Vetromilla Bruna M, Mazzetti Thais, Pereira-Cenci Tatiana
Graduate student, Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil.
Graduate student, Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil.
J Prosthet Dent. 2021 Oct;126(4):503-511. doi: 10.1016/j.prosdent.2020.08.002. Epub 2020 Sep 18.
Bone loss in the edentulous posterior maxilla complicates dental implant placement. In spite of the evidence available, there is continued uncertainty about the benefit of short implants for different outcomes.
The purpose of this review was to evaluate the existing evidence for short and standard implants in association with sinus floor elevation regarding implant survival, marginal bone loss, and complications by using an umbrella review of the evidence across meta-analysis of interventional studies.
Medline, Scopus, and Cochrane Library were searched to identify systematic reviews and meta-analyses comparing short implants and standard implants associated with sinus floor elevation. Data extraction and methodological quality (AMSTAR-2) was assessed by 2 authors independently. Outcomes were categorized and tabulated to assess effectiveness. Qualitative data were analyzed using thematic synthesis. The certainty of the evidence was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
From 2011 studies, 7 systematic reviews (66 studies) were included as per the eligibility criteria. There was no statistically significant difference between groups for implant survival (risk ratio=1.08; P=.79), and the qualitative analysis did not show differences for prosthetic outcomes. Standard implants were associated with fewer prosthetic complications in the quantitative analysis (risk ratio=3.27; P<.01), but no difference was found between the treatments in the qualitative analysis. Short implants showed reduced marginal bone loss (0.98 ±0.12 mm; mean difference=-0.22; P<.01) and better biologic outcomes (risk ratio=0.16; P<.01). Patient satisfaction was similar for both groups, whereas costs and time for the procedure favored short implants. The quality of the evidence was graded as "critically low" (57.1% of the reviews) and "low." There was a high certainty of evidence for implant survival, whereas marginal bone loss and complications had moderate certainty.
Short implants had a better or equal performance compared with standard implants for all outcomes assessed. However, assumptions were based on reviews with low or critically low quality of the evidence, suggesting the development of high-quality systematic reviews in this field.
无牙后上颌骨的骨质流失使牙种植体植入变得复杂。尽管有现有证据，但对于不同结果而言，短种植体的益处仍存在持续的不确定性。
本综述的目的是通过对干预性研究的荟萃分析进行证据汇总回顾，评估短种植体和标准种植体与窦底提升相关的现有证据，涉及种植体存活率、边缘骨丢失和并发症。
检索Medline、Scopus和Cochrane图书馆，以识别比较与窦底提升相关的短种植体和标准种植体的系统评价和荟萃分析。由两名作者独立评估数据提取和方法学质量（AMSTAR-2）。对结果进行分类和制表以评估有效性。使用主题综合法分析定性数据。采用推荐分级评估、制定和评价（GRADE）方法评估证据的确定性。
根据纳入标准，从2011项研究中纳入了7项系统评价（66项研究）。种植体存活率在组间无统计学显著差异（风险比=1.08；P=0.79），定性分析未显示修复结果存在差异。在定量分析中，标准种植体与较少的修复并发症相关（风险比=3.27；P<0.01），但在定性分析中未发现治疗组之间存在差异。短种植体显示边缘骨丢失减少（0.98±0.12mm；平均差异=-0.22；P<0.01）且生物学结果更好（风险比=0.16；P<0.01）。两组患者满意度相似，而手术成本和时间有利于短种植体。证据质量被评为“极低”（57.1%的综述）和“低”。种植体存活率的证据确定性高，而边缘骨丢失和并发症的证据确定性中等。
对于所有评估的结果，短种植体与标准种植体相比具有更好或同等的性能。然而，这些假设基于证据质量低或极低的综述，表明该领域需要开展高质量的系统评价。
