Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.
Clin Oral Implants Res. 2024 Jun;35(6):585-597. doi: 10.1111/clr.14261. Epub 2024 Apr 1.
To compare immediate implant placement (IIP) with early implant placement (EIP) for single tooth replacement in the aesthetic area in terms of aesthetic, clinical, and patient-reported outcomes.
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 February 2023. Randomized Controlled Trials (RCTs) comparing IIP with EIP were included for a qualitative and quantitative analysis. The primary outcome was vertical midfacial soft tissue change. Secondary outcomes were horizontal midfacial soft tissue change, vertical papillary change, pink esthetic score (PES), implant survival, buccal bone thickness, marginal bone level change, patient discomfort, chair time, and patient satisfaction.
Out of 1185 records, 6 RCTs were selected, reporting on 222 patients who received 222 single implants (IIP: 112 implants in 112 patients; EIP: 110 implants in 110 patients) in the anterior maxilla or mandible. Patients had a mean age ranging from 35.6 to 52.6 years and were followed between 8 and 24 months. Two RCTs showed some concerns, and four showed a high risk of bias. Four studies could be included in a meta-analysis on the primary outcome and three only considered cases with an intact buccal bone wall. Meta-analysis failed to demonstrate a significant difference in terms of vertical midfacial soft tissue change between IIP and EIP (mean difference: 0.31 mm, 95% CI [-0.23; 0.86], p = .260; I = 83%, p < .001). No significant differences were found for PES (standardized mean difference: 0.92, 95% CI [-0.23; 2.07], p = .120; I = 89%, p < .001), implant survival (RR: 0.98, 95% CI [0.93, 1.03], p = .480; I = 0%, p = .980), and marginal bone level change (mean difference: 0.03 mm, 95% CI [-0.12, 0.17], p = .700; I = 0%, p = .470). Insufficient data were available for meta-analyses of other secondary outcomes.
In low-risk patients with an intact buccal bone wall, there seems to be no difference between IIP and EIP in terms of aesthetic and clinical outcomes. The strength of this conclusion is rated as low since studies showed an unclear or high risk of bias. In addition, state-of-the-art therapy was only delivered in a minority of studies. Future RCTs should also provide data on patient-reported outcomes since these have been underreported.
比较单牙缺失患者在美学区即刻种植（IIP）与早期种植（EIP）的美学、临床和患者报告的结果。
两名独立的审查员在 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 2023 年 2 月的合格临床研究。纳入了比较 IIP 与 EIP 的随机对照试验（RCT）进行定性和定量分析。主要结局是垂直面中部软组织变化。次要结局包括水平面中部软组织变化、垂直乳头变化、粉色美学评分（PES）、种植体存活率、颊侧骨厚度、边缘骨水平变化、患者不适、椅旁时间和患者满意度。
在 1185 条记录中，选择了 6 项 RCT，报告了 222 名接受 222 个单种植体（IIP：112 个种植体在 112 名患者中；EIP：110 个种植体在 110 名患者中）的患者在前上颌或下颌骨中的情况。患者的平均年龄为 35.6 至 52.6 岁，随访时间为 8 至 24 个月。两项 RCT 存在一些担忧，四项 RCT 存在高偏倚风险。四项研究可纳入主要结局的荟萃分析，三项研究仅考虑了颊侧骨壁完整的病例。荟萃分析未能显示 IIP 和 EIP 之间在垂直面中部软组织变化方面有显著差异（平均差异：0.31mm，95%CI[-0.23；0.86]，p=0.260；I=83%，p<0.001）。PES 也没有显著差异（标准化均数差：0.92，95%CI[-0.23；2.07]，p=0.120；I=89%，p<0.001）、种植体存活率（RR：0.98，95%CI[0.93；1.03]，p=0.480；I=0%，p=0.980）和边缘骨水平变化（平均差异：0.03mm，95%CI[-0.12；0.17]，p=0.700；I=0%，p=0.470）。由于数据不足，无法进行其他次要结局的荟萃分析。
在颊侧骨壁完整的低风险患者中，即刻种植和早期种植在美学和临床结果方面似乎没有差异。由于研究存在不明确或高偏倚风险，因此该结论的强度被评为低。此外，少数研究中提供了最先进的治疗。未来的 RCT 还应提供患者报告的结果数据，因为这些数据报告不足。
