* Dr . Neha Saini ** Dr . Rishi Saini *** Dr . Manmohit Singh **** Dr . Ajay Bibra
***** Dr . Neeraj Mittal ****** Dr . Vishal Singh Banyal
The Journal
“ Socket shield technique " ... A shield against resorption !
After tooth loss , the alveolar bone undergoes a remodeling process , which leads to horizontal and vertical bone loss . These bone loss processes complicate dental rehabilitation , particularly in connection with implants . Various methods of guided bone regeneration ( GBR ) have been described to retain the original dimension of the bone after extraction . Most procedures use filler materials and membranes to support the buccal plate and soft tissue , to stabilize the coagulum and to prevent epithelial ingrowth . It has also been suggested that loss of the buccal bundle bone can be avoided by leaving a buccal root segment ( socket shield technique ) in place , because the biological integrity of the buccal periodontium ( bundle bone ) remains untouched . The desired effect is to remain the healthy periodontium , thereby maintaining the gingival tissues and keeping the crestal bone on its original level . This so called “ socket-shield technique .” The purpose of this article is to review socket shield technique and its modification for maintenance of buccal bone and interdental papilla .
Introduction
Alveolar bone formation is closely linked to
1
tooth eruption . Tooth loss , absence of teeth or ankylosis result in absent or reduced growth of
2 , 3
the alveolar process . Conversely , the loss of a tooth triggers a remodeling process as part of the healing , involving various degrees of alveolar bone resorption , especially affecting the buccal lamella . The periodontal membrane of the tooth vascularises the bundle bone . Therefore , this part of the alveolar bone is compromised by the extraction , to such an extent that the buccal lamella is insufficiently nourished , leading to its total or partial
4 , 5
resorption . Loss of bone up to an average
6 7
width of 50 % or 3.8 mm has been reported .
5 , 8
Losses in height of 2 mm to 4 mm or 1.24 mm
7
on average have also been measured . However , this process of loss of bone cannot be
9
predicted . A substantial 0.5 % to 1 % of the
10
alveolar ridge volume is lost as the result of it . With presence of flap formation , thin soft tissue biotype and prominent roots , especially with frontal teeth in buccal position can lead to
7 , 11 higher degree of resorption .
Immediate implant placement does not
12
necessarily prevent loss of the alveolar ridge . These resorption processes have a negative impact on the subsequent implant-based rehabilitation . From the last many year guided bone regeneration has been the technique of choice for preservation of ridge in all
11 , 13
dimensions . The most noble method to prevent the loss of bone is to preserve the inflammation free dental root . Techniques for submucosal vital and non-vital root retention
14 15
have already been described . Salama demonstrated that the so-called root submergence technique ( RST ) preserves the natural periodontium , thereby completely preventing bone resorption . Von Arx et al16 have recently published a new method to preserve the alveolar ridge after posttraumatic ankylosis and external root resorption by preserving the de-crowned root fragments . Davarpanah and Szmukler17 concluded with a case series of five patients showing that immediately placed implants where direct implant contact with ankylosed tooth fragments was ensured , were preserved without any signs of inflammatory changes over a follow-up period of two years .
* Post Graduate Student ( Pedodontics and preventive dentistry ), National Dental College , Derabassi , Punjab , India .
** Senior Resident , S . G . L . Multispeciality Hospital , Jalandhar .
*** Reader ( Prosthodontics and Crown & Bridge ), Bhogia Dental College , Baddi , H . P .
**** HOD ( Oral Surgery ), Genesis Dental College , Ferozepur , Punjab , India .
***** Reader ( Prosthodontics and Crown & Bridge ), Jannayak Chowdhary Devilal Dental College , Sirsa , Haryana
****** Senior Resident , Government Dental College , Calicut
31 42 Vol . 12 No . 23 May-August Sept-Dec 2016