Immediate implant placement with or without connective tissue graft: A systematic review and meta‐analysis

Seyssens, Lorenz; Lat, Liesa De; Cosyn, Jan

doi:10.1111/jcpe.13397

Cited by 70 publications

(93 citation statements)

References 113 publications

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“…These values are in line with those obtained in the present study. The results of this study agree with a recent meta-analysis study in which significant differences were not found between immediate implants with or without CTG with regard to marginal bone resorption ( p = 0.42) [ 20 ].…”

Section: Discussionsupporting

confidence: 91%

“…Several publications have investigated the tridimensional changes after immediate implants placed with SST or CTG, but no study has compared both techniques on immediate implants [ 18 , 19 , 20 ]. Therefore, this study aimed to observe the dimensional changes in peri-implant tissues after the placement of immediate postextraction implants and the performance of connective tissue graft and/or socket shield.…”

Section: Introductionmentioning

confidence: 99%

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Dimensional Changes in the Alveolus after a Combination of Immediate Postextraction Implant and Connective Grafting and/or Socket Shield Technique

Gómez-Meda

Rizo-Gorrita

Serrera-Figallo

et al. 2022

IJERPH

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Immediate implant placement protocols after dental extraction have enabled a reduction in surgical phases. This procedure has increased patient satisfaction and similar survival rates to late implant placement procedures. However, placing an implant immediately after dental extraction does not counteract the physiological remodeling of alveolar bone. For this reason, additional surgical techniques have been developed, such as the placement of a connective tissue graft (CTG) or the socket shield technique (SST). Dimensional changes in the peri-implant tissues were observed after placement of immediate implants following the extraction and CTG and/or SST. A total of 26 surgical interventions were carried out in which dimensional change variables of peri-implant tissues were analyzed. The preoperative state and immediate postoperative situation were compared with the situation after one year. Measurements were taken at 3, 5, and 7 mm from the gingival margin and analyzed in this CBCT radiological study (Planmeca Promax 3D). The implant platform was used as a reference point for the measurement of changes in alveolar crest height. One year after performing either of the two techniques (CTG and/or SST), a significant increase in the gingiva thickness and vestibular cortex occurred at 5 mm (0.65 ± 1.16 mm) and 7 mm (0.95 ± 1.45 mm) from the gingival margin. Additionally, an increase in thickness of palatal bone was registered at 3 mm (0.48 ± 0.90 mm). The graft placement group showed an increase in thickness of peri-implant tissue in the vestibular area after one year, although CTG and SST groups were clinically similar. The implementation of SST revealed promising results regarding the buccal thickness of hard and soft tissues after one year. A significant increase in vestibular cortical bone thickness, as well as the overall mucosa thickness and buccal bone at 3 mm from the gingival margin, was observed. A significant reduction in the distance from the bone crest to the platform was detected in both techniques. Both techniques (CTG and SST) are appropriate to provide sufficient volume to peri-implant tissues in the vestibular area of anterior maxillary implants. Some limitations were detected, such as the lack of an aesthetic analysis or small sample size, so results should be interpreted with caution. Future studies are necessary to further evaluate the long-term predictability of these techniques.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Dimensional Changes in the Alveolus after a Combination of Immediate Postextraction Implant and Connective Grafting and/or Socket Shield Technique

Gómez-Meda

Rizo-Gorrita

Serrera-Figallo

et al. 2022

IJERPH

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“…A radiographic, histologic, or clinical distinction should be made to identify the nature of the peri‐implant hard‐tissue structure, and its implications. After tooth extraction, the horizontal resorption is the most pronounced, compared with the vertical resorption 66,67 . Mitigating horizontal bone resorption in sites with thin buccal plate (≤2 mm) would provide the patients with many benefits; especially in the esthetic zone 66‐68 .…”

Section: Discussionmentioning

confidence: 99%

“… 66 , 67 Mitigating horizontal bone resorption in sites with thin buccal plate (≤2 mm) would provide the patients with many benefits; especially in the esthetic zone. 66 , 67 , 68 These benefits include better and stable peri‐implant soft‐tissue esthetics, in addition to improved implant function, and hygiene. 54 , 69 , 70 Thin biotype and inadequate oral hygiene are risk factors for developing peri‐implantitis and subsequent reduction in the quality of life.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of bone‐substitute materials use in immediate dental implant placement: A systematic review and meta‐analysis

