Fully Digital Immediate Implantation in the Esthetic Zone Using the Socket Shield Technique, a Novel Trephine Guide,...

The socket-shield technique (SST) aims to limit post-extraction remodeling by preserving the buccal root fragment and its periodontal attachment apparatus; however, the procedure remains technique-sensitive, particularly during root preparation. This Short Communication presents a digitally guided workflow integrating guided socket-shield preparation and immediate implant placement using the same CAD/CAM surgical guide incorporating a dedicated guiding sleeve.

The protocol was clinically applied in a 45-year-old female patient with a subgingival fracture of the maxillary right central incisor that precluded both conservative and prosthetic restoration. Digital planning was based on superimposed CBCT and intraoral scan datasets. Guided preparation of the buccal root fragment was followed by immediate implant placement, placement of a transmucosal CONNECT abutment, and immediate provisionalization. The provisional restoration was used to condition the peri-implant soft tissues, and its transmucosal contour was subsequently transferred unchanged to the definitive restoration without an additional intraoral scan or conventional impression.

Clinical and radiographic follow-up over 5 years demonstrated stable peri-implant soft tissues and bone levels without treatment-related complications.

This single clinical application supports the feasibility of the proposed digitally guided protocol. Further prospective comparative studies are required to assess root-preparation accuracy, reproducibility, and clinical benefits.

The use of a dedicated guiding sleeve enables socket-shield root preparation and immediate implant placement to be integrated within a single digitally planned surgical workflow.