Dental implants in fresh extraction sockets of the maxillary esthetic area are technique‑sensitive procedures where retaining a buccal root segment can enhance periodontium preservation and esthetics. This study aims to compare marginal bone levels and esthetic outcomes between conventional immediate implant placement and the socket‑shield technique in fresh maxillary extraction sockets. Twenty‑four patients with type 1 extraction sockets were included in this randomized trial and assigned to either conventional immediate implant placement or the socket‑shield technique. Implant survival, crestal bone levels, and pink esthetic scores (PES) were evaluated at 8 months (temporary prosthesis), 12 months, and 36 months (final crowns). All implant‑supported restorations were successful within the study’s observation period. The socket‑shield technique showed significantly lower marginal bone loss (e.g. 1.40 ± 0.29 mm vs. 1.70 ± 0.36 mm at 36 months; P = 0.040) and superior PES (e.g., 10.50 ± 0.90 vs. 9.36 ± 0.98 at 36 months; P = 0.008) compared to the conventional technique. However, the technique’s complexity underscores the need for expertise and careful execution to optimize tissue preservation in the maxillary esthetic zone. The socket‑shield technique better preserves hard and soft tissues around implant‑retained prostheses than conventional implant placement in maxillary esthetic regions. Further studies with larger sample sizes and longer follow‑up are required to validate these findings.
