Surgical interventions for implant placement in the anterior maxilla: A systematic scoping review with evidence mapping

Abstract

Objectives: Simplification and standardization of interventions are critical challenges to improving performance in implant dentistry. This study aimed to systematically identify and schematically present the evidence base of the implant dentistry surgical interventions for the anterior maxilla as a basis for further development and standardization. Methods: Electronic searches were conducted in PubMed, Embase and Cochrane CENTRAL. Primary clinical studies reporting surgical interventions in the anterior maxilla, with a sample size of at least ten patients, were included. Bibliometric information and study details were extracted. Descriptive analysis and a mind map approach were used to describe the documentation of different surgical interventions. Results: Two hundred and seventy-two studies reporting on 9001 patients were included. Within the past two decades, the number of literatures on implant placement in the anterior maxilla has increased dramatically (7 studies before 2005, 151studies after 2016). Overall, the evidence map identified six primary operations and 33 variations. For hopeless tooth extraction, immediate implant placement was the most frequently reported (141 studies, 4670 patients); flapless implant placement with hard tissue augmentation and immediate provisionalization was the most commonly reported variation (33 studies, 987 patients). Type 3/4 implant placement (62 studies, 1902 patients) and implant site augmentation (33 studies, 788 patients) were frequently reported for missing teeth. Geographical differences were observed, with type 2 placement studies almost exclusively from Europe. Conclusions:Research on immediate implant placement was the most reported surgical intervention in the anterior maxilla. Hard tissue augmentation was frequently reported simultaneously with or before implant placement. Immediate provisionalization was mainly used for type 1 implant placement. The finding that six primary operations with 33 variations have been reported indicates the need for additional research to simplify and consolidate the surgical approach.

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

“…It is, however, important to fully understand the confidence level of these results' precision. First, there is a large discrepancy between the body of evidence documenting immediate implant placement identified in the mapping review (Wu et al, 2022), which included 141 studies and 4670 patients, and this NMA with 22 RCTs with 948 subjects. This raises questions about the external applicability of the observed results.…”

“…In addition, an open‐flap approach without tissue augmentation, which is the traditional surgical approach and is set as the control group in most RCTs, was chosen as the common comparator in the network. Flapless surgery and tissue augmentation techniques were developed more recently based on the open‐flap approach (Wu et al, 2022). A flapless approach with HTA is likely superior for the preservation of BBT.…”

“…Immediate (type 1) implant placement, defined as implant placement immediately after tooth extraction, has the advantages of reduced treatment time, fewer surgical procedures, and preservation of the remaining bone (Hämmerle et al, 2004). A recent mapping review focusing on surgical approaches in the aesthetic field showed that type 1 implant placement is an area of active research focus with 141 clinical studies and 4670 patients (Wu et al, 2022). Clinical application requires the presence of a well‐preserved alveolus, absence of apparent infection, and specific anatomical situations that allow the achievement of primary stability of the implant.…”

“…On one side, research has focused on identifying prognostic indicators for a poor aesthetic outcome (i.e., resorption of the buccal plate of the bone and the presence of a thin tissue phenotype). In contrast, on the other, interventions have been devised to address them (flapless placement, hard tissue augmentation, soft‐tissue augmentation, and their combinations) (Wu et al, 2022). A recent systematic review including 15 RCTs reported that hard tissue augmentation (HTA) could better preserve buccal bone thickness (BBT) and mid‐facial soft tissue level (Seyssens et al, 2022).…”

“…Consequently, despite the broad scientific documentation (Wu et al, 2022), there is no research or clinical consensus on the standard approach for type 1 placement. To plan definitive trials, it is crucial to identify the components of the surgical procedure, and the results of a high‐quality systematic review with network meta‐analysis (NMA) could provide key input.…”