在后牙区应用4 mm超短种植体临床效果的Meta分析

doi:10.7518/hxkq.2023.01.011

华西口腔医学杂志 ›› 2023, Vol. 41 ›› Issue (1): 80-87.doi: 10.7518/hxkq.2023.01.011

在后牙区应用4 mm超短种植体临床效果的Meta分析

张启航¹(), 龚佳明², 余佳颖¹, 赵瑞敏², 苟萍¹, 余占海¹()

^1.兰州大学口腔医学院/口腔医院种植科，兰州 730000
^2.解放军联勤保障部队第940医院口腔科，兰州 730050

收稿日期:2022-09-09 修回日期:2022-12-23 出版日期:2023-02-01 发布日期:2023-02-21
通讯作者: 余占海 E-mail:zhangqh20@lzu.edu.cn;yuzhanhai@lzu.edu.cn
作者简介:张启航，硕士，E-mail：zhangqh20@lzu.edu.cn
基金资助:
兰州大学口腔医院科研基金(lzukqky-2020-t07)

Clinical efficacy of extra-short implant (4 mm) placed in posterior areas: a Meta-analysis

Zhang Qihang¹(), Gong Jiaming², Yu Jiaying¹, Zhao Ruimin², Gou Ping¹, Yu Zhanhai¹()

^1.Dept. of Implantology, School of Stomatology, Lanzhou University, Lanzhou 730000, China
^2.Dept. of Stomatology, The 940th Hospital of Joint Logistics Support Force of People’s Liberation Army, Lanzhou 730050, China

Received:2022-09-09 Revised:2022-12-23 Online:2023-02-01 Published:2023-02-21
Contact: Yu Zhanhai E-mail:zhangqh20@lzu.edu.cn;yuzhanhai@lzu.edu.cn
Supported by:
Hospital of Stomatology Lanzhou University Scientific Research Project(lzukqky-2020-t07)

摘要/Abstract

摘要：

目的通过系统评价及Meta分析的方法评估在后牙区骨量不足植入4 mm超短种植体（ESI）的安全性和效用。方法电子检索2010年1月1日—2022年8月31日PubMed、Embase、Cochrane Library、Web of Science、CNKI、万方数据库有关ESI与标准种植体（SI）（≥8 mm）的随机对照试验或临床对照试验，并进行引文检索。应用RevMan 5.4版软件进行Meta分析。结果共11篇研究符合纳入标准，其中随机对照试验6篇，临床对照试验5篇。Meta分析结果：在后牙区种植时，ESI与SI的存留率差异无统计学意义［RR=1.23，95%CI（0.66，2.27），P=0.52］；ESI表现出更稳定的边缘骨水平［MD=-0.16，95%CI（-0.25，-0.07），P=0.000 7］，更少的生物并发症［RR=0.34，95%CI（0.19，0.62），P=0.000 4］，然而机械并发症更多［RR=2.89，95%CI（1.05，7.92），P=0.04］。结论基于有限的证据，在后牙牙槽嵴高度低于5 mm时应用ESI可以获得媲美SI的临床效果，且具备技术敏感性低、术后生物并发症少等优势。由于ESI长期随访证据不足、样本量有限，仍需要更多临床试验评估ESI的长期效用。

关键词: 超短种植体, 标准种植体, 存留率, 边缘骨吸收, 并发症, Meta分析

Abstract:

