Socket Shield Technique for immediate implant placement - clinical, radiographic and volumetric data after 5 years

Implant placement immediately after tooth extraction is often accompanied by resorption of surrounding tissues. A clinical technique was developed where the buccal portion of the root is retained to preserve the periodontal ligament and bundle bone. This technique is based on animal studies showing the potential to preserve the facial tissues utilizing this approach. The purpose of this study was to gain more insight regarding the safety of the technique with regard to biological and implant-related long-term complications and to observe the clinical appearance of the peri-implant tissues. Another objective was to evaluate volumetric changes of the affected facial contours in long-term and the esthetic outcomes.

This study is a retrospective case series of 10 consecutive patients with implant replacement between the maxillary first premolars. Impressions were made prior to extraction (t1) and 5 years post-implant placement (t2). 3D-surface scans of the casts were digitally superimposed for quantitative evaluation of alterations of the facial peri-implant tissue contours and soft tissue recessions. Additionally, clinical data were collected (PPD, BOP, peri-apical radiographs and photographs).

All implants healed without adverse events. Peri-implant probing revealed healthy conditions. The comparison of radiographic images showed physiologic bone remodeling at the implant shoulders. Mean tissue loss on the facial side in oro-facial direction was -0.21 ± 0.18 mm. Average recession at implants was -0.33 ± 0.23 mm and at neighboring teeth -0.38 ± 0.27 mm. Mean loss of the marginal bone level at the implant shoulder amounted to 0.33 ± 0.43 mm at the mesial and 0.17 ± 0.36 mm at the distal aspect of the implants. A mean pink esthetic score of 12 was recorded.

Volumetric analysis showed a low degree of contour changes from extraction and implant placement to the follow-ups. Mucosal recession at the implant restoration was comparable to that of the neighboring teeth. Within the limitations of this descriptive study, the socket shield technique offers reduced invasiveness at the time of surgery and high esthetic outcomes with effective preservation of facial tissue contours. This technique should not be used in routine clinical practice until a higher level evidence in the form of prospective clinical trials is available.