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

Area of Science:

• Dental Implantology
• Periodontology
• Oral Surgery

Background:

• Dental implant placement often involves flap elevation, but flapless techniques may reduce patient discomfort.
• Soft tissue manipulation and augmentation are common for aesthetic reasons.
• Sufficient keratinized mucosa around implants is recommended for long-term prognosis.

Purpose of the Study:

• To evaluate the benefits of flapless implant procedures.
• To determine the ideal flap design and soft tissue augmentation techniques.
• To assess methods for increasing peri-implant keratinized mucosa.
• To identify optimal suturing techniques and materials.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) on soft tissue management in dental implantology.
• Searched Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE, and EMBASE.
• Included RCTs with at least 6 months follow-up, assessing outcomes like pain, aesthetics, and tissue changes.

Main Results:

• Flapless implant placement and laser-assisted exposure resulted in significantly less postoperative pain.
• Soft tissue augmentation with connective grafts improved aesthetics and tissue thickness.
• Both autografts and collagen matrices increased keratinized mucosa height but caused 0.5 mm recession.

Conclusions:

• Limited evidence suggests flapless placement reduces discomfort and grafts improve aesthetics.
• Increasing keratinized mucosa height may negatively impact aesthetics.
• Insufficient evidence exists to recommend specific flap designs, augmentation techniques, or suturing methods.
• High-quality RCTs are needed for definitive recommendations.