Int. J. Oral Maxillofac. Surg.

2013; 42: 643–650

http://dx.doi.org/10.1016/j.ijom.2013.01.018, available online at http://www.sciencedirect.com

Systematic Review
Dental Implants

Immediate versus delayed M. Clementini, A. Morlupi,

C. Agrestini, A. Barlattani
Department of Dentistry, University ‘‘Tor

positioning of dental implants in Vergata’’, Rome, Italy

guided bone regeneration or

onlay graft regenerated areas: a
systematic review
M. Clementini, A. Morlupi, C. Agrestini, A. Barlattani: Immediate versus delayed
positioning of dental implants in guided bone regeneration or onlay graft regenerated
areas: a systematic review. Int. J. Oral Maxillofac. Surg. 2013; 42: 643–650. # 2013
International Association of Oral and Maxillofacial Surgeons. Published by Elsevier
Ltd. All rights reserved.

Abstract. The aim of this study was to compare success rates in immediate and
delayed dental implant placement following guided bone regeneration or onlay
bone block ridge augmentation. A systematic review of all studies on this topic was
performed. For inclusion, studies had to involve at least five patients, report specific
success criteria, and have a minimum follow-up period of 6 months. Studies
reporting only the survival rate of implants were excluded. From 287 studies
identified, 79 were screened and 13 were included in the analysis. Six studies
provided data on simultaneous (immediate) positioning of implants, five studies on
delayed positioning, and two studies provided data on both of these approaches.
Success rates for implants placed using a simultaneous approach ranged from 61.5%
to 100%; success rates for implants placed using a staged approach ranged from
75% to 98%. Even though the current review revealed that there are not many
studies reporting data relevant to the analyzed topic, the data obtained suggest that
the delayed positioning of implants should be considered more predictable than the
immediate positioning. Studies presenting a control group and adopting
standardized success criteria are required, and data from this review must be Accepted for publication 24 January 2013
considered indicative. Available online 6 March 2013

The dental rehabilitation of partially or results.1–9 However, a minimum amount periodontal disease, may result in insuffi-
totally edentulous patients with osseointe- of bone width and height is an essential cient bone volume or an unfavourable
grated oral implants is nowadays one of prerequisite for the correct placement of inter-arch relationship, which will not
the most successful methods to restore oral oral implants. Thus, unfavourable local allow the correct and prosthodontically
aesthetics and function, with predictable conditions due to atrophy, trauma, and guided positioning of dental implants.

0901-5027/050643 + 08 $36.00/0 # 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
644 Clementini et al.

