Subepithelial Connective Tissue Graft Versus Socket Shield Technique In Immediately Placed Implants

The teeth will be extracted gently using periotomes to preserve facial and lingual bone plates. All walls of the socket will be inspected and checked for the presence of fenestration or dehiscence defects in bone. The length and width of extracted roots will be measured to determine the length and diameter of implants placed. The osteotomy sites will be prepared and the drills will be used in proper sequence according to manufacturer's instructions, with maximum use of bone apical to the extraction sockets. The drills will extend 3 to 5 mm beyond the apex of the socket to ensure primary stability after placement, taking care of the anatomical boundaries. The implants will be placed.

Connective tissue graft was harvested from palate using trap door technique utilizing a horizontal incision 3-4 mm away from the gingival margin with two vertical incisions on the either end of the first incision, the door is then undermined and opened using a sharp dissection, the underlying connective tissue is then harvested using a periosteal elevator, and the door was then sutured using 4 0 silk sutures Finally, the connective tissue graft was immediately placed into the recipient site after a tunneling procedure and sutured with 6-0 nonresorbable monofilament sutures.

The crown of the involved tooth will be removed and the root will be then sectioned in a mesiodistal direction along its long axis as far apical as was possible using a long shank fissure bur. Preserving the facial root section unmanipulated and attached to the tooth socket. Periotomes will be then inserted between the palatal root removed gentelly.The remaining root section will be then reduced coronally to 1 mm above the alveolar crest.The tooth socket's palatal wall and apex will be then curetted to remove any tissue or infective remnants and the root section will be checked for immobility with a sharp probe. With the preparation steps complete, the tooth root hereafter will be known as the socket-shield. An osteotomy will be then sequentially prepared and internal conical connection implant was inserted palatal to the shield with the implant 2 mm below the facial crest.