Abstract
BACKGROUND: The reduction in extraction socket volume resulting from spontaneous healing poses challenges for dental implant placement. This systematic review aims to evaluate and compare the multifaceted performance of immediate implant placement (IIP) and alveolar ridge preservation (ARP) in terms of changes in soft and hard tissues of the alveolar ridge, implant failure, postoperative complications, and patient-reported satisfaction following tooth extraction. METHODS: An electronic search was conducted utilizing the databases of MEDLINE (PubMed), Embase, Cochrane Library, Web of Science, and Scopus to identify randomized controlled trials (RCTs) reporting on the comparisons of IIP and ARP protocols. The primary outcome variables included marginal bone level (MBL), pink esthetic score (PES), and implant failure; secondary outcome variables included postoperative complications, horizontal width change, facial gingival margin change, and patient-reported satisfaction. The Cochrane RoB2 tool was used to assess the risk of bias in RCTs. Weighted or mean differences (MD), odds ratio (OR), and corresponding 95% confidence intervals (CI) were calculated. The protocol followed the preferred reporting items for systematic reviews and meta-analysis statements and was prospectively registered in PROSPERO (CRD42024503989). RESULTS: Eleven RCTs were included, involving 353 patients in the IIP group and 348 patients in the ARP group. Regarding MBL, the IIP protocol demonstrated a significantly greater reduction in both non-molar (MD = -0.36 mm, 95% CI = -0.64 to 0.07]) and molar regions (MD = -0.41 mm, 95% CI = -0.49 to -0.32]) compared to ARP; however, no statistical differences were observed regarding PES (MD = -0.05, 95% CI = -0.52 to 0.43) or implant failure (OR = 2.09, 95% CI = 0.98 to 4.44). Furthermore, both groups achieved similar outcomes in terms of horizontal width change, facial gingival margin change, and patient-reported satisfaction (P > .05), except for a higher incidence of postoperative complications observed in the IIP group (p < 0.05). CONCLUSION: Within the limitations of this study, the IIP protocol can achieve comparable esthetic outcomes and implant success as the ARP protocol; however, there may be a higher incidence of postoperative complications and MBL alterations. Further long-term and well-conducted RCTs are warranted to validate the efficacy of these protocols.