中国循证医学杂志

中国循证医学杂志

种植体即刻负重或早期负重与延期负重相比对种植体成功率影响的Meta分析

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目的 系统评价种植体即刻负重或早期负重与延期负重相比对种植体成功率的影响。
方法 计算机检索 PubMed、EMbase、CNKI 等数据库,收集 1997~2007 年间国内外所有有关种植体即刻负重或早期负重与延期负重对比的随机对照试验或前瞻性病例对照研究。对纳入研究进行质量评价、数据提取,并进行Meta 分析。
结果 共检索到16篇符合纳入与排除标准的文献,剔除两篇重复报道后,纳入14个研究进行Meta分析,其中5篇为随机对照试验。Meta分析结果显示,与延期负重相比,早期负重种植体失败率略低,但差异无统计学意义[OR=0.54,95%CI(0.22,1.33),P =0.18];纳入所有病例对照研究再分析以及进行敏感性分析,结果也是如此。与延期负重相
比,即刻负重种植体总失败率更大,但差异无统计学意义[OR=1.51, 95%CI(0.53, 4.25),P =0.44];分析随机对照试验时虽有即刻负重更有利于种植体成功的趋势,但差异亦无统计学意义;进行敏感性分析时除剔除 Jo 等的文献后结果不一样外,其余结果均显示即刻负重与延期负重对种植体成功率的影响无统计学差异。
结论 现有的有限证据表明,当骨质较好 ( 至少为Ⅲ级骨)时,早期负重比延期负重有更有利于种植体成功的趋势;而即刻负重和延期负重相比,种植体成功率差异无统计学意义。受纳入文献数量和质量的限制,本次Meta分析结果尚有待于高质量的大样本随机对照试验以予证实。

Objective To use a meta-analytic technique to estimate the survival of implants between immediate loading/early loading and delayed loading.
Methods We carried out a systematic search of electronic databases for all prospective trials comparing conventional delayed implant loading with early or immediate implant loading, reported between 1997 and 2007. The outcome of interest was implant failure rate. Quality assessment was performed for prospective trials that met the eligibility criteria and the data were then extracted and analyzed.
Results Sixteen articles were found to meet the eligibility criteria, but two studies were reported in four articles, so that 14 articles were analyzed. There were five randomized controlled trials (RCTs). Compared to delayed loading, implant failure occurred sl ightly, but not statistically significant,less often with early implant loading (OR=0.54, 95%CI 0.22 to 1.33, P =0.18). We combined all cohort studies and this analysis was consistent with this result. Immediate implant loading was associated with slightly, but not statistically significant, worse outcomes (OR=1.51, 95%CI 0.53 to 4.25, P =0.44). We only pooled the RCTs and results showed better implant success rate with immediate implant loading, but with no significant difference. When sensitivity analyses were performed by the sequential dropping of a single study, no significant differences were observed except when the study of Jo et al was excluded.
Conclusion Early implant loading was associated with better outcomes compared to delayed loading when the implants were placed into good quality bone. There was no significant difference of the implant success rate between immediate loading and delayed loading. Further evaluations in adequately powered large RCTs are needed to confirm these findings.

关键词: 种植体; 延期负重; 即刻负重; 早期负重; Meta分析

Key words: Dental implants; Delayed loading; Immediate loading; Early loading; Meta-analysis

引用本文: 肖慧娟,杨云东,施斌,柳忠豪,韩晓鹏,郭毅. 种植体即刻负重或早期负重与延期负重相比对种植体成功率影响的Meta分析. 中国循证医学杂志, 2008, 08(2): 120-126. doi: 10.7507/1672-2531.20080027 复制

