CATEGORY 42 AUSTRALASIAN DENTIST CLINICAL INTRODUCTION Various clinical studies have clearly demonstrated that bone remodeling following tooth extraction results in dimensional changes of the alveolar ridge contour, where the amount of resorption is more pronounced in the buccal aspect compared to the lingual aspect of the alveolar ridge. However, replacing a missing tooth with a dental implant requires sufficient hard and soft tissue dimensions to create a natural emergence for the restoration. To compensate for the negative outcomes of extraction, various treatment modalities have already been proposed, such as ridge preservation with bone substitutes, socket sealing with a free gingival graft, and immediate implant placement with or without a connective tissue graft and/or provisional restoration. For implant sites in particular, partial retention of a buccal root fragment in contact with the dental implant was proposed by Hürzeler et al for immediate implant placement surgery. Histological analysis suggests that the buccal bone plate is preserved without any inflammatory or resorptional response with the socketshield technique. Also, Davarpanah and Szmukler-Moncler reported on implant placement in contact with ankylosed root fragments without any adverse events after a period of 1 year post loading. Moreover, modification of the socket-shield technique to include the preservation of interproximal root fragments allows for the maintenance of the inter-implant papilla due to the natural attachment of the root fragments. This case review presents how the socket-shield technique was performed with a horizontally fractured root of #11, as well as #12. I will explain the surgical steps necessary for a successful outcome. If this case has been treated in the traditional way of extraction, bone grafting, and delayed dental implant placement, there would likely have been a totally different outcome and inferior aesthetic result to the socketshield outcome. Pre-Op C.C: A 55-year-old female presented with a symptomatic horizontally-fractured-root maxillary right central incisor and rootcanal-treated maxillary right lateral incisor that required frequent recementation of the post-core crown restorations (Fig 1a, 1b). The patient showed no signs or symptoms of any infection or inflammation around the central incisor. The supporting tooth root of the lateral incisor lacked adequate ferrule (Fig 2a, 2b). Past Dental History: Trauma to the front area 10 years ago. Comprehensive data collection included a CBCT scan, intra oral scan, and intra oral images. We found that tooth #11 had a horizontal fracture (Fig 3a, 3b), but no visible inflammation or radiolucency around it. Socket-shield therapy: an innovative approach to preserve the buccal bone plate in implant dentistry Case review of socket shield therapy performed in a horizontally fractured root Ahmed Keshkool By Ahmed Keshkool BDS, MFDS, FCOI ABSTRACT Socket-shield therapy is a contemporary technique in implant dentistry aimed at preserving the buccal bone plate during immediate implant placement. This innovative approach has gained popularity due to its potential to maintain both the esthetic and functional aspects of the alveolar ridge following tooth extraction. The socket-shield technique involves deliberate retention of a portion of the natural tooth root, the ‘socket shield’, to offset the risks of buccal bone loss and manage aesthetically challenging cases. The principle of the technique 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 attachment to the buccal plate intact and undisturbed, while simultaneously placing a dental implant. This strategy harnesses the natural healing process and promotes the long-term stability of the implant site. Fig 1a. Initial case presentation Fig 1b. Incisal view Fig 2a. Pre-op PA Fig 2b. Pre-op panoramic
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