Periodontol 2000. 2014 Oct;66(1):132-52. doi: 10.1111/prd.12044.
In recent years, immediate implant placement has become a common clinical therapeutic protocol representing an alternative to the classical delayed surgical protocol of implant placement. This protocol, however, has not been fully validated, either in terms of fully understanding the influence of implant placement on the socket-healing process or on the clinical outcomes. This narrative review evaluates the different experimental studies in humans and animals assessing the bone-healing dynamics of the socket after tooth extraction and the dimensional changes occurring at the socket bone walls. These experimental studies describe, in detail, the hard- and soft-tissue healing of implants placed into fresh extraction sockets, demonstrating that marked morphological changes of the alveolar ridge will occur, independently of the implant installation, thus demonstrating that postextraction bone loss is an inevitable biological process. This evidence has also been corroborated in clinical studies in humans, demonstrating the risk of significant peri-implant tissue loss, mainly in the areas of high esthetic demand. There is a lack of long-term evidence on the impact of this protocol on the preservation of the peri-implant tissues. In conclusion, despite the obvious advantages of this surgical protocol, it also has limitations and is more technically demanding than placing an implant into a healed crest. When selecting this protocol, clinicians should always consider: (a) the gingival biotype of the patient; (b) the thickness and integrity of the socket bony walls; (c) the implant selection as well as the adequate vertical and horizontal position of the implant; and (d) the ideal patient (a nonsmoker with good plaque control).
近年来,即刻种植已成为一种常见的临床治疗方案,它是经典的延迟种植方案的替代方案。然而,该方案在充分理解种植对种植窝愈合过程的影响以及临床结果方面还没有得到充分验证。本综述评估了不同的人体和动物实验研究,评估了拔牙后牙槽窝的骨愈合动态以及牙槽骨壁的尺寸变化。这些实验研究详细描述了在新鲜拔牙窝中植入种植体后的软硬组织愈合情况,证明牙槽嵴将发生明显的形态学变化,而与种植体安装无关,从而证明拔牙后骨丢失是一种不可避免的生物学过程。这一证据也在人体临床研究中得到了证实,表明种植体周围组织有大量丧失的风险,主要是在美学要求高的区域。关于该方案对种植体周围组织保存影响的长期证据还不足。总之,尽管该手术方案具有明显的优势,但它也有局限性,并且比将种植体植入愈合的牙槽嵴更具技术挑战性。在选择该方案时,临床医生应始终考虑:(a)患者的牙龈生物型;(b)牙槽骨壁的厚度和完整性;(c)种植体的选择以及种植体的适当垂直和水平位置;以及(d)理想的患者(不吸烟且具有良好的菌斑控制)。