LAUSR

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).