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Using the Socket Shield Technique with Dr. Pedro Trejo
191 Plays1 month ago
In this episode, Dr. Flavia Pirih and Dr. Pedro Trejo discuss the use of and research on the socket-shield technique. Listen in for a compelling discussion.
Read the full article here. https://aap.onlinelibrary.wiley.com/doi/10.1002/cap.10290
This podcast is produced by the American Academy of Periodontology. To learn more visit perio.org.
The views expressed in this episode are those of the participants and not necessarily those of the AAP.
Music Credit: Groove Nation by OctoSound
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Transcript
Introduction to Periodontology and Implantology
00:00:00
Speaker
Whether you're in training, in practice, or in research, the Journal of Periodontology and Clinical Advances in Periodontics have something new for you. Hello everyone, Dr. Efio Anidou and I'm the Editor-in-Chief of the Journal Periodontology and Clinical Advances in Periodontics.
00:00:20
Speaker
Tune with our team to Probing Perio, the podcast that aims to discuss advances and innovation in periodontology and implantology.
00:00:35
Speaker
Hello and welcome to another episode of Probing Perio, the podcast where we can explore the show stories behind the research published and clinical advances in periodontics in the Journal of Periodontology.
Welcoming Dr. Pedro Trejo
00:00:46
Speaker
My name is Flavia Peri and my guest today is Dr. Pedro Trejo. We'll be discussing soft and hard tissue evaluation of guided socket shield implant cases. So let's kick off today and let's welcome Dr. Trejo to Probing Perio.
00:01:03
Speaker
So Dr. Trejo, could you tell us a little bit about yourself and your work? Yes, absolutely, Flavia. Thank you for the invitation, first of all. I really appreciate the opportunity to be part of this podcast through my beloved AAP Academy, of course.
00:01:21
Speaker
And now again, thank you again. I trained as a prosthodontist years ago and then ah in periodontics, a at at the University of Texas, Houston, under Dr. Raul Cafesi.
00:01:38
Speaker
And since then, I've been um mixing prayer practice and and the and the and academic academics. So i we love what we do and we'll continue. We're looking forward to continuing evaluating these type of cases.
Evolution of Guided Socket Shield Techniques
00:01:56
Speaker
So can you explain a little bit about the technique that you've used, why you decided to do it? Absolutely, Flavia. All of this started, e you remember, Dr. Perry, when was this? At least, okay, Dr. Husserl first published this in 2010, right? years ago.
00:02:21
Speaker
so you so that's fifteen years ago And there were a lot of controversies and a lot of um debates and it still continues. Just last weekend at the AO, there were lot of negative views about the techniques, but a lot of positive views. Okay, why did I say that?
00:02:48
Speaker
It took me a while to really do one case in my practice because it was very uncertain whether this was malpractice, according to some experts.
00:03:03
Speaker
But I want to remind everybody that um that the literature is there. We have <unk> histology, human histology, randomized clinical trial, clinical reports, and meta-analysis.
00:03:19
Speaker
And great clinicians like Dr. Gluckman who reported the possible you complications. um So everything is there. And now the meta-analysis and the latest consus consensus is that the technique works well in selected cases, right?
00:03:37
Speaker
As part of the the immediate implant you know you know field or immediate implantation. and the preserv preservation of the vocal plate and the soft tissue stability as we as we know.
First Experience with Socket Shield Technique
00:03:50
Speaker
So all of that, finally, I dare to do one case, right? Okay, you I'm not gonna listen to you well um to have what I'm listening and let me try it.
00:04:05
Speaker
During those 10 years, um I was doing a lot of guided surgery. We've been doing guided surgery for more than 15 years since the inception. And when I was doing the anterior implants in particular,
00:04:20
Speaker
the um
00:04:24
Speaker
I was drilling through the tooth as a means to hemissect the tooth and place my implant in my plant position.
00:04:37
Speaker
All right. And I did a lot of these anterior implants and I took the shield out because was not sure about it. So I cut the tooth, and then I saw the shield there, and I took it out because i it was very controversial.
00:04:55
Speaker
Until one time I said, you know what, the shield is right there. So by drilling through the tooth, you achieved several things. One, of course, with a guide, with a guide right? Surgically planned. assure the position of the implant in the anterior zone.
00:05:12
Speaker
you extract the tooth out dramatically in the same time and turf, it carves your shield right there. right So that's why that's how I started, Flavia.
