logo 49 | The Camlog Partner Magazine Case study | 29 Discussion The concept of incision-free immediate implantation has gained in popularity in recent years. Meanwhile, it has been proven that the survival rate is on the level of late implantations in healed edentulous jaw sections. Convincing arguments are the reduced number of surgical procedures and the shortened treatment time in addition to higher patient comfort. The postoperative quality of the soft tissue is also better due to less surgical manipulation. However, there are some challenges to consider with immediate implantation. Next to achieving sufficient primary stability, these primarily relate to subsequent defect formation in the crestal alveolar region. Complete preservation of the peri-implant tissue structures in esthetically relevant areas can to date still only be achieved in rare cases. A complicating factor in planning is that the extent of resorption to be expected varies greatly in individual cases. The main reason for the loss of resorption is the biological remodeling process following tooth extraction. Crucial etiologic factors in this context are a thin buccal bone lamella and, from the resulting loss of the periodontium, induced degradation of the alveolar-lining bundle bone [8]. A key factor in stabilizing the midfacial crestal alveolar bone could be the targeted preservation of the bundle bone in this region. To preserve the periodontal attachment including cementum, periodontal ligament and bundle bone, the socket shield technique has increasingly moved into the focus of treatment in recent years. This should prevent the resorption cascade from being set in motion in the first place. Conclusion This case illustrates an experimental technique for preserving a buccal root segment in conjunction with immediate implantation and a temporary restoration. The socket shield technique is proving to be a valuable technique for minimizing buccal profile changes following tooth extraction, resulting in increased volume stability of the mucosa adjacent to the inserted implant. Even though the clinical application of the socket shield technique is still difficult and very technique-sensitive - with an apically tapered implant designed for high primary stability, such as the PROGRESSIVE-LINE, the dentist can achieve both good control over the implant position as well as a fairly favorable cost-benefit ratio with this technique. This case also demonstrates that the PROGRESSIVE-LINE implant is a reliable implant for immediate restoration protocols. The capabilities of computer-aided planning and guided surgery allow the benefits of a fully digital workflow to be realized in full. However, in the future, the long-term stability of the esthetic outcome must be evaluated in addition to the safety of the technique. [1] Markus B Hürzeler , Otto Zuhr, Peter Schupbach, Stephan F Rebele, Notis Emmanouilidis, Stefan Fickl; The socket-shield technique: a proof-of-principle report J Clin Periodontol. 2010 Sep;37(9):855-62. [2] Daniel Bäumer, Otto Zuhr , Stephan Rebelle , David Schneider,- Peter Schubach , Markus Hürzeler the Socket-Shield Technique: First Histological, Clinical, and Volumetrical Observations after Separation of the Buccal Tooth Segment – A Pilot Study ,Clin Implant Dent Relat Res .2015 Feb;17(1):71-82. [3] Bäumer D, Zuhr O, Rebele S, Hürzeler M.: Socket Shield Technique for immediate implant placement - clinical, radiographic and volumetric data after 5 years. Clin Oral Implants Res. 2017; 0, 1-9 [4] Howard Gluckman, Maurice Salama , Jonathan Du Toit; A retrospective evaluation of 128 socket-shield cases in the esthetic zone and posterior sites: Partial extraction therapy with up to 4 years follow-up Clin Implant Dent Relat Res. 2018 Apr;20(2):122-129 [5] Christian Blaschke, Donald R Schwass ;The socket-shield technique: a critical literature review Int J Implant Dent. 2020 Sep 7;6(1) [6] Bäumer, D., Zuhr, O., Rebele, S., Schneider, D., Schupbach, P. & hürzeler, M. The socket-shield-technique: first histological, clinical, and volumetrical observations after separation of the buccaltooth segment – a pilot study. Clin Implant Dent Relat Res. 2015 Feb;17(1):71-82. [7] Zhang X, Wang J, Wan Q, Li L; Guided residual root preparation for socket- shield procedures: A clinical report. .J Prosthet Dent. 2020 Dec;124(6):625-631. [8] Lee, C. T., Chiu, T. S., Chuang, S. K., Tarnow, D.,Stoupel, J.; Alterations of the bone dimensionfollowing immediate implant placement into extraction socket: systematic review and meta-analysis; J Clin Periodontol. 2014 Sep;41(9):914-26. • Degree in dentistry from the University of Santiago de Compostela • Master in occlusion and temporomandibular dysfunction • Postgraduate studies in periodontology and implant dentistry • International lecturer in periodontology, implant dentistry, esthetics and multidisciplinary treatments MEDA Dental Institute Pérez Colino 22 24402 Ponferrada-León-Spain Dr. Ramón Gómez Meda References
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