TABLE 7.
GRADE I‐IV summary‐of‐evidence compilation for each of the four comparisons that could be made between any two placement and loading combinations (DPIL vs. DPDL, IPIL vs. DPDL, DPEL vs. DPDL, IPEL vs. DPDL)
| Summary of findings: GRADE I | |||||
|---|---|---|---|---|---|
| Delayed placement and immediate loading (DPIL) compared to delayed placement and delayed loading (DPDL) for implant treatment in partially edentulous individuals | |||||
|
Patient or population: implant treatment in partially edentulous individuals (analysis at implant level) Setting: University/private clinic Intervention: delayed placement and immediate loading (DPIL) Comparison: delayed placement and delayed loading (DPDL) | |||||
| Outcomes | Anticipated absolute effects | No. of implants (contributing arm/studies) | Certainty of the evidence (GRADE) | Comments | |
| Weighted effect with delayed placement and delayed loading (DPDL) | Weighted effect with delayed placement and immediate loading (DPIL) | ||||
| Rx bone loss around the implant platform assessed with: Radiographic image d | The mean rx bone loss around the implant platform was 1.68 mm ± 0.97 | The mean rx bone loss around the implant platform was 0.71 mm ± 0.66 | 676 implants (4 RCTs, 6 observational studies) |
⨁◯◯◯ VERY LOW a |
Immediate loading after delayed placement seems to reduce potential bone loss after loading. Follow‐up period varied from 3 years up to 15 years |
| Bleeding on probing assessed with: Sulcus Bleeding Index c | The mean SBI was 0.066 (±0.253) | The mean SBI was 0.00 (±0.00) | 60 implants (1 RCT) |
⨁⨁◯◯ LOW b |
Immediate loading after delayed placement does not seems to affect the Sulcus Bleeding Index. Follow‐up was 15 years |
| Peri‐implant probing depth | The mean peri‐implant pocket depth was 3.12 mm ± 1.08 | The mean peri‐implant pocket depth was 2.83 mm ± 0.92 | 352 (4 RCTs, 1 observational studies) |
⨁◯◯◯ VERY LOW a |
Peri‐implant pocket depth does not exhibit substantial difference between immediate and delayed loading after delayed implant placement |
| Peri‐implantitis prevalence assessed with: Radiographic and clinical examination d | The mean percentage of implants with peri‐implantitis was 3.5% | The mean percentage of implants with peri‐implantitis was 0.9% | 535 (4 RCTs, 4 observational studies) |
⨁◯◯◯ VERY LOW a |
Evidence is scarce on peri‐implantitis and low rates were reported in the included studies. This could be in part due to poor reporting of the study of the clinical examination. Follow‐up period varied from 3 years up to 15 years |
| Mucositis | No muscositis was reported in all studies with data on peri‐implantitis | 535 (4 RCTs, 4 observational studies) |
⨁◯◯◯ VERY LOW a |
Evidence is scarce on mucositis. No cases were reported in the included studies but this could be in part due to poor reporting of the study of the clinical examination. Follow‐up period varied from 3 years up to 15 years | |
| Survival rate assessed with: Radiographic and clinical examination d | The mean survival rate was 98.1.2% | The mean survival rate was 97.2% % | 879 implants (6 RCTs, 7 observational studies) |
⨁◯◯◯ VERY LOW a |
Both delayed and immediate loading after delayed placement after delayed implant placement present high survival rates. Follow‐up period varied from 3 years up to 15 years |
| GRADE Working Group grades of evidence: High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | |||||
| Summary of findings: GRADE II | |||||
|---|---|---|---|---|---|
| Immediate placement and immediate loading (IPIL) compared to delayed placement and delayed loading (DPDL) for implant treatment in partially edentulous individuals | |||||
|
Patient or population: implant treatment in partially edentulous individuals Setting: University/private clinic Intervention: immediate placement and immediate loading Comparison: delayed placement and delayed loading | |||||
| Outcomes | Anticipated absolute effects | No. of implants (contributing arm/studies) | Certainty of the evidence (GRADE) | Comments | |
| Weighted effect with delayed placement and delayed loading (DPDL) | Weighted effect with immediate placement and immediate loading (IPIL) | ||||
| Rx bone loss around the implant platform assessed with: Radiographic image f | The mean rx bone loss around the implant platform was 1.68 mm ± 0.97 | The mean rx bone loss around the implant platform 1.57 mm ± 0.91 | 318 (2 RCTs, 3 observational studies) |
⨁◯◯◯ VERY LOW b |
Implants placed with immediate implant placement and immediate loading may exhibit comparable mean bone loss after loading. Follow‐up period varied from 3 years up to 15 years |
| Bleeding on probing assessed with: 0 to 6 scale (unknown reference) | Mean bleeding was 2.91 ± 2.11 | Mean bleeding was 1.76 ± 1.79 | 53 (1 observational study) |
⨁◯◯◯ VERY LOW b |
Implants placed with immediate implant placement and immediate loading may exhibit decreased bleeding on probing. Follow‐up period varied from 3 years up to 15 years |
