Bone growth between socket shield and implant

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Posted on By andoni jones In Implants

As evidence in this field grows, with recently published articles in humans showing it is possible to get bone between shield and implant, but still some soft tissue invasion of the top third of the socket.

I would like to show some of my own experience.

Case A: Immediate implant placement with socket shield. At 3 months bone bridge all the way to the top of the crest. Zero probing, no soft tissue.

Case B: Delayed socket shield, extraction and allograft, implant placement at 3 months showing bone-like hard tissue to the top of the crest.

I have also added a related case on the right, old case where I had complete soft tissue invasion of the socket.

I have learnt a few lessons since then, nowadays my socket shield principles are:

- Open flap to improve visibility, ALWAYS.
- Reduce shield to bone level, beveling inwards.
- Thin socket shield.
- Place implant away from the shield.
- Not sure if bone graft makes a difference.

I always got soft tissue invasion if the shield became exposed. I work hard to avoid this now.

Thought on this? What's your own experience?

Case A
Case A periapical

Case B
Case B

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Great cases and review. Yes, more and more research and articles required in this arena to qualify and quantify the methods and biology of wound healing in these situations. There is SO MUCH we still need to does the area heal between shield and implant is critical. Where do cells come from? how do they contact and connect to INSIDE of shield which does NOT have a PDL? What happens at this interface long term? Ankylosis? Resorption? My views are that you are very close to many others that have broad experience in the field. Proud to say XP and the FORUM have been critical in broadening the reach in areas like PET, SS, SRT, OD etc. etc. and we will continue to use our influence to share experience and knowledge. I do not ALWAYS use flap to prepare shield but of course visibility and access are critical, 1mm thickness of shield is a minimum for me, I rarely graft the space between shield and implant and keep that space minimal WITHOUT contact of implant with shield. Dr. S


Hi Maurice, Couldn't agree more with your comments. SS has still a long way to go and we have to use caution. I learnt about SS in dentalXP for the first time, and I have learnt invaluable lessons about SS and many other fields of implant dentistry in this community. Can't put it in words. Thanks


Andoni; It is people like YOU that makes this community so special. We elevate our collective abilities by sharing our work. Thanks Dr. S


Cannot agree more with both Andoni and Dr. S.
This Forum make me progress many years reading interesting post and showing the good and the bad. Also by the comments of Dr. S.
I´m really gratefull for this, like everybody. Together we improve quicker!
On the other hand, Andoni, the PET CONSENSUS established the principles Dr. S has told you.
I believe that even in immediate cases , without SS, the first 3mm are soft tissues invation on buccal side of our implant. See D Tarnow histology of his canine case...has soft tissue contact in almost 4 mm... But we don´t pay atention to this.
I don´t care about it, since I do 1A1T.


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