What is the Socket-Shield Technique? : A Case Report

Introduction

What is Socket-Shield?

The socket-shield technique is a treatment protocol where a part of the root is intentionally left behind. Dental Surgeons utilise the socket-shield technique to prevent the collapse of the natural gum and bone contour from tooth loss. 

When a dentist extracts a tooth, they also remove the periodontal ligament which holds the tooth in the bone. This ligament contains a vital blood supply for the bone. Therefore, removing the ligament leads to bone resorption due to the lack of nutrients from the ligament’s blood supply.  

The socket-shield technique prevents this outcome by removing only a portion of the root while preserving the outer root section (or ‘shield’). Keeping this section mitigates bone resorption and helps us avoid the collapse of the bone and soft tissue.

Benefits of the Socket-Shield Technique  

Using the socket-shield technique allows us to provide our patients with superior soft tissue and bone stability over the long term. In addition, it enables our patients to enjoy outstanding aesthetics and better-looking crowns at the end of their treatment.  

According to Dr Gluckman, the beauty of this technique is that it is a single surgery that does not require many materials. This benefit radically reduces the time and cost of the treatment by minimising the number of procedures needed.   

Socket-Shield Technique Case Study 

Dr Gluckman implemented the socket-shield technique in conjunction with immediate implant placement to treat the patient. 

The patient sought Dr Gluckman to treat a fractured crown. The broken crown’s root was no longer viable to place a new crown. An implant was the best solution to implement.

Dr Gluckman removed the bad part of the root and prepared the socket shield. He then placed the implant and a provisional bridge to keep the space and enable the patient to smile. 

After three months, the bone has adapted to the implant, and the soft tissue has healed according to the custom abutment.   

Following these measures, Dr Gluckman fitted the individual final crowns to the implant and natural tooth, restoring the area to health and beauty.

Alternative Case Solutions

An implant is the best treatment option we can use to replace a missing tooth.  If, however, this is not a viable option due to cost or time, then the alternative is either a bridge or a removable denture.  

Dental Bridge 

Though a viable alternative, a bridge would put increased stress on the adjacent teeth, which would have to take the load of the missing tooth.  

The adjacent teeth also need to be prepared for a crown, which causes extensive damage to the teeth and increases the risk of root canal problems and possible fracture. Therefore, this treatment may reduce long-term success. 

Removable Partial Denture

A removable partial denture is another option; however, this option provides no help with bite forces. Moreover, it also has to be removed at night. Food tends to get below dentures, and they are generally uncomfortable to live with. 

Although it is a very cheap and speedy solution, a removable denture is one of our oldest treatment options. Unfortunately, this treatment method has been made obsolete by implants.

Routine Immediate Implant Without Socket-Shield Technique

Dr Gluckman, alternatively, could have performed a routine immediate implant without a socket shield.  However, without the socket shield, this solution would have led to soft tissue and bone collapse and, hence, a poor long-term aesthetic result.  

To mitigate the above problem, a soft tissue graft to prevent poor aesthetics would be required. Soft tissue grafting is a technique that takes tissue from the palate and places it into the socket at the time of implant placement.  Soft tissue grafting over bulks the tissue to compensate for the collapse of the bone following extraction.

The benefit is a much more aesthetic result.  The negative is that we would have to operate in a second site (the palate), which is more painful than the socket shield, which does not require this.

Conclusion

In this article, we defined the socket-shield technique, including its different benefits. Then, we illustrated how it is implemented alongside immediate implant placement to achieve highly superior results through a case study. 

We also discussed the alternative case solutions, showing why implementing the socket-shield method was optimal for the patient.

Learn more about the socket-shield technique in Dr Gluckman’s research paper, A decade of the socket-shield technique: a step-by-step partial extraction therapy protocol.