Non-Cochrane · intervention · PM41417433
Clinical efficacy of socket shield technique compared to conventional immediate implant placement in the aesthetic zone: a meta-analysis.
Lu Wei, Du Shanshan, Su Jingtong, et al. · International journal of implant dentistry · 2025 · PubMed · doi:10.1186/s40729-025-00657-z
Findings
Population Patients requiring immediate implant placement in the esthetic zone (second premolar to second premolar)
48 findings
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Implant stability quotient (ISQ) all studies had follow-up of 12 months or less · Esthetic zone; implants as unit of analysis | MD 5.83 [4.08, 7.57] GRADE not reported 8 studies · 456 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Pink esthetic score (PES) long-term (>12 months) · Esthetic zone; implants as unit of analysis · Follow-up: long-term | MD 1.17 [0.63, 1.71] GRADE not reported 5 studies · 261 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Horizontal buccal bone loss (mm) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Bone grafting in the gap: yes | MD -0.59 [-0.75, -0.44] GRADE not reported 11 studies · 777 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Horizontal buccal bone loss (mm) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Publication language: English | MD -0.31 [-0.40, -0.22] GRADE not reported 9 studies · 300 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Horizontal buccal bone loss (mm) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Height of buccal shield: above crestal bone | MD -0.59 [-0.80, -0.38] GRADE not reported 7 studies · 536 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Horizontal buccal bone loss (mm) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Thickness of buccal shield: >1.5 mm | MD -0.66 [-0.79, -0.53] GRADE not reported 2 studies · 68 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Vertical buccal bone loss (mm) long-term (>12 months) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding studies with inconsistent bone grafting protocols; long-term | MD -0.51 [-0.57, -0.45] GRADE not reported 1 study · 40 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Horizontal buccal bone loss (mm) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Thickness of buccal shield: <=1.5 mm | MD -0.55 [-0.71, -0.40] GRADE not reported 12 studies · 803 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Horizontal buccal bone loss (mm) long-term (>12 months) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding studies with inconsistent bone grafting protocols; long-term | MD -0.62 [-0.86, -0.39] GRADE not reported 3 studies · 191 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Implant success rate long-term (>12 months) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding 5 NRSI; long-term | RR 1.01 [0.97, 1.06] GRADE not reported 3 studies · 168 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Horizontal buccal bone loss (mm) short-term (<=12 months) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding studies with inconsistent bone grafting protocols; short-term | MD -0.45 [-0.57, -0.34] GRADE not reported 14 studies · 775 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Pink esthetic score (PES) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding 5 NRSI | MD 1.22 [0.79, 1.66] GRADE not reported 16 studies · 858 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Vertical buccal bone loss (mm) short-term (<=12 months) · Esthetic zone; implants as unit of analysis · Follow-up: short-term | MD -0.58 [-0.69, -0.48] GRADE not reported 8 studies · 252 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Pink esthetic score (PES) short-term (<=12 months) · Esthetic zone; implants as unit of analysis · Follow-up: short-term | MD 1.28 [0.90, 1.65] GRADE not reported 19 studies · 846 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Implant success rate maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding studies with inconsistent bone grafting protocols | RR 1.01 [0.98, 1.03] GRADE not reported 11 studies · 641 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Horizontal buccal bone loss (mm) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis | MD -0.50 [-0.60, -0.41] GRADE not reported 22 studies · 1155 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Implant stability quotient (ISQ) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Publication language: Chinese | MD 7.31 [6.25, 8.39] GRADE not reported 4 studies · 330 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Horizontal buccal bone loss (mm) short-term (<=12 months) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding 5 NRSI | MD -0.45 [-0.55, -0.34] GRADE not reported 16 studies · 844 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Horizontal buccal bone loss (mm) short-term (<=12 months) · Esthetic zone; implants as unit of analysis · Follow-up: short-term | MD -0.48 [-0.58, -0.39] GRADE not reported 21 studies · 1057 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Implant success rate maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Publication language: English | RR 1.00 [0.96, 1.04] GRADE not reported 8 studies · 278 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Horizontal buccal bone loss (mm) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Height of buccal shield: at crestal bone level | MD -0.46 [-0.62, -0.30] GRADE not reported 7 studies · 303 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Horizontal buccal bone loss (mm) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Publication language: Chinese | MD -0.60 [-0.71, -0.48] GRADE not reported 13 studies · 855 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Vertical