Abstract
BackgroundImmediate implants are frequently employed in the anterior maxillary area. However, the installation of dental implants simultaneously with tooth extraction can also provide with benefits in the posterior areas with a reduction in time prior the recovery of the masticatory function. Results previously reported in the literature show high-survival and success rates for implants placed in extraction sockets in molar areas; however, this topic has received limited systematic analysis.Material and methodsElectronic and manual literature searches were performed by two independent reviewers in several data-bases, including MEDLINE, EMBASE, and Cochrane Oral Health Group Trials Register, for articles up to January 2019 reporting outcomes of immediate implants placed in molar areas. Primary outcomes included survival and success rates, as well as marginal bone loss. Secondary outcomes included the influence of implant position, type of implant connection, grafting protocol, flap or flapless approach, implant diameter, surgical phase, presence of buccal plate, and loading protocol.ResultsTwenty studies provided information on the survival rate, with a total sample of 1.106 implants. The weighted mean survival rate of immediate implants after 1 year of follow-up was 96.6%, and the success rate was 93.3%. On the other hand, marginal bone loss was 1.29 ± 0.24 mm. Secondary outcomes demonstrated that grafting the gap and the loading protocol have an effect on survival and success rates. Similarly, the presence or absence of the buccal bone affect crestal bone levels. Meta-analysis of 4 investigations showed a weighted mean difference of 0.31 mm ± 0.8 IC 95% (0.15–0.46) more marginal bone loss at immediate implant placement versus implants in healed sites (p < 0.001) I2 = 15.2%.ConclusionIn selected scenarios, immediate implant placement in molar extraction socket might be considered a predictable technique as demonstrated by a high survival and success rates, with minimal marginal bone loss.
Highlights
As implant therapy evolves, new challenges are faced as result of higher functional and esthetics demands
Type 1 refers to immediate implant placement (IIP) after tooth extraction, type 2 is considered when implants are placed after 4 to 8 weeks, achieving complete soft tissue coverage, type 3 consists in implants placed after 12 to 16 weeks when substantial clinical and/or radiographic bone fill has occurred, and type 4 refers to implants placed in healed sites [2]
2019 by two independent examiners (G.M.R and B.E) aiming at answering the following PICO (Patient, Intervention, Comparison and Outcome) question: In patients over 18 years of age, does the placement of immediate implants in molar areas result in similar implant survival rate, success rate, and marginal bone loss as implants installed in healed sites, after 6 months of healing from tooth extraction? When necessary, disagreements were resolved by discussion with a third examiner (F.H.A)
Summary
New challenges are faced as result of higher functional and esthetics demands. IIP is a therapeutic approach introduced in 1976 as an alternative to the classic delayed implant placement described by Branemark [3] This treatment alternative offers several advantages; including a reduction in both treatment time and the number of surgical interventions, increasing patient satisfaction. In addition to these advantages, survival and success rates of immediate implants have shown favorable results, proving similar outcomes to implants installed in healed edentulous ridges. A systematic review on implants installed immediately after tooth extraction demonstrated survival rates of more than 98% after a minimum of 1-year follow up These results are comparable to conventional implant placement in healed sites which showed 5-year survival rates of up to 95% [4]. Results previously reported in the literature show high-survival and success rates for implants placed in extraction sockets in molar areas; this topic has received limited systematic analysis
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