Abstract：
OBJECTIVE: To compare immediate implant placement (IIP) with early implant placement (EIP) for single tooth replacement in the aesthetic area in terms of aesthetic, clinical, and patient-reported outcomes.
METHODS: Two independent reviewers conducted an electronic literature search in PubMed, Web of Science, Embase, and Cochrane databases as well as a manual search to identify eligible clinical studies up to February 2023. Randomized Controlled Trials (RCTs) comparing IIP with EIP were included for a qualitative and quantitative analysis. The primary outcome was vertical midfacial soft tissue change. Secondary outcomes were horizontal midfacial soft tissue change, vertical papillary change, pink esthetic score (PES), implant survival, buccal bone thickness, marginal bone level change, patient discomfort, chair time, and patient satisfaction.
RESULTS: Out of 1185 records, 6 RCTs were selected, reporting on 222 patients who received 222 single implants (IIP: 112 implants in 112 patients; EIP: 110 implants in 110 patients) in the anterior maxilla or mandible. Patients had a mean age ranging from 35.6 to 52.6 years and were followed between 8 and 24 months. Two RCTs showed some concerns, and four showed a high risk of bias. Four studies could be included in a meta-analysis on the primary outcome and three only considered cases with an intact buccal bone wall. Meta-analysis failed to demonstrate a significant difference in terms of vertical midfacial soft tissue change between IIP and EIP (mean difference: 0.31 mm, 95% CI [-0.23; 0.86], p = .260; I2 = 83%, p < .001). No significant differences were found for PES (standardized mean difference: 0.92, 95% CI [-0.23; 2.07], p = .120; I2 = 89%, p < .001), implant survival (RR: 0.98, 95% CI [0.93, 1.03], p = .480; I2 = 0%, p = .980), and marginal bone level change (mean difference: 0.03 mm, 95% CI [-0.12, 0.17], p = .700; I2 = 0%, p = .470). Insufficient data were available for meta-analyses of other secondary outcomes.
CONCLUSIONS: In low-risk patients with an intact buccal bone wall, there seems to be no difference between IIP and EIP in terms of aesthetic and clinical outcomes. The strength of this conclusion is rated as low since studies showed an unclear or high risk of bias. In addition, state-of-the-art therapy was only delivered in a minority of studies. Future RCTs should also provide data on patient-reported outcomes since these have been underreported.
METHODS: Two independent reviewers conducted an electronic literature search in PubMed, Web of Science, Embase, and Cochrane databases as well as a manual search to identify eligible clinical studies up to February 2023. Randomized Controlled Trials (RCTs) comparing IIP with EIP were included for a qualitative and quantitative analysis. The primary outcome was vertical midfacial soft tissue change. Secondary outcomes were horizontal midfacial soft tissue change, vertical papillary change, pink esthetic score (PES), implant survival, buccal bone thickness, marginal bone level change, patient discomfort, chair time, and patient satisfaction.
RESULTS: Out of 1185 records, 6 RCTs were selected, reporting on 222 patients who received 222 single implants (IIP: 112 implants in 112 patients; EIP: 110 implants in 110 patients) in the anterior maxilla or mandible. Patients had a mean age ranging from 35.6 to 52.6 years and were followed between 8 and 24 months. Two RCTs showed some concerns, and four showed a high risk of bias. Four studies could be included in a meta-analysis on the primary outcome and three only considered cases with an intact buccal bone wall. Meta-analysis failed to demonstrate a significant difference in terms of vertical midfacial soft tissue change between IIP and EIP (mean difference: 0.31 mm, 95% CI [-0.23; 0.86], p = .260; I2 = 83%, p < .001). No significant differences were found for PES (standardized mean difference: 0.92, 95% CI [-0.23; 2.07], p = .120; I2 = 89%, p < .001), implant survival (RR: 0.98, 95% CI [0.93, 1.03], p = .480; I2 = 0%, p = .980), and marginal bone level change (mean difference: 0.03 mm, 95% CI [-0.12, 0.17], p = .700; I2 = 0%, p = .470). Insufficient data were available for meta-analyses of other secondary outcomes.
