title: The Effect of Subepithelial Connective Tissue Graft Placement on Esthetic Outcomes After Immediate Implant Placement: Systematic Review.
abstract: BACKGROUND
  Immediate implantation, despite many advantages, carries a risk of gingival recession, papilla loss, collapse of ridge contour, and other esthetic complications. Soft tissue graft placement combined with immediate implantation may be used to reduce these concerns. This review aims to systematically analyze clinical esthetic outcomes of the immediate implant combined with soft tissue graft (IMITG).
  
  
  METHODS
  The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews were used. The electronic search was conducted using MEDLINE (PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) from January 1980 to October 2014. Quality assessments of selected articles were performed. Mid-buccal gingival level, interproximal gingival level, facial gingival thickness, gingival ridge dimension, and width of keratinized gingiva were the esthetic outcomes reviewed. Weighted mean difference of mid-buccal gingival level (WDBGL), papilla index score (WDPIS), and width of keratinized gingiva (WDKG) between initial and last measurements were calculated. Other esthetic outcomes were assessed by the descriptive analysis.
  
  
  RESULTS
  Ten studies with a minimum of 6-month follow-up were included, and reported esthetic outcomes were analyzed. Mid-buccal gingival level (WDBGL, 0.07 mm; 95% confidence interval [CI] = -0.44 to 0.59; P = 0.12) and interproximal gingival level did not significantly change after IMITG (WDPIS in the mesial site, 0.31; 95% CI = -0.01 to 0.64; P = 0.06; and WDPIS in the distal site, 0.29; 95% CI = -0.06 to 0.65; P = 0.11). Width of keratinized gingiva significantly increased after IMITG (WDKG, 1.27 mm; 95% CI = -0.08 to 2.46; P = 0.04). Facial gingival thickness and gingival ridge dimension could be increased after IMITG.
  
  
  CONCLUSIONS
  Because of the heterogeneity and limited number of selected studies, no conclusive statement could be made regarding the benefit of IMITG on esthetic outcomes. More randomized controlled trials are needed to provide definite clinical evidence.
authors.affiliation: Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA; Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston, TX, USA.|Department of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan.
authors.forename: Chun-Teh
authors.initials: CT
authors.lastname: Lee
authors.affiliation: Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston, Houston, TX.
authors.forename: Chih-Yun
authors.initials: CY
authors.lastname: Tao
authors.affiliation: Department of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan.
authors.forename: Janet
authors.initials: J
authors.lastname: Stoupel
mesh_terms: D003238:Connective Tissue; D003758:Dental Implantation, Endosseous / Q000009:adverse effects; D015921:Dental Implants; D004954:Esthetics; D005881:Gingiva / Q000601:surgery; D005889:Gingival Recession / Q000209:etiology; D006801:Humans; D016896:Treatment Outcome
chemical_list: D015921:Dental Implants
keywords: Dental implants; esthetics, dental; evidence-based dentistry; periodontics; treatment outcome