Guided Selective Preservation of Tooth (SPOT) Protocol: Fully Guided Socket-Shield Technique

The socket-shield procedure focuses on soft- and hard-tissue preservation of the extraction socket in an immediate implant procedure. Selective preservation of tooth (SPOT) is a tooth-guided protocol for socket-shield preparation for both anterior and posterior teeth. It allows for consistent apex removal as well as shield preparation, implant site preparation, and immediate implant placement. The use of osseodensification burs in the guided SPOT protocol allows the clinician to incorporate a sequential clockwise rotation for simultaneous precise apex removal with shield preparation. In addition, a counterclockwise operation is implemented for implant site preparation with compaction-autografting of bone and dentin into the alveolus trabecular bone to improve implant primary stability and, subsequently, early healing. Guided SPOT enables improved drilling accuracy, enhances reproducibility, and reduces chairside time through the implementation of two static surgical guides to produce two separate trajectories: one for guided apex removal and shield preparation and the other for guided implant site preparation. This facilitates the prefabrication of a provisional restoration or custom anatomical healing abutment. This article presents a fully guided protocol for the SPOT procedure and immediate implant placement for a single-rooted tooth.