Objectives: The purpose of this study was to evaluate clinically and radiographically the effect of four different materials and techniques on buccal bone preservation during immediate implant placement in order to obtain maximum best esthetical outcome.

Materials and methods: Forty implant cases were divided randomly into four groups. In group A, an implant with adequate diameter was placed to create a gap between the implant and the buccal wall of the socket, which was then filled with tricalcium phosphate. In Group B, the buccal gap between the implant and buccal wall of socket was filled by Allograft. In Group C, the buccal gap between the implant and buccal wall of socket was filled by L-PRF. In Group D, buccal shield technique was applied by sectioning root into buccal and palatal segments. The palatal segment was removed, while the buccal segment was reduced into thin shield which was then preserved with implant placement to preserve the blood supply from the periodontal attachment. Initial CBCT was taken preoperatively and final CBCT was taken six months after implant placement, from Buccal bone height and width was measured.

Results: The four groups attained sufficient final stability to support successful prosthetic. LPRF application and buccal shield technique application preserved buccal bone height and width eliminating the expected buccal bone resorption due to the loss of blood supply from the periodontal attachment, while tricalcium phosphate and allograft application increased buccal bone width beside preserving buccal bone height.