Comparative Outcomes of Surgical Techniques for Immediate Implant Placement: A Systematic Literature Review of Randomized Controlled Trials

Immediate implant placement has become a predictable treatment option in modern implant dentistry, aiming to reduce treatment time and maintain peri-implant hard and soft tissues. However, choosing the surgical technique remains controversial, particularly regarding flap elevation, the use of a socket shield, and additional grafting procedures. This systematic review and meta-analysis aimed to compare the effectiveness of various surgical techniques for immediate implant placement with respect to hard-tissue preservation, soft-tissue stability, implant success, aesthetic results, and patient-reported outcomes, based solely on randomized controlled trials. Electronic searches were conducted in PubMed/MEDLINE, Embase, Web of Science, and Cochrane Central from the start to January 2025. Twelve randomized controlled trials involving 446 implants were included. Random-effects meta-analysis showed significantly better horizontal buccal bone preservation with flapless surgery compared to flapped methods (mean difference 0.48 mm; 95% confidence interval 0.13 to 0.84; p = 0.007; I² = 0%). Implant survival was similar across techniques (risk ratio 1.00; p = 0.920). The socket shield technique notably decreased horizontal and vertical bone loss and enhanced Pink Esthetic Scores (PES). Using additional grafts significantly decreased horizontal crestal resorption. Minimally invasive methods were linked to lower postoperative pain levels. Based on current evidence, tissue-preserving surgical methods provide better hard-tissue stability without sacrificing implant success.