Clinical Reader / Consultant in Restorative Dentistry, Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.
Institute of Clinical Dentistry, University of Bergen, Bergen, Norway.
J Evid Based Dent Pract. 2022 Sep;22(3):101731. doi: 10.1016/j.jebdp.2022.101731. Epub 2022 Apr 18.
OBJECTIVES: This systematic review and meta-analysis was undertaken to answer the following focus questions: Is the implant survival in augmented bone utilizing iliac crest bone grafts the same as while using intraoral autologous bone grafts? Is the incidence of postoperative donor site complications the same when using iliac crest bone grafts as opposed to intraoral grafts? METHODS: Systematic searches of electronic databases (PubMed, Embase, CENTRAL) were performed to identify studies which reported on implant survival and postoperative complications for dental implants placed in grafted partially/completely edentulous human jaws. Studies were included if: they reported on 2-piece micro-rough surface root form dental implants placed in bone-augmented completely or partially edentulous human jaws, and the jaws must have been augmented with autologous bone graft materials. Time and nature of postoperative complications must have been reported. Two investigators performed data extraction and a Cohen's unweighted kappa was calculated for inter-investigator reliability. A meta-analysis was performed for the extracted data on implant survival rate in both iliac crest grafts and intra-oral grafts. A qualitative analysis was performed on the information extracted on graft donor site complications. Quality assessment of the included studies were done using the Cochrane collaboration tool and the Newcastle-Ottawa scales. RESULTS: A total of 23 studies were included in the final analysis. The calculated kappa ranged between 0.77-0.89 for the literature search and identification process. Fourteen studies were included with data on implant survival including five randomized controlled clinical trials. The meta-analysis of included studies revealed that the implant survival rate of dental implants placed in jaws augmented with iliac crest grafts was lower than those placed in jaws augmented with intra-oral bone grafts at 6-months [ICG = 95.8% IOG = 98.4%; P < .001], 12-months [ICG = 97.0%, IOG = 98.4%; P < .001], 24-months [ICG = 85.9%, IOG = 98.2%; P < .001], 60-months [ICG = 90.0%, IOG = 91.5%; P < .001], and at 120-months [ICG = 88.8%, IOG = 95.2%; P < .001] follow-up periods. Iliac crest grafts were also frequently associated with donor site complications including pain / discomfort, gait disturbance, and sensory disturbance. CONCLUSIONS: This systematic review and meta-analysis demonstrates that implant survival is consistently higher in bone harvested from intraoral sites compared to iliac crest grafts. Donor site complications seemed to be a frequent finding with iliac crest grafts and mental grafts. FUNDING: None. REGISTRATION: The review protocol was registered with PROSPERO: International prospective register of systematic reviews (CRD42021283738).
目的:本系统评价和荟萃分析旨在回答以下焦点问题:在使用髂嵴骨移植物增强骨的情况下,植入物的存活率是否与使用口腔内自体骨移植物相同?使用髂嵴骨移植物与口腔内移植物相比,术后供体部位并发症的发生率是否相同?
方法:系统检索电子数据库(PubMed、Embase、CENTRAL),以确定报告在增强的部分/完全无牙颌中放置牙科植入物的植入物存活率和术后并发症的研究。如果研究符合以下标准,则将其纳入:他们报告了 2 件微粗糙表面根形式牙科植入物放置在骨增强的完全或部分无牙颌人类颌骨中,并且颌骨必须使用自体骨移植物材料进行增强。必须报告术后并发症的时间和性质。两名研究人员进行了数据提取,并计算了两位研究人员之间的 Cohen 未加权 kappa 值以进行可靠性评估。对髂嵴移植物和口腔移植物中提取的植入物存活率数据进行荟萃分析。对提取的供体部位并发症信息进行定性分析。使用 Cochrane 协作工具和纽卡斯尔-渥太华量表对纳入研究进行质量评估。
结果:最终分析共纳入 23 项研究。文献检索和鉴定过程中计算的 kappa 值在 0.77-0.89 之间。包括五项随机对照临床试验在内的 14 项研究报告了植入物存活率数据。纳入研究的荟萃分析表明,在 6 个月[ICG=95.8%,IOG=98.4%;P<0.001]、12 个月[ICG=97.0%,IOG=98.4%;P<0.001]、24 个月[ICG=85.9%,IOG=98.2%;P<0.001]、60 个月[ICG=90.0%,IOG=91.5%;P<0.001]和 120 个月[ICG=88.8%,IOG=95.2%;P<0.001]随访期间,放置在髂嵴移植物增强的颌骨中的种植体存活率较低。髂嵴移植物还常与供体部位并发症相关,包括疼痛/不适、步态障碍和感觉障碍。
结论:本系统评价和荟萃分析表明,在口腔内采集的骨中,植入物的存活率始终高于髂嵴移植物。髂嵴移植物和颏骨移植物常伴有供体部位并发症。
资金:无。
登记:该综述方案已在 PROSPERO 中注册:国际前瞻性系统评价注册库(CRD42021283738)。
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