Socket Shield technique indication: Immediate implant placement with adjacent implants in the aesthetic area

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Posted on By Emilio Rodriguez-Fernández In Anterior/Esthetic

As Kan said in 2003, single-implant tooth replacements have been documented with success. Traditional immediate implants can not avoid the hard and soft-tissue changes so it may compromise the aesthetics results. However, after the description of the “socket-shield technique” (SST) by Hurzeler and cols. in 2010. The partial tooth extraction therapy preserves the initial buccal tissues. From my clinical point of view, The SST could be the treatment election when you have adjacent dental implants and high esthetic compromise. I show a case of a woman of 43 years old, non smoker with a horizontal tooth fracture and apical lesion associated of the 1.2. Furthermore, She has two adjacent dental implants very well restored. So I did not have more choices than a tooth extraction and the immediate implant or a partial tooth extraction and the immediate implant. I chose the second option because I had a thin buccal plate, an apical lesion, an adjacent implant and a esthetic compromise.

I removed the partial tooth including the apical lesion with integrity of the tissues around. The implant was introduced 3 mm deeper as the adjacent implant leaving a gap of 1/1.5 mm to the Shield. No allograft were employed and no stitches were necessary. I toke and modify her old ceramic crown to a provisional screw-retained crown without occlusion.

tooth fracture
CTBC

Initial situation
SST and the implant


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5 Comments

Excellent. Do you have more photos to share? Occlusal view prior to restoration? Thanks Dr. Salama


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Dr. Salama here is the picture where you can see the final implant position. More less 5mm from the gingival contour. Thank you!

Final position


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Thank you very much Dr. Salama, here you have more photos. The moment of the implant insertion when I achieved 35Nw and the root removed with the lesion added.

Shield and Implant
PET and lesion


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nice.
U got to love picture of the root with attached lesion!
how were U certain U would get the whole apex out ? just by free hand drilling ?
do U have any tricks\tips how to do this predictably ?
masterful
aryeh


Reply

Hi! thank you so much for your interest. An apical lesion without symptoms could be consider a crhonic injury. It is not a contraindication (D. Schward-Arad). It is a risk consideration. However, I prescribed to my patient, 24 hours before, a systemic antibiotic (Penicillin 750mg/8h/10 days). The extraction was atraumatic with the lesion included. I clean with EDTA, clorhexidine 0,20% and serum. Of course, I can not guarantee that the lesion will disappear 100%. But the probability of success is very high.


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