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

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.