Assessment of Dimensional Changes in Periodontium with Immediate Replacement of Tooth by Socket-shield Technique.

Background: The reduction of alveolar bone volume following tooth extraction may interfere with the placement of implants. The present study was conducted to assess dimensional changes in periodontium with immediate replacement of tooth by socket-shield technique. Materials and
Methods: Twenty fractured central incisors were enrolled, and periodontal ligament (PDL)-mediated root preservation technique was planned with simultaneous implant placement.
Results: Out of 20 patients, males were 11 and females were 9. Preoperatively, buccolingual alveolar bone width was 8.1 mm and postoperatively, 9.0 mm. There was 2.1 mm bone loss preoperatively and 2.2 mm postoperatively. The difference was significant (P < 0.05).
Conclusion: PDL-mediated root preservation technique with simultaneous implant placement is effective. Copyright:

INTRODUCTION

Extraction of tooth changes the dimension of the alveolar ridge, which has a direct effect on future implant prosthesis and its emergence profile, especially in the anterior region.[1] Trauma during extraction and loss of periodontal ligament (PDL) were the lead cause of alteration; therefore, many techniques were introduced to prevent the resorption of alveolar bone.[2] These techniques show the significant result in maintaining the postextraction alveolar bone, but no studies show the complete preservation of alveolar socket.[3]

The reduction of alveolar bone volume following tooth extraction may interfere with the placement of implants.[4] Even with the introduction of traumatic techniques for socket preservation and advances in biomaterials used in conjugation with these techniques, ridge resorption can only be partially countered.[5] Especially in the areas of esthetic importance, the preservation of peri-implant tissues has been the biggest challenge in the field of implant dentistry and can only be achieved in select few cases depending upon the etiology of tooth loss. In an attempt to overcome these challenges, researchers started preserving the ridges by maintaining the natural attachment apparatus of tooth.[6] The present study was conducted to assess dimensional changes in periodontium with immediate replacement of tooth by socket-shield technique.

MATERIALS AND METHODS

The present study comprised twenty fractured central incisors. All patients were enrolled with their written consent.

Demographic data were recorded. All cases had extension of caries subgingivally. All patients underwent extraction of fractured central incisors with partial retention of the buccal part of the root. In all cases, immediate replacement with an implant was done. PDL-mediated root preservation technique was planned with simultaneous implant placement. Radiographs were taken to assess bone level. Prosthetic part was given after 4 months. Results were assessed statistically.

RESULTS

Table 1 shows that out of 20 patients, males were 11 and females were 9.

Table 1

Distribution of patients

Gender	Number
Males	11
Females	9
Total	20

Table 2 shows that preoperatively, buccolingual alveolar bone width was 8.1 mm and postoperatively, 9.0 mm. There was 2.1 mm bone loss preoperatively and 2.2 mm postoperatively. The difference was significant (P < 0.05).

Table 2

Assessment of parameters

Parameters	Preoperative (mm)	Postoperative (mm)	P
Buccolingual width	8.1	9.0	0.02
Bone loss	2.1	2.3	0.91

DISCUSSION

Sufficient alveolar bone volume and favorable architecture of the alveolar ridge are essential to obtain ideal functional and esthetic prosthetic reconstruction following implant therapy. Within 12 months of tooth extraction, the width of the alveolar ridge reduces by 50% during the observation period. The loss corresponds to 5–7 mm as reported in earlier studies.[7] The present study was conducted to assess dimensional changes in periodontium with immediate replacement of tooth by socket-shield technique.

In the present study, out of 20 patients, males were 11 and females were 9. Durrani et al.[8] in their study found that extraction socket healing and osseous remodeling took 120 to 180 days. Healing results in 50% reduction in the buccolingual bone in 12 months. Buccal bone loss of the extraction socket exceeds more than two-thirds with reduction in apico-coronal height by approximately 0.8 mm within 3 months of healing.

We found that preoperatively, buccolingual alveolar bone width was 8.1 mm and postoperatively, 9.0 mm. There was 2.1 mm bone loss preoperatively and 2.2 mm postoperatively. Buser et al.[9] attempted to introduce a new concept – implants surrounded by PDL. A very important observation was made; the portion of the implant that was in contact with the retained portion of the root was covered by a layer of cementum populated by collagen fibers. Hürzeler et al.[10] were the first to demonstrate the socket-shield technique in a study on one beagle dog. Hemisection of mandibular premolar was performed, and a buccal fragment of the distal root was retained 1-mm coronal to the buccal bone plate. The immediate implant placement was done lingually to the retained root piece with or without contact with root fragment.

CONCLUSION

The authors found that the PDL-mediated root preservation technique with simultaneous implant placement is effective.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.