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Though studies show that the remaining tooth segments showed healthy periodontal ligament at buccal side and no osteoclastic remodeling of the coronal part of the buccal plate, more long term research is still needed in this relatively new technique

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Videos

Technique

Indications

Socket Shield Technique (Partial Extraction Therapy)

Mainly in upper anterior teeth with thin buccal plate

First described in 2010 by Hürzeler et al,

Complications

  • Decoronation
  • Section the tooth mesiodistally to the apex
  • Palatal fragment removed
  • Buccal fragment is thinned and shaped by round bur flushing with buccal bone

A partial buccal root fragment is retained to support the buccal plate and soft tissue in immediate implants

  • Infection
  • loosening of the tooth fragment

Rationale:

Following extraction, 35 to 40 % expected resportion in the width of the socket.

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

Clinical tip: The membrane can be pierced with the healing collar which will act as a fixation method to the membrane

  • Primary Closure
  • By barrier membranes
  • Collagen plug
  • Connective Tissue Graft
  • PRF

Soft Tissue Closure

VIDEOS

if gap is 2 mm or greater>> graft

Generally

The gap created between the implant and the socket walls has been debated in the literature if it should be filled with a grafting material or left to be filled with blood clot.

THE GAP "Jump Gap"

Clinicial Tip: Drilling through the tooth aids in the aligment and positioning of the implant

Classification of molar socket

Implants ideally placed in the interradicular bone and ideally to be surrounded completely by bone

Molar Implant Positioning:

Drilling beyond the apex to get primary stability

The implant should be placed in a palatal position and with an inclination that is still palatal to the incisal edge of planned restoration.

Anterior Maxilla Implant positioning:

NB A flap is elevated if there is GBR to be done with immediate implant otherwise not raising a flap benefits from the natural soft tissue architecture present

Step 2 : Implant Osteotomy

Seperation of multi rooted teeth

Physics Forceps

Dedicated Leverage Systems: eg Benex

Contraindications

Periotomes

It is important to extract the tooth with minimal disruption to the alveolar bone

  • presence of pus discharge and infection at the site
  • No enough apical bone to the root apex to gain primary stability ( minimum 3 mm)
  • Insufficient width to allow 1.5-2 mm bone circumfential to the implant
  • Deficient labial/buccal bone as described by this classification

STEP 1) Atraumatic Extraction

Surgical Technique

Advantages of Immedaite Placement

Introduction

Reduce overall treatment time

Immediate Implant Placement

Implants placed immediately after extraction

  • patient satisfaction
  • shorten the time the area will not be with dental units > less resorption

Early Implant placement

Implants placed 4 - 8 weeks after extraction

Soft tissue coverage and primary healing of socket

Socket act as guide for angualation and alignment of the implant

Delayed Implant Placement

Non-functional restorations can be provided for better esthetics, especially in the anterior region maintianing the natural soft tissue emergence profile

Implants after complete bony fill of socekts (4-6 months)

Immediate Loading

Implants are loaded with prosthetic part immedialely after implant placement; whether implants placed immediate or delayed.

Immediate Implant Placement:

Indications and Techniques

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