Supracrestal Socket Shield Technique in Anterior Maxilla. A Case Series

Overview

Post-extraction labio-palatal ridge collapse is a significant challenge in restorative and implant dentistry particularly in anterior maxilla. Following tooth extraction, marked dimensional alveolar ridge changes occur. The buccal plate of bone in the anterior zone is primarily composed of bundle bone, a tooth dependent structure that derives its blood supply from the periodontal ligament (PDL). The PDL loss after tooth extraction results in rapid resorption of the bundle bone, leading to horizontal and vertical ridge reduction (Araújo and Lindhe, 2005, Schropp et al., 2003). Studies have shown that 50% of ridge width reduction occurs within 12 months, with two thirds of this reduction occurring within the first 3 months (Schropp et al., 2003). Moreover, the labial plate thickness in the anterior maxilla is frequently thinner than 1 mm in the majority of cases (Huynh-Ba et al., 2010). The high incidence of mid-facial recession and soft tissue volume loss is attributed to those biological events. Although IIP has become increasingly popular due to its short treatment time, it doesn't prevent physiological remodeling associated with bundle bone resorption (Araújo and Lindhe, 2005). Consequently, soft tissue collapse and midfacial recession remain common complications, especially in thin periodontal phenotypes (Chappuis et al., 2013, Cosyn et al., 2012). In order to overcome the inevitable consequences of tooth extraction, a variety of ridge preservation techniques were proposed in the literature including; flapless implant placement, bone grafting, soft tissue augmentation procedures, immediate provisionalization, a more palatal orientation of the implant in the socket and the socket shield technique.

The Supracrestal Socket Shield Technique is a modification of the original Socket Shield Technique used in implant dentistry to preserve buccal bone and gingival architecture after tooth extraction, especially in the esthetic zone (anterior maxilla). The key difference is that a small portion of the buccal root fragment is intentionally left slightly above the crestal bone level (supracrestal) to better support the soft tissue contour.