Cochrane · intervention · CD006697

Interventions for replacing missing teeth: management of soft tissues for dental implants

Esposito, M, Maghaireh, H, Grusovin, MG, et al. · Cochrane Database of Systematic Reviews · 2012 · Cochrane Library

Oral Health Implants and prosthodontics2 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

current version

GRADE rated

No studies

Included studies

as reported

No studies 3 · 15%Ungraded 17 · 85%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

Element	Planned (methods)	Found (results)
Population	Any patient rehabilitated with implant supported/retained prostheses	138 patients (six trials); all trials included only adults (two trials in Spain, two in the Netherlands, one in Italy, one in Austria)
Intervention	Any flap design including flapless procedures (manual or computer-guided), soft tissue augmentation and suture technique/material used in relation with osseointegrated root-formed dental implants	Flapless implant placement (n=2); Conventional flap elevation (n=2); Crestal incision (n=1); Erbium:YAG laser (n=1); Connective tissue graft (n=1); Xenogeneic collagen matrix (n=1)
Comparison	Conventional flap elevation; Vestibular incision; Flap elevation at implant exposure; No augmentation; Connective tissue autograft	Conventional flap elevation (n=2); Vestibular incision (n=1); Flap elevation at implant exposure (n=1); No augmentation (n=1); Connective tissue autograft (n=1)
Outcomes	Prosthetic failures; Implant failures; Biological complications; Postoperative pain; Marginal bone level changes on periapical radiographs; Aesthetics evaluated by patients; Aesthetics evaluated by dentists; Patient preference including aesthetics (only in split-mouth trials); Height of the attached/keratinised mucosa changes; Soft tissue thickness changes; Ease of maintenance by patient	Prosthetic failures (n=6); Implant failures (n=6); Biological complications (n=5); Postoperative pain (n=4); Aesthetics evaluated by patients (n=1); Aesthetics evaluated by dentists (n=2); Patient preference including aesthetics (n=2); Peri-implant marginal bone level changes (n=2); Soft tissue thickness changes (n=1); Keratinised mucosa height changes (n=1)
Study designs	Randomised controlled trials (RCTs) with exception of quasi-randomised controlled trials	Four trials had a parallel group study design and two a split-mouth study design
Timing	Trials to be included had to have a minimum of 6-month follow-up after implant loading	Follow up ranged from 6 months to 1 year after loading

Search date: 2011-06-09. Databases: Cochrane Oral Health's Trials Register; CENTRAL; MEDLINE; EMBASE

Questions and results

Current version only

Flapless implant placement vs Conventional flap elevation

Population: Patients receiving dental implants

CD006697.PUB2 (current) · 6 questions

Outcome	Effect	Evidence	Status / GRADE
Peri-implant marginal bone level change same question in other reviews	MD -0.05 [-0.25, 0.15]	1 study · 78 participants	Ungraded
Biological complications same question in other reviews	RR 5.58 [0.65, 48.23]	1 study · 80 participants	Ungraded
Postoperative pain same question in other reviews	MD -1.1 [-2.02, -0.18]	1 study · 80 participants	Ungraded
Patient preference same question in other reviews	RR 106.70 [20.97, 542.82]	1 study · 80 participants	Ungraded
Implant failure same question in other reviews	RR 1.70 [0.32, 8.94]	2 studies · 96 participants	Ungraded
Prosthetic failure same question in other reviews	RR 1.0 [0.14, 7.10]	1 study	Ungraded

Crestal incision vs Vestibular incision

Population: Patients receiving dental implants

CD006697.PUB2 (current) · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Prosthesis failure same question in other reviews	RR 3.0 [0.15, 59.89]	1 study · 10 participants	Ungraded
Biological complications same question in other reviews	Biological complications: Odds Ratio (M-H, Fixed, 95% CI), Subtotals only (no pooled estimate reported); 1 study (Heydenrijk 2000); 4 crestal vs 1 vestibular had hyperplastic tissue over the healing abutment	1 study	Ungraded
Implant failure same question in other reviews	RR 3.0 [0.15, 59.89]	1 study · 10 participants	Ungraded

Erbium:YAG laser (implant exposure) vs Flap elevation at implant exposure

Population: Patients undergoing implant exposure (second-stage surgery)

CD006697.PUB2 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Postoperative pain same question in other reviews	RR 0.25 [0.07, 0.90]	1 study · 20 participants	Ungraded
Biological complications same question in other reviews	RR 3.0 [0.14, 65.90]	1 study · 20 participants	Ungraded

Subepithelial connective tissue graft (palate) at implant placement vs No augmentation

Population: Partially edentulous patients receiving posterior mandibular implants

