Esthetic and patient-reported outcomes in immediate implants with adjunctive surgical procedures to increase soft tissue thickness/height: A systematic review.

To explore the impact of soft tissue augmentation procedures during immediate implant placement (IIP) on clinician-assessed esthetic outcomes and patient-reported outcome measures (PROMs). A systematic literature search was conducted in PubMed, Cochrane Library, and Embase until March 2024. Two independent reviewers selected randomized and controlled clinical trials with ≥12 months follow-up, evaluating IIP in the premolar-to-premolar area with or without STA. Primary outcomes included esthetic assessments by clinicians (Pink Aesthetic Score, Implant Crown Aesthetic Index and mid-facial soft tissue recession) as well as PROMs. Secondary outcomes comprised post-operative morbidity, soft tissue stability, and interproximal bone changes. Data extraction was done by two independent reviewers, and the risk of bias was assessed using RoB 2.0 or ROBINS-I. Sixteen publications were included. The only relevant finding was that soft tissue augmentation significantly reduced midfacial soft tissue recession (n = 4, WMD = 0.38; 95% CI (0.15, 0.61)). No significant differences could be found between grafting and no grafting regarding the other clinician-assessed esthetic outcomes or for PROMs. Soft tissue augmentation during IIP reduces midfacial soft tissue recession. However, no other effects could be found based on clinician-assessed or patient-reported esthetic outcomes.