The University of Hong Kong, Faculty of Dentistry, Prince Philip Dental Hospital, Hong Kong, SAR, China.
Clin Oral Implants Res. 2012 Feb;23 Suppl 5:39-66. doi: 10.1111/j.1600-0501.2011.02372.x.
Type I immediate implant placement has gained popularity because it may reduce treatment time, number of surgeries and post-extraction bone loss. However, this is potentially challenged by inadequate keratinized mucosa for flap adaptation and difficulties in achieving primary stability. Moreover, it has been proven that post-extraction bone loss is an inevitable biological process, which affects treatment outcomes.
To estimate survival and success rates of implants and the implant-supported prostheses, the prevalence of biological, technical and aesthetic complications, and the magnitude of soft and hard tissue changes following implant placement immediately into fresh extraction sockets.
An electronic search in MEDLINE (PubMed) and the Cochrane Library from 1991 to July 2010 was performed to include prospective studies on immediate implants with a mean follow-up time of at least 1 year. The survival rates were computed using the STATA statistical software. Weighted means of soft and hard tissue changes were obtained by the inverse variance method.
A total of 46 prospective studies, with a mean follow-up time of 2.08 years, were included. The annual failure rate of immediate implants was 0.82% (95% CI: 0.48-1.39%), translating into the 2-year survival rate of 98.4% (97.3-99%). Among the five factors analysed (reasons for extraction, antibiotic use, position of implant [anterior vs. posterior, maxilla vs. mandible), type of loading], only the regimen of antibiotic use affected the survival rate significantly. Lower failure rates were found in groups that were provided with a course of post-operative antibiotics. The success of implant therapy was difficult to assess due to scarce reporting on biological, technical and aesthetic complications. Soft tissue changes occurred mostly in the first 3 months after the provision of restoration, and then stabilized towards end of the first year. Marginal bone loss predominantly took place in the first year after implant placement, with a magnitude generally less than 1 mm. Controversy on hard tissue preservation with platform-switching technique remained unsolved.
Despite the high survival rate observed, more long-term studies are necessary to determine the success of implant treatment provided immediately after tooth extraction. Special attention has to be given to aesthetic outcomes.
I 型即刻种植因其可减少治疗时间、手术次数和拔牙后骨量丢失而受到欢迎。然而，角化黏膜不足会影响瓣的适应性，且难以达到初始稳定性，这可能会对即刻种植造成挑战。此外，已证实拔牙后骨量丢失是一种不可避免的生物学过程，会影响治疗效果。
评估即刻植入物及种植体支持修复体的存活率和成功率、生物、技术和美学并发症的发生率，以及即刻植入物植入新鲜拔牙窝后软组织和硬组织变化的程度。
对 1991 年至 2010 年 7 月期间 MEDLINE（PubMed）和 Cochrane 图书馆的电子文献进行检索，纳入了具有至少 1 年平均随访时间的即刻种植体前瞻性研究。使用 STATA 统计软件计算存活率。采用倒数方差法获得软组织和硬组织变化的加权平均值。
共纳入 46 项前瞻性研究，平均随访时间为 2.08 年。即刻种植体的年失败率为 0.82%（95%CI：0.48-1.39%），则 2 年存活率为 98.4%（97.3%-99%）。在分析的 5 个因素（拔牙原因、使用抗生素、种植体位置[前牙 vs. 后牙、上颌骨 vs. 下颌骨]、加载类型）中，只有抗生素使用方案显著影响存活率。使用术后抗生素疗程的组失败率较低。由于生物、技术和美学并发症的报告很少，因此难以评估种植治疗的成功率。软组织变化主要发生在修复体提供后的前 3 个月，然后在第一年结束时趋于稳定。边缘骨丢失主要发生在种植体放置后的第 1 年，通常小于 1mm。平台转换技术的硬组织保存仍存在争议。
尽管观察到高存活率，但仍需要更多的长期研究来确定拔牙后即刻种植的治疗成功率。需要特别注意美学效果。
