Partial tooth extraction using the ˝socket-shield˝ and partial root submergence techniques

Socket-shield tehnika je modificirani način imedijatne postave implantata u ekstrakcijsku alveolu. Tehnike očuvanja alveolarnog grebena razvijale su se od 1989. godine, a tehniku koju danas poznajemo opisao je 2010.godine Hürzeler sa svojim suradnicima. Naime, problematika odgođene postave implantata leži u tome da je smanjenje bukolingvalne širine 50% u razdoblju do dvanaest mjeseci nakon ekstrakcije zuba. Socket-shield tehnika nudi rješenje problemu resorpcije grebena, poglavito bukalnog, podložnijeg smanjenju vertikalne dimenzije. Za takav tip zahvata odlučuje se kod zubi koji su indicirani za ekstrakciju, međutim, imaju zdrav parodont i uredan nalaz bukalnog dijela korijena. Prilikom izvođenja zahvata, ostavlja se bukalni fragment korijena zuba dok se palatinalni ekstrahira. Bukalni fragment postaje štit koji se po određenom protokolu oblikuje. Nakon toga slijedi imedijatna postava implantata bez uskog dodira sa štitom. Nakon tri mjeseca dokazano je stvaranje kosti između implantata i štita te oseointegracija implantata. Ukoliko nalaz zadovoljava, implantat se optereti trajnim nadomjestkom. U situacijama u kojima se ne ide u imedijatnu postavu implantata, a želi se sačuvati volumen alveolarnog grebena, koristi se tehnika potapljanja zuba (root submergance tehnika) ili djelomičnog potapljanja zuba (pontic-shield tehnika). Obje tehnike pokazuju učinkovitost u očuvanju visine alveolarnog grebena nakon vađenja zuba i nude zadovoljavajuću estetiku.The socket-shield technique is a modified method of immediate implant placement in the extraction alveolus. The techniques for preserving the alveolar ridge have been developing since 1989, however, the technique we know today was described in 2010 by Hürzeler and his associates. Namely, the problem of delayed implant placement lies in the fact that the reduction in buccolingual width is 50% in the period up to twelve months after tooth extraction. The socketshield technique offers a solution to the problem of ridge resorption, especially buccal, more susceptible to the reduction of the vertical dimension. This type of procedure is chosen for teeth that are indicated for extraction but have a healthy periodontium and a neat finding of the buccal part of the root. When performing the procedure, a buccal fragment of the tooth root is left while the palatal is extracted. The buccal fragment becomes a shield that is shaped according to a certain protocol. This is followed by immediate placement of the implant without close contact with the shield. After three months, bone formation between the implant and the shield as well as osseointegration of the implant were demonstrated. If the result is satisfying, the implant is loaded with a permanent replacement of the tooth. In situations where the immediate placement of the implant is not performed, and the volume of the alveolar ridge is to be preserved, the root submergence technique or the ponticshield technique is used. Both techniques show efficacy in maintaining the height of the alveolar ridge after tooth extraction and offer satisfactory aesthetics