Review finds failure rates lower for delayed loaded submerged dental implants

PubMed, Web of Science, Cochrane Oral Health Group Trials Register, ClinicalTrials.gov, CenterWatch.com, ClinicalConnection.com.

Randomised and non-randomised studies were included comparing implant failure rates in any group of patients receiving submerged versus immediately loaded non-submerged dental implants. Selection was conducted independently by three reviewers. DATA EXTRACTION AND synthesis: Titles and abstracts of all reports identified through the electronic searches were read independently by the three authors. Studies were selected based on inclusion and exclusion criteria, with disagreements resolved through discussion. Study quality was assessed using the Cochrane risk of bias tool. Implant failure and post-operative infection were the dichotomous outcome measures evaluated. Weighted mean differences (WMD) were calculated and meta-analysis conducted.

Twenty eight studies, consisting of six randomized clinical trials, 14 controlled clinical trials and eight retrospective analyses were included. 23 studies were considered to be at high risk of bias, one at moderate risk and four at low risk of bias. The relative risk (RR) of failure was higher in immediately loaded implants RR = 1.78 (95% CI; 1.12- 2.83). The number needed to treat (NNT) to prevent one patient having an implant failure is 50 (95% CI; 25-100). Analysis suggests the possibility of publication bias.

The difference between immediately loading and delayed loading of an implant statistically affected the implant failure rate. No statistically significant effects on the occurrence of post-operative infection were observed between the two techniques. Results should be interpreted with caution due to lack of control of confounding factors, the retrospective design of some studies included and the small cohort sizes within the studies.