-
The Cochrane Database of Systematic... Aug 2021Traditionally, amalgam has been used for filling cavities in posterior teeth, and it continues to be the restorative material of choice in some low- and middle-income... (Review)
Review
BACKGROUND
Traditionally, amalgam has been used for filling cavities in posterior teeth, and it continues to be the restorative material of choice in some low- and middle-income countries due to its effectiveness and relatively low cost. However, there are concerns over the use of amalgam restorations (fillings) with regard to mercury release in the body and the environmental impact of mercury disposal. Dental composite resin materials are an aesthetic alternative to amalgam, and their mechanical properties have developed sufficiently to make them suitable for restoring posterior teeth. Nevertheless, composite resin materials may have potential for toxicity to human health and the environment. The United Nations Environment Programme has established the Minamata Convention on Mercury, which is an international treaty that aims "to protect the [sic] human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds". It entered into force in August 2017, and as of February 2021 had been ratified by 127 governments. Ratification involves committing to the adoption of at least two of nine proposed measures to phase down the use of mercury, including amalgam in dentistry. In light of this, we have updated a review originally published in 2014, expanding the scope of the review by undertaking an additional search for harms outcomes. Our review synthesises the results of studies that evaluate the long-term effectiveness and safety of amalgam versus composite resin restorations, and evaluates the level of certainty we can have in that evidence.
OBJECTIVES
To examine the effects (i.e. efficacy and safety) of direct composite resin fillings versus amalgam fillings.
SEARCH METHODS
An information specialist searched five bibliographic databases up to 16 February 2021 and used additional search methods to identify published, unpublished and ongoing studies SELECTION CRITERIA: To assess efficacy, we included randomised controlled trials (RCTs) comparing dental composite resin with amalgam restorations in permanent posterior teeth that assessed restoration failure or survival at follow-up of at least three years. To assess safety, we sought non-randomised studies in addition to RCTs that directly compared composite resin and amalgam restorative materials and measured toxicity, sensitivity, allergy, or injury.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane.
MAIN RESULTS
We included a total of eight studies in this updated review, all of which were RCTs. Two studies used a parallel-group design, and six used a split-mouth design. We judged all of the included studies to be at high risk of bias due to lack of blinding and issues related to unit of analysis. We identified one new trial since the previous version of this review (2014), as well as eight additional papers that assessed safety, all of which related to the two parallel-group studies that were already included in the review. For our primary meta-analyses, we combined data from the two parallel-group trials, which involved 1645 composite restorations and 1365 amalgam restorations in 921 children. We found low-certainty evidence that composite resin restorations had almost double the risk of failure compared to amalgam restorations (risk ratio (RR) 1.89, 95% confidence interval (CI) 1.52 to 2.35; P < 0.001), and were at much higher risk of secondary caries (RR 2.14, 95% CI 1.67 to 2.74; P < 0.001). We found low-certainty evidence that composite resin restorations were not more likely to result in restoration fracture (RR 0.87, 95% CI 0.46 to 1.64; P = 0.66). Six trials used a split-mouth design. We considered these studies separately, as their reliability was compromised due to poor reporting, unit of analysis errors, and variability in methods and findings. Subgroup analysis showed that the findings were consistent with the results of the parallel-group studies. Three trials investigated possible harms of dental restorations. Higher urinary mercury levels were reported amongst children with amalgam restorations in two trials, but the levels were lower than what is known to be toxic. Some differences between amalgam and composite resin groups were observed on certain measures of renal, neuropsychological, and psychosocial function, physical development, and postoperative sensitivity; however, no consistent or clinically important harms were found. We considered that the vast number of comparisons made false-positive results likely. There was no evidence of differences between the amalgam and composite resin groups in neurological symptoms, immune function, and urinary porphyrin excretion. The evidence is of very low certainty, with most harms outcomes reported in only one trial.
