An interventional study of Guided socket shield with immediate implant and Guided Autogenous Root Slicing Replantation with Immediate Implant in TEETH EXTRACTION, Esthetic Zone Implantology and Socket Shield Technique Implant Placement, sponsored by Minia University. Recruiting at 1 site in Egypt. Open to participants aged 20 Years to 40 Years. Per ClinicalTrials.gov, last updated 2026-09-28.
Sponsored by Minia University · Not applicable, Interventional, and Treatment
The goal of this clinical trial is to learn whether two different tooth-preservation techniques work equally well when placing a dental implant right after a tooth is removed in the front of the mouth (the "esthetic zone"). It will also learn whether using artificial intelligence (AI) to help plan the surgery improves the results.
The main questions it aims to answer are:
Researchers will compare participants who receive autogenous root slice replantation to participants who receive the socket-shield technique to see if one produces better outcomes than the other. Both groups will have their implants placed using a 3D-printed surgical guide made from AI-assisted digital planning.
Participants will:
Class II extraction socket according to Sabri and Barootchi classification ( Sabri, H.
et al., 2024)
Exclusion Criteria:
Participants in this arm will undergo the socket-shield technique for immediate implant placement using a single, fully guided digital protocol. Following artificial intelligence (AI)-assisted digital planning, a single surgical guide will direct both the sectioning of the facial root fragment (shield preparation) and the immediate implant osteotomy and placement in one continuous, fully guided sequence. The facial root fragment will be retained to support the labial bone plate and peri-implant soft tissues, while immediate provisionalization will be performed. Participants will be followed to assess implant accuracy, esthetic outcomes, and peri-implant tissue health.
Procedure: Guided socket shield with immediate implant · Procedure: Guided Immediate Implant
Participants in this arm will undergo the autogenous root slice replantation (ARSR) technique for immediate implant placement using a single, fully guided digital protocol. Following artificial intelligence (AI)-assisted digital planning, a single surgical guide will direct both the sectioning and preparation of the autogenous root slice and the immediate implant osteotomy and placement in one continuous, fully guided sequence. The prepared root slice will be replanted and retained facially within the socket to support the labial bone plate and peri-implant soft tissues, while immediate provisionalization will be performed. Participants will be followed to assess implant accuracy, esthetic outcomes, and peri-implant tissue health.
Procedure: Guided Autogenous Root Slicing Replantation with Immediate Implant · Procedure: Guided Immediate Implant
Participants in this arm will undergo immediate implant placement combined with conventional guided bone grafting to manage any labial bone defects (dehiscence or fenestration), rather than a partial extraction therapy technique. Following artificial intelligence (AI)-assisted digital planning, a single surgical guide will direct the immediate implant osteotomy and placement. Bone graft material and a barrier membrane will be used to restore the labial bone defect at the time of implant placement, and immediate provisionalization will be performed. Participants will be followed to assess implant accuracy, esthetic outcomes, and peri-implant tissue health.
Procedure: Conventional Bone Augmentation with Immediate Implant · Procedure: Guided Immediate Implant
A single, AI-planned surgical guide is used to perform both root sectioning and implant osteotomy/placement in one uninterrupted guided sequence. The facial (buccal) portion of the natural root is intentionally retained in situ - decoronated and prepared to a defined sub-crestal height and thickness under full guidance - to preserve the labial bone plate and periodontal ligament-derived vascularity. The implant is placed immediately palatal/lingual to the shield, and immediate provisionalization is performed. This differs from conventional socket-shield protocols, which typically use freehand or dual-guide sequences (separate guides for sectioning and implant placement).
A single, AI-planned surgical guide directs both the harvesting/slicing of an autogenous root segment and the immediate implant osteotomy and placement in one continuous guided workflow. Unlike the socket-shield technique, the root slice is sectioned and then replanted (repositioned) facially within the fresh socket as a free graft, rather than left attached in its native position. The slice is guided to a standardized dimension, position, and depth to support the labial plate and soft tissue architecture. Immediate provisionalization is performed. This is the first reported application of full digital/AI guidance to the ARSR technique.
Immediate implant placement is performed using a single AI-planned surgical guide for implant osteotomy and positioning only (no root-sectioning component). Any labial dehiscence or fenestration defect present after extraction is managed using the current gold-standard approach: particulate bone graft material placed against the defect and covered with a barrier membrane to guide bone regeneration. No tooth root structure is retained. Immediate provisionalization is performed. This arm serves as the active control, isolating the effect of partial extraction therapy (root retention) from AI-guided implant placement alone.
Implant placement performed on the same day as tooth extraction, using a single, AI-assisted, fully guided digital surgical protocol common to all three study arms. Pre-operative digital planning (integrating CBCT and intraoral scan data with AI-assisted analysis) is used to determine implant position, angulation, and depth, and to design a single surgical guide. This guide directs the osteotomy and implant insertion, standardizing implant positioning across all arms regardless of the labial defect-management technique used (socket shield, ARSR, or bone augmentation). This shared, standardized component allows the trial to isolate the effect of the labial defect-management technique on esthetic and peri-implant outcomes, since implant placement accuracy is controlled identically across groups.
Labial Bone Thickness
Labial bone plate thickness measured via cone-beam computed tomography (CBCT) to evaluate preservation of the labial bone contour following autogenous root slice replantation (ARSR), socket shield, or conventional bone augmentation.
Time frame: through study completion, an average of 1 year
Marginal Bone Level
Radiographic marginal bone level around the implant, assessed via CBCT, to evaluate crestal bone stability across the three treatment groups.
Time frame: through study completion, an average of 1 year
Accuracy of AI-Assisted Digital Planning
AI-based segmentation of the tooth/root to be sectioned will be compared against human (manual) segmentation using a heat map to quantify the average discrepancy between the two, assessing the accuracy and reliability of AI integration in surgical planni
Time frame: through study completion, an average of 1 year
Bone Density
Peri-implant bone density assessed labially and proximally via CBCT.
Time frame: through study completion, an average of 1 year
Peri-Implant Probing Depth
Clinical probing depth around the implant measured at multiple sites.
Time frame: through study completion, an average of 1 year
Modified Gingival Index
Clinical assessment of peri-implant soft tissue inflammation.
Time frame: through study completion, an average of 1 year
Modified Plaque Index
Clinical assessment of plaque accumulation around the implant.
Time frame: through study completion, an average of 1 year
Keratinized Tissue Width and Thickness
Width and thickness of keratinized mucosa surrounding the implant, measured clinically.
Time frame: through study completion, an average of 1 year
Pink Esthetic Score (PES) scaled from 0 to 2
Validated index evaluating the esthetic appearance of the peri-implant soft tissues.
Time frame: through study completion, an average of 1 year
White Esthetic Score (WES)
Validated index evaluating the esthetic appearance of the implant-supported crown.
Time frame: through study completion, an average of 1 year
Postoperative Pain (Visual Analog Scale)
Patient-reported pain intensity measured using a Visual Analog Scale (VAS).
Time frame: through study completion, an average of 1 year
AI Utility in Postoperative Follow-Up
AI-assessed proposed implant fixture position compared against the actual postoperative position, to evaluate the utility and accuracy of AI in follow-up assessment.
Time frame: through study completion, an average of 1 year
Plan to share: No
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