Esposito M, Grusovin M G, Willings M, Coulthard P, Worthington H V
School of Dentistry, Department of Oral and Maxillofacial Surgery, University of Manchester, Higher Cambridge Street, Manchester, UK, M15 6FH.
Cochrane Database Syst Rev. 2007 Apr 18(2):CD003878. doi: 10.1002/14651858.CD003878.pub3.
To minimize the risk of implant failure, osseointegrated dental implants are conventionally kept load-free during the healing period. During healing removable prostheses are used, however many patients find these temporary prostheses rather uncomfortable and it would be beneficial if the healing period could be shortened without jeopardizing implant success. Nowadays immediately and early loaded implants are commonly used in mandibles (lower jaws) of good bone quality. It would be useful to know whether there is a difference in success rates between immediately or early loaded implants compared with conventionally loaded implants.
To test the null hypothesis of no difference in the clinical performance between osseointegrated implants loaded at different times 6 months to 1 year after loading.
The Cochrane Oral Health Group's Trials Register, The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE were searched. Handsearching included several dental journals. Authors of all identified trials, an internet discussion group and 55 dental implant manufacturers were contacted to find unpublished randomised controlled trials (RCTs). The last electronic search was conducted on 7 August 2006.
All RCTs of root-form osseointegrated oral implants having a follow up of 6 months to 1 year comparing the same osseointegrated root-form oral implants immediately (within 1 week); early (between 1 week to 2 months); and conventionally loaded (after 2 months). Outcome measures were: prosthesis failures, implant failures and marginal bone levels on intraoral radiographs.
Data were independently extracted, in duplicate, by two review authors. Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Oral Health Group's statistical guidelines were followed.
Twenty RCTs were identified and 11 trials including 300 patients in total were included. Six trials compared immediate versus conventional loading, three early versus conventional loading and two immediate versus early loading. On a patient, rather than per implant basis, there were no statistically significant differences for any of the meta-analyses.
AUTHORS' CONCLUSIONS: It is possible to successfully load dental implants immediately or early after their placement in selected patients, though not all clinicians may achieve optimal results when loading the implant immediately. A high degree of primary implant stability (high value of insertion torque) seems to be one of the prerequisites for a successful immediate/early loading procedure. More well designed RCTs are needed. Priority should be given to trials comparing immediately versus early loaded implants to improve patient satisfaction and decrease treatment time. These trials should be reported according to the CONSORT guidelines (http://www.consort-statement.org/).
为了将种植体失败的风险降至最低，传统上骨结合牙种植体在愈合期保持无负载状态。在愈合期间使用可摘义齿，然而许多患者发现这些临时义齿相当不舒服，并且如果愈合期能够缩短而不危及种植成功，将会很有益处。如今，即刻负载和早期负载种植体常用于骨质良好的下颌骨。了解即刻或早期负载种植体与传统负载种植体的成功率是否存在差异将会很有用。
检验在负载后6个月至1年不同时间负载的骨结合种植体之间临床性能无差异的零假设。
检索了Cochrane口腔健康组试验注册库、Cochrane对照试验中心注册库、MEDLINE和EMBASE。手工检索包括几本牙科杂志。联系了所有已识别试验的作者、一个互联网讨论组和55家牙种植体制造商，以查找未发表的随机对照试验（RCT）。最后一次电子检索于2006年8月7日进行。
所有对根形骨结合口腔种植体进行6个月至1年随访的RCT，比较相同的根形骨结合口腔种植体即刻（1周内）、早期（1周至2个月之间）和传统负载（2个月后）情况。观察指标为：义齿失败、种植体失败以及口腔X光片上的边缘骨水平。
由两位综述作者独立、一式两份地提取数据。联系作者获取随机化和撤组的详细信息，并进行质量评估。遵循Cochrane口腔健康组的统计指南。
识别出20项RCT，纳入了11项试验，共300例患者。6项试验比较了即刻负载与传统负载，3项比较了早期负载与传统负载，2项比较了即刻负载与早期负载。基于患者而非每个种植体，任何荟萃分析均无统计学显著差异。
在部分选定患者中，种植体植入后即刻或早期成功负载是可能的，不过并非所有临床医生在即刻负载种植体时都能取得最佳效果。较高的种植体初期稳定性（较高的植入扭矩值）似乎是成功的即刻/早期负载程序的先决条件之一。需要更多设计良好的RCT。应优先进行比较即刻负载与早期负载种植体的试验，以提高患者满意度并缩短治疗时间。这些试验应按照CONSORT指南（http://www.consort-statement.org/）进行报告。