Objective This study aimed to systematically evaluate the safety and clinical efficacy of 4 mm-extra-short implant (ESI) placement in severely atrophic posterior areas. Methods Databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang from January 1, 2010, until August 31, 2022, were searched to identify randomized controlled trials or controlled clinical trials related to ESI and standard implants (SI). An additional hand search of the references of included articles was also conducted. Meta-analyses were carried out with RevMan 5.4 software. Results A total of 11 studies were included, involving six randomized controlled trials and five controlled clinical trials. The meta-analyses indicated that when implants were placed in the posterior area, the implant survival rate between ESI and SI did not significantly differ [RR=1.23, 95%CI (0.66, 2.27), P=0.52]. ESI resulted in significantly stable marginal bone level [MD=-0.16, 95%CI (-0.25,-0.07), P=0.000 7] and less biological complications [RR=0.34, 95%CI (0.19, 0.62), P=0.000 4] but more mechanical complications [RR=2.89, 95%CI (1.05, 7.92), P=0.04]. Conclusion Based on the limited evidence, ESI could achieve clinical outcomes similar to those of SI when the height of the posterior alveolar bone is less than 5 mm, with lower technical sensitivity and fewer postoperative clinical complications than SI. Due to insufficient evidence and limited sample size, further clinical trials are needed to verify the long-term efficacy of ESI.

Key words: extra-short implant, standard implant, survival rate, marginal bone resorption, complications, Meta-analysis

中图分类号:

R 783.1

张启航, 龚佳明, 余佳颖, 赵瑞敏, 苟萍, 余占海. 在后牙区应用4 mm超短种植体临床效果的Meta分析[J]. 华西口腔医学杂志, 2023, 41(1): 80-87.

Zhang Qihang, Gong Jiaming, Yu Jiaying, Zhao Ruimin, Gou Ping, Yu Zhanhai. Clinical efficacy of extra-short implant (4 mm) placed in posterior areas: a Meta-analysis[J]. West China Journal of Stomatology, 2023, 41(1): 80-87.

