title: Immediate loading of postextraction implants in the esthetic area: systematic review of the literature.
abstract: OBJECTIVE
  The purpose of the present systematic review was to estimate the survival rate of implants placed in fresh extraction sockets and immediately restored. Secondary aims were to compare it with the survival rate of implants placed in healed ridges and of implants restored according to a delayed protocol as well as to assess the influence of several other confounding factors on the clinical outcomes.
  
  
  METHODS
  An electronic search was performed on MEDLINE, EMBASE, and CENTRAL databases in order to identify prospective clinical studies published from 1990 to October 2012. A hand search was also done. Studies were selected according to specific inclusion criteria. The effect of the following parameters on 1-year implant survival (IS) was statistically evaluated: study design, risk of bias, prosthesis type, type of loading (occlusal or nonocclusal), type of incision (flap or flapless), presence of infection, and grafting material. A meta-analysis of studies comparing immediately restored implants placed in fresh postextraction sockets versus healed ridges was conducted.
  
  
  RESULTS
  Seven randomized trials, three controlled trials, and 35 case series were included, accounting for 1170 patients and 1974 postextraction implants immediately restored. Twenty-eight studies had a low risk of bias. The overall 1-year IS was 97.6%. All failures occurred within 1 year of function. Meta-analysis showed a significant better outcome for implants placed in healed ridge (IS = 99.4%) as compared with postextraction implants (IS = 95.6%). No other parameter had a significant effect on clinical outcomes. Most variables, among which the esthetic aspect, could not be assessed as they were not systematically reported.
  
  
  CONCLUSIONS
  Though the conventional protocol still represents the gold standard, immediate restoration of implants placed in fresh extraction sites displayed an excellent implant prognosis. Such clinical approach can be successfully adopted in order to minimize the treatment time with a relevant impact on patient's satisfaction.
authors.affiliation: Department of Biomedical, Surgical and Dental Sciences, CRSO (Centro di Ricerca per la Salute Orale), IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Galeazzi Orthopedic Institute, University of Milan, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Del Fabbro
authors.forename: Valentina
authors.initials: V
authors.lastname: Ceresoli
authors.forename: Silvio
authors.initials: S
authors.lastname: Taschieri
authors.forename: Caterina
authors.initials: C
authors.lastname: Ceci
authors.forename: Tiziano
authors.initials: T
authors.lastname: Testori
mesh_terms: D019232:Dental Restoration Failure; D004955:Esthetics, Dental; D006801:Humans; D057893:Immediate Dental Implant Loading; D014081:Tooth Extraction; D020390:Tooth Socket / Q000601:surgery*
keywords: dental implants; immediate implants; immediate loading; postextraction socket; systematic review