Citation Information :
Salem AS, Mowafey B, El-Negoly SA, Grawish ME. Socket-shield Technique vs Conventional Immediate Implant Placement for Esthetic Rehabilitation: A Systematic Review and Meta-analysis. J Contemp Dent Pract 2022; 23 (2):237-244.
Aim: The present systematic review and meta-analysis (SR/MA) aimed to test the null hypothesis that there is no difference between socket-shield technique (SST) and conventional immediate implant placement (CIIP) as an esthetic rehabilitation option for permanent human anterior teeth, against the alternative one of a difference.
Background: Socket-shield technique is considered as a highly promising procedure that has the potential to prevent resorption of anterior alveolar ridges, maintains white and pink esthetics, and provides a solution for esthetically critical cases. Controlled randomized clinical trials (RCT) and nonrandomized ones had been identified by searching the following databases: Google Scholar, Scopus, and PubMed. Literature search was determined from January 2010 up to June 2020. Hand searches were also accomplished for relevant abstracts, books, and reference lists. The eligibility criteria included prospective observational controlled RCTs and non-RCTs. Populations: patients with endodontically treated/nonrestorable permanent mature anterior teeth indicated for extraction. Interventions: the sockets were subjected to immediate implant placement using SST. Controls: implants placed with SST compared with those of CIIP. Outcome: the pink esthetic score measured for esthetic rehabilitation. To assess article quality, the Cochrane risk-of-bias tool was used by two independent authors. The data across quantitative studies were analyzed using comprehensive MA software.
Review results: The initial search found out 172 references through the search strategy and three additional ones were recognized through hand searching. After being filtered, 101 references were screened and recorded. After the inclusion and exclusion criteria were applied, only seven unduplicated prospective controlled RCTs and non-RCTs were involved in the quantitative MA. At the 6-month evaluation period, the total standard difference in mean was 1.07 and I2 test value measuring heterogeneity was 77.182, whereas at the 12-month period, the total standard difference in mean was 1.43 and I2 test value measuring heterogeneity was 64.914.
Conclusion: SST had a positive effect on the esthetic rehabilitation for anterior teeth better than CIIP. However, this conclusion was dependent on a very few well-conducted prospective RCT and non-RCT. Further RCTs with longer observational time, proper methodology, and of larger sample size are still required to adequately answer the question of the present SR.
Clinical significance: There is limited knowledge about the appropriateness of SST in the field of implant dentistry, specifically for esthetic consideration. This SR/MA confirmed the positive effect of the SST over CIIP for esthetic rehabilitation for anterior teeth.
Systematic review registration: PROSPERO, identifier CRD42020194086.
Kumar PR, Kher U. Shield the socket: procedure, case report and classification. J Indian Soc Periodontol 2018;22(3):266–272. DOI: 10.4103/jisp.jisp_78_18.
Dayakar MM, Waheed A, Bhat HS, et al. The socket-shield technique and immediate implant placement. J Indian Soc Periodontol 2018;22(5):451–455. DOI: 10.4103/jisp.jisp_240_18.
Viña-Almunia J, Candel-Martí ME, Cervera-Ballester J, et al. Buccal bone crest dynamics after immediate implant placement and ridge preservation techniques: review of morphometric studies in animals. Implant Dent 2013;22(2):155–160. DOI: 10.1097/ID.0b013e318287a947.
Gluckman H, Salama M, Du Toit J. Partial extraction therapies (PET) part 2: procedures and technical aspects. Int J Periodontics Restorative Dent 2017;37(3):377–385. DOI: 10.11607/prd.3111.
Gluckman H, Salama M, Du Toit J. Partial extraction therapies (PET) part 1: maintaining alveolar ridge contour at pontic and immediate implant sites. Int J Periodontics Restorative Dent 2016;36(5):681–687. DOI: 10.11607/prd.2783.
Salama M, Ishikawa T, Salama H, et al. Advantages of the root submergence technique for pontic site development in esthetic implant therapy. Int J Periodontics Restorative Dent 2007;27(6): 521–527. DOI: 10.11607/prd.00.0775.
Gluckman H, Du Toit J, Salama M. The pontic-shield: partial extraction therapy for ridge preservation and pontic site development. Int J Periodontics Restorative Dent 2016;36(3):417–423. DOI: 10.11607/prd.2651.
Kumar T, Kulkarni S, Kher U. Pontic site management. In: Kher U, Tunkiwala A, editors. Partial extraction therapy in implant dentistry. Springer, Cham; 2020. p. 159–189. DOI: 10.1007/978-3-030-33610-3_7.
Saeidi Pour R, Zuhr O, Hürzeler M, et al. Clinical benefits of the immediate implant socket shield technique. J Esthet Restor Dent 2017;29(2):93–101. DOI: 10.1111/jerd.12291.
Hürzeler MB, Zuhr O, Schupbach P, et al. The socket-shield technique: a proof-of-principle report. J Clin Periodontol 2010;37(9):855–862. DOI: 10.1111/j.1600-051X.2010.01595.x.
Bäumer D, Zuhr O, Rebele S, et al. Socket shield technique for immediate implant placement–clinical, radiographic and volumetric data after 5 years. Clin Oral Implants Res 2017;28(11):1450–1458. DOI: 10.1111/clr.13012.
