Modified socket shield technique versus unassisted socket healing: A randomized controlled clinical trial using CBCT-based dimensional analysis.

Abstract

Background: Tooth loss leads to alveolar bone resorption due to deficiency of blood supply and socket shield technique was introduced to prevent this bone loss. Therefore, this study aimed to evaluate the effect of the modified socket shield technique (mSST) without immediate implant placement (test group) compared with unassisted socket healing (USH) (control group) on vertical and horizontal bone dimensional changes.

Material and methods: Patients requiring dental extraction at a non-molar site were recruited and randomly allocated to the test or control group. Cone-beam computed tomography (CBCT) scans obtained before and 4 months after surgery were superimposed to assess horizontal ridge width and vertical bone height changes. Group comparisons were performed using analysis of covariance (ANCOVA).

Results: Significant differences between the groups were found for buccal height (BH) reduction (p<0.001), buccal bone width (BW) reduction at 1mm, 3mm and 5mm (p<0.001), and overall bone resorption (p<0.001). The test group showed reduced dimensional changes, with mean differences of 1.527mm in BH, 0.982mm in BW1, 0.783mm in BW3, 0.545mm in BW5, and 26.2mm³ in volume resorption (p<0.001). No significant differences were observed in vertical or horizontal bone resorption on the lingual side. Regarding the influence of buccal bone thickness (BBT) on buccal socket dimensional changes, significant differences between groups were detected. A critical threshold of 1.5mm BBT was identified.

Conclusions: The modified socket shield technique without immediate implant placement appears to be a protective factor against post-extraction bone remodeling, particularly in sites with buccal bone thickness less than 1.5mm.