Navigation guided socket‐shield technique for implant and pontic sites in the esthetic zone: A proof‐of‐concept 1‐year prospective study with immediate implant placement and loading

Abstract Objective To assess clinical, radiological performance of novel navigation guided socket‐shield technique (NSS) with immediate implant placement and loading. Materials and Methods Eighteen patients (12 females; age 52.54 ± 4.92; 33–72) treated between January 2018 and June 2019, were investigated, and followed for at least 1 year after definitive prosthesis placement (mean 20.1 months, 18–23). Primary outcomes: implant and prosthetic success rates, surgical, biologic, prosthetic complications. Secondary outcomes: marginal bone loss (MBL), implant stability quotient (ISQ), pink esthetic score (PES), plaque and bleeding indexes. Results Sixty‐nine navigation guided socket‐shield procedures were performed (27 implant‐sites and 42 pontic‐sites) and 27 implants (NobelParallel, NobelBiocare AG) positioned and immediately loaded. Mean insertion torque and ISQ at implant positioning were 49 ± 5.34 Ncm (36–74), 73 ± 5.72 (68–81). No implant failure was experienced. Two root‐shield exposures with mucositis, ulceration and bleeding were reported at two pontic‐sites (2.9%) and successfully treated. No complications were experienced at implant‐site leading to an overall NSS success‐rate of 100%. No prosthetic complications occurred. Mean MBL was −0.72 ± 0.26 mm (−0.42 to −1.06 mm). PES final at the last follow‐up 12.84 ± 0.92. The plaque and bleeding scores were 18.5 ± 6.12 and 3.15 ± 2.21. Conclusions Within study limitations, dynamic navigation was effective to streamline execution of socket‐shield technique at implant and pontic sites, shortening treatment time and reducing complications. Navigation guided socket‐shield technique was reliable to achieve digitally planned shield‐to‐implant distance, facilitate immediate implant placement and loading and establish the mucosal dimension needed for underlying bone‐to‐implant protection and esthetic integration. Clinical Significance The investigated NSS technique overcomes the difficulties related to root preparation at implant and pontic‐sites, facilitating immediate implant placement and loading. Dynamic guided surgery contributed to make socket‐shield technique less technical‐sensitive, shortening time for execution, reducing complication rate.