Del Fabbro Massimo, Ceresoli Valentina, Taschieri Silvio, Ceci Caterina, Testori Tiziano
Department of Biomedical, Surgical and Dental Sciences, CRSO (Centro di Ricerca per la Salute Orale), IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Galeazzi Orthopedic Institute, University of Milan, Milan, Italy.
Clin Implant Dent Relat Res. 2015 Feb;17(1):52-70. doi: 10.1111/cid.12074. Epub 2013 Apr 22.
The purpose of the present systematic review was to estimate the survival rate of implants placed in fresh extraction sockets and immediately restored. Secondary aims were to compare it with the survival rate of implants placed in healed ridges and of implants restored according to a delayed protocol as well as to assess the influence of several other confounding factors on the clinical outcomes.
An electronic search was performed on MEDLINE, EMBASE, and CENTRAL databases in order to identify prospective clinical studies published from 1990 to October 2012. A hand search was also done. Studies were selected according to specific inclusion criteria. The effect of the following parameters on 1-year implant survival (IS) was statistically evaluated: study design, risk of bias, prosthesis type, type of loading (occlusal or nonocclusal), type of incision (flap or flapless), presence of infection, and grafting material. A meta-analysis of studies comparing immediately restored implants placed in fresh postextraction sockets versus healed ridges was conducted.
Seven randomized trials, three controlled trials, and 35 case series were included, accounting for 1170 patients and 1974 postextraction implants immediately restored. Twenty-eight studies had a low risk of bias. The overall 1-year IS was 97.6%. All failures occurred within 1 year of function. Meta-analysis showed a significant better outcome for implants placed in healed ridge (IS = 99.4%) as compared with postextraction implants (IS = 95.6%). No other parameter had a significant effect on clinical outcomes. Most variables, among which the esthetic aspect, could not be assessed as they were not systematically reported.
Though the conventional protocol still represents the gold standard, immediate restoration of implants placed in fresh extraction sites displayed an excellent implant prognosis. Such clinical approach can be successfully adopted in order to minimize the treatment time with a relevant impact on patient's satisfaction.
本系统评价的目的是评估植入新鲜拔牙窝并即刻修复的种植体的存留率。次要目的是将其与植入愈合牙槽嵴的种植体以及按延期方案修复的种植体的存留率进行比较，并评估其他几个混杂因素对临床结果的影响。
对MEDLINE、EMBASE和CENTRAL数据库进行电子检索，以识别1990年至2012年10月发表的前瞻性临床研究。还进行了手工检索。根据特定的纳入标准选择研究。对以下参数对种植体1年存留率（IS）的影响进行统计学评估：研究设计、偏倚风险、修复体类型、加载类型（咬合或非咬合）、切口类型（翻瓣或不翻瓣）、感染的存在以及移植材料。对比较植入新鲜拔牙窝与愈合牙槽嵴的即刻修复种植体的研究进行了荟萃分析。
纳入了7项随机试验、3项对照试验和35个病例系列，涉及1170例患者和1974颗即刻修复的拔牙后种植体。28项研究的偏倚风险较低。总体1年IS为97.6%。所有失败均发生在功能1年内。荟萃分析显示，与拔牙后种植体（IS = 95.6%）相比，植入愈合牙槽嵴的种植体的结果显著更好（IS = 99.4%）。没有其他参数对临床结果有显著影响。大多数变量，包括美学方面，由于未系统报告而无法评估。
尽管传统方案仍是金标准，但植入新鲜拔牙位点的种植体即刻修复显示出极佳的种植预后。这种临床方法可以成功采用，以尽量减少治疗时间，对患者满意度有显著影响。
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