Department of Prosthodontics, School & Hospital of Stomatology, Tianjin Medical University, Tianjin, 300070, China.
State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, 610041, China.
BMC Oral Health. 2021 Mar 17;21(1):122. doi: 10.1186/s12903-021-01486-3.
Immediate loading has recently been introduced into unsplinted mandibular implant-retained overdentures for the management of edentulous patients due to their increasing demand on immediate aesthetics and function. However, there is still a scarcity of meta-analytical evidence on the efficacy of immediate loading compared to delayed loading in unsplinted mandibular implant-retained overdentures. The purpose of this study was to compare the marginal bone loss (MBL) around implants between immediate and delayed loading of unsplinted mandibular implant-retained overdentures.
Randomized controlled trials (RCTs), controlled clinical trials (CCTs), and cohort studies quantitatively comparing the MBL around implants between immediate loading protocol (ILP) and delayed loading protocol (DLP) of unsplinted mandibular overdentures were included. A systematic search was carried out in PubMed, EMBASE, and CENTRAL databases on December 02, 2020. "Grey" literature was also searched. A meta-analysis was conducted to compare the pooled MBL of two different loading protocols of unsplinted mandibular overdentures through weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). The subgroup analysis was performed between different attachment types (i.e. Locator attachment vs. ball anchor). The risk of bias within and across studies were assessed using the Cochrane Collaboration's tool, the Newcastle-Ottawa scale, and Egger's test.
Of 328 records, five RCTs and two cohort studies were included and evaluated, which totally contained 191 participants with 400 implants. The MBL of ILP group showed no significant difference with that of DLP group (WMD 0.04, CI - 0.13 to 0.21, P > .05). The subgroup analysis revealed similar results with Locator attachments or ball anchors (P > .05). Apart from one RCT (20%) with a high risk of bias, four RCTs (80%) showed a moderate risk of bias. Two prospective cohort studies were proved with acceptable quality. Seven included studies have reported 5.03% implant failure rate (10 of 199 implants) in ILP group and 1.00% failure rate (2 of 201 implants) in DLP group in total.
For unsplinted mandibular implant-retained overdentures, the MBL around implants after ILP seems comparable to that of implants after DLP. Immediate loading may be a promising alternative to delayed loading for the management of unsplinted mandibular implant-retained overdentures. PROSPERO registration number: CRD42020159124.
由于患者对即刻美观和功能的需求不断增加，即刻加载已被应用于无支架下颌种植覆盖义齿，以治疗无牙颌患者。然而，关于无支架下颌种植覆盖义齿即刻加载与延迟加载相比的疗效，仍缺乏荟萃分析证据。本研究旨在比较无支架下颌种植覆盖义齿即刻加载和延迟加载时种植体周围边缘骨吸收（MBL）的差异。
纳入了随机对照试验（RCT）、对照临床试验（CCT）和队列研究，这些研究定量比较了即刻加载方案（ILP）和延迟加载方案（DLP）下无支架下颌种植覆盖义齿的种植体周围 MBL。于 2020 年 12 月 02 日在 PubMed、EMBASE 和 CENTRAL 数据库中进行了系统检索，并对“灰色”文献进行了检索。通过加权均数差（WMD）及其 95%置信区间（95%CI），采用荟萃分析比较了两种不同加载方案的无支架下颌覆盖义齿的 MBL。采用亚组分析比较不同附着体类型（Locator 附着体与球型附着体）之间的差异。采用 Cochrane 协作工具、纽卡斯尔-渥太华量表和 Egger 检验评估研究内和研究间的偏倚风险。
在 328 条记录中，纳入了 5 项 RCT 和 2 项队列研究，共包含 191 名参与者和 400 个种植体。ILP 组的 MBL 与 DLP 组无显著差异（WMD 0.04，CI -0.13 至 0.21，P>.05）。亚组分析显示，Locator 附着体或球型附着体的结果相似（P>.05）。除了一项（20%）偏倚风险高的 RCT 外，其余 4 项 RCT（80%）的偏倚风险为中度。两项前瞻性队列研究被认为质量良好。7 项纳入研究报告了 ILP 组的种植体失败率为 5.03%（199 个种植体中有 10 个），DLP 组的失败率为 1.00%（201 个种植体中有 2 个）。
对于无支架下颌种植覆盖义齿，即刻加载后种植体周围的 MBL 似乎与延迟加载后相似。即刻加载可能是治疗无支架下颌种植覆盖义齿的一种有前途的替代延迟加载的方法。PROSPERO 注册号：CRD42020159124。
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