目的:第3工作组的目的是探讨材料和抗再吸收药物相关因素对植入牙科临床和生物学结果及并发症的影响。重点关注的问题是(a)钛(合金)以外的植入物材料,解决了(b)经粘膜基台材料和(c)影响骨代谢的药物。
方法:三个系统综述构成了第3组讨论的基础。根据系统评价结果,通过小组共识制定共识声明和临床建议。还传达了患者的观点和对未来研究的建议。然后根据全体会议的要求进行进一步讨论和修改后,提出并接受了这些建议。
结果:氧化锆是钛的有效替代品,可用作植入物和透粘膜组件的材料,允许软组织和硬组织与临床结果整合-通过植入物存活来识别,边缘骨质流失和种植体周围探查深度-与胫骨相似,最长为5年。然而,氧化锆植入物的大多数证据是基于限制适应症范围的1件式植入物。此外,根据专家意见,在美学区,氧化锆透粘膜成分可能是首选。在接受低剂量双膦酸盐治疗的患者中,早期植入物失败率没有增加,而对长期影响的研究仍然很少。尽管尚未得到充分解决,低剂量denosumab可以预期类似的结果.当考虑在接受低剂量ARD治疗的患者中放置植入物时,不建议休药期。然而,特定的治疗窗口,应考虑累积剂量和给药时间。必须获得种植体周围的支持性护理,以防止种植体周围炎相关的药物相关的颌骨坏死(MRONJ)或种植体相关的后遗症(IRS)。在接受低剂量抗吸收药物(ARD)治疗的患者中,与植入物放置相关的并发症风险很高,在这一特定人群中的植入程序应在综合的多学科中心严格处理。最后,在低或高剂量ARD之前,不应移除健康的牙科植入物。
结论:在选定的适应症中,氧化锆植入物可以替代钛植入物。然而,目前的证据仍然有限,特别是2件植入物的设计。低剂量ARD的给药对早期植入结果没有任何负面影响,但建议谨慎随访和支持治疗,以预防MRONJ和IRS植入。必须在综合的多学科中心严格考虑大剂量患者的植入物放置。
OBJECTIVE: The aim of Working Group 3 was to address the influence of both material- and anti-resorptive drug- related factors on clinical and biological outcomes and complications in implant dentistry. Focused questions were addressed on (a) implant materials other than titanium (alloy)s, (b) transmucosal abutment materials and (c) medications affecting bone metabolism were addressed.
METHODS: Three systematic reviews formed the basis for discussion in Group 3.
Consensus statements and clinical recommendations were formulated by group
consensus based on the findings of the systematic reviews. Patient perspectives and recommendations for future research were also conveyed. These were then presented and accepted following further discussion and modifications as required by the plenary.
RESULTS: Zirconia is a valid alternative to titanium as material for implant and transmucosal components, allowing soft and hard tissue integration with clinical outcomes-identified by implant survival, marginal bone loss and peri-implant probing depths-up to 5-years comparable to titatnium. However, most of the evidence for zirconia implants is based on 1-piece implants limiting the indication range. Furthermore, based on expert opinion, zirconia transmucosal components might be preferred in the esthetic zone. In patients receiving low-dose bisphosphonate therapy, the rate of early implant failure is not increased, while the long-term effects remain poorly studied. Although it has not been sufficiently addressed, similar outcomes can be expected with low-dose denosumab. A drug holiday is not recommended when considering implant placement in patients treated with low-dose ARD. However, the specific therapeutic window, the cumulative dose and the administration time should be considered. Access to peri-implant supportive care is mandatory to prevent peri-implantitis-related medication-related osteonecrosis of the jaw (MRONJ) or implant-related sequestra (IRS). In patients receiving low-dose anti-resorptive drugs (ARD) therapy, the risk of complications related to implant placement is high, and implant procedures in this specific population should be strictly treated in a comprehensive multidisciplinary center. Finally, healthy dental implants should not be removed before low or high-dose ARD.
CONCLUSIONS: Zirconia implants can be an alternative to titanium implants in selected indications. However, the current state of evidence remains limited, especially for 2-piece implant designs. Administration of low-dose ARD did not show any negative impact on early implant outcomes, but careful follow-up and supportive care is recommended in order to prevent peri-implant MRONJ and IRS. Implant placement in high-dose patients must be strictly considered in a comprehensive multidisciplinary center.