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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