Comparison of Partial Extraction Therapy and Conventional Bone Grafting in the Anterior Maxilla: A Clinical Report Within a Single Patient

Abstract

Introduction: Preservation of soft tissue contours is a major esthetic challenge in anterior implant rehabilitation. This clinical report presents two implant placement protocols—immediate placement with partial extraction therapy (socket shield technique) and delayed placement with bone grafting—performed within the same patient. The objective was to compare the clinical workflow, peri-implant soft tissue response, and esthetic outcomes of each approach under identical patient-related conditions. Methods: Following fabrication of a new interim restoration, digital data acquisition was completed using an intraoral scanner and cone-beam computed tomography (CBCT). A digital diagnostic wax-up was superimposed on the CBCT dataset to enable virtual implant positioning and guided surgical planning. Based on the CBCT evaluation, both anterior sites (#8 and #9) demonstrated insufficient buccal bone. Consequently, a socket shield technique was applied to site #8, while simultaneous bone grafting was indicated for site #9. Static computer-assisted guided surgery was used for implant placement, followed by the fabrication of implant-supported provisional restorations in conjunction with adjacent tooth-supported provisionals to guide peri-implant soft tissue maturation. Results: After four months of healing, both implants demonstrated successful osseointegration. The site treated with partial extraction therapy maintained a stable buccal contour and exhibited harmonious soft tissue adaptation, while the grafted site showed minor buccal flattening. Definitive screw-retained monolithic zirconia implant-supported fixed dental prostheses were delivered. At the two-year follow-up, both restorations exhibited stable peri-implant tissues, favorable esthetics, and functional success, with superior soft tissue architecture noted at the socket shield site. Conclusion: This clinical report highlights that both implant protocols achieved predictable osseointegration and prosthetic success. However, the partial extraction therapy demonstrated improved preservation of the buccal contour and more natural peri-implant soft tissue architecture compared with the conventional bone grafting approach. Within the limitations of a single-patient comparison, partial extraction therapy may offer esthetic advantages in the anterior maxilla when integrated with a precise digital workflow and careful case selection.