Associate Professor, Department of Prosthodontics, Presidente Prudente Dental School, University of Western São Paulo (UNOESTE), Presidente Prudente, Brazil.
Adjunct Professor, Department of Dental Materials and Prosthodontics, Araçatuba Dental School, São Paulo State University (UNESP), Araçatuba, Brazil.
J Prosthet Dent. 2019 Jan;121(1):41-51. doi: 10.1016/j.prosdent.2018.03.004. Epub 2018 Jun 29.
The decision to splint or to restore independently generally occurs during the planning stage, when the advantages and disadvantages of each clinical situation are considered based on the proposed treatment. However, clinical evidence to help clinicians make this decision is lacking.
The purpose of this systematic review and meta-analysis was to assess the marginal bone loss, implant survival rate, and prosthetic complications of splinted and nonsplinted implant restorations.
This study was designed according to the Cochrane criteria for elaborating a systematic review and meta-analysis and adopted the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Also, this review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42017080162). An electronic search in the PubMed/MEDLINE, Cochrane Library, and Scopus databases was conducted up to November 2017. A specific clinical question was structured according to the population, intervention, comparison, outcome (PICO) approach. The addressed focused question was "Should the restoration of adjacent implants be splinted or nonsplinted?" The meta-analysis was based on the Mantel-Haenszel and inverse variance methods to assess the marginal bone loss, implant survival, and prosthetic complications of splinted and nonsplinted implant restorations.
Nineteen studies were selected for qualitative and quantitative analyses. A total of 4215 implants were placed in 2185 patients (splinted, 2768; nonsplinted, 1447); the mean follow-up was 87.8 months (range=12-264 months). Quantitative analysis found no significant differences between splinted and nonsplinted restorations for marginal bone loss. The assessed studies reported that 75 implants failed (3.4%), of which 24 were splinted (99.1% of survival rate) and 51 were nonsplinted (96.5% of survival rate). Quantitative analysis of all studies showed statistically significant higher survival rates for splinted restorations than for nonsplinted restorations. Ceramic chipping, screw loosening, abutment screw breakage, and soft tissue inflammation were reported in the selected studies. The quantitative analysis found no statistically significant difference in the prosthetic complications of splinted and nonsplinted restorations.
Within the limitations of this systematic review and meta-analysis, it was concluded that there was no difference in the marginal bone loss and prosthetic complications of splinted and nonsplinted implant restorations; this is especially true for restorations in the posterior region. However, splinted restorations were associated with decreased implant failure.
一般来说，在规划阶段就会做出夹板固定或独立修复的决定，此时根据拟议的治疗方案来考虑每种临床情况的优缺点。然而，目前缺乏有助于临床医生做出这一决策的临床证据。
本系统评价和荟萃分析的目的是评估夹板固定和非夹板固定种植体修复的边缘骨丢失、种植体存活率和修复体并发症。
本研究根据制定系统评价和荟萃分析的 Cochrane 标准设计，并采用了 Preferred Reporting Items for Systematic Reviews and Meta-analyses（PRISMA）声明。此外，本研究已在国际前瞻性注册系统评价（PROSPERO）（CRD42017080162）注册。对 PubMed/MEDLINE、Cochrane 图书馆和 Scopus 数据库进行了电子检索，检索截至 2017 年 11 月。根据人群、干预、比较、结局（PICO）方法构建了一个具体的临床问题。所提出的聚焦问题是“相邻种植体的修复是否应夹板固定或非夹板固定？”荟萃分析基于 Mantel-Haenszel 和逆方差方法，以评估夹板固定和非夹板固定种植体修复的边缘骨丢失、种植体存活率和修复体并发症。
选择了 19 项研究进行定性和定量分析。共有 2185 名患者（夹板固定 2768 名，非夹板固定 1447 名）共植入 4215 枚种植体；平均随访时间为 87.8 个月（范围 12-264 个月）。定量分析发现，夹板固定修复和非夹板固定修复的边缘骨丢失没有显著差异。评估研究报告称，有 75 枚种植体失败（3.4%），其中 24 枚为夹板固定（存活率为 99.1%），51 枚为非夹板固定（存活率为 96.5%）。所有研究的定量分析显示，夹板固定修复的存活率显著高于非夹板固定修复。在选定的研究中报告了陶瓷碎裂、螺丝松动、基台螺丝断裂和软组织炎症。定量分析发现夹板固定修复和非夹板固定修复的修复体并发症没有统计学上的显著差异。
在本系统评价和荟萃分析的限制范围内，可以得出结论，夹板固定和非夹板固定种植体修复的边缘骨丢失和修复体并发症没有差异；这在后部区域的修复中尤其如此。然而，夹板固定修复与种植体失败减少有关。
