Manfredini Mattia, Poli Pier Paolo, Giboli Luca, Beretta Mario, Maiorana Carlo, Pellegrini Matteo
Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy.
Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Dent J (Basel). 2024 Jun 28;12(7):200. doi: 10.3390/dj12070200.
Dental implant fractures pose a significant challenge to long-term treatment success. This systematic review aims to comprehensively examine the clinical factors influencing dental implant fractures (IFs). Furthermore, strategies to choose the right type of implant and prevent this complication are addressed. A systematic search was conducted across PubMed, Scopus, and Web of Science databases. Eligible studies included retrospective case-control, prospective cohort studies, and clinical trials. The initial search yielded 361 articles, of which 312 were excluded being these reviews, case reports, irrelevant, or written in languages other than English. This left 49 articles, with only 6 meeting the eligibility criteria for an in-depth review. These studies, all retrospective case-control, examine implant characteristics, patient demographics, surgical and prosthetic variables, biomechanical and functional factors, clinical and procedural variables, complications and maintenance issues. The risk of bias was assessed as low using the ROBINS-I tool. Key findings suggest a correlation between implant diameter and structural resistance, with wider implants demonstrating reduced fracture risk. Additionally, posterior regions, especially molars and premolars, exhibit higher susceptibility to IFs due to increased masticatory forces. Implant design and material may considerably influence fracture risk, with conical implants and screw-retained prostheses showing higher vulnerability. Biomechanical overload, particularly in patients with bruxism, emerges as a primary contributing factor to IFs. Prosthesis type significantly influences fracture incidence, with cantilever prostheses posing a higher risk due to increased stress. Peri-implant bone loss is strongly associated with IFs, emphasizing the need for meticulous preoperative assessments and individualized management strategies. Future research should prioritize larger and heterogeneous populations with long-term follow-up and standardized methodologies to enhance the generalizability and comparability of findings. Randomized controlled trials and biomechanical studies under controlled conditions are also essential to elucidate the complex interactions contributing to IFs and developing effective prevention strategies. Additionally, integrating patient-reported outcomes may offer a comprehensive understanding of the impact of IFs on quality of life.
牙种植体骨折对长期治疗成功构成重大挑战。本系统评价旨在全面研究影响牙种植体骨折的临床因素。此外，还探讨了选择合适种植体类型及预防该并发症的策略。通过对PubMed、Scopus和Web of Science数据库进行系统检索。符合条件的研究包括回顾性病例对照研究、前瞻性队列研究和临床试验。初步检索得到361篇文章，其中312篇因属于综述、病例报告、不相关或非英文撰写而被排除。剩下49篇文章，只有6篇符合深入综述的纳入标准。这些研究均为回顾性病例对照研究，考察了种植体特征、患者人口统计学资料、手术和修复变量、生物力学和功能因素、临床和操作变量、并发症及维护问题。使用ROBINS-I工具评估偏倚风险为低。主要研究结果表明，种植体直径与结构抗力之间存在相关性，直径较宽的种植体骨折风险降低。此外，后牙区，尤其是磨牙和前磨牙，由于咀嚼力增加，种植体骨折的易感性更高。种植体设计和材料可能会显著影响骨折风险，锥形种植体和螺丝固位修复体显示出更高的易损性。生物力学过载，尤其是在磨牙症患者中，是种植体骨折的主要促成因素。修复体类型显著影响骨折发生率，悬臂式修复体因应力增加而具有更高风险。种植体周围骨丢失与种植体骨折密切相关，强调了术前细致评估和个体化管理策略的必要性。未来的研究应优先针对更大规模、异质性人群进行长期随访，并采用标准化方法，以提高研究结果的普遍性和可比性。随机对照试验和受控条件下的生物力学研究对于阐明导致种植体骨折的复杂相互作用以及制定有效的预防策略也至关重要。此外，纳入患者报告的结果可能有助于全面了解种植体骨折对生活质量的影响。
