###### Abstract  
Both surgical and non-surgical techniques are employed for implant site development. However, the efficacy of these methods has not been thoroughly evaluated and compared. This systematic review aims to compare the biologic, functional and esthetic outcomes of three different approaches before implant placement in both the maxillary and mandibular arches: orthodontic extrusion, regenerative surgery and spontaneous healing after extraction. The systematic research of articles was conducted up to January 2020 in Medline, Scopus and the Cochrane Library databases. Studies were selected in a three-stage process according to the title, the abstract and the inclusion criteria. The methodological quality and the risk of bias of the included studies were evaluated using ROBINS-I tools for non-randomized studies, Rob 2.0 for RCT. Quality evaluation of case reports was performed using CARE guidelines. Through the digital search, 1607 articles were identified, and 25 of them were included in the systematic review. The qualitative evaluation showed a good methodological quality for RCT, sufficient for non-randomized studies and poor for case reports. Based on the available results, both orthodontic extrusion and regenerative surgery allowed the development of the implant site with satisfying esthetic and functional outcomes. Studies about the spontaneous healing of the extraction socket showed resorption of the dedentulous ridge, which complicated the implant insertion. No study referred to failures or severe complications. Most of the studies reported only qualitative results. The present systematic review demonstrated that there is a substantial lack of data and evidence to determine which of the presented methods is better for developing a future implant site. Both surgical and non-surgical procedures appear effective in the regeneration of hard tissue, whereas not all the techniques can improve soft tissue volume, too. The orthodontic technique simultaneously enhances both hard and soft tissue. Clinical Medicine  
20 October 2020  
Deptept 20 October 2022  
Dept 20 October 2022  
Several surgical techniques have been employed to develop the implant site, including bone and soft tissue grafting, guided bone regeneration (GBR), distraction osteogenesis and ridge splitting [3; 4; 5; 6; 7; 8; 9; 10; 11; 12; 13; 14; 15]. For large defects, autogenous bone blocks remain the 'gold standard'. Ideally, the autograft is taken from an intraoral site, either the ramus or symphysis. Selection depends on the defect morphology, location of the recipient site, available bone and the position of vital structures. The ramus is often preferable; however, the presence of third molars, lack of width between the lingual wall and the external oblique ridge, or reduced bone height above the inferior dental canal may prohibit its use [16; 17; 18]. Symphyseal donor sites are selected according to bone availability between the inferior border of the mandible and the apices of the lower incisors and canines. A minimum safe distance of 5 mm should be left to avoid injury to these teeth. If the amount of bone needed exceeds what is available intraorally, then extraoral sites can be considered, such as the iliac crest and calvarium [16]. Autogenous bone is the ideal biomaterial. As it is a genetic match, there are no issues with biocompatibility, carcinogenicity, disease transmission, or religious or ethical objections. Compared with the other graft materials, it is more resistant to infections and has a shorter healing time. However, its single most important and unique property is its osteogenicity [16]. While other graft materials merely act as a scaffold, into which the host bone eventually grows and substitutes, an autograft will stimulate bone opposition. A complicating factor in the use of autologous grafts is the need for a donor site with its associated morbidity. As an alternative to this type of grafting, allogenic, xenographic and alloplastic materials have been developed.