AUTHORS' CONCLUSIONS
Low-certainty evidence suggests that composite resin restorations may have almost double the failure rate of amalgam restorations. The risk of restoration fracture does not seem to be higher with composite resin restorations, but there is a much higher risk of developing secondary caries. Very low-certainty evidence suggests that there may be no clinically important differences in the safety profile of amalgam compared with composite resin dental restorations. This review supports the utility of amalgam restorations, and the results may be particularly useful in parts of the world where amalgam is still the material of choice to restore posterior teeth with proximal caries. Of note, however, is that composite resin materials have undergone important improvements in the years since the trials informing the primary analyses for this review were conducted. The global phase-down of dental amalgam via the Minamata Convention on Mercury is an important consideration when deciding between amalgam and composite resin dental materials. The choice of which dental material to use will depend on shared decision-making between dental providers and patients in the clinic setting, and local directives and protocols.
Topics: Bias; Child; Composite Resins; Dental Amalgam; Dental Caries; Dentition, Permanent; Humans; Randomized Controlled Trials as Topic
PubMed: 34387873
DOI: 10.1002/14651858.CD005620.pub3 -
Clinical Oral Implants Research Oct 2018The aim of the present systematic review was to analyze the survival and complication rates of zirconia-based and metal-ceramic implant-supported single crowns (SCs).
OBJECTIVES
The aim of the present systematic review was to analyze the survival and complication rates of zirconia-based and metal-ceramic implant-supported single crowns (SCs).
MATERIALS AND METHODS
An electronic MEDLINE search complemented by manual searching was conducted to identify randomized controlled clinical trials, prospective cohort and retrospective case series on implant-supported SCs with a mean follow-up time of at least 3 years. Patients had to have been clinically examined at the follow-up visit. Assessment of the identified studies and data extraction was performed independently by two reviewers. Failure and complication rates were analyzed using robust Poisson's regression models to obtain summary estimates of 5-year proportions.
RESULTS
The search provided 5,263 titles and 455 abstracts, full-text analysis was performed for 240 articles, resulting in 35 included studies on implant-supported crowns. Meta-analysis revealed an estimated 5-year survival rate of 98.3% (95% CI: 96.8-99.1) for metal-ceramic implant supported SCs (n = 4,363) compared to 97.6% (95% CI: 94.3-99.0) for zirconia implant supported SCs (n = 912). About 86.7% (95% CI: 80.7-91.0) of the metal-ceramic SCs (n = 1,300) experienced no biological/technical complications over the entire observation period. The corresponding rate for zirconia SCs (n = 76) was 83.8% (95% CI: 61.6-93.8). The biologic outcomes of the two types of crowns were similar; yet, zirconia SCs exhibited less aesthetic complications than metal-ceramics. The 5-year incidence of chipping of the veneering ceramic was similar between the material groups (2.9% metal-ceramic, 2.8% zirconia-ceramic). Significantly (p = 0.001), more zirconia-ceramic implant SCs failed due to material fractures (2.1% vs. 0.2% metal-ceramic implant SCs). No studies on newer types of monolithic zirconia SCs fulfilled the simple inclusion criteria of 3 years follow-up time and clinical examination of the present systematic review.
CONCLUSION
Zirconia-ceramic implant-supported SCs are a valid treatment alternative to metal-ceramic SCs, with similar incidence of biological complications and less aesthetic problems. The amount of ceramic chipping was similar between the material groups; yet, significantly more zirconia crowns failed due to material fractures.
Topics: Ceramics; Crowns; Databases, Factual; Dental Implants; Dental Materials; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Esthetics, Dental; Humans; Metal Ceramic Alloys; Survival Analysis; Zirconium
PubMed: 30328190
DOI: 10.1111/clr.13306 -
Clinical Oral Implants Research Oct 2018The aim of the present review was to compare the outcomes, that is, survival and complication rates of zirconia-ceramic and/or monolithic zirconia implant-supported... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The aim of the present review was to compare the outcomes, that is, survival and complication rates of zirconia-ceramic and/or monolithic zirconia implant-supported fixed dental prostheses (FDPs) with metal-ceramic FDPs.
