Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.
Clin Implant Dent Relat Res. 2022 Jun;24(3):339-351. doi: 10.1111/cid.13079. Epub 2022 Mar 21.
To assess the effect of grafting the gap (SG) between the implant surface and alveolar socket on hard and soft tissue changes following single immediate implant placement (IIP).
Two independent reviewers conducted an electronic literature search in Pubmed, Web of Science, Embase and Cochrane databases as well as a manual search to identify eligible clinical studies up to August 2021. Randomized controlled trials (RCTs) comparing IIP with and without SG were included for a qualitative analysis. Meta-analyses were performed when possible.
Out of 3627 records, 15 RCTs were selected and reported on 577 patients who received 604 single immediate implants (IIP + SG: 298 implants in 292 patients; IIP: 306 implants in 285 patients) with a mean follow-up ranging from 4 to 36 months. Two RCTs showed low risk of bias. Meta-analysis revealed 0.59 mm (95% CI [0.41; 0.78], p < 0.001) or 54% less horizontal buccal bone resorption following IIP + SG when compared to IIP alone. In addition, 0.58 mm (95% CI [0.28; 0.88], p < 0.001) less apical migration of the midfacial soft tissue level was found when immediate implants were installed with SG. A trend towards less distal papillary recession was found (MD 0.60 mm, 95% CI [-0.08; 1.28], p = 0.080) when SG was performed, while mesial papillae appeared not significantly affected by SG. Vertical buccal bone changes were also not significantly affected by SG. Insufficient data were available for meta-analyses on horizontal midfacial soft tissue changes, pink esthetic score, marginal bone level changes, probing depth and bleeding on probing. Based on GRADE guidelines, a moderate recommendation for SG following IIP can be made.
SG may contribute to horizontal bone preservation and soft tissue stability at the midfacial aspect of immediate implants. Therefore, SG should be considered as an adjunct to IIP in clinical practice.
评估种植体表面与牙槽窝之间的间隙（SG）对单次即刻种植（IIP）后软硬组织变化的影响。
两位独立的审查员在 Pubmed、Web of Science、Embase 和 Cochrane 数据库中进行了电子文献检索，并进行了手工检索，以确定截至 2021 年 8 月的合格临床研究。纳入了比较 IIP 与有无 SG 的随机对照试验（RCT）进行定性分析。当可能时进行荟萃分析。
在 3627 条记录中，选择了 15 项 RCT，并报告了 577 名接受 604 个单即刻种植体（IIP+SG：292 名患者 298 个种植体；IIP：285 名患者 306 个种植体）的患者，平均随访时间从 4 到 36 个月。两项 RCT 显示低偏倚风险。荟萃分析显示，与单独 IIP 相比，SG 后水平颊侧骨吸收减少 0.59mm（95%CI[0.41;0.78]，p<0.001）或 54%。此外，当在 SG 中安装即刻种植体时，发现中面部软组织水平的根尖迁移减少了 0.58mm（95%CI[0.28;0.88]，p<0.001）。当进行 SG 时，发现远中乳头退缩的趋势减少（MD 0.60mm，95%CI[-0.08;1.28]，p=0.080），而近中乳头似乎不受 SG 的影响。SG 对颊侧骨的垂直变化也没有显著影响。关于水平中面部软组织变化、粉色美学评分、边缘骨水平变化、探诊深度和探诊出血，荟萃分析的可用数据不足。根据 GRADE 指南，可以对 IIP 后进行 SG 提出中度推荐。
SG 可能有助于即刻种植体水平骨保存和中面部软组织稳定性。因此，SG 应在临床实践中被视为 IIP 的辅助手段。
