Advanced Specialty Education Program in Prosthodontics, Department of Restorative Dentistry, University of Illinois at Chicago College of Dentistry, Chicago, Illinois 60612-7212, USA.
J Evid Based Dent Pract. 2010 Mar;10(1):52-5. doi: 10.1016/j.jebdp.2009.11.027.
The authors used MEDLINE, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) databases to locate studies for this systematic review (SR). For studies to be eligible for this SR, all had to evaluate single-implant restorations with a follow-up of at least 1 year after implant loading. A total of 19 prospective studies met inclusion and exclusion criteria. Fifteen studies provided implant survival data (499 patient/509 implants), whereas 5 studies provided radiographic marginal bone height data (52 patients/52 implants). The analysis included studies with patients with single anterior or premolar,maxillary or mandibular edentulous sites bounded by anterior and posterior neighboring teeth. Meta-analyses of prospective trials (randomized-controlled trials, clinical trials, cohort studies, case series) reported loaded implant survival with one-year or more than one-year follow-up. Meta-analysis of prospective trials reporting marginal bone loss with one-year follow-up was also reported.
The key interventions were the timing of implant placement following extraction and the timing of implant loading after implant placement. Comparisons following greater than one-year follow-up were made between implants with immediate placement with immediate loading, immediate/early placement with conventional loading, conventional placement with immediate/early loading, or conventional placement with conventional loading.
The main outcome was implant survival. Radiographically determined peri-implant bone level change was also reported. Meta-analyses were completed using studies that reported one-year implant survival data (15 studies) and more than one-year implant survival data (11 studies). One-year marginal bone level data were analyzed for implants treated conventionally (5 studies). For survival and marginal bone levels, weighted rates and random effects models were used to calculate overall effects of the included studies. For greater than one-year follow-up, survival data were stratified by intervention type. Results were weighted for study size and stratified based upon timing of implant placement and loading. Esthetics, and patient satisfaction, and complications were reported, but heterogeneity of study design and reported outcomes excluded the results from meta-analysis.
Approximately two-thirds of patients received implants in healed edentulous sites. Survival of single-tooth implants one year in function was 95.5% [95% CI: 93.0-97.1]. Meta-analysis identified no difference in survival rate at one year when the results were weighted for study size and stratified based upon timing of implant placement and loading. Survival of single-tooth implants more than one year in function ranged from 92.4% [95% CI: 84.4-96.4] for conventional placement with immediate loading to 97.5% [95% CI: 88.3-99.5] for immediate placement with immediate loading. The third meta-analysis identified 0.20-mm [95% CI:0.034-0.36] marginal bone loss for implants one year in function. Qualitative interpretation of other esthetic, patient satisfaction, and complication outcomes revealed no difference in immediate, early, or conventional therapy approaches.
The authors concluded that implant-supported single-tooth replacement in the aesthetic zone with adjacent natural teeth can lead to short-term, favorable outcomes with regard to implant survival and marginal bone level change with early/immediate or conventional surgical placement and loading strategies.
作者使用 MEDLINE、EMBASE 和 CENTRAL（Cochrane 对照试验中心注册库）数据库来定位本系统评价（SR）的研究。为了使本 SR 的研究符合条件，所有研究都必须评估在种植体加载后至少随访 1 年的单种植体修复。共有 19 项前瞻性研究符合纳入和排除标准。15 项研究提供了种植体存活率数据（499 名患者/509 个种植体），而 5 项研究提供了放射学边缘骨高度数据（52 名患者/52 个种植体）。分析包括在前牙或前磨牙、上颌或下颌单个缺牙部位接受治疗的患者，这些部位由前牙和后牙相邻。对具有 1 年或 1 年以上随访的前瞻性试验（随机对照试验、临床试验、队列研究、病例系列）进行了种植体存活率的荟萃分析。还报告了具有 1 年随访的边缘骨丢失的前瞻性试验荟萃分析。
关键干预措施是拔牙后种植体放置的时间和种植体放置后种植体加载的时间。在大于 1 年的随访后，对即刻放置与即刻负载、即刻/早期放置与常规负载、常规放置与即刻/早期负载或常规放置与常规负载的种植体进行了比较。
主要结局为种植体存活率。还报告了放射学确定的种植体周围骨水平变化。使用报告了 1 年种植体存活率数据（15 项研究）和 1 年以上种植体存活率数据（11 项研究）的研究进行了荟萃分析。对接受常规治疗的种植体（5 项研究）进行了 1 年边缘骨水平数据的分析。对于存活率和边缘骨水平，使用加权率和随机效应模型计算纳入研究的总体效果。对于大于 1 年的随访，根据干预类型对生存数据进行分层。结果按研究规模加权，并根据种植体放置和加载的时间进行分层。报告了美学、患者满意度和并发症，但由于研究设计和报告结果的异质性，排除了荟萃分析的结果。
大约三分之二的患者在愈合的缺牙部位接受了种植体。功能 1 年的单颗牙种植体存活率为 95.5%[95%CI：93.0-97.1]。荟萃分析确定，按研究规模加权并根据种植体放置和加载的时间进行分层，在 1 年时，存活率没有差异。功能 1 年以上的单颗牙种植体存活率从即刻负载的常规种植体的 92.4%[95%CI：84.4-96.4]到即刻负载的即刻种植体的 97.5%[95%CI：88.3-99.5]。第三次荟萃分析确定，功能 1 年的种植体边缘骨丢失 0.20 毫米[95%CI：0.034-0.36]。对其他美学、患者满意度和并发症结果的定性解释表明，即刻、早期或常规治疗方法之间没有差异。
作者得出结论，在有相邻天然牙的美学区域，用种植体支持单颗牙修复，可以在种植体存活和边缘骨水平变化方面带来短期、有利的结果，采用早期/即刻或常规的手术放置和加载策略。
