Reis Isabella Neme Ribeiro Dos, Fukuoka Gisele Lie, Nagay Bruna Egumi, Pannuti Claudio Mendes, Spin-Neto Rubens, da Silva Emily Vivianne Freitas
Postgraduate student, Department of Stomatology, Division of Periodontics, School of Dentistry, University of São Paulo (USP), São Paulo, Brazil.
Postgraduate student, Department of Prosthodontics, School of Dentistry, University of São Paulo (USP), São Paulo, Brazil.
J Prosthet Dent. 2023 Oct 2. doi: 10.1016/j.prosdent.2023.08.030.
Implant-supported fixed dental prostheses can be cement- or screw-retained on the implant or abutment, with advantages and disadvantages for each method. Cemented prostheses have been associated with peri-implant disease because cement remnants act as a reservoir for bacteria and hinder biofilm control. However, contrasting evidence has been presented regarding this association based on studies with varying designs, and a systematic review and meta-analysis is required.
The purpose of this systematic review and meta-analysis was to answer the focused question: In patients who received implant-supported prostheses, is the incidence of peri-implant diseases higher in cemented implant-supported prostheses than in screw-retained ones?
The search was conducted using the National Library of Medicine (MEDLINE-PubMed), SCOPUS, EMBASE, and ISI Web of Science databases. Randomized clinical trials (RCTs) that assessed the incidence of peri-implant disease in cement- and screw-retained prostheses were included. Two authors independently screened the titles and abstracts, and analyzed the full texts, extracted data, and assessed the risk of bias. The findings were summarized using meta-analyses with random effects, and the level of certainty of the evidence was determined using the grading of recommendations, assessments, development, and evaluations (GRADE) approach.
The search yielded 4455 articles that met the inclusion criteria based on the title and/or abstract selection. A total of 6 RCTs were included for analysis. The meta-analysis revealed no significant difference between cement- and screw-retained prostheses for the risk of peri-implant mucositis (RR: 1.36, 95% CI: 0.42-4.38, P=.61). Similarly, no significant difference was observed between cement- and screw-retained prostheses for the incidence of peri-implantitis (RR: 1.00, 95% CI: 0.23-4.31, P=1.00).
Moderate certainty evidence suggests that cement- and screw-retained prostheses present a similar risk for peri-implant mucositis and peri-implantitis.
种植体支持的固定义齿可以用粘结剂或螺丝固定在种植体或基台上，每种方法都有其优缺点。粘结式义齿与种植体周围疾病有关，因为粘结剂残留可作为细菌的储存库并阻碍生物膜控制。然而，基于不同设计的研究，关于这种关联存在相互矛盾的证据，因此需要进行系统评价和荟萃分析。
本系统评价和荟萃分析的目的是回答以下重点问题：在接受种植体支持义齿的患者中，粘结式种植体支持义齿的种植体周围疾病发生率是否高于螺丝固定式义齿？
使用美国国立医学图书馆（MEDLINE-PubMed）、SCOPUS、EMBASE和ISI科学网数据库进行检索。纳入评估粘结式和螺丝固定式义齿种植体周围疾病发生率的随机临床试验（RCT）。两位作者独立筛选标题和摘要，并分析全文、提取数据和评估偏倚风险。使用随机效应荟萃分析总结研究结果，并使用推荐分级、评估、制定和评价（GRADE）方法确定证据的确定性水平。
根据标题和/或摘要筛选，检索到4455篇符合纳入标准的文章。共纳入6项RCT进行分析。荟萃分析显示，粘结式和螺丝固定式义齿在种植体周围黏膜炎风险方面无显著差异（RR：1.36，95%CI：0.42-4.38，P=0.61）。同样，粘结式和螺丝固定式义齿在种植体周围炎发生率方面也未观察到显著差异（RR：1.00，95%CI：0.23-4.31，P=1.00）。
中等确定性证据表明，粘结式和螺丝固定式义齿在种植体周围黏膜炎和种植体周围炎方面的风险相似。
