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Table 1 Included studies

From: The socket-shield technique: a critical literature review

n

Author

Title

Year

Study type

N patients

n implants

Region

Augmentation

Observation period

po radiography supplied

Follow-up radiography supplied

Osseointegration rate

Complications

n survival implants

Cosmetic outcome

Results/conclusion

19

Bramanti, et al. [4]

Postextraction dental implant in the aesthetic zone, socket shield technique versus conventional protocol

2018

Randomised controlled trial

40

40

13–23 or 33–43

allograft (copiOs)

36

  

100%

Nil

100%

PAS significantly higher in test group

Significantly higher PAS and lower amount of crestal bone change in test group

10

Dary et al. [5]

The socket shield technique using bone trephine: a case report

2015

Case report

1

 

Pre molar (maxilla)

 

0

   

Not reported

  

Authors conclude that socket-shield represents a promising technique to preserve buccal bone

23

Arabbi et al. [6]

Socket shield: a case report

2019

Case report

1

2

Teeth 21 and 11

No

Nil

No

No

100%

Not recorded

n/a

Not recorded

Authors conclude that the socket-shield technique has not enough clinical data to recommend for daily practice

11

Baumer et al. [7]

The socket-shield technique: First histological, clinical and volumetrical observation after separation of the buccal tooth segment- a pilot study

2013

Case report

1 post IV bisphosphonate use

2

Canine (maxilla)

-Socket shield central incisor

-No socket shield

No

Nil

No

No

 

Not reported

2

 

Socket-shield technique is technique sensitive and needs for more scientific data

Socket-shield technique can still not be generally recommended for clinicians in daily practice. Yet the observed results are promising

12

Baumer et al. [8]

Socket shield technique for immediate implant placement—clinical, radiographic and volumetric data after 5 years

2017

Retrospective clinical study

10 (5 male, 5 female)

Unknown

Unknown

 

51 to 63 months (mean 51 months)

  

100%

Not reported

 

Volumetric changes measured by means of stl comparison

Mean loss of buccal tissue − /0.37 ± 0.18 mm avr mid facial recession − .33 ± .23 mm

Mean loss of marginal bone level 0.33 mm ± 0.43 mm (mesial) 0.17 ± 0.36 mm at distal

Pink aesthetic score mean 12 (11–14)

Authors conclude, scientific evidence lacking, socket shield suggests advantages in immediate implant placement, low morbidity and favourable cost-benefit ratio additionally might provide more predictable aesthetic outcome in complex cases

Further research required for long-term stability

5

Cherel and Etienne [9]

The socket-shield technique and immediate implant placement

2013

Case report

1

2

Central incisors

Bio-Oss

6 months post restoration

No

1 month post restoration

6 months post restoration

 

Not reported

2

 

PA at follow-up shows no interpret bone change

4

Dayakar et al. [10]

Immediate implant combined with modified socket-shield technique: a case letter

2018

Case report

1

1

 

Unknown

3 months

Yes

pa 2 months

 

Not reported

1

 

Authors conclude that SS-technique is successful in preserving of tissue

24

Dayakar et al. [10]

The socket-shield technique and immediate implant placement

2018

Case report

1

1

Tooth 22

No

Nil

No

No

100%

Nil

n/a

Not recorded

Authors conclude that socket-shield technique shows promising result

25

Glocker et al. [11]

Ridge preservation with modified “socket-shield” technique: a methodological case series

2014

Case report

3

3

13 (2) 22 (1)

Yes (Bio-Oss) (2) fgg (1)

Nil

Yes

No

100%

Not reported

n/a

Not recorded

Authors conclude that the socket-shield technique is a cost-effective technique which avoids resorption of bundle bone

13

Gluckman et al. [12]

A retrospective evaluation of 128 socket-shield cases in the esthetic zone and posterior sites: partial extraction therapy with up to 4 years follow-up

2018

Retrospective study

Unknown

128

Numerous

Unknown

1–4 years

na

na

123/128 (96.1%)

5 implant failures, reason unknown

3 infected socket shields + mobile removal of socket shield, retention of implant

2 socket shields mobile, removal of socket shield and implant

12 internal socket shield exposures

4 external (oral cavity) exposures of socket shields

2/4 external exposures required ctg

1 socket shield migration

123

Author noted that no dark hues or recession exposing the abutment to fixture interface were noted

Similar osseointegration rate compared to traditional treatment concept, with the added benefit of a less invasive approach. Most common complication—internal exposure of socket shield—conclusion that the ss was not reduced enough to all for adequate space, furthermore authors now recommend the ss reduction to bone level

18

Gluckman et al. [13]

The pontic-shield: partial extraction therapy for ridge preservation and pointed site development.