MATERIALS AND METHODS
An electronic MEDLINE search complemented by manual searching was conducted to identify randomized controlled clinical trials, prospective cohort studies and retrospective case series on implant-supported FDPs with a mean follow-up of at least 3 years. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data extraction was performed independently by two reviewers. Failure and complication rates were analyzed using robust Poisson regression models to obtain summary estimates of 5-year proportions.
RESULTS
The search provided 5,263 titles and 455 abstracts. Full-text analysis was performed for 240 articles resulting in 19 studies on implant FDPs that met the inclusion criteria. The studies reported on 932 metal-ceramic and 175 zirconia-ceramic FDPs. Meta-analysis revealed an estimated 5-year survival rate of 98.7% (95% CI: 96.8%-99.5%) for metal-ceramic implant-supported FDPs, and of 93.0% (95% CI: 90.6%-94.8%) for zirconia-ceramic implant-supported FDPs (p < 0.001). Thirteen studies including 781 metal-ceramic implant-supported FDPs estimated a 5-year rate of ceramic fractures and chippings to be 11.6% compared with a significantly higher (p < 0.001) complication rate for zirconia implant-supported FDPs of 50%, reported in a small study with 13 zirconia implant-supported FDPs. Significantly (p = 0.001) more, that is, 4.1%, of the zirconia-ceramic implant-supported FDPs were lost due to ceramic fractures compared to only 0.2% of the metal-ceramic implant-supported FDPs. Detailed analysis of factors like number of units of the FDPs or location in the jaws was not possible due to heterogeneity of reporting. No studies on monolithic zirconia implant-supported FDPs fulfilled the inclusion criteria of the present review. Furthermore, no conclusive results were found for the aesthetic outcomes of both FDP-types.
CONCLUSION
For implant-supported FDPs, conventionally veneered zirconia should not be considered as material selection of first priority, as pronounced risk for framework fractures and chipping of the zirconia veneering ceramic was observed. Monolithic zirconia may be an interesting alternative, but its clinical medium- to long-term outcomes have not been evaluated yet. Hence, metal ceramics seems to stay the golden standard for implant-supported multiple-unit FDPs.
Topics: Ceramics; Databases, Factual; Dental Implants; Dental Materials; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Denture, Partial, Fixed; Esthetics, Dental; Humans; Metal Ceramic Alloys; Survival Analysis; Zirconium
PubMed: 30328185
DOI: 10.1111/clr.13277 -
Clinical Oral Implants Research Jan 2022To analyze the clinical outcomes of all-ceramic single crowns (SCs) and fixed dental prostheses (FDPs) supported by ceramic implants. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To analyze the clinical outcomes of all-ceramic single crowns (SCs) and fixed dental prostheses (FDPs) supported by ceramic implants.
MATERIALS AND METHODS
Based on a focused question and customized PICO framework, electronic (Medline/EMBASE/Cochrane) and manual searches for studies reporting the clinical outcomes of all-ceramic SCs and FDPs supported by ceramic implants ≥12 months were performed. The primary outcomes were reconstruction survival and the chipping proportion. The secondary outcomes were implant survival, technical complications, and patient-related outcome measurements. Meta-analyses were performed after 1, 2, and 5 years using random-effect meta-analyses.
RESULTS
Eight of the 1,403 initially screened titles and 55 full texts were included. Five reported on monolithic lithium disilicate (LS2) SCs, one on veneered zirconia SCs, and two on veneered zirconia SCs and FDPs, which reported all on cement-retained reconstructions (mean observation: 12.0-61.0 months). Meta-analyses estimated a 5-year survival rate of 94% (95% confidence interval [CI]: 82%-100%) for overall implant survival. Reconstruction survival proportions after 5 years were: monolithic LS2, 100% (95%CI: 95%-100%); veneered zirconia SCs, 89% (95%CI: 62%-100%); and veneered zirconia FDPs 94% (95%CI: 81%-100%). The chipping proportion after 5 years was: monolithic LS2, 2% (95%CI: 0%-11%); veneered zirconia SCs, 38% (95%CI: 24%-54%); and veneered zirconia FDPs, 57% (95%CI: 38%-76%). Further outcomes were summarized descriptively.