Kher U, Rajender Kumar P. Variations of the socket shield procedure. In: Kher U, Tunkiwala A, editors. Partial extraction therapy in implant dentistry. Springer, Cham; 2020. p. 129–158. DOI: 10.1007/978-3-030-33610-3_6.
Elaskary A. Advances in esthetic implant dentistry. John Wiley & Sons; 2018. DOI: 10.1002/9781119286707.
Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomized trials. BMJ 2011;343:d5928. DOI: 10.1136/bmj.d5928.
Bramanti E, Norcia A, Cicciù M, et al. Postextraction dental implant in the aesthetic zone, socket shield technique versus conventional protocol. J Craniofac Surg 2018;29(4):1037–1041. DOI: 10.1097/SCS.0000000000004419.
Sun C, Zhao J, Liu Z, et al. Comparing conventional flap-less immediate implantation and socket-shield technique for esthetic and clinical outcomes: a randomized clinical study. Clin Oral Implants Res 2020;31(2):181–191. DOI: 10.1111/clr.13554.
Abd-Elrahman A, Shaheen M, Askar N, et al. Socket shield technique vs conventional immediate implant placement with immediate temporization. Randomized clinical trial. Clin Implant Dent Relat Res 2020;22(5):602–611. DOI: 10.1111/cid.12938.
Xu YM, Huang H, Wang L, et al. Comparison of clinical effects of a modified socket shield technique and the conventional immediate implant placement. Hua Xi Kou Qiang Yi Xue Za Zhi 2019;37(5): 490–495. DOI: 10.7518/hxkq.2019.05.007.
Mathew L, Manjunath N, Anagha NP, et al. Comparative evaluation of socket shield and immediate implant placement. IJISRT 2020;5(4):1364–1369. https://www.ijisrt.com/assets/upload/files/IJISRT20APR879.pdf.
Fattouh H. Socket-shield technique versus guided bone regeneration technique for ridge preservation with immediate implant placement in the esthetic zone. Egypt Dent J 2018;64(3):2047–2055. DOI: 10.21608/edj.2018.76748.
Hana SA, Omar OA. Socket shield technique for dental implants in the esthetic zone, clinical and radiographical evaluation. J UoD 2020;23(1):69–80. DOI: 10.26682/sjuod.2020.23.1.8.
Blaschke C, Schwass DR. The socket-shield technique: a critical literature review. Int J Implant Dent 2020;6(1):52. DOI: 10.1186/s40729-020-00246-2.
Cohen J. Statistical power analysis for the behavioral sciences. New York: Academic Press; 1977. DOI: 10.1016/c2013-0-10517-x.
Tan Z, Fu G, Wen JR, et al. Clinical application and evaluation of socket shield technique. Zhonghua Kou Qiang Yi Xue Za Zhi 2020;55(11): 851–856. DOI: 10.3760/cma.j.cn112144-20200613-00342.
Tiwari S, Bedi RS, Wadhwani P, et al. Comparison of immediate implant placement following extraction with and without socket-shield technique in esthetic region. J Maxillofac Oral Surg 2020;19(4): 552–560. DOI: 10.1007/s12663-019-01272-3.
Durrani F, Painuly H, Shukla A, et al. Socket shield: an esthetic success? J Indian Soc Periodontol 2020;24(3):289–294. DOI: 10.4103/jisp.jisp_557_19.
Stangl DK, Berry DA. Meta-analysis in medicine and health policy. New York, NY: 2000. DOI: 10.1201/9780203909935.
Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557–560. DOI: 10.1136/bmj.327.7414.557.
Staehler P, Abraha SM, Bastos J, et al. The socket-shield technique: a step-by-step protocol after 12 years of experience. Int J Esthet Dent 2020;15(3):288–305. PMID: 32760924.
Melsen WG, Bootsma MC, Rovers MM, et al. The effects of clinical and statistical heterogeneity on the predictive values of results from meta-analyses. Clin Microbiol Infect 2014;20(2):123–129. DOI: 10.1111/1469-0691.12494.
Lin X, Gao Y, Ding X, et al. Socket shield technique: a systemic review and meta-analysis. J Prosthodont Res 2022;66(2):226–235. DOI: 10.2186/jpr.JPR_D_20_00262.
Zhang A, Liu Y, Liu X, et al. Could the socket shield technique be better than conventional immediate implantation? A meta-analysis. Clin Oral Investig 2022;26(2):1173–1182. DOI: 10.1007/s00784-021-04266-z.
Gao B, Lai X, Dong Y, et al. Clinical efficacy of the socket shield technique used in the aesthetic zone: a systematic review and meta-analysis. Int J Oral Implantol (Berl) 2022;15(1):45–55. PMID: 35266668.
Ogawa T, Sitalaksmi RM, Miyashita M, et al. Effectiveness of the socket shield technique in dental implant: a systematic review. J Prosthodont Res 2022;66(1):12–18. DOI: 10.2186/jpr.JPR_D_20_00054.
Atieh MA, Shah M, Abdulkareem M, et al. The socket shield technique for immediate implant placement: a systematic review and meta-analysis. J Esthet Restor Dent 2021;33(8):1186–1200. DOI: 10.1111/jerd.12812.
Dobrescu AI, Nussbaumer-Streit B, Klerings I, et al. Restricting evidence syntheses of interventions to English-language publications is a viable methodological shortcut for most medical topics: a systematic review. J Clin Epidemiol 2021;137:209–217. DOI: 10.1016/j.jclinepi.2021.04.012.