Papilla Reconstruction Of Consecutive Maxillary Incisor Using Socket Shield Technique

Maintaining and reconstructing the soft and hard tissue contours and gingival papilla in anterior consecutive tooth loss is a clinical challenge. In this case, the gingival papilla and labial contour of the consecutive missing maxillary central incisor were successfully reconstructed using the modified socket-shield technique (SST) combined with immediate implant placement (IIP). Bilateral maxillary central incisors of a patient could not be preserved because of crown-root fracture caused by trauma. The patient was a young woman with thin gingival thin labial bone, sharp round crown, high smile line and high aesthetic expectation. Modified SST, extending the root fragment from the labial to mesial-proximal side, was combined with static computer-assisted implant surgery to preserve labial bundle bone and complete precise implantation. The gingival contour was gradually shaped through the temporary crowns. A full labial contour and ideal red and white aesthetic scores were obtained. The aesthetic result remained stable over 18-month follow-up. The challenge of this case is to maintain and reconstruct the aesthetic contour and gingival papilla between adjacent implants. To overcome this, modified SST with static computer-assisted implant surgery was used to avoid marginal bone resorption and improve implant accuracy. Ultimately, the gingival papilla between adjacent implants was supported by ridge crest at the same height as adjacent natural teeth, effectively filling the adjacent gap without prosthesis-based compensation. Modified SST combined with IIP can effectively preserve the labial esthetic contour and gingival papilla between adjacent implants.