An Overview of Systematic Reviews and Meta-analyses Evaluating Different Impression Techniques for Implant-Supported Prostheses in Partially and Completely Edentulous Arches.

PURPOSE: To summarize the evidence and determine the most effective impression technique for implant-supported prostheses in terms of accuracy, time efficiency, and patient preference in partially and completely edentulous arches. MATERIALS AND METHODS: The searches were performed independently up to April 30, 2021 by two review authors through the Cochrane Oral Health Review, MEDLINE/PubMed, LILACS, and Science Direct databases. Moreover, manual and gray literature searches were performed to identify further potential reviews. Only English language-based systematic reviews with and without meta-analyses evaluating the different dental implant impression techniques were included. The outcomes assessed were accuracy, time efficiency, and patient preference. The methodologic quality of the included reviews was investigated by using the R-AMSTAR tool, and the degree of overlap of primary studies was assessed by calculating the percentage of corrected covered area (CCA) as proposed by Pieper et al.64 Results: The qualitative analysis included a total of 28 reviews, 8 of which included meta-analyses, published between 2008 and 2021, involving a total of 42 clinical trials and 203 laboratory studies. Digital vs conventional implant impression techniques were compared in 17 reviews, different digital impressions in 3 reviews, and different conventional impression techniques in the remaining reviews. Overall, the methodologic quality assessed by using the R-AMSTAR tool was moderate (mean: 26.7 ± 5.5) with slight overlap of primary studies (CCA; 5.23%). CONCLUSION: Within an overall moderate methodologic quality, the digital implant impressions showed favorable outcomes in terms of accuracy, time efficiency, and patient preference in partially edentulous arches involving three or fewer implants. However, the accuracy of full-arch digital impressions involving multiple implants is not satisfactory and needs significant improvements. Hence, future studies following stringent guidelines and robust methodology are recommended to substantiate the findings of this overview and provide a high level of evidence.

Clinical effect of the high insertion torque on dental implants: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: A consensus on the clinical performance in dental implants placed with different insertion torques is lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the effect of high insertion torque compared with regular or low torques during dental implant placement in terms of implant survival rate and marginal bone loss. MATERIAL AND METHODS: Two independent reviewers searched electronic databases for studies published until April 2019. The population, intervention, comparison, outcome (PICO) question was "Do patients who receive implants with a high torque (equal or higher than 50 Ncm) show similar implant survival rates and marginal bone loss as compared with those who receive implants with a regular or low torque (less than 50 Ncm)?". The meta-analysis was based on the Mantel-Haenszel (MH) and the inverse variance (IV) methods (α=.05). RESULTS: The search yielded 6 articles, which included 389 patients (mean age: 55.28 years) who had received 651 dental implants (437 with high torque and 214 with low or regular torque). Most studies evaluated delayed loading, except 1 study that evaluated immediate implant loading (n=50 for each group). Low or regular insertion torque had a high failure rate (4.2%) compared with high insertion torque (1.1%), chiefly because of immediate loading. However, the meta-analysis indicated no significant difference between high- and regular- or low-torque implant placement in implant survival rate (P=.52, risk ratio [RR]: 0.51, 95% confidence interval [CI]: 0.06-4.06) and marginal bone loss (P=.30, mean difference [MD]: 0.15, 95% CI: -0.14 to 0.44). CONCLUSIONS: A high insertion torque during implant placement does not affect implant survival rate or marginal bone loss. However, further research is recommended to reassess this clinical performance.

Quality assessment of systematic reviews regarding dental implant placement on diabetic patients: an overview of systematic reviews

Background: Since implant placement on diabetic patients still is a controversial topic and systematic reviews are at the top of scientific evidence hierarchy, a thorough assessment of the methodological quality of these reviews must be performed to inform clinicians if their conclusions and recommendations can be followed on clinical practice. An overview of systematic reviews was performed with the purpose to assess the methodological quality of systematic reviews regarding dental implant placement on diabetic patients. In addition, we presented a synthesis of clinical outcomes about the focused theme. Material and Methods: An online search was performed on MEDLINE via PubMed, EMBASE, DARE-Cochrane, Scopus, Web of Science, LILACS, and SIGLE via Open Grey. Searches were conducted from database inception to May 2018. Systematic review articles with or without meta-analysis about the placement of dental implants on diabetic patients were included. Exclusion criteria were: articles whose primary outcome was not the survival/success rate of dental implants on diabetic patients; studies that do not relate the survival/success rate of dental implants with diabetes; duplicated papers. Methodological quality assessment was performed with AMSTAR. A descriptive synthesis of clinical outcomes was performed

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Risk of bias assessment of systematic reviews regarding dental implant placement in smokers: An umbrella systematic review.

