Fate of root shell after pontic/socket shield techniques, is it better to extract the whole tooth?

Abstract

A series of changes occur in the remaining alveolar process after whole tooth extraction. The basic question is, why do the bony walls (especially the labial/buccal) get resorbed immediately after the tooth is removed? This could be because, with cementum of the concerned tooth and its periodontal ligament, the supporting bundle bone is dependent on the presence of the tooth. This loss can be compensated using numerous techniques, such as socket grafting using various biomaterials to preserve the alveolar bone and buccal grafting with guided tissue regeneration to increase the thickness of buccal bone or placement of implant immediately. However, none of these techniques prevent the modelling of the alveolar bone post-extraction. Few studies have demonstrated that preservation of the roots in the alveolar process maintains the bone volume and facilitates vertical bone growth. A histological study in animals and humans has shown that the retained root shell does not pose any interference in the osseointegration of the implant (if placed simultaneously). Although various names have been proposed to describe the concept of retaining full or part of the root to prevent the resorption of the ridge, socket-shield and pontic-shield are the two most commonly used terms worldwide. The extraction of the whole tooth might be the choice of therapy when socket-shield or pontic-shield is not possible due to anatomical variations, infections, or lack of clinical expertise. Irrespective of the size, when a whole root or a root fragment (is left in situ), it is the dentist’s ethical duty to advise/inform the patient and ensure repeated clinical and radiographic follow-up. The present study aimed to highlight the current status of these techniques, their benefits, and possible complications and address whether the paradigm of the teeth extraction methods should be altered.

Keywords: Socket shield technique; Pontic shield technique; Alveolar resorption; Tooth root; Tooth extraction; Ridge preservation; Alveolar resorption

Core Tip: The phrase ‘prevention is better than cure’ holds very true when it comes to alveolar ridge resorption. A significant bone is lost within 3 mo after extraction of the whole tooth. Socket/pontic shield techniques can preserve the alveolar bone and prevent a lot of surgical and economic burden to the patient in restoring what could have been saved in a very economical and natural way. Although these procedures are technique sensitive, clinicians must expertise in these techniques, since preserving what can be preserved is not only scientifically desirable but also ethically advisable.