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1. Brunski JB. Biomechanical factors affecting the bone-dental implant interface. Clin Mater, 1992, 10(3): 153-201.
2. Bidez MW, Misch CE. Force transfer in implant dentistry: Basic concepts and principles. Implant Dent, 1992, 1(4): 289-294.
3. Pill iar RM, Deporter D, Watson PA. Tissue-implant interface: Micro-movements effects.In: Vincenzini P(ed). Advances in Science and Technology. Vol 12: Materials in clinical appl ications: Proceedings of Topical Symposium Ⅷ on Materials in Clinical Appl ications of the 8th CLIMTEC World Ceramic Congress and Forum on New Materials, Florence,Italy,June 28 to July 4,1994. Faenza. Italy: Techna, 1995: 569-579.
4. Branemark PI. Osseointegration and its experimental background. J Prosthet Kent, 1983, 50: 399-410.
5. Branemark PI, Hansson BO, Adell R, et al. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg, 1977, 16(Suppl): 1-132.
6. Piattelli A,Ruggeri A,Franchi M,et al. A histologic and histomorphometric study of bone reactions to unloaded and loaded non-submerged single implants in monkeys: a pilot study.J Oral Implantol, 1993, 19: 314-320.
7. Piattelli A, Corigliano M, Scarano A, et al. Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants: a pilot study in monkeys. Int J Periodontics Restorative Dent, 1997, 17: 162-169.
8. Piattelli A, Corigliano M, Scarano A, et al.Immediate loading of titanium plasma-sprayed implants: a histologic analysis in monkeys. J Periodontol, 1998, 69: 321-327.
9. Gatti C, Haefliger W, Chiapasco M.Implant-related mandibular overdentures with immediate loading: a prospective study of ITI implants. Int J Oral Maxillofac Implants, 2000, 15: 383-388.
10. Chiapasco M, Abati S, Romeo E, et al. Implant-retained mandibular overdentures with Branemark System MKⅡ implants: a prospective comparative study between delayed and immediate loading. Int JOral Maxillofac Implants, 2001, 16: 537-546.
11. Degidi M, Piattelli A. Immediate functional and non-functional loading of dental implants: a 2- to 60-month follow-up study of 646 titanium implants. J Periodontol, 2003, 74(2): 225-241.
12. Ericsson I, Randow K, Peterson A. Early functional loading of Branemark dental? implants: 5-year clinical follow-up study, Clin Implant Dent Relat Res, 2000, 2: 70-77.
13. Degidi M, Scarano A, Iezzi G, et al. Periimplant bone in immediately loaded titanium implants: histologic and histomorqhometric evaluation in human. A report of two cases. Clin Implant Dent Relat Res, 2003, 3: 170-175.
14. Wolfinger GJ, Balshi TJ, Rangert B. Immediate functional loading of branemark system implants in edentulous mandibular: Clinical report of the results of developmental and simplified protocol. Int J Oral Maxillofac Implants, 2003, 18: 250-257.
15. Alderson P, Green S, Higgins JPT, editors. Cochrane Reviewers’ Handbook 4.2.2 [updated March 2004] [M /CD]. In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley &Sons, Ltd.
16. Khan K, Ter Riet G, Glanville J, et al. Undertaking systematic reviews of research on effectiveness CRD guidance for carrying out or commissioning reviews, 2nd edn. CRD Report 4. York, NHS Centre for Reviews and Dissemination (CRD), University of York, 2000.
17. Lorenzoni M, Pertl C, Zhang K, et al. In-patient comparison of immediately loaded and non-loaded implants within 6 months. Clin Oral Implants Res, 2003, 14(3): 273-279.
18. Turkyilmaz I. Clinical and radiological results of patients treated with two loading protocols for mandibular overdentures on Branemark implants. J Clin Periodontol, 2006, 33(3): 233-238.
19. Roccuzzo M,Bunino M,Priogl io F,et al .Early loading of sandblasted and acid-etched (SLA) implants: A prospective spl int-mouth comparative study: One year results. Clin Oral Implants Res, 2001, 12: 572-578.
20. Ostman PO, Hellman M, Sennerby L. Direct implant loading in the edentulous maxilla using a bone density-adapted surgical protocol and primary implant stability criteria for inclusion. Clin Implant Dent Relat Res, 2005, 7 Suppl 1: S60-69.
21. Attard NJ, David LA, Zarb GA. Immediate loading of implants with mandibular overdentures: one-year clinical results of a prospective study. Int J Prosthodont, 2005, 18(6): 463-470.
