Evaluation of soft tissue and labial plate of bone stability with immediate implant in direct contact versus gap with socket shield: A randomized clinical trial with 1 year follow‐up

Abstract

Objective In the anterior region, the resorption of the buccal plate of bone after tooth extraction leads to contraction of the overlying soft tissues, resulting in an esthetic problem. In the socket shield technique, the buccal root section of the tooth is maintained, to preserve the buccal bone for immediate implant placement. The aim of this randomized clinical trial was to investigate the effect of leaving a gap or not between implant and retained root fragment on bone dimensions and soft tissue esthetics. Methods This was a two armed parallel group randomized clinical trial with allocation ratio 1:1. Patients were eligible in case they needed immediate implant replacing teeth in esthetic zone with sufficient buccal bone support. CBCT was performed immediately after the intervention and 12 months later. Results Forty six patients (26 females and 20 males) were enrolled in the study with 23 of them placed in contact with shield and 23 were placed palatal leaving a gap to graft with a xenograft. After 12 months, excellent soft tissue stability was reported (mean pink esthetic score at placement group A: 12.00 ± 1.60 after 12 months 12.90 ± 1.69, group B 12.62 ± 2.07 and after 12 months 12.38 ± 2.20) Using both surgical techniques. Radiographic crestal bone level changes mean for group A was −0.26 ± 0.52 and for group B ‐0.34 ± 0.31. There was a strong positive correlation between clinical and radiographic bone width values which was statistically significant (r = 0.782, p < 0.001). Width and thickness of keratinized gingiva showed no significant difference between values measured in both groups. Nonsignificant difference between studied groups according to the labial plate of bone clinical and radiographic changes after immediate implantation. Conclusion Within the limitations of this study, the present data seem to support that the clinical outcome of the socket shield technique with immediate implant placement placed in contact or leaving a gap gave excellent esthetic results.

Socket Shield Technique to Improve the Outcomes of Immediate Implant: A Systematic Review and Meta-Analysis

“…Twelve RCTs involved 398 patients (both genders) with a mean age of about 33.74 years, who received 414 immediate dental implants [23][24][25][26][27][28][29][30][31][32][33][34]. All RCTs were conducted in…”

“…Twelve RCTs involved 398 patients (both genders) with a mean age of about 33.74 years, who received 414 immediate dental implants [23][24][25][26][27][28][29][30][31][32][33][34]. All RCTs were conducted in a university clinic, with six studies in Egypt, three in India, and one in each Iraq, Italy, and China, and the follow-up periods ranged from three months to three years.…”

“…Surgeries were conducted in the maxillary esthetic area in all RCTs, except for Hana et al [28] and Sun et al [29], wherein the surgeries were performed in the maxillary and mandibular areas; similarly, the surgical site was anterior teeth in all studies, except for Atef et al [31] and Abdullah et al [34], whose surgery sites involved anterior and premolar teeth.…”

“…Overall, seven studies were assessed as having a high risk of bias [23,[25][26][27][28]30,32], three studies as having some concerns risk of bias [24,29,34], and two studies as having a low risk of bias [31,33]. Six studies (50%) did not report information about allocation concealment, raising some concerns of bias.…”

“…Eight RCTs (66.67%) revealed no post-operative complications [26][27][28][29]32,[34][35][36], and two (17%) did not report information about post-operative complications [33,37]. Only Abd-Elrahman et al [30] and Hana et al [31] reported shield exposure incidences in the SST group (one and two patients, respectively).…”