STATEMENT OF PROBLEM: Although dental implant treatment has a high success rate, patient-related factors may cause implant failure. In this context, smoking is associated with adverse effects on implant osseointegration. In spite of systematic reviews addressing this topic, the risk of bias in these reviews must be assessed to inform readers whether the studies were conducted with methodological rigor and whether their recommendations are viable in daily clinical practice. PURPOSE: The purpose of this umbrella systematic review was to assess the risk of bias of systematic reviews regarding dental implant placement in smokers. MATERIAL AND METHODS: Systematic review articles with meta-analysis regarding dental implant placement in smokers were eligible for this study. The following were excluded: articles in which implant survival or failure rate was not the primary outcome; articles in which implant survival or failure rate was not related to smokers; and duplicated articles. The search was performed by 2 independent reviewers on MEDLINE (PubMed), Scopus, Web of Science, LILACS, DARE-Cochrane, and SIGLE via OpenGrey. Non-peer-reviewed literature was sought on SIGLE via OpenGrey without language restrictions. Reviewers read titles and/or abstracts to select potential eligible studies, and articles initially selected were read fully. A third reviewer was consulted in cases of disagreement. References of the selected articles were also screened to identify articles of potential interest. The last search was performed on April 29, 2017. Risk of bias assessment was performed with the Risk of Bias in Systematic Reviews (ROBIS) tool. RESULTS: Of the initial 2539 results, 6 systematic reviews with meta-analysis were eligible for the umbrella review (kappa=0.90; very good agreement). All studies were published in the last 11 years. One meta-analysis (16.7%) presented low risk of bias, 3 (50.0%) were assessed as of unclear risk of bias, and 2 (33.3%) received a score of high risk of bias according to the assessment with the ROBIS tool, which also indicated that the criteria most commonly not met were study eligibility criteria and identification and selection of studies. CONCLUSIONS: Five of the 6 included meta-analyses had a risk of bias (high or unclear). Therefore, their conclusions and recommendations required careful review. Future meta-analyses must focus especially on study eligibility criteria and identification and selection of studies.

Quality assessment of systematic reviews regarding immediate placement of dental implants into infected sites: An overview.

STATEMENT OF PROBLEM: With the increased number of published systematic reviews and in view of their wide clinical applicability, these studies must be carefully assessed before professionals begin to use their recommendations in daily practice, and above all, the methodological quality of this study design must be considered. In implant dentistry, one topic that has been arousing particular interest is the immediate placement of dental implants into infected sites. PURPOSE: The purpose of this systematic review was to determine the methodological quality of systematic reviews that evaluated the immediate placement of dental implants into infected sites. MATERIAL AND METHODS: A systematic search was performed by 2 independent reviewers of PubMed, LILACS, and ISI Web of Knowledge up to March 2016. All selected articles were published in the English language. Systematic reviews of original papers that assessed the immediate placement of dental implants into infected sites were eligible for the overview. Narrative reviews, randomized clinical trials, and case reports were excluded. Methodological quality assessment was performed using A Measurement Tool to Assess Systematic Reviews. RESULTS: Of the 5 selected systematic reviews, 3 were low methodological quality and 2 were assessed as moderate. None were high methodological quality. The first systematic review of the topic was published in 2010, and the most recent, published in 2015, was the only one that performed meta-analysis. CONCLUSIONS: The systematic reviews that assessed the immediate placement of dental implants into infected sites were assessed as low or moderate methodological quality. The topic focus remains controversial because the implant survival rate, the main outcome considered for the implant placement prognosis, presents contradictory results.