2016

Case report

10

14

Anterior maxilla

ctg, xenograft, fgc

12–18 months

   

1 socket shield exposure

  

Subjective observation noticed tissue volume to be preserved

1 patient had complications—all 3 socket shields exposed due to failure of soft tissue closure

Authors note that limited scientific evidence for this technique nomenclature is noted as being inconsistent

Authors note that additional research and scrutiny is needed to validate this technique for use in daily clinical practice

21

Guo et al. [14]

Tissue preservation through socket-shield technique and platelet-rich fibrin in immediate implant placement

2018

Case study

1

1

Tooth 21

Yes—PRF

18 months

Yes

Yes

100%

None

1

Stable soft tissue reported

The socket-shield was effective in preserving the peri-implant tissue and contour

20

Han et al. [15]

The modified socket shield technique

2018

Clinical trial

30

40

Premolar, canine and incisors in mandible and maxilla

No

1 year po

n/a

n/a

100%

None

40

Not supplied

Authors conclude that the socket shield technique is safe and efficient in preserving bone

3

Huang et al. [16]

The root membrane technique: human histologic evidence after 5 years of function

2017

Case report

1

1

 

Bio-Oss

9 months

 

cbct

 

Not reported

1

Score 13

 

14

Hurzeler et al. [1]

The socket-shield technique: a proof-of-principle report

2010

Proof of concept/case report

1

1

Central incisor maxilla

Emdogain

0

No

No

 

Not reported

  

Author concludes that this case report supports socket shields as a viable implant placement concept. This technique potentially could be used to reduce the risk of resorption of the bundle bone post extraction.

6

Kan et al. [17]

Proximal socket shield for interplant papilla preservation in the aesthetic zone

2014

Case report

1

1

Central incisor

Bio-Oss + puros (allograft) CTG

1 year post restoration

Yes

pa 1 year

 

Not reported

1

 

Authors report satisfactory aesthetic result, but that the socket shield is a technique sensitive procedure with limited long-term evidence

2

Mitsias et al. [18]

Clinical benefits of immediate implant socket shield technique

2017

Case report

1

1

 

None

5 years

   

Not reported

1

 

Buccal bone plate was maintained, no evidence or resorption apical and medial part between socket shield and implant was filled with mature bone coronal part that was connective tissue

16

Mitsias et al. [19]

A step-by-step description of PDL-mediated ridge preservation for immediate implant rehabilitation in the esthetic region

2015

Case report

1

1

Central incisor maxilla

Not stated

3 years

Yes

Yes

 

None

1

 

Novel technique similar to the socket shield technique (difference is the direct implant to root fragment contact)

Authors report that this technique might prevent psychological implications of tooth extraction ( as part of root remains); however, a careful case selection is recommended

17

Szmukler-Moncler et al. [20]

Unconventional implant placement part III: implant placement encroaching residual roots—a report of 6 cases

2014

Case report

6

6

Molars mandible, premolars maxilla and mandible, central incisor maxilla

Not stated

3–9 years

Yes

Yes

6/6

1 case possible resorption of tooth fragment

1 implant with crestal bone loss to second/third thread 9 years post restoration

5–1 patient drop out

 

Author reports that the presence or absence of root-filling material seemed to have no effect on implant on outcome

7

Nevins et al. [21]

Late dental implant failure associated with retained root fragments: case report with histologic and SEM analysis

2018

Case report

2

2

1st molars

Case 1: bio-Oss

Case 2: DFDBA

Case 1: 8 + years

Case 2: 4 years

Case 1: yes

Case 2: yes

Yes

 

Case 1: advanced peri-implantitis, root fragment attached to messiah aspect evident

Case 2: loss of integration

0

 

Case 1: Human histology (LM) revealed implant in bone contact consistent with osseointgration, graft biomaterial in close proximity to fixture, direct implant contact to cementum of the retained root surface, no sign of periodontal ligament

Case 2: LM shows bone in between implant surface and root fragment late implant failure might contribute to unintentionally remaining root fragments

1

Pour et al. [22]

 

2017

Case report

1

1

 

None

3 months

   

Not reported

1

 

Authors conclude that no added cost for patient, single surgical procedure, reduced morbidity, possibility of tx in patient with previous end pathology tutors describe as favourable technique for dental practice

8

Schwimer et al. [2]

Human histologic evidence of new bone formation and osseointegration between root dentin (unplanned socket-shield) and dental implant: case report

2018

Case report

1

1

Pre molar

Unknown

2  years

No

No

 

Loss of integration peri-implantitis

0

 

Authors reported failed osseointegration 2 years post restoration, human histology revealed root fragment attached to implant, bone formation on implant surface evident absence of fibrovascular tissue.

15

Siormpas et al. [23]

Immediate implant placement in the esthetic zone utilizing the “root-membrane” technique: clinical results up to 5 years postloading

2014

Retrospective case series

46 (20 male 26 female)

46

Anterior maxilla

Nil

24 –60 months (mean 40 months(

na

na

100%

1 case resorption of root fragment

46

 

Pre-, post-operative cbct in 4 cases with maintained buccal bone volume in 3/4 cases

Author concluded that similar complication rate to traditional placement protocol but minimising of facial bone volume changes

Author concludes bone volume has remained stable; however, volumetric investigation using cbct data was only carried out in 4/46 cases.

22

Siormpas et al. [24]

The root membrane technique: a retrospective clinical study with up to 10 years of follow-up

2018

Retrospective clinical study

182

250

Anterior

No

Mean 49 months

n/a

n/a

Not supplied

Not reported

5 (87.9%)

Not recorded

Author reports similar success rate as in conventional immediate implants

9

Wadhwani et al. [25]

Socket shield technique: a new concept of ridge preservation

2015

Case report

1

1

Central incisor

Yes, material unspecified

0

Yes

No

 

Unknown

Unknown

Unknown

Authors conclude that this case report suggest alveolar bone preservation