Trejo Pedro M, Rivas Raysa, Trejo Corletta C, Min Seiko, Nishikawa Arisa
Department of Periodontics and Dental Hygiene, School of Dentistry, University of Texas Health Science Center, Houston, Texas, USA.
Private practice, Houston, Texas, USA.
Clin Adv Periodontics. 2025 Mar;15(1):54-62. doi: 10.1002/cap.10290. Epub 2024 Apr 22.
The socket-shield (SS) technique results in long-term functional osseo- and dento-integration, preserving the dimensional stability of hard and soft tissues over time. This study aimed to describe the successful implementation of a surgical technique to facilitate "SS" cases.
The cases included males and females aged 32-81 years consecutively treated between 2020 and 2023 (longest follow-up, 3.5 years). For each case, pre- and post-operative cone-beam computed tomography (Digital Imaging and Communications in Medicine files) and intraoral optical scans (IOS; STL files) were performed. Digital immediate implant placement and simultaneous tooth extraction and SS production were planned using an implant planning software. Implants were planned considering sagittal-ridge and tooth-root angular-configuration. Surgical guides were used to perform the digitally-supported SS technique. All cases were planned and surgically performed by one operator (Pedro M. Trejo). Preoperative digital IOS-models were superimposed to post-operative models to assess soft-tissue changes. Pre and post sagittal views were used to assess the radiographic buccal-plate thickness at various healing times. An investigator not involved with case planning or treatment performed measurements.
Results reflected soft-tissue stability with minimal mean thickness change at 0-, 1-, 2-, and 3-mm measurement levels of 0.03, -0.2, 0.14, -0.07, and 0.04 mm, respectively, with a mean gingival-margin change of 0.04 mm. The free gingival-margin change ranged from a 0.58-mm gain in height to a -0.57-mm loss. The mean radiographic buccal-plate thickness post-operatively was 2.04 mm (range, 0.7-2.9 mm).
The digitally-supported guided SS technique enables predictable immediate implant-placement positions and stable buccal peri-implant soft and hard tissues over time.
Why are these cases new information? The uniqueness of the surgical technique described herein is that it results in favorable positions of immediate, socket-shielded (SSed), implant placements, with soft- and hard-tissue stability as the byproduct. What are the keys to successful management of these cases? Digitally, plan for the best possible implant position within the alveolar housing to satisfy prosthetic requirements, and then adjust this position to accommodate the socket shield dimensions. Digitally, provide a space/gap between the future dentinal shield and the implant. Clinically, allow for time to carve the final position and dimensions of the shield. Plan ahead the extent of the apical third of the SS, and the removal of the apex, if dealing with a long root. What are the primary limitations to success in these cases? Inadequate use of digital technology; case-sensitive technique requires proper execution of each digital and technical clinical step.
植体窝盾（SS）技术可实现长期功能性骨整合和牙整合，随着时间推移保持软硬组织的尺寸稳定性。本研究旨在描述一种手术技术的成功实施，以促进“SS”病例的治疗。
病例包括2020年至2023年连续治疗的32至81岁男性和女性（最长随访3.5年）。对于每个病例，术前行锥形束计算机断层扫描（医学数字成像和通信文件）和口内光学扫描（IOS；STL文件）。使用种植计划软件规划数字化即刻种植体植入、同时拔牙和SS制作。根据矢状嵴和牙根角度配置规划种植体。使用手术导板进行数字化支持的SS技术。所有病例均由一名操作者（佩德罗·M·特雷霍）规划并进行手术。将术前数字化IOS模型与术后模型叠加以评估软组织变化。使用矢状位前后视图评估不同愈合时间的放射学颊板厚度。由一名不参与病例规划或治疗的研究人员进行测量。
结果反映了软组织稳定性，在0、1、2和3毫米测量水平处的平均厚度变化最小，分别为0.03、-0.2、0.14、-0.07和0.04毫米，牙龈边缘平均变化为0.04毫米。游离牙龈边缘变化范围为高度增加0.58毫米至减少0.57毫米。术后放射学颊板平均厚度为2.04毫米（范围为0.7至2.9毫米）。
数字化支持的引导式SS技术能够实现可预测的即刻种植体植入位置，并随着时间推移保持种植体周围颊侧软硬组织的稳定。
为什么这些病例是新信息？本文所述手术技术的独特之处在于，它能使即刻、带窝盾（SSed）的种植体植入处于有利位置，同时软硬组织稳定性是其附带成果。成功管理这些病例的关键是什么？在数字化方面，规划牙槽窝内尽可能最佳的种植体位置以满足修复要求，然后调整该位置以适应窝盾尺寸。在数字化方面，在未来的牙本质盾和种植体之间留出空间/间隙。在临床方面，留出时间雕刻盾的最终位置和尺寸。提前规划SS根尖三分之一的范围，以及处理长牙根时根尖的去除。这些病例成功的主要限制是什么？数字技术使用不足；该技术对病例敏感，需要正确执行每个数字和技术临床步骤。
