Socket Shield Technique and Guided Bone Regeneration

Kutahya Health Sciences University24 enrolled

Overview

Among the individuals who applied to the Department of Periodontology, Faculty of Dentistry, Health Sciences University between 2019 and 2021, patients with an unrestorable tooth in the maxillary esthetic region and required implant placement were included in this randomized clinical trial. Before implant surgery, patients were randomized into socket shield technique and guided bone regeneration groups. While the buccal gap was untreated in the socket shield group, a xenograft, and membrane were applied in the regeneration group. Peri-implant pocket depth, modified plaque index, modified bleeding index, keratinized mucosa width, and mucosal thickness were recorded at the permanent restoration and the postoperative first year. Horizontal bone level and vertical bone level were assessed with cone beam computed tomography images taken before the surgery and one year after prosthesis insertion. The pink esthetic score was evaluated with intraoral photographs taken before the surgical procedure and first-year follow-up.

This study aimed to compare the non-grafted socket shield technique with simultaneously guided bone regeneration in immediate implant placement in terms of clinical, esthetic, and radiographic parameters. Within the scope, immediate implant placement was applied to randomized groups (socket shield technique and guided bone regeneration). Immediate implant placement was performed following shield preparation in the shield group, and guided bone regeneration was applied in the regeneration group. A temporary non-functional immediate prosthesis was inserted at the same visit. After four months, permanent restorations were applied. Clinical, radiographic, and esthetic parameters were compared between two groups at baseline and first-year follow-up.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Interventions

Socket shield techniquePROCEDURE

For the patients in the shield group, shields were prepared with the Root Membrane Kit. After the palatal part was removed, the buccal fragment was prepared at the crest level, and an internal bevel chamfer was formed on the fragment. Implants were placed 3-4 mm apical to the gingival margin of the adjacent teeth. Healing caps were placed, and the periphery of the caps was covered with an absorbable gelatin sponge.

Guided bone regenerationPROCEDURE

For the patients in the regeneration group, teeth were extracted atraumatically, implants were placed 3-4 mm to the gingival margin, and the space between the implant and buccal bone was filled with anorganic bovine bone graft at the time of implant placement. The graft particles were covered by a pericardium membrane. The membrane was fixed to the bone with titanium pins.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Patients with the health status of American Society of Anesthesiologists class I or II, * Nonsmokers, * Unrestorable single-rooted tooth in the maxillary esthetic region, * Periodontally healthy, non-mobile teeth, * Single implant placement, * Minimum 3-5 mm available vertical bone apical to the apex, * Intact socket wall after extraction. Exclusion Criteria: * Medically compromised patients, especially uncontrolled diabetes, * Psychiatric problems, * Pregnancy, lactation, or suspicion of pregnancy, * A history of radiation therapy to the head and neck region or immunosuppressive therapy, * Metabolic bone disorder or the presence of drugs known to affect bone metabolism, * Poor plaque control, * Vertical root fracture on the buccal surface or a horizontal fracture below the bone level, * External or internal resorption affecting the buccal part of the root, * Acute infection in the area intended for implant placement, * Refusal to attend follow-up appointments.