Background: Alveolar ridge preservation is essential for successful implant placement and prosthetic rehabilitation. The modified socket shield technique (mSST) is one of the techniques developed to minimize ridge resorption. Objective: To compare radiographic dimensional changes in post-extraction sites treated with spontaneous healing versus the mSST without immediate implantation using cone beam computed tomography (CBCT). Study Design, Setting, Sample: This randomized clinical study included 80 patients with a single
non-restorable non-molar maxillary tooth. Patients were divided into two equal groups: the test group (mSST) and the control group (atraumatic extraction with spontaneous healing). CBCT scans were performed at baseline (before or immediately after extraction) and 6 months post-surgery. Measurements included alveolar ridge width at 1 mm, 3 mm, and 5 mm levels, and buccal and palatal bone plate heights. Following this, implants were placed, and their primary stability was assessed. Intervention: The main intervention was the use of the mSST compared to atraumatic tooth extraction. Primary outcome: included change in buccal bone plate height over a 6-month follow-up period. Covariates: included patient age and gender. Analyses: Paired t-tests and independent t-tests were used to evaluate intra- and intergroup differences, respectively. Statistical significance was set at p < 0.05. Results: In the test group, a significant reduction in palatal wall height was observed (p < 0.001), while no significant changes were noted in other parameters (p ≥ 0.05). In the control group, significant decreases were seen in buccal and palatal plate heights and ridge width (p < 0.05). Comparing the groups, the test group demonstrated significantly less buccal wall height and ridge width resorption than the control group (p < 0.05). However, no significant difference was observed in palatal plate height resorption between groups (p = 0.507). The test group exhibited significantly higher primary stability compared to the control group (p = 0.001). Conclusion and Relevance: The modified socket shield technique with delayed implantation demonstrated superior maintenance of buccal bone plate height and ridge width, along with significantly higher primary implant stability, compared to spontaneously healed sockets. This approach is beneficial for maintaining ridge integrity when immediate implant placement is not planned.