Sendyk Daniel Isaac, Chrcanovic Bruno Ramos, Albrektsson Tomas, Wennerberg Ann, Zindel Deboni Maria Cristina
Int J Prosthodont. 2017 Jul/Aug;30(30):341-347. doi: 10.11607/ijp.5211.
The aim of this study was to assess the evidence of a correlation between the expertise of surgeons and the survival rate of dental implants.
An electronic search in four databases (MEDLINE, EMBASE, SCOPUS, and the Cochrane Library) was performed for publications from their inception to May 2016 and was supplemented by manual searches. Prospective and retrospective cohorts were included if they met the following criteria: (1) the presence of an exposed group (inexperienced surgeons); and (2) the presence of a control group (experienced surgeons). Meta-analyses were performed to evaluate the effect of expertise on implant failure.
Of 609 potentially eligible articles, 8 were included in the qualitative analysis and 6 in the quantitative synthesis. Two meta-analyses were performed for different definitions of experienced surgeons. In the first meta-analysis, which included four retrospective comparative studies that defined experienced professionals as specialists, the experience of the surgeon did not significantly affect the implant failure rate (P = .54), with an odds ratio (OR) of 1.24 (95% CI, 0.62-2.48). In the second meta-analysis, which included two retrospective studies that defined experienced surgeons as professionals that had placed more than 50 implants, the expertise of the surgeon did significantly affect the implant failure rates (P = .0005), with an OR of 2.18 (95% CI, 1.40-3.39).
The data from the included publications suggest that surgical experience did not significantly affect implant failure when considering experience based on specialty but were significantly affected when considering experience based on the number of implants placed. Further standardized prospective studies with a control of confounding factors are needed to clarify the role of surgical expertise on implant survival rates.
本研究旨在评估外科医生的专业水平与牙种植体存活率之间相关性的证据。
对四个数据库（MEDLINE、EMBASE、SCOPUS和Cochrane图书馆）进行电子检索，检索从建库至2016年5月的出版物，并辅以手工检索。符合以下标准的前瞻性和回顾性队列研究纳入分析：（1）存在暴露组（经验不足的外科医生）；（2）存在对照组（经验丰富的外科医生）。进行荟萃分析以评估专业水平对种植体失败的影响。
在609篇可能符合条件的文章中，8篇纳入定性分析，6篇纳入定量综合分析。针对经验丰富的外科医生的不同定义进行了两项荟萃分析。在第一项荟萃分析中，纳入了四项回顾性比较研究，这些研究将经验丰富的专业人员定义为专科医生，外科医生的经验对种植体失败率没有显著影响（P = 0.54），优势比（OR）为1.24（95% CI，0.62 - 2.48）。在第二项荟萃分析中，纳入了两项回顾性研究，这些研究将经验丰富的外科医生定义为植入超过50颗种植体的专业人员，外科医生的专业水平对种植体失败率有显著影响（P = .0005），OR为2.18（95% CI，1.40 - 3.39）。
纳入出版物的数据表明，基于专业来考量经验时手术经验对种植体失败没有显著影响，但基于种植体植入数量来考量经验时则有显著影响。需要进一步开展控制混杂因素的标准化前瞻性研究，以阐明手术专业水平对种植体存活率的作用。
