Felice Pietro, Soardi Elisa, Piattelli Maurizio, Pistilli Roberto, Jacotti Michele, Esposito Marco
Department of Peridontology and Implantalogy, University of Bologna, Bologna, Italy.
Eur J Oral Implantol. 2011 Winter;4(4):329-44.
To compare the effectiveness of immediate post-extractive single implants with delayed implants placed in preserved sockets after 4 months of healing. Implants that achieved an insertion torque of at least 35 Ncm were immediately non-occlusally loaded.
Just after tooth extraction and in the presence of a loss of the buccal plate bone less than 4 mm, compared to the palatal wall, 106 patients requiring a single immediate postextractive implant in the maxilla from second premolar to second premolar were randomly allocated to immediate implant placement (immediate group; 54 patients) or to socket preservation using anorganic bovine bone covered by a resorbable collagen barrier (delayed group; 52 patients) according to a parallel group design at three different centres. Bone-to-implant gaps were to be filled with anorganic bovine bone, however this was not done in 17 patients (corresponding to 40% of those who should have been grafted). Four months after socket preservation, delayed implants were placed. Implants placed with an insertion torque >35 Ncm were immediately loaded with non-occluding provisional single crowns, replaced, after 4 months, by definitive crowns. Outcome measures were implant failures, complications, aesthetics assessed using the pink esthetic score (PES), and patient satisfaction, recorded by blinded assessors. All patients were followed up to 4 months after loading.
Nineteen (35%) implants were not immediately loaded in the immediate group versus 39 (75%) implants in the delayed placement group because an insertion torque >35 Ncm could not be obtained. No patient dropped out. Two implants failed in the immediate group (4%) versus none in the delayed group. More minor complications occurred in the immediate group (8) than the in the delayed group (1) and this was statistically significant (P = 0.032). At delivery of definitive crowns, 4 months after loading, aesthetics were scored as 12.8 and 12.6 in the immediate and delayed groups, respectively. There was no statistically significant difference (P = 0.5). Patients of both groups were equally satisfied.
There were more complications at immediate post-extractive implants when compared to delayed implants. The aesthetic outcome appears to be similar for both groups and it seems more difficult to obtain a high insertion torque in sockets preserved with anorganic bovine bone.
比较拔牙后即刻单颗种植体与愈合4个月后在保存牙槽窝内植入的延期种植体的有效性。植入扭矩至少达到35 Ncm的种植体即刻进行非咬合加载。
在拔牙后且颊侧骨板骨丧失小于4 mm（相对于腭侧壁）时，106例需要在上颌第二前磨牙至第二前磨牙区域植入单颗拔牙后即刻种植体的患者，按照平行组设计，在三个不同中心被随机分配至即刻种植组（即刻组；54例患者）或使用可吸收胶原屏障覆盖的无机牛骨进行牙槽窝保存组（延期组；52例患者）。种植体与骨之间的间隙要用无机牛骨填充，然而17例患者未进行此操作（占应进行植骨患者的40%）。牙槽窝保存4个月后植入延期种植体。植入扭矩>35 Ncm的种植体即刻用非咬合的临时单冠进行加载，4个月后更换为永久冠。观察指标为种植体失败、并发症、使用粉色美学评分（PES）评估的美学效果以及患者满意度，由盲法评估者记录。所有患者随访至加载后4个月。
即刻组有19颗（35%）种植体未即刻加载，而延期种植组有39颗（75%）种植体未即刻加载，原因是无法获得>35 Ncm的植入扭矩。无患者退出。即刻组有2颗种植体失败（4%），延期组无种植体失败。即刻组发生的轻微并发症（8例）多于延期组（1例），且具有统计学意义（P = 0.032）。在加载后4个月永久冠戴入时，即刻组和延期组的美学评分分别为12.8和12.6。无统计学显著差异（P = 0.5）。两组患者的满意度相同。
与延期种植体相比，拔牙后即刻种植体出现的并发症更多。两组的美学效果似乎相似，且在用无机牛骨保存的牙槽窝中获得高植入扭矩似乎更困难。
