Andreiotelli Marina, Wenz Hans J, Kohal Ralf-Joachim
Department of Prosthodontics, School of Dentistry, Albert-Ludwigs University, Freiburg, Germany.
Clin Oral Implants Res. 2009 Sep;20 Suppl 4:32-47. doi: 10.1111/j.1600-0501.2009.01785.x.
The aim of this systematic review was to screen the literature in order to locate animal and clinical data on bone-implant contact (BIC) and clinical survival/success that would help to answer the question 'Are ceramic implants a viable alternative to titanium implants?'
A literature search was performed in the following databases: (1) the Cochrane Oral Health Group's Trials Register, (2) the Cochrane Central Register of Controlled Trials (CENTRAL), (3) MEDLINE (Ovid), and (4) PubMed. To evaluate biocompatibility, animal investigations were scrutinized regarding the amount of BIC and to assess implant longevity clinical data were evaluated.
The PubMed search yielded 349 titles and the Cochrane/MEDLINE search yielded 881 titles. Based upon abstract screening and discarding duplicates from both searches, 100 full-text articles were obtained and subjected to additional evaluation. A further publication was included based on the manual search. The selection process resulted in the final sample of 25 studies. No (randomized) controlled clinical trials regarding the outcome of zirconia and alumina ceramic implants could be found. The systematic review identified histological animal studies showing similar BIC between alumina, zirconia and titanium. Clinical investigations using different alumina oral implants up to 10 years showed survival/success rates in the range of 23 to 98% for different indications. The included zirconia implant studies presented a survival rate from 84% after 21 months to 98% after 1 year.
No difference was found in the rate of osseointegration between the different implant materials in animal experiments. Only cohort investigations were located with questionable scientific value. Alumina implants did not perform satisfactorily and therefore, based on this review, are not a viable alternative to titanium implants. Currently, the scientific clinical data for ceramic implants in general and for zirconia implants in particular are not sufficient to recommend ceramic implants for routine clinical use. Zirconia, however, may have the potential to be a successful implant material, although this is as yet unsupported by clinical investigations.
本系统评价旨在筛选文献，以查找有关骨-种植体接触（BIC）以及临床存留率/成功率的动物和临床数据，从而有助于回答“陶瓷种植体是否是钛种植体的可行替代方案？”这一问题。
在以下数据库中进行文献检索：（1）Cochrane口腔健康组试验注册库，（2）Cochrane对照试验中央注册库（CENTRAL），（3）MEDLINE（Ovid），以及（4）PubMed。为评估生物相容性，仔细审查动物研究中的BIC量，并评估种植体存留时间的临床数据。
PubMed检索得到349篇标题，Cochrane/MEDLINE检索得到881篇标题。基于摘要筛选并去除两次检索中的重复项，共获得100篇全文文章并进行进一步评估。通过手工检索又纳入一篇文献。筛选过程最终得到25项研究的样本。未找到关于氧化锆和氧化铝陶瓷种植体结果的（随机）对照临床试验。该系统评价确定了组织学动物研究，显示氧化铝、氧化锆和钛之间的BIC相似。使用不同氧化铝口腔种植体长达10年的临床研究表明，不同适应证的存留率/成功率在23%至98%之间。纳入的氧化锆种植体研究显示，21个月后的存留率为84%，1年后为98%。
在动物实验中，不同种植体材料之间的骨结合率未发现差异。仅找到科学价值存疑的队列研究。氧化铝种植体表现不佳，因此，基于本综述，它不是钛种植体的可行替代方案。目前，一般陶瓷种植体尤其是氧化锆种植体的科学临床数据不足以推荐其用于常规临床。然而，氧化锆可能有潜力成为一种成功的种植体材料，尽管目前尚无临床研究支持。
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