Sherif Sami, Susarla Harlyn K, Kapos Theodoros, Munoz Deborah, Chang Brian M, Wright Robert F
Harvard School of Dental Medicine, Boston, MA; Private Practice, London, United Kingdom.
J Prosthodont. 2014 Jan;23(1):1-9. doi: 10.1111/jopr.12128. Epub 2013 Dec 31.
To systematically evaluate the survival and success of screw- versus cement-retained implant crowns.
The authors performed an electronic search of nine databases using identical MeSH phrases. Systematic evaluation and data extraction of the articles from 1966 through 2007 were completed by three reviewers and two clinical academicians. The major outcome variable was implant or crown loss, and the minor outcome variables were screw loosening, decementation, and porcelain fracture. Random effects Poisson models were used to analyze the failure and complication rates.
The initial search produced 26,582 articles. Of these, 577 titles and subsequently 295 abstracts were available for evaluation, with 81 full texts meeting the criteria for review. Data were extracted from 23 level one and two research studies. Fleiss' kappa interevaluator agreement ranged from almost perfect to moderate. Major failures included 0.71 screw-retained and 0.87 cement-retained failures per 100 years. Minor failures included 3.66 screw loosenings, 2.54 decementations, and 0.46 porcelain fractures per 100 years.
There is no significant difference between cement- and screw-retained restorations for major and minor outcomes with regard to implant survival or crown loss. This is important data, as clinicians use both methods of restoration, and neither is a form of inferior care.
系统评估螺丝固位与粘结固位种植体牙冠的存留率及成功率。
作者使用相同的医学主题词（MeSH）对九个数据库进行电子检索。由三位评审人员和两位临床院士完成对1966年至2007年发表文章的系统评估和数据提取。主要观察指标为种植体或牙冠脱落，次要观察指标为螺丝松动、粘结剂松动及瓷裂。采用随机效应泊松模型分析失败率和并发症发生率。
初步检索得到26582篇文章。其中，577篇文章标题及随后的295篇摘要可供评估，81篇全文符合纳入标准。从23项一级和二级研究中提取数据。Fleiss' kappa评估者间一致性从几乎完全一致到中等一致不等。主要失败情况为每100年螺丝固位种植体牙冠失败0.71例，粘结固位种植体牙冠失败0.87例。次要失败情况为每100年螺丝松动3.66例、粘结剂松动2.54例、瓷裂0.46例。
在种植体存留率或牙冠脱落方面，粘结固位和螺丝固位修复体的主要和次要观察指标无显著差异。这是重要的数据，因为临床医生会使用这两种修复方法，且两种方法均非劣质治疗方式。
