Socket Shield Reutilization

211 Rating(s).


Posted on By Jorge Campos In Failures

Here I post a case that shows the posibilities of the PET treatments.
For me was a difficult case: an Immediate Load done on Socket Shield on the front that has worked successfully two months. After that the mobility of the 6 implants made this case a total faillure.
The day of the removal of the implants I cleaned the sockets WITHOUT REMOVING SHIELDS. Povidone 4 minutes, Clindamicine 4 minutes and filled with Mineross.
After 4 months new implants on same sites. There are two RST of vital teeth, check the vitality on the succesive reentries.
After 6 months, today, on the uncovery surgery ALL the implants where integrated. Probing on the SS-Implant interface showed the usual distance of 3 mm, when there is a gap. On the implant that was on contact, at starting, the probing depth is 0.
I did shield remodelling on 11 and the RST of 10.
The overall bone contour was mantained thanks to the PET treatment.
Should this be on Friday´s poetry but tomorrow I´m on Portugal for a lecture of....guess. (SS)
Regards
Jorge




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29 Comments

the day of implants insertion.


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Shield contouring


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Jorge, breathless I am turning the pages of your adventure story. Only a strongest convinced PET fan can bring this story to the end in this way. Thank you for this great lecture and inspiration.
Looking forward to see Chuck`s and Richard`s comments, preferable some Clint Eastwood quote.
I quote Schwarzenegger: " I`ll be back" said Jorge after taking out the implants.
I still envy you for not caring about soft tissue invagination. I know, I know, you are going to say is that we have it at every post ex placed implants...but still....
Best regards, enjoy your time in Portugal and spread PET idea!
Snjezana


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Ha, ha Snjezana, your vision is correct. This was a looong story with a happy ending. I was very worried because this never happened to me. A immediate load with two months successfull and then a sudden collapse. Weird...
But reallity was reallity, and had to face to extract the implants go for a removable and so on.
I decided to mantain the shields and clean exhaustivelly the sockets. And re-try to implant!
Yes , I don´t mind the soft tissue in between...;-)
Let´s see the final prosthesis!
Regards
Jorge


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Jorge. Great case management! I wouldn't give up either. See Outlaw Josey Wales quote below. Well done as always my friend. Chuck

You can't lose your head...That's just the way it is.


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Hahahahahahahaha-! And another Ha!
Good Chuck. Very good. I trully believe in this.
Thanks for posting cow-boy heros!
Jorge


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Wow....incredible documentation. why do you feel the implants failed originally? Any visible infection? How long was the patient in a removeable dentire prosthesis? The loading of the Soft tissue by the denture is a challenge for any implant site and even more so with a PET case....Thanks for sharing Mo


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Thanks MO, this man was 4 months after the extraction of the implants and the regeneration on the same day, New implants that waited 6 months more to be uncovered today. Total: 10 months.
It´s funy because this patient urged to have an immediate load because he didn´t wanted to wear a removable prosthesis...
All implants were above 45Nw. I really don´t understand the reason for this faillure.
May be he uses, discontinually, a removable lower prosthesis. And only loaded the anterior part when he does not uses some nights the lower prosthesis?
I´m begining to think that perhaps is better to position the implant IN CONTACT with the shield.
What is your idea about that?
Regards
Jorge


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Jorge,
Do you have any Xray ? I guess a lot has to do with mobile prosthetic.
But also primary stability is an issue.
Did you take into consideration immediate load ?
Nice thing about shield is that it function no matter the implant is there or not.
One thought: when implant moves you don't have bone integration but, what happens if it is the shield that moves as in your case here?
BTW I prefer calling it PET. SS doesn't sounds great for Europe past Memory.
Armando


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Hi Armando. I´ll post soon the CBCT images as well. It is indeed a good new how that PET works with or without the implant.
When was first loaded the implants had good primary stability.
Good to hear from you.
Regards
Jorge


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Jorge that is a frontier case! I can not imagine (maybe I can) what would have happened to your facial bone after the loss of the implants.
Amazing stuff..
Do you re-treat the inner surfaces of the roots other than chemically with POV and abs? (meaning do you prep with a diamond bur the inner surfaces at all?)

Yiannis


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Hi Yiannis, no I didn´t treat mechanically the inner side of the Shield. Just chemically.
I didn´t think it was necessary. Is it?
Thanks for your kind words. It´s really a FAITh case on PET, HA,HA.
Regards my friend
Jorge


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Great case of a even greater recovery !
This IS NOT a case for the faint hearted.
I imagine the emotion you felt when you realized you were loosing your initial implants.
Why do you think this happened ? Anything to do with occlusion ?


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Christian, may be the occlusion...it´s my only explanation. And yes, I had a thrill on the uncovery of the 2nd phase. The patient is also happy but with fear about another faillure.
Regards
Jorge


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Jorge,

Where do I start- Well to answer this post I had to read it on 2 laptops and an iPad to keep my thoughts fresh

first thing - Grreat post- Chuck the envelope is now a mail pouch- both you and Jorge in it together !

