Clinical efficacy of socket shield technique compared to conventional immediate implant placement in the aesthetic zone: a meta-analysis

Abstract Objective To systematically evaluate and compare the clinical effects of the socket shield technique (SST) and conventional immediate implant placement (CIIP) in the esthetic zone through meta-analysis. Methods A systematic search was conducted in PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database (VIP), and Wanfang Database for studies comparing the clinical and aesthetic effects of SST and CIIP, with the retrieval period spanning from database inception to October 9, 2024. After independent literature screening, data extraction, and bias risk assessment were independently performed by two investigations according to inclusion and exclusion criteria. All data analyses were performed by RevMan 5.4 software. Results A total of 27 studies, including 22 randomized controlled trials and 5 non-randomized studies of interventions (NRSI), involving 1307 implants, were included in the meta-analysis. Meta-analysis demonstrated that SST significantly outperformed CIIP in reducing horizontal buccal bone loss (MD = −0.50, 95%CI [−0.60, −0.41], I2 = 97%) and vertical buccal bone loss (MD = −0.56, 95%CI [−0.64, −0.48], I = 78%), as well as improving the pink esthetic score (PES: MD = 1.25, 95%CI [0.93, 1.57], I = 90%) and implant stability quotient (ISQ: MD = 5.83, 95%CI [4.08, 7.57], I2 = 69%). No significant difference was observed in implant success rate (RR = 1.00, 95% CI [0.98, 1.02], I2 = 0%). Subgroup analyses (the height and thickness of buccal shield, bone grafting, and publication language) aligned with primary outcome (horizontal buccal bone loss), and sensitivity analysis confirmed stable results. Conclusion Based on the available evidence, SST demonstrated favorable outcomes in reducing buccal bone loss, enhancing esthetic outcomes and implant stability while maintaining comparable implant success rates to CIIP. Nevertheless, the technique exhibited technical sensitivity and a lack of standardized surgical protocols. Therefore, its clinical application should be approached with caution. Future high-quality studies with extended follow-up are required to validate long-term efficacy and establish standardized clinical guidelines.