Esposito Marco, Grusovin Maria Gabriella, Chew Yun Shane, Coulthard Paul, Worthington Helen V
Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, JR Moore Building, Oxford Road, Manchester, UK, M13 9PL.
Cochrane Database Syst Rev. 2018 May 23;5(5):CD006698. doi: 10.1002/14651858.CD006698.pub3.
Implants may be placed penetrating the oral mucosa (1-stage procedure) or can be completely buried under the oral mucosa (2-stage procedure) during the healing phase of the bone at the implant surface. With a 2-stage procedure the risk of having unwanted loading onto the implants is minimized, but a second minor surgical intervention is needed to connect the healing abutments and more time is needed prior to start the prosthetic phase because of the wound-healing period required in relation to the second surgical intervention.
To evaluate whether a 1-stage implant placement procedure is as effective as a 2-stage procedure.
The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched. Handsearching included several dental journals. Authors of all identified trials, an Internet discussion group and 55 dental implant manufacturers were contacted to find unpublished randomised controlled trials (RCTs). The last electronic search was conducted on 21 January 2009.
All RCTs of osseointegrated dental implants comparing the same dental implants placed according to 1- versus 2-stage procedures with a minimum follow up of 6 months after loading. Outcome measures were: prosthesis failures, implant failures, marginal bone level changes on intraoral radiographs, patient preference including aesthetics, aesthetics evaluated by dentists, and complications.
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. Authors were contacted for missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals.
Five RCTs were identified and included reporting data on 239 patients in total. On a patient, rather than per implant basis, the meta-analyses showed no statistically significant differences for prosthesis and implant failures, though trends, especially in fully edentulous patients, favoured 2-stage (submerged) implants.
AUTHORS' CONCLUSIONS: The number of patients included in the trials was too small to draw definitive conclusions. The 1-stage approach might be preferable in partially edentulous patients since it avoids one surgical intervention and shortens treatment times, while a 2-stage submerged approach could be indicated when an implant has not obtained an optimal primary stability or when barriers are used for guided tissue regeneration, or when it is expected that removable temporary prostheses could transmit excessive forces on the penetrating abutments especially in fully edentulous patients.
在种植体表面骨愈合阶段，种植体可以穿透口腔黏膜植入（一期手术），也可以完全埋置于口腔黏膜下（二期手术）。二期手术可将种植体承受意外负荷的风险降至最低，但需要进行第二次小型外科手术来连接愈合基台，并且由于与第二次外科手术相关的伤口愈合期，在开始修复阶段前需要更多时间。
评估一期种植体植入手术是否与二期手术同样有效。
检索了Cochrane口腔健康组试验注册库、Cochrane系统评价数据库、MEDLINE和EMBASE。手工检索包括几本牙科杂志。联系了所有已识别试验的作者、一个互联网讨论组和55家牙科种植体制造商，以查找未发表的随机对照试验（RCT）。最近一次电子检索于2009年1月21日进行。
所有关于骨结合牙科种植体的RCT，比较按照一期和二期手术植入的相同牙科种植体，加载后至少随访6个月。观察指标包括：修复体失败、种植体失败、口腔内X线片上的边缘骨水平变化、患者偏好（包括美观度）、牙医评估的美观度以及并发症。
由两位综述作者独立进行重复筛选符合条件的研究、评估试验的方法学质量以及数据提取。联系作者获取缺失信息。结果以随机效应模型表示，连续型结局采用均值差，二分法结局采用风险比，并给出95%置信区间。
共识别并纳入5项RCT，总计报告了239例患者的数据。基于患者而非单个种植体进行的荟萃分析显示，修复体和种植体失败方面无统计学显著差异，尽管存在一定趋势，尤其是在全口无牙患者中，二期（埋入式）种植体更具优势。
纳入试验的患者数量过少，无法得出明确结论。一期手术方法对于部分牙列缺损患者可能更可取，因为它避免了一次外科手术并缩短了治疗时间，而当种植体未获得最佳初期稳定性、或使用屏障进行引导组织再生、或预计可摘临时修复体可能对穿透式基台传递过大力量时（尤其是在全口无牙患者中），二期埋入式手术方法可能更适用。