CD006697.PUB2 (current) · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Peri-implant marginal bone level change same question in other reviews	MD 0.17 [-0.10, 0.44]	1 study · 20 participants	Ungraded
Patient preference (aesthetics evaluated by patients) same question in other reviews	OR 0 [0, 0.85]	1 study · 10 participants	Ungraded
Soft tissue thickness change same question in other reviews	MD -1.35 [-1.78, -0.92]	1 study · 20 participants	Ungraded
Aesthetics (pink aesthetic score, PES) evaluated by dentist same question in other reviews	MD -2.87 [-3.67, -2.07]	1 study · 20 participants	Ungraded

One soft tissue correction/augmentation technique vs A different soft tissue correction/augmentation technique

Population: Patients receiving dental implants

CD006697.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR same question in other reviews	No trial: which soft tissue correction/augmentation technique is most effective (objective 2b) - no trial identified	0 studies	No studies

Technique to increase peri-implant keratinised/attached mucosa vs No increase of keratinised/attached mucosa

Population: Patients receiving dental implants

CD006697.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR same question in other reviews	No trial: whether the peri-implant keratinised/attached mucosa has to be increased (objective 3a) - no trial identified	0 studies	No studies

Xenogeneic collagen matrix (porcine; Mucograft) vs Connective tissue autograft (palate)

Population: Patients with implant-supported prostheses and <=1 mm keratinised mucosa

CD006697.PUB2 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Keratinised mucosa height change same question in other reviews	MD 0.15 [-0.72, 1.02]	1 study · 22 participants	Ungraded
Recession (aesthetics) same question in other reviews	MD -0.10 [-1.19, 0.99]	1 study · 22 participants	Ungraded

One suturing technique/material vs A different suturing technique/material

Population: Patients receiving dental implants

CD006697.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR same question in other reviews	No trial: which suturing techniques/materials are most effective (objective 4) - no trial identified	0 studies	No studies

Flapless implant placement vs Conventional flap elevation

Population: Patients receiving dental implants

CD006697 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Biological complications	RR 1.0 [0.34, 2.93]	1 study · 40 participants	Ungraded
Postoperative pain	RR 1.87 [1.25, 2.80]	2 studies · 100 participants	Ungraded
Implant failure	Implant failure: RR 0.0 [0.0, 0.0] (not estimable; no events in either group); 1 study, 40 participants (Cannizzaro 2007)	1 study · 40 participants	Ungraded
Prosthetic failure	Prosthetic failure: RR 0.0 [0.0, 0.0] (not estimable; no events in either group); 1 study, 40 participants (Cannizzaro 2007)	1 study · 40 participants	Ungraded

Crestal incision vs Vestibular incision

Population: Patients receiving dental implants

CD006697 · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Biological complications	RR 1.30 [0.43, 3.90]	2 studies	Ungraded
Prosthesis failure	RR 3.00 [0.15, 59.89]	1 study · 10 participants	Ungraded
Implant failure	RR 3.00 [0.15, 59.89]	2 studies · 30 participants	Ungraded

Erbium:YAG laser (implant exposure) vs Flap elevation at implant exposure

Population: Patients undergoing implant exposure (second-stage surgery)

CD006697 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Implant failure	Implant failure: RR 0.0 [0.0, 0.0] (not estimable; no events); 1 study, 20 participants (Arnabat-Dominguez 2003)	1 study · 20 participants	Ungraded
Postoperative pain	RR 0.25 [0.07, 0.90]	1 study · 20 participants	Ungraded
Prosthesis failure	Prosthesis failure: RR 0.0 [0.0, 0.0] (not estimable; no events); 1 study, 20 participants (Arnabat-Dominguez 2003)	1 study · 20 participants	Ungraded
Biological complications	RR 3.00 [0.14, 65.90]	1 study · 20 participants	Ungraded

Soft tissue correction/augmentation vs No soft tissue correction/augmentation

Population: Patients receiving dental implants

CD006697 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	No trial: whether soft tissue correction/augmentation procedures are necessary (objective 2a) - no trial identified	0 studies	No studies

One soft tissue correction/augmentation technique vs A different soft tissue correction/augmentation technique

Population: Patients receiving dental implants

CD006697 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	No trial: which soft tissue correction/augmentation technique is most effective (objective 2b) - no trial identified	0 studies	No studies

Technique to increase peri-implant keratinised/attached mucosa vs No increase of keratinised/attached mucosa

Population: Patients receiving dental implants

CD006697 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	No trial: whether the peri-implant keratinised/attached mucosa has to be increased (objective 3a) - no trial identified	0 studies	No studies

One technique to increase keratinised/attached mucosa vs A different technique to increase keratinised/attached mucosa

Population: Patients receiving dental implants

CD006697 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	No trial: which technique to increase the keratinised/attached mucosa is most effective (objective 3b) - no trial identified	0 studies	No studies

One suturing technique/material vs A different suturing technique/material

Population: Patients receiving dental implants

CD006697 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	No trial: which suturing techniques/materials are most effective (objective 4) - no trial identified	0 studies	No studies