Godani Aashi, Iyer Janani, Nadgere Jyoti, Mohite Anuradha, Gaikwad Amit
Postgraduate student, Department of Prosthodontics and Crown & Bridge, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India.
Professor, Department of Prosthodontics and Crown & Bridge, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India.
J Prosthet Dent. 2024 Feb 13. doi: 10.1016/j.prosdent.2024.01.013.
Immediate implant placement with an immediate interim restoration is a well-established protocol. Nevertheless, a consensus regarding the impact of immediate interim restoration on peri-implant tissues around single dental implants is lacking.
The purpose of this systematic review and meta-analysis was to address the research question: "Does the placement of an immediate interim restoration influence the mid-facial mucosal (MFM) marginal and interdental papilla (IDP) levels around single dental implants placed in the anterior esthetic region by using an immediate implant placement protocol?"
A comprehensive literature search was made in the Medline/PubMed, Scopus, Cochrane, and Science Direct electronic databases for articles published in English evaluating the impact of immediate interim restoration on peri-implant tissues around single dental implants in the anterior esthetic region. The primary outcomes assessed were changes in the MFM marginal and IDP levels. Additional outcomes were marginal bone (MB) loss, esthetic outcomes involving the pink and white esthetic scores (PES and WES), implant survival rates, and patient reported outcome measures (PROMs). The risk of bias assessment was performed by using the RoB 2 tool for randomized trials and the Newcastle-Ottawa scale for nonrandomized studies. Meta-analysis was performed by using random and fixed effects model (α=.05) in the RevMan software program.
Sixteen studies were included that analyzed 836 single dental implants involving 823 patients. The meta-analysis showed no significant differences in implants with and without interim restoration in terms of MFM marginal level (MD=0.01; 95% CI=-1.23 to 1.25; P=.98), mesial IDP level (MD=0.12; 95% CI=-0.23 to 0.47; P=.50), distal IDP level (MD=0.20; 95% CI=-0.40 to 0.79; P=.52), and MB loss (MD=0.01; 95% CI=-0.42 to 0.43; P=.97). The systematic analysis for survival rates determined no notable difference in implants with or without an interim restoration. However, the esthetic outcomes and PROMs substantially improved with immediate interim restorations. The RoB 2 tool showed a moderate to low risk of bias, and the Newcastle-Ottawa scale indicated high-quality studies.
After a 12-month follow-up, immediate interim restoration had no significant impact on peri-implant soft (MFM marginal and IDP levels) and hard tissues (MB loss) around immediately placed single dental implants. Nevertheless, additional well-designed and well-implemented clinical trials with long-term follow-up periods are needed to provide more precise evidence-based recommendations.
即刻种植并同期进行即刻临时修复是一种成熟的方案。然而，对于即刻临时修复对单颗牙种植体周围种植体周围组织的影响，目前尚无共识。
本系统评价和荟萃分析的目的是解决以下研究问题：“采用即刻种植方案时，即刻临时修复的放置是否会影响前牙美学区单颗牙种植体周围的面部中部黏膜（MFM）边缘和牙间乳头（IDP）水平？”
在Medline/PubMed、Scopus、Cochrane和Science Direct电子数据库中进行全面的文献检索，以查找用英文发表的评估即刻临时修复对前牙美学区单颗牙种植体周围种植体周围组织影响的文章。评估的主要结局是MFM边缘和IDP水平的变化。其他结局包括边缘骨（MB）吸收、涉及粉红美学评分（PES）和白色美学评分（WES）的美学结局、种植体存活率以及患者报告的结局指标（PROMs）。采用RoB 2工具对随机试验进行偏倚风险评估，采用纽卡斯尔-渥太华量表对非随机研究进行评估。在RevMan软件程序中使用随机和固定效应模型（α = 0.05）进行荟萃分析。
纳入了16项研究，分析了涉及823名患者的836颗单颗牙种植体。荟萃分析显示，在MFM边缘水平（MD = 0.01；95% CI = -1.23至1.25；P = 0.98）、近中IDP水平（MD = 0.12；95% CI = -0.23至0.47；P = 0.50）、远中IDP水平（MD = 0.20；95% CI = -0.40至0.79；P = 0.52）和MB吸收（MD = 0.01；95% CI = -0.42至0.43；P = 0.97）方面，有临时修复和无临时修复的种植体之间无显著差异。对存活率的系统分析表明，有或无临时修复的种植体之间无显著差异。然而，即刻临时修复使美学结局和PROMs有了显著改善。RoB工具显示偏倚风险为中度至低度，纽卡斯尔-渥太华量表表明研究质量较高。
经过12个月的随访，即刻临时修复对即刻植入的单颗牙种植体周围的种植体周围软组织（MFM边缘和IDP水平）和硬组织（MB吸收）没有显著影响。然而，需要更多设计良好且实施完善的长期随访临床试验，以提供更精确的循证建议。
