Adjunctive Procedures in Immediate Implant Placement: Necessity or Option? A Systematic Review and Meta-Analysis.

Area of Science:

• Dental Implantology
• Biomaterials Science
• Evidence-Based Dentistry

Background:

• Immediate implant placement (IIP) is a common dental procedure.
• Adjunctive materials and techniques are often used to enhance IIP outcomes.
• Systematic evaluation of these adjunctive approaches is needed.

Purpose of the Study:

• To systematically assess the clinical effects of biomaterials, grafting materials, and techniques used with IIP.
• To evaluate the impact of these adjunctive strategies on hard and soft tissue dynamics, esthetics, and patient-reported outcomes.
• To assess the quality of evidence and risk of bias in relevant randomized controlled trials (RCTs).

Main Methods:

• Systematic review and meta-analysis of currently available RCTs on IIP adjunctive treatments.
• Qualitative data analysis and quantitative synthesis where appropriate.
• Evaluation of risk of bias using Cochrane RoB 2 and quality of evidence using GRADE framework.

Main Results:

• 12 RCTs (484 implants) showed high implant survival rates (96-100%) regardless of adjunctive methods.
• Xenografts, alloplastic/mixed grafts, connective tissue grafts, and socket shield technique showed potential benefits for peri-implant tissues and esthetics.
• Meta-analysis indicated significantly higher short-term patient-reported postoperative pain (VAS 19.45 mm) with adjunctive strategies (p=0.04).
• Most RCTs had moderate to high risk of bias; evidence quality was low to moderate.

Conclusions:

• IIP demonstrates high implant survival rates, irrespective of adjunctive materials or techniques.
• While adjunctive strategies may enhance hard and soft tissue stability, they are associated with increased short-term patient morbidity.
• Current evidence is limited by a lack of standardized and patient-centered outcome reporting.