Background: With advances in dental technology, the placement of immediate implants has progressively gained popularity. However, a common complication that surfaced was mid-facial mucosal recession, which impaired esthetic outcomes. The use of soft tissue grafts has thus been introduced to manage and prevent this undesirable result. To date, no guidelines have been put forward for clinicians to identify the indications for a soft tissue graft during immediate implant placement. Therefore, this manuscript aimed to propose a decision-making model to prevent mid-facial mucosal recession following immediate implant placement. Method: An electronic search of the PubMed database for literature published in English on the occurrence and management of soft tissue alterations following immediate implant placement was performed. Results: Several factors, including implant position, buccal plate thickness, tissue thickness and width of keratinized mucosa, were found to influence the need for soft tissue grafting during immediate implant placement. For sockets with at least 2 mm of buccal plate thickness, a soft tissue graft was recommended for immediate implants placed at the incisal position. For sockets with less than 2 mm of buccal plate thickness, immediate implant placement in combination with bone or soft tissue augmentation was necessary. This was especially critical in scenarios with thin tissue biotypes or inadequate width of keratinized mucosa. Conclusion: Soft tissue grafts can maintain soft tissue stability following immediate implant placement.
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