I am going to borrow your idea of suturing the flap to the buccal-

Chuck- I love Josey Wales but now you need a a Lee Van Cleef quote

Snjezana- I love Arnold but you now have to quote Stallone and Apollo Creed!

Okay lets get serious- Jorge- I admire your immed load- I was looking at photo with multi unit abutment and wondering about several factors- the height of the abutment -and bone and shield reduction- approximation of the abutment to the PET Why? well when I do cases like this, I have to reduce the entire alveolus in order to make room for the prosthetics- in addition I at times have to reduce bone to allow the multiunit abutment to completely seat or it will loosen ( maybe what armando is saying)
so what I am thinking is if you have to reduce bone you have to reduce shield- so maybe vertical dimension & occlusal forces - and yes a removable mandibular denture and off axis loading -

Also did you load all implants? typically if I have six I will only load 4 - the ones with highest torque

Lastly ( Phew) your thoughts about exposing the alveolus several times - blood supply - soft tissue -

Oh yeah- Believe in the force! believe in PET- it is powerful - The Dark side can be overcome!

Cheers,

Richard


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Hi Richard, thanks for your words!!
You can borrow anything I post. I do the same with all of you.
The Multiunit was used only on the distal implants that had no PET. Both were adjusted at 20 nw.
I usually load the anterior 4 implants and left the posterior implants submerged on mandible. On the upper I try to load all 6. On the 2nd attempt I insert 8 implants, and the posterior with inner sinus lift with Densah, I didn´t mentioned before.
I believe the oclusion had a role, but this was very weird.
Regards my friend, and may the Force be with you.
Jorge-Jedi


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Jorge


Makes sense- at times we have no cause- Setback is an opportunity for a comeback!!

cheers,

Richard


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Hard to say what is better at Saturday evening: Howie`s presentation from NY or this post.
Chuck and Richard, you made my evening:)
Richard, I agree with you regarding multi-unit abutments.
Cheers
Snjezana


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Hi Snjezana. I love your chosen phrases. Keep on!
I´m also a kind of samurai, so I continue my way till the end. Like in this post, you can see that I give a 2nd opportunity to PET and I worked. (It was not my first time: when an implant does not integrate on a PET socket I retry, and allways had ben successfull on the 2nd.)
Regards
Jorge


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I could not have said it better,
To many punches may cloud your decision making!

Friday's Poetry
Saturday's Quotes

Cheers,

Richard


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Great Richard!
"Saturday night fever"...ha, ha.
Jorge


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Jorge,

As The Bee Gees say! "Staying Alive" is what we hope for PET!

Enjoy Lisbon!

Cheers,

Richard


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Ha, ha, staying alive, Ha, ha , ha staying alive!
Thanks Richard
Jorge


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Jorge,

As The Bee Gees say! "Staying Alive" is what we hope for PET!

Enjoy Lisbon!

Cheers,

Richard


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The "socket shield technique" has demonstrated the potential
in preventing buccal tissue from resorption in animal and
clinical studies. It is assumed that retaining a root fragment
aached to the buccal bone plate in this technique can avoid
tissue alteration after tooth extraction. This article presents
a 58-year-old healthy man with a failing upper right second
premolar which would be replaced by an implant-supported
single crown. Leaving a partial root fragment at buccal side
in combination with immediate implant placement lingual
to the retained fragment was performed. Four months aer
implant placement, clinical examination showed healthy
peri-implant so tissue and the ridge was well preserved. A
denitive metal ceramic crown was fabricated and cemented
on a titanium abutment. The prosthesis successfully
restored the function of the patient. A maximum amount
of horizontal resorption at the buccal side was 0.72mm.
Applying socket shield technique and immediate implant
placement may be a feasible treatment option in case with
high esthetic concern.


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The "socket shield technique" has demonstrated the potential
in preventing buccal tissue from resorption in animal and
clinical studies. It is assumed that retaining a root fragment
aached to the buccal bone plate in this technique can avoid
tissue alteration after tooth extraction. This article presents
a 58-year-old healthy man with a failing upper right second
premolar which would be replaced by an implant-supported
single crown. Leaving a partial root fragment at buccal side
in combination with immediate implant placement lingual
to the retained fragment was performed. Four months aer
implant placement, clinical examination showed healthy
peri-implant so tissue and the ridge was well preserved. A
denitive metal ceramic crown was fabricated and cemented
on a titanium abutment. The prosthesis successfully
restored the function of the patient. A maximum amount
of horizontal resorption at the buccal side was 0.72mm.
Applying socket shield technique and immediate implant
placement may be a feasible treatment option in case with
high esthetic concern.


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Wow, this post brought out the "All Stars". Jorge, just a simple question. Why the soft tissue reflection at the initial appointment? Was it full or split thickness? Do you feel that this may have contributed to the bone loss/implant exposure seen? Glad for your excellent teaching. One word "Pioneer".

I so enjoyed your closing comment at the Densah Symposium about getting into the little boat. The Titanic may indeed be sinking. Thank you.


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