Clinical Associate Professor, Department of Prosthodontics, Faculty of Dentistry, Beirut Arab University; Director of Biomaterials and Technology Unit, School of Dentistry, Lebanese University, Beirut, Lebanon.
Associate Professor, Department of Prosthodontics, University Paris Descartes, Paris, France.
J Prosthet Dent. 2017 Aug;118(2):144-152.e5. doi: 10.1016/j.prosdent.2016.10.037. Epub 2017 Apr 3.
Different factors can affect prosthetic maintenance requirements for mandibular implant overdentures (IODs). However, the literature shows a high level of disagreement concerning the effect of each factor on maintenance needs.
The purpose of this systematic review was to address the focus question: "In the clinical studies published since 2004 of adult patients with totally edentulous mandibles treated by IODs with a variable number of implants and different designs, what were the maintenance types, frequencies, and complications?"
A search of MEDLINE and PubMed databases was performed targeting papers in English on prosthetic maintenance of mandibular IODs published between 2004 and June 2015, aiming at recognizing the needs for adjustment, repair, and renewal. The recorded data were divided into 6 categories, and a percentage value was attributed to each.
From a total of 130 articles, 33 studies met the specified inclusion criteria for the review (14 randomized controlled trials, 8 prospective clinical trials, 3 retrospective studies, and 4 systematic reviews). These articles provided evidence that a mean complication rate was impossible to determine because of the multiplicity of contributing factors. No clear identification of the causes of mechanical complications was found, nor was there any clear evidence of superiority of one implant and/or attachment design over another.
Prosthetic complications with IODs are unavoidable. However, they can be reduced to an expected level if a close follow-up protocol is implemented aiming at anticipating risks of unexpected complications. Further clinical studies are needed to achieve a constructive meta-analysis that accounts for different parameters such as opposite arch, attachment functional variety, connection method, and prosthesis quality.
不同的因素会影响下颌种植覆盖义齿（IOD）的修复体维护需求。然而，文献表明，对于每个因素对维护需求的影响，存在高度不一致的观点。
本系统评价的目的是回答焦点问题：“在 2004 年以后发表的、针对采用不同数量和设计种植体的 IOD 治疗完全无牙颌下颌患者的临床研究中，义齿的维护类型、频率和并发症是什么？”
对 2004 年至 2015 年 6 月期间发表的、关于下颌 IOD 修复体维护的英文文献进行了 MEDLINE 和 PubMed 数据库检索，旨在识别调整、修复和更新的需求。记录的数据分为 6 类，并为每类分配一个百分比值。
从总共 130 篇文章中，有 33 项研究符合本次综述的特定纳入标准（14 项随机对照试验、8 项前瞻性临床试验、3 项回顾性研究和 4 项系统评价）。这些文章提供的证据表明，由于多种因素的存在，平均并发症发生率是无法确定的。没有明确识别出机械并发症的原因，也没有明确证据表明一种种植体和/或附着体设计优于另一种。
IOD 义齿的修复体并发症是不可避免的。然而，如果实施密切的随访方案，以预测意外并发症的风险，那么这些并发症可以降低到可预期的水平。需要进一步的临床研究来进行建设性的荟萃分析，考虑不同的参数，如对颌、附着体功能多样性、连接方法和义齿质量。
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