Pravinkumar G Patil, Division of Restorative Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia, e-mail:
Division of Restorative Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.
J Contemp Dent Pract. 2021 Nov 1;22(11):1346-1354.
The purpose of this review is to compare randomized clinical trials evaluating the peri-implant tissue outcomes using different unsplinted attachment systems in two implant-retained mandibular overdentures.
Literature lacks information on various unsplinted attachment systems and their effect on peri-implant tissue health. A focus question (as per PICOS) was set as follows: Does one particular unsplinted attachment system (I) compared with another (C) results in better peri-implant outcomes (O) in two implant-retained mandibular overdentures (P) using randomized controlled trials (RCTs) (S)? The literature search was conducted in the PubMed, MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL) databases between January 2011 and December 2021. The keywords used were "denture, overlay," "denture," "overlay" AND "dental prosthesis, implant supported," "dental implants," "dental implant abutment design" AND "jaw, edentulous," "mouth, edentulous" AND "mandible." Only RCTs on two implant-retained mandibular overdentures using unsplinted attachment systems measuring peri-implant tissue outcomes with minimum 1-year follow-up were selected. In total, 224 studies were identified in initial search, and 25 were shortlisted for full-text evaluation. Four studies were included for systematic review upon considering inclusion and exclusion criteria. The risk of bias was evaluated using Cochrane Risk of Bias Tool 2.0 (RoB 2.0).
A total of 41 patients received ball attachments (in 3 studies), 36 patients received low-profile attachments (in 3 studies), 16 patients received magnet attachments (in 1 study), and 13 patients received telescopic attachments (in 1 study). All four studies used standard sized implants, however, differed in implant manufacturers. Two studies which compared ball attachments low-profile attachments revealed-similar peri-implant tissue health parameters but differed in crestal bone-level changes. One study compared ball with telescopic attachments and revealed similar results in crestal bone-level changes and all four peri-implant tissue health parameters. Single study compared magnets with low-profile attachments and shown lesser bone loss with magnet attachments. Single study was judged to have low risk of bias, single with some concerns, and remaining two to have high risk of bias.
Gingival index and bleeding index of the patients were not influenced by any of the unsplinted overdenture attachment (stud, magnet, telescopic) system. Inconclusive results found among the studies evaluated comparing crestal bone loss and plaque index.
This review manuscript has simplified comparative analysis of different unsplinted attachment systems used in two implant mandibular overdentures to help clinicians choose correct system in such situation.
本综述的目的是比较使用不同无支架附着体系统的 2 个种植体支持下颌覆盖义齿的围植入组织结局的随机临床试验。
文献中缺乏各种无支架附着体系统及其对种植体周围组织健康影响的信息。根据 PICOS 设置了一个焦点问题如下：与另一种（C）相比，一种特定的无支架附着体系统（I）是否会导致使用随机对照试验（RCT）（S）的 2 个种植体支持下颌覆盖义齿（P）中的围植入组织结局更好（O）？在 2011 年 1 月至 2021 年 12 月期间，在 PubMed、MEDLINE 和 Cochrane 中央对照试验注册中心（CENTRAL）数据库中进行了文献检索。使用的关键词是“义齿，覆盖物”，“义齿”，“覆盖物”和“牙种植体支持的义齿”，“牙种植体”，“牙种植体基台设计”和“颌骨，无牙”，“口腔，无牙”和“下颌骨”。仅选择了使用无支架附着体系统测量至少 1 年随访的 2 个种植体支持的下颌覆盖义齿的围植入组织结局的 RCT。最初搜索共确定了 224 项研究，其中 25 项被列为全文评估。考虑纳入和排除标准后，有 4 项研究被纳入系统评价。使用 Cochrane 偏倚风险工具 2.0（RoB 2.0）评估偏倚风险。
共有 41 名患者接受了球附着体（3 项研究），36 名患者接受了低轮廓附着体（3 项研究），16 名患者接受了磁铁附着体（1 项研究），13 名患者接受了伸缩式附着体（1 项研究）。所有四项研究均使用标准尺寸的种植体，但种植体制造商不同。两项比较球附着体与低轮廓附着体的研究显示出相似的围植入组织健康参数，但在牙槽骨水平变化方面有所不同。一项研究比较了球附着体与伸缩式附着体，显示出相似的牙槽骨水平变化和所有四个围植入组织健康参数。单项研究比较了磁铁与低轮廓附着体，显示磁铁附着体的骨丢失较少。单项研究被判断为低偏倚风险，单项研究有一些关注，其余两项研究为高偏倚风险。
无支架覆盖义齿附着体（钉、磁铁、伸缩式）系统对患者的牙龈指数和出血指数没有影响。评估的研究中比较牙槽骨丧失和菌斑指数的结果不一致。
本综述手稿简化了比较两种种植体支持下颌覆盖义齿中使用的不同无支架附着体系统的分析，以帮助临床医生在这种情况下选择正确的系统。
