A Comparative Review of Immediate Implant Placement with or without Socket Shield Technique

Aim: This review compares the clinical efficacy of the socket shield technique (SST) and immediate implant placement (IIP) in the esthetic zone, focusing on hard tissue preservation, implant stability, and esthetic outcomes.Background: While IIP offers procedural efficiency, it is inherently limited by post-extraction buccal bone resorption and soft tissue recession.The SST was developed to overcome this by retaining a buccal root fragment to preserve the periodontal ligament's blood supply and the natural dentogingival scaffold.Methods: A comprehensive search of PubMed, Scopus, Embase, and the Cochrane Library identified relevant randomized controlled trials (RCTs).Data from the included studies were extracted and synthesized into comparative tables for analysis.Results: Based on nine RCTs, SST demonstrated statistically and clinically superior outcomes compared to IIP.Key findings included significantly better buccal bone preservation (-0.35 ± 0.62 mm vs -1.71 ± 1.02 mm buccal bone height loss), reduced crestal bone loss (-0.54 ± 0.06 mm vs -1.02 ± 0.10 mm at 6 months), higher secondary implant stability [implant stability quotient (ISQ) 69.80 ± 3.77 vs 65.60 ± 5.66], and markedly improved pink esthetic scores (PES) (12.00 vs 8.85 at 6 months). Conclusion:The SST provides a biologically grounded and esthetically superior alternative to IIP, enhancing the preservation of both hard and soft tissues in the short to medium term.It represents a paradigm shift from managing to proactively preventing post-extraction bone loss.Clinical significance: Socket shield technique can reduce the need for adjunctive bone grafting, improve esthetic predictability, and support immediate restoration.However, its success is highly technique-sensitive, requiring meticulous execution and careful case selection by experienced clinicians.