Koutouzis Theofilos, Gholami Fatemeh, Reynolds John, Lundgren Tord, Kotsakis Georgios A
Int J Oral Maxillofac Implants. 2017 May/June;32(3):575–581. doi: 10.11607/jomi.5367. Epub 2017 Mar 23.
Preclinical and clinical studies have shown that marginal bone loss can be secondary to repeated disconnection and reconnection of abutments that affect the peri-implant mucosal seal. The aim of this systematic review and meta-analysis was to evaluate the impact of abutment disconnections/reconnections on peri-implant marginal bone level changes.
To address this question, two reviewers independently performed an electronic search of three major databases up to October 2015 complemented by manual searches. Eligible articles were selected on the basis of prespecified inclusion and exclusion criteria after a two-phase search strategy and assessed for risk of bias. A random-effects meta-analysis was performed for marginal bone loss.
The authors initially identified 392 titles and abstracts. After evaluation, seven controlled clinical studies were included. Qualitative assessment of the articles revealed a trend toward protective marginal bone level preservation for implants with final abutment placement (FAP) at the time of implant placement compared with implants for which there were multiple abutment placements (MAP). The FAP group exhibited a marginal bone level change ranging from 0.08 to 0.34 mm, whereas the MAP group exhibited a marginal bone level change ranging from 0.09 to 0.55 mm. Meta-analysis of the seven studies reporting on 396 implants showed significantly greater bone loss in cases of multiple abutment disconnections/reconnections. The weighted mean difference in marginal bone loss was 0.19 mm (95% confidence interval, 0.06-0.32 mm), favoring bone preservation in the FAP group.
Within the limitations of this meta-analysis, abutment disconnection and reconnection significantly affected peri-implant marginal bone levels. These findings pave the way for revisiting current restorative protocols at the restorative treatment planning stage to prevent incipient marginal bone loss.
临床前和临床研究表明，基台反复的拆卸和重新连接会影响种植体周围黏膜封闭，进而导致边缘骨吸收。本系统评价和荟萃分析的目的是评估基台的拆卸/重新连接对种植体周围边缘骨水平变化的影响。
为解决这一问题，两名评价者独立对三个主要数据库进行了电子检索，检索截至2015年10月，并辅以手工检索。在采用两阶段检索策略后，根据预先设定的纳入和排除标准选择符合条件的文章，并评估偏倚风险。对边缘骨吸收进行随机效应荟萃分析。
作者最初识别出392篇标题和摘要。经评估，纳入了七项对照临床研究。对这些文章的定性评估显示，与多次放置基台（MAP）的种植体相比，在种植体植入时放置最终基台（FAP）的种植体在保护边缘骨水平方面有一定趋势。FAP组的边缘骨水平变化范围为0.08至0.34mm，而MAP组的边缘骨水平变化范围为0.09至0.55mm。对七项涉及396颗种植体的研究进行的荟萃分析显示，多次基台拆卸/重新连接的情况下骨吸收明显更多。边缘骨吸收的加权平均差异为0.19mm（95%置信区间，0.06 - 0.32mm），表明FAP组更有利于骨保存。
在本荟萃分析的局限性内，基台的拆卸和重新连接显著影响种植体周围边缘骨水平。这些发现为在修复治疗计划阶段重新审视当前的修复方案以预防早期边缘骨吸收铺平了道路。
