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:
* Does keeping part of the root in place using a technique called autogenous root slice replantation work as well as a similar technique called socket shielding, in terms of appearance and gum health around the implant? * Does AI-guided surgical planning improve accuracy, appearance, and gum health compared with traditional planning?
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:
* Have a tooth removed and an implant placed on the same day, using one of the two techniques * Have their surgery guided by a custom surgical guide, planned with AI assistance * Return for follow-up visits so researchers can check healing, gum appearance, and how well the implant fits with their smile
Selected patients of both sexes are 20-40 years old.
Patients are systemically healthy based on questionnaire dental modification of Cornell index.
Clinical gingival health either on intact or reduced periodontium according to the new classification system (2017). (Lang, N. P. et al., 2018)
The recipient site of the implant is free from any active pathological conditions.
Pregnant female.
Parafunctional habits such as bruxism and clenching Patients suffering from periodontitis.
Smokers.
Parallel
Guided socket shield with immediate implant
Procedure/SurgeryA 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).
Guided Autogenous Root Slicing Replantation with Immediate Implant
Procedure/SurgeryA 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.
Conventional Bone Augmentation with Immediate Implant
Procedure/SurgeryImmediate 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.
Guided Immediate Implant
Procedure/SurgeryImplant 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.
Marginal Bone Level
Radiographic marginal bone level around the implant, assessed via CBCT, to evaluate crestal bone stability across the three treatment groups.
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
Bone Density
Peri-implant bone density assessed labially and proximally via CBCT.
Peri-Implant Probing Depth
Clinical probing depth around the implant measured at multiple sites.
Modified Gingival Index
Clinical assessment of peri-implant soft tissue inflammation.
Modified Plaque Index
Clinical assessment of plaque accumulation around the implant.
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