Dual zone, Socket Shield or Buccal Contour Grafting?

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Posted on By andoni jones In Implants

It's just amazing to see 3 lectures from 3 top teams showing 3 ways to deal with the single implant in the esthetic area.
I think anyone doing an immediate/delayed implant in the esthetic area would be pretty much looking at one of these techniques. We can discuss connective tissue grafting in addition as well of course.

I regularly use these 3 techniques, I think they all have their indication. Not 1 size fits all. This would be my insight:

- Dual Zone grafting: The very first procedure I used for immediate implants. In my hands the simplest one, works beautifully used in the right case. Doesn't work that well in thin biotypes or prominent roots with high potential of buccal plate resorption. Custom healing cap or provisional crown is paramount.

- Socket shield: Definitively here to stay. Not always possible unfortunately ( periodontal/ apical disease, buccal plate loss). Nothing comparable to this technique from a cosmetic point of view.

- Buccal Contour Grafting: The most technically challenging and time consuming in my hands. By far the worst from a patient's morbidity aspect. Still, necessary in many cases, but not all biotypes respond in the same way. In order to obtain the results (bone graft), I many times have to give up some cosmetic points ( papilla, scarring, mucogingival line asymmetry, gingival color).

Would love to hear from others.


Dual Zone grafting
Dual Zone grafting

Dual Zone grafting
Dual Zone grafting freshly fitted permanents

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Socket Shield


Buccal Contour grafting


Buccal Contour Grafting


The Third Lecture at the bottom of Homepage: SVG by Agnini brothers covers CTG along with bone graft....so ALL are 4 options are covered. You are correct that there are options where all may be be the relevant procedure. Depends on diagnosis and doctor knowledge/skills. regards Dr. Salama


Nice discussion starter, Andoni.
I follow the same rules. If PET not possible I nowadays apply SVG. FCTG harvesting and placement in tunnel technique doesn’t cause a lot of morbidity, it’s done in few minutes and make long term results safer. And in many cases we (at least I) can’t say for sure if it’s thin or thick biotype, but inbetween.
Regarding early implant placement with buccal contouring - in my experience not only technique with the most morbidity, but also PES is not as good as for other techniques. Instead I prefer IDR or mIVAN, if buccal bone is missing.
Nice cases that you show here, Andoni
Best regards


Hi Snjezana, Thanks for the comments, you always give some very nice input. I think it's all about having the skills to deliver the best possible outcome for each case, as one technique alone is not indicated or possible always. Warm regards