For such cases, many different techniques The aim of this study was to compare, in of the success criteria previously defined
have been developed to reconstruct the a systematic manner, publications report- by Albrektsson et al.2 and adapted by Buser
deficient alveolar jaws for the placement ing the success rate of dental implants et al.5: absence of mobility, absence of
of dental implants.10–13 placed simultaneously or as a second sur- persistent subjective complaints (pain, for-
Further, the ideal timing of implant gery following ridge augmentation by eign body sensation and/or dysesthesia),
placement after dental extraction has been means of guided bone regeneration absence of recurrent peri-implant infection
extensively discussed in the literature, and (GBR) or onlay graft regeneration techni- with suppuration, absence of a continuous
advantages and disadvantages have been que. radiolucency around the implant,44 and
attributed to the different protocols14,15: absence of a pocket probing depth (PPD)
(1) immediate or type 1,when the implant >5 mm.45 Even if during the first year of
Materials and methods
is placed during the same surgical inter- function 1.5 mm of vertical bone resorption
vention as the dental extraction; (2) early Inclusion and exclusion criteria were was accepted, after that time, the annual
implant placement or type 2, when defined by the authors, before beginning vertical bone loss should not exceed
implants are placed during the early stages the study, according to the protocol out- 0.2 mm (mesially or distally).2,46
of healing (from 4 to 8 weeks); and (3) lined below. The search strategy incorporated a
delayed implant placement or type 3, For inclusion, publications had to be search of electronic databases, supplemen-
when implants are placed when the ridge based on human subjects and written in ted by cross-checking of the bibliogra-
has healed (from 3 to 6 months). The English, and had to analyze the success phies of relevant review articles. A
timing of implant placement after recon- rate of endosseus implants placed in aug- search on MEDLINE and EMBASE was
struction of atrophic alveolar ridges mented jaws by means of GBR or onlay conducted up to January 2010 in accor-
instead, also remains a controversial topic. graft technique, specifying the type of dance with the Preferred Reporting Items
In fact implants can be positioned in implant surgery (simultaneous or staged) Systematic review and Meta-Analyses
conjunction with grafting procedures with the respective results. Every study (PRISMA) statement,47 using a combina-
(one-stage surgery or immediate implant design (prospective and retrospective) was tion of medical subject heading (MeSH)
placement) or after a consolidation period accepted, but studies had to involve more terms and text words: ‘‘Implants’’, ‘‘Den-
(two-stage surgery or delayed implant than five healthy patients and report on tal Implants’’, ‘‘Osseointegrated
placement). Although it is difficult to implant success with at least 6 months of Implants’’, ‘‘Oral Implants’’, ‘‘Implant
determine a clear indication for immediate loading, in order to observe biological Supported Prosthesis’’, ‘‘Transmucosal
or delayed implant placement, the major- complications during function rather than Implants’’, ‘‘Alveolar Ridge Augmenta-
ity of authors suggest immediate implant early implant failures. tion’’, ‘‘Lateral Ridge Augmentation’’,
placement when the residual alveolar bone Publications that reported the same data ‘‘Alveolar Ridge Atrophy’’, ‘‘Regenera-
presents adequate quality and quantity10. as reported in later publications by the tion’’, ‘‘Bone Regeneration’’, ‘‘Guided
In fact, the primary stability of dental same authors were not considered. Studies Bone Regeneration’’, ‘‘Guided Tissue
