The socket-shield technique to support the buccofacial tissues at immediate implant placement

Introduction Immediate implant placement is a well-recognized and successful treatment option following tooth removal.1 Although the success rates for both immediate and delayed implant techniques are comparable, the literature reports that one can expect there to be recession of the buccal / facial gingiva of at least 1 mm following immediate implant placement, with the recession to possibly worsen in thin gingival biotypes.2 Low aesthetic value areas may be of less concern, however this recession and ridge collapse can pose an aesthetic disaster in areas such as the anterior maxilla. Compromised aesthetics may be masked to some degree by a low lip-line, thick gingival biotype, when treating single tooth cases, and so forth, but when implant therapy is carried out in patients with high lip-lines, patients with high aesthetic demands, with a very thin gingival biotype or multiple missing teeth where there is more extensive tissue deficit, then the risk for an aesthetic failure is far greater.3 The socket-shield (SS) technique provides a promising treatment adjunct to better manage these risks and preserve the post-extraction tissues in aesthetically challenging cases.4 The principle is to prepare the root of a tooth indicated for extraction in such a manner that the buccal / facial root section remains in-situ with its physiologic relation to the buccal plate intact. The tooth root section’s periodontal attachment apparatus (periodontal ligament (PDL), attachment fibers, vascularization, root cementum, bundle bone, alveolar bone) is intended to remain vital and undamaged so as to prevent the expected post-extraction socket remodeling and to support the buccal / facial tissues. Hereafter a case is presented where the SS technique was carried out at implant placement and the results from the case followed up at 1 year post-treatment demonstrate the degree of facial ridge tissue preservation achieved. C L I N I C A L