| [Background] The osseointegrated titanium implants are one of the main methods to repair missing teeth,with reliable long-term clinical effects.In the past,some patients suffering from osteoporosis,uncontrolled diabetes or taking bisphosphonates,were unable to have dental implants in the edentulous areas,as well as those patients with severely absorbed alveolar bone.However,with improved design of implant morphology,especially the innovation of surface treatment,osseointegration between dental implants and alveolar bone interface has been strengthened.As a result,dental implants can achieve better clinical results in more complicated cases.Many researchers also believe that the improved surface treatment allows the minimum length of implants become shorter,so that short implants can also achieve good stability,which provides less invasive and relatively inexpensive treatment options for patients with seriously absorbed alveolar bone.There are currently more than 2,000 kinds of implant systems on the market with different surface treatments.However,related studies have shown that implants with moderately rough surface have most stable clinical efficacy.Among them,Sandblasted/Large-grit/Acid-etched(SLA)surface and Titanium Anodized(TA)surface are most representative and mainstream.However,there are no relative researches having compared the these two surface treatments through meta-analysis or systematic review.Analysis of the efficacy between implants with different surface treatments,especially short implants,can provide guidance for dentists to choose suitable dental implants for patients with systematic diseases or severely absorbed alveolar bone.[Purpose] This part aimed to employ meta-analysis of randomized clinical studies to compare the clinical effects between SLA and TA surface-treated implants,and also search for the prospective studies,retrospective studies and cohort studies which used implants with SLA or TA surface,in order to explore whether different surface treatments would affect clinical effects of dental implants.[Methods] In this study,we searched the related clinical trials in Pub Med,EMBASE,Cochrane Library,and other three Chinese databases,all published after 2000.We also manually searched the clinical studies referring to the relevant implant brands.The software Endnote X9 was used to screen and exclude the duplicated documents.Then those irrelevant studies were excluded according to the titles and abstracts.Two independent researchers read the full text and decided whether the study should be included according to the pre-set screening criteria.Two researchers independently evaluated the quality and bias risk of the literature,extracted data,and conducted quantitative analysis or descriptive statistical analysis on the relevant data.The prospective studies,retrospective studies and cohort studies either containing implants with SLA or TA surface were also searched,screened and analyzed.In this systematic review and meta-analysis,implant success rate was the most important outcome,and marginal bone level and complications were secondary important outcomes.[Results] Based on the pre-set screening standards,3 randomized clinical trials were finally included among all 558 related literatures.There were 347 patients with 392 implants in total,being followed up for 2 to 6 years.Among all the implants,241 were treated by SLA while 151 implants were treated by TA.The implants were restored by single crown or splinted crowns in two of the studies,while the others were restored by the overdenture.Overall,the risk of bias in the included studies was relatively low.There was no statistical difference between the survival rates of these two kinds of implants when half a year or one year through quantitative analysis(P>0.05).Due to the different scoring criteria for aesthetic outcomes and peri-implantitis,as well as different observation periods,the quantitative analysis of marginal bone loss,biological and mechanical complications could not be performed.In the systematic analysis,both implants treated by SLA and those treated by TA had a relatively high one-year survival rates and acceptable marginal bone loss.Since the included studies did not illustrate the failures of short implants,the comparison of efficacy between implants with different surface treatments could not be further analyzed.[Conclusion] The survival rates and marginal bone loss of implants with different surface treatments were similar within one year.In the future,more well-designed and long-term observed randomized controlled studies are needed to evaluate the clinical effects of implants,especially short implants with different surface treatments.[Background] Missing teeth are often related to patients' occlusal dysfunctions,malnutrition and even poor mental health.Over the past few decades,the dental implantation has become one of the most reliable treatments for missing teeth.However,due to lack of chewing stimulations,maxillary sinus gasification,or relatively high position of inferior alveolar nerve in the edentulous areas,sometimes the alveolar bone cannot accommodate standard implants.In order to increase the vertical bone mass,new surgical procedures such as maxillary sinus augmentation,alveolar nerve lateralization technique,and autogenous or allogeneic bone grafting were proposed and improved.Also,with the improvements of dental implants' morphology and surface treatment,the minimum length of implants introduced by various brands is getting shorter,which makes short dental implants become an alternative treatment for patients with inadequate alveolar bone height.Recent studies have shown that the short implants can also have relatively high long-term survival rate,which is similar to that of conventional implants'.What's more,short implants are less invasive,with shorter healing periods and lower surgical costs than standard implants.However,due to the large crown-to-implant ratio and the relatively small contact surface between implants and alveolar bone interface,doubts about the initial stability and long-term efficacy of short implants still exist.Studies on the potential risk factors related to short implants are not sufficient,and large-samplesized evidence-based medical research is still needed to provide guidance for clinical work.[Purpose] This retrospective analysis aimed to compare the clinical efficacy between short implants and standard implants,and to find when and why the failures happened.Also,the risk factors related to the failures of short implants would also be analyzed.[Methods] This study combed the follow-up data of patients receiving dental implants in Nanjing Stomatological Hospital from 2014 to 2017.A total of 7001 implants were included.Among the all,5765 were standard implants,and 106 failed during the observation.There were 1236 short implants,with 45 failed cases.In this study,survival analysis was used to compare the survival rates of short implants and standard implants.The possible causes of 45 failed short implants were descriptively counted.The ?2 analysis,Logistic regression analysis,Kaplan-Meier analysis and multiple Cox regression analysis were applied to comprehensively analyze the potential risk factors,including gender,age,implant site,bone grafting,implant diameter and surface treatment.[Results] The results showed that the short-term to medium-term survival rate of short implants was 96.36%,which was slightly lower than that of standard implants(P<0.05).The failures mostly occurred before the implants were finally restored,mainly because of infection.Only a few failures occurred after restoration,most due to peri-implant inflammation and poor osseointegration.Male patients and short implants with TA treated surface were two risk factors that affected the survival rate of short implants through all statistical analysis.Age,implant site,bone grafting,implant diameter were not correlated to the failures of short implants.If compared separately,short implants placed in maxillary molar area were at higher risk of failure than those in the mandibular molar areas(P<0.05).[Conclusion] The short-term to medium-term survival rate of short implants was slightly lower than that of standard implants.The failures mostly occurred before restoration,mainly due to infections.Male patients and implants with TA surface were risk factors for the clinical application of short implants.Compared with the mandibular molar region,being placed in the maxillary molar region was also a risk factor for the application of short implants. |
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