Dental Implants Inserted in Fresh Extraction Sockets versus Healed Sites: A Systematic Review and Meta-Analysis

Adam Ibrahim, Bruno Ramos Chrcanovic, Adam Ibrahim, Bruno Ramos Chrcanovic

Abstract

The present review aimed to evaluate the difference of dental implant failure rates and marginal bone loss (MBL) between implants inserted in fresh extraction sockets or healed sites. Electronic search was undertaken in three databases, plus manual search of journals, including studies randomized or not. Meta-analyses were performed besides meta-regressions, in order to verify how the odds ratio (OR) and MBL were associated with follow-up time. The review included 163 publications. Altogether, there were 17,278 and 38,738 implants placed in fresh extraction sockets and healed sites, respectively. Pairwise meta-analyses showed that implants in sockets had a higher failure risk in comparison to healed sites: OR 1.349, all studies included; OR 2.070, only prospective non-RCTs; OR 2.487, only RCTs (all p < 0.001). The difference in implant failure between the groups was statistically significant in the maxilla (OR 1.616, p = 0.029), but not in the mandible (OR 2.192, p = 0.075). The MBL mean difference (MD) between the groups was -0.053 mm (p = 0.089). There was an estimated decrease of 0.003 in OR (p = 0.284) and an increase of 0.006 mm (p = 0.036) in the MBL MD between groups for every additional month of follow-up. In conclusion, implants placed in fresh extraction sockets present higher risk of failure than implants placed in healed sites.

Keywords: dental implant; failure; fresh extraction socket; healed site; marginal bone loss; meta-analysis; meta-regression; systematic review.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study screening process.
Figure 2
Figure 2
Forest plot for the event ‘implant failure’, studies evaluating implants inserted exclusively in maxillae. Estimate in Odds Ratio.
Figure 3
Figure 3
Forest plot for the event ‘implant failure’, studies evaluating implants inserted exclusively in mandibles. Estimate in Odds Ratio.
Figure 4
Figure 4
Forest plot for the event ‘implant failure’, studies evaluating implants immediately loaded exclusively. Estimate in Odds Ratio.
Figure 5
Figure 5
Forest plot for the event ‘implant failure’, studies evaluating implants with delayed loading exclusively. Estimate in Odds Ratio.
Figure 6
Figure 6
Forest plot for the event ‘marginal bone loss’.
Figure 7
Figure 7
Scatter plot for the meta-regression with the association between the odds ratio (OR) of failure between implants placed in fresh extraction sockets and implants placed in healed sites, and the follow-up time (in months; limited to 60 months). Every circle represents a study, and the size of the circle represents the weight of the study in the analysis.
Figure 8
Figure 8
Scatter plot for the meta-regression with the association between follow-up (in months) and MBL mean difference between implants placed in fresh extraction sockets and healed sites. Every circle represents a study, and the size of the circle represents the weight of the study in the analysis.
Figure 9
Figure 9
Funnel plot.

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