Failure Rate, Marginal Bone Loss, and Pink Esthetic with Socket-Shield Technique for Immediate Dental Implant Placement in the Esthetic Zone. A Systematic Review and Meta-Analysis

SIMPLE SUMMARY: The socket-shield technique has been proposed for preserving the bone ridge and surrounding soft tissues with immediate implantation in the extraction socket, maintaining the buccal wall fragment of the dental root. However, the socket-shield technique has not been compared with the conventional technique for immediate dental implant placement in the esthetic zone regarding the failure rate, marginal bone loss, and pink esthetic. Therefore, it is necessary to develop a systematic review and meta-analysis that provides evidence associated with the prognosis when using the socket-shield technique compared to the conventional technique. ABSTRACT: Aim: To compare the failure rate, marginal bone loss, and pink esthetic for the socket-shield technique and the conventional technique for immediate dental implant placement in the esthetic zone. Material and methods: A systematic literature review and meta-analysis, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, of clinical studies that evaluated the failure rate, marginal bone loss, and pink esthetic with the socket-shield technique for immediate dental implant placement in the esthetic zone was performed. A total of 4 databases were consulted in the literature search: PubMed-MEDLINE, Scopus, Embase, and Web of Science. After eliminating duplicated articles and applying the inclusion criteria, 16 articles were selected for the qualitative and quantitative analysis. Results: Four randomized controlled trials, five prospective clinical studies, four retrospective studies, and three case series were included in the meta-analysis. The dental implant failure rate for the socket-shield technique for immediate dental implant placement was 1.37% (95% CI, 0.21–2.54%); however, no statistically significant differences between the conventional and socket-shield technique were found. The estimated mean difference in the marginal bone loss for the socket-shield technique was −0.5 mm (95% CI, −0.82 to −0.18) and statistically significant (p < 0.01), with a high heterogeneity (I(2) = 99%). The mean pink esthetic score was 12.27 (Q test = 4.47; p-value = 0.61; I(2) = 0%). The difference in pink esthetic between the conventional (n = 55) and socket-shield techniques (n = 55) for immediate dental implant placement was 1.15 (95% CI, 0.73–1.58; Q test = 8.88; p value = 0.11; I(2) = 44%). The follow-up time was found to be significant (beta coefficient = 0.023; R(2) = 85.6%; QM = 3.82; p = 0.049) for the PES for the socket-shield technique. Conclusions: Within the limitations of this systematic review with meta-analysis, the dental implant failure rate did not differ between the socket-shield technique and conventional technique for immediate implant placement in the esthetic zone. However, a lower marginal bone loss and higher pink esthetic scores were found for the socket-shield technique compared to the conventional technique.