CONCLUSIONS
Due to the limited data available, only tendencies could be identified. All-ceramic reconstructions supported by ceramic implants demonstrated promising survival rates after mid-term observation. However, high chipping proportions of veneered zirconia SCs and, particularly, FDPs diminished the overall outcome. Monolithic LS2 demonstrated fewer clinical complications. Monolithic reconstructions could be a valid treatment option for ceramic implants.
Topics: Ceramics; Crowns; Dental Implants; Dental Porcelain; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Humans; Metal Ceramic Alloys; Zirconium
PubMed: 34665900
DOI: 10.1111/clr.13871 -
The Cochrane Database of Systematic... Dec 2017Fixed prosthodontic treatment (crowns, fixed dental prostheses (FDPs), complete arch prostheses) involves the use of several different materials to replace missing tooth... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Fixed prosthodontic treatment (crowns, fixed dental prostheses (FDPs), complete arch prostheses) involves the use of several different materials to replace missing tooth structure. Traditionally full metal or metal frameworks veneered with ceramic (metal-ceramic (MC)) have been used. In recent years several different metal-free systems have become available to clinicians and patients. In general, metal-free restorations should allow practitioners to better reproduce natural tooth colour, avoiding shortcomings of MC restorations. The comparative in service clinical performance of fixed prosthodontic treatments of different materials is unclear.
OBJECTIVES
To assess the effects of metal-free materials for prosthodontic restorations compared to metal-ceramic or other conventional all-metal materials.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (searched 3 May 2017), Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 4) in the Cochrane Library (searched 3 May 2017), MEDLINE Ovid (1946 to 3 May 2017), and Embase Ovid (1980 to 3 May 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials (searched 3 May 2017). No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
Randomised controlled trials (RCTs) in which the clinical performance of metal-free fixed prosthodontic restorations was compared with metal-ceramic (MC) or other conventional restorations in adult patients requiring prosthodontic treatment. RCTs in which the clinical performance of different kinds of metal-free systems were compared among themselves were also considered.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Trial authors were contacted for missing information. Available results for the outcomes of interest of the systematic review of the studies included were tabulated as they could not be included in a formal meta-analysis.
MAIN RESULTS
Nine trials involving a total of 448 participants were included. We judged two trials to be at unclear risk of bias and seven to be at high risk of bias. The majority of items of risk of bias were evaluated to be at unclear or high risk level in more than 50% of the included trials. Each trial except two was addressing a different type of intervention. All evidence was rated as being of very low quality due to problems with risk of bias and imprecision of results, the latter being due to very small sample sizes, low event rates, 95% confidence intervals including the possibility of benefit for both the test and control groups, or combinations of these problems. This means that we are very uncertain about all of the results presented in this review.One trial compared metal-free single crowns (full contour zirconia) to cast gold single crowns in 224 participants and found insufficient evidence of a difference in failure rate after one year, but after five years there was some evidence of a benefit for the gold crowns. There was insufficient evidence of a difference for crown complications at either time of assessment.One trial compared three-unit metal-free FDPs (lithium disilicate) to three-unit metal-ceramic FDPs in 37 participants. There was insufficient evidence of a difference in bridge failure at one and six years, but some evidence of a benefit for the lithium disilicate group in terms of bridge complications at six years. One trial compared zirconia-ceramic FDPs to metal-ceramic FDPs in 34 participants but found insufficient evidence of a difference in bridge failures (i.e. no failures in either treatment group), bridge complications or patients' aesthetic evaluation at any time of assessment up to three years.One trial compared metal-free cantilevered FDPs to metal-ceramic cantilevered FDPs in 21 participants. There was insufficient evidence of a difference for any primary outcome: bridge failures (i.e. no failures in either treatment group), bridge complications, or patients' aesthetic evaluation at any time of assessment up to three years.One trial compared metal-free implant-supported screw retained single crowns (zirconia veneered with feldspathic ceramic) to metal-ceramic implant-supported screw-retained single crowns in 20 participants. There was insufficient evidence of a difference for any primary outcome: crown failures (i.e. no failures in either treatment group), crown complications, or satisfaction/aesthetic evaluation at any time of assessment up to two years.Two trials compared metal-free implant abutments (zirconia) to metal implant abutments both supporting single crowns in 50 participants. There was insufficient evidence of a difference in abutment failure at one year.One trial compared metal-free implant-supported FDPs made of two different types of zirconia ceramic in 18 participants. There was insufficient evidence of a difference in failures at any time of assessment up to 10 years (i.e. no failures in either treatment group). There was some evidence of a benefit for the zirconia-toughened alumina group in terms of complications (chipping).One trial compared metal-free tooth-supported FDPs made with two different veneering techniques (pressed versus layered) in 40 participants. There was insufficient evidence of a difference for failures (i.e. no failures in either treatment group) or complications at any time of assessment up to three years.
