Gaddale Reetika, Chowdhary Ramesh, Mishra Sunil K, Sagar Kamal
Department of Periodontology, Sri Siddhartha Dental College, SSAHE University, Tumkur, Karnataka, India.
Department of Prosthodontics, Sri Siddhartha Dental College, SSAHE University, Tumkur, Karnataka, India.
Evid Based Dent. 2024 Dec 2. doi: 10.1038/s41432-024-01091-7.
Type I immediate implant placement has its own advantages like reduced treatment time, number of surgeries and post-extraction bone loss, however, the presence of insufficiently keratinized mucosa poses a challenge for flap adaptation and hinders the achievement of primary stability. Additionally, scientific evidence supports the notion that post-extraction bone loss is a natural biological occurrence that can impact the success of treatments.
The primary outcome was to find out the hard and soft tissues changes around the implant following immediate placement and immediate loading. The secondary outcome was to record the adverse events post implant placement such as infection during the course of healing and after restoration, implant failure which would include surgical and post restoration, and over- all success and survival rate of implant.
A detailed electronic literature search of the articles published in English language was undertaken in October 2023 on online search engines Medline/PubMed and Cochrane databases with no restriction on year of search to include studies on immediate implant placement and loading with a mean follow-up time of at least 1 year. Weighted means of soft and hard tissue changes were obtained by the inverse variance method.
A total of 16 studies were included. There was no difference in crestal bone levels in immediate or delayed implant placement with immediate provisionalization in the anterior maxilla. The peri-implant margin remained and no differences in papillary loss was seen when compared to the delayed implant placement cases. Papilla were more stable or showed less recession in flapless approach compared to full thickness flap approach. Among the studies which filled the GAP with bone graft materials, no significant changes were found in the bone level changes. In case of recession, immediate implant placement with provisionalization did result in approximately 1 mm less facial gingival recession compared with that in the group that had a socket graft. Implant related complications occurred more in immediate implant placement and provisionalization compared to delayed group. And almost similar implant success and survival rates were seen in comparison to delayed implant placement groups.
Despite the similar implant survival rates observed in comparison to delayed implant placement groups, more long-term studies are necessary to determine the success of immediate implant placement and immediate loading. Special attention has to be given to aesthetic outcomes.
I型即刻种植具有减少治疗时间、手术次数和拔牙后骨吸收等优点，然而，角化黏膜不足对瓣的贴合构成挑战，并阻碍实现初期稳定性。此外，科学证据支持拔牙后骨吸收是一种会影响治疗成功的自然生物学现象这一观点。
主要结果是了解即刻种植和即刻负重后种植体周围软硬组织的变化。次要结果是记录种植体植入后的不良事件，如愈合过程中和修复后感染、种植失败（包括手术期和修复后）以及种植体的总体成功率和存留率。
2023年10月，在在线搜索引擎Medline/PubMed和Cochrane数据库中对以英文发表的文章进行了详细的电子文献检索，检索年份无限制，以纳入关于即刻种植和负重且平均随访时间至少为1年的研究。采用逆方差法获得软硬组织变化的加权均值。
共纳入16项研究。在上颌前部即刻种植并即刻临时修复与延期种植并即刻临时修复的病例中，种植体嵴顶骨水平无差异。与延期种植病例相比，种植体周围边缘保留，乳头丧失无差异。与全厚瓣法相比，在无瓣法中乳头更稳定或退缩较少。在使用骨移植材料填补间隙的研究中，骨水平变化未发现显著差异。在出现退缩的情况下，即刻种植并临时修复与牙槽窝植骨组相比，面部牙龈退缩约少1mm。与延期组相比，即刻种植并临时修复组发生种植体相关并发症更多。与延期种植组相比，即刻种植组的种植成功率和存留率几乎相似。
尽管与延期种植组相比观察到相似的种植体存留率，但仍需要更多长期研究来确定即刻种植和即刻负重的成功率。必须特别关注美学效果。
