Long‐Term Stability of Alveolar Bone Dimensions Using the Socket Shield Technique: A Retrospective Cone Beam Computed Tomography Analysis

Background Alveolar bone resorption following tooth extraction, especially in the buccal plate, can compromise ridge dimensions, esthetic outcomes, and implant stability. The socket shield technique (SST) aims to preserve buccal bone by retaining a thin buccal root fragment, maintaining the periodontal ligament (PDL) and associated bone. Objective To evaluate long‐term dimensional stability of the alveolar ridge following immediate implant placement using SST, focusing on horizontal buccal and palatal bone changes over a 3‐year period. Methods This retrospective study included 20 patients requiring single‐tooth implant‐supported restorations in the esthetic zone, treated between 2019 and 2021 at the University of Messina. All implants were placed using SST with the “Preserving Nature” protocol, retaining a buccal root fragment of approximately 1 mm. Immediate provisionalization was performed following standardized surgical and prosthetic protocols. Cone‐beam computed tomography (CBCT) scans at baseline (T0) and 3 years (T1) were aligned using a three‐point superimposition method to standardize measurements. Paired statistical analysis assessed changes in bone dimensions, with significance set at p < 0.05. Results No measurable horizontal buccal bone loss was detected in any patient. Minimal horizontal palatal bone loss occurred in 15% of cases, while vertical palatal bone height remained stable. Mean dimensional changes were not statistically significant ( p = 0.109). Conclusion SST provided excellent preservation of alveolar bone dimensions, particularly in the buccal plate, over 3 years. The technique offers predictable benefits for implant placement in the esthetic zone. Despite limitations related to retrospective design and small sample size, the standardized surgical protocol and precise CBCT analysis support reproducibility. Randomized controlled trials are warranted to confirm these results.