Received: 30 November 2019 Revised: 29 June 2020 Accepted: 2 July 2020

DOI: 10.1111/cid.12938

ORIGINAL ARTICLE

Socket shield technique vs conventional immediate implant

placement with immediate temporization. Randomized clinical
trial

Ahmed Abd-Elrahman MSc1 | Mostafa Shaheen MSc1 | Niveen Askar PhD2 |

2
Mohammed Atef PhD

1
Department of Oral Implantology, Cairo
University, Giza, Egypt Abstract
2
Department of Oral and Maxillofacial Surgery, Background: Alveolar bone resorption and labial bone plate reduction follow teeth
Cairo University, Giza, Egypt
extraction due to the deficiency of blood supply, derived from the loss of periodontal
Correspondence ligaments, and hence the socket shield technique was introduced to preserve the
Ahmed Abd-Elrahman, Department of Oral
periodontal ligaments related perfusion.
Implantology, Faculty of Dentistry, Cairo
University, 11765 7 Abd ElAzim Salama St., Purpose: The study aimed to compare the vertical and horizontal changes of the buc-
Nasr City, Cairo, Egypt.
cal cortical bone plates, encountered after utilizing the socket shield technique with
Email: airplayer2003@yahoo.com
immediate temporization vs an immediate implant placement with immediate tempo-
rization, and analyzing the differences of the implant stability and pink esthetic score
evaluation between both techniques.
Materials and Methods: A total of 40 dental implants were placed in the maxillary
esthetic zone, 20 implants were placed using the socket shield technique with imme-
diate temporization; the study group and 20 implants were placed immediately with
immediate temporization; the control group. All patients received immediate and
6 months postoperative CBCT to assess the dimensional changes in the labial bone
plates. Implant stability quotients (ISQs) and pink esthetic scores were measured at
the time of implant placement and 6 months postoperatively.
Results: The horizontal bone loss; ranged from 0 to0.26 (0.15) mm and 0.03 to0.44
(0.32) mm for the study and control groups, respectively. The vertical bone loss; ranged
from 0.11 to 0.55 (0.31) mm and 0.25 to 1.51 (0.7) mm for the study and control groups,
respectively. The ISQ for the study group increased from 68.6 ± 3.81 to 76.7 ± 3.49,
while in the control group it increased from 66.4 ± 5.64 to 75 ± 4.4. PES for the study
group increased from 11 to 12, while in the control group it decreased from 13 to 9.
Conclusion: The socket shield technique with immediate temporization is a reliable
method to reduce the labial bone loss following teeth extraction. However, further
studies are required to investigate the effect of grafting the jumping gaps, to evaluate
the graft contribution in further reduction of the bone loss.

KEYWORDS

extraction socket, immediate implants, immediate loading, immediate temporization,

socket shield

Clin Implant Dent Relat Res. 2020;1–10. wileyonlinelibrary.com/journal/cid © 2020 Wiley Periodicals LLC 1
2 ABD-ELRAHMAN ET AL.

