Failed Socket Shield

143 Rating(s).


Posted on By Gregory Mark In Implants

This is my first failure of Socket shield. Patient lives in different State, came to me after 4 years of placing implant. Patient did not have ant discomfort, perio probing was 10mm on palatal. Palpation on buccal was tender.
I had to remove shield and implant at the same time , socket was augmented with MinerOss mixed cancellous and cortical bone 0.6-1.25mm, membrane A-PRF. When I removed shield, buccal wall only consist of periosteum. I think shield will not work where you not have adequate support of buccal bone. What is your thoughts? Gregory




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6 Comments

Greg; Do you have any images from original treatment? Perhaps clinical images, CBCT Sagital sections, PA radiographs etc. These are IMPORTANT to learn from. How do you manage your shield preparation, what did the restorative space look like after prep? Any images of sulcus with implant in position at the the time of impression or crown seating? We can all learn from failure way more than success. Thanks for sharing. Dr. Salama


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Maurice, I linked a case on upper right on the screen. Best regards! Gregory


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Greg thanks for posting this is where we learn the most is our failures. There are two issues here for me and Oreo cbct would help us here. The first is the presence of bone on the buccal of the root. If there is none the shield will become loose and the rules of socket shield are clear it can only be done in a type 1 socket. The second issue here is the retention of the apical portion. I’m not sure if I’m correct however it looks like the root tip is still there. So it begs the question was there apical pathology and if so how was it removed. Did you leave the apex and could this have lead to failure. Please provide us with more info and perhaps the Preop and intraop xrays as well as immediate post op and we may be able to make more sense of it

Thanks for sharing


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Gregory, I cannot add more data here. We need, as demanded by MO and Howie, preop pics and xrays....and everything you have. If you have a SS failure, the shield is mobile, infected...but the implant remains! Here I suspect of poor osseointegration, and a bad diagnosis for doing the SS... A nice CBCT showing bone on buccal will give more info to better understand what had happened here. Thanks for posting! Regards Jorge


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Hi Gregory,

Unfortunate for the patient when this happens- Similar questions to previous- as far as radiographs - medical history- restorative space prior to impressions- subgingival contours of crown- 0cclusal restorative scheme- and you mentioned that patient was a bruxer- what did you do to manage- night guard etc. ?

Cheers,

Richard


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Hi Guys! Thank you for your response. I would answer to all of you here. I link a case I posted 4 years ago, this was my first socket shield case and it failed. Patient is a bruxer and likes to bite his nails and grind hard staff. His brother is a dentist who did a full rehab on him but due to failure of lungs retired as a dentist and patient comes to me on emergency basis from Tennessee. When I see him I have only 2 days and then we communicate with his Iphone pictures. He is taking Antidepressants, Vit D. I had 3D Cone Beam pictures in the past but my server fried last year and I lost all 15 years Cone Beams. I think all the pictures and X-rays you can find on a link case . I hope it helps. Gregory


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