Objectives Comparing PES/WES scores, modified success rate, survival, success, buccal bone thickness and patient‐reported outcomes of immediate dental implants placed in fresh alveolar sockets using a flap or a minimal split‐thickness envelope flap (MSTEF). Materials and methods Implants following random assignment into a flap or MSTEF group were placed immediately in anterior and premolar areas. Guided bone regeneration and autogenous connective tissue graft were used in all cases. A temporary prosthesis was provided followed by the final prosthesis at 16–18 weeks. Success and survival rates together with radiographic buccal bone thickness and patient satisfaction were evaluated at 12‐month post‐loading. The aesthetic outcome was evaluated through the Pink (PES) and White (WES) Aesthetic Score by 8 blind clinicians of different training background and incorporated in modified success criteria. Results 28 implants were placed on 28 patients. No statistically significant differences were noted in PES (10.54 control versus 10.80 test), WES scores (6.97 control versus 6.95 test) or success criteria including aesthetic parameters (modified success criteria) for the different specialty groups (Range 69%‐92%). In addition, no statistically significant differences were noted in survival (100%), success (100%), buccal wall thickness between control (0.72 ± 0.22) and test group (0.92 ± 0.31) and patients’ reported outcomes. Conclusions Immediate dental implant treatment with flap/ MSTEF provided similar mean PES/WES scores, modified success rate, survival, mean buccal bone levels and patients’ satisfaction. However, aesthetic failures were common in both groups.
Objective: Two focused questions were addressed: Focused question (Q1) 1) Are there any differences between immediate and delayed placement in terms of (i) survival rate, (ii) success rate, (iii) radiographic marginal bone levels, (iv) height/(v)thickness of buccal wall, (vi) peri-implant mucosal margin position, (vii) aesthetics outcomes and (viii) patient reported outcomes? Focused question 2 (Q2) What is the estimated effect size of immediate implant placement for all parameters included in Q1? Materials and methods: An electronic search (MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials and OpenGray) and hand search were conducted up to November 2019. Randomised controlled trials (RCT) with delayed implant placement as controls were eligible in the analysis for Q1. Immediate dental implant arms RCTs, controlled clinical trials (CCTs) and prospective case series of immediate implant placement were eligible in the analysis for Q2.Results: Six papers (RCTs) were included in the analysis for Q1 and 53 papers ( 22RCTs, 11 CCTs and 20 case series) for Q2. Q1: Meta-analyses did not show any significant difference in implant survival, but it did for bone levels and PES scores at 1 year post-loading, favouring the immediate group. Q2: Meta-analyses showed that immediate implants had a high survival rate (97%) and presented high PES scores (range 10.36 to 11.25). Information regarding marginal bone loss and gingival/papillary recession varied among all included studies. Conclusion:Similar survival rate was found between immediate and delayed implants.Immediate implants presented threefold early complications and twofold delayed complications. Success criteria should be reported more consistently, and the incidence/type of complications associated with immediate implants should be further explored. Radiographic bone loss. (Mmesial, D-Distal) Gingival margin recession immediate (mm) PES immediate Papilla fill immediate Pat. Reported outcomes No No No No No M mean gain of 0.18 ± 1.38 mm, D mean gain of 0.34 ± 1.40 m Mean recession of 0.29 ± 0.74 mm 11.25 ± 1.36 at 5 years Mesial mean recession of 0.05 ± 0.64 mm and Distal 0.16 ± 0.63 mm, No 0.72 ± 0.13 (SE) No No No No MAX imp. 1.36 ± 0.78(SD). MND imp. 1.54 ± 0.91(SD).
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