| One: A systematic review on clinical effects of implants inserted in different healed sockets in esthetic single tooth sites[Background] The alveolar ridge undergoes an inevitable remolding and reconstruction process along with the change of soft tissues following tooth extraction,which mainly happen in the first six months.The traditional implant placement surgery was given after 4-6 months post tooth extraction（defined as delayed implant placement）,which might be confronted with insufficient hard and soft tissues.To prevent or minimize the bone loss,a number of methods were applied,such as site preservation,guided bone regeneration and immediate implant placement.Site preservation can help prevent bone loss to a certain extent,but it also prolongs the treatment period,even has the possibility of additional bone augmentation.The superiorities of immediate implant placement have been well documented,but it may increase the risk of implant failure and soft tissue recession.The concept of early implant placement was proposed recent years.Thus,the evidences of the selection of implant placement timing post extraction in the esthetic site need to be found out through RCTs for clinical decisions.[Objective] This research aims to compare the clinical outcomes of immediate implant placement with other implant placement methods,via current randomized controlled trial studies.[Methods] Based on the inclusion criteria,databases including Pub Med,EMBASE,and CENTRAL and several journals were artificially searched until February 2020.The files were imported into Endnote X9 software to screen out repetitive files.Two independent researchers performed the process of screening articles,data extraction,and quality assessment.The main evaluation index is the survival rate of implants,and the secondary indexes include the bone remodeling amount,esthetic score（PES and WES）,complications and patient’s satisfaction.Data analysis is conducted through Review Manager 5.3.[Results] Two hundred and ninety-two articles were collected thorough electronic databases and manual searching at first.Then,the duplicated files were deleted,and two independent researchers browsed through 208 articles by the title and summary and preliminary screened out 20 articles.After reading the whole researches,8 articles were eligible with low risk of overall bias.Totally,four hundred and ninety-eight single implants in anterior maxilla were included.The survival rates between the immediate group and socket preserved group had a significant difference（RR=0.94;95%CI: [0.95,1.02];P=0.04）,the latter group showed higher implant survival rate.Immediate group had higher PES comparing to the early group（MD=1.06;95%CI: [0.78,1.36];P<0.0001）.The survival rates had no statistical significance neither between immediate and delayed group nor between immediate and early group.As for the marginal bone loss,PES and complications,no significant differences were shown between immediate group and preserved group.[Conclusion] The available evidences support high survival rates of the different implant placement methods within one-year follow-up.Immediate implant placement showed an inferior implant survival rates compared to implant placed after site preservation methods,and a superior outcome of PES compared to early implant placement.Two: A study of clinical outcomes following immediate versus delayed implantations with GBR in esthetic single tooth sites[Background] Missing teeth in the anterior maxilla affects both the oral function and the patient’s appearance.With the development of dental implantology,implant in anterior maxilla has become a reliable and predictable treatment procedure,and immediate and delayed implant placement are the most popular methods clinically.Some scholars believe that the success rate of immediate implant is lower than that through traditional method,while others mention that no significant difference exist between the two treatments.Controversial opinions also exist in esthetic outcomes.Some studies indicate that immediate implant placement alleviate the reconstruction of hard and soft tissues,leading to better esthetic results,while some others hold completely contrary opinions.As the alveolar bone deficiency exists in most cases in the anterior maxilla,bone augmentation procedures are needed to obtain sufficient bone around implants.Among different techniques,GBR is the most commonly adopted methods because of its safety and wide indications.Immediate implant placement procedure also needs bone substitutes to fill the ‘jump space’ between implant surface and alveolar wall.However,some scholars consider that additional bone grafting outside the labial alveolar wall can obtain more stable outcomes.Until now,there is limited evidence on the clinical outcomes of additional bone grafting in immediate implant placement,as well as the efficacy compared with delayed implant placement with GBR.[Objective] This research aims to analyze and compare the clinical effects between immediate and delayed implant placement with simultaneous bone grafting procedure in the maxillary central incisor area.[Methods] Fifty-seven patients who received dental implant in the maxillary central incisor area from January to December 2018 were included in this study.The patients were divided into two groups,the immediate group（n=28）and delayed group（n=29）,according to the timing of implantation.All peri-implant bone volumes were evaluated by CBCT before surgery（T0）,immediately after operation（T1）and 6 months after surgery（T2）.The image analysis software was used to measure the horizontal lingual bone mass at 2 mm and 10 mm sites below the implant shoulder.The satisfaction and esthetic scores of patients were carried out 3 months after final crown restorations.[Results] The implant success rates of both groups were 100% during observation period.Within the T1-T2 time period,the immediate group showed less bone absorption at the lingual side than the delayed group both at the 2 mm and 10 mm sites below the implant shoulder（P<0.05）.Meanwhile,there were more patients in the immediate group revealing thicker lingual bone（>2 mm）at both sites than in the delayed group.Also,the immediate group had higher pink esthetic scores and satisfaction scores.[Conclusion] Both immediate and delayed implant placement showed a high success rate in anterior maxilla.Immediate implant placement with simultaneous bone grafting procedure received higher score of satisfaction and showed more reliable clinical effects both in reducing the absorption of alveolar bone at the lingual side and maintaining the stability of the soft and hard tissues around the implants. |
