Graft, what to graft or don’t graft in immediate implant placement

: a systematic review and meta-analysis

Abstract

Background: After the extraction of a single tooth, tissues remodeling processes affect the post extraction socket. As a result of post-extraction implant insertion into the socket, a gap is formed between the inner surface of the buccal cortical and the implant. This gap is called a jumping gap. In the 1990s, the concept of guided bone regeneration (GBR) was introduced with the aim to compensate for volumetric changes in hard and soft tissues by using autogenous bone grafts, deprotonized bovine bone mineral (DBBM) as fillers and connective tissue grafts (CTG) and xenogenic collagen grafts for post placement alveolus closure of type 1. However, there is no unequivocal opinion in the literature with respect to which materials and how much benefit these can bring to implant rehabilitation technique. The objective of our review and metaanalysis was to evaluate the effectiveness of using bone and soft tissue grafts associated with immediate (type 1) implant placement. Materials and Methods: This review work was registered on the PROSPERO platform and was conducted in accordance with the PRISMA statement protocol for systematic reviews. The electronic search process was performed on two databases (Medline/PubMed and CochraneDatabase) including only RCTs from the last 10 years (until December 2022). Identified articles were analyzed and included/excluded according to the defined inclusion criteria. Results: Nine RCTs with a follow-up of not less than 6 months were selected (403patients and 425implants). Significant differences were found for MID-Facial Mucosa Level and Facial Bone Thickness at 12 months between grafted and nongrafted sites. Conclusions: The use of biomaterials for regenerative procedures in immediate implant placement is in line with the maintenance of the alveolar tissues volume. Connective tissue grafts are suitable for the periimplant mucosa margin position conservation, together with a alveolar bone graft.

Date of Award	25 Jul 2023
Original language	English
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Tiago Borges (Supervisor) & Bruno Almeida (Co-Supervisor)