Aim: To assess the effect of immediate provisionalization (IP) on soft tissue changes, hard tissue changes, and clinical parameters following single immediate implant placement (IIP). Materials and Methods: Two independent reviewers conducted an electronic literature search in PubMed, Web of Science, Embase, and Cochrane databases as well as a manual search to identify eligible clinical studies up to September 2021. Randomized controlled trials (RCTs) comparing IIP with IP (test) and IIP without IP (control) were included for a qualitative and quantitative analysis. The primary outcome was vertical midfacial soft tissue changes. Secondary outcomes included horizontal midfacial soft tissue changes, implant survival, mesial and distal papillary changes, Pink Esthetic Score (PES) at final follow-up, marginal bone-level changes, probing depth at final follow-up, and bleeding on probing at final follow-up. Results: Of the 8213 records, 7 RCTs reporting on 323 patients who received 323 single immediate implants (IIP + IP: 161 implants in 161 patients; IIP:162 implants in 162 patients) were selected with a mean follow-up ranging from 12 to 60 months. Risk of bias assessment yielded some concerns for five RCTs and high risk for two RCTs. Meta-analysis on the cases with intact alveoli demonstrated 0.87 mm (95% confidence interval [CI] [0.57; 1.17], p < .001) less apical migration of the midfacial soft tissue level for IIP + IP when compared to IIP alone. Implant survival, papillary changes, marginal bone-level changes, probing depth, and bleeding on probing were not significantly affected by IP. Insufficient data were available for meta-analyses on horizontal midfacial soft tissue changes and PES.Conclusions: IP may contribute to midfacial soft tissue stability at immediate implants. However, high-quality RCTs are needed since the strength of this conclusion is currently rated as low according to GRADE guidelines.

Aim To assess the impact of mucoperiosteal flap elevation for single immediate implant placement (IIP) on buccal hard and soft tissue changes, and on clinical, aesthetic and patient‐reported outcomes. Materials and Methods Two independent reviewers conducted an electronic literature search in Pubmed, Web of Science, Embase and Cochrane databases as well as a manual search to identify eligible clinical studies up to June 2022. Randomized controlled trials (RCTs) comparing IIP without flap elevation to IIP with flap elevation were included for a qualitative and quantitative analysis. The primary outcome was horizontal buccal bone change. Secondary outcomes were implant survival, vertical buccal bone change, pain, and clinical and aesthetic parameters. Results Out of 1029 records, 5 RCTs were selected reporting on 140 patients who received 140 single immediate implants (flapless: 68; flap: 72). Patients had a mean age ranging from 30 to 67 years and were followed between 6 and 12 months. Four RCTs pertained to (nearly) intact alveoli. Risk of bias assessment yielded low risk for two RCTs and high risk for three RCTs. Meta‐analysis demonstrated a mean difference of 0.48 mm (95% confidence interval [CI] [0.13, 0.84], p = .007) in horizontal buccal bone change between surgical approaches, favouring flapless surgery. Meta‐analysis failed to demonstrate a significant difference in implant survival between the groups (RR 1.00, 95% CI [0.93, 1.07], p = .920). Given the scarcity of data, meta‐analyses could not be performed on other secondary outcomes. Available studies were consistent in the direction of the effect favouring flapless surgery for vertical buccal bone change as well as for pain. Clinical and aesthetic parameters were underreported. Conclusions Based on CBCT data, flapless surgery resulted in more buccal bone preservation at immediate implants. However, the clinical relevance of this finding is unclear, since clinical and aesthetic outcomes were underreported.

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