Immediate implant placement with socket shield technique in the maxilla: a prospective case series evaluation at 1-year follow-up

Abstract

Background: The aims of this case series were to investigate the clinical, radiographic, implant success, complication incidence, esthetic, and patient-reported outcomes of 10 immediately placed implants associated with the socket shield technique at 12 months post-loading and to assess the ridge width changes that occurred at 8 months following implant placement.

Methods: A total of 10 patients received 10 socket shield immediate implants (MegaGen AnyRidge). At 8 months postimplantation, casts were made to assess the ridge width changes by measuring the ridge width at the implant sites and comparing them with the corresponding measurements at the contralateral tooth site. At 12 months post-loading, clinical indices, marginal bone loss, pink esthetic score, and patient-assessed outcomes were evaluated. The mean, standard deviation and median were calculated for all continuous variables.

Results: All implants demonstrated a 100% success rate, while 2 implants presented with external shield exposure that was managed successfully. The mean marginal bone loss was 0.08 ± 0.14 mm mesially and 0.21 ± 0.23 mm distally. Esthetic evaluation yielded an average modified pink esthetic score of 8.65. A mean gain of 0.17 mm in the facial-palatal ridge width was recorded at 8 months postimplantation.

Conclusions: The socket shield technique enhanced the functional and esthetic results by preserving the alveolar bone and peri-implant soft tissues. However, this is a sensitive technique and still needs more robust evidence before it can be recommended for everyday clinical practice.

Keywords: Case series; Dental implantation; Osseointegration; Socket shield; Success rate.

Fig. 1

The apex was removed with the palatal portion of the root for SS preparation

Fig. 2

Incisal view showing implant placement palatal to the prepared facial shield; the gap was filled with mineralized allograft particles

Fig. 3

Incisal view of the customized healing abutment attached to the implant at the time of implant placement. The customized healing abutments were fabricated chairside by attaching a prefabricated titanium abutment with serrations created on its walls to retain the composite. Then, a flowable composite resin was injected to capture the soft tissue contour at the site remote from the wound to avoid contamination from the composite resin. The customized healing abutment was removed from the mouth, and a flowable composite resin was added to create a smooth transition between the abutment and the outline of the resin

Fig. 4

A-D: Photos and a radiograph of case # 1 replacing the maxillary right central incisor. a Preoperative incisal view; b frontal view of the definitive crown at 12 months postloading; c lateral view of the definitive crown and peri-implant soft tissue at 12 months postloading; and d periapical radiograph at 12 months postloading

Fig. 5

A-D: Photos and a radiograph of case #2 replacing the maxillary left lateral incisor. a Preoperative frontal view; b frontal view of the definitive crown at 12 months postloading; c incisal view of the definitive crown at 12 months postloading; and d periapical radiograph at 12 months postloading

Fig. 6

A-D: Photos and a radiograph of case #3 replacing the maxillary left first premolar. a Preoperative frontal view; b frontal view of the definitive crown at 12 months postloading; c occlusal view of peri-implant soft tissue at 12 months postloading; and d periapical radiograph at 12 months postloading

Fig. 7

A-D: Photos and a radiograph of case #4 replacing the maxillary left central incisor. a Preoperative frontal view; b frontal view of the definitive crown at 12 months postloading; c lateral view of the definitive crown and peri-implant soft tissue at 12 months postloading; and (d) periapical radiograph at 12 months postloading

Fig. 8

A-D: Photos and a radiograph of case #5 replacing the maxillary right canine. a Preoperative incisal view; b frontal view of the definitive crown at 12 months postloading; c incisal view of the definitive crown at 12 months postloading; and d periapical radiograph at follow-up postloading

Fig. 9

A-D: Photos and a radiograph of case #6 replacing the maxillary left lateral incisor. a Preoperative frontal view; b frontal view of the definitive crown at 12 months postloading; c incisal view of the definitive crown at 12 months postloading; and (d) periapical radiograph at 12 months postloading

Fig. 10

A-D: Photos and a radiograph of case #7 replacing the maxillary left first premolar. a Preoperative frontal view; b frontal view of the definitive crown at 12 months postloading; c occlusal view of the definitive crown at 12 months postloading; and d periapical radiograph at 12 months postloading

Fig. 11

A-D: Photos and a radiograph of case #8 replacing the maxillary right canine. a Preoperative frontal view; b frontal view of the definitive crown at 12 months postloading; c lateral view taken at > 2 years after implant placement with extraction of the first premolar and insertion of FPD supported by implants in the canine and second premolar regions; and d periapical radiograph at 12 months postloading. *Note: The patient was told of the poor prognosis of the first premolar at the time of canine implant placement but chose to maintain it

Fig. 12

A-D: Photos and a radiograph of case #9 replacing the maxillary left central incisor. a Preoperative frontal view; b frontal view of the definitive crown at 12 months postloading; c incisal view of the definitive crown at 12 months postloading; and d periapical radiograph at 12 months postloading

Fig. 13

A-D: Photos and a radiograph of case #10 replacing the maxillary left lateral incisor. a Preoperative frontal view; b frontal view of the definitive prosthesis at 12 months postloading; c incisal view of the definitive prosthesis at 12 months postloading; and d periapical radiograph at 12 months postloading. *Note: the left central incisor and the left canine fractured during the 12-month follow-up period that led to a change in the type of restoration, from crown to fixed partial denture, supported by implants in the left central incisor, lateral incisor and first premolar areas, while the canine was transferred to the pontic shield area