A Cochrane review [Abstract] 1 included 6 studies with a total of 138 subjects. Two trials (56 patients) compared flapless placement of dental implants with conventional flap elevation, one trial (10 patients) crestal versus vestibular incisions, and one trial (20 patients) Erbium:YAG laser versus flap elevation at the second-stage surgery for implant exposure. One split-mouth trial (10 patients) evaluated whether connective tissue graft at implant placement could be effective in augmenting peri-implant tissues, and one trial (40 patients) compared autograft with an animal-derived collagen matrix to increase the height of the keratinised mucosa. On a patient, rather than per implant basis, implants placed with a flapless technique and implant exposures performed with laser induced statistically significant less postoperative pain than flap elevation. Sites augmented with soft tissues connective grafts showed a better aesthetic and thicker tissues. Both palatal autografts or the use of a porcine-derived collagen matrix are effective in increasing the height of keratinised mucosa at the price of a 0.5 mm recession of peri-implant soft tissues. There were no other statistically significant differences for any of the remaining analyses.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment).
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