Sherif Kamel, Jonathan Rees

Introduction & aims

A two-stage surgical protocol for implant placement has been the standard surgical technique for insertion of dental implants. Recently, one-stage implant placement has been widely used, which involves placing a transmucosal healing abutment at the time of implant placement. This eliminates the need for a second surgery and may reduce treatment time. The objective of this review is to evaluate and appraise available evidence comparing one-stage and two-stage implant placement in terms of clinical outcomes. The outcome measures evaluated are implant failure/survival, radiographic peri-implant bone loss, soft tissue parameters, complications and patient centred outcomes.

Methods

A search strategy was developed for all available databases to identify randomised controlled clinical trials comparing one-stage to two-stage implant placement. Eligible studies were selected against predetermined inclusion and exclusion criteria. Studies were appraised for risk of bias and data extracted and tabulated and used for analysis. A Meta- analysis of Implant survival rate, and peri-implant bone loss were performed.

Results

A total of eight studies were included in this review. No significant difference was found in terms of implant failure/survival and peri-implant bone loss between the one-stage and two-stage protocol. The overall mean bone loss analysis included 277 one-stage implants and 299 two-stage implants with mean bone loss of 0.47mm and 0.51mm respectively over a mean follow up period of 28.8 month. No differences in the results were seen in terms of soft tissue parameters or complications between the two groups. Patient centred outcomes showed no preference of one protocol over the other.

Conclusions

There was no statistically significant difference between a one stage and a two stage surgical protocol for implant placement in the outcome measures of failure/survival, bone loss, soft tissue parameters, complications and patient centred outcomes between. Submerging the implant is not a prerequisite for osseointegration and successful healing.

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