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CATEGORY LINICAL

Socket Shield – uncompromised aesthetics & architecture through biologic preservation

Dr Jeff Li

By Dr Jeff Li, Dual Board-certified Periodontist (Canada & USA) Faculty, BITES Institute MINEC Knight (Canada)

A nterior tooth replacement with a dental implant is one of the most challenging aspects of implant dentistry, especially when it comes to maintaining the soft and hard tissue volume and aesthetics. is is especially trueof theanteriormaxilla, where we face many challenges following tooth loss, such a bone loss in both horizontal and vertical dimensions, and subsequent soft tissue recession. is is compounded by the fact that the buccal plate thickness is very limited (<1mm) more often than not. Many methods involving di erent forms of bone and soft tissue augmentation have been described and attempted in hopes of minimizing the aforementioned dimensional changes. One more recent and innovative method is the Socket Shield Technique, part of a larger group of techniques known as Partial Extraction erapies. Brie y, the goal of the Socket Shield Technique is to preserve a thin layer of the buccal root of the tooth to be replaced. When performed correctly, this will help to preserve the PDL bers, which connect the root to the buccal plate and maintain the blood supply to this thin cortical bone, which in turn supports the overlying soft tissue. e following case study highlights the use of the Socket Shield Technique for a single maxillary anterior implant case. Patient GW, a healthy 60-year-oldmale, presented with a relatively typical anterior implant case. Tooth 21 had a history of root canal treatment, followed by a post and a porcelain-fused-to-metal (PFM) crown. Presently, the crown had fractured with the post and tooth structure within, leaving a root with inadequate retention. e initial presentation (Figs. 1 & 2) showed: u A high smile line in exaggerated smile. u A very opaque PFM crown for tooth 21 Abstract: Implant surgery in the aesthetic zone is very challenging. Remodeling events after a tooth is extracted often lead to undesirable outcomes. Many techniques exist but Socket Shield is the only one that utilizes true biologic preservation. It should be considered for all aesthetic implant cases.

Figure 1. Exaggerated Smile, Initial

Figure 2. Retracted View, Initial

Figure 3. Initial PA

Figure 4. Initial CBCT Slices

Figure 5. Occlusal View, Initial

Figure 6. Broken Crown Removed

Figure 7. Mesio-Distal Root Sectioning

Figure 8. Refined Socket Shield

Figure 9. Removal of Palatal Portion of Root

Figure 10. R2GATE Guide, Occlusal

Figure 11. R2GATE Guide, Frontal

70 AUSTRALASIAN DENTIST