Bone grafting in socket shield: necessary or optional for immediate implants?

A COMMENTARY ON: Gurbuz E, Ceylan E Comparison of a non-grafted socket shield technique with guided bone regeneration in immediate implant placement: a randomized clinical trial. Int J Oral Maxillofac Surg 2025; 54: 356-364. DESIGN: This randomised clinical trial compared the outcomes of a non-grafted socket shield technique (SST) versus guided bone regeneration (GBR) in immediate dental implant placement within the maxillary aesthetic zone, evaluating clinical, aesthetic, and radiographic outcomes over a 1-year period. CASE SELECTION: Participants were adults with a single unrestorable tooth in the maxillary anterior region requiring extraction and immediate implant placement. A total of 24 patients completed the study, with 12 allocated to each group (SST and GBR), following exclusions due to complications such as shield mobility or incomplete follow-up. DATA ANALYSIS: Clinical parameters (peri-implant pocket depth, plaque and bleeding indices, keratinized mucosa width, and mucosal thickness) and radiographic measures (horizontal and vertical bone levels) were assessed at baseline and 1-year post-procedure. Aesthetic outcomes were evaluated using the pink aesthetic score (PES). Statistical comparisons employed t tests and Mann-Whitney U-tests, with significance set at P < 0.05. RESULTS: At 1 year, no notable differences emerged between SST and GBR groups in terms of peri-implant health (pocket depth, plaque, bleeding) or bone stability (horizontal and vertical bone levels). However, the SST group exhibited significantly wider keratinized mucosa (P = 0.013) and superior aesthetic outcomes, with higher PES scores (P = 0.004), compared to the GBR group. CONCLUSIONS: Both SST and GBR proved effective in maintaining hard tissue integrity during immediate implant placement in the aesthetic zone. The SST, however, offered advantages in soft tissue preservation and aesthetic enhancement, suggesting it as a viable alternative to GBR for single-tooth replacements in this region.