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Intervention Review

Interventions for replacing missing teeth: different types of dental implants

  1. Marco Esposito1,*,
  2. Lawrence Murray-Curtis1,
  3. Maria Gabriella Grusovin1,
  4. Paul Coulthard1,
  5. Helen V Worthington2

Editorial Group: Cochrane Oral Health Group

Published Online: 17 OCT 2007

Assessed as up-to-date: 9 AUG 2007

DOI: 10.1002/14651858.CD003815.pub3


How to Cite

Esposito M, Murray-Curtis L, Grusovin MG, Coulthard P, Worthington HV. Interventions for replacing missing teeth: different types of dental implants. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003815. DOI: 10.1002/14651858.CD003815.pub3.

Author Information

  1. 1

    School of Dentistry, The University of Manchester, Department of Oral and Maxillofacial Surgery, Manchester, UK

  2. 2

    School of Dentistry, The University of Manchester, Cochrane Oral Health Group, MANDEC, Manchester, UK

*Marco Esposito, Department of Oral and Maxillofacial Surgery, School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester, M15 6FH, UK. espositomarco@hotmail.com. marco.esposito@manchester.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 17 OCT 2007

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Dental implants are available in different materials, shapes and with different surface characteristics. In particular, numerous implant surface modifications have been developed for enhancing clinical performance.

Objectives

To test the null hypothesis of no difference in clinical performance between various root-formed osseointegrated dental implant types.

Search methods

We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of relevant clinical trials and review articles for studies outside the handsearched journals. We wrote to authors of the identified randomised controlled trials (RCTs), to more than 55 oral implant manufacturers; we used personal contacts and we asked on an internet discussion group in an attempt to identify unpublished or ongoing RCTs. No language restriction was applied. The last electronic search was conducted on 13 June 2007.

Selection criteria

All RCTs of oral implants comparing osseointegrated implants with different materials, shapes and surface properties having a follow up of at least 1 year.

Data collection and analysis

Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI).

Main results

Forty different RCTs were identified. Sixteen of these RCTs, reporting results from a total of 771 patients, were suitable for inclusion in the review. Eighteen different implant types were compared with a follow up ranging from 1 to 5 years. All implants were made in commercially pure titanium and had different shapes and surface preparations. On a 'per patient' rather than 'per implant' basis no significant differences were observed between various implant types for implant failures. There were statistically significant differences for perimplant bone level changes on intraoral radiographs in three comparisons in two trials. In one trial there was more bone loss only at 1 year for IMZ implants compared to Brånemark (mean difference 0.60 mm; 95% CI 0.01 to 1.10) and to ITI implants (mean difference 0.50 mm; 95% CI 0.01 to 0.99). In the other trial Southern implants displayed more bone loss at 5 years than Steri-Oss implants (mean difference -0.35 mm; 95% CI -0.70 to -0.01). However this difference disappeared in the meta-analysis. More implants with rough surfaces were affected by perimplantitis (RR 0.80; 95% CI 0.67 to 0.96) meaning that turned implant surfaces had a 20% reduction in risk of being affected by perimplantitis over a 3-year period.

Authors' conclusions

Based on the available results of RCTs, there is limited evidence showing that implants with relatively smooth (turned) surfaces are less prone to lose bone due to chronic infection (perimplantitis) than implants with rougher surfaces. On the other hand, there is no evidence showing that any particular type of dental implant has superior long-term success. These findings are based on a few RCTs, often at high risk of bias, with few participants and relatively short follow-up periods. More RCTs should be conducted, with follow up of at least 5 years including a sufficient number of patients to detect a true difference. Such trials should be reported according to the CONSORT recommendations (www.consort-statement.org/).

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Interventions for replacing missing teeth: different types of dental implants

There is limited evidence showing that implants with relatively smooth surfaces are less prone to lose bone due to chronic infection (perimplantitis) than implants with rougher surfaces. On the other hand implants with a turned (smoother) surface might be at greater risk to fail early than implants with roughened surfaces. There is no evidence showing that any particular type of dental implant has superior long-term success.

