Chrcanovic Bruno Ramos, Albrektsson Tomas, Wennerberg Ann
Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
Department of Biomaterials, Göteborg University, Göteborg, Sweden.
J Dent. 2014 Sep;42(9):1052-9. doi: 10.1016/j.jdent.2014.06.010. Epub 2014 Jul 1.
The purpose of the present review was to test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated using dental implants with immediate nonfunctional loading (INFL) compared to immediate functional loading (IFL), against the alternative hypothesis of a difference.
An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomized or not. The estimates of relative effect were expressed in risk ratio (RR) and mean difference (MD) in millimeters.
1059 studies were identified and 11 studies were included, of which 7 were of high risk of bias, whereas four studies were of low risk of bias. The results showed that the procedure used (nonfunctional vs. functional) did not significantly affect the implant failure rates (P=0.70), with a RR of 0.87 (95% CI 0.44-1.75). The wide CI demonstrates uncertainty about the effect size. The analysis of postoperative infection was not possible due to lack of data. No apparent significant effects of non-occlusal loading on the marginal bone loss (MD 0.01mm, 95% CI -0.04-0.06; P=0.74) were observed.
The results of this study suggest that the differences in occlusal loading between INFL and IFL might not affect the survival of these dental implants and that there is no apparent significant effect on the marginal bone loss.
There has been a controversy concerning whether dental implants should be subjected to immediate functional or nonfunctional loading. As the philosophies of treatment may alter over time, a periodic review of the different concepts is necessary to refine techniques and eliminate unnecessary procedures. This would form a basis for optimum treatment.
本综述的目的是检验零假设，即与即刻功能负荷（IFL）相比，采用即刻非功能负荷（INFL）进行牙种植体修复的患者在种植体失败率、术后感染和边缘骨丢失方面无差异，备择假设为存在差异。
2014年3月进行了无时间或语言限制的电子检索。纳入标准包括临床人体研究，无论是否为随机研究。相对效应估计值以风险比（RR）和毫米为单位的平均差（MD）表示。
共识别出1059项研究，纳入11项研究，其中7项研究存在高偏倚风险，4项研究存在低偏倚风险。结果显示，所采用的方法（非功能与功能）对种植体失败率无显著影响（P = 0.70），RR为0.87（95%CI 0.44 - 1.75）。宽泛的CI表明效应大小存在不确定性。由于缺乏数据，无法对术后感染进行分析。未观察到非咬合负荷对边缘骨丢失有明显显著影响（MD 0.01mm，95%CI -0.04 - 0.06；P = 0.74）。
本研究结果表明，INFL和IFL之间的咬合负荷差异可能不会影响这些牙种植体的存留率，且对边缘骨丢失无明显显著影响。
关于牙种植体应即刻进行功能负荷还是非功能负荷一直存在争议。随着治疗理念可能随时间变化，定期回顾不同概念对于改进技术和消除不必要的程序是必要的。这将为优化治疗奠定基础。