CONCLUSIONS: In low-risk patients with an intact buccal bone wall, there seems to be no difference between IIP and EIP in terms of aesthetic and clinical outcomes. The strength of this conclusion is rated as low since studies showed an unclear or high risk of bias. In addition, state-of-the-art therapy was only delivered in a minority of studies. Future RCTs should also provide data on patient-reported outcomes since these have been underreported.
摘要：
目的：在美学方面比较在美学领域进行单颗牙齿置换的立即植入物放置（IIP）与早期植入物放置（EIP），临床,和患者报告的结果。
方法：两名独立审稿人在PubMed进行了电子文献检索，WebofScience,Embase,和Cochrane数据库以及手动搜索，以确定截至2023年2月的合格临床研究。纳入比较IIP和EIP的随机对照试验（RCT）进行定性和定量分析。主要结果是垂直的中面部软组织改变。次要结果为水平面中软组织改变，垂直乳头状改变,粉红色的审美得分（PES），植入物存活，颊骨厚度,边缘骨水平变化，患者不适,椅子时间,患者满意度。
结果：在1185条记录中，选择了6个随机对照试验，报告222例患者在前上颌骨或下颌骨接受了222个单植入物（IIP：112例患者中的112例植入物；EIP：110例患者中的110例植入物）。患者的平均年龄为35.6至52.6岁，随访时间为8至24个月。两个RCT表现出了一些担忧，和四个显示出高风险的偏见。四项研究可以包括在主要结局的荟萃分析中，三项仅考虑颊骨壁完整的病例。荟萃分析未能证明IIP和EIP之间在垂直面中软组织变化方面存在显着差异（平均差：0.31mm，95%CI[-0.23；0.86]，p=.260；I2=83%，p<.001)。PES没有发现显著差异(标准化平均差：0.92，95%CI[-0.23；2.07]，p=.120；I2=89%，p<.001),植入物存活率（RR：0.98，95%CI[0.93，1.03]，p=.480；I2=0%，p=.980)，和边缘骨水平变化(平均差:0.03毫米，95%CI[-0.12，0.17]，p=.700；I2=0%，p=.470）。其他次要结局的荟萃分析数据不足。
结论：在颊骨壁完整的低风险患者中，IIP和EIP在美学和临床结局方面似乎没有差异.该结论的强度被认为是低的，因为研究显示出不清楚或高的偏倚风险。此外,仅在少数研究中提供了最先进的治疗方法.未来的RCT还应提供患者报告结果的数据，因为这些数据被低估了。
方法：两名独立审稿人在PubMed进行了电子文献检索，WebofScience,Embase,和Cochrane数据库以及手动搜索，以确定截至2023年2月的合格临床研究。纳入比较IIP和EIP的随机对照试验（RCT）进行定性和定量分析。主要结果是垂直的中面部软组织改变。次要结果为水平面中软组织改变，垂直乳头状改变,粉红色的审美得分（PES），植入物存活，颊骨厚度,边缘骨水平变化，患者不适,椅子时间,患者满意度。
结果：在1185条记录中，选择了6个随机对照试验，报告222例患者在前上颌骨或下颌骨接受了222个单植入物（IIP：112例患者中的112例植入物；EIP：110例患者中的110例植入物）。患者的平均年龄为35.6至52.6岁，随访时间为8至24个月。两个RCT表现出了一些担忧，和四个显示出高风险的偏见。四项研究可以包括在主要结局的荟萃分析中，三项仅考虑颊骨壁完整的病例。荟萃分析未能证明IIP和EIP之间在垂直面中软组织变化方面存在显着差异（平均差：0.31mm，95%CI[-0.23；0.86]，p=.260；I2=83%，p<.001)。PES没有发现显著差异(标准化平均差：0.92，95%CI[-0.23；2.07]，p=.120；I2=89%，p<.001),植入物存活率（RR：0.98，95%CI[0.93，1.03]，p=.480；I2=0%，p=.980)，和边缘骨水平变化(平均差:0.03毫米，95%CI[-0.12，0.17]，p=.700；I2=0%，p=.470）。其他次要结局的荟萃分析数据不足。
结论：在颊骨壁完整的低风险患者中，IIP和EIP在美学和临床结局方面似乎没有差异.该结论的强度被认为是低的，因为研究显示出不清楚或高的偏倚风险。此外,仅在少数研究中提供了最先进的治疗方法.未来的RCT还应提供患者报告结果的数据，因为这些数据被低估了。