Missing teeth can sometimes be replaced with dental implants into the jaw, as bone can grow around the implant. A crown, bridge or denture can then be attached to the implant. Many modifications have been developed to try to improve the long-term success rates of implants, and different types have been heavily marketed. More than 1300 types of dental implants are now available, in different materials, shapes, sizes, lengths and with different surface characteristics or coatings. However, the review found there is not enough evidence from trials to demonstrate superiority of any particular type of implant or implant system.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

取代缺牙的介入方式: 各種不同形式的牙科植體

目前有許多不同的材料、形狀以及不同的表面特徵的牙科植體。尤其是許多植體表面經過改良後可以增強臨床的效果。

目標

測試我們的虛無假設: 各種不同的牙根型牙科植體在臨床上的表現並無明顯差異。

搜尋策略

我們經由Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE 以及 EMBASE 等網站搜尋。人工搜詢則包括許多牙科期刊。我們檢閱相關臨床試驗以及文獻回顧文章中的參考書目來尋找人工搜尋之外的研究。我們寫信給找到的臨床隨機試驗的作者, 還有超過55家的口腔植體製造廠商;我們經過個別聯絡以及網路討論的方式來找出還未發表的和正在進行中的臨床隨機試驗。尋找的文章並不限制語言。最後電子搜尋的日期為2007年6月13日。

選擇標準

所有比較各種不同材料, 形狀以及表面性質的骨整合口腔植體, 並且至少追蹤一年以上的隨機臨床試驗。

資料收集與分析

篩選可使用的研究, 評估該試驗採用方法的品質好壞以及資料的擷取是由二位檢查者各自獨立並重複進行。所得結果是用隨機效果模型(randomeffects models)表示,以平均差異作為連續性結果,以危險比率作為二分式結果,而有效區間為95%

主要結論

在找到的40篇不同的隨機臨床試驗中, 其中16篇從771個病人得到的結果, 適合包含於此篇文獻回顧. 比較18種不同的植體在1 – 5年的追蹤結果.所有的植體都是以商業用的純鈦製成,各有不同的形狀及表面處理.若以每個病人為基準而不以每個植體來看,則各種不同的植體種類和植體的失敗間並無統計學上的差異.在二個隨機臨床試驗中的三個比較結果,在口內X光檢查植體周圍骨頭的變化則有統計上的差異。其中一個隨機臨床試驗發現IMZ植體系統在一年後的骨吸收比 Branemark植體系統多(平均差 0.60 mm; 95%有效區間 0.01 to 1.10),也比ITI植體系統多(平均差0.50 mm; 95%有效區間0.01 to 0.99).在另一隨機臨床試驗中, Southern植體系統比SteriOss植體系統在5年後呈現更多的骨吸收(平均差 −0.35 mm; 95% 有效區間 −0.70 to −0.01)。然而這個差異在metaanalysis中則看不到。在粗糙面的植體設計中3 年內的觀察期有更多的植體會有植體牙周炎的產生(危險比率 0.80; 95% 有效區間0.67 to 0.96),意謂機械切割的植體表面受到植體牙周炎的影響比率較粗糙面植體少了20%。

作者結論

由目前可得到的隨機臨床試驗結果, 並無足夠的證據顯示平滑面(切割面)植體相較於粗糙面植體較不易發生慢性感染 (植體牙周炎)。另一方面, 也沒有證據顯示那一種植體設計有較佳的長期成功率。這些發現都是根據少數的隨機臨床試驗結果,常常有產生偏差的危險,而且受測者少,追蹤的時間短。為了偵測出真實的差異性,應該進行更多的隨機臨床試驗,並且有足夠的病患追蹤至少5年。這種試驗應該根據CONSORT的建議方式來報告(http://www.consort statement.org/)。

翻譯人

本摘要由臺灣大學附設醫院鄭偉立翻譯。

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

總結

取代缺牙的介入方式: 各種不同形式的牙科植體.並無足夠的證據顯示平滑面(切割面)植體相較於粗糙面植體較不易發生慢性感染 (植體牙周炎)。另一方面, 切割面(平滑面)植體相較於粗糙面植體可能有較高的風險產生早期的失敗。沒有證據顯示那一種植體設計有較佳的長期成功率。缺牙可以被植入顎骨的牙科植體取代,因為骨頭可以在植體的周圍生長。之後可以將牙冠, 牙橋或活動義齒聯結在植體上。許多設計上的改變被研發來試著改進植體長期的成功率,而市面上也充斥著各種不同的植體。現在有超過1300種植體可買的到,包括不同的材料、形狀、大小、長度、以及不同的表面特徵或塗層。然而這篇文獻回顧發現從試驗中所得的結論並沒有足夠的證據顯示那一種植體或植體系統呈現出較佳的結果。