Modified Pontic-Shield Technology: A Proof-Of-Principle Technique

We explored the feasibility of preparing a socket shield under direct observation in vitro and evaluated the impact of this novel approach on tissue preservation. A female patient had missing maxillary central incisors and mobile, crown-root fractured lateral incisors, which were extracted. The buccal root fragment of tooth 12 was precisely prepared in vitro and repositioned. Implants were placed in the central incisor sites, with pontics for the lateral incisors. After 5 years, radiographic and clinical follow-up showed effective preservation of tissue contours, stable root fragments, healthy gingiva, and excellent aesthetic outcomes. The conventional Socket-Shield Technique, involving extraction of palatal and proximal root segments while retaining the buccal root fragment, is highly technique-sensitive and may lead to complications, with root fragment mobility being a contraindication. We modified the technique by preparing root fragments in vitro in an animal study, effectively stabilizing the root fragment and preserving the buccal alveolar ridge. In this case, tooth 12 was extracted, decoronated, and split mesiodistally. The buccal root fragment was trimmed to 1.5 mm thick, with the apical 3 mm removed to prevent infection. It was then rinsed, repositioned without disturbing the periodontal ligament, and covered with Bio-Oss collagen. The modified technique achieved satisfactory outcome with key points including: no scraping of the buccal root surface or socket wall; procedure completion within 10 minutes; maintaining root surface moisture with saline. The modified technique appears to preserve tissue contours, simplify socket-shield preparation, and potentially expand conventional indications.