buccal bone loss (mm) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis | MD -0.56 [-0.64, -0.48] GRADE not reported 8 studies · 252 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Implant success rate short-term (<=12 months) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding studies with inconsistent bone grafting protocols; short-term | RR 1.00 [0.98, 1.03] GRADE not reported 8 studies · 446 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Pink esthetic score (PES) short-term (<=12 months) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding studies with inconsistent bone grafting protocols; short-term | MD 1.57 [1.07, 2.08] GRADE not reported 12 studies · 604 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Pink esthetic score (PES) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Publication language: Chinese | MD 1.10 [0.64, 1.57] GRADE not reported 10 studies · 605 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Implant success rate maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Publication language: Chinese | RR 1.01 [0.98, 1.03] GRADE not reported 10 studies · 605 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Horizontal buccal bone loss (mm) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Height of buccal shield: below crestal bone | MD -0.28 [-0.38, -0.18] GRADE not reported 5 studies · 122 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Pink esthetic score (PES) long-term (>12 months) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding 5 NRSI; long-term | MD 1.14 [0.40, 1.88] GRADE not reported 3 studies · 168 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Pink esthetic score (PES) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis | MD 1.25 [0.93, 1.57] GRADE not reported 21 studies · 1001 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Vertical buccal bone loss (mm) short-term (<=12 months) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding studies with inconsistent bone grafting protocols; short-term | MD -0.66 [-0.89, -0.42] GRADE not reported 4 studies · 120 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Implant success rate long-term (>12 months) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding studies with inconsistent bone grafting protocols; long-term | RR 1.01 [0.97, 1.05] GRADE not reported 3 studies · 195 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Pink esthetic score (PES) short-term (<=12 months) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding 5 NRSI; short-term | MD 1.24 [0.75, 1.73] GRADE not reported 15 studies · 690 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Pink esthetic score (PES) long-term (>12 months) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding studies with inconsistent bone grafting protocols; long-term | MD 1.23 [0.62, 1.85] GRADE not reported 4 studies · 231 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Implant success rate maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding 5 NRSI | RR 1.00 [0.98, 1.02] GRADE not reported 14 studies · 706 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Horizontal buccal bone loss (mm) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding studies with inconsistent bone grafting protocols | MD -0.48 [-0.60, -0.37] GRADE not reported 15 studies · 966 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Implant success rate short-term (<=12 months) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding 5 NRSI; short-term | RR 1.00 [0.98, 1.02] GRADE not reported 11 studies · 538 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Pink esthetic score (PES) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Publication language: English | MD 1.49 [0.87, 2.10] GRADE not reported 11 studies · 396 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Horizontal buccal bone loss (mm) long-term (>12 months) · Esthetic zone; implants as unit of analysis · Follow-up: long-term | MD -0.62 [-0.86, -0.39] GRADE not reported 3 studies · 191 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Implant success rate short-term (<=12 months) · Esthetic zone; implants as unit of analysis · Follow-up: short-term | RR 1.00 [0.98, 1.03] GRADE not reported 14 studies · 658 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Implant success rate maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis | RR 1.00 [0.98, 1.02] GRADE not reported 18 studies · 883 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Implant stability quotient (ISQ) all studies had follow-up of 12 months or less · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding studies with inconsistent bone grafting protocols | MD 5.51 [3.09, 7.93] GRADE not reported 6 studies · 350 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Implant success rate long-term (>12 months) · Esthetic zone; implants as unit of analysis · Follow-up: long-term | RR 1.01 [0.97, 1.05] GRADE not reported 4 studies · 225 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Implant stability quotient (ISQ) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Publication language: English | MD 3.09 [1.39, 4.80] GRADE not reported 4 studies · 126 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Vertical buccal bone loss (mm) long-term (>12 months) · Esthetic zone; implants as unit of analysis · Follow-up: long-term | MD -0.51 [-0.57, -0.45] GRADE not reported 1 study · 40 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Pink esthetic score (PES) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding studies with inconsistent bone grafting protocols | MD 1.48 [1.08, 1.89] GRADE not reported 14 studies · 835 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Vertical buccal bone loss (mm) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Sensitivity analysis: excluding studies with inconsistent bone grafting protocols | MD -0.54 [-0.64, -0.43] GRADE not reported 4 studies · 160 participants |