1 | I N T RO DU CT I O N good oral hygiene. The exclusion criteria included patients with sys-
temic diseases that would interfere with the normal healing such as
The reduction of the alveolar ridge width and height represents a uncontrolled diabetes mellitus, history of radiation therapy to the
physiologic sequela of teeth extraction, which would compromise an head and neck, and the heavy smoker patients. Teeth with periodontal
ideal prosthetic positioning of the dental implants.1 Immediate disease, vertical root fracture, horizontal fracture at or below the bone
implant placement, guided bone regeneration, flapless implant place- level, and teeth with local pathologic incidents that affect the labial
ment, palatally positioned implants, and platform switched implants part of the root as external or internal root resorption were also
are several techniques that have been reported in the literature to excluded.
overcome the shortcoming resorption.2-6 Although these methods Twenty-five patients were recruited and evaluated for the indica-
showed variable degrees of cortical bone preservation, none of them tion of implant placement. Forty recipient sites were demarcated
completely prevents the mid-facial recession following immediate within the esthetic zones of the selected patients and these sites were
implant placement, as the postulated understand of alveolar bone loss considered the study population (n = 40). The allocated sites were
following teeth extraction is the loss of the coinciding periodontal lig- randomly divided into two equal groups (study and control groups)
aments, it seems logical that root retention would avert the resorption using block randomization with stratification (block size: 4) using a
7
process. Microsoft Excel Formula. The purpose, the nature of this study, and
Casey and and Lauciello8 in the 1970s first applied the root sub- detailed surgical procedure along with the possible complications
mergence concept to preserve the ridge dimensions for full denture were discussed with the patients and the written consents were
fabrication. Hurzeler et al,7 in 2010, hemi sectioned the third and clearly declared and signed up.
fourth mandibular premolars in a beagle dog, retaining the buccal frag- Cone beam computed tomography (CBCT) scans (Planmeca
ment of the distal root 1 mm coronal to the buccal bone plate; intro- Promax 3D, Planmeca, Finland) were ordered for all patients to assess
ducing the socket shield technique. Gluckman et al,9 in 2018, the labial bone thickness, the bone height, and were plotted for the
published a 5-year retrospective evaluation of 128 socket shield cases selection of the size of the proper implants. Dual implant system
in the esthetic zone and posterior sites, reporting a survival rate of (Titan Industries, Egypt) with diameters (3.3 and 3.7 mm) and lengths
96.1%. The most common complications were the internal followed (14 and 16 mm) were used in the study. One week prior to surgery, all
by the external exposures of the shields. A modification of the original the patients were subjected to plaque control measures and oral
socket shield technique was introduced in 2019 by Gluckman et al,10 hygiene instructions. After extra-oral disinfection of the surgical sites,
who emphasized on reducing the height of the socket-shield to the the patients were asked to rinse their mouths with Chlorohexidine
bone crest level to avoid the internal shield exposure and fabricated HCL 1.25% mouthwash (Orovex mouthwash, Macro group, Egypt)
provisional restorations with an “S-shaped” emergence profile to immediately preoperatively. Local infiltration anesthesia [Articaine 4%
enhance maximum soft tissue infill. 1:100,000 epinephrine] (Artinibsa 40 mg/0.1 mg/mL—epinephrine
The little collected body of evidence all over the literature did not 1:100.000, Spain) was used for all procedures.
declare the effect of immediate temporization following immediate Among the study group cases, tooth decoronation was reduced
implant placement utilizing the socket shield technique. Hence, the using a diamond bur, 1 mm above the gingival level, using a high-
present study aimed to compare the socket shield technique with speed handpiece under copious irrigation. The facial root segment
immediate temporization vs the conventional immediate implant with was separated from the rest of the root using a Lindemann bur in gen-
immediate temporization. The primary outcome was the assessment tle mesiodistal sweeping strokes from the gingival margin to the apex
of the horizontal and vertical dimensional changes of the labial plate of the root, aiming to separate the palatal and the labial root seg-
of bone. The secondary outcomes included implant stability and pink ments. (Figure 1).
esthetic score (PES) evaluation. A fine periotome was then wedged between the palatal root
section and the palatal alveolar plate to sever the periodontal liga-
ments, the separated palatal section was carefully delivered, without
2 | MATERIALS AND METHODS disturbing the patent labial segment. The coronal reduction of the
labial segment was executed almost to the level of the alveolar crest
The study was approved by the research ethics committee of the Fac- and followed by careful thinning in a mesiodistal and apical-coronal
ulty of Dentistry, Cairo University. Twenty-five patients with non- direction, performed using a long-shanked round diamond bur (Komet
restorable maxillary teeth in the esthetic zone were indicated for Dental, Germany) that shaped the shield contour concave.
implant placement. The patients were selected from the outpatient Careful socket curettage was performed to eliminate any
clinic of Oral and Maxillofacial Surgery Department, Faculty of Den- remaining tissue debris, followed by gentle probing to rule out the
tistry, Cairo University. The inclusion criteria demanded to require shield mobility. The osteotomy was directed palatal to the shield leav-
patients with an age range of 20 to 60 years, of both sexes, demon- ing a 2 mm approximate gap. The implant was inserted 2 to 3 mm api-
strating nonrestorable maxillary teeth in the esthetic zone with as far cal to the bone crest, engaging the socket's apical and palatal bony
diagnosable, fairly intact buccal periodontal tissues. Any periodontal boundaries. Immediate provisional restorations were then fabricated
phenotype (thick or thin) was included as well as the patient reveals on stock straight titanium abutments with an S-shaped emergence
ABD-ELRAHMAN ET AL. 3

F I G U R E 1 A, Decoronation of the tooth 1 mm above the gingival level. B, Separation of the labial and palatal root segments. C, Delivery of
the palatal root section

