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

Methods: Currently available randomized controlled clinical trials (RCTs) reporting on the adjunctive clinical effects of biomaterials, grafting materials, and grafting techniques on immediate implant placement (IIP) were systematically assessed. Data were qualitatively analyzed and, when appropriate, meta-analysis was performed. Risk of bias and quality of evidence were evaluated using the Cochrane RoB 2 tool and the GRADE framework, respectively. Results: A total of 12 RCTs (484 implants, 6-36 months of follow-up) were included and consistently reported high implant survival rates (96-100%). Data on the use of xenografts, alloplastic and mixed grafts, connective tissue grafts and socket shield technique seem, to different extents, to demonstrate favorable results in terms of peri-implant hard and soft tissue dynamics and esthetic outcomes. Quantitative synthesis conducted on four RCTs demonstrated significantly higher short-term patient-reported postoperative pain, assessed on a 0-100 Visual Analog Scale (VAS) (weighted mean difference 19.45 mm; 95% CI 0.55-38.36; p = 0.04). Most RCTs were rated at moderate to high risk of bias, and certainty of evidence was low to moderate. Conclusions: Regardless of the use of adjunctive materials/approaches, IIP guarantees high implant survival rates. Although different adjunctive strategies to IIP may favor hard and soft tissue stability, they appear to increase short-term patient-reported morbidity. Currently available evidence lacks standardized and patient-centered outcome reporting.