Flapless Immediate Implant Placement With and Without Bone Grafting: A Systematic Review and Meta-Analysis

This study aims to evaluate the influence of bone grafting peri-implant gap on the changes in hard and soft tissues following flapless immediate implantation.

A comprehensive research process was undertaken, including electronic searches of databases such as Embase, PubMed, Web of Science, and Cochrane, as well as a manual search. This approach identified relevant clinical studies until March 2024. Randomized controlled trials (RCTs) that compared flapless immediate implant placement with and without bone grafting were selected for qualitative assessment. Meta-analyses were conducted where feasible. The protocol was registered in PROSPERO with code CRD42024499377, ensuring transparency and accountability in our research.

Out of 1065 articles, 5 RCTs were included, involving 179 patients who underwent placement of 179 immediate implants (92 with bone grafting and 87 without) with follow-up periods ranging from 6 to 12 months. Analysis revealed no significant differences in horizontal bone changes within 0 to 3 mm apical to the bone crest between the two groups (weighted mean difference [WMD]: 0.147 (-0.012, 0.306), I²: 0.0%; standardized mean difference [SMD]: 0.337 (-0.016, 0.690), I²: 0.0%). However, significant differences were observed in horizontal bone changes at 4-5 mm apical to the reference point, favoring bone grafting (WMD: 0.484 (0.142, 0.826), I²: 75.4%; SMD: 0.794 (0.402, 1.186), I²: 36.6%). No significant differences were found in vertical midfacial soft tissue changes between the groups (WMD: 0.300 (-0.425, 1.024), I²: 62.4%; SMD: 0.213 (-0.339, 0.764), I²: 60.2%). Data limitations precluded meta-analyses on additional outcomes such as mesial and distal papillary alterations and vertical bone level changes.

Flapless immediate dental implants with a bone graft may enhance alveolar bone preservation, warranting further investigation.