Abstract：
To assess the impact of mucoperiosteal flap elevation for single immediate implant placement (IIP) on buccal hard and soft tissue changes, and on clinical, aesthetic and patient-reported outcomes.
Two independent reviewers conducted an electronic literature search in Pubmed, Web of Science, Embase and Cochrane databases as well as a manual search to identify eligible clinical studies up to June 2022. Randomized controlled trials (RCTs) comparing IIP without flap elevation to IIP with flap elevation were included for a qualitative and quantitative analysis. The primary outcome was horizontal buccal bone change. Secondary outcomes were implant survival, vertical buccal bone change, pain, and clinical and aesthetic parameters.
Out of 1029 records, 5 RCTs were selected reporting on 140 patients who received 140 single immediate implants (flapless: 68; flap: 72). Patients had a mean age ranging from 30 to 67 years and were followed between 6 and 12 months. Four RCTs pertained to (nearly) intact alveoli. Risk of bias assessment yielded low risk for two RCTs and high risk for three RCTs. Meta-analysis demonstrated a mean difference of 0.48 mm (95% confidence interval [CI] [0.13, 0.84], p = .007) in horizontal buccal bone change between surgical approaches, favouring flapless surgery. Meta-analysis failed to demonstrate a significant difference in implant survival between the groups (RR 1.00, 95% CI [0.93, 1.07], p = .920). Given the scarcity of data, meta-analyses could not be performed on other secondary outcomes. Available studies were consistent in the direction of the effect favouring flapless surgery for vertical buccal bone change as well as for pain. Clinical and aesthetic parameters were underreported.
Based on CBCT data, flapless surgery resulted in more buccal bone preservation at immediate implants. However, the clinical relevance of this finding is unclear, since clinical and aesthetic outcomes were underreported.
Two independent reviewers conducted an electronic literature search in Pubmed, Web of Science, Embase and Cochrane databases as well as a manual search to identify eligible clinical studies up to June 2022. Randomized controlled trials (RCTs) comparing IIP without flap elevation to IIP with flap elevation were included for a qualitative and quantitative analysis. The primary outcome was horizontal buccal bone change. Secondary outcomes were implant survival, vertical buccal bone change, pain, and clinical and aesthetic parameters.
Out of 1029 records, 5 RCTs were selected reporting on 140 patients who received 140 single immediate implants (flapless: 68; flap: 72). Patients had a mean age ranging from 30 to 67 years and were followed between 6 and 12 months. Four RCTs pertained to (nearly) intact alveoli. Risk of bias assessment yielded low risk for two RCTs and high risk for three RCTs. Meta-analysis demonstrated a mean difference of 0.48 mm (95% confidence interval [CI] [0.13, 0.84], p = .007) in horizontal buccal bone change between surgical approaches, favouring flapless surgery. Meta-analysis failed to demonstrate a significant difference in implant survival between the groups (RR 1.00, 95% CI [0.93, 1.07], p = .920). Given the scarcity of data, meta-analyses could not be performed on other secondary outcomes. Available studies were consistent in the direction of the effect favouring flapless surgery for vertical buccal bone change as well as for pain. Clinical and aesthetic parameters were underreported.
Based on CBCT data, flapless surgery resulted in more buccal bone preservation at immediate implants. However, the clinical relevance of this finding is unclear, since clinical and aesthetic outcomes were underreported.
摘要：
目的：评估单即刻植入（IIP）粘膜骨膜瓣抬高对颊硬软组织变化的影响，在临床上，美学和患者报告的结果。
方法：两名独立审稿人在Pubmed，WebofScience,Embase和Cochrane数据库以及手动搜索，以确定截至2022年6月的合格临床研究。包括比较无皮瓣抬高的IIP与有皮瓣抬高的IIP的随机对照试验（RCT），以进行定性和定量分析。主要结果是水平颊骨改变。次要结果是植入物存活率，垂直颊骨改变，疼痛,临床和美学参数。
结果：在1029条记录中，选择了5个RCTs，报告140例接受了140例一次性植入物（无瓣：68；皮瓣：72）的患者。患者的平均年龄为30至67岁，随访时间为6至12个月。四个RCT与（几乎）完整的肺泡有关。偏倚风险评估对2项随机对照试验的风险较低，对3项随机对照试验的风险较高。荟萃分析显示平均差异为0.48mm(95%CI[0.13;0.84]，p=0.007）在手术入路之间的水平颊骨变化中，喜欢无翼手术。荟萃分析未能证明两组之间植入物存活率的显著差异(RR1.00,95%CI[0.93,1.07],p=0.920）。鉴于数据的稀缺性,无法对其他次要结局进行荟萃分析.现有的研究在有利于无舌手术治疗垂直颊骨变化和疼痛的效果方面是一致的。临床和美学参数被低估。
结论：基于CBCT数据，无瓣手术可在即刻植入时保留更多的颊骨。然而,这一发现的临床意义尚不清楚，由于临床和美学结果被低估。
方法：两名独立审稿人在Pubmed，
结果：在1029条记录中，
结论：基于CBCT数据，