F I G U R E 2 A, Implant placed
palataly leaving a jumping gap of
approximately 2 mm. B, Final shape of
the provisional restoration showing
the S-shaped emergence profile. C,
Immediate postoperative view after
placement of the provisional
restoration

F I G U R E 3 A, Conventional atraumatic
extraction of the tooth. B, Palatal implant
placement leaving approximately 2 mm
jumping gap

profile that supports maximal soft tissue infill and were immediately Macro group, Egypt) mouthwash for 2 weeks. The patients were
loaded. (Figure 2). followed up every other day for the first week, then weekly for the
In the control group, an atraumatic extraction using periotomes first month and 6 months postoperatively.
and forceps was performed to preserve the available alveolar bone, For all the patients, CBCT scans immediately postoperatively and
then the socket was debrided gently following tooth extraction using after 6 months, aided in the assessment of the horizontal and vertical
curettes, and irrigated by physiologic saline solution. The osteotomy bone loss which represents the primary outcome of this study. The
was directed in a palatal position leaving a gap of approximately 2 mm sagittal views were plotted to measure the bone dimensional changes
between the implant and the labial plate (Figure 3). The implant was as follows: for the horizontal bone level, a line was drawn intersecting
placed 2 to 3 mm apical to the bone crest. A provisional crown was the implant apex and perpendicular to the implant shoulder. From that
then constructed chairside on stock straight titanium abutment with line, another line was drawn to the outer margin of the labial plate of
an emergence profile to support the coronal tissues (Figure 4). bone to record the horizontal bone level for each implant in both
For both groups, all the provisional crowns were relieved out of groups. For the vertical bone level, starting from the implant shoulder,
occlusion with an approximate clearance of 1 mm, and the patients perpendicular lines were drawn to the bone crest labially and palatally
were instructed to avoid functional overloads. and the average was recorded for each implant in both groups
Postoperative medications included oral antibiotic, a dose of 1 g (Figure 5). The difference between horizontal bone levels immediately
twice daily for 5 days (Amoxicillin/Clavulanic acid [Augmentin 1 g tab., postoperatively and 6 months postoperatively calibrated the horizon-
Pfizer, United States of America]) and an oral analgesic, a dose of tal bone loss. The same modality was repeated to calculate the vertical
400 mg three times daily for 5 days (Ibuprofen [Brufen 400MG 30tab. bone loss.
Abbott/Cairo, Egypt]). The patients followed strict oral hygiene mea- The secondary outcomes included the assessment of the implant
sures and regular rinsing of Chlorohexidine 0.2% (Orovex mouthwash, stability which was measured immediately after implant placement
4 ABD-ELRAHMAN ET AL.

F I G U R E 4 A, Final shape of the provisional

restoration showing the S-shaped emergence
profile. B, Immediate postoperative view after
placement of the provisional restoration

F I G U R E 5 Showing horizontal
(H) and vertical (V) bone level in study
and control groups immediately
postoperative and 6 month later. A,
H&V bone level in study group
immediately postoperative. B, H&V
bone level in study group post
6 month. C, H&V bone level in control
group immediately postoperative. D,
H&V bone level in control group post
6 month. The red arrow shows the
line representing the shoulder of the
implant and the blue arrow shows the
line intersecting the implant apex

and 6 months postoperatively, using a resonance frequency analysis Shapiro-Wilk tests). Implant stability quotient (ISQ) data showed nor-
device (Osstell, W&H, UK), and the PES evaluation, immediately post- mal (parametric) distribution while amounts of bone loss and PESs
operative and 6 months postoperatively, using the PES scoring system data showed nonparametric distribution. Numerical data were pres-
11
for dental implants; introduced by Furhauser in 2005. ented as mean, SD (SD), and 95% Confidence Interval for the mean
(95% CI) values. Nonparametric data were presented as median and
range values. For parametric data, Two-way repeated measures
2.1 | Statistical methods ANOVA test was used to compare between the groups as well as to
study the changes by time within each group. Bonferroni's post hoc
Numerical data were explored for normality by checking the distribu- test was used for pair-wise comparisons when ANOVA test is signifi-
tion of data and using tests of normality (Kolmogorov-Smirnov and cant. For nonparametric data, Wilcoxon signed-rank test was used to
ABD-ELRAHMAN ET AL. 5

compare between the two groups as well as to study the changes by 3 | RE SU LT S

time within each group. The significance level was set at P ≤ 0.05. Sta-
tistical analysis was performed with IBM SPSS Statistics for Windows, Twenty-five patients (14 females and 11 males) were included in the
Version 23.0. Armonk, NY: IBM Corp. study with an age range of 21 to 39 (30.9 ± 5.5). A total of 40 implants

