What about outcomes for these patients for Socket Shielding?

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Posted on By George Duello In Implants

This patient has been in periodontal maintenance therapy in my practice for 32 years. He has had extensive gingival recession for many years. About 10 years ago we extracted his lower anteriors and did a cement retained fixed partial denture.

My question to the Dental XP community is what if I would have done a socket shield technique from 6-11 when this patient was in his early 20's when he probably didn't have recession at the level he has now.? Would there be titanium showing on the buccal of 6-11 and what if anything could I do about it?

This is my concern with the procedure. The socket shields posted on Dental XP look great now but give the patient 30-40 years of wear and tear on the periodontium and what will these cases look like then?

Periodontal Patient of 32 years with extensive bone and gingival recession

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6 Comments

What a beautiful case to present. Both you and the patient should be congratulated.
The question you pose is something I too have been very concerned about and is extremely pertinent.
I believe the answer is no-one truly knows. As I understand the theory one reason for doing SS is to prevent further bone loss. However ,in a case similar to yours "dont the implants themselves prevent further bone loss if placed with good bone circumferentially?"
I fully appreciate the need to consider SS for anterior cases but I am skeptical about the need for posterior implants.
As Howie Gluckman and several others have shown on this site the procedure is not simple and brings with it potential further complications and concerns.
Your case is one of those that "you could ask 20 dentists and they could create 20 different plans."
I believe an answer is -what works best in your hands. Thirty years ago the clinical implant options would have been entirely different than today as they will be in thirty years. By maintaining his dentition who have improved the patient's choices and prognosis


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Barry,

Thank you for the kind remarks.


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Barry,

Just to remind us, the case I showed was nice "recession".
This is case is similar but not as pretty when it comes to the recession. I would have same reservation on socket shielding. It is a long term periodontal maintenance patient whose bone and gingiva has not progressed significantly over many years. Most of his loss of periodontal tissues occurred in his early 30s and has been pretty stable since.

If he had lost teeth, which he didn't, and I would have done implants with socket shield procedures to replace teeth in his 30s on the maxillary arch-what would he look like in his 60s in the maxilla?

I would like to hear the research group on socket shielding thoughts on the cases I posted.

One last thought-what would these cases look like if I had not done socket shielding when placing implants in the patient's 30s.

George

Adult Recession Again


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George -you are obviously a great clinician who can inspire his patients
I agree, it' so hard to decide when to what to do
Like all of us on this site, my decision is "what would I do if this was a family member (assuming you still love all of your family member)
In UK the problem we have is litigation!
Its easier to remove teeth than save them!
Thats crap, unfortunately we often decide a plan with fear of litigation


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George; Great service for the patient. Your question also is a fair and honest one. So far we have not seen a single PET in our office with recession after PET therapy albeit only 9-10 years is our longest case. But I believe the reason is that when PET is performed "correctly" the tissue is "thickened" by the placement of an implant palatal to the shield. Leaving more thickness and a different sulcular environment than you have with teeth present. Having said that IF we have tissue recession, why not treat it like you would a tooth? CTG graft? regards Mo


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George; Let me ask you a question, WHAT do you do when your standard immediate implants have recession, abutment exposure or thread exposure? Mo


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