Open flap socket shield in the esthetic zone

Implants in the esthetic zone can be challenging due to the buccal plate resorption that occurs after tooth extraction. The socket shield technique has proven to maintain the buccal bone and midfacial tissue, minimizing the risk of tissue loss that can lead to an unesthetic emergence of the implant restoration. The socket shield technique is, however, a technically difficult procedure to perform. Key aspects for achieving a successful treatment outcome are a careful extraction of the palatal portion of the root, a meticulous buccal shield preparation, and accurate implant drilling and placement. A flapless approach has been described classically in the postextraction socket shield implant scenario. This case report describes an immediate implant in the maxillary right central incisor on a patient with a high lip line and exacting cosmetic demands. An open flap approach to improve the visibility of the partial extraction and to minimize potential complications derived from an inadequate shield preparation is described. No adverse effects such as soft tissue scarring were visible after 1 year of loading, and tissue volume, color, and contour were maintained during the observation period.