Socket Shield Technique of an Ailing Mandibular Molar With Customized Healing Abutment: Graftless Management of the Hard and Soft Tissue Foundation Around Immediate Dental Implants

It is an established fact that postextraction ridge resorptive changes are inevitable and are very evident in the molar areas. Resorption in the molar sites can cause a reduction in the attached gingiva and affect the long-term success of the osseointegrated implant. To prevent significant postextraction tissue alteration, the socket shield technique (SST) was developed to preserve the buccal plate, over a decade ago. Since then, various studies showcasing modifications of the technique have been published mainly focusing on SST in conjunction with immediate implants in the anterior esthetic zone. Gluckman gave a collective term called partial extraction therapy (PET) which includes SST, pontic shield technique, and root submergence technique. He suggested using a graft material in the gap between the shield and the implant. Later, Siormpas et al. advocated a root membrane technique (RMT) and suggested that it may not be necessary to use the graft material. With the evolution of the technique, the terms SST and RMT are more similar to each other now, with the only difference in the sequence of shield preparation and implant placement. The shield is prepared first, and osteotomy is done in the former and osteotomy is done before shield preparation in the latter. The SST technique is often ignored as a possibility in the molar sites. Though technique-sensitive, SST with immediate implants in molars with a customized healing abutment ensures the maintenance of the original hard and soft tissue volumes in the most conservative way. The following case report showcases a stepwise, graftless management approach for a nonrestorable right mandibular molar with SST and immediate implant. Long-term randomized controlled trials (RCTs) on molar SST are encouraged to make a recommendation for routine clinical practice.