Peri-Implant Hard and Soft Tissue Changes After Immediate Implant Placement With Socket Shield and Immediate Restoration Versus Early Implant Placement in the Esthetic Zone

Evaluation of Peri-implant Hard And Soft Tissues Changes Between Immediate Implant Placement With Socket Shield Technique and Immediate Restoration Versus Early Type II Implant Placement in The Esthetic Zone - A Randomized Controlled Clinical Trial

This randomized controlled clinical trial aims to compare peri-implant hard and soft tissue dimensional changes following immediate implant placement with the socket shield technique and immediate restoration versus early type II implant placement with contour graft in the esthetic zone. The primary outcome is the Pink Esthetic Score (PES), while secondary outcomes include mid-facial mucosal recession, radiographic vertical and horizontal buccal bone remodeling, and patient satisfaction after 12 months.

Immediate implant placement is widely used for replacing non-restorable teeth in the esthetic zone. However, post-extraction remodeling of the buccal bone plate can lead to soft tissue recession and compromised esthetic outcomes. The socket shield technique has been proposed as a partial extraction therapy designed to preserve the buccal root fragment and maintain the facial bone and gingival architecture.

This single-center, prospective randomized controlled clinical trial aims to evaluate the effectiveness of the socket shield technique with immediate implant placement and immediate restoration compared with early type II implant placement with contour augmentation.

Forty-two patients requiring extraction of a single non-restorable tooth in the esthetic zone will be randomly allocated into two groups:

Test group: Immediate implant placement with socket shield technique and immediate restoration.

Control group: Early implant placement following soft tissue healing with contour augmentation.

Clinical, radiographic, and patient-reported outcomes will be assessed over a 12-month follow-up period.

Inclusion Criteria:

1. Adults aged 18 years or older
2. Patients presenting with a single non-restorable tooth in the esthetic zone indicated for extraction and implant replacement
3. Presence of a thin buccal bone plate (<1 mm)
4. Adequate bone volume to allow implant placement in a prosthetically ideal position
5. Intact socket walls following tooth extraction
6. Ability to achieve primary implant stability ≥35 Ncm at the time of implant placement
7. Patients willing to participate in the study and able to provide written informed consent

Exclusion Criteria:

1. History of systemic diseases that may affect bone healing
2. Use of medications that may influence bone metabolism (e.g., bisphosphonates)
3. Smoking within the past 5 years
4. Presence of acute infection at the surgical site or adjacent teeth
5. Teeth with vertical or subcrestal horizontal root fractures on the buccal aspect
6. Presence of internal or external root resorption
7. Severe periodontal destruction at the implant site