短种植体（≤6 毫米）与上颌窦底提升后较长种植体在萎缩性上颌后牙区的应用：系统评价和荟萃分析。

Short implants (≤6 mm) versus longer implants with sinus floor elevation in atrophic posterior maxilla: a systematic review and meta-analysis.

机构信息

Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China.

Department of Oral Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.

出版信息

BMJ Open. 2019 Oct 28;9(10):e029826. doi: 10.1136/bmjopen-2019-029826.

OBJECTIVES

To compare the use of short implants (≤6 mm) in atrophic posterior maxilla versus longer implants (≥10 mm) with sinus floor elevation.

DESIGN

A systematic review and meta-analysis based on randomised controlled trials (RCTs).

DATA SOURCES

Electronic searches were conducted in PubMed, Embase and the Cochrane CENTRAL. Retrospective and prospective hand searches were also performed.

ELIGIBILITY CRITERIA

RCTs comparing short implants (≤6 mm) and longer implants (≥10 mm) with sinus floor elevation were included. Outcome measures included implant survival (primary outcome), marginal bone loss (MBL), complications and patient satisfaction.

DATA EXTRACTION AND SYNTHESIS

Risks of bias in and across studies were evaluated. Meta-analysis, subgroup analysis and sensitivity analysis were undertaken. Quality of evidence was assessed according to Grading of Recommendations Assessment, Development and Evaluation.

RESULTS

A total of seven RCTs involving 310 participants were included. No significant difference in survival rate was found for 1-3 years follow-up (RR 1.01, 95% CI 0.97 to 1.04, p=0.74, I²=0%, moderate-quality evidence) or for 3 years or longer follow-up (RR 1.00, 95% CI 0.97 to 1.04, p=0.79, I²=0%, moderate-quality evidence). However, short implants (≤6 mm) showed significantly less MBL in 1-3 years follow-up (MD=-0.13 mm, 95% CI -0.21 to 0.05; p=0.001, I²=87%, low-quality evidence) and in 3 years or longer follow-up (MD=-0.25 mm, 95% CI -0.40 to 0.10; p=0.001, I²=0%, moderate-quality evidence). In addition, short implant (≤6 mm) resulted in fewer postsurgery reaction (RR 0.11, 95% CI 0.14 to 0.31, p<0.001, I²=40%, moderate-quality evidence) and sinus perforation or infection (RR 0.11, 95% CI 0.02 to 0.63, p=0.01, I²=0%, moderate-quality evidence).

CONCLUSIONS

For atrophic posterior maxilla, short implants (≤6 mm) are a promising alternative to sinus floor elevation, with comparable survival rate, less MBL and postsurgery reactions. Additional high-quality studies are needed to evaluate the long-term effectiveness of short implants (≤6 mm).

TRIAL REGISTERATION NUMBER

The protocol has been registered at PROSPERO (CRD42018103531).

目的

比较在骨吸收的上颌后区使用短种植体（≤6mm）与长种植体（≥10mm）联合鼻窦提升的效果。

设计

基于随机对照试验（RCTs）的系统评价和荟萃分析。

数据来源

电子检索 PubMed、Embase 和 Cochrane 中央数据库。还进行了回溯和前瞻性手工检索。

入选标准

纳入比较短种植体（≤6mm）和长种植体（≥10mm）联合鼻窦提升的 RCTs。主要结局为种植体存活率，次要结局包括边缘骨吸收（MBL）、并发症和患者满意度。

数据提取和综合

评估各研究和跨研究的偏倚风险。进行荟萃分析、亚组分析和敏感性分析。根据推荐分级评估、制定与评价（Grading of Recommendations Assessment, Development and Evaluation，GRADE）标准评估证据质量。

结果

共纳入 7 项 RCTs，涉及 310 名参与者。1-3 年随访时，两组种植体的存活率无显著差异（RR 1.01，95%CI 0.97 至 1.04，p=0.74，I²=0%，中质量证据），3 年以上随访时也无显著差异（RR 1.00，95%CI 0.97 至 1.04，p=0.79，I²=0%，中质量证据）。然而，在 1-3 年随访时，短种植体（≤6mm）的 MBL 显著较少（MD=-0.13mm，95%CI -0.21 至 0.05；p=0.001，I²=87%，低质量证据），在 3 年以上随访时也较少（MD=-0.25mm，95%CI -0.40 至 0.10；p=0.001，I²=0%，中质量证据）。此外，短种植体（≤6mm）还导致较少的术后反应（RR 0.11，95%CI 0.14 至 0.31，p<0.001，I²=40%，中质量证据）和窦穿孔或感染（RR 0.11，95%CI 0.02 至 0.63，p=0.01，I²=0%，中质量证据）。

结论

对于骨吸收的上颌后区，短种植体（≤6mm）联合鼻窦提升是一种有前途的替代方法，具有相似的存活率、较少的 MBL 和术后反应。需要更多高质量的研究来评估短种植体（≤6mm）的长期效果。

试验注册号

该方案已在 PROSPERO（CRD42018103531）上注册。