implants, which is considered to be the describing only the results of bone aug- Regeneration’’, ‘‘Barrier Membranes’’,
essential condition for osseointegration, is mentation, only the survival rate of ‘‘Membranes’’, ‘‘Bone Substitutes’’,
closely related to these parameters. implants, and those without any specified ‘‘Autogenous Bone Grafts’’, ‘‘Allograft’’,
Through the years, many studies pro- success criteria, were excluded. Studies on ‘‘Xenograft’’, ‘‘Calvarial Bone Graft’’,
posing the two different approaches have major maxillofacial reconstruction fol- ‘‘Iliac Crest Graft’’, ‘‘Chin Bone Grafts’’,
appeared in the scientific literature. lowing tissue resection in the case of ‘‘Onlay Bone Grafts’’, ‘‘Implant Out-
According to the authors who support tumours and bone defects related to con- comes’’, ‘‘Success Rate’’, ‘‘Simultaneous
immediate implant placement,16–28 the genital malformations (such as cleft lip Positioning’’, ‘‘Staged Approach’’,
reason is that the resorption of grafted and palate or major craniofacial malfor- ‘‘Immediate’’, ‘‘Delayed’’. To exclude
bone over time is not a linear process but mations), as well as socket preservation some non-relevant studies, ‘‘NOT
most pronounced soon after its transplan- techniques or the treatment of peri- (‘‘trauma’’ OR ‘‘tumour’’ OR ‘‘injuries’’
tation.29 Those who advocate delayed implantitis were not included. OR ‘‘cancer’’ OR ‘‘animal’’)’’ was added
placement30–39 instead, affirm that The following augmentation procedures to the search.
immediate placement of implants were considered: (1) GBR, according to A three-stage (Fig. 1) screening process
exposes the patient to some risks, such the biological principle of a protected was performed independently by two
as partial or total loss of the graft in the space, created with a resorbable or non- reviewers (MC and AM).
case of wound dehiscence, membrane or resorbable barrier membrane over the area At first, all the titles were screened to
onlay graft exposure and/or infection, and to be augmented, in order to stabilize the eliminate irrelevant publications, review
non-integration of implants related to the blood clot and to exclude soft tissue pene- articles, and animal studies; then, all
immediate placement into avascular tration42,43; and (2) bone block grafts, abstracts of publications selected during
bone. In fact, when a delayed protocol according to an onlay graft technique, the first screening were analyzed, and
is performed, it would be possible to place used alone or associated with particulate studies were excluded on the basis of
implants in a revascularized graft. Since bone, and covered or not by a resorbable the number of patients, the intervention,
the regenerative capacity of bone is deter- membrane.10 and the outcome characteristics. In the
mined by the presence of vessels, bone Even if studies did not adopt the same last stage, through an analysis of the
marrow, and vital bone surfaces, a criteria, implant success was the main out- whole selected full texts, study eligibility
delayed approach would permit a better come, and it had to be well-specified in the was based on the predetermined inclu-
integration of implants (higher values of publications for inclusion. However, when sion and exclusion criteria. Any disagree-
bone–implant contact) and stability of possible, the following clinical and radio- ments between the two reviewers were
implants as compared with immediate graphic criteria were utilized to define resolved after additional discussion with
implant placement.31,40,41 implant success based on a combination a third reviewer (CA). The inter-reviewer
 Immediate vs. delayed positioning of dental implants 645

