Abstract
Introduction: In implant dentistry, maintaining the red aesthetics of the gingiva is very important for smile quality and patient comfort. In this context, immediate loading or function requires primary implant stability, necessitating the maintenance of gingival architecture and alveolar bone tissue. Objective: It was to analyze the main considerations and clinical outcomes of maintaining or rehabilitating red aesthetics in dental implants. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from February to April 2026 in the Scopus, PubMed, Science Direct, SciELO, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 133 articles were found, 38 articles were evaluated in full, and 29 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 16 studies with a high risk of bias and 24 studies that did not meet GRADE and AMSTAR-2 standards. Most studies did not show homogeneity in their results, with X2=77.2%>50%. It was concluded that the aesthetic effect of using porcelain veneers to repair developmental anterior interdental spaces is ideal, and that filling the papillae between the teeth meets patients' expectations. Digitalization plays an important role in anterior aesthetic restorations. The use of digital technology to manage the entire process of anterior aesthetic restorations can improve results, reduce the number of follow-up appointments, shorten consultation time, and increase patient satisfaction. Collaborative decision-making is crucial to optimizing aesthetic results.