Zaki

Yusuf

Elkhadem

et al. 2021

Clin Implant Dent Rel Res

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Objective To assess the efficacy of using a bone substitute material (BSM) in the fixture–socket gap in patients undergoing tooth extraction and immediate implant placement. Materials and methods MEDLINE, EMBASE, and CENTRAL databases were searched for randomized controlled trials (RCTs). RCTs were screened for eligibility, and data were extracted by two authors independently. Risk of bias (ROB) was assessed using Cochrane's ROB tool 2.0. Primary outcomes were implant failure, overall complications, and soft‐tissue esthetics. Secondary outcomes were vertical buccal bone resorption, vertical interproximal bone resorption, horizontal buccal bone resorption, and mid‐buccal mucosal recession. Meta‐analysis was performed using random‐effects model with generic inverse variance weighing. GRADE was used to grade the certainty of the evidence. Results After screening 19 544 potentially eligible references, 20 RCTs were included in this review, with a total of 848 patients (916 sites). Most included RCTs were deemed of some concerns (53%) or at low (38%) risk of bias, except for overall complications (high ROB). Implant failure did not differ significantly RR = 0.92 (confidence intervals [CI] 0.34 to 2.46) between using a BSM compared with not using a BSM (NoBSM). BSM use resulted in less horizontal buccal bone resorption (MD = −0.52 mm [95% CI −0.74 to −0.30]), a higher esthetic score (MD = 1.49 [95% CI 0.46 to 2.53]), but also more complications (RR = 3.50 [95% CI 1.11 to 11.1] compared with NoBSM. Too few trials compared types of BSMs against each other to allow for pooled analyses. The certainty of the evidence was considered moderate for all outcomes except implant failure (low), overall complications (very low), and vertical interproximal bone resorption (very low). Conclusion BSM use during immediate implant placement reduces horizontal buccal bone resorption and improves the periimplant soft‐tissue esthetics. Although BSM use increases the risk of predominantly minor complications.

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“…Furthermore, thick soft tissue can even mask and hide alveolar bone loss on the buccal side of implants [12,13,15]. Therefore, soft tissue augmentation is recommended in esthetical regions where a certain amount of buccal bone remodeling is expected, like immediate implant placement in situations with thin biotype or thin buccal bone plate [17,18].…”

Section: Esthetic Appearancementioning

confidence: 99%

Peri-Implant Soft Tissue Augmentation

Blašković¹,

Blašković²

2022

Dentistry

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The peri-implant soft tissue (PIS) augmentation procedure has become an integral part of implant-prosthetic rehabilitation. Minimal width of keratinized mucosa (KM) of 2 mm is deemed necessary to facilitate oral hygiene maintenance around the implant and provide hard and soft peri-implant tissue stability. PIS thickness of at least 2 mm is recommended to achieve the esthetic appearance and prevent recessions around implant prosthetic rehabilitation. The autogenous soft tissue grafts can be divided into two groups based on their histological composition—free gingival graft (FGG) and connective tissue graft (CTG). FGG graft is used mainly to increase the width of keratinized mucosa while CTG augment the thickness of PIS. Both grafts are harvested from the same anatomical region—the palate. Alternatively, they can be harvested from the maxillary tuberosity. Soft tissue grafts can be also harvested as pedicle grafts, in case when the soft tissue graft remains attached to the donor site by one side preserving the blood supply from the donor region. Clinically this will result in less shrinkage of the graft postoperatively, improving the outcome of the augmentation procedure. To bypass the drawback connected with FGG or CTG harvesting, substitutional soft tissue grafts have been developed.

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Immediate implant placement with or without connective tissue graft: A systematic review and meta‐analysis

Cited by 70 publications

References 113 publications

Dimensional Changes in the Alveolus after a Combination of Immediate Postextraction Implant and Connective Grafting and/or Socket Shield Technique

Dimensional Changes in the Alveolus after a Combination of Immediate Postextraction Implant and Connective Grafting and/or Socket Shield Technique

Efficacy of bone‐substitute materials use in immediate dental implant placement: A systematic review and meta‐analysis

Peri-Implant Soft Tissue Augmentation

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