Socket Shield & Partial Extraction Therapy (PET) for Dental Implants

The concept of submergence of roots for conservation of alveolar bone as described by O’Neal and
colleagues in 1978 is not a new concept. With this technique vertical and horizontal hard tissue is
preserved, thus, maintaining soft tissue architecture. In the aesthetic zone this approach is often used in
order to maximize the cosmetic/restorative outcome.
A modification of this technique is being used when placing implants immediately following the extraction
of a tooth in the anterior region of a patient’s mouth. Originally discussed in 2010 by Hurzeler et al as the
Socket Shield Technique, Gluckman and Salama have recently suggested further modification and called
it Partial Extraction Therapy. This new approach calls for leaving a small sliver of the labial portion of the
tooth being removed in order to preserve the labial hard and soft tissue. The piece of tooth can not be
mobile and the implant should avoid contact with it.
There are 3 major benefits of the Partial Extraction Therapy. First, it minimizes resorption of labial bone
and soft tissue. Second, it requires less grafting of bone and/or soft tissue at time of implant. Third, it
minimizes trauma in difficult extraction cases.
There are some disadvantages of this new approach. It is technically more challenging then simple
atraumatic removal of a tooth for immediate implant placement. There is no osseointegration of the
implant to the fragment of tooth left behind. There is risk of infection or loss of the tooth fragment causing
loss of alveolar bone.
The technique is outline above in the images taken during a recent procedure.
Image 1. Pre-operative photo of tooth #9 with internal resorption and failing prognosis, short/wide papilla
and thick biotype of tissue.

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Image 2. Incisal view showing excellent labial bone convexity in anterior area.

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Image 3/4. Surgical management to remove tooth and leave labial sliver of tooth for Partial Extraction

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Image 5. Sliver of tooth is reduced 3mm from crest of soft tissue margin.

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Image 6/7. Implant is placed while maintaining excellent soft tissue architecture.

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Image 8. Sliver is tooth is noted on labial with lack of implant contact to tooth.

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Image 9. Incisal view showing maintenance of hard/soft tissue architecture on labial aspect.

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The implant had greater than 70NcM insertional torque and thus was temporized in a non-loaded
manner the same day by the patient’s restorative dentist.

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