Socket shield technique- enhancing pes around immediate implants in esthetic zone- a clinical study

15260 ORAL COMMUNICATION CLINICAL RESEARCH - PERI-IMPLANT BIOLOGY

Background

The extraction of teeth is inevitably associated with definitive changes in the surrounding hard and soft tissues. Despite the use of various socket preservation and pontic site development techniques, the ridge is bound to some remodelling due to the loss of bundle bone-periodontium complex (BBPC). Socket shield technique (SST) aims at preserving the buccal 2 3 of the root in socket so that the periodontium, along with the bundle bone and the buccal bone remains intact

Aim/Hypothesis

The aim of the study was to do a comparative analysis between the clinical (Pink Esthetic Index) and radiological outcomes of two techniques; conventional immediate implant placement (without SST) and immediate implant placement with SST; without involving any grafting procedure

Material and Methods

20 patients (6 female; mean age 38.65 years) with vital or non-vital non-restorable tooth were treated with 30 immediate flapless, graftless implant placements via two different techniques- SST (group S; 15 implants) and the conventional technique without SST (group C; 15 implants). Immediate chairside temporaries were fabricated for all of them. 4 months postop, all implants were restored either with screw or cement-retained prostheses. Each group was analyzed at two different time intervals- 15 days, post-implant placement and 4 months post-implant placement. An aesthetic analysis was done using five parameters of Pink Esthetic Index (PES); mesial papilla (MP); distal papilla (DP); curvature of the facial mucosa (CFM); the level of the facial mucosa (LFM) and root convexity (RC) at the facial aspect of the implant site. A score of 2, 1, or 0 was assigned to all five PES parameters so the maximum possible PES was 10. Radiographic analysis was done using digital periapical radiographs taken using the long-cone paralleling technique Patients were followed up for 6,12,18 months period and the clinical parameters were recorded.

Results

When intragroup comparison was done between the two different time intervals there was no statistically significant difference seen for the parameters MP, DP, CFM, LFM and RC in S group whereas there was a statistically significant difference seen for the values in group C i.e. the soft tissue parameters deteriorated in group C. Further when intergroup comparison of difference of mean values of the different parameters was done, there was statistically significant difference seen between the two techniques with group S showing better results than group C. It was observed that the buccal bone was maintained in all the cases of shield group S while almost all the cases except one with thick soft tissue (5 mm) showed loss of root convexity in group C. It confirms the finding that the thick soft tissue decreases buccal bone loss. It was also observed that adjacent implants sites had less scores than single implant sites. Radiological scores were in compliance with PES scores

Conclusion and clinical implications

Based on preliminary observations, the Socket Shield Technique appears to be an excellent option for the rehabilitation of unsalvageable tooth in the esthetic zone with least surgical trauma with no requirement of grafting procedures, less duration of total treatment and least complications. This technique can be looked upon for not only preserving but also in maintaining the hard and soft tissues, in the future, as long as the shield remains intact.