De Rouck 2009.

Methods	Trial design: randomised, parallel group trial Location: Bruxelles, Belgium Number of centres: one (Dental Clinic of the Free University) Recruitment period: not stated Funding source: not stated
Participants	Inclusion criteria: patients requiring the immediate replacement of a single tooth in the anterior maxilla (15‐25) having both neighbouring teeth and at least 5 mm of bone height apical to the alveolus of the failing tooth to allow implant placement with a minimal insertion torque of 35 Ncm Exclusion criteria: systemic diseases, smoking more than 10 cigarettes a day, bruxism, lack of posterior occlusion, non‐treated periodontal diseases, presence of active infection (pus, fistula) around the hopeless tooth, loss of the labial crest after extraction of the failing tooth Age at baseline: immediate 55 years (SD 13); conventional 52 years (SD 12) Gender: immediate M11/F13; conventional M12/F13 Number randomised: 52 Number evaluated: 49
Interventions	Comparison: Immediate versus conventional loading Gp A (n = 26) Immediate loading: Single immediate post‐extractive implants restored the same day with non‐occluding screw‐retained acrylic crowns, replaced after 6 months by permanent metal‐ceramic crowns Gp B (n = 26) Conventional loading: Implants were conventionally loaded and restored after 3 months with screw‐retained acrylic crowns, replaced after 3 months by permanent metal‐ceramic crowns. A collagen membrane (Bio‐Gide, Geistlich Biomaterials) covered the implant prior to crown placement The implant‐bone gap was grafted with granules of anorganic bovine bone Nobelreplace Tapered Groovy (Nobel Biocare AB, Göteborg, Sweden) TiUnite titanium screws were used Duration of follow‐up: 1 year
Outcomes	Prosthesis/implant failures, marginal bone level changes on intraoral radiographs, plaque, bleeding on probing, probing pocket depths, papilla levels, midfacial mucosal levels, patient's esthetic satisfaction 1‐year data used
Notes	Sample size calculation: paper states that 24 patients per group were required to show a difference in soft tissue dimensions of 0.5 mm
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Reported in the article: "This was performed by means of a computer‐generated randomization scheme"
Allocation concealment (selection bias)	Unclear risk	Reported in the article: "After screening for recruitment, impressions were made to fabricate an acrylic stent for recording purposes. Thereupon, patients were randomly allocated to the ‘immediate restoration group’ (IRG) or the ‘delayed restoration group’ (DRG)". Allocation concealment not mentioned
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Nothing reported in the article No reply to letter
Incomplete outcome data (attrition bias) All outcomes	Low risk	Reported in the article: "From the 52 patients that had been recruited (actually randomised), 49 were included in the study [IRG: 24 patients, DRG: 25 patients]. In two patients the labial crest was partially lost following tooth removal. Another patient listed for immediate restoration was excluded as the insertion torque was only 20 Ncm"
Selective reporting (reporting bias)	Low risk	All outcomes appear to be presented
Other bias	High risk	The author used different baseline radiographic assessment making the 2 groups actually non‐comparable