TABLE 1 Demographic data

Treatment Group Site No. Patient No. Age Sex Tooth Restored Total No. of Placed Implants
Socket shield group 3 3 32 F 22 1
4 4 28 F 11 2
5 4 28 F 21 2
6 5 34 M 21 1
10 8 37 M 12 3
11 8 37 M 11 3
14 10 25 F 11 2
16 12 30 M 13 1
19 14 24 M 21 1
20 15 23 F 11 2
21 15 23 F 12 2
23 16 27 F 21 2
25 17 29 F 22 2
27 19 32 M 24 2
31 21 38 M 12 3
32 21 38 M 13 3
33 22 36 M 22 1
36 23 35 F 22 3
37 24 25 M 11 2
39 25 30 F 21 2
Conventional immediate implant group 1 1 31 M 21 1
2 2 27 F 11 1
7 6 29 F 22 1
8 7 39 M 11 1
9 8 37 M 22 3
12 9 26 F 24 1
13 10 25 F 21 2
15 11 28 M 11 1
17 13 21 M 11 2
18 13 21 M 21 2
22 16 27 F 11 2
24 17 29 F 12 2
26 18 30 F 13 1
28 19 32 M 23 2
29 20 36 F 21 1
30 21 38 M 11 3
34 23 35 F 12 3
35 23 35 F 13 3
38 24 25 M 22 2
40 25 30 F 23 2
6 ABD-ELRAHMAN ET AL.

FIGURE 6 CONSORT flow

diagram

F I G U R E 7 A, Socket shield
preparation and implants placement
(study group). B, Immediate postoperative
view after placement of the provisional
restoration (study group)

were placed (20 implants in each group) (Table 1, Figure 6). The no. 11, fortunately, the internal shield exposure was minute with no
healing went uneventful throughout the cases, all of the implants inflammatory signs, hence no corrective treatment was required
were properly osseointegarated and successfully received final pros- (Figure 8). The radiographic interpretation was emphasized to mea-
thesis after 6 months postoperatively (Figure 7). None of the cases sure the horizontal and vertical bone loss for both groups. For the
showed external shield exposure, however, an internal shield expo- study group, the horizontal bone loss for the labial plate after
sure was detected in one surgical site; related to a tooth position 6 months ranged from 0 to 0.26 mm with a median value of 0.15 mm
ABD-ELRAHMAN ET AL. 7

F I G U R E 8 A, Occlusal view showing

emergence profile after removal of provisional
restoration (study group). B, Final prosthesis in
place (study group)

F I G U R E 9 A, Occlusal view after implant

placement intraoperatively. B, Significant
reduction in the labial contour for the control
group (black arrow) in comparison to the study
group (red arrows)

