Five-year tomographic and clinical evaluation of the socket shield technique: Case report.

Abstract

Background: The socket shield technique, one modality of partial extraction therapy, aims to preserve periodontal tissues and maintain the buccal alveolar bone volume following immediate implant placement or in prosthetic pontic sites, by the strategic maintenance of a tooth root fragment. This case report presents a 5 year-follow up of this technique, in a full maxillary implant-supported rehabilitation, evaluating the alveolar dimensional changes over time.

Methods: A 54-year-old patient underwent a full maxillary implant-supported rehabilitation. Partial tooth extraction was performed on the five anterior sites, numbers 6, 8, 9, 10, and 11. In each site where the socket shield technique was performed, changes in alveolar dimensions at the cervical, middle, and apical levels were measured using computed tomography at baseline, 1, 3, and 5-year follow-up intervals. In addition, the Pink Esthetic Score evaluation was performed.

Results: The mean values (mm) in the five evaluated sites, at each time period, were respectively: cervical = 7.92 ± 0.46; 8.38 ± 0.61; 8.28 ± 0.51; and 8.32 ± 0.47. Medium third = 7.84 ± 0.99; 8.18 ± 1.05; 7.22 ± 0.69; 7.24 ± 0.72. Apical = 6.84 ± 0.91; 6.88 ± 0.74; 6.40 ± 0.70; 6.40 ± 0.69.

Conclusion: Despite its inherent limitations, this case report suggests that the socket shield technique can represent a promising alternative for the stability of peri-implant tissues, in pontic and implant sites.

Key points: In this case report, the socket shield technique was able to preserve alveolar dimension in both implant and pontic sites at 5-year follow-up. Careful planning and execution are crucial to prevent interference between retained root fragments and prosthetic components. Patient satisfaction and favorable Pink Esthetic Scores demonstrated good esthetic outcomes with this technique.

Plain language summary: Preserving bone and soft tissue volume and position after tooth extraction is a major challenge in implant dentistry, particularly in anterior sites. This case report illustrates the five-year follow-up of a patient who received a full-arch, implant-supported rehabilitation in the upper jaw using the socket shield technique. This approach preserves a portion of the tooth root to help maintain the natural contour of bone and soft tissues. Clinical and tomographic evaluations, along with esthetic scoring systems, were used to assess tissue stability and appearance over time. In this case report, after five years, the technique showed stable preservation of bone and gingival tissues, with favorable esthetic outcomes and high patient satisfaction. Although based on a single case, these findings suggest that the socket shield technique may be a useful option for achieving long-term tissue stability and esthetic success in challenging implant-supported rehabilitations.