SOCKET SHIELDING IMMEDIATE IMPLANT USING NEOBIOTECH IS-II ACTIVE FIXTURE

tan soon teik

Author
Dr. Tan Soon Teik
BDS (MALAYA,
MFDS RCS(EDINBURGH,
MSc IMPLANTOLOGY(FRANKFURT),
FICCDE
GAO core member
슬라이드1
- LOSS OF BLOOD SUPPLY FROM PERIODONTAL LIGAMENT HAS BEEN IDENTIFIED AS MAJOR ETIOLOGY FOR RIDGE RESORPTION (KOTSAKIS 2014)
- IN IMPLANT-BIOLOGIC INTERPHASE, THERE IS LACK OF BLOOD SUPPLY
- GRADUAL DEGRADATION OF PERI-IMPLANT TISSUE, DIFFICULTY TO MAINTAIN TISSUE VOLUME AND INTEGERITY
- RIDGE PRESERVATION TECHNIQUES LIMIT BUT DO NOT PREVENT RIDGE RESORPTION
- BIOLOGIC RATIO OF SUPRA-IMPLANT MUCOSA (NOZAWA 2006)
- VERTICAL :HORIZONTAL 1:1.5
- NO DIFFERENCES IN BIOLOGIC WIDTH TO HEIGHT RATIO IN TERMS OF IMPLANT DIAMETER
- STABLE BUCCAL CERVICAL LINE AROUND IMPLANT SUPRASTRUCTURE CAN BE ACHIEVED IF THE RATIO IS MAINTAINED
- CEMENTUM AND PDL – THE SECRET OF NATURAL TEETH’S BEAUTY AND FUNCTIONAL MAINTENENCE
- SOCKET SHIEDING TECHNIQUE STARTED OF AS AN “EXTENSION” OF ROOT SUBMERGING TECHNIQUE
- ROOT SUBMERGENCE PRESERVE THE PERIODONTAL ARCHITECTURE OF PONTIC SITE
- BLOOD SUPPLY OF BUCCAL PLATE WAS NEVER DISTURBED
- TECHNIQUES SUCH AS SOCKET SHIELDING/ROOT MEMBRANE/PARTIAL EXTRACTION THERAPY TECHNIQUE WAS INTRODUCED TO REDUCE LONG TERM PERI-IMPLANT TISSUE VOLUME LOSS
- HÜRZELER 2013 PUBLISHED THE FIRST HISTOLOGICAL, CLINICAL AND VOLUMETRIC STUDY ON THE SOCKET SHIELD TECHNIQUE.
- HISTOLOGY SHOWS HEALTHY PERIODONTAL LIGAMENT ON BUCCAL SIDE OF ROOT WITH NEW BONE BETWEEN IMPLANT AND THE ROOT SHIELD
- THIS TECHNIQUE MIGHT HELP PRESERVE LABIAL BONE OF IMPLANT
INDICATION
1.ALL INDICATIONS OF IMMEDIATE IMPLANT
2.HORIZONTAL FRACTURE TEETH UP TO BONE LEVEL
3.ANKYLOTIC TEETH
4.PLACING IMMEDIATE IMPLANT ADJACENT TO AN EXISTING IMPLANT (KAN 2013, CHEREL 2014)
CONTRAINDICATION
1.PERIODONTALLY COMPROMISED TEETH
2.VERTICAL ROOT FRACTURE
3.ACUTE INFLAMMATION
PATIENT INFORMATION
- 22 YEARS OLD MALE
- PMH: MEDICALLY FIT WITHOUT ANY KNOWN ALLERGIES, NON SMOKER
- PDH: ROOT CANAL TREATMENT DONE ON 21
- CHIEF COMPLAIN: FRACTURE TOOTH NO. 11 AND DISCOLOURED TOOTH NO. 21
- DIAGNOSIS: CARIOUS INDUCED FRACTURE ON 11 WITH LESION EXTENDING TO CERVICAL OF TOOTH 21 INTERNAL STAIN AFTER ROOT CANAL TREATMENT
TREATMENT PLAN
1.IMMEDIATE EXTRACTION WITH SOCKET SHIELDING TECHNIQUE TO PRESERVE LABIAL TISSUE DIMENSION
2.TOOTH 21 TO BE TREATED WITH INTERNAL BLEACHING AND FULL CERAMIC CROWN RESTORATION
슬라이드2
LOW LIP LINE SMILE

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CLOSE UP VIEW

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PRE-OPERATIVE

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PRE-OPERATIVE

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PRE-OPERATIVE

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PRE-OPERATIVE

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PRE-OPERATIVE

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OPG

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Decoronation of tooth and caries removal

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Tooth splited with high speed handpiece

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Palatal root fragment removed.

