DENT 655- Health Technology Assessment A Health Technology Assessment Report on: Different retention systems used for Endosteal Implant supported prosthesis in partially edentulous sites by Murali Ramamoorthi a with the expert assistance of Shahrokh Esfandiari b April 2015 Report No: S2015.03 a Masters candidate, Faculty of Dentistry, McGill University, Montreal, Canada b Associate Professor, Division of Oral Health and Society, Faculty of Dentistry, McGillUniversity For more information contact Dr. Shahrokh Esfandiari at [email protected]
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“The views expressed in this report are those of the author(s) and do not necessarily reflect the views of the Faculty of Dentistry, McGill University. This report was developed for the course ‘DENT 655- Health Technology Assessment’ and assumes a call from general dentists to assist decision-making in dental offices, clinical and hospitals. All are welcome to make use of it. However, to help us estimate the impact, it would be deeply appreciated if users could inform us whether it has influenced policy decisions in any way.”
Suggested citation: Ramamoorthi M & Esfandiari S. (2015). A Health Technology Assessment Report on Different retention systems used for endosteal implant supported prosthesis in partially edentulous sites (Report no: S2015.03). Montreal, Faculty of Dentistry, McGill University. Retrieved from:
3.1.1. Literature search strategy. 3.1.2. Selection criteria and methods. 3.1.3. Data extraction strategy. 3.1.4. Critical Appraisal of included studies. 3.1.5. Data analysis & meta-analysis
methods. 3.2. Economic analysis.
3.2.1. Type of economic evaluation. 3.2.2. Model structure. 3.2.3. Data inputs. 3.2.4. Costs & Perspective 3.2.5. Assumptions.
4. RESULTS………………………………………………………………………20-50 4.1. Selection of primary studies. 4.2. Study characteristics. 4.3. Critical appraisal of included studies. 4.4. Data synthesis 4.5. Economic Evaluation
5. DISCUSSION…………………………………………………………………..50-55 5.1. Summary of clinical evidence.
• Biological events that require change of prosthesis/ implant components
• Crown remake • Crown lost
Event free is defined as prosthesis being free of all complications and symptom-free over
the entire observation period. The report seeks to answer the following focused research
question: Do the different retention methods affect the success, failure, survival and cost
of Endosseous supported prostheses for partially edentulous patients aged 15 to 90 years?
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3. METHODS3.1. Systematic review
3.1.1.Literaturesearchstrategy.
Published literature was identified by searching Ovid interface: MEDLINE
in process & other non-indexed citations, EMBASE and PUBMED. The search was
not restricted to the year of publication and the search date was until Jan 30th 2015.
Regular alerts were established to update the search until April 7th 2015. Both
National library of medicine MeSH and keywords were used. The comprehensive
literature search strategy is shown in table-4. Health technology databases [INHATA,
CRD, Cochrane registry and CADTH] were searched for existing health technology
reports. CENTRAL and clinicaltrials.gov were searched for the clinical trials. Google
scholar and IADR abstracts were searched to identify grey literatures. The literature
search was further complimented by searching the major journal database( Wiley, Elsevier,
Quintessence, Sage pub) that publishes dental implant studies and the bibliographies
of systematic reviews, meta-analysis and consensus statements.
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Table-4: Literature search strategy
Focused Question: Does different retention methods affect the success, failure, survival and cost of Endosseous supported prostheses for partially edentulous patients aged
15 to 90 years?
Population Partially edentulous patients aged 15 to 90 years.
#1 ((((((edentulous*) AND partial*)) OR ((dentulous*) AND partial*)) OR ((partial) AND ((dental arch) OR dental arch*))) OR (((partial edentulism) OR partial edentulous*) OR jaw, edentulous, partially))))
#2 (((((((((dental implants, single tooth) OR ((((((dental*) AND implant*) AND endosseous*)) OR ((dental*) AND implant*)) OR (((dental implants) OR dental implant*) OR dental implantation, endosseous))))
Comparison Screw retained/Cement retained/Screwless, cementless/mechano- chemical
# 3(((((((dental) OR dental*)) AND ((bridge) OR bridge*))) OR ((((dental) OR dental*)) AND ((crown) OR crown*))) OR ((((denture, partial, fixed) OR dental prosthesis retention)) OR (((((dental prosthesis) AND implant) AND supported)) OR ((((((((((((((((((dental prosthesis, implant supported) OR implant supported prosthesis*) OR implant supported prostheses) OR dental implant-abutment design) OR implant crown*) OR implant bridge*) OR suprastruct*) OR implant suprastruct*) OR fixed partial denture) OR fixed partial denture*) OR fixed denture partial) OR fixed denture partial*) OR FPD) OR FDP) OR (crown and bridge)) OR (crown* AND and bridge*)) OR crowns) OR bridges)))))) AND ((((((((screw) AND fixation)) OR screw fixation)) OR ((screw retain) OR ((((dental*) AND screw*)) OR ((((((screw*) AND retention*)) OR ((screw retained) OR screw-retained))) OR ((screw retained crown*) OR screw retained crown)))))) OR ((chemomechanically bonded) OR ((dental cement*) OR ((((cement) AND retention)) OR ((((cement) AND retained)) OR (((((((((((cementation) OR cement retain) OR cement retained) OR cement retention) OR cement fixation) OR screwless) OR integrated abutment crown) OR integrated abutment crowns) OR locking-taper implant) OR locking-taper implant*) OR dental cements)))))))
Outcome success, Failure, survival and cost
#4 (((economic analysis) OR (((cost benefit analysis) OR cost-benefit analysis) OR cost effectiveness))) OR (((((patient safety) OR safety)) OR ((((((((((((((screw) OR cement) OR ceramic*) OR porcelain*) OR crown*) OR denture, partial, fixed) OR bridge*)) OR abutment)) AND ((fracture) OR deformation))) OR (((dental leakage) OR screw loosening) OR abutment loosening)) OR (((((((((((((((survival) OR survival analysis) OR survival rate) OR success) OR success rate) OR longevity) OR failure) OR prosthesis failure) OR crown failure) OR bridge failure) OR abutment failure) OR treatment outcome) OR loss of retention)) OR ((((((((((((technical*) OR biological*) OR prosthetic*) OR prosthodontic*) OR restorative*) OR esthetics*)) AND ((complication) OR complicat*))) AND failure*)) OR ((((((((technical*) OR biological*) OR prosthetic*) OR prosthodontic*) OR restorative*) OR esthetics*)) AND ((complication) OR complicat*))))))))
Studies less than 10 patients. Studies based on questionnaire or interviews. Studies which doesn’t report atleast one outcome measure as defined earlier. Case reports, Case series. Combination prosthesis.
