Soft tissue changes after connective tissue grafts around immediately placed and restored dental implants in the esthetic zone: A systematic review and meta-analysis
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Objective: The aim of this systematic review and meta-analysis was to evaluate the soft tissue outcomes of connective tissue graft (CTG) combined with immediate implant placement and restoration (IIPR) in the esthetic zone. Materials and methods: Following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, randomized controlled trials (RCTs) were searched for in electronic databases and complemented by hand searching. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool and data were analyzed using statistical software. Results: A total of 180 studies were identified, of which, four trials were included with 144 implant sites in 144 participants. Overall meta-analysis showed that CTG in conjunction with IIPR had a significantly greater gingival thickness than IIPR alone. The IIPR with CTG had less recession and higher esthetic pink score compared to IIPR group, but the difference was not statistically significant. No significant differences in implant failure rate were found between IIPR with and without CTG. Conclusions: The use of CTG in conjunction with IIPR in the esthetic zone significantly improved the thickness of the gingival tissues compared to IIPR without CTG. No significant differences were observed in the level of soft tissues around immediately placed implants with or without CTG. Clinical significance: The use of connective tissue graft with IIPR can be considered to improve the soft tissue profile and minimize mucosal recession in esthetic zone.