and the vertical bone loss ranged from 0.11 to 0.55 mm with a median immediate temporization to the conventional immediate implant
value of 0.31 mm. While for the control group, the horizontal bone placement with immediate temporization.
loss after 6 months ranged from 0.03 to 0.44 mm with a median value The case selection in the study was crucial, as any shield move-
of 0.32 mm and the vertical bone loss ranged from 0.25 to 1.51 mm ment during its preparation would complicate or even induce a failed
with a median value of 0.7 mm. The horizontal and vertical bone loss intervention, which demanded to limit the selected teeth into those
within each group was statistically significant. Additionally, the differ- nonrestorable or with horizontal fractures above the level of the bone
ence in horizontal and vertical bone loss between both groups was crest, excluding the badly decayed teeth and those with root caries, as
statistically significant (Figure 9). it would be difficult to prepare the shield and remove the palatal seg-
The mean implant stability value of the study group recorded ment of the root without dislodging the shield in the process.
68.6 ± 3.81 ISQ immediately postoperatively and increased to 76.7 Gluckman et al13 prepared the socket shield as far apical as possi-
± 3.49 ISQ 6 months postoperatively. While for the control group, it ble using long shank root resection bur, while Baumer et al14 reported
recorded 66.4 ± 5.64 ISQ immediately postoperatively and increased leaving only the coronal part of the labial shield. In our study, the
to 75.5 ± 4.4 ISQ after 6 months. shield was prepared according to Gluckman recommendations since it
The PES for the study group ranged from 10 to 14 with a median is more predictable, reproducible, and of low risk for the labial plate
value of (11) immediately postoperatively and ranged from 11 to fenestration compared to the technique described by Baumer.
14 with a median value of (12) 6 months postoperatively. While for Hurzeler et al,7 in 2010, Gluckman et al,15 in 2015, as well as
the control group, it ranged from 11 to 14 with a median value of Baumer et al,14 in 2017, recommended the shield to be reduced 1 mm
(13) immediately postoperatively and ranged from 6 to 11 with a above the labial bone crest in order to preserve the supracrestal mar-
median value of (9) 6 months postoperatively. The difference in PES ginal gingival fibers. In 2018, Gluckman et al9 reported in a retrospec-
between the immediate and the 6 months postoperative was signifi- tive evaluation of 128 socket shield cases that the most common
cant in the control group (P < 0.001) as well as in the study group complication was the internal exposure of the shield, followed by the
(P = 0.005). (Table 2, Figure 10). external exposure of the shield. In 2019, Gluckman et al10 reported
preparing the shield to the level of the labial bone crest using a gingi-
val retractor to overcome the shield exposure complications accompa-
4 | DISCUSSION nied with the previous technique. In our study, the shield was
prepared as close as possible to the level of the labial bone crest with
The root submergence technique was first introduced in the 1970s by the aid of magnifying loupes. Trying to be as minimally invasive as
Casey and Lauciello.8 Salama et al12 later used root submergence as a possible, we did not use gingival retractors as it might injure the peri-
method to preserve the alveolar ridge dimensions in pontics of fixed odontal ligaments and cause minute lacerations in the adjacent
7
partial dentures. Hurzeler et al was the first to introduce the root papilla.
retention therapy to the implant field and named it the socket shield Baumer et al,14 in 2017, recommended preparation of the implant
technique. This study is comparing the socket shield technique with bed through the tooth before the shield preparation and reported that
8 ABD-ELRAHMAN ET AL.

TABLE 2 Results for vertical and horizontal bone loss, ISQ, and PES in the studied groups at different time intervals

A. Bone Loss

Bone loss Study Group (n = 20) Control Group (n = 20) P-value Effect Size (d)
Horizontal bone loss 0.002a 1.993
Median (range) 0.15 (0–0.26) 0.32 (0.03–0.44)
Mean (SD) 0.12 (0.07) 0.28 (0.15)
Vertical bone loss <0.001a 2.676
Median (range) 0.31 (0.11–0.55) 0.7 (0.25–1.51)
Mean (SD) 0.34 (0.12) 0.77 (0.35)

B. Implant Stability Quotient

Time Study Group (n = 20) Control Group (n = 20) P-value Effect Size (Partial Eta Squared)
Immediate 0.212 0.081
Mean (SD) 68.6 (3.81) 66.4 (5.64)
95% CI 66.82-70.38 63.75-69.04
6 months 0.349 0.046
Mean (SD) 76.71 (3.49) 75.5 (4.4)
95% CI 75.07-78.34 73.44-77.55
P-value <0.001a <0.001a
Effect size (partial eta squared) 0.875 0.717

C. Pink Esthetic Score

Time Study Group (n = 20) Control Group (n = 20) P-value Effect Size (d)
Immediate 0.026a 1.144
Median (range) 11 (10–14) 13 (11–14)
Mean (SD) 11.45 (1.54) 12.6 (1.19)
6 months <0.001a 2.567
Median (range) 12 (11–14) 9 (6-11)
Mean (SD) 12 (1.12) 8.85 (1.81)
P-value 0.005a <0.001a
Effect size (d) 1.644 3.720

Significant at P ≤ 0.05.
a

F I G U R E 1 0 A, Immediate
postoperative view after placement
of the provisional restoration (control
group). B, Final prosthesis in place
(control group)

utilizing new implant drills and keeping the drills stable in vertical drilling through the tooth since it requires new drills for each
direction reduced the risk for heat generation and dislodgement of intervention.
the root segment. On contrary, the shield was prepared in the present Hurzeler et al,7 in 2010, assessed the connection between the
study followed by implant bed preparation as in the original technique implant and tooth shield histologically, he reported cementum forma-
reported by Hurzeler et al,7 which avoids heat generation and possible tion at the contact areas between the implant and root surfaces.
shield dislodgment as well as the added cost that can result from Which has been confirmed by Mitsias et al,16 in 2017, as they
ABD-ELRAHMAN ET AL. 9

