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

Abstract

Background: The socket shield technique (SST) could address the challenges in immediate implant placement by minimizing post-extraction bone resorption while maintaining soft tissue levels. This study aimed to summarize the available evidence and systematically assess the effectiveness of SST immediate implant placement regarding all outcomes (bone loss, esthetics, implant stability, probing depth, complications, and survival rate). Methods: We searched seven electronic databases through April 2023 to identify randomized clinical trials that assessed the effect of immediate implant placed with SST (test group) versus other implant placement protocols without SST. The risk of bias was assessed using Cochrane’s randomized trial quality assessment Tool (RoB 2.0). Random-effects meta-analysis was conducted, with mean difference and 95% confidence intervals (MD, 95% CI) as effect estimates. We used the GRADE approach to assess the certainty of evidence. Results: Twelve RCTs, involving 414 immediate implants, placed in 398 patients, were included. Meta-analyses revealed that the immediate implants placed with SST had a statistically significant decrease in horizontal (MD = −0.28, 95% CI [−0.37, −0.19], p < 0.0001), vertical (MD = −0.85, 95% CI [−1.12, −0.58], p < 0.0001), and crestal (MD = −0.35, 95% CI [−0.56, −0.13], p = 0.002) bone loss, as well as probing depth (MD = −0.64, 95% CI [−0.99, −0.29], p = 0.0003). Additionally, SST had a significant increase in implant stability (MD = 3.46, 95 % CI [1.22, 5.69], p = 0.002) and pink esthetic score (MD = 1.60, 95% CI [0.90, 2.30], p < 0.0001). Only two studies reported shield exposure incidences in the SST group; however, all studies revealed no implant failure and a 100% survival rate. The evidence certainty was assessed as very low. Conclusions: Based on limited evidence, SST was more effective in minimizing bone resorption and improving implant stability and esthetic outcomes than conventional immediate implant placement. Still, SST could not be recommended as a routine clinical protocol due to the lack of a standardized surgical approach; thus, further high-quality RCTs are required to support this conclusion.

Prevalence of temporomandibular disorders (TMD) in bleeding disorders: A systematic review with meta‐analysis

“…This activation subsequently proceeds in a stepwise manner down the cascade, ultimately leading to thrombin generation and the formation of cross‐linked fibrin. Bleeding disorders also cause problems during implant and prosthetic procedures 3–7 …”

Self‐designed surgical guides for accurate socket shield preparation: An in vitro evaluation supported by a clinical report

“…3 Similar to conventional immediate implantation in the esthetic area, a flapless surgery is recommended in the socket shield technique. 4 In this way, blood supply from the soft tissue can be reserved for peri-implant tissues and thus tissue absorption after implant placement can be decreased. 5 Without flap elevation, however, it will not be easy to orient the alveolar bone and tooth root.…”

“…In the last decades, reports on the socket shield technique started to thrive because of its effectiveness in preserving peri‐implant tissues, 1,2 especially in the esthetic area 3 . Similar to conventional immediate implantation in the esthetic area, a flapless surgery is recommended in the socket shield technique 4 . In this way, blood supply from the soft tissue can be reserved for peri‐implant tissues and thus tissue absorption after implant placement can be decreased 5 .…”