The impact on the esthetic outcomes of immediate dental implant placement in anterior areas with or without soft tissue graft: A systematic review

Abstract

Introduction: One of the primary challenges of immediate dental implants is the risk of soft tissue recession and the compromised esthetic result, especially in the anterior sector of the upper maxilla. To solve this problematic, soft tissue graft, such as autogenous connective tissue grafts and biomaterials, have been introduced as an adjuvant technique to increase peri-implant tissue stability, improving esthetic results and reducing the risk of long-term complications. The objective was to evaluate the esthetic outcomes in terms of Pink Esthetic Score (PES) and White Esthetic Score (WES) in immediate dental implants using soft tissue graft compared to immediate implants without soft tissue graft. Material and method: An electronic search was carried out in the PubMed, Web of Science and Scopus databases on immediate implants placement with and without the use of soft tissue graft technique and the esthetic outcomes on the anterior sector of the upper maxilla, until November 2024. Results: Out of 187 articles, 9 studies were included in this systematic review, comparing immediate implants with and without connective tissue grafts and Pink Esthetic Score (PES). Six articles used both PES and White Esthetic Score (WES). Grafted implants showed slightly better esthetic outcomes with a total weighted average of: PES 8,35 in grafted group and 8,11 in non-grafted group and WES 8,02 in grafted group and 7,76 in non-grafted group, with minor differences and some variability. Risk of bias was generally moderate to high. Overall, connective tissue grafting offered modest esthetic improvements. Conclusion: Immediate implants with connective tissue grafts showed better soft tissue esthetic outcomes (higher PES), particularly beneficial in patients with thin gingival biotype. While WES was only slightly higher in grafted cases, with grafting supporting and improving the overall esthetic integration of the prosthetic crown.