This study aims to prospectively evaluate and compare the socket shield technique versus the conventional technique for immediate dental implants. The socket shield technique involves retaining the buccal root portion after extraction to preserve the buccal bone and soft tissues, while the conventional technique is immediate implant placement after full root extraction. Thirty patients needing a single anterior tooth extraction will be randomly allocated to receive implants with either the socket shield technique or conventional technique. Outcomes of implant survival, marginal bone loss, and esthetics will be clinically and radiographically evaluated.

1.  Postextraction Dental Implant in the Aesthetic
Zone,
Socket Shield Technique Versus
Conventional Protocol
 Presenter: Dr. Mohd Younis Bhat Guided by : (Prof) Dr. Ajaz Ahmad Shah
PG SCHOLAR Prof and Head
OMFS, GDC, Srinagar

2.  Socket Shield Technique: First demonstrated
by Hurzeler et al
 The technique retains the buccal root after extraction, preserving
periodontal vascularization, cementum bundle bone and the buccal bone
wall.1
 Preserving the periodontal ligament and the supra-crestal attachment of the
tooth on the buccal aspect in conjunction with immediate implant
placement appears to have the potential to avoid buccal bone remodelling.2

3.  In this technique, during the time of extraction, the coronal 1/3 of the
buccal root was preserved and an immediate implant was placed palatal to
the root fragment. 3
 The root fragments function like a shield and preserve the resorption of the
buccal bone and thus enhance the contour of the tissues and increase the
esthetic outcomes.3
 There are suggestions in the literature that a root can be retained to
preserve alveolar ridge volume underneath removable complete prostheses
without complications such as infection.4

5. the alveolar ridge
remodeling took place soon
after tooth extraction, which
would particularly affect the
shape of buccal lamella
Implant Based Rehabilitation

6. The major drawback on
implant-based rehabilitation
was bone resorption.
The question remains on
how to prevent the bone
loss during tooth
implantation.

7. After tooth extraction, the
remarkable alterations in
the buccal bone plate were
caused by periodontal
ligament loss and the
consecutive trauma .
Intriguingly, it seemed that
bone resorption could be
prevented by root retention

8. Hürzeler et al evaluated the effects of
retaining the buccal portion of the root
inconjunction with immediate implant
placement.
Their results demonstrated that this
technique could restrain the buccal bone
resorption to a large degree.
It also achieved significantly higher implant
success rates compared to longitudinal data
on immediate implant placement following
complete root extraction

9.  The aim of this study is to prospectively
evaluate
 survival , marginal bone loss , esthetics of
dental implants inserted with the
postextractive technique defined ‘‘socket-
shield’’ and to compare with conventional
technique of immediate implant.

10.  To evaluate the effectiveness of Socket shield
technique in implants for following:
1. Implant survival
2. Marginal Bone Loss
3. Esthetics

11.  Ethical clearance - Institutional review board of
Govt. Dental College, Srinagar.
 Informed/ Written consent will be obtained.
 This prospective and comparative study will be
conducted to clinically and radiographically evaluate and
compare immediate implants placed socket shield
technique versus conventional

12.  Patients who needed to replace a single anterior tooth comprised in the
space between 2 maxillary/mandibular premolars are to be included in this
study.
 The tooth to be extracted for one of the following reasons
 horizontal or vertical fracture,
 destructive caries, internal resorption and
 endodontic problems not treatable with root canal therapy.
 Patient’s cooperation, motivation and good oral hygiene.
 No Acute Infection or clinical sign of inflammation present

13.  General contraindications to implant surgery, irradiation,
 Chemotherapy, or immunosuppressive therapy
 poor oral hygiene and motivation, active periodontitis,
 uncontrolled diabetes, pregnancy or lactation, substance
abusers,
 smoking more than 0 cigarette per day, psychiatric problems
or
 unrealistic expectations, acute infection in the area intended
for implant placement

14.  Study setting –
 Dept. of Oral and Maxillofacial Surgery, “Govt.
Dental College, Srinagar.”
 30 patients who will meet the inclusion criteria
and will be willing to participate in the study shall
be placed (fifteen each) into the Socket Shield
technique and Conventional group.

15.  This study will include 30 subjects treated in the department of
Oral and Maxillofacial Surgery at Govt. Dental College and
Hospital, Srinagar. The patients will be randomly allocated to
the SST group (n-15) and Conventional group (n-15).
 Group A: SST group (n=15).
 Group B: Conventional group (n=15).

16.  All the patients will receive antibiotics prior to the surgery.
 Furthermore, antimicrobial prophylaxis to be performed with
the use of 1 gr for 12 hours of Amoxicillin þ Clavulanic acid
(Augmentin, GlaxoSmithKline, Brentford, Middlesex, UK) or
erythromycin 500mg one a day for 3 days if allergic to
penicillin, starting 1 day before surgery
 All patients will be subjected to proper oral hygiene
instructions, scaling and root planning for all teeth and
periodontal treatment if needed to provide an oral environment
more favourable to wound healing.

17. Following local anesthesia, the crown, if exists, is hemisected by a coarse
bur, then the root is dissected in a mesiodistal direction along the long
axis down to the apex using a long shank bur coupled to a hydrated high-
speed handpiece.
The root is separated into buccal and palatal fragments.
The palatal fragment is removed with high caution keeping the buccal
segment unmanipulated and attached to the buccal bone.

18. The tooth is totally removed except the vestibular shield hence,
the coronal margin of the residual root is lowered up to 1mm below
the bone crest and taking care to protect the gingival margin.
Curettage was performed in the extraction socket and a copious
saline irrigation followed to remove any infectious remnants.
The stability of the buccal shield is checked with a sharp probe.
The buccal socket shield was then ready
The implant is then positioned 2mmbelow the bone crest

19. For the patients in the control group, the surgical treatment
protocol is atraumatic tooth removal without flap elevation
there by maintaining the periosteal blood supply to the labial
bone plate, and teeth to be extracted atraumatically.
The extraction socket is debrided thoroughly, and osteotomy
to be performed with a placement of the implant.

23.  1. Chen CL, Pan YH. Socket Shield technique for ridge preservation: a case report.
J Prost Implant 2013;2:16–21.
 2. The socket-shield technique: a proof-of-principle report : Markus B. Hurzeler
 3. Socket‐shield technique for implant placement to stabilize the facial gingival and
osseous architecture: A systematic review
 4. Araujo MG, Sukekava F, Wennstr€om JL, Lindhe J. Tissue modeling following
implant placement in fresh extraction sockets. Clin Oral Implants Res
2006;17:615–24.
 5. Postextraction Dental Implant in the Aesthetic Zone, Socket Shield Technique
Versus Conventional Protocol