title: A systematic review on the frequency of advanced recession following single immediate implant treatment.
abstract: OBJECTIVE
  It has been stated that midfacial recession is common following immediate implant treatment (IIT). The objective of this systematic review was to assess the frequency of advanced recession (>1 mm) following single IIT.
  
  
  METHODS
  An electronic search in Pubmed, Web of Science and the Cochrane Oral Health Group Specialized Trials Register database was performed using a search algorithm. Reference lists of relevant articles were also scrutinized to identify prospective studies on ≥10 implants installed in patients with an intact buccal bone wall and followed for ≥12 months. Study eligibility and quality were independently assessed by two investigators. Primary outcome variables were advanced inter-proximal and midfacial recession defined as soft tissue loss surpassing 1 mm between the pre- or postoperative status and the final re-assessment.
  
  
  RESULTS
  Thirteen of 171 papers were selected. Inter-examiner agreement on eligibility (κ = 0.879; p < 0.001) and quality (κ = 0.788; p < 0.001) was high. Advanced inter-proximal recession was described in 0-27% of the cases. However, these data were only based on two studies. Mean inter-proximal recession was frequently reported (11/13) and was <1 mm in all studies suggesting limited risk for advanced inter-proximal recession. Advanced midfacial recession was described in 0-64% of the cases. Again, few papers provided such information (4/13). Only one of these studies demonstrated high risk for advanced midfacial recession (>10%). This could be attributed to the fact that implants had not been restored with an immediate implant crown, which seems of pivotal importance given the results of a randomized controlled trial reporting on the preserving effect of immediate provisionalization on midfacial mucosa level. There is limited evidence to support an increased risk for midfacial recession following flap surgery and in patients with a thin-scalloped gingival biotype. The impact of implant-specific parameters on inter-proximal and midfacial soft tissue level seems conflicting.
  
  
  CONCLUSIONS
  Soft tissue recession may be expected following IIT and multiple factors seem to contribute to the phenomenon. Taking into account the paucity of papers, patients with an intact buccal bone wall and thick gingival biotype, treated by means of flapless surgery and an immediate implant crown may demonstrate limited risk for advanced midfacial recession (<10%). Proper risk assessment addressing diagnostic, surgical and restorative aspects is mandatory to avoid compromised outcome of IIT.
authors.affiliation: Department of Periodontology and Oral Implantology, University of Ghent, Faculty of Medicine and Health Sciences, Dental School, Ghent, Belgium. jan.cosyn@ugent.be
authors.forename: Jan
authors.initials: J
authors.lastname: Cosyn
authors.forename: Nele
authors.initials: N
authors.lastname: Hooghe
authors.forename: Hugo
authors.initials: H
authors.lastname: De Bruyn
mesh_terms: D003758:Dental Implantation, Endosseous / Q000009:adverse effects* / Q000379:methods; D019250:Dental Implants, Single-Tooth / Q000009:adverse effects*; D005889:Gingival Recession / Q000209:etiology*; D006801:Humans; D057893:Immediate Dental Implant Loading; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D013997:Time Factors