Thoma D S, Zeltner M, Hüsler J, Hämmerle C H F, Jung R E
Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland.
Clin Oral Implants Res. 2015 Sep;26 Suppl 11:154-69. doi: 10.1111/clr.12615. Epub 2015 May 21.
To compare short implants in the posterior maxilla to longer implants placed after or simultaneously with sinus floor elevation procedures. The focused question was as follows: Are short implants superior to longer implants in the augmented sinus in terms of survival and complication rates of implants and reconstructions, patient-reported outcome measures (PROMs) and costs?
A MEDLINE search (1990-2014) was performed for randomized controlled clinical studies comparing short implants (≤8 mm) to longer implants (>8 mm) in augmented sinus. The search was complimented by an additional hand search of the selected papers and reviews published between 2011 and 2014. Eligible studies were selected based on the inclusion criteria, and quality assessments were conducted. Descriptive statistics were applied for a number of outcome measures. Survival rates of dental implants were pooled simply in case of comparable studies.
Eight randomized controlled clinical trials (RCTs) comparing short implants versus longer implants in the augmented sinus derived from an initial search count of 851 titles were selected and data extracted. In general, all studies were well conducted with a low risk of bias for the majority of the analyzed parameters. Based on the pooled analyses of longer follow-ups (5 studies, 16-18 months), the survival rate of longer implants amounted to 99.5% (95% CI: 97.6-99.98%) and for shorter implants to 99.0% (95% CI: 96.4-99.8%). For shorter follow-ups (3 studies, 8-9 months), the survival rates of longer implants are 100% (95% CI: 97.1-100%) and for shorter implants 98.2% (95% CI: 93.9-99.7%). Complications were predominantly of biological origin, mainly occurred intraoperatively as membrane perforations, and were almost three times as higher for longer implant in the augmented sinus compared to shorter implants. PROMs, morbidity, surgical time and costs were generally in favor of shorter dental implants. All studies were performed by surgeons in specialized clinical settings.
The outcomes of the survey analyses demonstrated predictably high implant survival rates for short implants and longer implants placed in augmented sinus and their respective reconstructions. Given the higher number of biological complications, increased morbidity, costs and surgical time of longer dental implants in the augmented sinus, shorter dental implants may represent the preferred treatment alternative.
比较在上颌后牙区使用短种植体与在进行上颌窦底提升术之后或同时植入的长种植体。重点问题如下：就种植体及修复体的生存率和并发症发生率、患者报告结局指标（PROMs）及成本而言，在增龄性上颌窦中短种植体是否优于长种植体？
对MEDLINE（1990 - 2014年）进行检索，查找比较增龄性上颌窦中短种植体（≤8 mm）与长种植体（>8 mm）的随机对照临床研究。通过对2011年至2014年期间发表的选定论文和综述进行额外的手工检索来补充此次检索。根据纳入标准选择符合条件的研究，并进行质量评估。对一些结局指标应用描述性统计。在研究具有可比性的情况下，简单汇总牙种植体的生存率。
从初步检索的851篇标题中筛选出8项比较增龄性上颌窦中短种植体与长种植体的随机对照临床试验（RCTs）并提取数据。总体而言，所有研究实施良好，大多数分析参数的偏倚风险较低。根据对较长随访期（5项研究，16 - 18个月）的汇总分析，长种植体的生存率为99.5%（95%可信区间：97.6 - 99.98%），短种植体的生存率为99.0%（95%可信区间：96.4 - 99.8%）。对于较短随访期（3项研究，8 - 9个月），长种植体的生存率为100%（95%可信区间：97.1 - 100%），短种植体的生存率为98.2%（95%可信区间：93.9 - 99.7%）。并发症主要源于生物学因素，主要在术中发生，表现为膜穿孔，在增龄性上颌窦中长种植体的并发症发生率几乎是短种植体的三倍。患者报告结局指标、发病率、手术时间和成本总体上更有利于短牙种植体。所有研究均由专业临床环境中的外科医生进行。
调查分析结果表明，可以预见，在上颌窦增龄患者中植入的短种植体和长种植体及其各自的修复体的种植体生存率都很高。鉴于增龄性上颌窦中长牙种植体的生物学并发症较多、发病率增加、成本和手术时间增加，短牙种植体可能是首选的治疗方案。
