logo 49 | The Camlog Partner Magazine 24 | Case study Immediate restoration with Guided Surgery and the Socket Shield Technique PRAXISFALL Close to twelve years ago, Hürzeler et al [1] reported on a novel approach to preserve hard and soft tissue following tooth extraction. The key factor is the preservation of the bundle bone into which the periodontal fibers enter. Destruction of the fibrous system induces resorption of the bundle bone and consequently leads to thinning of the buccal bone lamella. The authors suggested preserving part of the buccal root in the crestal region of the alveolus during immediate implantation. The proof-of-concept study in beagle dogs showed that retaining the buccal aspect of the root at the time of implantation does not appear to compromise osseointegration and may be beneficial for buccal bone preservation. Since then, the socket shield technique as originally described by Hürzeler et al [2,3], or in complex situations such as multiple adjacent implants [4], has been further clinically evaluated with encouraging esthetic results. The most recent critical literature review by Blaschke et al [5] on the clinical data of the socket-shield technique summarized promising results and its high potential to reduce invasive bone grafts around implants in the esthetic zone. However, they also concluded that the supporting clinical data are very limited. The socket shield technique should be used by experienced surgeons as it is very technique sensitive. The following case report describes a completely guided immediate implantation and immediate restoration applying the socket shield technique as an efficient treatment concept with highly esthetic results. The patient case A 69-year-old man presented to the practice in good health (ASA I) with a fracture of a central incisor. The general state of health was good. All teeth had been restored alio loco with lithium disilicate crowns because, as the patient reported, the teeth were severely worn as a result of intense bruxism and grinding of teeth. And although the anterior crowns had been splinted, the crowned anterior tooth 21 fractured horizontally at the gingival level. The thermal sensitivity test with CO2 snow showed no response to the stimulus. The peri-coronal tissue was irritated but without any active purulent infection. Hard and soft tissue exhibited no signs of bone loss or recession, and no structural differences were evident when comparing the two quadrants of the upper jaw. No changes or signs of fracture were seen radiologically on the root remnant. Oral hygiene was good. Tooth preservation was considered feasible but did not seem to have a long-term prognosis because of the lack of a ferrule effect. As an alternative to implant restoration, a conventional bridge restoration was discussed with the patient. The patient opted for reconstruction with the aid of an implant. » In conjunction with immediate implantation in the esthetic zone and immediate insertion of a temporary restoration, the preservation of a buccal root segment to stabilize the buccal lamella has proven to be a promising treatment option. The so-called socket shield technique is a technique used since 2010 for the primary prevention of both hard and soft tissue profile changes following tooth extraction in the buccal region. Pre-surgical digital planning enables optimal, minimally invasive implant positioning using guided surgery. If an implant that achieves predictable primary stability is used, then temporary immediate restoration is beneficial for preserving the peri-implant mucosa. Dr. Ramón Gómez Meda Oral surgeon
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