Di Gianfilippo Riccardo, Valente Nicola Alberto, Toti Paolo, Wang Hom Lay, Barone Antonio
Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.
Department of Stomatology, University of Seville Faculty of Dentistry, Seville, Spain.
J Periodontal Implant Sci. 2020 Aug;50(4):209-225. doi: 10.5051/jpis.1904440222. Epub 2020 Jun 23.
Marginal bone loss (MBL) is an important clinical issue in implant therapy. One feature that has been cited as a contributing factor to this bone loss is peri-implant mucosal thickness. Therefore, in this report, we conducted a systematic review of the literature comparing bone remodeling around implants placed in areas with thick (≥2-mm) vs. thin (<2-mm) mucosa.
A PICO question was defined. Manual and electronic searches were performed of the MEDLINE/PubMed and Cochrane Oral Health Group databases. The inclusion criteria were prospective studies that documented soft tissue thickness with direct intraoperative measurements and that included at least 1 year of follow-up. When possible, a meta-analysis was performed for both the overall and subgroup analyses.
Thirteen papers fulfilled the inclusion criteria. A meta-analysis of 7 randomized clinical trials was conducted. Significantly less bone loss was found around implants with thick mucosa than around those with thin mucosa (difference, -0.53 mm; <0.0001). Subgroups were analyzed regarding the apico-coronal positioning, the use of platform-matched vs. platform-switched (PS) connections, and the use of cement-retained vs. screw-retained prostheses. In these analyses, thick mucosa was found to be associated with significantly less MBL than thin mucosa (<0.0001). Among non-matching (PS) connections and screw-retained prostheses, bone levels were not affected by mucosal thickness.
Soft tissue thickness was found to be correlated with MBL except in cases of PS connections used on implants with thin tissues and screw-retained prostheses. Mucosal thickness did not affect implant survival or the occurrence of biological or aesthetic complications.
International Prospective Register of Systematic Reviews (PROSPERO): CRD42018084598.
边缘骨吸收（MBL）是种植治疗中的一个重要临床问题。被认为是导致这种骨吸收的一个因素是种植体周围黏膜厚度。因此，在本报告中，我们对文献进行了系统回顾，比较了种植于厚（≥2毫米）黏膜区域与薄（<2毫米）黏膜区域的种植体周围的骨重塑情况。
定义了一个PICO问题。对MEDLINE/PubMed和Cochrane口腔健康组数据库进行了手动和电子检索。纳入标准为前瞻性研究，这些研究通过术中直接测量记录软组织厚度，且随访至少1年。可能的情况下，对总体分析和亚组分析均进行荟萃分析。
13篇论文符合纳入标准。对7项随机临床试验进行了荟萃分析。发现厚黏膜种植体周围的骨吸收明显少于薄黏膜种植体周围（差异为-0.53毫米；<0.0001）。对种植体的冠根位置、平台匹配连接与平台转换（PS）连接的使用以及黏固固定与螺丝固定修复体的使用进行了亚组分析。在这些分析中，发现厚黏膜与明显少于薄黏膜的MBL相关（<0.00,01）。在不匹配（PS）连接和螺丝固定修复体中，骨水平不受黏膜厚度影响。
发现软组织厚度与MBL相关，但在薄组织种植体上使用PS连接和螺丝固定修复体的情况除外。黏膜厚度不影响种植体存活或生物或美学并发症的发生。
国际系统评价前瞻性注册库（PROSPERO）：CRD42018084598。
