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- SOCKET SHIELD - THE BLACK SWAN OF IMPLANTOLOGY RAJEEV CHITGUPPI
Socket Shield is a black swan event that happened right before our eyes, and is here to stay.
A black swan is a high impact event or occurrence that deviates beyond what is normally expected of a situation and is extremely difficult to predict; the term was popularized by Nassim Nicholas Taleb, a finance professor, writer and former Wall Street trader. I was expecting a black swan event to happen in implantology since long. Implantology was a black swan in itself, as it forever changed the way dentistry in general, and rehabilitation in particular, was being practiced. However, the ever growing literature of implantology was necessitating the use of more and more grafts, the material cost making it difficult for a common practitioner & patient to achieve the ideal outcomes, within their economical constraints. It needed a black swan to solve the problem. Black Swan is a metaphor that describes an event that comes as a surprise, has a major effect, and is often inappropriately rationalized after the fact with the benefit of hindsight. Almost all major scientific discoveries, historical events, and artistic accomplishments have been "black swans"— undirected and unpredicted.
The term 'black swan' is based on an ancient saying which presumed 'all swans were white and black swans did not exist', but the saying was rewritten after black swans were discovered in the wild. This is exactly what happened in implantology. The implants were introduced as the best possible solution for 'missing teeth'; and 'missing teeth' would mean 'buccal (esp. crestal) bone permanently losing periodontal ligament blood supply' leading to resorption of bundle bone & resultant loss of contour. This was presumed to be the normal course of events 'in every case', necessitating the extensive use of grafts and bone substitutes in an attempt to 'restore' the contour or at least bring it back towards the normal. All subsequent developments - the thought process, science, materials, techniques & most importantly, the industry- evolved & got improvised, but all within the realm of grafting & augmentation. There was no way by which anyone could expect, predict or visualize a 'tooth- bone complex' co-existing with an implant in the same site. This is similar to the old world presumption that all swans must be white because all historical records of swans reported that they had white feathers. In that context, a black swan was impossible or at least nonexistent, but the assumption had to be changed after black swans were sighted.
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- SOCKET SHIELD - THE BLACK SWAN OF IMPLANTOLOGY RAJEEV CHITGUPPI Socket Shield is a black swan event that happened right before our eyes, and is here to stay. Three attributes of a black swan: 1. Black swan is a surprise (to the observer) : It is an outlier, as it lies outside the realm of regular expectations, because nothing in the past could convincingly point to its possibility. In implantology, the grafting protocols were just getting mature & optimized after decades of research, when socket shield arrived & caused turbulence in thought process & the entire industry ecosystem. It was a big surprise to old school and met with resistance for the obvious reasons. 2. Black swan has a major effect: It carries an extreme 'impact'; socket shield removes the necessity or at least minimizes the use of grafting materials. Right now, the data is not huge, the number of people practicing socket shield is not big, but looking at the available clinical data, the results are not just stable, but mind boggling. No amount of grafting can recreate the lost contour as naturally as done by socket shield. Socket shield does not recreate the contour nor it restores the lost contour. It essentially prevents the loss of contour. This means lesser necessity to use grafting materials for socket preservation, contour augmentation, and simultaneous grafting with immediate implants - means a big threat to material research & material industry. The volumes are going to reduce big time - another reason for this concept not receiving an enthusiastic industry support; and facing resistance. It's also the best naturally available surgical guide that can be created at minimal cost, which can assure you an ideal 3D position of implant.
3. Black swan has a hindsight bias: After the first recorded instance of black swan, it is rationalized by hindsight, as if it could have been expected; that is, the relevant data were 'available but unaccounted for' in risk mitigation programs. The same is true for the personal perception by individuals. In other words, in spite of its outlier status, human nature makes us concoct explanations for its occurrence after the fact, making it explainable and predictable. Almost all consequential events in history come from the unexpected — yet humans later convince themselves that these events are explainable in hindsight. The current evidence available on socket shield is extremely encouraging. Its impact in implantology is similar to the disproportionate role of high-profile, hard-to-predict, and rare events that are beyond the realm of normal expectations in history, science, finance, and technology; and also to the non-computability of the probability of the consequential rare events using scientific methods (owing to the very nature of small probabilities). Socket shield is a black swan; it is here to stay and disrupt further. Black swans arrive suddenly and cause extreme impact. The rise of the Internet, the personal computer, World War I, the dissolution of the Soviet Union, and the 9/11 attacks are all examples of black swan events. Socket shield is not the first nor the last black swan in implantology or dentistry. The next decade will bring in more black swans - but again, I'm predicting here!!! page 2 of 2
