Socket Shield: How we can save labial plate of bone (GP02)

Clinicians must realize that alveolar resorption is a consequence of tooth extraction or avulsion. Dental implant therapy must include rational consideration of these phenomena. The recognition of alveolar resorption is longstanding. This process for the edentulous patient has been characterized as an inevitable and progressive process that occurred rapidly following tooth extraction. Remarkable changes in the maxillary alveolar ridges following the removal of teeth have been reported. During the past decade, renewed interest in this phenomenon has surfaced in the context of single missing teeth and the residual alveolar ridge. It has been observed that the maxillary alveolar ridge width diminishes approximately 50% following tooth extraction. (2) It has also been demonstrated that alveolar bone resorption occurs following tooth extraction and implant placement in premolar regions with marked loss of horizontal and vertical buccal architecture.
Some clinical observations suggest that buccal bone resorption varies in magnitude among individuals and from site to site.
Factors implicated in this variation include the presence and absence of existing infection, flap versus flapless extraction and implant placement, the extent of trauma during extraction and the thickness of the buccal plate of bone prior to tooth extraction. The width of the buccal plate of bone may be an important determinant of bone morphologic changes following extraction. The marked alterations after tooth extraction appear to be attributable to the loss of periodontal ligament and the consecutive trauma in particular at the buccal bone plate. Thus, it can be assumed that root retention may have an influence on the occurring resorption process. The loss of a tooth triggers a remodeling reaction as part of the healing process, involving various degrees of alveolar bone resorption, especially affecting the buccal lamella: The bundle bone is primarily vascularized by the periodontal membrane of the tooth. Therefore, this part of the alveolar bone is compromised by the extraction, to such an extent that the buccal lamella is insufficiently nourished, leading to its total or partial resorption. With the root submergence technique (RST), submucosal root retention can virtually eliminate bone resorption. Based on this concept, the retention and stabilization of the coronal and buccal bundle bone and the retention of the periodontal membrane by retaining a coronal tooth fragment (so-called “socket shield”), including adequate blood supply, can be expected.