图/表 3

表 1

图 1

表 2

参考文献 36

1	史远, 杨国利. 外斜线取骨自体骨移植及其他牙槽嵴骨增量法的研究进展[J]. 口腔医学, 2021, 41(6): 557-560, 571.
	Shi Y, Yang GL. Research progress of autogenous bone graft from mandibular lateral oblique line and other alveolar ridge augmentation methods[J]. Stomatology, 2021, 41(6): 557-560, 571.
2	范震, 刘月, 王佐林. 牙列缺失倾斜种植设计[J]. 华西口腔医学杂志, 2021, 39(4): 377-385.
	Fan Z, Liu Y, Wang ZL. Tilted implantation technique for edentulous patients[J]. West China J Stomatol, 2021, 39(4): 377-385.
3	Romanos GE. Severe atrophy of the posterior mandible and inferior alveolar nerve transposition[J]. Int J Periodontics Restorative Dent, 2021, 41(5): e199-e204.
4	张富贵, 宿玉成, 邱立新, 等. 牙槽骨缺损骨增量手术方案的专家共识[J]. 口腔疾病防治, 2022, 30(4): 229-236.
	Zhang FG, Su YC, Qiu LX, et al. Expert consensus on the bone augmentation surgery for alveolar bone defects[J]. J Dent Prevent Treat, 2022, 30(4): 229-236.
5	Lozano-Carrascal N, Anglada-Bosqued A, Salomó-Coll O, et al. Short implants (<8 mm) versus longer implants (≥8 mm) with lateral sinus floor augmentation in posterior atrophic maxilla: a meta-analysis of RCT s in humans[J]. Med Oral Patol Oral Cir Bucal, 2020, 25(2): e168-e179.
6	Li QL, Yao MF, Cao RY, et al. Survival rates of splinted and nonsplinted prostheses supported by short dental implants (≤8.5 mm): a systematic review and meta-analysis [J]. J Prosthodont, 2022, 31(1): 9-21.
7	Afrashtehfar KI, Katsoulis J, Koka S, et al. Single versus splinted short implants at sinus augmented sites: a systematic review and meta-analysis[J]. J Stomatol Oral Maxillofac Surg, 2021, 122(3): 303-310.
8	Leighton Y, Carpio L, Weber B, et al. Clinical evaluation of single 4-mm implants in the posterior mandible: a 3-year follow-up pilot study[J]. J Prosthet Dent, 2022, 127(1): 80-85.
9	Barausse C, Pistilli R, Canullo L, et al. A 5-year randomized controlled clinical trial comparing 4-mm ultrashort to longer implants placed in regenerated bone in the posterior atrophic jaw[J]. Clin Implant Dent Relat Res, 2022, 24(1): 4-12.
10	路泊遥, 杨大维, 刘蔚晴, 等. 超短种植体临床应用效果的影响因素[J]. 国际口腔医学杂志, 2021, 48(3): 329-333.
	Lu BY, Yang DW, Liu WQ, et al. Influencing factors of the clinical application effect of ultrashort implant[J]. Int J Stomatol, 2021, 48(3): 329-333.
11	Torassa D, Naldini P, Calvo-Guirado JL, et al. Prospective, clinical pilot study with eleven 4-mm extra-short implants splinted to longer implants for posterior maxilla rehabilitation[J]. J Clin Med, 2020, 9(2): 357.
12	Rossi F, Tuci L, Ferraioli L, et al. Two-year follow-up of 4-mm-long implants used as distal support of full-arch FDPs compared to 10-mm implants installed after sinus floor elevation. A randomized clinical trial[J]. Int J Environ Res Public Health, 2021, 18(7): 3846.
13	Rokn AR, Monzavi A, Panjnoush M, et al. Comparing 4-mm dental implants to longer implants placed in augmented bones in the atrophic posterior mandibles: one-year results of a randomized controlled trial[J]. Clin Implant Dent Relat Res, 2018, 20(6): 997-1002.
14	Karcı BL, Oncu E. Comparison of osteoimmunological and microbiological parameters of extra short and longer implants loaded in the posterior mandible: a split mouth randomized clinical study[J]. Acta Stomatol Croat, 2021, 55(3): 238-247.
15	Gašperšič R, Dard M, Linder S, et al. One-year results assessing the performance of prosthetic rehabilitations in the posterior maxilla supported by 4-mm extrashort implants splinted to 10-mm implants: a prospective case series[J]. Int J Oral Maxillofac Implants, 2021, 36(2): 371-378.
16	Felice P, Checchi L, Barausse C, et al. Posterior jaws reha-bilitated with partial prostheses supported by 4.0×4.0 mm or by longer implants: one-year post-loading results from a multicenter randomised controlled trial[J]. Eur J Oral Implantol, 2016, 9(1): 35-45.
17	Estévez-Pérez D, Bustamante-Hernández N, Labaig-Rueda C, et al. Comparative analysis of peri-implant bone loss in extra-short, short, and conventional implants. a 3-year retrospective study[J]. Int J Environ Res Public Health, 2020, 17(24): 9278.
18	Calvo-Guirado JL, López Torres JA, Dard M, et al. Evaluation of extrashort 4-mm implants in mandibular edentulous patients with reduced bone height in comparison with standard implants: a 12-month results [J]. Clin Oral Implants Res, 2016, 27(7): 867-874.
19	Bolle C, Felice P, Barausse C, et al. 4 mm long vs longer implants in augmented bone in posterior atrophic jaws: 1-year post-loading results from a multicentre rando-mised controlled trial[J]. Eur J Oral Implantol, 2018, 11(1): 31-47.
20	Barausse C, Felice P, Pistilli R, et al. Posterior jaw rehabilitation using partial prostheses supported by implants 4.0×4.0 mm or longer: three-year postloading results of a multicentrerandomised controlled trial[J]. Clin Trials Dent, 2019, 1: 25-36.
21	Moraschini V, Mourão CFAB, Montemezzi P, et al. Cli-nical comparation of extra-short (4 mm) and long (>8 mm) dental implants placed in mandibular bone: a systematic review and metanalysis[J]. Healthcare (Basel), 2021, 9(3): 315.
22	Elias D, Valerio CS, de Oliveira DD, et al. Evaluation of different heights of prosthetic crowns supported by an ultra-short implant using three-dimensional finite element analysis[J]. Int J Prosthodont, 2020, 33(1): 81-90.
23	Ercal P, Taysi AE, Ayvalioglu DC, et al. Impact of peri-implant bone resorption, prosthetic materials, and crown to implant ratio on the stress distribution of short implants: a finite element analysis[J]. Med Biol Eng Comput, 2021, 59(4): 813-824.
24	Naguib GH, Hashem AB, Natto Z, et al. The effect of Implant length and diameter on stress distribution of too-th-implant and implant supported prostheses:an in-vitro finite element study[J]. J Oral Implantol, 2021-12-22. doi: 10.1563/aaid-joi-D-21-00023 .
25	Gümrükçü Z, Korkmaz YT. Influence of implant number, length, and tilting degree on stress distribution in atrophic maxilla: a finite element study[J]. Med Biol Eng Comput, 2018, 56(6): 979-989.
26	Wang M, Liu F, Ulm C, et al. Short implants versus longer implants with sinus floor elevation: a systemic review and meta-analysis of randomized controlled trials with a post-loading follow-up duration of 5 years[J]. Materials (Basel), 2022, 15(13): 4722.
27	Leles CR, de Paula MS, Curado TFF, et al. Flapped versus flapless surgery and delayed versus immediate loading for a four mini implant mandibular overdenture: a RCT on post-surgical symptoms and short-term clinical outcomes[J]. Clin Oral Implants Res, 2022, 33(9): 953-964.
28	Jung RE, Al-Nawas B, Araujo M, et al. Group 1 ITI consensus report: the influence of implant length and design and medications on clinical and patient-reported outcomes[J]. Clin Oral Implants Res, 2018, 29: 69-77.
29	Kim S, Jung UW, Cho KS, et al. Retrospective radiographic observational study of 1 692 Straumann tissue-level dental implants over 10 years: I. Implant survival and loss pattern[J]. Clin Implant Dent Relat Res, 2018, 20(5): 860-866.
30	Lin G, Ye S, Liu F, et al. A retrospective study of 30,959 implants: risk factors associated with early and late implant loss[J]. J Clin Periodontol, 2018, 45(6): 733-743.
31	De Angelis P, Gasparini G, Camodeca F, et al. Technical and biological complications of screw-retained (CAD/CAM) monolithic and partial veneer zirconia for fixed dental prostheses on posterior implants using a digital workflow: a 3-year cross-sectional retrospective study[J]. Biomed Res Int, 2021, 2021: 5581435.
32	施斌, 吴涛. 种植修复体机械并发症的原因、预防及处理[J]. 口腔疾病防治, 2018, 26(7): 415-421.
	Shi B, Wu T. Technical complications associated with implant prostheses in terms of reason, prevention, and management[J]. J Dent Prevent Treat, 2018, 26(7): 415-421.
33	da Rocha Ferreira JJ, Machado LFM, Oliveira JM, et al. Effect of crown-to-implant ratio and crown height space on marginal bone stress: a finite element analysis[J]. Int J Implant Dent, 2021, 7(1): 81.
34	Malchiodi L, Ricciardi G, Salandini A, et al. Influence of crown-implant ratio on implant success rate of ultra-short dental implants: results of a 8- to 10-year retrospective study[J]. Clin Oral Investig, 2020, 24(9): 3213-3222.
35	Ravidà A, Barootchi S, Alkanderi A, et al. The effect of crown-to-implant ratio on the clinical outcomes of dental implants: a systematic review[J]. Int J Oral Maxillofac Implants, 2019, 34(5): 1121-1131.
36	de Souza Batista VE, Verri FR, Lemos CAA, et al. Should the restoration of adjacent implants be splinted or nonsplinted? A systematic review and meta-analysis[J]. J Prosthet Dent, 2019, 121(1): 41-51.

