Esposito Marco, Grusovin Maria Gabriella, Polyzos Ilias P, Felice Pietro, Worthington Helen V
Oral and Maxillofacial Surgery, School of Detistry, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
Eur J Oral Implantol. 2010 Autumn;3(3):189-205.
This review is based on a Cochrane systematic review entitled ‘Interventions for replacing missing teeth: dental implants in fresh extraction sockets (immediate, immediate-delayed and delayed implants)' published in The Cochrane Library (see http://www.cochrane.org/ for information). Cochrane systematic reviews are regularly updated to include new research, and in response to comments and criticisms from readers. If you wish to comment on this review, please send your comments to the Cochrane website or to Marco Esposito. The Cochrane Library should be consulted for the most recent version of the review. The results of a Cochrane review can be interpreted differently, depending on people's perspectives and circumstances. Please consider the conclusions presented carefully. They are the opinions of the review authors, and are not necessarily shared by the Cochrane Collaboration.
To evaluate success, complications, aesthetics and patient satisfaction among immediate, immediate-delayed and delayed implants in post-extractive sockets and whether and when augmentation procedures are necessary and which is the most effective augmentation technique.
The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched up to the 2nd of June 2010 for randomised controlled clinical trials (RCTs) with a follow-up of at least 1 year in function comparing immediate, immediate-delayed and delayed implants, or comparing various bone augmentation procedures around the inserted implants. Outcome measures were prosthesis and implant failures, complications, patient satisfaction and preference including aesthetics, aesthetics evaluated by a dentist, peri-implant marginal bone level changes, etc. Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. The statistical unit of the analysis was the patient. Results were expressed as fixed effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CIs).
Fourteen eligible RCTs were identified but only seven trials could be included. Four RCTs evaluated implant placement timing. Two RCTs compared immediate versus delayed implants in 126 patients and found no statistically significant differences. One RCT compared immediate-delayed versus delayed implants in 46 patients. After 2 years, patients in the immediate-delayed group perceived the time to functional loading significantly shorter, were more satisfied and an independent blinded assessor judged the level of the peri-implant marginal mucosa in relation to that of the adjacent teeth as more appropriate (RR = 1.68; 95% CI 1.04 to 2.72). These differences disappeared 5 years after loading, and significantly more complications occurred in the immediate-delayed group (RR = 4.20; 95% CI 1.01 to 17.43). One RCT compared immediate with immediately delayed implants in 16 patients for 2 years and found no differences. Three RCTs evaluated different techniques of bone grafting for implants immediately placed in extraction sockets. No statistically significant differences were observed when evaluating whether autogenous bone is needed in post-extractive sites (one trial with 26 patients) or which was the most effective augmentation technique (two trials with 56 patients).
There is insufficient evidence to determine the possible advantages or disadvantages of immediate, immediate-delayed or delayed implants, therefore these preliminary conclusions are based on few underpowered trials often judged to be at high risk of bias. There is a suggestion that immediate and immediate-delayed implants may be at a higher risk of implant failure and complications than delayed implants, on the other hand the aesthetic outcome might be better when placing implants just after tooth extraction. There is not enough reliable evidence supporting or refuting the need for augmentation procedures at immediate implants placed in fresh extraction sockets or whether any of the augmentation techniques is superior to the others.
评估即刻种植、即刻延期种植和延期种植于拔牙后牙槽窝的成功率、并发症、美观效果及患者满意度，以及是否需要和何时进行骨增量手术，哪种骨增量技术最有效。
检索考克兰口腔健康组试验注册库、考克兰对照试验中心注册库（CENTRAL）、MEDLINE和EMBASE，检索截至2010年6月2日的随机对照临床试验（RCT），这些试验对即刻种植、即刻延期种植和延期种植进行至少1年的功能随访，或比较植入种植体周围的各种骨增量手术。观察指标包括修复体和种植体失败情况、并发症、患者满意度和偏好，包括美观效果、由牙医评估的美观度、种植体周围边缘骨水平变化等。两名综述作者独立重复进行合格研究的筛选、试验方法学质量评估和数据提取。分析的统计单位是患者。结果以固定效应模型表示，连续结局采用均值差，二分结局采用风险比（RR），并给出95%置信区间（CI）。
共识别出14项合格的RCT，但仅纳入7项试验。4项RCT评估了种植体植入时机。2项RCT比较了126例患者的即刻种植与延期种植，未发现统计学显著差异。1项RCT比较了46例患者的即刻延期种植与延期种植。2年后，即刻延期种植组患者感觉达到功能负荷的时间明显更短，满意度更高，且独立盲法评估者判断种植体周围边缘黏膜与相邻牙齿的水平更合适（RR = 1.68；95% CI 1.04至2.72）。负荷后5年这些差异消失，且即刻延期种植组出现的并发症明显更多（RR = 4.20；95% CI 1.01至17.43）。1项RCT对16例患者的即刻种植与即刻延期种植进行了2年比较，未发现差异。3项RCT评估了即刻植入拔牙窝的种植体的不同骨移植技术。在评估拔牙后位点是否需要自体骨（一项26例患者的试验）或哪种骨增量技术最有效（两项56例患者的试验）时，未观察到统计学显著差异。
尚无足够证据确定即刻种植、即刻延期种植或延期种植的潜在优缺点，因此这些初步结论基于少数效力不足且常被判定存在高偏倚风险的试验。有迹象表明，即刻种植和即刻延期种植可能比延期种植有更高的种植体失败和并发症风险，另一方面，拔牙后即刻植入种植体时美观效果可能更好。没有足够可靠的证据支持或反驳在新鲜拔牙窝即刻植入种植体时进行骨增量手术的必要性，也无法确定任何一种骨增量技术是否优于其他技术。
