Statement of problem

Evidence provided by implant-supported mandibular overdenture research on different loading protocols is important. However, methodological inconsistency, as well as inadequate reporting of results, hampers a consistent decision in terms of clinical applicability.

Purpose

The purpose of this systematic review and meta-analysis was to evaluate whether immediate or early loading protocols can achieve comparable clinical outcomes when compared with a conventional loading protocol in edentulous patients rehabilitated with mandibular overdentures.

Material and methods

In accordance with the Participant, Intervention, Comparison, Outcome strategy, prospective clinical studies without restrictions as to language or follow-up period were included. The Cochrane collaboration and ROBINS-I tools were used for quality assessment and risk-of-bias evaluation. The follow-up for the different outcomes ranged from 3 to 168 months, with the focus on implant success and survival rates, marginal bone loss, bleeding on probing, probing depth, plaque index, and the implant stability quotient. Statistical analyses in which standard mean differences were applied with a 95% confidence interval when continuous data were included were performed. For dichotomous data, risk difference was adopted.

Results

The search strategy resulted in 14 234 references. Twenty-three studies fulfilled the inclusion criteria. Meta-analysis showed statistically significant differences for plaque index at 12 months (standard mean difference=0.284 [0.022, 0.545], P=.033, I²=35%), probing depth at 36 months (standard mean difference=0.460 [0.098, 0.823], P=.013, I²=0%), and on pooled results for plaque index (standard mean difference=0.157 [0.031, 0.284], P=.015, I²=18%) in which the conventional loading protocol presented lower indices than those of immediate loading protocol or early loading protocol. Implant stability quotient presented a statistically significant difference only at 3 months (standard mean difference=0.602 [0.309, 0.895], P<.001, I²=0%) with higher values for the conventional loading protocol. For the other parameters, statistically significant differences (P>.05) were not found.

Conclusions

Immediate loading protocol or early loading protocolfor mandibular overdentures has been determined to be a well-established treatment and worthy of consideration in clinical practice.

中文翻译：

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种植体支持下颌覆盖义齿不同负荷方案的长期结果：系统评价和荟萃分析

问题陈述

种植体支持的下颌覆盖义齿研究提供的不同负荷方案的证据很重要。然而，方法学上的不一致以及结果报告不足，阻碍了在临床适用性方面的一致决定。

目的

本系统评价和荟萃分析的目的是评估在下颌覆盖义齿修复的无牙颌患者中，与传统负重方案相比，即刻负重方案或早期负重方案能否获得可比较的临床结果。

材料与方法

根据参与者、干预、比较、结果策略，包括不受语言或随访期限制的前瞻性临床研究。Cochrane 协作和 ROBINS-I 工具用于质量评估和偏倚风险评估。不同结果的随访时间从 3 个月到 168 个月不等，重点是种植体成功率和存活率、边缘骨丢失、探诊出血、探诊深度、斑块指数和种植体稳定性商。当包括连续数据时，应用标准平均差和 95% 置信区间的统计分析被执行。对于二分数据，采用风险差异。

结果

搜索策略产生了 14 234 条参考文献。23 项研究符合纳入标准。Meta 分析显示，12 个月时斑块指数的差异有统计学意义（标准均数差=0.284 [0.022, 0.545]，P =.033，I ² =35%），36 个月时探查深度（标准均数差=0.460 [0.098] , 0.823], P =.013, I ² =0%)，以及斑块指数的汇总结果 (标准平均差 = 0.157 [0.031, 0.284], P =.015, I ²= 18%），其中常规加载协议的指数低于立即加载协议或早期加载协议的指数。种植体稳定性商仅在 3 个月时出现统计学显着差异（标准平均差 = 0.602 [0.309, 0.895]，P <.001，I ² =0%），常规加载方案的值更高。其他参数无统计学差异（P >.05）。

结论

下颌覆盖义齿的即刻负重方案或早期负重方案已被确定为一种行之有效的治疗方法，值得在临床实践中加以考虑。