Comparative effectiveness of the socket shield technique versus conventional implantation approaches in the esthetic zone: A systematic review and network meta-analysis

The socket shield technique (SST) shows promising potential in esthetic dental implantation. Nonetheless, studies on its relative efficacy in comparison with other traditional implantation methods are limited. The purpose of this network meta-analysis was to comparatively evaluate SST, conventional immediate implant placement (IIP), nonimmediate implant placement with guided bone regeneration (NIIP-GBR), and nonimmediate implant placement after alveolar ridge preservation (NIIP-ARP) for optimal soft and hard tissue preservation and outcomes in the esthetic zone. The review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024627077) and conducted by following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive systematic search was performed across the PubMed, Embase, Web of Science, Scopus, and Cochrane Library electronic databases for studies published from January 2015 to November 2024. The outcomes included pink esthetic score (PES), labial bone thickness (LBT) changes, marginal bone loss (MBL), and patient-reported esthetic outcomes (PROs). A random-effects network meta-analysis was performed, with effect sizes calculated as weighted mean differences and 95% confidence intervals. Study quality and evidence certainty were assessed using Cochrane risk of bias and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodologies. This network meta-analysis encompassed 19 studies, comprising 13 randomized controlled trials and 6 nonrandomized controlled trials, with a total of 760 dental implants situated in the esthetic zone. SST was associated with a superior pink esthetic score at the 6-month mark (PES-6M), showing superiority (IIP versus SST: MD=-1.31, 95%CI: -1.97, -0.66; NIIP-GBR versus SST: MD=-1.46, 95%CI: -2.80, -0.12; NIIP-ARP versus SST: MD=-1.88, 95%CI: -3.42, -0.35), and long-term follow-up over 12 months (PES-12M+, IIP versus SST: MD=-1.39, 95%CI: -1.86, -0.93; NIIP-GBR versus SST: MD=-1.50, 95%CI: -2.61, -0.40; NIIP-ARP versus SST: MD=-1.52, 95%CI: -2.97, -0.08). SST showed superiority in LBT changes (IIP versus SST: MD=0.52, 95%CI: 0.21,0.83), MBL exhibited no significant differences among comparisons. PROs indicated higher satisfaction with SST compared with IIP (MD=-0.27, 95%CI: -0.51, -0.02). Implant-supported prostheses with the socket shield technique demonstrated a superior postoperative esthetic outcome and the effective preservation of soft and hard tissues, suggesting that it is an optimal approach for the esthetic zone in patients with bone defects.