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Mukesh Soni

Socket Shield Complication: This is one of my first Socket Shield cases back in 2011. I did not use CBCT scan for this case and this was a big mistake, because I could not make good measurements and I was not able to notice that the root had much more prominence than I thought. So I forgot/ was not able to remove all the rootfilling material. The problem was that clinical symptoms of infection started 1 year after insertion of the definitive crown! The patient came for her regular checkup in 2013 and suddenly I could probe a 10mm deep pocket at the mid-buccal, also I could notice some loss of papillary height and swelling of the cervical tissue at the buccal. The patient did not feel any pain and was not aware of the changes. I could also feel some mobility of the shield, so I had to remove it. I performed a flap, removed the shield. There was a 3-wall defect. ( I was lucky that there was a tiny thin buccal plate left. Notably: it was not a circumferential defect like a peri-implantittis.So I could try a regenerative procedure and keep the implant. I cleaned the implant surface as good as possible with Airflow and H2O2 + saline and filled the gap with BioOss granules. I used a CTG ( Zucchelli style) and closed the flap with 6-0 monofilament. The healing went uneventful, but the result after 4 weeks was a distaster. I instructed the patient to clean with a apico-coronal brushtechnique and told her to have patiënce. Every 3 months I saw her back and I noticed changes in the tissue ; It was creeping coronally! It took some years, but the situation is now accaptable again The lessons I learned from this case: -never ever again do a socket shield without CBCT diagnostics. -Soft tissue has the potential to improve and grow over time, so always use CTG in a resque treatment

What great honesty. And yes while i agree PET/socket shield is an option, but it is not for the faint hearted me thinks. Be careful very careful and practice outside the mouth first i feel. Thanx Haakon Kuit for a great . great post respect #opensourcelearning at its best for me #practicalimplantology

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situation at intake: rootfracture with vertical compoent at the palatal side; the root was irrational to treat, high smile line. patient did not lijke her old crowns so the treatment plan was to replace tooth 11 by an implant ( socket shield technique and an new crown on 21
situation at intake: rootfracture with vertical compoent at the palatal side; the root was irrational to treat, high smile line. patient did not lijke her old crowns so the treatment plan was to replace tooth 11 by an implant ( socket shield technique and an new crown on 21
situation at intake : close up 11 and 21
Socket Shield prapration according to Hürzeler protocol; 1 mm above crest
Socket Shield prapration according to Hürzeler protocol; ( I thought I had removed all the filling material)
Implant placement, palatal of the shield with no shield contact
Emdogain application according to the porotocol , with a bottle neckabutment
Temporary crown on 21, with cantilever on 11 ( not enough primary stability) Cantilver concave at the cervical part in order to avoid shield contact and create some space for the soft tissues to grow in
temporary in place
Healing after 2weeks
Healing after 3 maonths
Try-in phase of the definitve abutmet and crowns
Avatar
Mukesh Soni

Socket Shield Complication: This is one of my first Socket Shield cases back in 2011. I did not use CBCT scan for this case and this was a big mistake, because I could not make good measurements and I was not able to notice that the root had much more prominence than I thought. So I forgot/ was not able to remove all the rootfilling material. The problem was that clinical symptoms of infection started 1 year after insertion of the definitive crown! The patient came for her regular checkup in 2013 and suddenly I could probe a 10mm deep pocket at the mid-buccal, also I could notice some loss of papillary height and swelling of the cervical tissue at the buccal. The patient did not feel any pain and was not aware of the changes. I could also feel some mobility of the shield, so I had to remove it. I performed a flap, removed the shield. There was a 3-wall defect. ( I was lucky that there was a tiny thin buccal plate left. Notably: it was not a circumferential defect like a peri-implantittis.So I could try a regenerative procedure and keep the implant. I cleaned the implant surface as good as possible with Airflow and H2O2 + saline and filled the gap with BioOss granules. I used a CTG ( Zucchelli style) and closed the flap with 6-0 monofilament. The healing went uneventful, but the result after 4 weeks was a distaster. I instructed the patient to clean with a apico-coronal brushtechnique and told her to have patiënce. Every 3 months I saw her back and I noticed changes in the tissue ; It was creeping coronally! It took some years, but the situation is now accaptable again The lessons I learned from this case: -never ever again do a socket shield without CBCT diagnostics. -Soft tissue has the potential to improve and grow over time, so always use CTG in a resque treatment

What great honesty. And yes while i agree PET/socket shield is an option, but it is not for the faint hearted me thinks. Be careful very careful and practice outside the mouth first i feel. Thanx Haakon Kuit for a great . great post respect #opensourcelearning at its best for me #practicalimplantology

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