Socket Shield Because of Difficult Extraction
Extraction of the fractured tooth at #21 is as difficult as #19 (requiring incision). Because of the long root and hemorrhage, the apex of the tooth (Fig.1 black *) and a thin layer of the buccal shield (white *) remain when osteotomy is initiated. Due to hard bone, a 3.8x11.5 mm implant achieves insertion torque of ~35 Ncm (Fig.2); with placement of a 4.5x4(3) mm abutment, an immediate provisional is fabricated. There is limited remaining space for bone graft. The patient will return for final restoration 4 months postop; the buccal plate will be expected to have not collapsed! The implant seems to be osteointegrated, while the root piece (socket shield *) is exposed 4 months postop (Fig.3). The socket shield seems to be harmless, difficult to trim without local anesthesia and associated with no buccal plate concavity (Fig.4,5 <). With socket shield at #21, the crown looks normal, whereas the one at #19 without socket shield looks long, suggesting vertical bone loss early postop (before restoration, Fig.6).
31,15 Acrylic Dressing
Xin Wei, DDS, PhD, MS 1st edition 02/26/2019, last revision 10/15/2019