Consultant prosthodontist shares insight into the Socket-Shield Technique

Retaining part of the tooth root to preserve the bone is quite a well-accepted concept. In 2010, Prof. Markus B. Hürzeler and colleagues conducted animal studies looking at partial root retention using the socket shield technique, combined with immediate implant placement. Over the years, there have been numerous modifications to the SST protocol.

When I started, many of my peers associated the technique with implant failure and complications such as exposure, infections, peri-implantitis, and shield migration. However, now there is increasing evidence about the predictability of this technique.

The objective of Prof. Hürzeler's studies was to assess if retaining roots of teeth with hopeless prognosis could prevent tissue alterations following tooth extraction. Their findings showed that osseointegration did not seem to have been challenged by the retention of the buccal aspect of the root during implant placement, suggesting that preserving the buccal aspect of the root could be advantageous.

From that time onwards, the mindset evolved towards SST and clinicians became a lot more confident in its value. The reality is that whenever a tooth is extracted, the buccal bone collapses. Embracing SST prevents that collapse and resorption.

The a design of a particular implant can be used for to encourage bone growth. I have been using German company bredent’s dental implants for over six years; and its blueSKY and copaSKY in particular. The Backtaper, conical connection and subcrestal positioning on these implants really help in growing the bone onto the platform. I have had very consistent, positive results with these implants. The prosthetic elements of the treatment using these bredent implants are really easy to conduct as there aren’t many components required. The final abutment can be used as an impression coping and that is only one of the many other advantages for me as a prosthodontist.

Buccal bone loss can be prevented by keeping a part of the root on the buccal side. Thanks to SST, the bone can be preserved without having to resort to the use of any biomaterials. This is cheaper for the patient, with the advantage of being minimally invasive. I have successfully completed numerous cases, with only a few complications that were easily managed. For these reasons I advocate that SST is a very good technique which can achieve impressive outcomes.

Bone loss is multifactorial and is not just attributed to an implant, a connection, a prosthesis, and the condition of the soft tissue.

I use bredent’s blueSKY and copaSKY implants, but have a preference for the latter, essentially because of its Backtaper and conical connection. The Backtaper is now an additional element which gives the hard and soft tissue more space for attachments. The slim concave-shape of the abutments also provides more space for soft tissue attachment and bone growth on the Backtaper. The concavity beneath the gum is what we want.

The copaSKY also provides me with a bevel platform and horizontal micro-grooves. Placing the implant subcrestally requires the bone to have a certain thickness with a cancellous component. Bone thickness is important but we also need the vascularity of the bone. Together with SST, we are in a position to stabilise the blood clot with Fibrin during the healing phase, which favours bone formation.

If we can randomise the thickness, quality and vascularity of the bone, and see if there is bone formation around the copaSKY implant all the time, the microgroove on the implant neck might be the most critical factor for the bone growth.

 

 

 

 

 

 

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