IDR and Socket Shield: immediate implant placement that preserves bone and gum

Key points

• After a tooth is extracted, the outer (labial) wall of the socket is very thin and partly resorbs over the first months. In the smile zone this shows: the gum recedes, and a grey margin or dark triangle appears next to the implant crown.
• IDR (Immediate Dentoalveolar Restoration) and Socket Shield are two immediate-implant techniques designed to prevent this loss.
• Socket Shield: when the tooth is extracted, a thin fragment of the root is left against the outer wall, and it "holds" the bone. IDR: the implant is placed right away, and the wall defect is simultaneously rebuilt with the patient's own bone and gum tissue.
• Both techniques are technically demanding and not suitable for everyone: they require a healthy outer wall (for Socket Shield) or a clearly limited defect (for IDR), no acute inflammation, and precise diagnostics.
• At Tursunov Clinic, surgeons Arnur Tursunov and Almas Khamiyev completed training in these techniques in 2026.

Why bone is lost after a tooth is extracted

The tooth root supports a thin plate of bone around it — especially on the outer, labial side: on front teeth it is often less than a millimetre thick. This plate survives thanks to the tooth's ligament. Once the tooth is gone, the ligament is gone too, and the plate resorbs: over the first six months the ridge width there can shrink by roughly a third. The gum sinks along with the bone.

For molars this is usually manageable: the implant is placed slightly deeper and the crown covers it. Not for front teeth: every millimetre of loss shows when smiling. That is exactly why, in the smile zone, surgeons look for ways not just to "place an implant" but to preserve the volume of tissue around it. Almas Khamiyev's article on atraumatic extraction makes the same point: preserving the socket walls matters more than extracting quickly.

Socket Shield: a root fragment as a shield

The technique was described in 2010 (Hürzeler et al.). In essence: the tooth is not removed whole. The root is split lengthwise, the inner (palatal) part is removed, and a thin outer sliver of root — the "shield" — is left attached to the labial bone wall. The implant is placed into the socket behind the shield, without touching it.

What this achieves: the ligament between the retained fragment and the bone survives, so the bone never gets the "tooth is gone" signal and does not resorb. The outer contour of the gum and bone stays the same as it was with the natural tooth.

When it is possible: a root with no cracks along the outer wall, no inflammation at the apex in that area, intact bone on the outside. When it is not: a longitudinal root fracture, a purulent process, mobility, or a destroyed outer wall. The decision is made from the CBCT scan and again during surgery — if the wall turns out different from expected, the surgeon switches to the classic protocol.

A limitation of the technique: it requires precise work under magnification, special instruments and experience; there are 5–10-year follow-up data, but it is still a comparatively young protocol, and the doctor is obliged to tell the patient this.

IDR: implant and wall reconstruction in a single visit

IDR — Immediate Dentoalveolar Restoration — is a technique developed by the Brazilian surgeon José Carlos da Rosa. It is designed for cases where the outer socket wall is already partly destroyed — for example after prolonged inflammation or trauma — when Socket Shield is not possible.

What happens in one operation: the tooth is extracted, the implant is placed, then the wall defect is rebuilt with a bone block taken from the patient (usually from the maxillary tuberosity) and covered with a connective-tissue graft for the gum. A temporary crown is fitted right away, holding the gum's shape from day one.

What this achieves: the patient avoids three separate stages — extraction, bone grafting six months later, and implant placement another six months after that. And the gum contour forms around the temporary crown right away, not after every stage has healed.

When it is possible: the defect is limited to one wall, the bone above and to the sides is intact, and the implant can be firmly anchored in the remaining bone. When it is not: an extensive defect, an acute infection, or an inability to achieve primary implant stability. Then the classic route with a separate bone graft is used.

How these techniques differ from ordinary immediate implant placement

The clinic has been placing implants immediately for years — there are cases where implants were placed right after extraction. The standard protocol: extract the tooth, place the implant, and, if needed, fill the gap with bone material and a membrane. It works well when the socket is intact.

IDR and Socket Shield are the next level for the smile zone: they target exactly the outer wall and the gum, where the standard protocol does not always hold the volume. This is not "better for everyone" but "more precise for selected cases." In the clinic's case "Implant placement with soft-tissue grafting," the same task — gum contour in the smile zone — was solved with a connective-tissue graft; IDR combines such a graft with bone reconstruction in a single stage.

Training of Tursunov Clinic's doctors

Implant surgeons Arnur Tursunov and Almas Khamiyev completed training in the IDR and Socket Shield techniques in 2026 [course, provider, date — NEEDS_OWNER]. Certificates are on the /sertifikaty page and in the doctors' profiles [after upload]. Both techniques require magnification, CBCT-based planning and experience in bone and soft-tissue surgery — all of which the clinic has: a microscope, CBCT, and its own bone-grafting and soft-tissue-grafting cases.

What to ask at the consultation

Is the outer socket wall intact on the scan, and what do you recommend: the standard protocol, Socket Shield or IDR?

What happens if, during surgery, the wall turns out to be worse than on the scan?

Will there be a temporary crown right away?

What is included in the price: the implant, the grafts, the membrane, the temporary crown?

How many such operations have you performed, and what has the follow-up shown?

What it costs

There is no separate "Socket Shield" or "IDR" line in the price list — the cost is made up of items: the implant (Izen 80,000 ₸ on promotion, Straumann BLT 410,000 ₸, and other systems), augmentation 60,000 ₸, a collagen membrane 60,000–80,000 ₸, a bone-block graft for one tooth site 250,000 ₸, a temporary crown from 20,000 ₸. A step-by-step estimate is given in writing after the consultation and CBCT (11,000 ₸); the consultation is free.

Related services and guides

• Dental implants in Astana
• Single-tooth implant in Astana
• Bone grafting in Astana

Frequently asked questions

Won't the retained root fragment rot?

With correct selection — a root free of inflammation and cracks — the fragment stays alive thanks to the ligament. That is exactly why the technique is not for everyone.

Can Socket Shield be done on a molar?

Technically yes, but there is no aesthetic task there, so the standard protocol is usually used instead.

How long does the operation take?

Longer than ordinary immediate implant placement — the surgeon will give an exact estimate for your case.

What if the bone is lost after all, a year later?

This can happen with any protocol; then the contour is restored with gum plastic surgery. The doctor follows up with the patient on a set schedule after surgery.