revealed cementum formation between the apical part of the shield inflammation, this agrees with Gluckman et al9 retrospective study, in
and the implant surface due to close proximity between both surfaces, 2018, where he found the most common complication of socket
vs bone formation in the middle part where the shield and the implant shield technique to be the internal shield exposure followed by the
did not merge. That is why in our study the implant was palatally external shield exposure and his management ranged from no treat-
placed to maintain a jumping gap of approximately 2 mm between the ment and observation, in case of internal shield exposure showing no
shield and the implant to allow room for new bone formation. signs of inflammation, to shield reduction in case of inflammation.
15 17
Gluckman et al and Abadzhiev et al reported grafting the In the present study, the median and range of the PES of the con-
jumping gap with xenogeneic bone particulate. While Mitsias et al16 in trol group was 13 (11-14) immediately and decreased to 9 (6-11) after
an in vivo histological study did not graft the gap. They reported that 6 months, while the median and range of the PES for the study group
after 5 years of implant loading following graftless socket shield, the was 11 (10-14) immediately and increased to 12 (11-14) after
patient was a victim of a serious car accident and suffered from multi- 6 months. The PES results of the socket shield group agree with the
ple fractures of the craniomaxillofacial region. In the context of a max- PES reported by Baumer et al,14 in 2017, where he reported a mean
illofacial surgical intervention for repositioning and recomposing the PES of 12. The decrease in the control group compared to the
fractured bones, it was necessary to remove a small maxillary bone increase in the study group can be attributed to increased horizontal
portion that also included the area of the implant. This area appeared and vertical bone loss in the control group compared to the study
intact; therefore, the fixture and the surrounding hard tissues were group, which leads to reduced labial contour and incomplete papilla in
subjected to histologic examination. In his histological examination, some cases of the control group.
they reported a bone-implant contact of 76.2%, and noninfiltrated
connective tissue in the most coronal threads between the implant
and the shield, which was attributed to the absence of grafting mate- 5 | CONC LU SION
rials. In this study, the jumping gaps were not filled with xenogeneic
bone particulate to minimize the variables affecting the bony dimen- The socket shield technique is a reliable technique to be combined
sional changes. with immediate implant placement in the esthetic zone. However, it
The temporary crown was fabricated chairside with an S-shaped is a sensitive technique that needs the practice to be executed
emergence profile to allow for maximum infill of the coronal soft properly.
tissue around the interim and definitive restoration as reported by
Gluckman et al.10 This technique of temporization allowed for soft tis- ACKNOWLEDG MENTS
sue stability and high PESs during the follow-up. The authors thank Dr. Amr Gibaly, Lecturer of Oral and Maxillofacial
The mean ISQ for the control group was 66.4 ± 5.64 and Surgery, Beni-Suef University, for his significant contribution to this
increased to 75.5 ± 4.4 after 6 months, while it was 68.6 ± 3.81 for study.
the study group and increased to 76.7 ± 3.49 after 6 months. These
results agree with Degidi et al18 study in 2010, who reported that all CONFLIC T OF INT ER E ST
the implants with an initial ISQ below 46 ISQ failed, while those with The authors declare no conflicts of interest.
ISQ over 60, showed successful osseointegration.
The range of the horizontal bone loss for the control group was AUTHOR CONTRIBU TIONS
0.03 to 0.44 mm and was 0 to 0.26 mm for the study group while the Study design, data collection, analysis, and interpretation: AA and MA
range of the vertical bone loss for the control group was 0.25 to with support from MS and NA. Manuscript drafting/proofreading: MS
1.51 mm and was 0.11 to 0.55 mm for the study group. This clearly and NA with input from AA and MA. Critical revision: MS, AA, NA,
shows the difference in tissue stability between the socket shield and and MA. Providing general advice on the study: NA, MA, MS, and AA.
the conventional immediate implant placement. The horizontal and
vertical bone loss results for the socket shield group are comparable
OR CID
to the results reported by Chen and Pan,19 in 2013, where they
Ahmed Abd-Elrahman https://orcid.org/0000-0001-9495-6043
reported 0.72 mm of buccal bone resorption. Abadzhiev et al,17 in Mostafa Shaheen https://orcid.org/0000-0002-9760-2619
2014, reported 0.8 mm bone loss. Baumer et al,20 in 2015, reported a Mohammed Atef https://orcid.org/0000-0003-4849-6626
mean of 1 mm horizontal loss after final restoration. Baumer et al,14 in
2017, reported that the marginal bone loss changes at the mesial and RE FE RE NCE S
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