22. Degidi M, Piattelli A, Gehrke P,et al. Cl inical outcome of 802 immediately loaded 2-stage submerged implants with a new grit-blasted and acid-etched surface: 12-month follow-up. Int J Oral Maxillofac Implants, 2006, 21(5): 763-768.
23. Friberg B, Henningsson C,Jemt T. Rehabilitation of edentulous mandibles by means of turned Branemark System implants after one-stage surgery: a 1-year retrospective study of 152 patients. Clin Implant Dent Related Res, 2005, 7(1): 1-9.
24. Schnitman P, Wohrle PS, Rubenstein JE, et al. Ten year results for Branemark implants immediately loaded with fixed prostheses at implant placement. Int J Oral Maxillofac Implants, 1997, 12: 495-503.
25. Randow K, Ericsson I,Nilner K, et al. Immediate functional loading of Branemark dental implants. An 18-month cl inical follow-up study. Clin Oral Implants Res, 1999, 10: 8-15.
26. Ericsson I, Nilson H, Lindh T, et al. Immediate functional loading of Branemark single tooth implants. An 18 month clinical pilot follow-up study. Clin Oral Implants Res, 2000, 11:26-33.
27. Jo YH, Hobo PK, Hobo S. Freestanding and multiunit ?immediate loading of the expandable implant: An up-to-40-month prospective survival study. J Prosthet Dent, 2001, 85: 148-155.
28. Roynesdal AK, Amundrud B, Hannaes HR. A comparative clinical investigation of 2 early loaded ITI dental implants supporting an overdenture in the mandible.Int J Oral Maxillofac Implants, 2001,16: 246-251.
29. Tawse-Smith A, Payne AGT, Kumara R, et al. Early loading of unspl inted implants supporting mandibular overdentures using a one-stage operative procedure with two different implant systems: A 2-year report. Clin Implant Dent Related Res, 2002, 4: 33-42.
30. Payne A, Tawse-Smith A, Duncan WD,et al. Conventional and early loading of unspl inted ITI implants supporting mandibular overdentures. Two-year results of a prospective randomized clinical trial. Clin Oral Implants Res, 2002, 13: 603-609.
31. Romeo E, Chiapasco M, Lazza A, et al. Implant-retained mandibular overdentures with ITI?implants. A comparison of 2-year results between conventional and immediate loading. Clin Oral Implants Res, 2002, 13: 495-501.
32. Cannizzaro G, Leone M. Restoration of partially edentulous patients using dental implants with microtextured surface: A prospective comparison of delayed and immediate full occlusal loading. Int J Oral Maxillofac Implants, 2003, 18: 512-522.
33. Fischer K, Stenberg T. Early loading of ITI implants supporting a maxillary full-arch prosthesis: 1-year data of a prospective, randomized study. Int J Oral Maxillofac Implants, 2004, 19(3): 374-381.
34. Engquist B, Astrand P, Anzen B, et al. Simplified methods of implant treatment in the edentulous lower jaw. Part II: Early loading. Clin Implant Dent Relat Res, 2004, 6(2): 90-100.
35. Engquist B, Astrand P, Anzen B, et al. Simplified methods of implant treatment in the edentulous lower jaw: a 3-year follow-up report of a controlled prospective study of one-stage versus two-stage surgery and early loading. Clin Implant Dent Related Res, 2005, 7(2): 95-104.
36. Degidi M, Piattelli A, Carinci F. Parallel screw cyl inder implants: comparative analysis between immediate loading and two-stage heal ing of 1,005 dental implants with a 2-year follow up. Clin Implant Dent Related Res, 2006, 8(3): 151-160.
37. Fischer K,Stenberg T. Three-year data from a randomized, controlled study of early loading of single-stage dental implants supporting maxillary full-arch prostheses. Int J Oral Maxillofac Implants, 2006, 21(2): 245-252.
38. Esposito M, Worthington HV, Coulthard P.Interventions for replacing missing teeth: different times for loading dental implants. The Cochrane Database of Systematic Reviews. The Cochrane Library, 2004, 1: 1-16.
39. Immediate loading of dental implants. An Alert Report from the Swedish Council on Technology Assessment in Health Care, March 2003. Available at: www.sbu.se/www.index.asp
40. Babbush CA, Kent JN, Misiek DJ. Titanium plasma-sprayed (TPS) screw implants for the reconstruction of the edentulous mandible. J Oral Maxillofac Surg, 1986, 44: 274-282.