一体式和分体式氧化锆基台长期存留率及机械并发症的Meta分析

Clinical evaluation of the long⁃term survival rate and mechanical complications of different zirconia abutments:An⁃up⁃to⁃date Meta⁃analysis

目的评价一体式和分体式氧化锆基台种植修复5年以后在基台存留率、螺丝松动发生率和上部修复体崩瓷率方面的差异。方法通过PubMed、Medline、EMBASE、Cochrane Library及中国期刊网全文数据库(CJFD)检索2010年1月至2020年3月已发表的中英文文献,收集关于氧化锆基台的随机对照试验、前瞻性研究和回顾性研究。建立相应的纳入和排除标准,如随访时间至少为5年、需评价氧化锆基台存留率、螺丝松动发生率和上部修复体崩瓷率。由两位研究者分别独立地对文献进行检索、筛选、质量评价和数据提取。结果共纳入英文文献9篇,无符合要求的中文文献,所有文献均经过非随机干预性试验的偏倚风险评估(ROBINS⁃I)量表评价。内连接一体式氧化锆基台5年存留率95.9%[95%可信区间(CI):94.1%,97.6%],机械并发症发生率7.6%(95%CI:5.3%,10.0%);内连接分体式氧化锆基台5年存留率99.8%(95%CI:99.4%,100%),机械并发症发生率4.6%(95%CI:2.7%,6.4%)。Meta分析结果显示,分体式氧化锆基台长期存留率更高,机械并发症更少,结果有统计学意义。结论氧化锆全瓷基台长期存留率高,临床效果好,但仍存在一些机械并发症如基台折断和螺丝松动。在机械力学性能上,分体式氧化锆基台优于一体式氧化锆基台。但结合具体临床情况,建议临床医师谨慎选择合适的全瓷基台。

Objective To evaluate the long⁃term(more than 5 years)survival rate and the difference in fracture,screw loosening and chipping between different zirconia abutments.Methods The electronic databases included PubMed,Medline,EMBASE,Cochrane library and China National Infrastructure.English and Chinese literature from 2010 to present limited to randomized clinical trials,prospective studies,and retrospective studies on zirconia abutments were collected.According to certain inclusion criteria,such as follow⁃up time of at least 5 years,mentioning survival rates of zirconia abutment,the rates of screw loosening and the rates of chipping.Two researchers searched,screened and extracted data from the literature independently.Results A total of 9 English articles were included.No Chinese literature met the requirements.All literature was evaluated by ROBINS⁃I scale.The overall survival rate of internal full zirconia abutment was estimated to 95.9%(95%CI:94.1%,97.6%),and the mechanical complication rate was estimated to 7.6%(95%CI:5.3%,10.0%);whereas the survival rate of internal zirconia abutments with titanium base was estimated to 99.8%(95%CI:99.4%,100%),and the mechanical complication rate was estimated to 4.6%(95%CI:2.7%,6.4%).Conclusions Zirconia abutments had a good performance on implant prosthesis.However,there were still some mechanical complications such as fracture and screw loosening.In addition,the internal zirconia abutments with titanium base had a little higher survival rate and lower mechanical complication rate than the internal full zirconia abutment.