Interventions for replacing missing teeth: horizontal and vertical bone augmentation techniques for dental implant treatment

  • Review
  • Intervention

Authors


Abstract

Background

Dental implants require sufficient bone to be adequately stabilised. For some patients implant treatment would not be an option without horizontal or vertical bone augmentation. A variety of materials and surgical techniques are available for bone augmentation.

Objectives

To test whether and when augmentation procedures are necessary and which is the most effective technique for horizontal and vertical bone augmentation.

Search methods

The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched. Several dental journals were handsearched. The bibliographies of review articles were checked, and personal references were searched. More than 55 implant manufacturing companies were also contacted. Last electronic search was conducted on 11 June 2009.

Selection criteria

Randomised controlled trials (RCTs) of different techniques and materials for augmenting bone horizontally or vertically or both for implant treatment reporting the outcome of implant therapy at least to abutment connection. Trials were divided into two broad categories: horizontal augmentation and vertical augmentation techniques.

Data collection and analysis

Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and odd ratios for dichotomous outcomes with 95% confidence intervals. The statistical unit of the analysis was the patient.

Main results

Thirteen RCTs out of 18 potentially eligible trials were suitable for inclusion. Three RCTs (106 patients) dealt with horizontal and 10 trials (218 patients) with vertical augmentation. Since different techniques were evaluated in different trials, only one meta-analysis could be performed. When comparing whether vertical augmentation procedures are advantageous over short implants, a meta-analysis of two trials resulted in more implant failures odds ratio (OR) = 5.74 (95% confidence interval (CI) 0.92 to 35.82; borderline significance, P = 0.06) and statistically more complications OR = 4.97 (95% CI 1.10 to 22.40) in the vertically augmented group. When comparing various horizontal augmentation techniques (three trials) no statistically significant differences were observed. When comparing various vertical bone augmentation techniques (eight trials) no statistically significant differences were observed with the exception of three trials which showed that more vertical bone gain could be obtained with osteodistraction than with inlay autogenous grafts (mean difference 3.25 mm; 95% CI 1.66 to 4.84), and with a bone substitute rather than autogenous bone in guided bone regeneration (mean difference 0.60 mm; 95% CI 0.21 to 0.99) in posterior atrophic mandibles, and that patients preferred a bone substitute block than a block of autogenous bone taken from the iliac crest (OR = 0.03; 95% CI 0.00 to 0.64; P = 0.02).

Authors' conclusions

These conclusions are based on few trials including few patients, sometimes having short follow-up, and often being judged to be at high risk of bias. Various techniques can augment bone horizontally and vertically, but it is unclear which are the most efficient. Short implants appear to be a better alternative to vertical bone grafting of resorbed mandibles. Complications, especially for vertical augmentation, are common. Some bone substitutes could be a preferable alternative to autogenous bone. Osteodistraction osteogenesis allows for more vertical bone augmentation than other techniques which on the other hand can allow for horizontal augmentation at the same time. Titanium screws may be preferable to resorbable screws to fixate onlay bone grafts.

摘要

背景

取代缺牙的治療:植牙手術水平和垂直骨增強技術

植牙手術需足夠骨固動.有些病人必須使用水平和垂直骨增強技術否則無法植牙.骨增強技術可使用許多材質和手術技術

目標

檢視是否和何時骨增強技術是必須的,哪種水平和垂直骨增強技術最有用

搜尋策略

搜尋Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE 和EMBASE.手動搜尋一些牙醫期刊.檢查回顧文獻的參考文獻.聯繫超過 55 家植牙醫材廠商.2009年6月11日進行最後一次電子搜尋.