00:05:25
Speaker
can tell you more and more as we go, but but that's how i started. And then um um then I saw that patient, followed that patient, and beautiful results. The soft tissues look like nothing ever happened. Excellent results. So I decided to do more and more.
00:05:45
Speaker
So what when did you start? When did you think that? in This first case is only only five years ago. who can tell you this. um I was late.
00:05:56
Speaker
And again, maybe because of all the be controversy back then. So now I have... a about five years ago, but with about ah around 50 cases, which, you know, we we're following because I just reported on the seven.
00:06:13
Speaker
this but Yeah, I have a few more questions. I think this is actually very interesting. So you said, you know, you really need to make sure you have the right indications and what' what's your criteria for doing it? When do you decide to do these types of cases?
00:06:28
Speaker
Absolutely.
Ideal Conditions and Contraindications
00:06:29
Speaker
done Okay. So, And let me continue with, I will answer that question, but I also will, I will tell you that um in the paper, what um I tried to say twice is that I'm just reporting on the technique.
00:06:45
Speaker
It's a technique, right? paper de something technique The detect The socket shield or the partial extraction therapy in the anterior zone has been validated.
00:06:56
Speaker
So I kind of but just confirmed that for for myself and kind of coin coincided with with what Kurssel and Baumer and their group yeah reported after five years.
00:07:09
Speaker
So the indications. So the indications are um at reported in the literature, which I pretty much agree with all of them. the the The ideal case is that anterior tooth that you have a vocal height, vocal plate height, that there's no soft tissue recession, if you will. Chances are you may have to do something else or may not be indicated. And a case that is ah the patient may be aesthetically concerned about it.
00:07:44
Speaker
Actually, really, I think this ah in a case with with a high smile line, with that patient in particular, and and And, you know, just select the case straight route, nothing tilted or infections, contraindications, you know, are the obvious ones.
00:08:00
Speaker
Vertical fractures, although there's a paper that reports on how to handle that vertical fractures of your teeth, but I would be careful with those. And um and now so get the right case.
00:08:14
Speaker
yeah Excellent soft tissue contour. Okay, one important thing is the adjacent crystal bone levels. You know, you're missing that. You may have other consequences.
00:08:26
Speaker
So those are the the cases that we that we're doing, including premolars, okay? Premolars, anteriors, laterals, canines. And I think that's a good indication.
00:08:39
Speaker
ah Short roots work better than longer roots. You can't choose those very well sometimes. but That's true. That's true. so but But yeah, you can. The technique facilitates the whole technique, right?
00:08:53
Speaker
So you drill through the tooth, as stated, and you'll find it amazing that um that um that are you have the extraction, the position of the implant, and the shield pretty pretty fast.
00:09:07
Speaker
it Definitely... yeah Flavia, you know, also when we started doing the anterior immediate implants, even any immediate implants, non-guided, right?
00:09:20
Speaker
It's difficult to put that implant in the lateral central by hand. Okay. So that's problem number one. Now, number problem two, now you have it. Now, number two, go ahead and, of course, first take the tooth out without making the vocal play. Then put that implant in position and then carve the shield.
00:09:39
Speaker
that is That is technique sensitive, for sure. i Honestly, i I never done that one free hand. It would be hard. People do it and with great results, you know, like Horseler and his team and many others.
00:09:56
Speaker
But i that's the beauty of the technique, I think. I mean, ah that's what I decided. Let's publish it because it may
Efficiency and Simplicity of Technique
00:10:03
Speaker
be helpful yeah to facilitate the technique. Yeah, I think it's actually very, very helpful. So in terms of the benefits, in your hands, I know there's a lot of literature published. Some people might not know too much about this technique and some might know the controversies on this technique, which, as you mentioned before, there was a lot of talk at the AO this weekend on on this technique, mean, several sessions on Socket Shoot.
00:10:29
Speaker
So for you, what are the main clinical benefits of using this technique? Well, you know, in one of the biggest benefits is that you keep um with less therapy, you're more efficient.
00:10:46
Speaker
And what was the the major program title of the AO was simpler or make things simpler. um This will make it simpler and easier the patient and for the clinician.
00:11:02
Speaker
So the benefits are that you will may not need to do a soft tissue graft, go to the palate. you know What else? It's a simplified technique, which lots of long-term benefits.
00:11:18
Speaker
So to me, that's pretty simple. for the patient and for us. um Do you also see an improvement in the aesthetic outcome by maintaining? yeah Yes, absolutely.