Resulting studies not performed and the synthesis of data is placed simultaneously or in a second stage
n=3510 described in a narrative manner. surgery after the GBR technique. The
mean bone resorption after a 3-year
post-loading follow-up was 2.06 mm for
Ridge augmentation
the simultaneous approach; for the staged
Selected studies Chiapasco et al.48 reported the values of approach, values of mean bone resorption
after screening all vertical augmentation following the posi- were 1.35 mm before the implant place-
titles tioning of bone blocks harvested from ment and 1.69 mm after 3 years of func-
n=287 calvaria in the area of the anterior mand- tion.
ible (residual bone height <5 mm). The Nyström et al.27 reported data on the
Ineligible mean bone augmentation obtained after augmentation of atrophic maxillary ridges
publications after the reconstruction procedure was 8– by means of bone blocks harvested from
screening abstracts
11 mm, with a mean resorption lower than the iliac crest in 30 consecutively treated
n=208
10% at the time of implant positioning (6 patients. The implants (a total of 177) were
months after the bone grafting surgery). inserted simultaneously with the grafts
Another study by the Chiapasco et al.49 and patients were followed for an obser-
Potentially provides data on the reconstruction of vation period of 10 years. The resorption
relevant atrophic mandibles by means of bone results were higher in the first 3 years after
publications
blocks harvested from the mandible function and became stable in the follow-
n=79
ramus. The mean bone gain after the pro- ing years, without other significant losses.
cedure was 4.6 mm and the mean bone Buser et al.52 reported data on bone gain
Ineligible studies
resorption before the implant positioning in the case of horizontal GBR by means of
because didn’t
fulfill the inclusion
(4–5 months after the augmentation pro- autologous bone and non-resorbable
criteria cedure) was 0.6 mm. After a post-loading membranes. The mean bone gain was
n=66 follow-up of 1 year, the mean bone resorp- 3.5 mm at the time of implant placement
tion was 0.3 mm, and after 2 and 4 years it (6–9 months after ridge augmentation),
was 0.9 and 1.1 mm, respectively. and a success rate (absence of mobility,
In the study by Llambés et al.50, a mean absence of peri-implant radiolucency,
Included vertical ridge augmentation of 3 mm in the absence of persistent subjective com-
publications area of posterior mandible was obtained plaints, and absence of suppuration) of
n=13
by means of bioabsorbable membranes 98.3% was reported after a post-loading
and a mixture of autologous and bovine follow-up of 5 years.
Fig. 1. Flow diagram showing study selection bone. A complete regeneration was In the study of Brunel et al.53, the bone
for the review. achieved in 24 of 32 implants, but three gain obtained in 14 patients by means of
implants failed to show any new bone GBR with resorbable collagen membranes
formation. and hydroxyapatite is reported. After a
reliability of the data extraction was cal- Juodzbalys et al.43 also performed a healing period of 8 months, 14 implants
culated by determining the percentage of vertical ridge augmentation by means of were placed, with a bone loss (7 years
agreement and the correlation coeffi- bioabsorbable membranes and bovine post-loading follow-up) of <2 mm in 13
cients with a kappa analysis. bone, simultaneously with the implant of the 14 treated areas.
A table was created to organize the data placement. In this case, the mean vertical Chiapasco et al.,33 in their study,
from all the included studies (Table 1) and defect ranged from 3.8 to 10 mm. At the reported data on the regeneration of hor-
the results were discussed. time of prosthesis placement, good peri- izontal defects in both mandibles and
implant defect filling (the mean distance maxillas. The GBR was obtained by
from the implant shoulder to the alveolar means of non-resorbable ePTFE mem-
bone level (DIB) = 1.69 mm) was shown, branes and autologous bone chips har-
Results
except in one case (DIB = 3.6 mm). vested from intraoral donor sites. For
The preliminary investigation resulted in Van der Meij et al.28 provide data on the mean residual bone values of 3.2 mm, a
3510 titles. Following the first stage of positioning of bone blocks harvested from mean bone gain of 2.7 mm at the time of
screening (titles), 287 potentially relevant the iliac crest. The grafts were positioned implant placement was reported.
studies were identified, and then, after in the atrophic anterior mandibles of 17 Lorenzoni et al.54 reported data on GBR
second-stage screening (abstracts), 79 patients, and the mean bone gain was obtained by means of ePTFE membranes
full-text publications were obtained and 8.5 mm (mean augmentation of 95%). in association with grafting materials, for
analyzed. Finally, 13 articles were found The implants (two for each patient) were the immediate placement of 85 implants
to fulfil the inclusion criteria. Agreement positioned simultaneously with the grafts, (39 in the maxilla and 46 in the mandible).
in study selection between reviewers was and the mean bone resorption after a mean The mean recorded bone loss at 24 months
89.53% (kappa value = 0.46). post-loading follow-up period of 4 years after implant positioning was 1.51 mm.
Because of the absence of appropriate was 15%. Triplett and Schow30, in their study,
randomized controlled trials (RCTs) and In another study by Chiapasco et al.51, analyzed not only the success rate of
controlled clinical trials (CCTs), this sys- data on vertical GBR by means of non- dental implants placed in grafted areas,
tematic review included only prospective resorbable expanded polytetrafluoroethy- but also the success of the augmentation
and retrospective cohort studies. As such, lene (ePTFE) membranes and autologous procedure. Thirty-two grafts were posi-
and due also to the significant heteroge- bone chips, both in the maxilla and mand- tioned (29 harvested from the iliac crest
neity between studies, a meta-analysis was ible, are reported. The implants were and three from calvaria) in patients with
 646
Table 1. Immediate versus delayed positioning of dental implants in GBR or onlay-graft regenerated areas. Characteristics of the included studies.
Number Implants Success Survival
Study Type of of patients Mean age, (number/ Area of Post-loading Restorative rate of rate of
Ref. design Year City augmentation (smokers) years type/surface) implants follow-up design Approach implants implants

