Socket Preservation Combined with Early Implant Placement in the Anterior Esthetic Zone: A Systematic Review
Anh Dinh Viet Vu, Huyen Thanh Nguyen, Nguyen Phu Thang, Do Hoang Viet, Vu Thi Thu TrangAbstract
Background:
Extracting teeth in the anterior esthetic zone triggers rapid horizontal and vertical bone resorption. This tissue loss is particularly severe in the thin buccal plate, frequently jeopardizing final implant alignment and clinical esthetics. Combining socket preservation with early implant placement protocols is a clinical strategy designed to limit this post-extraction collapse and maintain peri-implant tissue stability.
Objective:
This study systematically reviews how socket preservation combined with early or immediate implant placement performs clinically in the anterior maxilla. The analysis focuses primarily on implant survival, marginal bone loss (MBL), esthetic scores, and complication rates.
Methods:
This systematic review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses 2020 guidelines. Electronic searches were performed in PubMed/MEDLINE, Scopus, and Web of Science for studies published between January 2020 and December 2025. Eligible studies included randomized controlled trials (RCTs), cohort studies, and systematic reviews involving human participants who received socket preservation with early or immediate implant placement in the anterior esthetic region. Primary outcomes included implant survival, MBL, and esthetic outcomes measured using validated indices such as the Pink Esthetic Score (PES). Risk of bias was assessed using the Cochrane RoB 2.0 and the Newcastle–Ottawa Scale. Because of heterogeneity among studies, qualitative synthesis was performed.
Results:
Twenty-seven studies met the inclusion criteria, including eight RCTs, eleven cohort studies, and eight systematic reviews. Implant survival ranged from 95.0% to 98.5%, while MBL remained within 0.5–1.5 mm. Grafted sites demonstrated lower bone loss than nongrafted sites. Protocols incorporating socket preservation, guided bone regeneration, connective tissue augmentation, immediate provisionalization, and the socket shield technique showed improved tissue stability and higher PES values. Complication rates were low and generally manageable.
Conclusion:
The integration of socket preservation with early implant placement provides a predictable clinical pathway in the esthetic zone. The approach yields stable bone levels, high implant survival, and strong esthetic outcomes. Standardizing these workflows still requires larger, long-term randomized clinical trials.