作者/年份	研究类型	种植区	样本量	种植体尺寸（直径×长度/mm）	术后修复时机/月	骨增量程序（对照组）	随访/年	结局指标
Barausse2019^[20]	RCT	下颌	ESI：124	ESI：4.0×4.0	4	—	3	①②③④
Barausse2019^[20]	RCT	下颌	SI：116	SI：4.0×8.5，10，11.5，13	4	—	3	①②③④
Barausse2022^[9]	RCT	全口	ESI：80	ESI：4，4.5×4	4	骨块移植术；上颌窦底提升术	5	①②③④
Barausse2022^[9]	RCT	全口	SI：87	SI：4×10，11.5，13	4	骨块移植术；上颌窦底提升术	5	①②③④
Bolle2018^[19]	RCT	全口	ESI：43	ESI：4.0，4.5×4.0	4	骨块移植术；上颌窦底提升术	1	①②③④
Bolle2018^[19]	RCT	全口	SI：46	SI：4.0×8.5，10，11.5，13	4	骨块移植术；上颌窦底提升术	1	①②③④
Calvo-Guirado2016^[18]	CCT	下颌	ESI：40	ESI：4.1×4.0	3	—	1	①②③④
Calvo-Guirado2016^[18]	CCT	下颌	SI：20	SI：4.1×10	3	—	1	①②③④
Estévez-Pérez2020^[17]	CCT	上颌	ESI：16	ESI：4.8×4.0	3	—	3	①③④
Estévez-Pérez2020^[17]	CCT	上颌	SI：16	SI：4.8×8，10，12	3	—	3	①③④
Felice2016^[16]	RCT	全口	ESI：124	ESI：4.0×4.0	4	—	1	①②③④
Felice2016^[16]	RCT	全口	SI：116	SI：4.0×8.5，10，11.5，13	4	—	1	①②③④
Ga?per?i?2021^[15]	CCT	上颌	ESI：17	ESI：4.1×4.0	6	—	1	①③④
Ga?per?i?2021^[15]	CCT	上颌	SI：11	SI：4.1×10	6	—	1	①③④
Karc?2021^[14]	CCT	下颌	ESI：30	ESI：4.1×4.0	—	—	3	①③④
Karc?2021^[14]	CCT	下颌	SI：30	SI：4.1×8，10，12	—	—	3	①③④
Rokn2018^[13]	RCT	全口	ESI：25	ESI：4.1×4.0	2	骨块移植术	1	①②③④
Rokn2018^[13]	RCT	全口	SI：22	SI：4.1×8.0，10	2	骨块移植术	1	①②③④
Rossi2021^[12]	RCT	上颌	ESI：12	ESI：4.1×4.0	1.5	上颌窦底提升术	2	①②③④
Rossi2021^[12]	RCT	上颌	SI：10	SI：3.3，4.1×10	1.5	上颌窦底提升术	2	①②③④
Torassa2020^[11]	CCT	上颌	ESI：11	ESI：4.1×4.0	6	—	2	①②③④
Torassa2020^[11]	CCT	上颌	SI：11	SI：3.3，4.1×10	6	—	2	①②③④