Clementini et al.
Chiapasco48 CS 2007 Milan Onlay from 6 56 23/ITI (Nobel Mandible 1–3 years Overdentures Delayed 95.7% 100%
(Italy) calvaria (>15 cigarettes/ Biocare)/surface
day excluded) not reported
Chiapasco49 RPS 2007 Milan Onlay from 8 41 19/Straumann/ Mandible 24–48 Single Delayed 89.5% 100%
(Italy) mandibular (>15 cigarettes/ surface not months crowns
ramus day excluded) reported
Llambés50 CS 2007 Valencia Vertical GBR 11 (all but one 48 32/Osseotite Mandible 1 year NR Immediate 93.75% 93.75%
(Spain) <10 cigarettes/ (BIOMET 3i)/
day) surface not
reported
Juodzbalys43 CS 2007 Kaunas Vertical GBR 17 39.6 20/Osteofix/ NR 5 years Single Immediate 90% 100%
(Lithuania) (>10 cigarettes/ surface not crowns
day excluded) reported
Van der Meij28 CS 2005 Alkmaar Onlay from iliac 17 (no data 56 34/Frialit/ Mandible From 6 months Overdentures Immediate 88.2% –
(Netherlands) crest about smoking) surface not to 7 years
reported
Chiapasco51 RPS 2004 Milan Vertical GBR 11 NR 25/Brånemark/ 10 maxilla From 29 to NR 13 immediate 61.5% 100%
(Italy) (>15 cigarettes/ surface not 15 mandible 41 months 12 delayed immediate
day excluded) reported 75% delayed
Nyström27 CS 2004 Umea Onlay from iliac 30 (no data 53 177/NR/surface Maxilla 10 years Full arch screw Immediate 72.8% –
(Sweden) crest about smoking) not reported bridges
52
Buser PCS 2002 Berne Horizontal GBR 40 (no data NR 61/ITI/surface NR 5 years Single crowns or Delayed 98.3% 100%
(Switzerland) about smoking) not reported fixed partial
dentures
Brunel53 CS 2001 Toulouse GBR 14 (no smokers) 48 14/NR/surface 13 maxilla 7 years NR Delayed 86% 100%
(France) not reported 1 mandible
33
Chiapasco CS 1999 Milan GBR and onlay 15 (heavy NR 30/18 ITI; 12 21 maxilla From 18 to NR Delayed 93.3% 100%
(Italy) from intra-oral smokers Brånemark/ 9 mandible 36 months
sites, calvaria, excluded) surface not
iliac crest reported
Lorenzoni54 CS 1999 Graz GBR 82 (no data 21–61 85/Frialit/ 39 maxilla 24 months Single crowns Immediate 100% 100%
(Austria) about smoking) surface not 46 mandible cemented
reported Single crowns
screw
Bridges
cemented
Bridges screw
Bars
Triplett30 RS 1996 Dallas Onlay from NR (no data NR 175/NR/surface Maxilla and From NR 65 immediate 84.6% –
(Texas) ilium and about smoking) not reported mandible 12 months 110 delayed immediate
cranium 88.2%
delayed
Isaksson19 CS 1992 NR Onlay from 8 (all heavy NR 46/Brånemark/ Maxilla 32–64 months Implant Immediate 83% –
iliac crest smokers apart surface not supported
from one reported partial dentures
patient)
CS, case series; GBR, guided bone regeneration; NR, not reported; PCS, prospective controlled study; RPS, randomized prospective study; RS, retrospective study.
 Immediate vs. delayed positioning of dental implants 647

