Stafford Gary L
Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, Wisconsin, USA.
Evid Based Dent. 2010;11(2):50-1. doi: 10.1038/sj.ebd.6400722.
Publications were sought using Medline, and searches were made by hand of the journals Clinical Oral Implants Research, International Journal of Periodontics and Restorative Dentistry, Journal of Periodontology, Journal of Clinical Periodontology and the International Journal of Oral and Maxillofacial Implants, along with reference lists of identified articles.
Titles and abstracts were initially screened by two independent reviewers to identify prospective or retrospective longitudinal cohort studies or controlled studies reporting on implant-supported cantilever fixed dental prostheses (ICFDP) with a mean followup period of at least 5 years. A clinical examination had to be performed at the end of the followup. For multiple publications reporting on the same population, only the most recent report was included.
Data for the meta-analysis were extracted by two independent reviewers. Information regarding survival and complication rates of both implants and ICFDP were extracted. Implant survival was considered if the implant was present at the followup examination; ICFDP survival was considered if the prosthesis was present at the followup visit without any modifications. Peri-implantitis and soft tissue complications were included in the category of biological complications. As for technical complications, all the events affecting the implant and/ or the meso- and/ or the suprastructures' integrity were considered. Among them, the following categories were defined: implant fractures, veneer fractures, framework fractures, abutment or screw fractures, loss of retention and screw loosening.
The five studies included in the meta-analysis yielded an estimated 5- and 10-year ICFDP cumulative survival rate of 94.3% [95% confidence interval (CI), 84.1-98%] and 88.9% (95% CI, 70.8- 96.1%), respectively. Five-year estimates for peri-implantitis were 5.4% (95% CI, 2.0-14.2%) and 9.4% (95% CI, 3.3-25.4%) at implant and prosthesis levels, respectively. Veneer fracture (5-year estimate; 10.3%; 95% CI, 3.9-26.6%) and screw loosening (5-year estimate, 8.2%; 95% CI, 3.9-17.0%) represented the most common complications, followed by loss of retention (5-year estimate, 5.7%; 95% CI,1.9-16.5%) and abutment/ screw fracture (5-year estimate, 2.1%; 95%CI, 0.9-5.1%). Implant fracture was rare (5-year estimate, 1.3%; 95% CI, 0.2-8.3%); no framework fracture was reported. Radiographic bone level changes did not yield statistically significant differences either at the prosthesis or at the implant levels when comparing ICFDP with short-span implant-supported end-abutment fixed dental prostheses.
ICFDP represent a predictable and reliable treatment for the replacement of posterior missing teeth in partially edentulous patients. The most frequent technical complications included veneer fractures, followed by screw loosening and loss of retention. No detrimental effects on bone levels were observed around implants in the proximity of cantilever extensions. To date, however, evidence is still sparse on the effects of various prosthetic designs (eg, distal or mesial cantilever extension), number of implants supporting ICFDP and occlusal concepts on the incidence of complications in ICFDP.
通过医学文献数据库检索相关出版物，并手动检索《临床口腔种植研究》《国际牙周病与修复牙科学杂志》《牙周病学杂志》《临床牙周病学杂志》以及《国际口腔颌面种植杂志》等期刊，同时查阅已识别文章的参考文献列表。
由两名独立评审员初步筛选标题和摘要，以确定前瞻性或回顾性纵向队列研究或对照研究，这些研究报告了平均随访期至少为5年的种植体支持的悬臂固定义齿（ICFDP）。随访结束时必须进行临床检查。对于报道同一人群的多篇出版物，仅纳入最新报告。
由两名独立评审员提取用于荟萃分析的数据。提取有关种植体和ICFDP的生存率及并发症发生率的信息。如果随访检查时种植体仍存在，则视为种植体存活；如果随访时义齿存在且未进行任何修改，则视为ICFDP存活。种植体周围炎和软组织并发症归为生物并发症类别。至于技术并发症，考虑所有影响种植体和/或中间结构及/或上部结构完整性的事件。其中，定义了以下类别：种植体骨折、贴面骨折、支架骨折、基台或螺钉骨折、固位丧失和螺钉松动。
纳入荟萃分析的五项研究显示，ICFDP的估计5年和10年累积生存率分别为94.3%[95%置信区间（CI），84.1 - 98%]和88.9%（95%CI，70.8 - 96.1%）。种植体和义齿水平的种植体周围炎5年估计发生率分别为5.4%（95%CI，2.0 - 14.2%）和9.4%（95%CI，3.3 - 25.4%）。贴面骨折（5年估计发生率；10.3%；95%CI，3.9 - 26.6%）和螺钉松动（5年估计发生率，8.2%；95%CI，3.9 - 17.0%）是最常见的并发症，其次是固位丧失（5年估计发生率，5.7%；95%CI，1.9 - 16.5%）和基台/螺钉骨折（5年估计发生率，2.1%；95%CI，0.9 - 5.1%）。种植体骨折很少见（5年估计发生率，1.3%；95%CI，0.2 - 8.3%）；未报告支架骨折。将ICFDP与短跨度种植体支持的末端基牙固定义齿进行比较时，在义齿或种植体水平，影像学骨水平变化均未产生统计学上的显著差异。
ICFDP是部分牙列缺损患者后牙缺失修复的一种可预测且可靠的治疗方法。最常见的技术并发症包括贴面骨折，其次是螺钉松动和固位丧失。在悬臂延伸附近的种植体周围未观察到对骨水平的有害影响。然而，迄今为止，关于各种修复设计（如远中或近中悬臂延伸）、支持ICFDP的种植体数量以及咬合概念对ICFDP并发症发生率影响的证据仍然很少。
