Aung Zin Hnin Pwint, Win Pyae Phyo, Sastraruji Thanapat, Khongkhunthian Pathawee
Centre of Excellence for Dental Implantology, Faculty of Dentistry, Chiang Mai University, Mueang Chiang Mai 50200, Suthep, 50200, Muang Chiang Mai, Thailand.
Cho Thar Dental Clinic, North Okkalapa Township, Yangon, Myanmar.
BMC Oral Health. 2025 Apr 13;25(1):560. doi: 10.1186/s12903-025-05961-z.
Mini implant retained overdentures have been treated in edentulous patients with promising long-term results. However, various attachment systems in this process remain insufficiently investigated. This systematic review and meta-analysis aimed to compare the effects of the ball and other attachments used in mini-implant overdentures. Marginal bone loss, bite force, implant survival rate, prosthetic maintenance, and complications were assessed.
A systematic search was conducted across PubMed, Cochrane Library, and Scopus databases until 25th February 2025. This systematic review aimed to find studies that compare ball attachments with other attachment systems in mini dental implant (MDI) overdentures. The primary outcome was marginal bone loss, while the secondary outcomes were maximum bite force, implant survival rate, prosthetic maintenance, and complications. The risk of bias was assessed using the Cochrane risk-of-bias tool for RCTs, and a quantitative meta-analysis was performed.
Of the 561 publications, six randomized clinical trials (101 participants, 234 mini-implants) met the inclusion criteria. Risk of bias assessment revealed three studies with a low risk of bias and three studies with some concerns for risk of bias. There was no significant difference in the marginal bone loss between the ball attachments and others (WMD = 0.15, 95% CI -0.50 to 0.81, p = 0.65), though ball attachments performed better than telescopic ones (P < 0.05) in subgroup analysis. No significant difference in bite force was found (WMD = -5.29, 95% CI -33.46 to 22.87, p = 0.71). Two-year survival rates were 90.9% for ball and 97.8% for bar attachments. The ERA (Extra-Coronal Resilient Attachment) group required five interventions (sore spot adjustments, relining, nylon replacements), while the ball attachment group required only two (denture repair, nylon cap replacement) over the one-year follow-up period.
Within the limitations of the study, it can be concluded that ball, bar, and ERA attachments yield similar outcomes in marginal bone loss while telescopic attachments show more statistically significant marginal bone loss (p < 0.05). The type of attachment does not significantly affect maximum bite force.
CRD42024610018.
在无牙颌患者中使用微型种植体固位覆盖义齿已取得了令人满意的长期效果。然而，在此过程中各种附着系统仍未得到充分研究。本系统评价和荟萃分析旨在比较球帽附着体与微型种植体覆盖义齿中使用的其他附着体的效果。评估边缘骨吸收、咬合力、种植体存留率、修复体维护情况及并发症。
截至2025年2月25日，在PubMed、Cochrane图书馆和Scopus数据库中进行了系统检索。本系统评价旨在查找比较微型牙种植体（MDI）覆盖义齿中球帽附着体与其他附着系统的研究。主要结局为边缘骨吸收，次要结局为最大咬合力、种植体存留率、修复体维护情况及并发症。使用Cochrane随机对照试验偏倚风险工具评估偏倚风险，并进行定量荟萃分析。
在561篇出版物中，六项随机临床试验（101名参与者，234颗微型种植体）符合纳入标准。偏倚风险评估显示，三项研究偏倚风险较低，三项研究存在一些偏倚风险问题。球帽附着体与其他附着体在边缘骨吸收方面无显著差异（加权均数差[WMD]=0.15，95%置信区间[-0.50，0.81]，p=0.65），尽管在亚组分析中球帽附着体的表现优于套筒冠附着体（P<0.05）。咬合力方面未发现显著差异（WMD=-5.29，95%置信区间[-33.46，22.87]，p=0.71）。球帽附着体的两年存留率为90.9%，杆附着体为97.8%。在一年的随访期内，ERA（冠外弹性附着体）组需要五次干预（痛点调整、重衬、尼龙部件更换），而球帽附着体组仅需要两次（义齿修复、尼龙帽更换）。
在本研究的局限性范围内，可以得出结论，球帽、杆和ERA附着体在边缘骨吸收方面产生相似的结果，而套筒冠附着体在边缘骨吸收方面显示出更具统计学意义的差异（p<0.05）。附着体类型对最大咬合力无显著影响。
PROSPERO注册号：CRD42024610018。
