This study focuses on the anatomical vulnerability of the buccal bone plate in the aesthetic part of the maxilla, which is prone to significant resorption following tooth extraction. While immediate dental implant placement can help preserve the surrounding tissues, it does not completely prevent bone resorption. This systematic review aims to assess how two key surgical protocols—full-thickness flap elevation and bone grafting—affect bone remodeling after the immediate placement of dental implants. The review followed the PRISMA guidelines and included only prospective clinical trials that assessed changes in the buccal bone plate of the maxilla using CBCT scans, comparing pre-operative and 6-12 month post-operative data. A total of 358 publications were initially identified, of which 8 studies with 272 surgical sites met the inclusion criteria. The results were categorized based on the surgical methods used, but due to significant heterogeneity among the subgroups, no reliable intergroup comparisons could be made. Nevertheless, the study shows that buccal bone plate resorption in the maxilla is inevitable after immediate implantation, with a trend suggesting that flapless procedures combined with bone grafting may help maintain better buccal bone plate stability.
