Purpose: Accurate extraction socket evaluation is crucial for aesthetic success with immediate implant placement. The present authors propose a socket classification system to assist selection of the approach most likely to offer an optimal aesthetic outcome. The objectives of this study were to describe this novel system and evaluate the inter-rater agreement.
Materials and methods: Socket type identification was based on three parameters: the position of the gingival margin in relation to the homologous tooth, the morphology of the buccal bone plate, and the interproximal attachment level (the latter two were evaluated through gingival probing). These data were used to identify four socket types, including three from a widely applied classification system, which were subdivided into two subtypes to give types 1A, 1B, 2A, 2B, 3A, 3B, 4A and 4B. After establishing a “gold standard” classification, a questionnaire was sent to 50 postgraduate students and 45 experienced dental practitioners.
Results: A simple system was used to classify single extraction sockets from observations of marginal and interproximal tissues. In a sample of 95 examiners, the percentage agreement with gold standard classifications was 78.7% ± 0.023% [0.56% to 0.98%] and was not significantly influenced by the examiner’s level of clinical experience (P > 0.05). Treatment recommendations were proposed for each socket type.
Conclusion: The single extraction socket classification for aesthetic outcomes simplifies the prediction of aesthetic outcomes and provides a rational basis for the approach to each socket type.