atrophic ridges. After a minimum 1-year recorded success rate (absence of mobi- suppuration) of 98.3% after 5 years of
follow-up period, five of the 32 grafts had lity, absence of peri-implant radiolucency, function, with a survival rate of 100%,
failed, resulting in a success of the aug- absence of persistent subjective com- referring to 61 implants positioned in hor-
mentation procedure of 84.3%. plaints, and absence of suppuration) was izontal guided bone regenerated areas.
100%. A success rate (absence of mobility,
Triplett and Schow30 reported a success absence of peri-implant radiolucency,
Immediate implant placement—success
rate (absence of mobility, absence of peri- absence of persistent subjective com-
and survival rate
implant radiolucency, absence of persis- plaints, and absence of suppuration) of
Six studies19,27,28,43,50,54 provided data on tent subjective complaints, and absence of 86% after 7 years of function, with a
simultaneous (immediate) positioning of suppuration) of 84.6%, referring to 65 survival rate of 100%, was reported by
implants, and two studies30,51 provided implants inserted simultaneously with Brunel et al.53, referring to 14 implants
data on both of the approaches (immediate the augmentation procedure. placed in GBR areas.
and delayed). In the study by Isaksson et al.19, 46 In the study by Chiapasco et al.33, a
Llambés et al.50, who reported a success implants were inserted in the atrophic success rate (according to the Albrektsson
rate of 93.75%, described the immediate maxillas simultaneously with the position- criteria) of 93.3% (survival rate of 100%)
positioning of all 32 implants inserted ing of bone blocks harvested from the iliac after a period of function ranging from 18
during the study together with vertical crest. A success rate (absence of mobility, to 36 months was reported, referring to 30
GBR. All the implants were situated in absence of peri-implant radiolucency, and implants placed in a second stage surgery
the area of the posterior mandible, with a absence of suppuration) of 83% was following the augmentation by means of
mean required vertical augmentation of reported, with the majority of failures horizontal GBR technique.
3.5 mm. occurring in the period between the posi- According to the reported data, the suc-
Juodzbalys et al.43, referring to the posi- tioning of the fixtures and the positioning cess rate of implants placed using a simul-
tioning of 17 implants, reported a success of the abutments. taneous approach ranged from 61.5% to
rate of 90% after 5 years of post-loading 100% (Llambés50: 93.75%; Juodzbalys43:
follow-up, according to the Albrektsson 90%; Van der Meij28: 88.2%; Chia-
Delayed implant placement—success
criteria; the survival rate was 100%. All 17 pasco51: 61.5%; Nystrom27: 72.8%; Lor-
and survival rate
implants were placed simultaneously with enzoni54: 100%; Triplett30: 84.6%;
the guided bone augmentation procedure. Five studies48,49,51–53 provided data on Isaksson19: 83%), with all the studies
Van der Meij et al.28 reported data on delayed positioning of implants, and two but two reporting a success rate higher
the immediate positioning of 34 implants studies30,33 provided data on both of the than 83%.
(two for each patient) in the area of the approaches (delayed and immediate). Success rate of implants placed using a
anterior mandible simultaneously with Chiapasco et al.48 reported a success staged approach ranged from 75% to
vertical bone augmentation by means of rate (according to the Albrektsson criteria) 98.3% (Chiapasco48: 95.7%; Chiapasco49:
bone blocks harvested from the iliac crest. of 95.7% and a survival rate of 100% 89.5%; Chiapasco51: 75%; Buser52:
The success rate (PPD <5 mm and (post-loading follow-up of 12–24 98.3%; Brunel53: 86%; Chiapasco33:
absence of peri-implant radiolucency) months), referring to the positioning of 93.3%; Triplett30: 88.2%), with all the
after a mean post-loading follow-up of 4 23 implants inserted in a second stage studies but two reporting a success rate
years was 88.2%. surgery after bone reconstruction. higher than 88.2%.
In the study by Chiapasco et al.51, the In another study by Chiapasco et al.49,
success rate (according to the Albrektsson data are reported on the delayed position-
Smoking status
criteria) of the 13 implants placed with an ing (4–5 months after the vertical regen-
immediate approach in association with eration procedure) of 19 implants in the Only one study53 did not include smokers.
ePTFE membranes and autologous bone mandible. The success rate (according to Two studies43,50 included light smokers
chips, was 61.5% after 3 years of function, the Albrektsson criteria) after 24–48 (<10 cigarettes/day) and four stu-
with the majority of failures associated months of function was 89.5%, with a dies33,48,49,51 included moderate smokers
with the exposure of the membrane during survival rate of 100%. (<15 cigarettes/day), while only one
the healing period. Triplett and Schow30 reported a success study19 included heavy smokers. Five stu-
In the study by Nyström et al.27, 177 rate (absence of mobility, absence of peri- dies27,28,30,52,54 did not report on smoking
implants were placed simultaneously with implant radiolucency, absence of persis- status.
the augmentation procedure by means of tent subjective complaints, and absence of
bone blocks harvested from the iliac crest. suppuration) of 88.2%, referring to 110
Discussion
A success rate (absence of mobility and implants placed in a second stage surgery
absence of peri-implant radiolucency) of after the ridge augmentation procedure The aim of this study was to compare the
72.8% was reported after a follow-up per- (after a healing period of 6–9 months). success rates of dental implants placed
iod of 10 years. Some failures occurred: in In the study by Chiapasco et al.51, the simultaneously or as a second surgery
only three patients during the first 3 years success rate of 12 implants placed with a following ridge augmentation by means
after implant positioning, related to soft delayed approach following vertical GBR of GBR or onlay graft technique. Because
tissues traumas in the grafting area, with procedure by means of non-resorbable of the absence of appropriate RCTs, this
subsequent dehiscence during the healing ePTFE membranes and autologous bone systematic review included only 13 pro-
period. chips was 75%. spective and retrospective cohort studies
Lorenzoni et al.54 reported data on the Buser et al.52 reported a success rate fulfilling the inclusion criteria, and so no
positioning of 85 implants placed simul- (absence of mobility, absence of peri- meta-analysis could be performed.
taneously with the GBR procedure, after a implant radiolucency, absence of persis- Data reported in the literature seem to
post-loading follow-up of 24 months. The tent subjective complaints, and absence of demonstrate that GBR and onlay graft
648 Clementini et al.

