14 Months Immediate Case. SS vs. Standard Technique

Bone Zone vs Tissue Zone?? Remodeling? Changes in Ridge Contour....all part of the Study we just published last year with Chu and Tarnow. Thoughts?

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Mo. Beautiful result! I also have had "success" with this approach. Flapless extraction / immediate implant /1A1T combined with a QUALITY PROVISIONAL is key. IMO comparison to SS adhering to the same principles will be most appropriate several years from now and especially significant if issues arise with the adjacent teeth. When I think about the potential advantages of SS, I am thinking LONG TERM STABILITY IN A DYNAMIC (vs static) ENVIRONMENT. Great case for discussion. Thank you for sharing. Chuck

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Chuck; I actually agree with you. IF you look really hard you will see that even with absolute care and skill we are beginning to see some contraction at 14 months, minimal but present. What is the timeline for further possible changes? How would this look compare to an adjacent central with Socket Shield? How different after multiple years?? regards Mo

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Good job

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Good job

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Mo nice case because you managed very well all the details. Even though tissues are a little more thin than on right side. What will happen in one or two years ?
Slowly resorption takes place.
Unfortunately we can't always have a good shield...but if we have it...it is a pity not to use it!
As you said great case for discussion!
Jorge
(Merry Christmast to All)

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Mo,

few thoughts- Do you have Xray-
Noticed you used collared implant- could this contribute to retraction? But what do you think about the rotation of #10 versus 7- isnt the IHB "altered"versus "ideal" position?

Could SS improve this? who knows because biotype is excellent-
I have to go back and review Howie's lecture- to see comparison between- SS in thick Vs thin biotype-

Cheers,

Richard

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Good points Richard. The IHB "ca" be effected but the rotation is in our favor bring IHB labially. As for machined collar, yes today we would reconsider with textured surface and platform switch although no definitive studies yet.......SS vs. no SS? That is the issue. regards Mo

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I agree with Richard that the rotated lateral will affect the long term soft tissue contours. I would also like you to recheck the edge to edge occlusion on the two centrals because my bet is that the left central touches a nanosecond ahead of the right central creating traumatic occlusion and tissue changes.

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Gerald; The occlusion we display here is edge to edge in protrusion.....we always allow natural tooth to pick up guidance over implants. Will post radiograph shortly. I think you and Richard will be impressed. "One abutment-One Time". Notice where bone is on radiograph. Almost no resorption!! regards Mo

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Mo,

I like being impressed- Very nice bone maint- emergence of abutment is ideal- Do think SS would have prevented slight change is tissue? I dont think we have enough long term on SS to compare quite yet and as we all know- many times long term results are results of those who do the procedure- and again where does the biotype play a role?

Cheers,

Richard

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Richard; Thanks my friend. It is an impressive radiographic bone to implant response. I do believe that SS would provide less labial change over time....but at what risk and cost? We have no real research on long term effects, and the technique of extraction need to change, and those of us that have discarded our high speed burs and motors may need to relocate them. regards Mo

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I agree with Richard, biotype plays a role, but on SS favour. With thin biotypes, CTG grafts, and bone grafts are more unpredictable, IMHO, than SS.
Which are the risks of SS?
SS early exposure, SS loosening and...no more I think. With proper tech skill, the SS results are more predictable than GBR+CTG to change biotype.
May be in a few years we will have enough data regarding long term stability.
Regards

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Jorge,
I totally agree with your analysis. I would add a possible infection risk and a personal thought:
In this case Mo had a deep vestibular shield and then placed bone on gap:couldn't be a simpler move to have shield higher with an internal bevel? , IMO, could be beneficial for healing pattern, preserving the marginal gengiva and a possible more favorable outcome and stability.
Armando

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Armando, I do agree with you. Internal bevel helps , with a reduced height to full shield coverage that we look for.
But, on the cases we have seen, the limited shield exposure hardly can lead to a local infection. Think that bacteria don´t have a canal to go thru, not a periodontum to destroy. Once the little part exposed is being decayed it will be submerged naturally. This is my way of thinking, but is only thoughts. Time will tell us what the really problems will be.
Regards Armando from Buenos Aires.
Jorge

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