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

  • Review
  • Intervention

Authors


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 methods

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.

Plain language summary

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

Dental implants can be placed in sockets just after tooth extraction (immediate implants) or after a couple of weeks up to a couple of months (immediate-delayed implants) or thereafter (delayed implants). This review looked at which was the best time to place dental implants and whether it would be advantageous to augment sites with gaps present at implant placement. It also tried to determine the most effective bone augmentation procedure.

The seven identified studies included too few patients to answer the questions. Four studies evaluated which is the best time to place implants. One study evaluated whether bone grafting is advantageous at implant placement and two studies evaluated which are the best grafting techniques.

There is currently too little evidence to draw any reliable conclusions, however, the aesthetic outcome could be slightly better when placing implants early after tooth extraction, though early placed implants might be at a higher risk of failure. There is not enough evidence supporting or refusing the need of bone augmentation when extracted teeth are immediately replaced with dental implants, nor it is known whether any augmentation procedure is better than the others. Bone substitutes (anorganic bovine bone) can be used instead of self generated (autogenous) bone graft.

Laički sažetak

Intervencije za nadomještanje zuba koji nedostaju: zubni implantati (usadci) odmah nakon vađenja zuba (bez odgode, s kratkom odgodom ili odgođeno stavljanje implantata)

Zubni implantati mogu biti smješteni u koštane džepove odmah nakon vađenja zuba (usadci bez odgode, engl. immediate implants), ili nekoliko tjedana nakon vađenja zuba sve do nekoliko mjeseci (usadci s odgodom, engl. immediate-delayed) ili još dulje nakon toga (kasni usadci, engl. delayed implants). Ovaj Cochrane sustavni pregled pokušao je ustanoviti koje je najbolje vrijeme za ugradnju zubnih usadaka i preporučuje li se povećanje šupljina prisutnih na mjestu implantacije. Također su htjeli utvrditi najučinkovitiji postupak nadoknađivanja koštane strukture.

Pronađeno je sedam studija, ali one su uključivale premalo pacijenata da bi se moglo odgovoriti na postavljenja pitanja. Četiri studije su ispitale koje je najbolje vrijeme za ugradnju zubnih usadaka. Jedna studija je ispitala je li koštani presadak preporučljiv tijekom ugradnje zubnih usadaka, a dvije su studije istražile najbolje tehnike presađivanja.

Trenutno postoji premalo dokaza kako bi se izveo ikakav pouzdan zaključak. Međutim, estetski ishod mogao bi biti nešto bolji ugradnjom usadaka odmah nakon vađenja zuba, iako rano ugrađeni implantati mogu imati veći rizik od neuspjeha. Nema dovoljno dokaza koji bi poduprli ili odbacili potrebu poboljšanja koštane strukture kada je izvađeni zub odmah zamijenjen usadkom. Isto tako, nije poznato je li ijedan proces poboljšanja koštane strukture bolji od drugoga. Koštane zamjene (anorganska goveđa kost) mogu se upotrijebiti umjesto vlastitog (autogenog) koštanog presadka.

Bilješke prijevoda

Hrvatski Cochrane
Prevela: Josipa Tadić
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr

Ringkasan bahasa mudah

Intervensi untuk mengganti kehilangan gigi: implan pergigian dalam soket cabutan yang segar (implan segera, segera-tertunda dan tertunda)

Implan pergigian boleh diletakkan dalam soket sejurus selepas cabutan (implan segera) atau selepas beberapa minggu hingga beberapa bulan (implan segera-tertunda) atau tempoh selepas itu (implan tertunda). Ulasan ini melihat kepada masa yang terbaik untuk meletakkan implan pergigian dan sama ada lebih wajar untuk menambah kawasan yang ada ruang semasa perletakan implan. Ia juga bertujuan untuk menentukan prosedur augmentasi tulang yang paling berkesan.

Tujuh kajian yang dimasukkan mempunyai terlalu sedikit bilangan pesakit untuk menjawab persoalan-persoalan. Empat kajian menilai masa yang terbaik untuk meletakkan implan. Satu kajian menilai sama ada graf tulang adalah lebih wajar pada perletakan implan dan dua kajian menilai teknik graf manakah yang terbaik.

Terdapat terlalu sedikit bukti untuk membolehkan sebarang kesimpulan yang boleh dipercayai dapat dibuat, namun hasil estetik mungkin lebih baik jika implan diletak seawal selepas cabutan, walaupun perletakan implan awal berisiko lebih tinggi untuk gagal. Tidak terdapat bukti yang cukup untuk menyokong atau menyangkal keperluan augmentasi tulang apabila cabutan gigi diikuti dengan perletakan segera implan pergigian, atau sama ada sebarang prosedur augmentasi adalah lebih baik dari yang lain. Tulang gantian (tulang bovin takorganik) boleh digunakan selain dari graf tulang terjana kendiri (autogenous).

Catatan terjemahan

Diterjemahkan oleh Noorliza Mastura Ismail (Kolej Perubatan Melaka-Manipal). Disunting oleh Tuan Hairulnizam Tuan Kamauzaman (Universiti Sains Malaysia). Untuk sebarang pertanyaan berkaitan terjemahan ini sila hubungi noorliza.mastura@manipal.edu.my

Ancillary