目的:测试植入物失败率无差异的零假设,与在愈合部位插入相比,在新鲜拔牙槽中插入牙种植体的术后感染和边缘骨丢失,反对差异的替代假设。
方法:组合使用的主要搜索术语:牙科植入物,口腔植入物,resh提取插座,立即安置,立即插入,立即植入。
方法:2014年7月在PubMed进行了电子搜索,WebofScience,Cochrane口腔健康小组试验注册加上手工搜索。
方法:合格标准包括临床人体研究,随机或不随机。
结论:搜索策略产生了73种出版物,将8,241个植入物插入插座中(330个失败,4.00%),和19,410在愈合的部位(599个故障,3.09%)。建议在新鲜的拔牙槽中插入植入物会影响故障率(RR1.58,95%CI1.27-1.95,P<0.0001)。当评估插入上颌骨或下颌骨的植入物的研究被汇集时,差异没有统计学意义。或当使用植入物来修复全弓假体的患者的研究被汇集;然而,对于修复植入物支持的单冠患者的研究和对照研究具有重要意义.对术后感染的发生或边缘骨丢失的程度无明显影响。由于在纳入的研究中存在潜在的偏差和存在不受控制的混杂因素,因此应谨慎解释结果。他们中的大多数没有随机化。
结论:在过去的几年中,直接植入物是否比放置在成熟骨中的植入物更容易失败的问题越来越受到关注。随着治疗理念的改变,定期审查不同的概念是必要的,以完善技术和消除不必要的程序。这将形成最佳治疗的基础。
OBJECTIVE: To test the null hypothesis of no difference in the implant failure rates, postoperative infection and marginal bone loss for the insertion of dental implants in fresh extraction sockets compared to the insertion in healed sites, against the alternative hypothesis of a difference.
METHODS: Main search terms used in combination: dental implant, oral implant, resh extraction socket, immediate placement, immediate insertion, immediate implant.
METHODS: An electronic search was undertaken in July/2014, in PubMed, Web of Science, Cochrane Oral Health Group Trials Register plus hand-searching.
METHODS: Eligibility criteria included clinical human studies, either randomized or not.
CONCLUSIONS: The search strategy resulted in 73 publications, with 8,241 implants inserted in sockets (330 failures, 4.00%), and 19,410 in healed sites (599 failures, 3.09%). It is suggested that the insertion of implants in fresh extraction sockets affects the failure rates (RR 1.58, 95% CI 1.27-1.95, P<0.0001). The difference was not statistically significant when studies evaluating implants inserted in maxillae or in mandibles were pooled, or when the studies using implants to rehabilitate patients with full-arch prostheses were pooled; however, it was significant for the studies that rehabilitated patients with implant-supported single crowns and for the controlled studies. There was no apparent significant effect on the occurrence of postoperative infection or on the magnitude of marginal bone loss. The results should be interpreted with caution due to the potential for biases and to the presence of uncontrolled confounding factors in the included studies, most of them not randomized.
CONCLUSIONS: The question whether immediate implants are more at risk for failure than implants placed in mature bone has received increasing attention in the last years. As the philosophies of treatment alter over time, a periodic review of the different concepts is necessary to refine techniques and eliminate unnecessary procedures. This would form a basis for optimum treatment.