结局指标	亚组	纳入研究数	效应模型	MD/RR	95%CI	P值
边缘骨吸收	1年	4^{[13,16,18-19]}	随机	-0.13	-0.22~-0.05	0.003
	2年	2^[11-12]	随机	-0.14	-0.62~0.34	0.57
	3年	1^[20]	随机	-0.06	-0.14~0.02	0.14
	5年	1^[9]	随机	-0.41	-0.56~-0.26	<0.000 01
	合并效应值			-0.16	-0.25~-0.07	<0.000 7
机械并发症	1年	5^{[13,15-16,18-19]}	固定	1.65	0.26~10.39	0.59
	2年	2^[11-12]	固定	-	-	-
	3年	3^[14,17,20]	固定	10.72	0.59~196.13	0.11
	5年	1^[9]	固定	2.27	0.55~9.40	0.26
	合并效应值			2.89	1.05~7.92	0.04
生物并发症	1年	5^{[13,15-16,18-19]}	固定	0.19	0.07~0.53	0.002
	2年	2^[11-12]	固定	3.00	0.26~34.57	0.38
	3年	3^[14,17,20]	固定	0.93	0.23~3.82	0.92
	5年	1^[9]	固定	0.26	0.09~0.73	0.01
	合并效应值			0.34	0.19~0.62	0.000 4

