Department of Oral and Maxillofacial Surgery, Indiana University School of Dentistry, Indianapolis, Indiana.
Department of Oral and Maxillofacial Surgery, UCLA School of Dentistry, Los Angeles, California.
Clin Oral Implants Res. 2018 Oct;29 Suppl 16:154-183. doi: 10.1111/clr.13312.
The main purpose of this systematic review was to evaluate outcomes related to the number of implants utilized to support complete-arch fixed prostheses, both for the maxilla and the mandible.
This review followed the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A focused question using the PICO format was developed, questioning whether "In patients with an implant supported fixed complete dental prosthesis, do implant and prosthetic survival outcomes differ between five or more compared to fewer than five supporting implants?". A comprehensive search of the literature was formulated and performed electronically and by hand search. Two independent reviewers selected the papers and tabulated results. Primary outcomes analyzed were implant and prosthesis survival. Implant distribution, loading, and type of retention were observed as secondary outcomes, as they relate to the number of implants. A meta-analysis was performed to compare results for studies by number of implants.
The search strategy identified 1,579 abstracts for initial review. Based on evaluation of the abstracts, 359 articles were identified for full-text evaluation. From these, 93 were selected and included in this review, being nine RCTs, 42 prospective and 42 retrospective. Of the 93 selected studies, 28 reported number of implants for the maxilla, 46 for the mandible, and 19 for both maxilla and mandible. The most reported number of implants for the "fewer than five" group is 4 for the maxilla, and 3 and 4 for the mandible, whereas for the "five or more" implants group, the most reported number of implants was 6 for the maxilla and 5 for the mandible. No significant differences in the primary outcomes analyzed were identified when fewer than five implants per arch were compared with five or more implants per arch (p > 0.05), in a follow-up time ranging from 1 to 15 years (median of 8 years).
Evidence from this systematic review and meta-analysis suggests that the use of fewer than five implants per arch, when compared to five or more implants per arch, to support a fixed prosthesis of the completely edentulous maxilla or mandible, present similar survival rates, with no statistical significant difference at a p < 0.05 and a confidence interval of 95%.
本系统评价的主要目的是评估用于支持全口固定修复体的种植体数量相关的结果，包括上颌和下颌。
本研究遵循系统评价和荟萃分析的首选报告项目（PRISMA）的报告指南。制定了一个使用 PICO 格式的重点问题，质疑“在接受种植体支持的固定全口义齿修复的患者中，与使用少于 5 个种植体相比，使用 5 个或更多种植体支持的种植体和修复体的存活率是否不同？”。进行了全面的文献检索，并通过电子和手动搜索进行了检索。两名独立的审查员选择了论文并进行了结果制表。分析的主要结果是种植体和修复体的存活率。种植体分布、负荷和保留类型作为次要结果进行观察，因为它们与种植体数量有关。对按种植体数量比较结果的研究进行了荟萃分析。
搜索策略确定了 1579 篇初始审查的摘要。基于对摘要的评估，确定了 359 篇全文评估的文章。从这些文章中，选择了 93 篇并纳入本综述，其中 9 项为 RCT，42 项为前瞻性研究，42 项为回顾性研究。在所选择的 93 项研究中，28 项报告了上颌的种植体数量，46 项报告了下颌的种植体数量，19 项报告了上颌和下颌的种植体数量。“少于 5 个”组中报告数量最多的种植体为上颌 4 个，下颌 3 个和 4 个，而“5 个或更多”种植体组中报告数量最多的种植体为上颌 6 个，下颌 5 个。在随访时间从 1 到 15 年（中位数为 8 年）的情况下，与每弓使用 5 个或更多种植体相比，每弓使用少于 5 个种植体时，在分析的主要结果中未发现差异具有统计学意义（p>0.05）。
本系统评价和荟萃分析的证据表明，与每弓使用 5 个或更多种植体相比，当用于支持完全无牙的上颌或下颌的固定修复体时，每弓使用少于 5 个种植体的使用具有相似的存活率，在 p<0.05 时无统计学显著差异，置信区间为 95%。