AUTHORS' CONCLUSIONS
There is insufficient evidence to support or refute the effectiveness of metal-free materials for fixed prosthodontic treatment over metal-ceramic or other type of standard restorations. The overall quality of existing evidence was very low, therefore great caution should be exercised when generalising the results of the included trials. Until more evidence becomes available clinicians should continue to base decisions on which material to use for fixed prosthodontic treatment on their own clinical experience, whilst taking into consideration the individual circumstances and preferences of their patients. There is urgent need of properly designed RCTs.
Topics: Crowns; Dental Alloys; Dental Materials; Dental Restoration, Permanent; Humans; Randomized Controlled Trials as Topic; Zirconium
PubMed: 29261853
DOI: 10.1002/14651858.CD009606.pub2 -
Journal of Prosthodontic Research Jan 2022This study comprehensively reviewed the current status of the digital workflow of removable partial dentures (RPDs) and summarized information about the fabrication...
PURPOSE
This study comprehensively reviewed the current status of the digital workflow of removable partial dentures (RPDs) and summarized information about the fabrication methods and material properties of the dental framework, artificial teeth, and denture base.
STUDY SELECTION
We performed a systematic review of the literature published in online databases from January 1980 to April 2020 regarding RPD fabrication and materials used in the related digital technology. We selected eligible articles, retrieved information regarding digital RPDs, and conducted qualitative/quantitative analyses. In this paper, the computer-aided design/computer-aided manufacturing (CAD/CAM) framework, artificial teeth, and denture base materials are reported.
RESULTS
A variety of materials, such as cobalt-chromium alloy, titanium, zirconia, and polyether ether ketone, are used for dental CAD/CAM frameworks. The mechanical strength of the metal materials used for the CAD/CAM framework was superior to that of the cast framework. However, the fitness and surface roughness of the framework and clasp fabricated using a selective laser melting (SLM) method were not superior to those obtained via cast fabrication. Most material properties and the surface roughness of poly methyl methacrylate (PMMA) discs used for digital RPDs were superior to those of heat-cured PMMA.
CONCLUSION
The use of a CAD/CAM framework and PMMA disc for digital RPDs offers numerous advantages over conventional RPDs. However, technical challenges regarding the accuracy and durability of adhesion between the framework and denture base remain to be solved. In digital fabrication, human technical factors influence the quality of the framework.
Topics: Computer-Aided Design; Denture Bases; Denture, Partial, Removable; Humans; Tooth, Artificial; Workflow
PubMed: 33504722
DOI: 10.2186/jpr.JPR_D_20_00117 -
International Journal of Dentistry 2022The objective of this work is to study galvanic corrosion of different couples of prosthetic and implant alloys through the realization of a systematic review. (Review)
Review
PURPOSE
The objective of this work is to study galvanic corrosion of different couples of prosthetic and implant alloys through the realization of a systematic review.
MATERIALS AND METHODS
An electronic search was performed on Pubmed, Google Scholar, Scopus, ScienceDirect, EbscoHost, and Web of Science for published studies related to electrogalvanism in oral implantology. The keywords used were "dental implants" and "galvanic corrosion." Two independent readers read the scientific articles.