[1]	张静, 王雁. 中国学龄前儿童龋齿患病率及填充率的Meta分析[J]. 华西口腔医学杂志, 2023, 41(5): 573-581.
[2]	程小明, 唐睿, 葛自力. 比较隧道术及冠向复位瓣术治疗牙龈退缩的疗效及长期稳定性的Meta分析[J]. 华西口腔医学杂志, 2023, 41(4): 450-462.
[3]	李雨霖, 徐静晨, 蒋晓鸽, 陈嵩. Twin-block矫治器对安氏Ⅱ类错患者髁突影响的Meta分析[J]. 华西口腔医学杂志, 2023, 41(4): 463-470.
[4]	余磊, 李紫薇, 康芙嘉, 王宋庆, 谢尊玄, 朱宪春. 隐形功能矫治器对比传统功能矫治器前导下颌治疗骨性Ⅱ类错畸形患者疗效的meta分析[J]. 华西口腔医学杂志, 2023, 41(3): 305-314.
[5]	洪飞若, 陈飘飘, 俞雪芬, 曾江. 中国成年人牙科焦虑症患病率的Meta分析[J]. 华西口腔医学杂志, 2023, 41(1): 88-98.
[6]	从兆霞, 刘媛, 赵今. 运用脱细胞真皮基质或结缔组织移植物治疗多发性相邻牙龈退缩的Meta分析[J]. 华西口腔医学杂志, 2022, 40(6): 690-697.
[7]	龚佳明, 张启航, 苟萍, 王辉, 余佳颖, 余占海. 自体牙本质用于牙槽嵴增量的Meta分析[J]. 华西口腔医学杂志, 2022, 40(5): 566-575.
[8]	祝颂松, 王旭东, 杨学文, 王晓霞, 田磊, 刘曙光, 郑广森, 唐正龙, 吴国民, 李志勇, 白晓峰, 黄旋平, 黄立, 习伟宏, 朱耀旻. 下颌支矢状骨劈开术并发症防治的专家共识[J]. 华西口腔医学杂志, 2022, 40(3): 247-254.
[9]	殷荫, 曾维, 敬伟, 汤炜, 郭维华. 高压氧治疗放射性颌骨骨坏死效果的系统评价[J]. 华西口腔医学杂志, 2021, 39(6): 690-697.
[10]	包明哲, 刘伟, 余树容, 门乙, 韩波, 李春洁. 富血小板纤维蛋白在下颌第三磨牙拔除术的应用系统评价与Meta分析[J]. 华西口腔医学杂志, 2021, 39(5): 605-611.
[11]	吴瑾, 刘堃, 李明, 朱志军, 汤春波. 翼上颌区种植体联合前部种植体修复萎缩上颌无牙颌的临床回顾研究[J]. 华西口腔医学杂志, 2021, 39(3): 286-292.
[12]	陈玲, 陈成, 李志勇, 张绮. 口内扫描数字化印模对固定修复临床应用效果的Meta分析[J]. 华西口腔医学杂志, 2021, 39(3): 306-312.
[13]	郭锦材, 谢辉, 吴昊, 童铁军. 姜黄素治疗口腔黏膜下纤维性变有效性的Meta分析[J]. 华西口腔医学杂志, 2021, 39(2): 195-202.
[14]	柏银, 白远亮, 赖静, 黄姣. 克拉霉素辅助治疗慢性牙周炎疗效的Meta分析[J]. 华西口腔医学杂志, 2020, 38(3): 290-296.
[15]	乐鑫, 申静, 张海峰. 比较3种微套管装置提取分离器械效果的体外实验研究[J]. 华西口腔医学杂志, 2020, 38(2): 160-165.

在后牙区应用4 mm超短种植体临床效果的Meta分析

Clinical efficacy of extra-short implant (4 mm) placed in posterior areas: a Meta-analysis

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 3

参考文献 36

相关文章 15

编辑推荐

Metrics

本文评价