背景:今天,在部分或全部缺牙症的情况下,牙科植入物是一种有效的治疗方法,具有出色的成功率。尽管获得了结果,治疗期间可能有生物或机械并发症,导致植入物的丢失。本系统综述旨在评估用于去除牙种植体的技术文献中的当前技术水平。将对各个方面进行分析,比如技术的成功,任何并发症,以及它们使用的优点和缺点。
方法:两位审稿人进行了文献分析(PubMed,Embase,WebofScience)过去20年(2003-2023年)。分析的主要标准是该技术的成功,同时还分析了该技术的并发症和风险等次要结局。在各种搜索数据库中确定了258篇文章。在文章筛选后,随后确定了42篇合格文章。随后只有18个全文被列入审查。
结果:共选取18篇文献,纳入1142个植入物和595名患者。使用的主要技术是反扭矩棘轮技术(CTRT),压电骨手术(PBS),环钻,碳化物毛刺,铒,铬,钇,钪,镓,Garnett(Er:Cr:YSGG)激光和二氧化碳(CO2)激光。已经确定了技术的组合使用,例如:PBS和环钻钻或硬质合金钻,使用3d打印的指南,CTRT和环钻。成功率最高的技术,患者的发病率较低,少切除骨头似乎是CTRT。
结论:使用保守技术,尤其是CTRT,在骨移除中是有用的,以允许在移除区域中立即放置植入物。然而,需要对所有技术进行高样本量的进一步研究,特别是新的随机对照试验(RCT),允许分析替代技术的成功,如激光和压电手术,这似乎很有希望。
Today dental implants represent an effective therapy in case of partial or total edentulism, with an excellent success rate. Despite the results obtained, there may be biological or mechanical complications during the therapy, which lead to the loss of the implant. This systematic
review aims to evaluate the current state of the art in the literature on techniques used for the removal of dental implants. Various aspects will be analyzed, such as the success of the technique, any complications, and the advantages and disadvantages of their use.
Two reviewers conducted a literature analysis (PubMed, Embase, Web of Science) of the last 20 years (2003-2023). The main criterion analyzed was the success of the technique, while secondary outcomes such as complications and risks of the technique were also analyzed. 258 articles were identified in the various search databases. 42 eligible articles were subsequently identified after an article screening. Only 18 full texts were subsequently included in the
review.
A total of 18 articles were selected and 1142 implants and 595 patients were included. The main techniques used were the Counter-Torque Ratchet Technique (CTRT), Piezoelectric bone surgery (PBS), trephine drills, carbide burs, Erbium, Chromium,
Yttrium, Scandium, Gallium, Garnett (Er:Cr:YSGG) laser and carbon dioxide (CO2) laser. Combined uses of techniques have been identified such as: PBS and trephine burs or carbide burs, trephine burs with the use of a 3d-printed guide, CTRT and trephine burs. The technique with the highest success rate, less morbidity for the patient, and less removal of bone appears to be the CTRT.
The use of conservative techniques, especially CTRT, in bone removal is useful to allow for immediate implant placement in the removal area. However, further studies with a high sample size are needed to be performed on all techniques, particularly new randomized controlled trials (RCTs) that allow for the analysis of the success of alternative techniques such as Laser and Piezosurgery, which appear to be very promising.