Goiato Marcelo Coelho, Pellizzer Eduardo Piza, da Silva Emily Vivianne Freitas, Bonatto Liliane da Rocha, dos Santos Daniela Micheline
Department of Dental Materials and Prosthodontics, Aracatuba School of Dentistry, São Paulo State University (UNESP), José Bonifácio, 1193, Vila Mendonça, Araçatuba, São Paulo, 16015-295, Brazil,
Oral Maxillofac Surg. 2015 Sep;19(3):229-42. doi: 10.1007/s10006-015-0494-5. Epub 2015 Apr 25.
This systematic review aimed to evaluate if the internal connection is more efficient than the external connection and its associated influencing factors.
A specific question was formulated according to the Population, Intervention, Control, and Outcome (PICO): Is internal connection more efficient than external connection in mechanical, biological, and esthetical point of views? An electronic search of the MEDLINE and the Web of Knowledge databases was performed for relevant studies published in English up to November 2013 by two independent reviewers. The keywords used in the search included a combination of "dental implant" and "internal connection" or "Morse connection" or "external connection." Selected studies were randomized clinical trials, prospective or retrospective studies, and in vitro studies with a clear aim of investigating the internal and/or external implant connection use.
From an initial screening yield of 674 articles, 64 potentially relevant articles were selected after an evaluation of their titles and abstracts. Full texts of these articles were obtained with 29 articles fulfilling the inclusion criteria. Morse taper connection has the best sealing ability. Concerning crestal bone loss, internal connections presented better results than external connections. The limitation of the present study was the absence of randomized clinical trials that investigated if the internal connection was more efficient than the external connection.
The external and internal connections have different mechanical, biological, and esthetical characteristics. Besides all systems that show proper success rates and effectiveness, crestal bone level maintenance is more important around internal connections than external connections. The Morse taper connection seems to be more efficient concerning biological aspects, allowing lower bacterial leakage and bone loss in single implants, including aesthetic regions. Additionally, this connection type can be successfully indicated for fixed partial prostheses and overdenture planning, since it exhibits high mechanical stability.
本系统评价旨在评估内连接是否比外连接更有效及其相关影响因素。
根据人群、干预措施、对照和结局（PICO）制定了一个具体问题：从机械、生物学和美学角度来看，内连接是否比外连接更有效？两名独立评审员对MEDLINE和Web of Knowledge数据库进行了电子检索，以查找截至2013年11月发表的英文相关研究。检索中使用的关键词包括“牙种植体”与“内连接”或“莫氏连接”或“外连接”的组合。入选研究为随机临床试验、前瞻性或回顾性研究以及体外研究，其明确目的是研究内种植体连接和/或外种植体连接的使用情况。
从初步筛选出的674篇文章中，在评估其标题和摘要后，选择了64篇可能相关的文章。获取了这些文章的全文，其中29篇文章符合纳入标准。莫氏锥度连接具有最佳的密封能力。关于牙槽嵴骨吸收，内连接的结果优于外连接。本研究的局限性在于缺乏调查内连接是否比外连接更有效的随机临床试验。
外连接和内连接具有不同的机械、生物学和美学特性。除了所有显示出适当成功率和有效性的系统外，内连接周围牙槽嵴水平的维持比外连接更重要。莫氏锥度连接在生物学方面似乎更有效，可减少单个种植体（包括美学区域）的细菌渗漏和骨吸收。此外，这种连接类型可成功应用于固定局部义齿和覆盖义齿修复设计，因为它具有较高的机械稳定性。