選擇標準

隨機對照試驗,比較使用不同技術和材料進行水平,垂直,或兩者併用的骨增強術.至少須有牙基連接的結果.試驗分為兩類:水平,垂直骨增強術

資料收集與分析

多人獨立重複檢閱可能試驗,評估方法學品質和擷取資料.聯繫作者取得缺少的資訊.連續變項採隨機效果模式平均差,二元變項採OR和95%CI.統計單位為病人

主要結論

18試驗中納入13個.13個(共106病患)試驗研究水平技術,10個(218病患)研究垂直技術.因為試驗研究不同技術,只能進行一項統合分析.比較垂直骨增強術是否優於使用短的植體之統合分析(包含兩個試驗的資料),顯示垂直骨增強術組有較高的植牙失敗率OR(5.74, 95% CI 0.92−35.82; 差一點達到統計顯著, P = 0.06) 和統計顯著較多併發症(OR = 4.97, 95% CI 1.10−22.40). 與多種水平骨增強術相比(3試驗),則沒有顯著差異.與多種垂直骨增強術相比(8試驗),也沒有顯著差異,.但其中三試驗顯示,骨撐開術比鑲嵌自體移植較能達成垂直骨增益(平均差3.25 公釐; 95% CI 1.66−4.84), 骨替代物比起自體骨在下頜骨後萎縮骨增生的表現(平均差0.60公釐; 95% CI 0.21−0.99), 病患偏好骨替代物勝過取自髂骨的自體骨 (OR = 0.03; 95% CI 0.00 – 0.64; P = 0.02).

作者結論

結論根據為少數試驗和少數受試者,有些追蹤期短,偏差風險大.許多技術可垂直或水平增強顎骨,但不知道哪種最好.短植牙似乎比垂直下顎骨移植好.併發症常見,尤其對垂直牙增強術.一些骨替代物優於自體骨. 骨轉移成骨比其他技術更能達成垂直增強顎骨,也可達到水平牙骨增強. 鈦鑽頭勝過可吸收頭又勝過早熟骨移植

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

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

總結

取代缺牙的治療:植牙手術水平和垂直骨增強技術.有些病患沒有足夠顎骨植牙,有許多手術可增加牙量以植牙.短植牙似乎比傳統植體有效且併發症較少.傳統將來自髖骨或牛骨的骨替代物放入下顎骨.顎骨可以不同技巧使其於水平或垂直增生,但不知哪種方法叫好.併發症常見於垂直牙增強術.一些骨替代物優於自身體各部位取得的骨頭植體好,併發症和疼痛較少.

Plain language summary

Interventions for replacing missing teeth: horizontal and vertical bone augmentation techniques for dental implant treatment

Some patients may have insufficient bone to place dental implants but there are many surgical techniques to increase the bone volume making implant treatment possible.
Short implants appear to be more effective and cause less complications than conventional implants placed in resorbed lower jaws (mandibles) augmented with bone from the hip or bone substitutes (cow bone blocks). Bone can be regenerated in a horizontal and vertical direction using various techniques, but it is unclear which techniques are preferable, and complications especially for augmenting bone in a vertical direction are frequent. Some bone substitutes may cause less complications and pain than taking the own bone from various parts of the body.

Ringkasan bahasa mudah

Intervensi untuk menggantikan kehilangan gigi: teknik augmentasi tulang mendatar dan menegak untuk rawatan implan

Sesetengah pesakit mungkin tidak mempunyai cukup tulang untuk meletakkan implan gigi tetapi terdapat banyak teknik pembedahan untuk menambah isipadu tulang bagi membolehkan rawatan implan.
Implan pendek lebih berkesan dan kurang komplikasi berbanding implan konvensional yang diletakkan di dalam rahang bawah (mandibel) yang meresap yang diperkukuhkan dengan tulang dari pinggul atau pengganti tulang (blok tulang lembu) Tulang boleh terbentuk arah mendatar atau menegak dengan pelbagai teknik, namun adalah tidak jelas teknik mana yang lebih utama dan komplikasi adalah lebih kerap terutama bagi mengukuhkan tulang menegak.Beberapa pengganti tulang mungkin menyebabkan kurang komplikasi dan sakit berbanding pengambilan tulang sendiri dari beberapa bahagian tubuh.

Catatan terjemahan

Diterjemahkan oleh Noorliza Mastura Ismail (Kolej Perubatan Melaka-Manipa). Disunting oleh Norhayati Mohd Noor/Tuan Hairulnizam Tuan Kamauzaman (Universiti Sains Malaysia). Untuk pertanyaan tentang terjemahan ini, sila hubungi noorliza.mastura@manipal.edu.my.

Ancillary