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Meta-Analysis
. 2010 Sep 8;2010(9):CD005968.
doi: 10.1002/14651858.CD005968.pub3.

Interventions for replacing missing teeth: dental implants in fresh extraction sockets (immediate, immediate-delayed and delayed implants)

Marco Esposito  1 , Maria Gabriella Grusovin, Ilias P Polyzos, Pietro Felice, Helen V Worthington
Affiliations
Meta-Analysis

Interventions for replacing missing teeth: dental implants in fresh extraction sockets (immediate, immediate-delayed and delayed implants)

Marco Esposito et al. Cochrane Database Syst Rev. .

Abstract

Background: 'Immediate' implants are placed in dental sockets just after tooth extraction. 'Immediate-delayed' implants are those implants inserted after weeks up to about a couple of months to allow for soft tissue healing. 'Delayed' implants are those placed thereafter in partially or completely healed bone. The potential advantages of immediate implants are that treatment time can be shortened and that bone volumes might be partially maintained thus possibly providing good aesthetic results. The potential disadvantages are an increased risk of infection and failures. After implant placement in postextractive sites, gaps can be present between the implant and the bony walls. It is possible to fill these gaps and to augment bone simultaneously to implant placement. There are many techniques to achieve this but it is unclear when augmentation is needed and which could be the best augmentation technique.

Objectives: To evaluate success, complications, aesthetics and patient satisfaction between 'immediate', 'immediate-delayed' and 'delayed' implants.To evaluate whether and when augmentation procedures are necessary and which is the most effective technique.

Search strategy: The Cochrane Oral Health Group's Trials Register (to 2 June 2010), CENTRAL (The Cochrane Library 2010, Issue 2), MEDLINE via OVID (1950 - 2 June 2010) and EMBASE via OVID (1980 - 2 June 2010) were searched. Several dental journals were handsearched.

Selection criteria: Randomised controlled trials (RCTs) comparing immediate, immediate-delayed, and delayed implants, or comparing various bone augmentation procedures around the inserted implants, reporting the outcome of the interventions to at least 1 year after functional loading.

Data collection and analysis: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Trial authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CIs). The statistical unit of the analysis was the patient.

Main results: Fourteen eligible RCTs were identified but only seven trials could be included. Four RCTs evaluated implant placement timing. Two RCTs compared immediate versus delayed implants in 126 patients and found no statistically significant differences. One RCT compared immediate-delayed versus delayed implants in 46 patients. After 2 years patients in the immediate-delayed group perceived the time to functional loading significantly shorter, were more satisfied and independent blinded assessor judged the level of the perimplant marginal mucosa in relation to that of the adjacent teeth as more appropriate (RR = 1.68; 95% CI 1.04 to 2.72). These differences disappeared 5 years after loading but significantly more complications occurred in the immediate-delayed group (RR = 4.20; 95% CI 1.01 to 17.43). One RCT compared immediate with immediately delayed implants in 16 patients for 2 years and found no differences. Three RCTs evaluated different techniques of bone grafting for implants immediately placed in extraction sockets. No statistically significant difference was observed when evaluating whether autogenous bone is needed in postextractive sites (1 trial with 26 patients) or which was the most effective augmentation technique (2 trials with 56 patients).

Authors' conclusions: There is insufficient evidence to determine possible advantages or disadvantages of immediate, immediate-delayed or delayed implants, therefore these preliminary conclusions are based on few underpowered trials often judged to be at high risk of bias. There is a suggestion that immediate and immediate-delayed implants may be at higher risks of implant failures and complications than delayed implants on the other hand the aesthetic outcome might be better when placing implants just after teeth extraction. There is not enough reliable evidence supporting or refuting the need for augmentation procedures at immediate implants placed in fresh extraction sockets or whether any of the augmentation techniques is superior to the others.

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Conflict of interest statement

None known.

