Case report: immediate implant placement in the esthetic zone using the socket shield technique

The patient presented with a fracture of tooth 21. Clinical examination revealed a retained root remnant at the gingival level. CBCT analysis showed a periapical lesion, inadequate endodontic filling, and a buccally positioned root segment with preserved attachment to the buccal bone plate.

The treatment plan included the socket shield technique, immediate implant placement, and simultaneous enucleation of the periapical lesion. After preparation of the socket shield, an apical approach was performed through a separate surgical field, allowing resection of the root apex together with complete enucleation of the periapical lesion.

An ​MegaGen​ AnyRidge 4.0 × 11.5 mm implant was placed immediately, achieving primary stability of more than 45 Ncm. The remaining gap was grafted using a combination of PRF and xenograft material. A customized composite healing abutment was fabricated chairside to support the peri-implant soft tissue architecture.

Seven days later, a provisional PMMA crown was delivered. The patient wore this provisional restoration for 8 weeks, allowing controlled development of the emergence profile before fabrication of the definitive prosthetic restoration.

The provisional crown successfully shaped the emergence profile, with full preservation of the peri-implant mucosal contours and no visible horizontal or vertical soft tissue collapse. The final restoration was a screw-retained single zirconia-ceramic crown on a Ti-base.

Radiographic evaluation confirmed an ideal implant position and the presence of the retained socket shield segment. With careful surgical and prosthetic planning, and precise laboratory work, the final crown was able to closely mimic tooth 11, resulting in a highly natural and esthetic outcome.

Dr. Kemal Hairlahović

Dental Hairlahović Tuzla

Bosnia and Herzegovina