ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Excellent Implant Survival Rate After Placement in Fresh Extraction Sockets
Clinical Question What is the survival rate after two years for an implant that was placed immediately in a fresh extraction socket?
Clinical Bottom Line When an implant is placed in a fresh extraction socket there is a 98.4% survival rate after two years.
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) 22211305Lang/2012Data collected from 46 prospective studies (2908 implants from 2092 patients) Systematic Review
Key resultsSystematic review of 46 studies with a mean follow-up of 2.08 years showed that the annual failure rate of immediate implants was 0.82% (95% CI: 0.48-1.39%), and a 2-year survival rate of 98.4% (97.3-99%). Of the implants reviewed, bone loss around the implant primarily took place during the first year post placement and commonly resulted in a loss of less than 1 mm.
Evidence Search (("Dental Implantation"[Mesh]) AND "Tooth Extraction"[Mesh]) AND "Time Factors"[Mesh]
Comments on
The Evidence
Based on historical evidence, the immediate placement of an implant has a comparable survival rate to an implant placed in healed alveolar bone. The author mentions a significant difference in implant survival rate based on the regimen of antibiotics use. However, due to the small sample size of the pre-operative antibiotic group and the lack of comparative studies, the true benefit from the use of post-operative antibiotics remains in question. Studies were not excluded based on restoration type, immediate vs. delayed loading, location of implants, or bone quality. Studies had to have a follow period of at least one year and the mean follow up time was two years. This review collected data from a wide range of adults enhancing its applicability to the clinical setting.
Applicability Based on this review of studies, immediate implant placement appears to be a reliable and acceptable treatment. The study did suggest a benefit to post-operative antibiotics following immediate placement, but did not identify the reason for tooth extraction, tooth position, or immediate restoration as having a significant effect on implant survival. Limitations of this review were that only healthy patients were included and that the survival rate may not extend to longer-term survival.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords Implant, fresh extraction socket, systematic review, survival rate
ID# 2328
Date of submission: 08/13/2012spacer
E-mail holdenpete@gmail.com
Author Pete Holden
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Thomas Oates, DMD, PhD
Faculty mentor/Co-author e-mail OATES@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
by Pete Holden (San Antonio, Texas) on 09/17/2012
The biological basis for this treatment modality comes from understanding the mechanism of endosseous integration (publication PMID: 9922731). After an implant is placed in a fresh extraction socket there is a defect between the implant surface and the socket wall. This defect will be filled in with new bone, and this process has been broken down into three different phases. First, there is osteoconduction where there is recruitment and migration of osteogenic cells to the implant surface. These osteogenic cells must migrate through the fibrin blood clot that formed upon placement of the implant. Second, there is the de novo phase of bone formation. This is where a mineralized interfacial matrix forms on the implant surface. Together, osteo conduction and de novo bone formation results in contact osteogenesis. Last, there is the bone remodeling phase. Extensive research has been done on different implant surfaces and how they affect the mechanism of endosseous integration.
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