RESULTS
From 65 articles initially identified, only 19 articles met the eligibility criteria. The evaluation of the selected articles allowed us to determine the parameters compared, such as the resistance to galvanic corrosion, the influence of fluorine and pH on the electrochemical behavior, and the release of metal ions and their cytotoxicity. Indeed, Ti6Al4V and precious alloys coupled to titanium were found to be the most resistant to galvanic corrosion, followed by cobalt-chromium alloys and nickel-chromium alloys which were least resistant. This resistance decreases with increasing fluorine concentration and with decreasing pH of the environment. . The implant-prosthetic system's galvanic resistance is influenced by many intrinsic factors: alloy composition and surface condition, as well as extrinsic factors such as pH variations and amount of fluorine. The effects of oral electrogalvanism are essentially the result of two main criteria: effects due to electric currents generated by corrosion and effects due to the release of metal ions by corrosion.
CONCLUSION
To avoid this phenomenon, it is wise to follow the proposed recommendations such as the use of the minimum of distinct metals as much as possible, favoring the commercially pure titanium implant of Ti6Al4V, opting for the choice of couples, titanium/titanium, favoring daily mouthwashes of 227 ppm of fluoride, and avoiding fluorinated acid solutions.
PubMed: 36034476
DOI: 10.1155/2022/4575416 -
Bioinorganic Chemistry and Applications 2022Magnesium alloys have great application prospects as ideal bone implant materials. However, their poor corrosion resistance limits their clinical orthopedic application.... (Review)
Review
Magnesium alloys have great application prospects as ideal bone implant materials. However, their poor corrosion resistance limits their clinical orthopedic application. Surface modification promotes the corrosion resistance of magnesium. Conversion coatings, such as calcium phosphate (Ca-P) coating, microarc oxidation (MAO) treatment, and fluoride (FLU) treatment, have been extensively investigated in in vivo studies. This systematic review and network meta-analysis compared the influence of different conversion coatings on bone repair, material properties, and systemic host response in orthopedic applications. Using the PICOS model, the inclusion criteria for biodegradable magnesium and its alloys were determined for in vivo studies. Four databases were used. The standard and weight mean differences with 95% confidence intervals were used to analyze new bone formation and degradation rate. Network structure and forest plots were created, and ranking probabilities were estimated. The risk of bias and quality of evidence were assessed using SYRCLE, CERQual, and GRADE tools. In the qualitative analysis, 43 studies were selected, and the evaluation of each outcome indicator was not entirely consistent from article to article. In the quantitative analysis, 21 articles were subjected to network meta-analysis, with 16 articles on implant degradation and 8 articles for new bone formation. Additionally, SUCRA indicated that Ca-P coating exhibited the highest corrosion resistance, followed by FLU treatment. MAO demonstrated the best capability for new bone formation, followed by Ca-P coating. Ca-P coating exhibited the highest overall performance. To conclude, coated Mg can promote better new bone formation than bare Mg and has considerable biocompatibility. Ca-P-coated Mg and MAO-coated Mg have the greatest potential to significantly promote corrosion resistance and bone regeneration, respectively. The findings of this study will provide a theoretical basis for the investigation of composite coatings and guidance for the orthopedic application of Mg bone implants.
PubMed: 35399618
DOI: 10.1155/2022/4529520 -
Clinical Oral Implants Research Sep 2023For the present review, the following focused question was addressed: In patients with root-analog dental implants, what is the effect of implants made of other... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
For the present review, the following focused question was addressed: In patients with root-analog dental implants, what is the effect of implants made of other materials than titanium (alloy) on implant survival, marginal bone loss (MBL), and technical and biological complications after at least 5 years.
MATERIALS AND METHODS
An electronic (Medline, Embase, Web of Science) search was performed to identify observational clinical studies published from January 2000 investigating a minimum of 20 commercially available zirconia implants with a mean follow-up of at least 60 months. Primary outcome was implant survival, secondary outcomes included peri-implant MBL, probing depths (PDs), and technical and biological complications. Meta-analyses were performed to evaluate implant survival, MBL, and PD.
