Esposito Marco, Trullenque-Eriksson Anna, Blasone Rodolfo, Malaguti Giuliano, Gaffuri Cristiano, Caneva Marco, Minciarelli Armando, Luongo Giuseppe
Eur J Oral Implantol. 2016;9(4):367-379.
To evaluate the safety and clinical effectiveness of a novel dental implant system (GENESIS Implant System, Keystone Dental, Massachusetts, USA) using another dental implant system by the same manufacturer as a control (PRIMA Implant System, Keystone Dental).
A total of 53 patients requiring at least two single crowns had their sites randomised according to a split-mouth design to receive both implant systems at six centres. If implants could be placed with a torque superior to 40 Ncm they were to be loaded immediately with provisional crowns, otherwise after 3 months of submerged healing. Provisional crowns were replaced by definitive crowns 4 months after initial loading, when the follow-up period for the initial part of this study was completed. Outcome measures were crown/implant failures, complications, pink esthetic score (PES), peri-implant marginal bone level changes, plaque score, marginal bleeding, patients and preference of the clinician.
In total 53 PRIMA and 53 GENESIS implants were placed. Three patients dropped out but all of the remaining patients were followed up to 4-months post-loading. No PRIMA implant failed whereas four GENESIS implants failed. Only two complications were reported for PRIMA implants. There were no statistically significant differences for crown/implant failures (difference in proportions = 0.080; P (McNemar test) = 0.125) and complications (difference in proportions = -0.04; P (McNemar test) = 0.500) between the implant systems. There were no differences at 4-months post-loading for plaque (difference = -0.54, 95% CI: -3.01 to 1.93; P (Paired t-test) = 0.660), marginal bleeding (difference = -3.8, 95% CI: -7.63 to 0.019; P (Paired t-test) = 0.051), PES (difference = 0.47, 95% CI: -0.56 to 1.50; P (Paired t-test) = 0.365) and marginal bone level changes (difference in mm = -0.04, 95% CI: -0.33 to 0.26; P (Paired t-test) = 0.795). The majority of the patients (46) had no preference regarding the two implant systems evaluated. Three operators preferred GENESIS implants, two had no preference and one preferred GENESIS in medium and soft bone and PRIMA in hard bone.
CONCLUSIONS: No statistically significant differences were observed between the systems' implant types, although four GENESIS implants failed versus none of the PRIMA type. Longer follow-ups of wider patient populations are needed to better understand whether there is an effective advantage with one of the two implant designs. Conflict-of-interest statement: This research project was originally funded by Keystone Italia, Dental spa (Verona, Italy), the manufacturer of the implants evaluated in this investigation. However, when Keystone Italia received the data of the present manuscript, they refused to honour the financial agreement for the present publication. Therefore, no further follow-ups of this trial will be considered. A legal action was initiated against Keystone Italia. The data belonged to the authors and by no means was the manufacturer allowed to interfere with the conduct of the trial or the publication of the results.
使用同一制造商生产的另一种牙科种植系统(PRIMA种植系统,美国马萨诸塞州凯斯通牙科公司)作为对照,评估一种新型牙科种植系统(GENESIS种植系统,美国马萨诸塞州凯斯通牙科公司)的安全性和临床有效性。
共有53例需要至少两颗单冠修复的患者,根据分口设计将其种植部位随机分组,在六个中心接受两种种植系统。如果种植体植入时扭矩超过40 Ncm,则立即用临时冠修复,否则在潜行愈合3个月后修复。初始加载4个月后,用最终冠替换临时冠,此时本研究初始阶段的随访期结束。观察指标包括牙冠/种植体失败情况、并发症、粉色美学评分(PES)、种植体周围边缘骨水平变化、菌斑评分、边缘出血情况、患者及临床医生的偏好。
共植入53颗PRIMA种植体和53颗GENESIS种植体。3例患者退出研究,但其余所有患者均随访至加载后4个月。PRIMA种植体无失败病例,而GENESIS种植体有4例失败。PRIMA种植体仅报告了2例并发症。两种种植系统在牙冠/种植体失败率(比例差异 = 0.080;P(麦克尼马尔检验) = 0.125)和并发症发生率(比例差异 = -0.04;P(麦克尼马尔检验) = 0.500)方面无统计学显著差异。加载后4个月时,在菌斑(差异 = -0.54,95%置信区间:-3.01至1.93;P(配对t检验) = 0.660)、边缘出血(差异 = -3.8,95%置信区间:-7.63至0.019;P(配对t检验) = 0.051)、PES(差异 = 0.47,95%置信区间:-0.56至1.50;P(配对t检验) = 0.365)和边缘骨水平变化(毫米差异 = -0.04,95%置信区间:-0.33至0.26;P(配对t检验) = 0.795)方面均无差异。大多数患者(46例)对所评估的两种种植系统无偏好。3名手术医生更喜欢GENESIS种植体,2名无偏好,1名在中、软骨质中更喜欢GENESIS种植体,在硬骨质中更喜欢PRIMA种植体。
尽管有4颗GENESIS种植体失败而PRIMA种植体无一失败,但两种种植系统的种植体类型在统计学上无显著差异。需要对更广泛的患者群体进行更长时间的随访,以更好地了解这两种种植设计中的一种是否具有实际优势。利益冲突声明:本研究项目最初由意大利凯斯通牙科公司(位于意大利维罗纳)资助,该公司是本研究中评估的种植体制造商。然而,当意大利凯斯通牙科公司收到本稿件的数据时,他们拒绝履行本次发表的财务协议。因此,不会考虑对该试验进行进一步随访。已对意大利凯斯通牙科公司提起法律诉讼。数据属于作者,制造商绝无干涉试验实施或结果发表的权利。