Saqib Habib*; Kamil Zafar; Farhan Raza

Agha Khan University, stadium road, Karachi, Pakistan, Karachi, Pakistan

Background: Immediate implant placement in the anterior maxilla requires careful treatment planning to optimize functional and esthetic outcomes. Factors such as root position, labial cortical plate thickness and extent of jumping distance should be considered while planning immediate implants. Evidence regarding the outcomes of bone grafting in jumping distance is variable. There is lack of consensus whether bone grafting in the jumping distance affects the outcomes of immediate implants or not.

Aim/Hypothesis: The aim of this systematic review and meta-analysis was to analyze the existing literature regarding the effects of bone grafting in the jumping distance on the outcomes of immediate implants in anterior maxilla.

Material and Methods: A systematic review and meta-analysis was carried in accordance with the guidelines set by PRISMA. The following PICOS model was employed: Population: Patients undergoing immediate implant placement, Intervention: Bone grafting in jumping distance, Control: No bone grafting in jumping distance, Outcomes: Bone resorption, Study designs: Randomized and non- randomized clinical trials. Our review question was “Does bone grafting in jumping distance affect the outcomes of immediately placed implants in anterior maxilla?”. A comprehensive literature search was performed across four major electronic health sciences databases i.e. PubMed (NLM), Dentistry and Oral Science, CINAHL Plus (EBSCO) and Cochrane Library. Our inclusion criteria was RCTs, that reported at least a follow-up of six months and having an intact buccal cortical plate before implant placement. Primary outcome was the changes in alveolar bone dimensions. For analysis of quantitative variables, Review Manager V 5 was used.

Results: A total of 108 studies were identified after a comprehensive literature search. After removing duplicates and detailed screening of the studies, seven studies fulfilled our inclusion criteria. There were six randomized and one non- randomized clinical trial in the included studies. A total number of 261 immediate dental implants in the anterior maxilla were placed. Out of seven included studies, three studies favored the use of bone graft in jumping distance to reduce the bone resorption Among these studies only one study significantly favored bone grafting in the jumping distance (P = 0.001). Four studies showed some extent of bone loss in no grafting group but the difference was statistically non-significant (p≥0.05).Meta-analysis was done on five studies for the assessment of bone resorption. The forest plot slightly favored the bone grafting group, however the difference between the two treatment modalities was not statistically significant (P = 0.50).

Conclusion and Clinical implications: Within the limitation of this systematic review and meta-analysis, we conclude that bone grafting in the jumping distance appears to yield less bone resorption among immediately placed implants in anterior maxilla (irrespective of the dimensions of jumping distance). However, the difference is not statistically significant. The results of this meta-analysis must be cautiously reported as high heterogeneity among the studies was observed.

Disclosure of Interest: None Declared.

Keywords: guided bone regeneration, immediate implant placement, systematic Review