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Pre-extractive Versus Postextractive Implant Site Preparation for Immediate Implant Placement in Mandibular Molar
Momen A Atieh1, Maanas Shah2, Abeer Hakam2
1Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Dubai, United Arab Emirates; Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand; School of Dentistry, University of Jordan, Amman, Jordan.
Abstract:
The aim of this systematic review and meta-analysis was to compare outcomes of pre-extractive to postextractive site preparation for immediate implant placement in mandibular molar sites in terms of implant stability, changes in marginal bone levels, implant position and implant failure rate. Following PRISMA and Cochrane guidelines, this review included randomised controlled trials comparing pre-extractive and postextractive implant site preparation in mandibular molars. Searches were conducted in MEDLINE, EMBASE and ClinicalTrials.gov. Data extraction and risk of bias assessment were performed independently by 2 reviewers. Meta-analysis used a random-effects model, and evidence of certainty was evaluated using GRADE. A total of 120 studies were initially identified, of which 4 studies, involving 82 dental implants in 82 participants, were included. The overall meta-analysis showed that the pre-extractive approach resulted in significantly higher implant stability quotient (ISQ) values at the time of implant placement (mean difference (MD) -3.39; 95% confidence interval (CI) -4.20 to -2.59; P < .0001) and less deviation from the central implant position (relative risk (RR) 0.05; 95% CI 0.01-0.33; P = .002) compared to the postextractive approach. Anatomically guided pre-extractive implant site preparation may improve primary implant stability and optimise implant position compared to conventional surgical approaches. Pre-extractive site preparation may improve implant stability and positioning in mandibular molar sites, but the low certainty of evidence warrants cautious interpretation.
