Impacto do número de implantes empregados em protocolos mandibulares - Revisão sistemática

Abstract

Purpose: To assess edentulous patients rehabilitated by implant-supported mandibular full-arch bridges and to analyze the impact of the different number of implants used on implant survival rate, bone loss around the fixtures and prosthesis survival rate. Material and methods: This systematic review followed PRISMA guidelines and was registered on PROSPERO (registration number CRD42016048523). PubMed/MEDLINE electronic database was searched for articles published up until July 17th, 2016 without restrictions about publication year and aimed to answer the following question in PICO format: “In edentulous patients, full arch-bridges supported by three implants, compared to those with different number of implants, show satisfactory implant survival rate, bone loss and prosthesis survival rate?” Evidence level of studies were evaluated according to OCEBM e the methodological quality by MINORS scale and Cochrane Risk of Bias Tool. Descriptive statistics was performed when applicable. Implant survival curves were constructed with Kaplan-meyer method and marginal bone loss was analyzed with kruskal-Wallis, Dunn’s and Mann Whitney tests. Results: 21 studies were enrolled. Overall, 4712 implants and 1245 implant-supported fullarch bridges were examined in 1245 patients. Results were grouped on categories based on the number of fixtures on each patient: Group 1 (three implants) showed an implant survival rate of 90%, Group 2 (four implants) presented 95% and the Group 3 (five implants) reached the lowest implant survival rate (74%). Group 1 and Group 3 showed the lowest values of first year bone loss (0.73 and 0.70 mm respectively), statistically significant different of Group 2 that registered median = 1,31mm (p = <0.001). Conclusion: Despite of the limitations regarding the lack of high level of evidence studies and the methodology of MeSH terms research itself, it was concluded that full archbridges supported by three implants show satisfactory implant survival rate and first year bone loss. The prosthesis survival rate, however, was inferior to the other groups and this suggests a bigger follow-up of these rehabilitations with the aim of clarifying data and search for solutions.