procedures are reliable techniques, provid- because a high implant survival rate may 2. Albrektsson T, Zarb G, Worthington PM,
ing sufficient bone volume to allow not correspond to the success of the tech- Eriksson AR. The long term efficacy of
implant placement in the case of vertical nique itself, considering that an implant can currently used dental implants: a review
and/or horizontal defects of partially or remain stable and osseointegrated even if and proposed criteria of success. Int J Oral
totally edentulous patients. Most studies the total amount of regenerated tissue after Maxillofac Implants 1986;1:11–25.
demonstrated that success rates of the surgical procedure has been resorbed. 3. Van Steenberghe D. A retrospective multi-
implants placed in the augmented areas This is important, for example, in cases of center evaluation of the survival rate of
by means of GBR or onlay graft technique vertical or horizontal regeneration, because osseointegrated fixtures supporting fixed
partial prostheses in the treatment of partial
are similar to those reported for implants while in the first clinical situation the sup-
edentulism. J Prosthet Dent 1989;61:217–
placed in pristine bone.55–59 porting bone all around the implant is
23.
The timing of implant placement after recreated, in the latter, regeneration of only 4. Lindquist LW, Carlsson GE, Jemt TA. A
reconstruction of alveolar ridges by means the facial aspect is required, mostly for prospective 15-year follow-up study of man-
of GBR or onlay graft technique remains a aesthetic demand. dibular fixed prostheses supported by
controversial topic. Implants can be posi- For these reasons, only studies reporting osseointegrated implants. Clinical results
tioned in conjunction with grafting proce- well-defined implant success criteria were and marginal bone loss. Clin Oral Implants
dures or after consolidation of the graft has included in this review. Res 1996;7:329–36.
occurred. Although it is difficult to deter- Finally, it should be important to 5. Buser D, Mericske-Stern R, Bernard JP,
mine a clear indication for immediate or address the restorative design. In fact, Behneke A, Behneke N, Hirt HP, Belser
delayed implant placement, the majority of even when this is not the case, bone loss UC, Lang NP. Long-term evaluation of non-
authors suggest immediate implant place- during the years appears also to be related submerged ITI implants. Part I: 8-year life
ment when the residual alveolar bone pre- to the type of prosthetic rehabilitation table analysis of a prospective multicenter
sents adequate quality and quantity10. In (single crown, fixed partial dentures, or study with 2359 implants. Clin Oral
fact, the primary stability of dental implants, overdentures). Implants Res 1997;8:161–72.
which is considered to be the essential con- In conclusion, the present systematic 6. Arvidson K, Bystedt H, Frykholm A, von
dition for osseointegration, is closely related review found, on average, poor methodo- Konow L, Lothigius E. Five-year prospective
to these parameters. However, in this logical quality of a limited number of follow-up report of Astra Tech Implant Sys-
review, no article recorded the attainment articles focusing on the topic. None was tem in the treatment of edentulous mand-
of a required level of primary stability as the an RCT, which is considered to be the ibles. Clin Oral Implants Res 1998;9:225–
34.
outcome to follow for selecting an immedi- most appropriate type of study to test the
7. Lekholm U, Gunne J, Henry P, Higuchi K,
ate or delayed implant placement. effectiveness of interventions, because
Linden U, Bergstrom C, van Steenberghe D.
Through the years, many studies have this type is less prone to the effect of bias. Survival of the Brånemark implant in par-
proposed the two different approaches. The Within the limits of these findings the tially edentulous jaws: a 10-year prospective
present review suggests that in GBR and following conclusions can be drawn: from multicenter study. Int J Oral Maxillofac
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dictable than immediate positioning. areas should be considered more predict- prospective clinical and radiographic study
The success rates of implants placed able than immediate positioning. In the of non-submerged dental implants. Clin Oral
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but two reporting a success rate higher control group and adopting standardized Lekholm U. Long-term follow-up of
than 83%. The success rates of implants criteria to define success and failure of osseointegrated titanium implants using clin-
placed using a staged approach ranged implants placed either simultaneously or ical, radiographic and microbiological para-
from 75% to 98.3%, with all the studies as a second surgery following ridge aug- meters. Clin Oral Implants Res
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‘survived’ do not satisfy the essential cri- cessful in furnishing bony support for
teria that define the success rate. The sur- Competing interests
implant placement. Int J Oral Maxillofac
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