Socket Shield with Osseodensification

164 Rating(s).


Posted on By Salah Huwais In Implants

1- Patient is 68 years old. Medically stable. # 9 is fractured with post. 2- PET was done with buccal shield.
3- Densah Burs were used in osseodensification mode to create the osteotomy and to compact allograft prior to implant placement.
4- Implant was placed with 50ncm torque.
Additional allograft was placed and collagen plug was used to seal socket.
I will be posting follow-ups.

SS with Osseodensification
Densah Bur used to compact allograft

Implant placement with 50ncm
12 wks follow up


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18 Comments

Very nice.

A few questions, what is the function of a grafting material in a socket shield socket? You would expect complete bond fill and no buccal bone resorption due to the shield. Wouldn't the allograft slow down the implant integration period by taking space away from vital bone?

What provisional did you use? If the implant achieved 50 ncm, why not immediate load?

Thanks for sharing


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Andoni:

This is my 3rd SS case. I am still building my learning curve. The socket diameter was significantly larger than the 4.2 mm implant, I used the DFDBA bone to act as a matrix around the implant. I did compacted it against the walls prior to implant placement. The case was referred back to the GP for restorative work. I do only surgical implantology with a referrals base.


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Salah. Outstanding! Especially remarkable skill level and documentation for your 3rd attempt! My personal preference would have been a custom abutment or healing collar rather than collagen. Great job. Thank you for sharing. Best regards. Chuck


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Hi Sallah, this staged procedure is very safe. Surelly you'll get a nice stanle frame to work with.
Nowadays I prefer to do a mini flap (SSOF-SSopen flap), just to be sure to be even with the bone crest to avoid external exposure posibility.
I don't like radiolucency on lateral apex besides, check this.
I had some faillures due to infection for neighboring infections like this.
Thanks for sharing
Jorge


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Jorge:

I agree, # 10 might present a risk. I am watching the radiolucency. Clinically it is asymptomatic. I spoke to Chuck, he also favor a mini-flap with his cases. I am favoring that as well. It allows better control. SS is exciting, I am doing more and more. Thank you, will keep you posted.

Salah


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What is OD (opposite direction) or (osseodensification mode)?


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Maurice:
Samvel is right. OD is for Osseodensification.

Salah


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od is densifying mode -800-1500 rpm in counterclockwise direction


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That seems like very high RPM?? Salah is that correct?


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Maurice:
Not at all. Speed is needed to produce the hydrodynamic effect and provide better control. Biomechanical study has showed that an appropriate RPM to achieve the hydro propeller is 1100-1200 RPM. The protocol calls for 800-1500 RPM. I use 1200 RPM most of the time.


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12-wks follow up of socket shield with osseodensification. Notice bone growth between the shield and the implant.
Notice buccal bone resorption and shield exposure. IMO, PTE saved the remaining buccal bone.
Shield hight was reduced further.

Salah

12 wks
12 wks


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15/16-wks follow up with provional restoration. Notice the maintaned buccal tissue geometry.

Salah

15 wks provisional
16 wks follow up


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Salah, great result and confirmation of clinical validity of PET. The Densah drill is an add, IMO, and both providing two major facts: -predictable healing margin quote (PET) -improvement of primary stability (Densah). Looking at your last picture can be noticed an inner overlap of free vestibular gingival margin with modification of crown labial aspect (smaller emergence profile). I wonder if we could improve that profile using an immediate custom abutment and if this is a desirable procedure for solving the esthetic goal in that specific area. Thanks for the very nice follow up, my friend. Armando


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Armando:

Right on. The provisional restoration needs to have a wider emergence profile at the gingival margin. I will make sure to pass on your note to my restorative colleague. Are there any parameters that we need to watch for restoratively?

Salah


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Salah, great actualization. IMO here we see that the SS done was on closed enviroment, asuming that bone covers the root "entirely" but I guess there was a deshicens and you noticed later, now, when you uncover the implant. That´s why I told you to do a open flap SS. It hapened to me ...many times also.
Thanks for posting this actualization!
Jorge


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Jorge:

I agree, I do all my PET now with mini flap approach. This case was my 2nd SS case. Some mistakes to learn from. I believe the key is to
1- Leave an adequate space between the implant and the shield to allow for bone growth during healing.
2- The shield should be at the bone level or slightly coronal.

Any parameters exist for that?

Salah


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Really impressive as I come back to this post after now having worked with the Versah drills. Great documentation. Only concern is dislodging shield or over compression that causes microfracture of buccal plate that is often quite thin over shield. regards Maurice


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Maurice:

Thank you. I use the Densah Burs in the densifying mode to prepare the osteotomy in a more palatal position away from the shield. I only use my final Densah Bur (in this case it was the 4.3mm bur) in CCW rotation at 1200 RPM to get closer to the shield to smooth it further. And that is the only time the DB touches the shield on purpose. The DB has no detected chatter and should not dislodge or compress the shield.
Also please notice that I used allograft in the socket and used my final densah bur (4.3 mm) CCW at 1200 with no irrigation to densify the graft and push it outwardly into the walls then placed the 4.2mm implant. We are finding that densifying allograft in an immediate extraction socket may improve implant stability. In a way, we can turn an oval shape large osteotomy into a circular shape that matches the implant diameter.
I will post a case with that example soon.
Salah



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