Immediate restoration/loading of immediately placed single implants: is it an effective bimodal approach?
OBJECTIVE
To compare systematically the survival and radiographic marginal bone level changes of two immediate implant protocols in the aesthetic region; immediate single implant restoration/loading in extraction sockets (the bimodal approach) compared with the same in healed sites.


METHODS
A literature search of electronic databases, Cochrane Oral Health Group's Trials Register, National Research Register, conference proceedings and abstracts was performed without language restriction up to 1 August 2008. Hand searching included several dental journals and authors were contacted for missing information. Controlled trials that compared immediate restoration/loading of single implants placed in extraction sites with those placed in healed sites were selected. The meta-analysis was prepared according to the guidelines of the Quality of Reporting of Meta-analyses statement. The data were analysed using RevMan version 5.0 software. A fixed effects model was chosen with standardized mean differences for continuous data, and risk ratios for dichotomous data with 95% confidence intervals.


RESULTS
Ten studies with 629 implants were included. Immediate single implant restoration/loading in extraction sockets in the aesthetic zone was associated with significantly higher risk of implant failure (risk ratio of 3.62, 95% confidence interval 1.15-11.45, P=0.03). However, the bimodal approach showed favourable marginal bone changes after 1 year.


CONCLUSIONS
The review and meta-analysis supported the potential advantages offered by this bimodal approach, but indicated a higher risk when compared with immediate restoration/loading in healed ridges. Further long-term, well-conducted, randomized-controlled studies are needed to confirm the validity of this treatment option.
Atieh
Momen A
MA
Oral Implantology Research Group, Sir John Walsh Research Institute, School of Dentistry, University of Otago, Dunedin, New Zealand.
Payne
Alan G T
AG
Duncan
Warwick J
WJ
Cullinan
Mary P
MP
D016301:Alveolar Bone Loss / Q000517:prevention & control; D000044:Dental Abutments; D003758:Dental Implantation, Endosseous / Q000379:methods*; D019250:Dental Implants, Single-Tooth; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D013997:Time Factors; D020390:Tooth Socket / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology