Socket Shield Technique With CGF and Xenograft for Immediate Implants

This study is designed as a prospective case series to evaluate the effectiveness of combining concentrated growth factors (CGF) and xenograft with the socket shield technique (SST) during immediate implant placement in the maxillary esthetic region.

Post-extraction alveolar ridge resorption, particularly of the buccal bone plate, represents a significant challenge in achieving optimal esthetic outcomes. The socket shield technique has been introduced to preserve the buccal bone by retaining the labial portion of the root, thereby minimizing post-extraction resorption. However, immediate implant placement is often associated with the presence of a gap between the implant surface and the socket wall, known as the "jumping gap," which may compromise implant stability and osseointegration.

To enhance bone regeneration within this gap, bone grafting materials are commonly utilized. Concentrated growth factors (CGF), an autologous platelet concentrate, have demonstrated the ability to promote angiogenesis, osteogenesis, and soft tissue healing through the sustained release of growth factors. When combined with xenograft, which provides an osteoconductive scaffold, this approach may improve bone regeneration and implant integration.

In this study, eligible patients requiring immediate implant placement in the esthetic zone will undergo partial extraction therapy using the socket shield technique. Implants will be placed immediately after extraction, and CGF will be prepared from the patient's venous blood and mixed with xenograft to form a "sticky bone" graft, which will be applied to fill the jumping gap.

Radiographic evaluation will be performed using cone-beam computed tomography (CBCT) at 2 weeks and 6 months postoperatively to assess crestal bone level changes. Implant stability will be measured using resonance frequency analysis (Osstell device) and expressed as implant stability quotient (ISQ) values.

The findings of this study are expected to provide clinical and radiographic evidence regarding the effectiveness of combining CGF and xenograft with the socket shield technique in enhancing bone regeneration and improving outcomes of immediate implant placement in the esthetic zone.

Inclusion criteria

• Age ≥18 years old. (Younis, W., & El-Rashidy, A. 2020).
• Both male and female patients.
• Maxillary, anterior and premolar segments.

Exclusion criteria

• A medical history that contraindicates oral surgical treatment such as (uncontrolled/untreated diabetes mellitus, immuno-compromised status, radio or chemotherapy of the oral and maxillofacial region, treatment with oral and/or intravenous bisphosphonates).
• Presence of active or untreated periodontal disease.
• Vertical root fractures involving the buccal aspect.
• Tooth /teeth with horizontal fractures below bone level.
• Tooth /teeth with external or internal resorption.
• Patients with destructive oral habits such as smoking, chewing tobacco, bruxism, etcetera.