Prosthetic management of implant placed with socket-shield technique
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The document discusses the prosthetic management of implants using the socket-shield technique (SST), which aims to preserve the alveolar ridge by retaining a partial root fragment during immediate implant placement. It details the technique's indications, contraindications, advantages, and disadvantages, as well as the necessary tools and preparation steps required for successful implementation. Additionally, it highlights the potential complications and the role of CAD/CAM technology in enhancing the precision of implant positioning.
Prosthetic management of implant placed with socket-shield technique
- 1. PROSTHETIC MANAGEMENT OF IMPLANTS PLACED WITH “SOCKET-SHIELD TECHNIQUE”
- 2. CONTENT Introduction History Principle Indication Contra indication Requirements Pros Cons -- Armamentarium, preparation Complication CAD/CAM with SST
- 3. INTRODUCTION Socket healing after tooth loss results in altered dimensions of the alveolar ridge due to remodeling and tooth‐dependent alveolar process. The degree of alterations varies and it can result in the loss of ridge volume and changes in ridge shape, Moreover, the greatest losses occur on the buccal aspect, which is related to a thinner bone wall composed of large amounts of bundle bone primarily vascularized by the periodontal tooth membrane and particularly susceptible to surgical trauma and resorption. Other important reasons to maintain the bone wall while teeth are present include maintenance of the periodontal ligament and the provision of nutritional and functional stimuli.
- 4. HISTORY Root submergence to preserve the alveolar ridge was first reported about 50 years In 2010, Hürzeler et al. introduced a new method, the socket shield technique, in which a partial root fragment was retained around an immediately placed implant with the aim of avoiding tissue alterations after tooth extraction
- 5. PRINCIPLE OF THE SST The original technique is altered Not only are because it necessitates materials exceedingly costly but also human histology has demonstrated that bone can grow between root dentin adjacent to an implant surface without enamel matrix derivative. NB; The original technique proposed applying enamel matrix derivative to the inner dentin surface of the socket-shield to promote cementum formation The preparation of the root with SST that buccal/facial section remains in-situ with buccal plate intact in addition the root’s peridontal attachment remain intact and prevent the post extraction remodeling
- 6. INDICATION The ideal The ideal extraction site for immediate implant placement Little or no periodontal bone loss on the tooth that is to be extracted ,such as tooth being extracted due to ; Endodontical involvment Root fracture Root resorption Root perforation Periapical pathology Unfavorable crown / root ratio Residual deciduous tooth
- 7. CONTRA-INDICATION Presence of infection eg; pus Resorption of bone beyond the apex Close proximity to anatomical vital structures Clinical conditions preventing primary closure
- 8. REQUIREMENTS Well trained and experienced clinician Comprehensive ttt planing, including the prosthetic outcomes with digital smile design ‘’ DSD ‘’ and/or with tial restoration 3- dimensional cone-beam computed tomography scan for proper data collection of the treatment site
- 9. PROS The technique retains the buccal root after extraction, preserving periodontal vascularization, cementum bundle bone and the buccal bone wall there is no added cost for materials, comorbidity is reduced, and it can be applied in the presence of endodontic apical pathology, and reduced surgical intervention. reduce the extent of treatment and decrease patient stress and pain the SST might reduce socket resorption and help avoid soft‐tissue or hard‐tissue grafting. The SST when associated with a CAD/CAM fabricated surgical guide, can reduce the amount of appointments, due to the immediate fabrication of the definitive restoration with the existing model.
- 10. CONS Not yet reliable or predictable No long term data Technique sensitive ( need extensive planning ) Its success greatly depends on the operator's skills and ability to create a satisfying and long‐lasting rehabilitation.
- 11. ARMAMENTARIUM straight diamond rotary instrument (Bur H254LE; Komet Dental) endodontic file or a Gates-Glidden rotary instrument periotomes and microelevators long-shank diamond rotary instrument (Bur 801; Komet Dental) Curette instrument rinse solution large round diamond rotary instrument (Bur 801; Komet Dental )
- 12. PRERPARATION socket-shield preparation steps for single-rooted teeth : After achieving adequate and profound anesthesia to the working area decronate the planned tooth for partial extraction using high speed hand piece coupled to straight diamond bur with copious irrigation until you reach the level of the gingiva . Once decronation completed , in mesio-distal direction split the root as far as you go vertically creating Palatal and facial segment and confirm the root splitting step using conventional periapical radiograph If the tooth was endodontically treated it necessitates to remove all the obturation material from the root canal, if not orient the apex by insertion of gates drillen or endodontic files and measure it on the radiograph
- 13. Carefully remove the palatal root segment using periotomes and microlevators while and do not ever touch the facial root segment but apply finger pressure only for support . Once you loose, remove the palatal root segment remove it microforceps Refine the facial root segment using long shank diamond bur with orientaion toward the tooth apex in triangular movement , avoid excessive cutting as much as possible
- 14. Reduce the thickness of the facial root segment to half from the canal to the root’s facial limit, creating concave structure extending from the mesial to distal of the socket Continuous rinsing and curette to insure that the canal is free from any obturation material, pathological tissue, peridontal ligament space or any radiopaque dental material . Reflect and protect the gingival tissue the complete the coronal reduction using large round diamond bur to the level of the alveolar crest but do not leave a 1-2 mm of coronal portion as previously described . Create an beveld chamfer in the socket shield for proper prosthetic space to accommodate an S-shaped prosthetic emergence profile Prepare the implant osteotomy apical/palatal to the fully prepared socket-shield. Then Follow conventional immediate implant placement protocol and insert the implant
- 15. Verify the implant’s primary stability ; - - If adequate implant stability quotient (ISQ; >70), attach an interim crown immediately - If less than adequate (<60 ISQ), attach a custom transgingival abutment to the implant that mimics the intended emergence profile Design a narrow expanding S-shape curve in the transgingival-prosthetic component , observe there’s no exessive pressure causing blanching of the tissue
- 16. Check the interim crown for premature contact in centric and eccentric movements Make a post operative radiograph
- 18. NB At all times, take care not to cut or damage the adjacent structures (gingiva, adjacent teeth, or restorations) during the coronal reduction Do not ever lever against the facial root portion but instead apply finger pressure to support and sense movement during the root splitting step avoid cutting excessively into adjacent alveolar bone. While refining the facial root portion do not leave a 1- to 2-mm coronal portion as previously described during the cutting step to the coronal socket sheild to prevent the internal exposure Observe the facial gingiva and ensure that minimal to no blanching of the tissue occurs after implant placment Ensure the interim crown has no contact in maximum intercuspation or excursive moments, or if a custom abutment is used, ensure no contact with the subsequent interim prosthesis.
- 19. COMPLICATION common complication encountered to be internal exposure Inflamation may occur risk of tissue loss
- 20. CAD/CAM WITH SST The use of a CAD/CAM surgical guide facilitate the correct and precise positioning of the implant with the residual buccal root, allowing the additional fabrication of the individual healing abutment
- 21. NEW RESEARCH QUESTION ? Is it possible to place an immediate implant or SST with more preservation of tooth structure ?
- 22. REFERENCES; Prosthetic management of implants placed with the socket-shield technique Howard Gluckman, BDS, MChD (OMP),a Katalin Nagy, DDS, PhD,b and Jonathan Du Toit, BChD, Dip Oral Surg, Dipl Implantol, MSc (Dent)c Ridge Preservation with Modified “Socket-Shield” Technique: A Methodological Case Series
- 23. DONE BY; DR. Mohammed Hamada Abo Al-Naga
- 24. Thank you