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Loss of blood supply derived from the periodontal ligament (PDL) has been identified as a major etiologic factor for ridge resorption. Animal studies and case reports provide proof-of-principle data on the feasibility of immediate implant placement in proximity to a retained root fragment for the strategic preservation of the natural tooth apparatus. This novel concept relies on the preservation of PDL, buccal bone and soft tissue esthetics via selective preservation of the buccal portion of the root and PDL which can lead to predictable and sustainable clinical stability of immediately placed and loaded implants.