Morena Danilo, Leitão-Almeida Bruno, Pereira Miguel, Resende Rodrigo, Fernandes Juliana Campos Hasse, Fernandes Gustavo Vicentis Oliveira, Borges Tiago
Faculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505 Viseu, Portugal.
Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 3504-505 Viseu, Portugal.
J Clin Med. 2024 Jul 31;13(15):4488. doi: 10.3390/jcm13154488.
The goal of this systematic review and meta-analysis was to assess whether there were clinically relevant differences in the treatment of edentulous areas comparing zirconia (Zr) and titanium (Ti) dental implants. The null hypothesis is that no differences can be observed in terms of the clinical parameters; the positive hypothesis I is that Zr implants have generally better results compared to Ti implants; and the positive hypothesis II is that Ti implants have a generally superior result than Zr implants. This review work was registered on the PROSPERO platform, and its development was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The electronic search process was conducted on three databases (PubMed/Scopus/Web of Science), including randomized controlled trials (RCTs) from the past 10 years (up to April 2024). Identified articles were analyzed and included/excluded based on pre-defined selection and exclusion criteria. The quality assessment and risk of bias were evaluated using a Cochrane risk-of-bias assessment tool specifically designed for randomized trials (RoB2). A meta-analysis was conducted to correlate different treatment options based on the described outcomes; a random-effects model was used in the analysis of the variables. The analysis of heterogeneity was conducted by means of Cochran's Q-test and Higgins' I statistic. Six RCTs were enrolled; 152 patients (90 males and 62 females) and 448 implants (267 Zr and 181 Ti) were included. Dental implant placement involved both the maxillary and mandibular arches. The implant sites showed heterogeneity in receiving Zr and Ti dental implants; in particular, 22 dental implants were placed in the mid-palatal region and 426 dental implants in the alveolar region (255 were in Zr and 171 in Ti). Regarding the success rate, it was better for Zr but with no statistical difference ( > 0.05); bleeding on probing had slight differences between Ti with 0.34% ± 0.42 and Zr with 0.26% ± 0.36 ( > 0.05); plaque score showed 0.46 ± 0.47 for Ti compared to 0.44 ± 0.49 for Zr ( > 0.05); no statistically significant difference was observed for pink esthetic score (PES). Statistically significant results were found for survival rate, which favored Ti implants (77.6%) compared to Zr (70.3%) ( < 0.05), and for marginal bone loss, which showed less loss in Ti implants (0.18 mm ± 0.47) compared to 0.42 mm ± 0.40 in Zr at 12 months ( < 0.001). The present systematic review and meta-analysis identified the positive hypothesis I and rejected the null and positive hypothesis II; it was possible to conclude that Ti dental implants have a better survival rate and less marginal bone loss than Zr dental implants after 1-year follow-up.
本系统评价和荟萃分析的目的是评估在无牙区治疗中，比较氧化锆（Zr）和钛（Ti）牙种植体是否存在临床相关差异。零假设是在临床参数方面未观察到差异；阳性假设I是Zr种植体总体上比Ti种植体有更好的效果；阳性假设II是Ti种植体总体上比Zr种植体有更优的效果。本综述工作已在PROSPERO平台注册，其开展符合PRISMA（系统评价和荟萃分析的首选报告项目）声明。电子检索过程在三个数据库（PubMed/Scopus/科学网）上进行，包括过去10年（截至2024年4月）的随机对照试验（RCT）。根据预先定义的纳入和排除标准对识别出的文章进行分析并纳入/排除。使用专门为随机试验设计的Cochrane偏倚风险评估工具（RoB2）评估质量和偏倚风险。进行荟萃分析以根据所述结果关联不同的治疗选择；分析变量时使用随机效应模型。通过Cochran's Q检验和Higgins' I统计量进行异质性分析。纳入了6项RCT；包括152例患者（90例男性和62例女性）和448颗种植体（267颗Zr和181颗Ti）。牙种植体植入涉及上颌和下颌牙弓。种植部位在接受Zr和Ti牙种植体方面存在异质性；特别是，22颗牙种植体植入腭中区域，426颗牙种植体植入牙槽区域（255颗为Zr，171颗为Ti）。关于成功率，Zr更好但无统计学差异（>0.05）；探诊出血方面，Ti为0.34%±0.42，Zr为0.26%±0.36，两者有轻微差异（>0.05）；菌斑评分Ti为0.46±0.47，Zr为0.44±0.49（>0.05）；粉色美学评分（PES）未观察到统计学显著差异。在生存率方面发现了统计学显著结果，与Zr（70.3%）相比，Ti种植体更占优势（77.6%）（<0.05），在边缘骨丢失方面，12个月时Ti种植体的骨丢失较少（0.18 mm±0.47），而Zr为0.42 mm±0.40（<0.001）。本系统评价和荟萃分析证实了阳性假设I，否定了零假设和阳性假设II；可以得出结论，在1年随访后，Ti牙种植体比Zr牙种植体有更好的生存率和更少的边缘骨丢失。
