中国循证医学杂志

中国循证医学杂志

即刻种植与延期种植相比对前牙区种植体成功率及美学影响的 Meta 分析

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目的系统评价即刻种植与延期种植相比对前牙区种植体成功率及术后美学的影响。方法计算机检索 PubMed、The Cochrane Library、EMbase、CBM、CNKI和 WanFang Data 数据库,搜集前牙区即刻种植与延期种植比较的随机对照试验(RCT)和队列研究,检索时限均为建库至 2017 年 4 月。由 2 位研究员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。结果纳入 16 个研究(4 个 RCT,12 个队列研究),共 1 316 颗种植体。Meta 分析结果显示:即刻种植组与传统延期种植组在种植体留存率[RCT:RR=0.99,95%CI(0.97,1.02),P=0.70;队列研究:RR=0.99,95%CI(0.96,1.02),P=0.54]、永久冠修复 4 个月后种植体稳定度[MD=0.82,95%CI(–0.11,1.76),P=0.08]、永久冠修复后长期种植体周围牙槽骨吸收量方面[12 个月:RCT:MD=0.06,95%CI(–0.35,0.47),P=0.79;队列研究:MD=–0.27,95%CI(–0.57,0.03),P=0.07;24 个月:队列研究 MD=–0.09,95%CI(–0.18,0.00),P=0.05]差异均无统计学意义。但即刻种植组在永久冠修复后短期种植体周围牙槽骨吸收量方面[3 个月:MD=–0.08,95%CI(–0.13,–0.04),P=0.000 1;6 个月:MD=–0.23,95%CI(–0.38,–0.07),P=0.004]少于延期种植组,永久冠修复 6 个月后的 PES 评分高于延期种植组[MD=1.12,95%CI(0.11,2.13),P=0.03]。结论即刻种植与延期种植在前牙区种植体留存率、长期稳定性和长期牙槽骨吸收量上基本相当,但即刻种植在短期减轻牙槽骨吸收及术后牙龈美学方面优于延期种植。受纳入研究数量和质量的限制,上述结论仍需开展更多大样本高质量研究来进行验证。

ObjectiveTo systematically review the implant survival and postoperative aesthetics of immediate versus delayed implant treatment in the anterior maxilla regions.MethodsWe searched databases including PubMed, The Cochrane Library, EMbase, CBM, CNKI and WanFang Data from inception to April 2017, to collect randomized controlled trials (RCTs) and cohort studies on immediate implant and delayed implant in the anterior teeth areas. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used to perform meta-analysis.ResultsA total of 4 RCTs and 12 retrospective cohort studies involving 1 316 implants were finally included. The results of meta-analysis showed that: there was no significant difference between two groups in retention rate (RCT: RR=0.99, 95%CI 0.97 to 1.02, P=0.70; retrospective cohort study: RR=0.99, 95%CI 0.96 to 1.02, P=0.54), the implant stability of permanent restoration for 4 months (MD=0.82, 95%CI –0.11 to 1.76, P=0.08), alveolar bone resorption of long-term permanent crown restoration (12 months: RCT: MD=0.06, 95%CI –0.35 to 0.47, P=0.79; retrospective cohort study: MD=–0.27, 95%CI –0.57 to 0.03, P=0.07; 24 months: retrospective cohort study MD=–0.09, 95%CI –0.18 to 0.00, P=0.05), respectively. The immediate implant group was superior to the control group in alveolar bone resorption of short-term permanent crown restoration (3 months: MD=–0.08, 95%CI –0.13 to –0.04, P=0.000 1; 6 months: MD=–0.23, 95%CI –0.38 to –0.07, P=0.004). The PES score in the immediate implant group was higher than that in the delayed implant group(MD=1.12, 95%CI 0.11 to 2.13, P=0.03).ConclusionsCurrent evidence shows that both immediate and delayed implant procedures have similar outcomes in terms of implant retention, long-term stability and long-term alveolar bone resorption of the implants in the anterior maxilla regions, but the former procedure possesses better short-term reduction of alveolar bone absorption and postoperative gingival aesthetics. Furthermore, due to the limited quality and quantity of the included studies, more large-scale and high-quality studies are needed to verify the above conclusions.

关键词: 即刻种植; 延期种植; 前牙区; 留存率; 红色美学评分; Meta 分析; 随机对照试验; 队列研究

Key words: Immediate implant; Delayed implant; Anterior teeth area; Retention rate; Pink esthetic score; Meta-analysis; Randomized controlled trial; Cohort study

引用本文: 张健, 孙晓峰, 张平. 即刻种植与延期种植相比对前牙区种植体成功率及美学影响的 Meta 分析. 中国循证医学杂志, 2018, 18(3): 342-350. doi: 10.7507/1672-2531.201706003 复制

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