A Novel Application of Dynamic Navigation System in Socket Shield Technique

Figure 1. Tooth #12 was nonrestorable due to severe caries. Figure 2. Pre-operative cone-beam computerized tomography scan image of tooth #12 indicating presence of buccal bone and adequate volume of apical bone. Figure 3. Planning of the initial osteotomy for socket shield preparation on the Navident software. The osteotomy was placed in a buccally inclined position. Figure 4. The JawTag was attached to the patient's maxillary right posterior teeth with flowable composite.

Figure 5 . (a) The Tracer Tool (1) was attached to the TracerTag (2) and calibrated on the Calibrator (3). (b) The Calibrator: #1 is the pin for calibrating the axis of a contra-angle handpiece; #2 is the dimple to calibrate the tip of an instrument, bur, or drill; #3 is the pin for calibrating the axis of a high-speed handpiece. Figure 6. Four teeth were selected as landmarks for the trace registration step. Tracing of 4 teeth to map the patient's actual anatomical structures to the CBCT scan images. Figure 7. (a) A high-speed hand-piece was attached to the TracerTag. (b) The chuck of the handpiece was placed over pin #3 on the Calibrator to register the axis of the bur. (c) A bur was inserted into the handpiece and calibrated by placing the tip of the bur in the dimple (#2) on the Calibrator.

Figure 8. The initial osteotomy was prepared according to the planned position, and a mesiodistal cut was performed to separate the buccal and lingual portions of the root. Figure 9. A C-shaped socket shield was prepared, and the coronal portion of the shield was reduced to the level of the buccal bone crest. Figure 10. A 3.6313 mm implant was planned on the Navident software for a screw-retained restoration.

Figure 11. A 3.6 × 13 mm was placed in a proper 3-dimensional position. Note the gap between the implant and the socket shield. Figure 12. Freeze-dried bone allograft (MinerOss) was placed into the space between the implant and the socket shield. Figure 13. A piece of sub-epithelial connective tissue graft was harvested from the palatal area and sutured inside the facial marginal tissue to cover the socket shield. Figure 14. A screw-retained provisional restoration with proper emergence profile was delivered. Figure 15. Postoperative cone-beam computerized tomography scan image of #12. Notice the relative positions of the implant and the socket shield. The buccal emergence profile should be concaved to allow space for soft tissue ingrowth.