Chiam Sieu Yien, Liu Han-Pang, Oh Won-Suk
Clinical Assistant Professor, Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Mich.
Postgraduate student, Department of Oral Medicine and Periodontics, University of Michigan School of Dentistry, Ann Arbor, Mich.
J Prosthet Dent. 2024 Nov 15. doi: 10.1016/j.prosdent.2024.10.009.
Scientific evidence to determine the clinical performance of angled screw channel (ASC) versus straight screw channel (SC) implant-supported prostheses is lacking.
This systematic review and meta-analysis investigated the mechanical and biological complications of ASC compared with those of SC implant-supported prostheses.
A systematic search was conducted by following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline in the PubMed, Embase, and Web of Science databases and was supplemented with a manual search for clinical studies reporting the mechanical and biological complications of ASC compared with those of SC implant-supported prostheses. The search was focused on porcelain fracture, screw loosening or fracture, marginal bone loss (MBL), and pink esthetic score (PES). The data were extracted from selected articles and compounded to estimate the complications with a 95% confidence interval (CI) using a random effects meta-analysis. The publication bias was assessed using the Cochrane Risk of Bias and Newcastle-Ottawa Scale (α=.05).
A total of 4217 records were identified, and 14 studies were selected for quantitative synthesis of 629 participants with 658 ASC and 166 SC implant-supported prostheses. The meta-analyses of comparative studies showed no statistically significant difference in mechanical complications between ASC and SC prostheses, with odds ratio (OR) of 1.75 (95% CI=0.71-4.34, P=.224). Porcelain fracture and screw loosening were the most common complications with ASC prostheses. In addition, no statistically significant difference was found between ASC and SC prostheses in the MBL (mean difference=-0.07, 95% CI=-0.15-0.01, P=.077) and PES (mean difference=-0.19, 95% CI=-0.90-0.52, P=.593).
The clinical performance of ASC may be comparable with that of SC implant-supported prostheses in terms of mechanical and biological complications. However, the moderate level of evidence necessitates further research to validate these findings.
缺乏科学证据来确定角度螺丝通道（ASC）与直螺丝通道（SC）种植体支持式修复体的临床性能。
本系统评价和荟萃分析研究了ASC与SC种植体支持式修复体的机械和生物学并发症。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，在PubMed、Embase和科学网数据库中进行系统检索，并辅以手动检索临床研究，报告ASC与SC种植体支持式修复体的机械和生物学并发症。检索重点为瓷崩裂、螺丝松动或断裂、边缘骨丢失（MBL）和粉色美学评分（PES）。从选定的文章中提取数据，并使用随机效应荟萃分析合并数据以估计并发症的95%置信区间（CI）。使用Cochrane偏倚风险和纽卡斯尔-渥太华量表评估发表偏倚（α = 0.05）。
共识别出4217条记录，选择了14项研究对629名参与者进行定量综合分析，其中有658个ASC种植体支持式修复体和166个SC种植体支持式修复体。比较研究的荟萃分析显示，ASC和SC修复体在机械并发症方面无统计学显著差异，优势比（OR）为1.75（95%CI = 0.71 - 4.34，P = 0.224）。瓷崩裂和螺丝松动是ASC修复体最常见的并发症。此外，ASC和SC修复体在MBL（平均差异 = -0.07，95%CI = -0.15 - 0.0l，P = 0.077）和PES（平均差异 = -0.19，95%CI = -0.90 - 0.52，P = 0.593）方面也未发现统计学显著差异。
在机械和生物学并发症方面，ASC的临床性能可能与SC种植体支持式修复体相当。然而，证据水平中等，需要进一步研究来验证这些发现。
