Immediate Implant Placement With or Without Immediate Provisionalization in the Maxillary Esthetic Zone: A Systematic Review and Meta-analysis.

IF 1.7 4区 医学 Q3 DENTISTRY, ORAL SURGERY & MEDICINE International Journal of Oral & Maxillofacial Implants Pub Date : 2023-05-01 DOI:10.11607/jomi.10112
Rao Qin, Yue Chen, Chong Han, Dongchao Wu, Feiyan Yu, Dongning He
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引用次数: 1

Abstract

Purpose: To determine whether immediate implant placement and loading renders different outcomes from delayed loading with respect to midfacial mucosal level in the maxillary esthetic area.

Materials and methods: A literature search was conducted in four electronic databases (PubMed, Web of Science, Embase, and Cochrane), identifying eligible clinical studies published prior to December 2021. Only randomized controlled trials (RCTs) comparing immediate implant placement with or without immediate loading in the maxillary esthetic zone with a mean follow-up of at least 12 months were selected for qualitative analysis and meta-analysis. The Cochrane Risk of Bias tool was adopted to assess the quality of the evidence. The heterogeneity between the pooled literature was analyzed through the chi-square test (P < .05) and quantified by the I2 index. A mixed-effects model was applied if it appeared that there was noteworthy heterogeneity; otherwise, a random-effects model was chosen. For continuous outcomes, the estimate of relative effect was presented to display the standardized mean differences (SMDs) and 95% CIs. For dichotomous variables, the Mantel-Haenszel statistical method was applied with effect sizes expressed as risk ratios (RRs) and 95% CIs. This study is registered on PROSPERO with number CRD42017078611.

Results: Out of 5,553 records, 8 RCTs were involved, providing data for 324 immediately placed implants (immediate implants subjected to immediate loading [IPIL]: 163; immediate implants subjected to delayed loading [IPDL]: 161) that had been in function within 12 to 60 months. Meta-analyses revealed significantly lower midfacial mucosal level changes for IPIL compared with IPDL, pointing to 0.48 mm (95% CI: -0.84 to -0.12; P = .01), as well as more significant papillary recession after IPDL (SMD -0.16; 95% CI: -0.31 to 0.00; P = .04). The differences regarding implant survival and marginal bone loss between the two loading groups showed no statistical significance. The result of metaanalyses revealed similar plaque score (SMD 0.03; 95% CI: -0.22 to 0.29; P = .79) and probing depth (SMD -0.09; 95% CI: -0.23 to 0.05; P = .21) for IPIL and IPDL. On the other hand, IPIL induced a trend toward more bleeding on probing (SMD 0.22; 95% CI: 0.01 to 0.42; P = .04) and less change in facial ridge dimension (SMD 0.94; 95% CI: -1.49 to -0.39; P < .01).

Conclusion: After a follow-up ranging from 12 to 60 months, midfacial mucosa level change was 0.48 mm lower following IPIL compared with IPDL. Immediate implant placement and loading is conducive to the preservation of physiologic soft and hard tissue architecture, appearing to offer considerable benefits in the anterior zone. In summary, IPIL should be considered in the esthetic zone if the primary implant stability permits. Int J Oral Maxillofac Implants 2023;38:422-434. doi: 10.11607/jomi.10112.

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上颌美学区即刻种植体置入与不即刻预备:系统回顾与meta分析。
目的:探讨即刻种植体植入与延迟植入对上颌美观区面中黏膜水平的影响。材料和方法:在四个电子数据库(PubMed、Web of Science、Embase和Cochrane)中进行文献检索,确定2021年12月之前发表的符合条件的临床研究。仅选择随机对照试验(rct)进行定性分析和荟萃分析,比较上颌美观区立即植入或不立即加载的即刻种植体,平均随访至少12个月。采用Cochrane偏倚风险工具评估证据质量。合并文献间异质性采用卡方检验(P < 0.05), I2指数量化。如果存在显著的异质性,则采用混合效应模型;否则,选择随机效应模型。对于连续结果,给出相对效应的估计,以显示标准化平均差异(SMDs)和95% ci。对于二分类变量,采用Mantel-Haenszel统计方法,效应量以风险比(rr)和95% ci表示。本研究已在PROSPERO上注册,注册号码为CRD42017078611。结果:在5553条记录中,涉及8个随机对照试验,提供了324个即刻放置种植体的数据(即刻加载的即刻种植体[IPIL]: 163;延迟加载的即刻种植体[IPDL]: 161),其功能在12至60个月内。荟萃分析显示,与IPDL相比,IPIL的面中粘膜水平变化显著降低,为0.48 mm (95% CI: -0.84至-0.12;P = 0.01),以及IPDL后更显著的乳头状退缩(SMD -0.16;95% CI: -0.31至0.00;P = .04)。两组间种植体存活和边缘骨丢失的差异无统计学意义。meta分析结果显示斑块评分相似(SMD 0.03;95% CI: -0.22 ~ 0.29;P = 0.79)和探测深度(SMD -0.09;95% CI: -0.23 ~ 0.05;ipl和IPDL的P = .21)。另一方面,IPIL诱导了更多的探查出血趋势(SMD 0.22;95% CI: 0.01 ~ 0.42;P = .04),面部脊尺寸变化较小(SMD = 0.94;95% CI: -1.49 ~ -0.39;P < 0.01)。结论:随访12 ~ 60个月,IPIL术后面中黏膜水平变化比IPDL低0.48 mm。即刻种植体放置和加载有利于保存生理软硬组织结构,似乎在前区提供了相当大的好处。综上所述,如果初级种植体稳定性允许,应考虑在美观区进行IPIL。口腔颌面种植[J]; 2009;38(3):422- 431。doi: 10.11607 / jomi.10112。
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来源期刊
CiteScore
3.30
自引率
5.00%
发文量
115
审稿时长
6 months
期刊介绍: Edited by Steven E. Eckert, DDS, MS ISSN (Print): 0882-2786 ISSN (Online): 1942-4434 This highly regarded, often-cited journal integrates clinical and scientific data to improve methods and results of oral and maxillofacial implant therapy. It presents pioneering research, technology, clinical applications, reviews of the literature, seminal studies, emerging technology, position papers, and consensus studies, as well as the many clinical and therapeutic innovations that ensue as a result of these efforts. The editorial board is composed of recognized opinion leaders in their respective areas of expertise and reflects the international reach of the journal. Under their leadership, JOMI maintains its strong scientific integrity while expanding its influence within the field of implant dentistry. JOMI’s popular regular feature "Thematic Abstract Review" presents a review of abstracts of recently published articles on a specific topical area of interest each issue.
期刊最新文献
Peri-implant Parameters of Dental Implants Inserted in Prefabricated Microvascular Fibular Flaps: A Retrospective Study. Different Surgical Techniques in the All-on-4 Treatment Concept: Evaluation of the Stress Distribution Created in Implant and Peripheral Bone with Finite Element Analysis. Augmentation of Peri-implant Keratinized Mucosa Using a Combination of Free Gingival Graft Strip with Xenogeneic Collagen Matrix or Free Gingival Graft Alone: A Randomized Controlled Study. Efficacy of Labial Split-Thickness Eversion Periosteoplasty for Soft Tissue Management in Posterior Mandibular Horizontal Ridge Augmentation Procedures: A Prospective Clinical Study. Porcine Resorbable Collagen Matrix Shows Good Incorporation of Liquid Platelet-Rich Fibrin In Vitro.
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