Borges Guilherme Almeida, Costa Raphael Cavalcante, Nagay Bruna Egumi, Magno Marcela Baraúna, Maia Lucianne Cople, Barão Valentim Adelino R, Mesquita Marcelo Ferraz
PhD student, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil.
PhD student, Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
J Prosthet Dent. 2021 May;125(5):732-745. doi: 10.1016/j.prosdent.2020.04.017. Epub 2020 Jul 17.
Evidence provided by implant-supported mandibular overdenture research on different loading protocols is important. However, methodological inconsistency, as well as inadequate reporting of results, hampers a consistent decision in terms of clinical applicability.
The purpose of this systematic review and meta-analysis was to evaluate whether immediate or early loading protocols can achieve comparable clinical outcomes when compared with a conventional loading protocol in edentulous patients rehabilitated with mandibular overdentures.
In accordance with the Participant, Intervention, Comparison, Outcome strategy, prospective clinical studies without restrictions as to language or follow-up period were included. The Cochrane collaboration and ROBINS-I tools were used for quality assessment and risk-of-bias evaluation. The follow-up for the different outcomes ranged from 3 to 168 months, with the focus on implant success and survival rates, marginal bone loss, bleeding on probing, probing depth, plaque index, and the implant stability quotient. Statistical analyses in which standard mean differences were applied with a 95% confidence interval when continuous data were included were performed. For dichotomous data, risk difference was adopted.
The search strategy resulted in 14 234 references. Twenty-three studies fulfilled the inclusion criteria. Meta-analysis showed statistically significant differences for plaque index at 12 months (standard mean difference=0.284 [0.022, 0.545], P=.033, I=35%), probing depth at 36 months (standard mean difference=0.460 [0.098, 0.823], P=.013, I=0%), and on pooled results for plaque index (standard mean difference=0.157 [0.031, 0.284], P=.015, I=18%) in which the conventional loading protocol presented lower indices than those of immediate loading protocol or early loading protocol. Implant stability quotient presented a statistically significant difference only at 3 months (standard mean difference=0.602 [0.309, 0.895], P<.001, I=0%) with higher values for the conventional loading protocol. For the other parameters, statistically significant differences (P>.05) were not found.
Immediate loading protocol or early loading protocolfor mandibular overdentures has been determined to be a well-established treatment and worthy of consideration in clinical practice.
关于不同加载方案的种植体支持下颌覆盖义齿研究提供的证据很重要。然而，方法学上的不一致以及结果报告不充分，阻碍了在临床适用性方面做出一致的决策。
本系统评价和荟萃分析的目的是评估在使用下颌覆盖义齿修复的无牙患者中，与传统加载方案相比，即刻或早期加载方案是否能取得可比的临床结果。
按照参与者、干预措施、对照、结局策略，纳入对语言或随访期无限制的前瞻性临床研究。使用Cochrane协作工具和ROBINS-I工具进行质量评估和偏倚风险评估。不同结局的随访时间为3至168个月，重点关注种植体成功率和生存率、边缘骨丢失、探诊出血、探诊深度、菌斑指数和种植体稳定性商数。当纳入连续数据时，采用标准均数差并结合95%置信区间进行统计分析。对于二分数据，采用风险差。
检索策略共获得14234篇参考文献。23项研究符合纳入标准。荟萃分析显示，在12个月时菌斑指数有统计学显著差异（标准均数差=0.284 [0.022, 0.545]，P = 0.033，I = 35%），36个月时探诊深度有统计学显著差异（标准均数差=0.460 [0.098, 0.823]，P = 0.013，I = 0%），以及菌斑指数汇总结果有统计学显著差异（标准均数差=0.157 [0.031, 0.284]，P = 0.015，I = 18%），其中传统加载方案的指数低于即刻加载方案或早期加载方案。种植体稳定性商数仅在3个月时有统计学显著差异（标准均数差=0.602 [0.309, 0.895]，P < 0.001，I = 0%），传统加载方案的值更高。对于其他参数，未发现统计学显著差异（P > 0.05）。
已确定下颌覆盖义齿的即刻加载方案或早期加载方案是一种成熟的治疗方法，值得在临床实践中考虑。
