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

doi:10.7518/hxkq.2023.01.011

Abstract

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

CLC Number:

R 783.1

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.

Figures/Tables 3

Tab 1

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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

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