Modified socket shield therapy (SST) has been proposed to preserve the facial plate and peri implant tissues. Whether spontaneous healing after two stage modified SST provides outcomes comparable to grafted SST before delayed implant placement remains unclear.

There remains no consensus regarding management of the space adjacent to the retained shield-whether it should be filled with a biomaterial or left for spontaneous healing. Clinical observations suggest that healing may not always yield complete mineralized fill; instead, a soft tissue interface can develop along the internal aspect of the root fragment, potentially limiting bone formation within the defect. At present, it remains unclear whether placement of a bone substitute can reliably reduce or prevent this soft tissue ingrowth along the inner surface of the retained fragment, providing a rationale for controlled comparisons of grafted and nongrafted two stage SST protocols. Therefore, the present controlled clinical study was designed to compare SST with xenograft combined with MPM augmentation versus SST alone, followed by delayed implant placement after a 6 month healing period. The study evaluated soft tissue ingrowth as key healing outcomes, alongside histologic findings and implant related parameters, including implant stability, as well as the incidence and management of procedure related complications.

Inclusion Criteria:

• ASA I (healthy)
• With intact buccal periodontal tissues
• No parafunctional habits
• Good oral hygiene
• Willingness to comply with the study protocol and follow up schedule

Exclusion Criteria:

• Acute infection at the extraction site
• Extensive buccal plate loss
• Vertical root fracture on the buccal aspect
• Fracture patterns extending below bone level
• Internal or external resorption
• Root caries compromising the shield
• Excessive tooth mobility
• Heavy smoking

Statistician