| Peri‐implant probing depth | No comparison was possible | ‐ | ‐ | ‐ | |
| Peri‐implantitis prevalence | No comparison was possible | ‐ | ‐ | ‐ | |
| Mucositis | No comparison was possible | ‐ | ‐ | ‐ | |
| Survival rate assessed with: Radiographic and clinical examination f | Survival rate was 98.1% | Survival rate was 75% | 318 (2 RCTs, 3 observational studies) |
⨁◯◯◯ VERY LOW e |
Implants placed using both delayed placement with delayed loading may present higher survival rates compared to immediate placement with immediate loading. Follow‐up period varied from 3 years up to 15 years |
| GRADE Working Group grades of evidence: High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | |||||
| Summary of findings: GRADE III | ||||||
|---|---|---|---|---|---|---|
| Delayed placement and early loading (DPEL) compared to delayed placement and delayed loading (DPDL) for implant treatment in partially edentulous individuals | ||||||
|
Patient or population: implant treatment in partially edentulous individuals Setting: University/private clinic Intervention: delayed placement and early loading Comparison: delayed placement and delayed loading | ||||||
| Outcomes | Anticipated absolute effects | No. of participants (contributing arm/studies) | Certainty of the evidence (GRADE) | Comments | ||
| Weighted effect with delayed placement and delayed loading (DPDL) | Weighted effect with delayed placement and early loading (DPEL) | |||||
| Rx bone loss around the implant platform assessed with: Radiographic image f | The mean rx bone loss around the implant platform was 1.68 mm ± 0.97 | The mean rx bone loss around the implant platform was 0.28 ± 0.88 | 298 + 107 (2 RCTs, 3 observational studies) |
⨁◯◯◯ VERY LOW b |
Implants placed with delayed implant placement and early loading may exhibit decreased mean bone loss after loading. Follow‐up period varied from 3 years up to 15 years | |
| Bleeding on probing | No comparison was possible | ‐ | ‐ | ‐ | ||
| Peri‐implant probing depth | No comparison was possible | ‐ | ‐ | ‐ | ||
| Peri‐implantitis prevalence | No comparison was possible | ‐ | ‐ | ‐ | ||
| Mucositis | No comparison was possible | ‐ | ‐ | ‐ | ||
| Survival rate assessed with: Radiographic and clinical examination f | Survival rate was 98.1% | Survival rate was 100% | 439 + 107 (3 RCTs, 3 observational studies) |
⨁◯◯◯ VERY LOW e |
Implants placed using both delayed placement with delayed loading and delayed placement with early loading seem to present high survival rates. Follow‐up period varied from 3 years up to 15 years | |
| GRADE Working Group grades of evidence: High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
| Summary of findings: GRADE IV | |||||
|---|---|---|---|---|---|
| Immediate placement and early loading (IPEL) compared to delayed placement and delayed loading (DPDL) for implant treatment in partially edentulous individuals | |||||
|
Patient or population: implant treatment in partially edentulous individuals Setting: University/private clinic Intervention: immediate placement and early loading Comparison: delayed placement and delayed loading | |||||
| Outcomes | Anticipated absolute effects f (95% CI) | No. of participants (contributing arm/studies) | Certainty of the evidence (GRADE) | Comments | |
| Weighted effect with delayed placement and delayed loading (DPDL) | Weighted effect with immediate placement and early loading (IPEL) | ||||
| Rx bone loss around the implant platform assessed with: Radiographic image f | The mean rx bone loss around the implant platform was 1.68 mm ± 0.97 | The mean rx bone loss around the implant platform 0.99 ± 1.35 | 298+67 (2 RCTs, 3 observational study) |
⨁◯◯◯ VERY LOW b |
Implants placed with delayed implant placement and early loading may exhibit decreased mean bone loss after loading. Follow‐up period varied from 3 years up to 15 years |
| Bleeding on probing | No comparison was possible | ‐ | ‐ | ‐ | |
| Peri‐implant probing depth | No comparison was possible | ‐ | ‐ | ‐ | |
| Peri‐implantitis prevalence | No comparison was possible | ‐ | ‐ | ‐ | |
| Mucositis | No comparison was possible | ‐ | ‐ | ‐ | |
| Survival rate assessed with: Radiographic and clinical examination f | Survival rate was 98.1% | Survival rate was 100% | 439+67 (3 RCTs, 3 observational study) |
⨁◯◯◯ VERY LOW e |
Implants placed with both delayed placement with delayed loading and immediate placement with early loading present high survival rates. Follow‐up period varied from 3 years up to 15 years |
| GRADE Working Group grades of evidence: High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | |||||
a
All studies except for one RCT (Göthberg et al., 2018) showed from some concerns to high risk of bias; only 3 direct comparisons.
b
The study Romanos et al. (2014) was rated with high risk of bias.
c
Based on withing study comparisons.
d
Based on within and between study comparisons
e
All studies except for one RCT showed from some concerns to high risk of bias.
f
Based on between study comparisons.