Background: It is difficult to achieve good primary stability of dental implants in soft bone, such as that in the posterior maxillae. Osseodensification (OD) burs, working in a non-subtractive fashion, condense the implant osteotomy bone in lateral direction and increase in the bone implant contact. Also, dental implants with deeper threads, and decreased thread pitch can increase initial bone implant anchorage. Methods: This study utilized 48 custom-made machined surface dental implants that were 13 mm long, with a major diameter of 4.5 mm and a minor diameter of 3.5 mm, a thread pitch of 1 mm, a thread depth of 0.5 mm, and a 4 mm long cutting flute at the apex.  The implants were divided into 4 groups, each group was made of 12 implants with a different thread design; V-shaped, trapezoid, buttress, and reverse buttress. The implants were inserted in 4-mm thick cancellous bone slices obtained from the head of Cow femur bone. The ostoetomies were prepared by conventional drilling and by OD drilling. Each inserted implant was then tested for primary stability using the Periotest. The Periotest values (PTVs) for the implant stability were tabulated and analyzed using a chi square test at significance level p< 0.05. Results: The results of this this study revealed no statistically significant difference between the Periotest readings for the implants in each category placed in either the OD or the regular osteotomies. However, it has been found that the implants placed in regular drilling ostoetomies had a significantly better primary stability than the implants placed in OD osteotomies. Conclusions: It was concluded that OD is not necessary in situations where there is bone of good quality and quantity.

Aim:To evaluate the role of socket-shield technique for ridge preservation in immediate implant placement sites. Background: The socket-shield technique seems to be beneficial for ridge preservation despite its insufficient documentation. In this case report series, implants were placed immediately after extracting a hopeless teeth using this technique and then were followed up for 1 year to document functional and esthetic outcomes. Cases description: Five patients presented with a non-restorable teeth were treated using the socket-shield protocol and immediate implant placement. Roots were dissected in a mesiodistal direction along the long axis down to the apex; a periotome was later used to detach the palatal fragment of the root, while keeping the buccal one. Following sequential osteotomy drilling, implants were placed. The gap between the implant and the shield was filled with a synthetic bone grafting material. A customized healing abutment with an S-shaped emergence profile was prepared to support a coronal emergence profile of the tooth. Patients had follow-up visits after 6 weeks and 5 or 6 months before proceeding to prosthetic reconstruction phase. Screw-retained porcelain fused to metal crowns and titanium abutments were inserted intraorally with 35 N cm torque and screw-access holes were restored. Conclusion:The socket-shield technique along with immediate implant placement is a minimally invasive approach that can preserve the hard and soft tissue contour of the ridge and can be implemented in areas of high esthetic demands for better esthetic outcomes.

Introduction: This study aimed at testing the effect of the socket shield technique on the maintenance of the labial plate of bone and the change in position of its surrounding gingival soft tissues upon the immediate placement of 3 different dental implants systems, with a bone graft material filling the defects around the implants, followed by clinical and radiographic evaluation using the cone beam computed tomography after 4 and 12 months of loading. Materials and Methods: Three groups, 6 male patients each, having a failing central or lateral maxillary incisor, had their failing tooth partially extracted, with the remaining tooth half reduced to be the socket shield, then the 3 groups received 3 different dental implants systems, the Tapered Internal implant RBT Laser-Lock for group I, the Touareg-S implant for group II, and group III received the Nobel Active implant. Then, the Novabone putty bone graft was dispensed in the space between the implant and the shield and covered with a customized healing abutment. After 4 months of healing, the patients were provided with definitive restorations, and followed after 4 and 12 months for gingival recession, papillae filling the interdental spaces, and CBCT evaluation of the labial plate of bone width and vertical resorption. Each result was then statistically analyzed. Results: For all the cases in the study, no implant failed, no gingival recession was recorded, and the interdental papillae filled their spaces in most of the cases. also, no significant changes were recorded for the labial plate of bone width or height. Conclusions: The socket shield technique was able to maintain the labial plate of bone and the position of the overlying free gingival margin, with the neighboring interdental papillae showing least dimensional changes.

Extraction Socket Healing undergoes a remodeling process that leads to vertical and horizontal tissue loss. Ridge volume alteration embeds a huge challenge on restoratively oriented three-dimensional placement of dental Implants. Socket shield technique demonstrated a histologic and clinical evidence on preventing soft and hard tissue alteration following tooth extraction. This case report describes an immediate implant placement with modification on socket-shied technique, where a buccal and palatal tooth fragments where prepared on buccal and palatal roots respectively of a failing upper first premolar, with two divergent roots. 3D deviation analysis of alveolar bone showed minimal loss of volume (-0.052mm, Avg+/-: 0.128/-0.232, SD 0.48), as well as, 3D deviation analysis of the ridge showed minimal loss of volume (-0.122mm, Avg+/-: 0.029/-0.202, SD 0.263). This Double Socketshield procedure showed to be a feasible treatment option for maximum tissue preservation at immediate implant replacement of multi-rooted teeth.