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Immediate versus delayed implants, Outcome 1 Prosthesis failure 1 year.
1.2
1.2. Analysis
Comparison 1 Immediate versus delayed implants, Outcome 2 Implant failure 1 year.
1.3
1.3. Analysis
Comparison 1 Immediate versus delayed implants, Outcome 3 Aesthetics (dentist): position of the perimplant tissues 1 year.
1.4
1.4. Analysis
Comparison 1 Immediate versus delayed implants, Outcome 4 Bone level changes 1 year.
2.1
2.1. Analysis
Comparison 2 Immediate‐delayed versus delayed implants, Outcome 1 Prosthesis failure.
2.2
2.2. Analysis
Comparison 2 Immediate‐delayed versus delayed implants, Outcome 2 Implant failure.
2.3
2.3. Analysis
Comparison 2 Immediate‐delayed versus delayed implants, Outcome 3 Complications.
2.4
2.4. Analysis
Comparison 2 Immediate‐delayed versus delayed implants, Outcome 4 Patients' perception of how long treatment took.
2.5
2.5. Analysis
Comparison 2 Immediate‐delayed versus delayed implants, Outcome 5 Patients' aesthetic perception.
2.6
2.6. Analysis
Comparison 2 Immediate‐delayed versus delayed implants, Outcome 6 Patients' general satisfaction of treatment.
2.7
2.7. Analysis
Comparison 2 Immediate‐delayed versus delayed implants, Outcome 7 Aesthetics (dentist): interproximal papilla dimension.
2.8
2.8. Analysis
Comparison 2 Immediate‐delayed versus delayed implants, Outcome 8 Aesthetics (dentist): position of perimplant tissues.
2.9
2.9. Analysis
Comparison 2 Immediate‐delayed versus delayed implants, Outcome 9 Bone level changes.
3.1
3.1. Analysis
Comparison 3 Immediate versus Immediate‐delayed implants, Outcome 1 Aesthetics (dentist): position of perimplant tissues.
3.2
3.2. Analysis
Comparison 3 Immediate versus Immediate‐delayed implants, Outcome 2 Bone level changes.
4.1
4.1. Analysis
Comparison 4 Augmentation versus no augmentation: immediate implants in extraction sockets, Outcome 1 Autogenous bone graft versus no augmentation (binary).
4.2
4.2. Analysis
Comparison 4 Augmentation versus no augmentation: immediate implants in extraction sockets, Outcome 2 Autogenous bone graft versus no augmentation (continuous).
5.1
5.1. Analysis
Comparison 5 Augmentation versus augmentation: immediate implants in extraction sockets, Outcome 1 Resorbable versus non‐resorbable barrier (binary).
5.2
5.2. Analysis
Comparison 5 Augmentation versus augmentation: immediate implants in extraction sockets, Outcome 2 Resorbable versus non‐resorbable (continuous).
5.3
5.3. Analysis
Comparison 5 Augmentation versus augmentation: immediate implants in extraction sockets, Outcome 3 Resorbable versus resorbable + autogenous bone (binary).
5.4
5.4. Analysis
Comparison 5 Augmentation versus augmentation: immediate implants in extraction sockets, Outcome 4 Resorbable versus resorbable + autogenous bone (continuous).
5.5
5.5. Analysis
Comparison 5 Augmentation versus augmentation: immediate implants in extraction sockets, Outcome 5 Non‐resorbable versus resorbable + autogenous bone (binary).
5.6
5.6. Analysis
Comparison 5 Augmentation versus augmentation: immediate implants in extraction sockets, Outcome 6 Non‐resorbable versus resorbable + autogenous bone (continuous).
5.7
5.7. Analysis
Comparison 5 Augmentation versus augmentation: immediate implants in extraction sockets, Outcome 7 Bio‐Oss versus Bio‐Oss + resorbable (binary).
5.8
5.8. Analysis
Comparison 5 Augmentation versus augmentation: immediate implants in extraction sockets, Outcome 8 Bio‐Oss versus Bio‐Oss + resorbable (continuous).
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Update of

References

References to studies included in this review

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References to other published versions of this review

Coulthard 2003
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Esposito 2006c
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