Socket Shield and Bioactive Glass Around Anterior Maxilla Immediate Dental Implants

Abstract

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.

Socket shield technique

“…Detailed analysis showed that of the included studies, 3 were randomized controlled trials,[ 18 21 30 ] 7 were retrospective studies,[ 11 15 16 17 19 22 25 ] 4 were prospective studies,[ 23 24 26 28 ] 1 was a prospective case series,[ 20 ] 1 was a prospective nonrandomized controlled study[ 27 ] and 2 were comparative studies. [ 14 29 ] A quantitative analysis of the total number of patients, the total number of implants placed with SST and complications associated with the SST is presented in Table 2 .…”

“…[ 26 ] reported the bone loss at the neck, middle, and root of the implants as 0.27 ± 0.21 mm, 0.19 ± 0.20 mm, and 0.28 ± 0.29 mm, respectively, in 10 cases of SST. Walid and Alkhodary[ 28 ] reported no significant changes in the thicknesses of the labial bone plate and absence of vertical resorption with SST during 1 year of follow-up. In a prospective nonrandomized controlled study by Xu et al .,[ 27 ] the labial bone thickness after 1 year was found to be 2.90 ± 0.64 mm in the SST group and 2.51 ± 0.69 mm with the conventional technique.…”

“…The clinical appearance of the peri-implant mucosa in the socket shield treated teeth was reported to be improved in other studies as well. [ 14 15 19 20 28 ] Yan et al . [ 26 ] used the pink and white aesthetic index proposed by Belser et al .…”

“…[ 40 41 42 ] Therefore, SST achieves better esthetic outcome because it reduces the alveolar bone resorption. In the majority of the included studies,[ 7 11 15 17 19 20 22 27 28 30 ] the fragment had been reduced around 1 mm coronal to the labial bone plate to retain the dentogingival fibers which seemed to increase soft tissue esthetics by maintaining the mucosal zenith at a more coronal position. [ 43 ] Furthermore, peri-implant probing in SST cases had revealed healthy conditions and volumetric analysis had shown a low degree of contour changes with effective preservation of facial tissue contours.…”

“…[ 8 ] the enamel matrix protein was administered on the inside of the root fragment before the placement of implants. Various graft materials have been used to fill the space between the implant and the shield-like xenograft mixed with platelet-rich in growth factors,[ 14 ] bioactive glass-calciumphosphosilicate,[ 28 ] Bio-Oss bone powder,[ 17 26 27 ] allograft,[ 17 21 ] and deproteinized bovine bone mineral. [ 30 ] Yan et al .…”