61. Chen CL, Pan YH. Socket shield technique for ridge preservation: A case report. J Prosthodontics Implant 2013;2:16–21.
  62. Kan J, Rungcharassaeng K. Proximal socket shield for interimplant papilla preservation in the esthetic zone. Int J Periodontics Restorative Dent 2013;33:e24–e31. DOI: 10.11607/prd.1346.
  63. Wadhwani P, Goyal S, et al. Socket shield technique: a new concept of ridge preservation. Asian J Oral Health Allied Sci 2015;5:55–58. DOI: 10.1017/S2044251314000083.
  64. Baumer D, Zuhr O, et al. Socket shield technique for immediate implant placement—clinical, radiographic and volumetric data after 5 years. Clin Oral Implants Res 2017;28:1450–1458. DOI: 10.1111/clr.13012.
  65. Gluckman H, Du Toit J, et al. The pontic-shield: partial extraction therapy for ridge preservation and pontic site development. Int J Periodontics Restorative Dent 2016;36:417–424. DOI: 10.11607/prd.2651.
  66. Gluckman H, Du Toit J, et al. The socket-shield technique to support buccofacial tissues at immediate implant placement. Int Dent Afr 2015;5:6–14.
  67. Abitbol J, Antoun H, et al. Outcome of dental implant with the socket-shield technique: A retrospective study. Clin Oral Implants Res 2016;27(Suppl 13):530.
  68. Mitsias M, Siormpas K, et al. The root membrane technique: Human histologic evidence after five years of function. Biomed Res Int 2017; 1–8. DOI: 10.1155/2017/7269467.
  69. Abadzhiev M, Nekov P, et al. Conventional immediate placement and immediate placement with socket-shield technique - which is better. Int J Clin Med Res 2014;1:176–180.
  70. Gharpure A, Bhatavadekar N. Current evidence on the socket-shield technique: a systematic review. J Oral Implantol 2016;43:395–403. DOI: 10.1563/aaid-joi-D-17-00118.
  71. Bramanti E, Norcia A, et al. Postextraction dental implant in the aesthetic zone, socket shield technique vs conventional protocol. J Craniofac Surg 2018;29:1037–1041. DOI: 10.1097/SCS.0000000000004419.
  72. Den Hartog L, Slatter JJ, et al. Treatment outcome of immediate, early and conventional single-tooth implants in the aesthetic zone: a systematic review to survival, bone level, soft-tissue, aesthetics and patient satisfaction. J Clin Periodontol 2008;35:1073–1086. DOI: 10.1111/j.1600-051X.2008.01330.x.
  73. Esposito M, Grusovin MG, et al. The efficacy of various bone augmentation procedures for dental implants: a Cochrane systematic review of randomized controlled trials. Int J Oral Maxillofac Implants 2006;21:696–710.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.