While I was off work for my time in January for what was called my sabbatical last year, it didn’t really have a name this year, I was quite glad to receive my European Dental Implant Journal courtesy of my membership with the ADI. I was surprised to see it was listed as the ‘Socket Shield Edition’ or similar.
Within this were a couple of articles related to the socket shield procedure which first seemed to hit the headlines in implant dentistry (in the UK at least) two ADI congresses ago in Glasgow.
Socket shield has become one of those procedures in implant dentistry which has gained reputation (in the UK at least) by social media.
Let’s for a minute go back to the inverted U-shaped curve and understand that the people who are in the top 10% of exponents of surgery in any field can pretty much do anything they want with any instrument they want and make it work.
In these pages that has never been up for dispute and I have known one or two surgeons in implant dentistry who can make anything work in their hands and are extraordinary people in terms of surgery.
For the rest of us though, these procedures do not apply. For anybody who is in their first 1000 dental implants they certainly don’t apply.
It was with great interest then that I read the literature that came with the papers in the ‘Socket Shield Addition’ of the journal (I sought out and read the papers) and in particular the article from Clinical Oral Implants Research by Baumer et al.
This is a particularly interesting paper because it’s a 5-year study of patients treated with the socket shield technique (retrospective). This is one of those papers that people hang their hat on when they talk about this technique; it’s actually a reasonable bit of work although it’s retrospective which does reduce its value somewhat.
Read the paper though, if you want a copy let me know, I’ve got a copy in a PDF format, but perhaps the most important thing you have to read is in the abstract section of the conclusion on the front page of the article. It reads as follows, “this technique should not be used in routine clinical practice until a higher-level evidence in the form of prospective clinical trials is available”.
This sentiment is reiterated throughout the paper.
Recent prospective reports suggest upto a 20% early failure rate.
The difficulty is that everybody who sat in the ADI lecture theatre in Glasgow thought they were in the top 10% and we know from some ver credible psychological research, some of which was presented at the failure conference last year by Shaun Sellors, that people in the 12th percentile usually grade themselves in the 62nd percentile in terms of ability!
I get criticized time and time again for teaching an anterior aesthetic technique which is more invasive and more time consuming than any number of the immediate techniques that exist.
The technique that I subscribe to, that I have carried out in my own practice for 20 years and that we teach in the Academy, is one which has been proven to be effective for the 80% of us who are not ‘blessed’ with ‘Harry Potter hands’. Before you teach or encourage aspiring implant surgeons who have placed limited ammounts of implants to provide advanced care, read the research.
Blog post number: 1565