ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Immediate Implant Placement Provides Acceptable Esthetic Outcomes but may be Associated with Greater Frequency of Mucosal Recession
Clinical Question In a partially dentate patient, do immediate implants significantly compromise gingival esthetic outcomes as compared to conventional two-step implants?
Clinical Bottom Line For patients in need of an implant in the esthetic zone, immediately placed implants are a successful treatment option with acceptable esthetic outcomes when compared to conventionally placed implants. However, immediately placed implants are associated with greater variability of outcomes regarding midfacial mucosal recession 1-3 years post-placement. This is supported by a Systematic Review of Randomized Control Trials and numerous studies that measured objective esthetic indices, determining that a median of 26% of sites had greater than 1 mm of midfacial mucosal recession 1-3 years after immediate implant placement.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24660198Chen/201450 studies (6 Randomized Control Trials, 6 Cohort Studies, 5 Cross-Sectional Studies, 33 case Series Studies) with 594 total patientsSystematic review of randomized trials
Key resultsSingle tooth implants placed immediately post-extraction in the esthetic zone provide reliable and acceptable esthetic outcomes. This was determined with esthetic indices such as the pink esthetic score and positional changes of the peri-implant mucosa. It is important to note, however, that immediate placed implants also were found to be associated with greater risk of midfacial mucosal recession (>1 mm; median 26% of sites 1-3 years post-placement) when compared to conventional delayed implant placement.
#2) 19040585Den Hartog/2008Patient Group 19 studies (5 Randomized Control Trials, 2 Clinical Trials, 12 Case Series) with 467 total patientsSystematic review of randomized trials
Key resultsKey Results: Both immediate post-extraction placed implants and conventional delayed implants placed in the esthetic zone have a comparable and successful survival rate (95.5% confidence interval, 93.0-97.1) after one year. No significant differences in gingival esthetics were found, as critical esthetic index components of the Randomized Control Trials studied were lacking and inconclusive.
Evidence Search immediate[All Fields] AND implant[All Fields] AND ("gingiva"[MeSH Terms] OR "gingiva"[All Fields] OR "gingival"[All Fields]) AND ("esthetics"[MeSH Terms] OR "esthetics"[All Fields]) AND ("review"[Publication Type] OR "review literature as topic"[MeSH Terms] OR "systematic review"[All Fields])
Comments on
The Evidence
Validity: The two references considered were Systematic Reviews of Randomized Control Trials. Chen (2014) provided a comprehensive and detailed search for relevant trials, and assessed individual trials included for validity, excluding those that were invalid. This Systematic Review included 50 studies with a total of 594 patients. A meta-analysis was not performed. Den Hartog (2008) provided a comprehensive, detailed search for relevant trials and included 19 studies with a total of 467 patients. Individual trials were excluded based on validity. A meta-analysis and a stratified meta-analysis were performed in this study, increasing the validity of the results. Perspective: The 2014 Chen Systematic Review effectively established significant results by analyzing objective esthetic indices (predominantly the Pink Esthetic Score) to rank esthetic outcomes in immediately placed implants. This was an important analysis because past Systematic Reviews failed to quantify esthetic indices in a valid or conclusive manner. The Den Hartog (2008) Systematic Review, for instance, found comparable high success rates in immediate implants placed in the esthetic zone when compared to conventional implants with support from a meta-analysis (95.5% survival rate after 1 year with a 95% confidence interval). While this study was valuable with regard to immediate implants, there was not sufficient evidence based on the RCT’s available at the time to make esthetic claims beyond success rate in the esthetic zone. Critically Appraised Topic #2861 analyzed a Randomized Control Trial of 24 patients, which determined no significant difference in the position of mid-buccal tissue height when comparing immediately placed implants and conventional delayed implants in the esthetic zone. This study is consistent with the Systematic Reviews analyzed in this CAT in that immediately placed implants and delayed implants have comparable successful and reliable survival rates and esthetics. However, this study failed to take into account the detailed pink esthetic score which determined that the immediately placed implants are associated with greater risk of midfacial mucosal recession (>1 mm; median 26% of sites 1-3 years post-placement).
Applicability Many patients present to General Practice Dental offices with implications for implant placement in the esthetic zone. Immediate implants placed in a post-extraction site provide acceptable gingival esthetic results. Patients may elect for this procedure because of the convenience and time saved with less surgical appointments as compared to conventional delayed implant placement. Patients should be informed that there is a risk of gingival recession with immediate implant placement and conventional implants.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords Implant, Immediate Implant, Esthetic, Mucosa, Recession
ID# 2880
Date of submission: 03/31/2015spacer
E-mail gassmanno@livemail.uthscsa.edu
Author Olivia Gassmann
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Norma Olvera, DDS, MS
Faculty mentor/Co-author e-mail OlveraN@uthscsa.edu
Basic Science Rationale
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