Abstract
PURPOSE:
To
summarise systematic reviews that assess the effects of different
interventions for implant prosthetic rehabilitation in partially
edentulous patients with the presence of bone atrophy.
MATERIALS AND METHODS:
Only
systematic reviews of randomised controlled trials (RCTs) dealing with
partially edentulous adult patients presenting bone defects were
included. Treatments of interest were bone augmentation procedures, use
of short, tilted or zygomatic implants, sinus lift and transposition of
the inferior alveolar nerve. Outcome variables considered were:
prosthetic and implant failure, complications, radiological and clinical
peri-implant bone level variation, aesthetic and functional
satisfaction, and vestibular peri-implant soft tissue recession. A
search of systematic reviews of RCTs selected from MEDLINE, the Cochrane
Database of Systematic Review, and the Prospero register published in
the past 5 years (May 2012 - May 2017) was performed. Systematic reviews
were also manually searched. Independent data extraction by two authors
using predefined data fields, including ROBIS risk of bias, was
executed.
RESULTS:
A total of 12 systematic reviews of
RCTs were identified for inclusion in the overview. Eight reviews were
considered at low risk of bias. Short implants (≤ 8 mm) were associated
with a notable decrease in complications compared to long implants with
bone augmentation procedures. Many trials compared different sinus lift
procedures and different bone augmentation techniques. None of these
indicated that one procedure could reduce prosthetic or implant failures
when compared to the other. The use of a membrane can contribute to the
regeneration of the hard tissue in horizontal augmentation. Different
membranes or bone substitutes did not give substantially different
results. No data are available regarding comparisons involving zygomatic
implants or tilted implants or transposition of the alveolar nerve.
CONCLUSIONS:
Overall,
the evidence is not sufficiently robust to determine the best treatment
for implant prosthetic rehabilitation in partially edentulous patients
presenting bone atrophy. In terms of vertical defects, if the short
implants can be used they should be used because the number of
complications are reduced compared to longer implants with sinus lift or
bone augmentation. Nevertheless, caution should be exercised because
long-term follow-up studies were not available. No conclusions can be
drawn regarding the comparison between different vertical bone
augmentation techniques in atrophic posterior mandible because
quantitative meta-analyses were not performed. With regards to
horizontal defects, the use of a membrane appears to increase the
regeneration of the hard tissue but no differences were detected in
prosthesis or implant failures or in complications.
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