Effects of Socket-Shield Therapy on Inter-Implant Papilla Preservation Between the Upper Central and Lateral Incisors

The use of partial extraction therapies in the context of implant therapy involving the maintenance of a part of the dental root, such as the socket-shield/root membrane technique, has been described as a viable treatment option owing to its main therapeutic advantage of preserving the alveolar process or minimizing postextraction dimensional changes. However, there is a lack of well-conducted clinical studies exploring its effect on interproximal soft tissues over time. Hence, the aim of this study is to gather more information about the effect of this therapy. This study included 6 patients (women, n = 4; men, n = 2) and observed uneventful wound healing over a follow-up period of 3 to 5 years as well as adequate probing depths without signs of inflammation at the final follow-up visit. Interestingly, during the initial evaluation, the papillary fill between the central and lateral incisors was found to be at a lower level in 2 patients, similar in 2, and higher in 2 compared with the contralateral tooth. Despite this heterogeneity, at the final follow-up, the authors reported stable interproximal papillae that were comparable to those on the contralateral side, except for 1 patient who presented with shorter papillae and another patient showing minor improvements. Therefore, this study concluded that the preservation of inter-implant papillae is independent of the timing of implant placement, shield design, and the presence of periapical lesions.

Although the findings of this study are interesting, there are important limitations that should be taken into consideration when making extrapolations to other populations or clinical scenarios with other characteristics. First, this study does not completely adhere to the guidelines for case reports, and there is no information on receiving approval from the ethics committee for conducting this study and whether the data were collected retrospectively or prospectively and by whom. Second, the study design is generally weak. The inclusion and exclusion criteria could lead to selection bias, and proper power analysis was not conducted to determine the minimum number of participants to be recruited to adequately measure the effect of this therapy. Third, owing to the limited number of patients, the timing of implant placement (ie, nine implants were placed immediately after the partial extraction of the tooth, and three implants were placed following a delayed approach after performing the pontic shield technique), the lack of socket integrity in 2 patients, design of the shield, missing information of systemic and local factors, the modification of the peri-implant phenotype with a subepithelial connective tissue graft in 1 patient, the absence of information about the type of the implant and system used, the use of non-standardized intraoral photographs, and the differences in the restorative plan make the generalizability of the study findings poor. Unfortunately, although the authors reported that periapical radiographs were taken to assess the alterations in crestal bone levels, this parameter was not reported. Moreover, clinicians should be aware that a meticulous case selection based on an adequate assessment of the systemic and local anatomical factors and clinical expertise is the key to successful implant-related outcomes after partial extraction therapies.