00:11:34
Speaker
Going back to the first question, Flavia, I noticed that in my cases that I was doing, we were doing different techniques, the dual zone technique, for example.
00:11:45
Speaker
And over the time, um I noticed that these soft tissues were changing a little bit. Patients were not complaining, but I noticed that. So I think that now with the cases that I have, yeah
Aesthetic Advantages Over Time
00:12:01
Speaker
that I'm following, I mean, I don't see i don't see that directly, right?
00:12:07
Speaker
So in in these cases that we published, we did measure with the help of Dr. Min at the school, he measured very nicely the changes to three and a half years, the the the longest one, and a minimal change. And so you don't see that, clinically they look really nice.
00:12:30
Speaker
one Yeah, I see in in your paper, your results, I mean, the changes are so minimal that almost it makes you wonder if it's actually just a measurement change, you know, it's just a little bit of a difference in measurement. Perhaps there's really no difference.
00:12:45
Speaker
Flavia, I was surprised. I was really surprised. Yeah, we went back again. I told them I want this two, three times measure. And we measured it. I mean, ah actually it was a blind, young and you know, her name is Arisa. She measured all of this, a blind examiner.
00:13:05
Speaker
and And she was very precise. And and now yeah, we we were comfortable with publishing this. And again, I'm planning to report on these same cases and more and really find for myself, right? and That is working.
00:13:20
Speaker
Yeah, I think a long-term follow-up, I mean, longer-term follow-up would be really, really important. I mean, a lot of times people do these types of procedures and they see a benefit, but and think it's very important to report on the results because then I think more people will get involved. Perhaps the controversy will decrease, which I think it would.
00:13:38
Speaker
So you mentioned also that you're at about 50 cases right now. So how often do you choose to do these procedures? if When we're planning the immediate implant, you can tell, right? Because when we plant, let's say let's say, let's let's stay with the central or e lateral, you know, you have this angulation and and the classification one, two, or three.
00:14:08
Speaker
And also, um what else? the Of course, you have the crystal bone levels, you You can't place the implant digitally after the extraction.
00:14:20
Speaker
So when you start planning this, you say this is a case for socket shield or not. So every time that we have an anterior immediate implant, chances are, if it's a candidate, that we're going to do the socket shield.
00:14:36
Speaker
I mean, we we we we believe in the technique. So we're going to do it. We're not going to do other techniques if we can do it But again, it's all in the digital planning when you say, yeah, this, we can do it.
00:14:49
Speaker
ah Flavia, something that I'd like to mention for for in this podcast, if people get to and go through it really well, the abutments, the angle, the screw channel abutments, the angulation that we have, what they do is they facilitate our surgery.
00:15:11
Speaker
okay So you can plan the implant surgery you um'm but then you can correct with the with this abutment up to 15 degrees.
00:15:23
Speaker
You know, we I look at that also with the school and um um i I was interested in to see how much correction you could do. And 15 degrees, all the literature tells you 15 degrees, which makes cases very feasible for immediate implantation and the shield technique.
00:15:42
Speaker
okay So you gotta do kind of go go with that and plan your cases. I will not send it out, you know, because you they may not know exactly what you're looking for when you're doing this.
00:15:54
Speaker
So that's really collaboration between a periodontist and a prostodontist or restorative dentist is really the key to make sure that they understand what you're looking for and what kind of aesthetic results you're exact expecting.
00:16:07
Speaker
Yes, fla absolutely. Yeah. So what are the main takeaways from this study? If you were to tell clinicians or if you were to tell your residents, what do you think the main findings are and what the future is going to be based on the the utilization or the increased utilization of the socket shoe technique?
00:16:27
Speaker
Yeah, absolutely. I think to my residents, I'm telling them, because again, even in our department, you know, where we are,
00:16:39
Speaker
I almost convinced them to start doing this, right? But, and I think that they haven't really done many, but yeah I will tell them try it and try the technique. Don't do it freehand because you may get frustrated.
00:16:54
Speaker
and ah But try a with the technique. yeah have ah Actually, we're planning to have a hands-on course with the residents. And I want them to try it because I think If you look at ah the randomized clinical trials comparative between techniques, right?
00:17:13
Speaker
The socket shields performed really well in comparison to just immediate implants with the bone grafting or as good as the dual zone.