| Socket shield technique (SST) | Conventional immediate implant placement (CIIP) | Horizontal buccal bone loss (mm) maximum follow-up per study (short- and long-term combined) · Esthetic zone; implants as unit of analysis · Bone grafting in the gap: no | MD -0.22 [-0.30, -0.14] GRADE not reported 4 studies · 96 participants |
Included primary studies 22
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Zhang 2020 matched by author and year (probable) | NR | 3 other reviews | not stated | not extracted yet |
| Abd-Elrahman 2020 Socket shield technique vs conventional immediate implant placement with immediate temporization. Randomized clinical trial DOI:10.1111/cid.12938 | 2020 | this review only | not stated | not extracted yet |
| Abdel-Raheim 2019 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Abdullah 2022 Evaluation of soft tissue and labial plate of bone stability with immediate implant in direct contact versus gap with socket shield: A… DOI:10.1111/cid.13117 | 2022 | this review only | not stated | not extracted yet |
| Atef 2021 Comparison of the soft and hard peri‐implant tissue dimensional changes around single immediate implants in the esthetic zone with socket… DOI:10.1111/cid.13008 | 2021 | this review only | not stated | not extracted yet |
| Barakat 2017 EVALUATION OF THE SOCKET SHIELD TECHNIQUE FOR IMMEDIATE IMPLANTATION DOI:10.21608/adjalexu.2017.57919 | 2017 | this review only | not stated | not extracted yet |
| Bramanti 2018 Postextraction Dental Implant in the Aesthetic Zone, Socket Shield Technique Versus Conventional Protocol DOI:10.1097/scs.0000000000004419 | 2018 | this review only | not stated | not extracted yet |
| Fattouh 2018 Socket- shield technique versus guided bone regeneration technique for ridge preservation with immediate implant placement in the esthetic… DOI:10.21608/edj.2018.76748 | 2018 | this review only | not stated | not extracted yet |
| Hana 2020 Socket Shield Technique for Dental Implants in The Esthetic Zone, Clinical And Radiographical Evaluation DOI:10.26682/sjuod.2020.23.1.8 | 2020 | this review only | not stated | not extracted yet |
| Hu 2024 DOI:10.19528/j.issn.1003-3548.2024.03.007 | NR | this review only | not stated | not extracted yet |
| Huang 2024 DOI:10.20010/j.issn.1000-1905.2024.03.0270 | NR | this review only | not stated | not extracted yet |
| Kumar 2021 Pink esthetic and radiological scores around immediate implants placed in the esthetic zone - Socket-Shield Technique versus Immediate… PMID:34898917 | 2021 | this review only | not stated | not extracted yet |
| Li 2023 DOI:10.19338/j.issn.1672-2019.2023.01.024 | NR | this review only | not stated | not extracted yet |
| Li 2024 Comparing the modified socket‐shield technique with the conventional immediate implantation technique in the anterior dentition: A 5‐year… DOI:10.1111/clr.14281 | 2024 | this review only | not stated | not extracted yet |
| Peng 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Santhanakrishnan 2021 Radiographic and Esthetic Evaluation Following Immediate Implant Placement with or without Socket Shield and Delayed Implant Placement… DOI:10.2147/ccide.s332687 | 2021 | this review only | not stated | not extracted yet |
| Santhanakrishnan 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Sun 2020 Comparing conventional flap‐less immediate implantation and socket‐shield technique for esthetic and clinical outcomes: A randomized… DOI:10.1111/clr.13554 | 2019 | this review only | not stated | not extracted yet |
| Tiwari 2020 Comparison of Immediate Implant Placement Following Extraction with and Without Socket-Shield Technique in Esthetic Region DOI:10.1007/s12663-019-01272-3 | 2019 | this review only | not stated | not extracted yet |
| Venkatraman 2023 Comparison of Soft Tissue Volumetric Changes and Pink Esthetics After Immediate Implant Placement with Socket Shield and Conventional… DOI:10.11607/ijp.8063 | 2023 | this review only | not stated | not extracted yet |
| Xu 2019 [Comparison of clinical effects of a modified socket shield technique and the conventional immediate implant placement]. PMID:31721495 | 2019 | this review only | not stated | not extracted yet |
| Zhou 2023 DOI:10.15909/j.cnki.cn61-1347/r.005584 | NR | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients requiring immediate implant placement in the esthetic zone (second premolar to second premolar) | 1307 implants (647 SST, 660 CIIP) in 27 studies, mostly maxillary incisors and canines |
| Intervention | Socket shield technique (SST) | SST (n=27 studies) |
| Comparison | Conventional immediate implant placement (CIIP) | CIIP (n=27 studies) |
| Outcomes | Horizontal buccal bone loss (primary); vertical buccal bone loss, pink esthetic score, implant stability quotient, implant success rate (secondary) | Horizontal buccal bone loss (n=22); vertical buccal bone loss (n=8); PES (n=21); ISQ (n=8); implant success rate (n=18) |
| Study designs | RCTs and non-randomized studies of interventions | 22 RCTs and 5 NRSI |
| Timing | Short-term (<=12 months) and long-term (>12 months); minimum follow-up 3 months | Follow-up 4 to 60 months |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | No | No | yes |
| 3Choice of study designs explained | Yes | No | no |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | NRSI: No · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | Yes | No | no |
| 13Risk of bias accounted for in interpretationcritical | Yes | No | no |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |