Master student, Department of Prosthodontics and Periodontology, University of Campinas Piracicaba Dental School, Piracicaba, SP, Brazil.
PhD student, Department of Prosthodontics and Periodontology, University of Campinas Piracicaba Dental School, Piracicaba, SP, Brazil.
J Prosthet Dent. 2024 Feb;131(2):197-211. doi: 10.1016/j.prosdent.2022.02.006. Epub 2022 Aug 3.
Evidence regarding the retention system for a mandibular overdenture is important for treatment planning. However, the clinical performance of stud and ball attachments for mandibular overdenture retainers is unclear.
The purpose of this systematic review and meta-analysis was to compare the clinical performance and self-reported patient outcomes of ball and stud attachments as mandibular overdenture retainers.
Randomized (RCTs) and nonrandomized (N-RCTs) controlled clinical trials were selected based on the eligibility criteria. The risk of bias was assessed by using the Cochrane Collaboration Tools, and the certainty of the evidence (COE) by using the grades of recommendation, assessment, development, and evaluation (GRADE) workshop approach. Meta-analyses according to the follow-up period were performed for implant survival, prosthetic maintenance and complications, bleeding on probing (BoP), marginal bone loss (MBL), satisfaction, and oral health-related quality of life (OHRQoL).
Thirteen RCTs and 4 N-RCTs were included. Twelve studies presented a high risk of bias. The stud demonstrated a lower risk ratio (RR) (P<.001) for maintenance and complications concerning the need for matrix activation (RR 7.12 [2.65, 19.15]) (very low COE) and new overdentures (RR 2.47 [1.02, 5.96]) (moderate COE), ranging from 1 to 5 years of follow-up. Mean difference (MD) for MBL after 1 (MD 0.40 [0.28, 0.52]; P<.001) and 5 years (MD 0.18 [0.16, 0.20]; P<.001) was higher for ball attachments than that for stud (very low COE) attachments. Stud attachments also improved satisfaction (P<.001) when compared with ball attachments (very low COE). Implant survival rate (high COE), BoP (very low COE), and OHRQoL (low COE) were similar for the attachments.
Stud and ball attachments are clinically appropriate options as mandibular overdenture retainers and are capable of restoring OHRQoL. Nevertheless, the stud showed greater improvement in satisfaction and less prosthetic aftercare and MBL.
关于下颌总义齿固位体的保留系统的证据对于治疗计划很重要。然而，球和栓附体作为下颌总义齿固位体的临床性能尚不清楚。
本系统评价和荟萃分析的目的是比较球和栓附体作为下颌总义齿固位体的临床性能和患者自我报告的结果。
根据纳入标准选择随机对照试验（RCT）和非随机对照试验（N-RCT）。使用 Cochrane 协作工具评估偏倚风险，并使用推荐评估、制定与评价（GRADE）工作坊方法评估证据确定性（COE）。根据随访时间进行荟萃分析，评估种植体存活率、修复体维护和并发症、探诊出血（BoP）、边缘骨丧失（MBL）、满意度和口腔健康相关生活质量（OHRQoL）。
纳入了 13 项 RCT 和 4 项 N-RCT。12 项研究存在高偏倚风险。栓附体在需要矩阵激活（RR 7.12 [2.65, 19.15]）（非常低的 COE）和新义齿（RR 2.47 [1.02, 5.96]）（中度 COE）方面的维持和并发症风险比（RR）较低，随访时间为 1 至 5 年。球附体的 MBL 平均值差异（MD）在 1 年（MD 0.40 [0.28, 0.52]；P<.001）和 5 年（MD 0.18 [0.16, 0.20]；P<.001）高于栓附体（非常低的 COE）。栓附体在提高满意度方面也优于球附体（非常低的 COE）。与附着体相比，种植体存活率（高 COE）、探诊出血（非常低的 COE）和口腔健康相关生活质量（低 COE）相似。
栓附体和球附体作为下颌总义齿固位体是临床可行的选择，并且能够恢复口腔健康相关生活质量。然而，栓附体在满意度方面的改善更大，修复体的后续维护和 MBL 较少。
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