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Impact of Splinting Implant-Supported Crowns on the Performance of Adjacent Posterior Implants
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersSTATEMENT OF PROBLEM
While rehabilitation with implant-supported crowns in the posterior region is widely practiced, guidance on clinical considerations when choosing between splinted or nonsplinted implant-supported crowns is limited.
PURPOSE
The purpose of this systematic review with meta-analysis was to assess whether adjacent implants with internal connections in the posterior region should be treated with splinted or nonsplinted crowns.
MATERIAL AND METHODS
The systematic review was registered on the prospective register of systematic reviews (PROSPERO) under the code, CRD42021248525. Two authors searched 4 electronic databases (PubMed, Cochrane Library, Scopus, and Web of Science) independently for articles published up to December 2023. Additionally, a hand search was conducted in the nonpeer-reviewed literature and the reference lists of included articles. Only clinical studies comparing splinted and nonsplinted hexagonal or conical internal connection adjacent implants in the posterior region were considered. A single-arm meta-analysis was conducted using RevMan. Risk of bias and quality were assessed using the Cochrane Collaboration's Tool for Assessing Risk and the Newcastle-Ottawa scale.
RESULTS
Qualitative synthesis included 17 studies, and quantitative synthesis involved 13 studies. A total of 2085 implants (1244 splinted and 841 nonsplinted) were inserted in 1027 participants, with observation times ranging from 5 months to 16 years. Thirteen studies related the type of crown retention (cemented or screw-retained). Only 2 studies related annual bone loss results considering the type of crown retention, but whether they were splinted or nonsplinted crowns and significant differences were not specified. The meta-analysis revealed no statistical differences between splinted and nonsplinted implants for biological complications (P=.95, I2=0%). However, the nonsplinted implants exhibited significantly more mechanical complications than the splinted implants (P<.001, I2=1%, RR 0.37; 95% IC [0.26-0.54]). The studies included demonstrated a low risk of bias and were of good quality.
CONCLUSIONS
Splinting was not found to affect the incidence of biological complications in posterior adjacent implants. However, more mechanical complications occurred in nonsplinted crowns than splinted ones.
Additional Info
Disclosure statements are available on the authors' profiles:
Impact of splinting implant-supported crowns on the performance of adjacent posterior implants: A systematic review and meta-analysis
J Prosthet Dent 2024 Jul 01;[EPub Ahead of Print], ALB Pascoal, KRG Paiva, LCN Marinho, ADS Bezerra, PDS CalderonFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The authors address an important clinical question of dental implant treatment for adjacent multiple missing teeth. Whether to splint or not to splint dental implant restorations becomes a critical treatment decision for the restorative dentist. The authors performed a systematic review of 1356 articles, resulting in the inclusion of 17 final studies that met the inclusion requirements. Included are 2 randomized controlled trials, 7 prospective studies, and 8 retrospective studies involving 2085 internal connection implants with 1027 participants, with nearly equal inclusion of sexes. Overall, the article suggests that minimal information is known. The authors did note some interesting findings. An increase in the number of reversible mechanical complications was noted in the non-splinted group. A higher complication rate of peri-implantitis was found in the splinted group (23.4%) than in the non-splinted group (15.5%). There was high patient satisfaction in both groups.
The authors concluded that splinting does not affect the success of adjacent dental implants and that non-splinted restorations result in an increase in the incidence of reversible mechanical complications.
From my perspective, this systematic review emphasized the lack of articles with homogeneity of the data and findings. There was an absence of standardization of the diagnosis criteria for peri-implant disease, and many of the articles reporting on complications did not distinguish between problems being reversible or irreversible.
A clinically relevant finding is that the treatment for complications resulted in approximately 20% higher costs for non-splinted restorations than for splinted restorations for the clinician and patient.
In addition, cemented versus screw-retained restorations were not conclusively reviewed. Clearly, more prospective controlled clinical studies are warranted. Currently, clinicians must use good clinical judgment regarding risk factors such as the quality of bone, parafunctional habits, and ability to maintain oral hygiene care. The article is enjoyable and provides a focal point of thought for clinicians, as decisions are made daily for best patient outcomes.