Number of implants placed for complete‐arch fixed prostheses: A systematic review and meta‐analysis

Abstract

Objectives:The main purpose of this systematic review was to evaluate outcomes related to the number of implants utilized to support complete-arch fixed prostheses, both for the maxilla and the mandible. Materials and methods:This review followed the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A focused question using the PICO format was developed, questioning whether "In patients with an implant supported fixed complete dental prosthesis, do implant and prosthetic survival outcomes differ between five or more compared to fewer than five supporting implants?". A comprehensive search of the literature was formulated and performed electronically and by hand search. Two independent reviewers selected the papers and tabulated results. Primary outcomes analyzed were implant and prosthesis survival. Implant distribution, loading, and type of retention were observed as secondary outcomes, as they relate to the number of implants. A metaanalysis was performed to compare results for studies by number of implants. Results:The search strategy identified 1,579 abstracts for initial review. Based on evaluation of the abstracts, 359 articles were identified for full-text evaluation. From these, 93 were selected and included in this review, being nine RCTs, 42 prospective and 42 retrospective. Of the 93 selected studies, 28 reported number of implants for the maxilla, 46 for the mandible, and 19 for both maxilla and mandible. The most reported number of implants for the "fewer than five" group is 4 for the maxilla, and 3 and 4 for the mandible, whereas for the "five or more" implants group, the most reported number of implants was 6 for the maxilla and 5 for the mandible. No significant differences in the primary outcomes analyzed were identified when fewer than five implants per arch were compared with five or more implants per arch (p > 0.05), in a follow-up time ranging from 1 to 15 years (median of 8 years). Conclusions:Evidence from this systematic review and meta-analysis suggests that the use of fewer than five implants per arch, when compared to five or more implants per arch, to support a fixed prosthesis of the completely edentulous maxilla or mandible, present similar survival rates, with no statistical significant difference at a p < 0.05 and a confidence interval of 95%.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Superioralization of the inferior alveolar nerve and roofing for extreme atrophic posterior mandibular ridges with dental implants

“…Overdenture supported by 2–4 implants at the interforaminal area is also widely used as a predictable treatment option. [ 8 9 ] The partially edentulous posterior mandible, with severe atrophy, is a common scenario, and lack of sufficient bone height above the IAN makes the treatment with dental implant challengeable and confusing even for the experienced clinicians. Recently, short implants become a popular alternative for the atrophic jaws.…”

Estudo retrospectivo da reabilitação do edentulismo com um novo protocolo de prótese fixa implantossuportada

“…The presence of prosthetic technical complications was consistent with previous findings. 23 Further development of veneering materials with improved loading capacity should facilitate stress distribution in the prosthetic/tissue interface. In the challenge to face disability imposed by edentulism on a global scale, oral health professionals should carefully consider a patient's clinical history as well as biomechanical conditions in order to avoid unexpected events and improve the long-term clinical outcome.…”

“…Fonte: Figura 2: Implantes inclinados para diminuir morbidade com a utilização de procedimentos de enxertos e aumento da área de suporte distal Devido às evidências que se construiam, no ano de 2003 foi apresentado o conceito "All-on-Four" (20), que previa a redução do número de implantes associados às inclinações dos mesmos (Figura 3), reduzindo custos, comprimento dos cantileveres distais e ampliando o escopo biomecânico das próteses totais fixas mandibulares (21)(22)(23).…”

“…20,21 Increased failure rates of mandibular MRISFCDs have been reported to be more frequent when opposed by a natural or fixed dentition than by a removable complete denture. 22,23 Long-term clinical complications are usually of a technical nature, for example, screw loosening, fractures, and loss of the denture teeth or the veneering material. [23][24][25] Diagnostic errors, [26][27][28] as well as the presence of overload in the masticatory system have been identified as decisive factors in such complications.…”

“…22,23 Long-term clinical complications are usually of a technical nature, for example, screw loosening, fractures, and loss of the denture teeth or the veneering material. [23][24][25] Diagnostic errors, [26][27][28] as well as the presence of overload in the masticatory system have been identified as decisive factors in such complications. 24,[29][30][31] Thus, the effects of individual occlusal forces and loading conditions are factors that may influence treatment survival rate and should be considered.…”