Weber Hans-Peter, Sukotjo Cortino
Department of Restorative Dentistry and Biomaterial Sciences, Harvard School of Dental Medicine, 188 Longwood Ave, Boston, MA 02115, USA.
Int J Oral Maxillofac Implants. 2007;22 Suppl:140-72.
Implant restoration of the partially edentulous patient has become highly predictable. The scientific information on the specifics of restorative designs and their influence on the long-term outcome is sparse. The main objective of this systematic review was to determine what scientific evidence exists regarding the influence of prosthodontic design features on the long-term outcomes of implant therapy (implant success and survival, prosthesis success and survival) in the partially edentulous patient.
Four questions of primary interest regarding implant prosthodontic design options were selected by the 2 reviewers: abutment type, retention type (cemented, screw-retained), support type (implant support alone versus combined implant-tooth support), and the type of restorative material. Inclusion and exclusion criteria were formulated and applied to a total of 1,720 titles. The list of titles was primarily based on a PubMed-type search provided by the State of the Science of Implant Dentistry workshop leadership. It was supplemented by a hand search of relevant journals at the Countway Library of the Harvard Medical School and of a personal collection of relevant publications of the 2 reviewers. Information on the survival and success of implants and prostheses as defined by the respective authors was retrieved from the included articles, entered into data extraction tables, and submitted for statistical analysis.
Seventy-four articles were selected for data extraction and analysis after critical appraisal and application of the exclusion criteria. The kappa value for reviewer agreement was 100% between the 2 reviewers. The majority of studies were in the "average" range and were published between 1995 and 2003. Only 2 "best" trials, ie, randomized controlled clinical trials, were identified. For the method of retention (screw-retained versus cemented), no differences were found in implant success or survival rates between screw-retained and cemented restorations. Prosthesis success rates showed greater variations between cemented and screw-retained restorations at the various evaluation times; however, the differences never reached statistical significance. The prosthesis success rate at the last reported examination (> 72 mo) was 93.2% for cemented and 83.4% for screw-retained restorations (P > .05). Regarding the type of support, implant success rates at the last reported evaluation were 97.1% for implant-supported fixed partial dentures (FPDs), 94.3% for single-implant restorations, and 89.2% for implant-tooth-supported FPDs. None of the differences reached statistical significance. Implant survival at the last examination (> 72 mo) was highest for implant-supported FPDs (97.7%), followed by single-implant restorations (95.6%) and implant-tooth-supported FPDs (91.1%). Differences were not statistically significant. Prosthesis success at the last examination (> 72 mo) resulted in overall lower percentage rates than implant success or survival (89.7% for implant-supported FPDs, 87.5% for implant-tooth-supported FPDs, and 85.4% for single-implant restorations; differences not statistically significant). Insufficient extractable information was available regarding the influence of abutment type or restorative material.
The scientific evidence obtained from this review is insufficient to establish unequivocal clinical guidelines for the design of implant-supported fixed prostheses in the partially edentulous patient.
部分牙列缺损患者的种植修复已具有很高的可预测性。关于修复体设计细节及其对长期疗效影响的科学信息较少。本系统评价的主要目的是确定关于修复设计特征对部分牙列缺损患者种植治疗长期疗效（种植体成功与存活、修复体成功与存活）影响的科学证据。
两位评价者选择了四个关于种植修复设计选项的主要问题：基台类型、固位类型（粘结固位、螺丝固位）、支持类型（仅种植体支持与种植体 - 牙联合支持）以及修复材料类型。制定了纳入和排除标准，并应用于总共1720篇文献标题。文献标题列表主要基于种植牙科学研讨会领导提供的类似PubMed的搜索。通过对哈佛医学院Countway图书馆相关期刊的手工检索以及两位评价者的个人相关出版物收藏进行补充。从纳入的文章中检索各作者定义的种植体和修复体的存活与成功信息，录入数据提取表并进行统计分析。
经过严格评价和应用排除标准后，选择了74篇文章进行数据提取和分析。两位评价者之间的一致性kappa值为100%。大多数研究处于“一般”水平，发表于1995年至2003年之间。仅确定了2项“最佳”试验，即随机对照临床试验。对于固位方式（螺丝固位与粘结固位），螺丝固位修复体和粘结固位修复体在种植体成功率或存活率方面未发现差异。在不同评估时间，粘结固位和螺丝固位修复体之间的修复体成功率差异更大；然而，这些差异从未达到统计学意义。在最后一次报告的检查（>72个月）时，粘结固位修复体的修复体成功率为93.2%，螺丝固位修复体为83.4%（P>.05）。关于支持类型，在最后一次报告的评估中，种植体支持的固定局部义齿（FPD）的种植体成功率为97.1%，单颗种植体修复为94.3%，种植体 - 牙支持的FPD为89.2%。这些差异均未达到统计学意义。在最后一次检查（>72个月）时，种植体支持的FPD的种植体存活率最高（97.7%），其次是单颗种植体修复（95.6%）和种植体 - 牙支持的FPD（91.1%）。差异无统计学意义。在最后一次检查（>72个月）时，修复体成功率总体百分比低于种植体成功率或存活率（种植体支持的FPD为89.7%，种植体 - 牙支持的FPD为87.5%，单颗种植体修复为85.4%；差异无统计学意义）。关于基台类型或修复材料的影响，可提取的信息不足。
本评价获得的科学证据不足以明确为部分牙列缺损患者设计种植支持固定修复体建立临床指南。
