Impact of an open healing approach on peri-implant mucosa following immediate implant placement with transmucosal provisionalization: a systematic review and meta-analysis

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Abstract
Objective: To compare the peri-implant mucosal stability between an “open healing” approach (test) during immediate dental implant placement with bone grafting and immediate transmucosal provisionalization (non-occlusal) versus primary flap closure (control). Methods: This systematic review followed the PRISMA guidelines. A literature search was conducted in multiple databases up to May 2025. The primary outcome was peri-implant mucosal stability (Midfacial Mucosal Level (MML). Secondary outcomes include peri-implant soft tissue parameters (e.g. Papilla evaluation, mucosal thickness) and bone related outcomes (e.g. Marginal Bone Loss (MBL), buccal bone thickness and implant survival rate). Results: Out of 362 records, 12 studies were included, representing 431 patients and 438 implants. Most studies demonstrated a low risk of bias, although heterogeneity in outcomes assessment was observed. Meta-analysis showed limited midfacial mucosal changes between control and test groups, showing good stability of peri-implant keratinized tissue. Other soft and hard tissue outcomes were comparable between groups. Conclusion: The open healing approach with bone particle grafting during immediate dental implant placement appears as a viable option for supporting midfacial mucosa and maintaining mucosa and bone stability. However, more high-quality randomized controlled trials are necessary to confirm these findings. Clinical Relevance: This minimally invasive protocol appears to provide satisfactory outcomes by preserving peri-implant tissues, thereby reducing the need for multiple surgical interventions.

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