00:17:24
Speaker
And again, I think the the difference will be long term, right? So it is very important also to to think on that. if If there are going to be any complications, because I agree.
00:17:36
Speaker
Now, what is so a catastrophic complication, right? Because with everything that we do, we have complications. And the complications that, again, I'm mentioning ah Marcus a lot, but that they reported how to take care of this these small complications, mainly the extension of the shield, you know?
00:17:57
Speaker
So you I will tell residents and whoever read this, try the technique.
Encouragement for Clinicians and Continuous Learning
00:18:04
Speaker
With whatever implant you are using, drill through the tooth and use your old burrs at a higher revolution and just to cut the tooth.
00:18:16
Speaker
And that's what we do normally with, when we MSA molars, maxillary molars, you know, we cut it in three. Same thing we're doing here, except we're doing with the already tooling. And and um try it.
00:18:30
Speaker
and then ah and then And then I think you'll you'll be amazed. Yeah, coquet-talk. Now, I was going to say, in terms of complications, what are the immediate complications that you end up seeing or long-term complications that you have seen, or maybe you haven't seen it, but they have been reported, and how to you know deal with them since you brought up the complications? Right, right, right.
00:18:54
Speaker
We've seen one complication that it was... a and We, it's interesting because we had, a the case was finished, and then we removed the abominant on the crown, the prosthodontist, and said, Dr. Eckhart, take a look.
00:19:14
Speaker
And I noticed that the shield was exposed. And I think Dr. Gluckman, the majority of the cases is the extrusion, a little bit of the extrusion of the the shield coronally, right?
00:19:27
Speaker
And I'm ah now you can either remove the shield or just bring that shield lower. So it will, the tissues will heal over it and and repair it.
00:19:38
Speaker
should be simple. So in this particular case, the only one we've seen, there's no infection, there's barely inflammation. So interesting, but still we, actually we haven't repaired it yet. I think that was last week, interestingly enough.
00:19:55
Speaker
So i'm I'm aware of this and I'm, you know, we got to be careful with this for sure because we don't want complications every week. yeah know yeah yeah One thing for the for dec clinicians, and I think um without going into what people technically do when they do the shield, what I thought, and if it is in a paragraph in the paper that I, that I,
00:20:25
Speaker
Place that shield, if possible, subcrestal just barely, 0.1, 0.2, or at crest. Don't leave it high.
00:20:37
Speaker
And what will happen if you put that shield just subcrestal to the vocal plate? You know, the bone is going to heal over. So we want to favor our healing.
00:20:48
Speaker
And I think that's important. So I think that is important for the thickness of the shield. and so on and so forth. but But that one will be a ah big one for everybody that does this. Don't leave it high or don't leave it too thin.
00:21:02
Speaker
Put it thin and low. Okay. And is there anything else you would like to talk about that we haven't discussed it yet? Or any take-home messages?
00:21:14
Speaker
Sure. I think the take-home message is yeah
00:21:20
Speaker
you can you have two two to ways to do this, right? One, try it and then read the literature or the literature to be convinced and then try it.
00:21:32
Speaker
I think that's the the the best way. In that way, you will be very confident. and And I'm not talking about my paper. the I would say, to I don't know if a hundred papers, but many, many papers on it that describes everything many, many times, different ways, different ways to get there.
00:21:53
Speaker
Ours is just an addition to it to make it a little simpler. So go here, review it, try it. You'll be very very happy with your results, particularly for patients. All right.
00:22:05
Speaker
Very, very nice. So it was really nice meeting you, really nice discussing this paper with you. um And you know I hope everybody gets a chance to to read your paper and read the other papers on socket shooting that are out there.
00:22:18
Speaker
And if you were to tell our listeners, how could they get hold of you? Can they follow you online? Are there other ways to reach out to you?
Contact and Further Information
00:22:29
Speaker
it Yes, it's Pedro Trejo. I'm a board member, so you can find in the AAP directory.
00:22:38
Speaker
And I'm in Houston, Texas. And my email is docptrejo at yahoo.com. Anytime, give me a call. And I think the my info is in the paper too.
00:22:52
Speaker
yeah Excellent. So, you know, I hope everybody gets a chance to read it. And for everyone out there, if you like this episode, share it with your friend, then subscribe to our podcast to get the latest episodes wherever you're listening.
00:23:05
Speaker
You can also rate the episodes, write a review, and follow us on social. Thank you very much.
00:23:13
Speaker
Thank you.