目的:评估植入失败,边缘骨丢失(MBL),以及在至少3年的功能后,由倾斜和笔直植入物支持的修复体的其他生物或技术并发症。
方法:在MEDLINE中进行电子和人工搜索,Embase,WebofScience,和OpenGrey,以确定截至2017年12月发表的临床研究。经过重复的研究选择和数据提取,使用ROBINS-I工具评估偏倚风险.进行了相对风险(RR)或平均差异(MD)及其95%置信区间(CI)的随机效应荟萃分析,其次是亚组/敏感性分析和GRADE方法的应用。
结果:共纳入17项非随机研究(8项前瞻性/9项回顾性研究)。整体系统评价的植入物数量为7,568个植入物,放置在1,849名支持全弓或部分植入物假体的患者中。没有发现倾斜和笔直植入物失败的差异(8项研究;4,436个植入物;RR=0.95;95%CI=0.70至1.28;p=0.74),由于偏见和不精确,证据质量非常低。同样,倾斜植入物和直植入物之间的MBL没有差异(16项研究;5,293植入物;MD=0.03mm;95%CI=-0.03至0.10mm;p=0.32),由于偏见和不一致,证据质量非常低。从前瞻性和回顾性研究中发现了关于植入物存活的矛盾结果,这可能表明后者的偏见。
结论:在本系统评价的局限性内,未发现种植体倾斜对种植体存活或种植体周围骨丢失的影响.
OBJECTIVE: To evaluate the implant failure, marginal bone loss (MBL), and other biological or technical complications of restorations supported by tilted and straight implants after at least 3 years in function.
METHODS: Electronic and manual searches were performed in MEDLINE, Embase, Web of Science, and OpenGrey to identify clinical studies published up to December 2017. After duplicate study selection and data extraction, the risk of bias was assessed with the ROBINS-I tool. Random-effects meta-analyses of relative risks (RRs) or mean differences (MD) and their 95% confidence intervals (CIs) were performed, followed by subgroup/sensitivity analyses and application of the GRADE approach.
RESULTS: A total of 17 nonrandomized studies (eight prospective/nine retrospective) were included. The number of implants of the overall systematic
review was 7,568 implants placed in 1,849 patients supporting either full-arch or partial implant prostheses. No difference in the failure of tilted and straight implants was seen (eight studies; 4,436 implants; RR = 0.95; 95% CI = 0.70 to 1.28; p = 0.74), with the quality of evidence being very low due to bias and imprecision. Likewise, no difference in MBL was seen between tilted and straight implants (16 studies; 5,293 implants; MD = 0.03 mm; 95% CI = -0.03 to 0.10 mm; p = 0.32), with the quality of evidence being very low due to bias and inconsistency. Contradictory results regarding implant survival were found from prospective and retrospective studies, which could indicate bias from the latter.
CONCLUSIONS: Within the limitations of the present systematic
review, no effect of implant inclination on implant survival or peri-implant bone loss was found.