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Extracted root

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Re-adjust labial root height

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Final position just at crestal bone height

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NEOBIOTECH IS-II Implant WAS PLACED more palatally giving sufficient jumping distance

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LESS THAN 20NCM TORQUE WAS ACHIEVED. IMPLANT WAS NOT IMMEDIATELY LOADED

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A SMALL HEALING ABUTMENT WAS PLACED TO ALLOW MORE SOFT TISSUE TO GROW. REGENOSS ALLOGRAFT WAS USED TO FILL THE JUMPING DISTANCE

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COLLAGEN FLEECE WAS USED TO COVER ON TOP OF THE EXTRACTION SOCKET

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Frontal view

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Provisional with essix retainer with acrylic tooth

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POST-OPERATIVE OPG

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3 MONTHS POST OPERATIVE
FRONTAL VIEW
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3 MONTHS POST OPERATIVE
OCCLUSAL VIEW
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IMPRESSION FOR PROVISIONAL

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IMPRESSION FOR PROVISIONAL

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PROVISIONAL CROWN
LARGER HEALING ABUTMENT TO PUSH OUT SOFT TISSUE
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PROVISIONAL CROWN
PROVISIONAL CROWN IN PLACE, INTERNAL BLEACHING ON 21
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FINAL IMPRESSION
GINGIVA LEVEL ON 11 WAS STILL SLIGHTLY CORONAL COMPARE TO 21 BUT PATIENT DID NOT MIND
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FINAL IMPRESSION
SINCE PATIENT IS STILL IN HIS 20S, IT IS NOT A BAD IDEA TO LEAVE THE SOFT TISSUE A BIT CORONALLY IN CASE OF FUTURE RECESSION
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FINAL IMPRESSION
EMERGENCE PROFILE MAINTAINED AND RECORDED WITH CUSTOMIZED IMPRESSION COPPING
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FINAL IMPRESSION

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FINAL PROSTHESIS
CEMENTABLE UCLA ABUTMENT WAS USED.
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FINAL PROSTHESIS
EXCESS CEMENT REMOVED FROM A DUPLICATED DIE
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FINAL PROSTHESIS
FRONTAL VIEW
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FINAL PROSTHESIS
EVEN OCCLUSAL CONTACT
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FINAL PROSTHESIS

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FINAL PROSTHESIS

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FINAL OPG

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FINAL COMPARISON
BEFORE
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FINAL COMPARISON
AFTER
- LITERATURE REVIEW
- 8 RESULTS BY SEPTEMBER 2016
- ONLY 3 ANIMAL HISTOLOGY STUDY (HÜRZELER 2015, GUIRADO 2016)
- 1 REVIEW PAPER
- 1 RETROSPECTIVE STUDY
- 2 CASE REPORTS
- 1 UNCERTAIN – DUTCH PAPER
- 0 RANDOMIZED CLINICAL TRIAL PUBLISHED
STANDARDIZATION REQUIRED FOR THIS TECHNIQUE:
1.SEPARATE THE PALATAL ROOT FRAGMENT OR DRILL THROUGH THE ROOT?
2.HOW MUCH THICKNESS OF ROOT BUCCAL-LINGUALLY?
3.HOW DEEP CORONAL-APICAL POSITION OF REMAINING ROOT IS TOLERABLE?
4.CIRCUMFERENTIAL OF LABIAL ROOT LEFT BEHIND - <180 °, 180°, >180 ° ?
5.NEED OF BONE GRAFT FOR JUMPING DISTANCE
- ROOT CANAL TREATED TOOTH – DENTINE SURFACE ALTERED BY NAOCL, SEALER MATERIAL AND GUTTA PERCHA. SUITABILITY OF THE CASE?
- APPLICATION IN MULTIPLE ROOTED TEETH?
- SOCKET SHIELDING TECHNIQUE COULD BE AN ALTERNATIVE TECHNIQUE TO PREVENT BUCCAL BONE RESORPTION
- IMMEDIATE IMPLANT VS SOCKET PRESERVATION VS SOCKET SHIELDING
- MORE LONG TERM DATA REQUIRED
 IMMEDIATE EXTRACTION WITH SOCKET SHIELDING TECHNIQUE TO PRESERVE LABIAL TISSUE DIMENSION. TOOTH 21 TO BE TREATED WITH INTERNAL BLEACHING AND FULL CERAMIC CROWN RESTORATION…

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