Significance of buccal bone wall thickness on the fate of peri-implant hard and soft tissues: A systematic review.

BACKGROUND The significance on the association between the peri-implant bucco-lingual dimension (BLD) at the stage of implant placement and the occurrence of biological and aesthetic complications is yet unknown. MATERIAL AND METHODS Systematic screening of electronic sources was carried out to identify clinical and preclinical studies reporting on the baseline BLD and/or buccal bone thickness (BBT) values. A secondary objective was to assess the effect of simultaneous grafting at sites with deficient or no buccal bone wall (BBW) at baseline. The primary outcome variables were BBT, BLD and vertical bone loss (VBL) at re-evaluation. Moreover, radiographic, clinical and patient-reported outcome measures (PROMs) were evaluated. RESULTS Overall, 12 clinical and 4 preclinical studies met the inclusion criteria. The clinical evidence demonstrated that during healing, dimensional changes occur in the alveolar bone and in the BBW that may compromise the integrity of bone around a dental implant. The preclinical evidence validated the fact that implants placed in the presence of thin BBW are more prone to exhibit major dimensional changes. Moreover, the clinical and preclinical data supported that in scenarios where dehiscence-type defects are left for spontaneous healing, greater VBL and mucosal recession (MR) together with the occurrence of biologic complications are expected. Furthermore, the augmentation of dehiscence-type defects is associated with hard and soft tissue stability. CONCLUSIONS Dimensional changes occur as a result of implant placement in healed ridges that may lead to VBL and MR. Thin BBW (≲2mm) are prone to exhibit major post-changes that may compromise the integrity of the buccal bone, biologic and esthetic complications