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| Title |
No Difference in Marginal Bone Loss Between Immediately and Conventionally Loaded Posterior Mandibular Single Implants |
| Clinical Question |
In adults who require a single implant in the posterior mandible, do immediate implant loading procedures produce less marginal bone loss compared to conventional implant loading? |
| Clinical Bottom Line |
In adults seeking a single dental implant in the mandibular region, there is no significant difference in marginal bone loss between immediate and conventional implant loading procedures. This is supported by a prospective clinical study and a systematic review encompassing multiple randomized clinical trials. |
| 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) 26259980 | Moraschini/2016 | 5 studies/ 177 patients | Meta-Analysis | | Key results | Randomized controlled studies were analyzed based on binary and continuous variables. The continuous outcomes (marginal bone loss) were specifically analyzed as standardized mean differences (SMD) with a 95% confidence interval. Periapical radiographs were used to compare the implant platform reference in relation to the alveolar bone crest. Marginal bone loss in the immediately loaded group ranged from 0.40 to 1.31 mm and the conventionally loaded group ranged from 0.68 to 1.2 mm. The overall effect was a SMD of -0.58 [-1.55 to 0.38] with no statistically significant difference between the procedures (P=0.24). | | #2) 18294232 | Guncu/2008 | 12 patients who had first molar loss bilaterally in mandible (8 women and 4 men) | Prospective Clinical Trial | | Key results | This split-mouth prospective clinical study analyzed the marginal bone loss through periapical radiographs taken at 6 and 12 months post surgery. The marginal bone loss was assessed using a reference point where alveolar bone met the implant on both the mesial and distal ends according to the radiograph. In the immediate loading group, the mean bone loss was 0.64 ± 0.44 mm and 0.45 ± 0.39 mm (at 6 months and 12 months respectively). The conventional loading group mean bone loss was 0.78 ± 0.27 mm and 0.68 ± 0.30 mm (at 6 and 12 months respectively). Although there were significant changes within each group over time (P<0.05), there were no statistically significant differences between the two groups at either 6 or 12 months during the study (P>0.05). | |
| Evidence Search |
(Implant [all fields]) OR “dental implant surgery”[MeSH] OR “mandibular implant”[MeSH] OR “immediate loading”[MeSH] OR “immediate single implant”[MeSH] OR “marginal bone loss”[MeSH] OR “implant bone resorption”[MeSH] OR “dental implant bone loss”[MeSH] |
Comments on
The Evidence |
Validity:
The meta-analysis, strict selection criteria and a comprehensive detailed search were used to locate relevant trials. The clinical trials were pooled according to heterogeneity relevant to the fixed- or random-effects model. Five studies were selected to be included in the meta-analysis. In the randomized controlled studies, only one involved the placement of immediate implants in fresh sockets. The remaining studies involved graft-free healed sockets.The healing period for the conventional loading of these implants ranged from 3 to 5 months. The patient pool matched the criteria of the PICO question and was deemed feasible in the selection protocol of this evaluation. In the prospective clinical study, patient pool, setting, and expectations aligned with the conditions of this evaluation.
Perspective:
In regard to the demographics of the systematic review, I do not believe some of the studies had an even distribution of males and females, which would have increased the efficacy of the research. Multiple implant manufacturers were also intermixed throughout the studies, possibly confounding the results. The prospective clinical research had a similar data collection to the previously mentioned RCTs in the systemic review. |
| Applicability |
Patients should be informed about possible secondary procedures such as bone augmentations or sinus lifts if there is not sufficient alveolar bone at the time of examination. Financial planning is a major concern for certain patients because of the variation in cost of secondary procedures. Some patient factors might lead the clinician to select immediate loading, such as esthetics (if the missing tooth is visible), patient preference, and the need to prevent movement of adjacent and opposing teeth. Individual patient risk factors such as diabetes, cardiovascular problems, smoking, osteoporosis, etc. should be taken into consideration for implant success by the surgeon. Contraindications such as bisphosphonate medications causing osteonecrosis of the jaw and uncontrolled systemic diseases should also be taken into account. Oral hygiene and periodontal health before and after the implant surgery should be assessed to predict implant success and longevity. |
| Specialty/Discipline |
(General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics) |
| Keywords |
Conventional implants, immediate implants, Marginal bone level, marginal bone loss
|
| ID# |
3210 |
| Date of submission: |
04/25/2017 |
| E-mail |
myersg@livemail.uthscsa.edu |
| Author |
Garrett Myers |
| Co-author(s) |
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| Co-author(s) e-mail |
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| Faculty mentor/Co-author |
Richard Finlayson, DDS |
| Faculty mentor/Co-author e-mail |
finlaysonr@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 |
| None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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