Full text evaluation
Human subjects. RCTs, Controlled clinical trials, Prospective studies, retrospective studies with clinical follow up examination Studies reported details of supra structure characteristics. English & Indexed publications.
Non-English. No characteristics of implants, supported prosthesis. Observation period less than 1 year after loading. Multiple studies of same trial /study Retrospective studies without clinical follow up. Systematic reviews, Meta-analysis. Studies from which data on outcome variable are not directly retrievable or not able to be calculated. Studies considering only biologic complications [peri-implantitis, marginal bone loss, radiolucency, bleeding index, suppuration, recession, fistula/sinus, soft tissue lesions] without considering technical or prosthodontic or mechanical complications. No clinical outcome reviewed at the follow up visit
Model Study nam e Subgroup within study Statistics for each study Event rate and 95% C I Weight (Fixed) Weight (Random ) Residual (Fixed)
Event Lower Upper Relative Relative Relative Relative S td S td S td S td S td S td rate lim it lim it Z-Value p-Value weight weight weight weight Residual Residual Residual Residual Residual Residual
Vigolo, 2012 R C T 0.005556 0.000011 0.736499 -1.635832 0.101875 0.73 0.73 -0.40 -0.40
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6. Conclusion:
The objective of this report was to assess the effectiveness of different retention
systems and to determine the cost effectiveness of retention systems used for treating
partially edentulous patient with IS- prosthesis. Results from the systematic review
and meta-analysis suggest that there were no statistically significant differences in
failure rates between the retention systems and the prosthesis design. However the
survival rate was better with cement retained single crown and FPD. There were no
differences between major events but statistically significant differences with minor
events. In conclusion, within the limitations of this review cement retained prosthesis
fared better than the screw retained single crown and FPDs in relation to cost
effectiveness.
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1996;11(3):379-86. 9. Balshi TJ, Ekfeldt A, Stenberg T, Vrielinck L. Three-year evaluation of Branemark implants connected to angulated abutments. The International journal of oral & maxillofacial implants. 1997;12(1):52-8. 10. Barrachina-Diez JM, Tashkandi E, Stampf S, Att W. Long-term outcome of one-piece implants. Part II: Prosthetic outcomes. A systematic literature review with meta-analysis. International Journal of Oral & Maxillofacial Implants. 2013;28(6):1470-82. 11. Behneke A, Behneke N, d'Hoedt B, Wagner W. Hard and soft tissue reactions to ITI screw implants: 3-year longitudinal results of a prospective study. International Journal of Oral & Maxillofacial Implants. 1997;12(6):749-57. 12. Behr M, Lang R, Leibrock A, Rosentritt M, Handel G. Complication rate with prosthodontic reconstructions on ITI and IMZ dental implants. Internationales Team fur Implantologie. Clinical oral implants research. 1998;9(1):51-8 13. Berglundh T, Persson L, Klinge B. A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years. Journal of clinical periodontology. 2002;29 Suppl 3:197-212; discussion 32-33. 14. Bianco G, Di Raimondo R, Luongo G, Paoleschi C, Piccoli P, Piccoli C, et al. Osseointegrated implant for single-tooth replacement: a retrospective multicenter study on routine use in private practice. Clinical Implant Dentistry & Related Research. 2000;2(3):152-8. 15. Bidra AS, Rungruanganunt P. Clinical Outcomes of Implant Abutments in the Anterior Region: A Systematic Review. Journal of Esthetic and Restorative Dentistry. 2013;25(3):159-76. 16. Block MS, Gardiner D, Kent JN, Misiek DJ, Finger IM, Guerra L. Hydroxyapatite-coated cylindrical implants in the posterior mandible: 10-year observations. The International journal of oral & maxillofacial implants. 1996;11(5):626-33. 17. Block MS, Lirette D, Gardiner D, Li L, Finger IM, Hochstedler J, et al. Prospective
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ii
Dent-655HealthTechno ogyAssessment.FacultyofDentistry.McG Un vers ty,Canada.
Annexe-1BasicCharacteristicstable-Prioriform
No
Retentiontype
Studydesign
Quality
score
NoofPatients
Agerange
NoofImplants
Noofprosthe
sis
Prosthesis
design
Observation
period
Dropouts
Studysetting
M F T
Annexure-2:Prioriform
RCT CCT
Prospective Retrospectiveee
Strong Medium Weak
Ref: Screwed Cemented/IAC Total patient: M
F No of Implants No of Single crowns
No of FPDS No of Splinted crowns
No of T-IS FPD No of cantilever FPD
No of fs-FPD Brand name
PFM/PBM PFG
All ceramic Resin
Custom abutment Prefabricated
Observation period Mean observation
Total lost to follow up Lost due to failure
Minor porcelain chip occlusal/prosthetic screw loosening