Multidisciplinary Department of Medical, Surgical and Oral Sciences, School of Dentistry, Campania University Luigi Vanvitelli, Via Luigi De Crecchio 7, 80138, Naples, Italy.
Academic Department of Clinical Stomatology, Section of Implant Dentistry, Universidad Peruana Cayetano Heredia, Lima, Peru.
BMC Oral Health. 2021 May 8;21(1):247. doi: 10.1186/s12903-021-01572-6.
Implant-supported overdentures offer enhanced mechanical properties, which lead to better patient satisfaction and survival rates than conventional dentures. However, it is unclear whether these satisfaction levels and survival rates depend on the number of implants supporting the overdenture. Therefore, this systematic review aimed to compare maxillary overdentures supported by four or six splinted implants in terms of patient satisfaction, implant survival, overdenture survival, and prosthodontic complications.
Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), and EMBASE databases were systematically searched and complemented by hand searching from 2000 to 2019, employing a combination of specific keywords. Studies comparing the use of four versus six implants for supporting overdentures with at least one-year of follow-up after prosthesis installation and including ten fully edentulous patients were included. The risk of bias (RoB) was analyzed with Cochrane's RoB 2 and Newcastle-Ottawa tools. Implants and prosthesis survival rates were analyzed by random-effects meta-analysis and expressed as risk ratios or risk differences, respectively, and by the non-parametric unpaired Fisher's test.
A total of 15 from 1865 articles were included, and reported follow-up times after implant placement ranged from 1 to 10 years. Irrespective of the number of implants used, high scores were reported by all studies investigating patient satisfaction. Meta-analysis and non-parametric Fisher's test showed no statistical differences regarding the survival rate of implants (P = 0.34, P = 0.3) or overdentures (P = 0.74, P = 0.9) when using 4 versus 6 splinted implants to support overdentures, and no significant differences regarding prosthodontic complications were found between groups. Randomized studies presented high RoB and non-randomized studies presented acceptable quality.
Within the limits of this systematic review, we can conclude that the bar-supported overdenture on four implants is not inferior to the overdenture supported by six implants for rehabilitating the edentulous maxilla, in terms of patient satisfaction, survival rates of implants and overdentures, and prosthodontic complications.
种植体支持的覆盖义齿具有增强的机械性能，相较于传统义齿，可带来更高的患者满意度和存活率。然而，目前尚不清楚这些满意度水平和存活率是否取决于覆盖义齿所使用的种植体数量。因此，本系统评价旨在比较上颌使用四个或六个夹板式种植体支持的覆盖义齿在患者满意度、种植体存活率、覆盖义齿存活率和修复并发症方面的情况。
系统检索了 Cochrane 对照试验中心注册库（CENTRAL）、MEDLINE（PubMed）和 EMBASE 数据库，并结合特定关键词进行了手工检索，检索时间范围为 2000 年至 2019 年。纳入的研究为比较至少在义齿安装后 1 年以上随访的四种植体与六种植体支持覆盖义齿的使用，并纳入了 10 名全口无牙患者。使用 Cochrane 的 RoB 2 和纽卡斯尔-渥太华量表分析偏倚风险（RoB）。采用随机效应荟萃分析分析种植体和义齿存活率，并分别表示为风险比或风险差，并采用非参数配对 Fisher 检验。
在 1865 篇文章中，共纳入 15 篇，报道的种植体放置后随访时间从 1 年到 10 年不等。所有研究报告患者满意度评分均较高，无论使用多少种植体。荟萃分析和非参数 Fisher 检验显示，使用 4 个或 6 个夹板式种植体支持覆盖义齿时，种植体（P=0.34，P=0.3）或覆盖义齿（P=0.74，P=0.9）的存活率无统计学差异，两组之间的修复并发症也无显著差异。随机研究的 RoB 较高，非随机研究的质量可接受。
在本系统评价的范围内，我们可以得出结论，对于上颌无牙患者的修复，四种植体支持的杆状覆盖义齿在患者满意度、种植体和覆盖义齿存活率以及修复并发症方面并不逊于六种植体支持的覆盖义齿。
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