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Interventions for replacing missing teeth: preprosthetic surgery versus dental implants

  • Review
  • Intervention

Authors


Abstract

Background

Preprosthetic surgery refers to the surgical procedures that can modify the oral anatomy to facilitate the retention of conventional dentures. Osseointegrated implants offer an alternative treatment to improve denture retention. A denture may be connected by special attachments to implants placed into the jaw.

Objectives

To test the null hypothesis of no difference in the success (patient satisfaction and morbidity) and cost effectiveness between conventional prostheses that require preprosthetic surgery (PPS) and implant retained prostheses (IRO) that do not require preprosthetic surgery, against the alternative hypothesis of a difference.

Search methods

The Cochrane Oral Health Group Trials Register (May 2002), CENTRAL (The Cochrane Library 2002, Issue 2), MEDLINE and EMBASE (May 2002) were searched. In addition, 55 implant companies were contacted and the bibliographies of review articles were checked for studies outside the hand searched journals and personal references were searched.

Selection criteria

Randomised controlled trials (RCTS) comparing preprosthetic surgery and implant retained dentures for improving denture retention.

Data collection and analysis

Data were independently extracted, in duplicate, by two review authors. Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Collaboration's statistical guidelines were followed.

Main results

One study, containing 60 participants, reported in four articles was identified for inclusion in this review. No studies were excluded. There was a statistically significant difference between mean patient satisfaction scores with patients in the IRO group being more satisfied in general at both year 1 (WMD = -0.66 (95% CI -1.28 to -0.04)) and 5 years (WMD = -0.90 (95% CI -1.74 to -0.06). Altered sensation of the lower lip and chin was measured at 1 year and 5 years. There was no statistically significant difference at either time point and no patients had altered sensation at 5 years.

Authors' conclusions

There is weak evidence from the results of one randomised controlled trial including 60 subjects that patients are generally less satisfied with preprosthetic surgery and a conventional denture than with an implant retained denture. There is a need for more well designed trials comparing the success and cost-effectiveness of preprosthetic surgery and implant supported dentures. Such trials should be reported according to the CONSORT guidelines (www.consort-statement.org/). However, since preprosthetic surgery is considered to be an obsolete treatment nowadays, almost completely replaced by dental implants, it may be that new RCTs on this topic will not be designed.

摘要

背景

重建缺牙的新發明:贗復前手術與人工牙根

贗復前手術可以改善口腔解剖型態以利傳統活動假牙的製作,骨整合人工牙根則可以提升活動假牙的固著力,例如使用一些特殊構造將假牙與植入顎骨的人工牙根連結。

目標

測試虛無假設是否成立,即證實傳統假牙合併贗復前手術(PPS)與不需合併贗復前手術的植體固位式假牙(IRO)並不影響成功率(包含病患滿意度與後遺症)與假牙效用。

搜尋策略

本研究搜尋The Cochrane Oral Health Group (OHG) Specialised Register (2002年五月), the Cochrane Controlled Trials Register (2002年第2期), MEDLINE and EMBASE (2002年五月). 此外我們與55家植體廠商連繫,參考回顧性文章的參考文獻,以及尋找手動蒐集文獻與個人著作以外的資料.

選擇標準

比較贗復前手術與植體固位式假牙之差異,以提升假牙固著力的隨機對照試驗。

資料收集與分析

所有資料由兩位專家獨立審查,為了更了解研究的細節,我們聯絡了文獻作者並完成有品質的分析。遵循Cochrane OHG的統計準則.

主要結論

有一個研究,含60位受試者,納入本次的回顧中.在一年(WMD = −0.66(95% CI; −1.28 to −0.04))及五年(WMD = −0.90(95%CI; −1.74 to −0.06)觀察點,IRO組擁有較高的滿意度並達到統計上的顯著差異。在下唇感覺異常的統計上.兩組並無顯著差異。在五年的觀察點,兩組皆無下唇感覺異常之案例。

作者結論

從樣本數為60的隨機對照試驗只能提供一個較弱的證明來確認傳統假牙合併贗復前手術患者的滿意度低於接受植體固位式假牙病患。因此需要一個良好設計的試驗來比較贗復前手術與植體固位式假牙的成功率與成本效益,而如此的試驗必須符合CONSORT的指導方針(http://www.consortstatement.org/)。然而,由於近來認為贗復前手術是多餘的治療,使得這方面的隨機對照試驗較少被使用。

翻譯人

本摘要由臺灣大學附設醫院鄭翔元翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

現今仍缺乏有利證據來確認傳統假牙合併贗復前手術患者的滿意度低於接受植體固位式假牙病患,因此需要更多的實證人工植體手術可以提高假牙的固著力,因為有許多病患因為牙齦或顎骨的型態或肌肉構造的影響,使得假牙固著力不佳。傳統假牙合併贗復前手術與人工牙根固位式假牙接可以提升假牙固著力,在本研究中尚無法對於何者為優做定論,但的確有證據顯示相對於傳統手術,病患偏好使用人工牙根。

Plain language summary

Interventions for replacing missing teeth: preprosthetic surgery versus dental implants

There is weak evidence that patients are generally less satisfied with a conventional denture made after oral surgery to improve the retention of the denture than with a denture retained by implants.
More evidence is needed to compare mouth surgery and dental implants to help retain dentures for people who cannot keep dentures in place easily.
Some people who need dentures will have trouble keeping them in place because of the shape of their gums and jaws, or muscle structure in the mouth. Surgery can be done to try and improve denture retention (preprosthetic surgery). Another option is an implant retained overdenture, where dentures are attached to dental implants that go into the jaw. The review found that there is not enough evidence from trials to show which surgical techniques, types of implant or types of denture may have better results. However, there is some evidence to suggest that people may prefer implants to conventional surgery.

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