Immediate Implant Combined With Modified Socket-Shield Technique: A Case Letter.

Abstract

I t had been clearly shown in both animal and clinical studies that the alveolar ridge remodeling took place soon after tooth extraction, which would particularly affect the shape of buccal lamella. The major drawback on implant-based rehabilitation was bone resorption. Several studies had suggested that osseointegration might be achieved through immediate implant placement, but this method could cause multiple biological responses in the extraction socket. The guided bone regeneration (GBR) was another widely used technique to preserve the alveolar ridge. However, the bone graft placed between the implants and labial bony plate may not compensate the buccal bundle bone loss. The question remains on how to prevent the bone loss during tooth implantation. Therefore, it is eager to demand desirable solution. After tooth extraction, the remarkable alterations in the buccal bone plate were caused by periodontal ligament loss and the consecutive trauma. Intriguingly, it seemed bone resorption could be prevented by root retention. Hürzeler et al evaluated effects of retaining the buccal portion of the root in conjunction 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 with longitudinal data on immediate implant placement after complete root extraction. In previous reports, only 1 root fragment exhibited signs of resorption, at the same time, the implant remained functional. Notably, when implants were placed lingual to the tooth fragment, connective tissues could be observed in the gaps, which would affect implants and the coronal root fragments. On the other hand, placing implants in direct contact with tooth fragments could increase risk of displacing buccal root fragments or missing the buccal lamellar bone. Even with those concerns, it was evident that the socket-shield technique could maintain the healthy periodontium, gingival tissues, and original crestal bone height and contour. To further improve this method and reduce adverse effects, we attempted to keep the gaps and fill them with bone graft materials to minimize root resorption. This case report was targeted to evaluate the feasibility of this modified approach in a clinical practice setting.