Interventions for replacing missing teeth: management of soft tissues for dental implants

Area of Science:

• Dental Implantology
• Oral Surgery
• Periodontology

Background:

• Dental implant placement typically involves flap elevation, but flapless techniques may reduce patient discomfort.
• Soft tissue manipulation and augmentation are common for aesthetic reasons and to ensure adequate keratinized mucosa for long-term implant prognosis.

Purpose of the Study:

• To evaluate the benefits of flapless implant procedures and compare different flap designs.
• To assess the efficacy of soft tissue augmentation and techniques for increasing perimplant keratinized mucosa.
• To determine the optimal suturing techniques and materials for dental implants.

Main Methods:

• A systematic review of randomized controlled trials (RCTs) was conducted using multiple databases (Cochrane, MEDLINE, EMBASE) and handsearching.
• Included RCTs compared various soft tissue management techniques for dental implants.
• Outcomes assessed included prosthetic/implant failures, aesthetics, complications, pain, patient preference, and mucosal width.

Main Results:

• Five RCTs involving 140 patients were included. Flapless implant placement and laser-assisted implant exposure resulted in significantly less postoperative pain compared to flap elevation.
• No other statistically significant differences were found for the remaining outcomes analyzed.

Conclusions:

• Flapless dental implant placement is a viable option that can decrease postoperative discomfort in suitable patients.
• There is a lack of robust evidence to guide the selection of specific flap designs, suturing techniques, or soft tissue augmentation methods.
• Further well-designed RCTs are necessary to establish evidence-based recommendations for soft tissue management in dental implantology.