Socket shield implant failure & recovery

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Posted on By narayan tv In Implants

50 year old female, had 2 implants placed in 32 & 42 positions with socket shields in both. About 3 months later, her fixed provisional came loose when she was travelling, and visited a local dentist, who bonded it all back, and she came back for a follow up after this episode wherein her provisional bridge was removed only to discover that the implant in the 42 region had failed to integrate, and was explanted,There was no sign of infection. The socket was curetted without removing the socket shield. Re-entry at 10 weeks showed bone fill into the failed implant socket with enough labio-lingual dimension to accommodate a 3.5X13 mm implant after removal of the shield. The shield itself left a minor facial defect which was treated by GBR

Pre-op & Incision. 32 is an integrated implant with successful socket shield. 42 is a failed implant site with socket shield left in situ. Note the comparable ridge widths in both sites.
Flap reflection & Socket shield removal. The failed implant site is completely healed with bone

3.5X13 mm implant placed completely within bone. Note the defect left from removal of the socket shield
Periosteal release and flap mobilisation in preparation for GBR

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very nice case narayan


Thanks Raghu.


Dr. Narayan, thanks for posting.
It happend the same to me, but I re-use the same shield after a decontamination with povidona and local antibiotic.
Again a new implant on the same site, and after 3 months the integration was a success.
In my opinion, if the Shield is not loose, it can be re-used.
Thanks for posting.


Thanks Dr. Jorge & Dr. Scwhimmer . I do realise that it may have been left in place. I have over 20 cases under my belt, this is my first implant loss. I looked at the shield remaining there as a ridge preservation technique. The science is still nascent and we are all finding our feet with the lack of literature as to which is the right approach. I do have a whole series of images of the initial procedure, but I would have to post it as a separate post here.


Good thing to learn here in this case, shield technician can be used to maintain buccolingual bone when we cannot place immediate implant


Dr. Narayan. I agree with Jorge. If the failure was due to a poor fitting prosthesis, you could have retained the shield. Knowing the bone regenerated adjacent to the shield after implant removal, you essentially have a modified SS approach as described by Glocker Do you have any images or radiographs of the initial SS/ implant surgery to share? Great case for discussion. Thank you for sharing. Regards. Chuck


Dr. Schwimmer, Please read above- I combined my reply to you & Dr. Campos


Dr. Narayan. It would great if you could make another post with additional information. Yes we are all learning together here. There are many possibilities to consider. I am curious why you didn't remove the shield along with the failed implant if you didn't feel it would be useful long term? What finally convinced you to remove the shield? I appreciate your contributions to our understanding. Thank you for sharing. Best regards. Chuck.


Dr. Schwimmer, Am posting Pics & CBCT from the first procedure. You will appreciate that if the shield were not there, I would have had a ridge collapse. So upon explantation of the implant, when I found no evidence of infection, I decided to let the shield be, not unlike a modified root submergence and it worked to my advantage upon re-entry. Leaving the shield behind in the re-entry was on my mind but upon flap elevation, it didn't seem altogether stable and I removed it.


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