Wu, Xin‐Yu; Shi, Jun‐Yu; Buti, Jacopo; Lai, Hong‐Chang; Tonetti, Maurizio S; (2023) Buccal bone thickness and mid-facial soft tissue recession after various surgical approaches for immediate implant placement: A systematic review and network meta-analysis of controlled trials. Journal of Clinical Periodontology , 50 (4) pp. 533-546. 10.1111/jcpe.13771.

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Abstract

Aim: To evaluate the relative efficacy and confidence in the precision of the results of different surgical interventions for immediate implant placement in the anterior area./ Materials and methods: Electronic searches were performed in PubMed, Embase, and Cochrane CENTRAL. Randomised controlled trials comparing different surgical techniques in anterior jaws for type 1 implant placement were included. Outcome measures included implant survival (primary outcome), buccal bone thickness reduction, and mid-facial soft tissue recession. Risks of bias assessment, network meta-analysis (NMA), sensitivity analysis, and quality of evidence assessment were performed./ Results: Twenty-two studies reporting on 948 subjects and five surgical interventions were included. Fourteen early failures were reported. Compared with open-flap surgery without tissue augmentation (F-N) and looking at buccal bone thickness preservation, NMA showed that there was moderate confidence that flapless surgery with hard tissue augmentation (FL-HTA) was better than flapless surgery without tissue augmentation (FL-N) or open-flap surgery with hard tissue augmentation (F-HTA) (mean difference − 0.8 mm, 95% confidence interval: −1.1 to −0.5 mm; −0.6 mm, −0.9 to −0.4 mm; and − 0.5 mm, −0.7 to −0.3 mm, respectively). There was moderate confidence that flapless surgery with hard and soft tissue augmentation (FL-HTA&STA) could significantly prevent mid-facial soft tissue recession compared with FL-HTA (−0.5 mm, −0.7 to −0.3 mm) and FL-N (−0.6 mm, −1.2 to −0.04 mm). However, there was no significant additional benefit in buccal bone thickness with the FL-HTA&STA approach compared to the FL-HTA approach (−0.30 mm, −0.81 to 0.21 mm)./ Conclusions: For immediate implant placement in the anterior areas, a FL-HTA approach better preserves buccal bone thickness (moderate confidence); adding STA improves the stability of the mid-facial soft tissue level (moderate confidence) but at the expense of buccal bone thickness (low confidence).

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