Short-term pink aesthetic outcomes of the socket shield techniques with different jumping gap managements and conventional immediate implantation techniques in the aesthetic zone: a systematic review and Bayesian network meta-analysis

Abstract

Abstract Objective This network meta-analysis compared short-term pink esthetic outcomes (PES-SO) among three socket shield technique (SST) protocols: SST (no grafting), SST-GBR (with guided bone regeneration), and SST-nJP (no jumping gap). And two conventional immediate implant placement protocols: IIP (no grafting) and IIP-GBR (with guided bone regeneration). Methods PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, CNKI, VIP, Wanfang, and SinoMed were searched for comparative studies published from January 2010 to January 2026. The only outcome was short-term PES-SO. Risk of bias was assessed using the Cochrane tool and certainty of evidence using CINeMA. A random-effects network meta-analysis was conducted. A clinically restricted analysis (excluding patients with thin labial plates and studies with reporting limitations that could affect comparability) and a supporting analysis were additionally performed. Results In the full network (21 studies), IIP was associated with significantly lower PES-SO than IIP-GBR, SST and SST-GBR, whereas no statistically significant differences were identified among SST and SST-GBR. The findings regarding SST-nJP in this study should be interpreted with caution, as the analysis is primarily based on a single small-sample study and indirect comparisons. The restricted and supporting analyses showed broadly consistent patterns. Nevertheless, procedure rankings and some indirect estimates varied across analyses. Conclusion Within the limitations of the available evidence, SST-GBR, SST, and IIP-GBR were associated with more favorable short-term PES-SO than IIP. The findings of SST-nJP should be interpreted cautiously because it was informed by a single study and imprecise estimates. Additional well-designed randomized trials directly comparing SST protocols are warranted. Due to the unquantifiable transitivity and exploratory nature of the MCID, our findings are exploratory in nature and require further validation, they should not be interpreted as precise clinical guidance.