RESULTS
From 5129 titles, 580 abstracts were selected, and 111 full-text articles were screened. Finally, 4 prospective and 2 retrospective observational clinical cohort studies were included for data extraction. Meta-analyses estimated after 5 years of loading mean values of 97.2% (95% CI 94.7-99.1) for survival (277 implants, 221 patients), 1.1 mm (95% CI: 0.9-1.3) for MBL (229 implants, 173 patients), and 3.0 mm (95% CI 2.5-3.4) for PDs (231 implants, 175 patients).
CONCLUSIONS
After 5 years, commercially available zirconia implants showed reliable clinical performance based on survival rates, MBL, and PD values. However, more well-designed prospective clinical studies and randomized clinical trials investigating titanium and zirconia implants are needed to confirm the presently evaluated promising outcomes.
Topics: Humans; Dental Implants; Prospective Studies; Retrospective Studies; Titanium; Bone Diseases, Metabolic
PubMed: 37750521
DOI: 10.1111/clr.14133 -
International Journal of Implant... Jul 2023The purpose of this study was to perform a systematic review with meta-analysis on the long-term survival rates of zygomatic implants (ZI). ZI success, prostheses... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The purpose of this study was to perform a systematic review with meta-analysis on the long-term survival rates of zygomatic implants (ZI). ZI success, prostheses survival and success, sinus pathology and patient reported outcomes were also investigated.
METHODS
Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed. Embase and OvidMedline databases were searched alongside the grey literature. The systematic review was recorded in PROSPERO (CRD42022358024). Studies reporting titanium/titanium alloy ZI survival data, ZI-supported prosthesis data, ZIs directly compared to any other implant therapy including grafted sites, a minimum follow-up time of 3 years and a minimum number of 10 patients were included. All study designs were considered if they met the inclusion criteria. Studies not involving ZIs, ZIs not made from titanium/titanium alloy, a follow-up time of < 3 years or < 10 patients, animal studies and in vitro studies were excluded. Long-term follow-up has not been defined in the literature. A minimum of 3 years follow-up was considered acceptable to capture survival after initial healing, alongside in-function prosthesis data via delayed or immediate load protocols. ZI success, was predominantly defined as ZI survival without biological or neurological complications. Meta-analyses were performed for ZI survival, ZI failure incidence, ZI success, loading protocol, prosthesis survival, and prevalence of sinusitis using random effects models. Descriptive analysis was used for ZI success, prosthesis success and patient reported outcome measures.
RESULTS
Five hundred and seventy-four titles were identified, of which 18 met the inclusion criteria. Eligible studies included 1349 ZIs in 623 patients. Mean follow-up period was 75.4 months (range 36-141.6). The mean survival of ZIs was 96.2% [95% CI: 93.8; 97.7] at 6 years. Mean survival for delayed loading was 95% [95% CI: 91.7; 97.1] and 98.1% [95% CI: 96.2; 99.0] for immediate loading (p = 0.03). Annual incidence rate of ZI failure was 0.7% [95% CI 0.4; 1.0]. Mean ZI success was 95.7% [95% CI 87.8; 98.6]. Mean prosthesis survival was 94% [95% CI 88.6; 96.9]. Sinusitis prevalence was 14.2% [95% CI 8.8; 22.0] at 5 years. Patients' reported increased satisfaction with ZIs.
CONCLUSIONS
ZIs have long-term survival comparable to conventional implants. Immediate loading showed a statistically significant increase in survival over delayed loading. Prosthesis survival was similar to that of prostheses supported by conventional implants, with similar complications. Sinusitis was the most frequently encountered biological complication. Patients reported improved outcome measures with ZI use.
Topics: Humans; Dental Implantation, Endosseous; Dental Implants; Prosthesis Failure; Titanium; Treatment Outcome; Alloys
PubMed: 37405545
DOI: 10.1186/s40729-023-00479-x