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

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 (I² = 99%). The mean pink esthetic score was 12.27 (Q test = 4.47; p-value = 0.61; I² = 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; I² = 44%). The follow-up time was found to be significant (beta coefficient = 0.023; R² = 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.

Keywords: immediate implant; implant failure; marginal bone loss; pink esthetic; socket shield.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

Figure 2

Forest plot of the meta-analysis of implant failure with immediate dental implant placement using the socket-shield technique.

Figure 3

Forest plot of the rates of dental implant failure (odds ratio) for immediate dental implant placement using the socket-shield technique in the esthetic zone and conventional immediate dental implant placement.

Figure 4

Initial funnel plot and plot after trim and fill adjustment of the dental implant failure of the socket-shield technique for dental immediate implant placement in the esthetic zone.

Figure 5

Forest plot of the mean difference in marginal bone loss (mm) between immediate dental implant placement using the socket-shield technique and conventional placement technique.

Figure 6

Initial funnel plot and plot after trim and fill adjustment of the mean difference in bone loss (mm) for the immediate dental implant placement in the esthetic zone using the socket-shield technique.

Figure 7

Forest plot of the mean PES of immediate dental implant placement using the socket-shield technique in the esthetic zone.

Figure 8

Forest plot of the mean difference in PES between immediate dental implant placement using the socket-shield technique and conventional technique in the esthetic zone.

Figure 9

Bubble plot of follow-up time as a covariate of the PES for the immediate dental implant placement using the socket-shield technique in the esthetic zone.

Figure 10

Initial funnel plot and plot after trim and fill adjustment of the mean difference in PES for the immediate dental implant placement using the socket-shield technique in the esthetic zone.