Editorial Type:
Article Category: Research Article
 | 
Online Publication Date: 01 Oct 2017

Current Evidence on the Socket-Shield Technique: A Systematic Review

BDS and
BDS, MS, MPH
Page Range: 395 – 403
DOI: 10.1563/aaid-joi-D-17-00118
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The recently popularized socket-shield technique involves intentional retention of a section of the remnant root at the time of immediate implant placement, thereby preserving the buccal/proximal bone from resorption. The objective of this systematic review was to assess the literature available on the socket-shield technique and weigh its biological plausibility and long-term clinical prognosis. A systematic search was performed on PubMed-Medline, Embase, Web of Knowledge, Google Scholar, and Cochrane Central for clinical/animal studies from January 1970 to April 2017. Twenty-three studies were assessed: 1 clinical case-control study, 4 animal histological reports, 1 clinical abstract, and 17+2* case reports. Eighteen out of the 23 studies had a duration of ≤12 months. A quality assessment of 5 studies (4 animal histologic and 1 clinical case-control) performed using the modified Animal Research: Reporting of In Vivo Experiments guidelines revealed that 4/5 studies had low scores. Fifty-eight out of 70 (82.86%) implants from 4 animal histological studies had complications; buccal/crestal bone loss (54.55%) and failure of osseointegration (27.27%) were the most common. Thirty-three out of 136 (24.26%) implants from 19+2 (2 studies had both histologic and clinical components, which are assessed separately) clinical studies had complications; buccal/crestal bone loss (78.78%) and shield exposure/failure (12.12%) were the most common. Other complications recorded were periodontal ligament and cementum formation on implant surfaces, pocket formation, inflammation, mucositis, and peri-implantitis. However, some clinical reports indicated stable results at 12 months. It would be difficult to predict the long-term success of this technique until high-quality evidence becomes available.

A video abstract is available for viewing at https://youtu.be/lNMeUxj2XPA?list=PLvRxNhB9EJqbqjcYMbwKbwi8Xpbb0YuHI.

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  <sc>Figure 1</sc>
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Figure 1

Diagrammatic representation of the socket-shield technique: The black arrow indicates the root fragment retained to serve as a “socket-shield” to prevent resorption of buccal bone. Placement of implant is palatal/lingual to this root fragment.


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Figure 2

Schematic representation of the search protocol used for the selection of studies used in the systematic review.


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Figure 3

Distribution of available literature according to the hierarchy of evidence.


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  <sc>Figures 4 and 5</sc>
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Figures 4 and 5

Figure 4. Graphical representation of the distribution of complications/ adverse effects in the histologic studies on the socket-shield technique included in this review. Figure 5. Graphical representation of the distribution of the complications/adverse effects in the clinical studies on the socket-shield technique included in this review.


Contributor Notes

Corresponding author, e-mail: amitsg188@gmail.com
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