In this new course organised by the BTI implant company in May 2017 we learned about the Socket-Shield technique, particularly focussing on the conditions of using this technique to produce a good provisional, and later, permanent dental prosthesis.
The Socket-Shield Technique consists of partially extracting the root of a tooth and simultaneously fitting an implant. According to Professor Filipe Lopes, this controversial cutting-edge technique has been functioning for 6 to 10 years, with many studies underway on the matter.
On removing the tooth, a fine external lamina of root is left in place, i.e. inside the external bone, in order that the width of the cavity remains unchanged after extraction. Apparently using this technique means that the bone loss normally occurring after tooth extraction is minimal. The speaker literally told us that the technique “had changed his life”.
It is above all used on premolars, both upper and lower.
-It is essential to correctly and completely section the root, cleanly separating the internal part to be extracted. The external part will be left attached to the bone, acting as a shield. It must be sectioned in such a way to ensure that, at the moment of extraction, and afterwards, the remaining radicular shield does not move. If it does move, the complete root has to be removed and the traditional technique applied.
-The root is drilled from the inside to obtain a fine, smooth lamina.
–Drilling of the neoalveolar segment, i.e. of the space made to receive the implant, must be deep and towards the internal, palatine or lingual area, staying well away from the radicular remnants. The implant must be firmly anchored, in other words, with primary stability.
-The implant is screwed to a UNIT pillar, at 35 Newtons, and will be permanently left in place. We will take a silicone impression to make the crown or provisional tooth. For delays of two or three days, we will fit a healing abutment to prevent the gum from closing and to ensure that it adopts the correct shape.
–A little separation or gap will be left between the implant and the radicular lamina which we will fill with growth factors mixed with tiny fragments of bone obtained during the drilling process.
-Today the crown is made using the CAD-CAM technique, which is enormously precise. This is why sometimes, instead of making a provisional crown, a permanent crown is directly fitted since, thanks to the socket-shield technique, the bone and the gum suffer very little alteration, at least according to the articles currently being published on the subject.
-Three days after surgery, the provisional or sometimes permanent crown is fitted at 20 Nw.
I believe that we are lacking the perspective of how these cases have evolved, and of what happened both to the root adhering the implant, and to the adjacent bone. It would be a pity if the bone was then lost and the implant ejected.