Statement of problem

Bone loss in the edentulous posterior maxilla complicates dental implant placement. In spite of the evidence available, there is continued uncertainty about the benefit of short implants for different outcomes.

Purpose

The purpose of this review was to evaluate the existing evidence for short and standard implants in association with sinus floor elevation regarding implant survival, marginal bone loss, and complications by using an umbrella review of the evidence across meta-analysis of interventional studies.

Material and methods

Medline, Scopus, and Cochrane Library were searched to identify systematic reviews and meta-analyses comparing short implants and standard implants associated with sinus floor elevation. Data extraction and methodological quality (AMSTAR-2) was assessed by 2 authors independently. Outcomes were categorized and tabulated to assess effectiveness. Qualitative data were analyzed using thematic synthesis. The certainty of the evidence was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Results

From 2011 studies, 7 systematic reviews (66 studies) were included as per the eligibility criteria. There was no statistically significant difference between groups for implant survival (risk ratio=1.08; P=.79), and the qualitative analysis did not show differences for prosthetic outcomes. Standard implants were associated with fewer prosthetic complications in the quantitative analysis (risk ratio=3.27; P<.01), but no difference was found between the treatments in the qualitative analysis. Short implants showed reduced marginal bone loss (0.98 ±0.12 mm; mean difference=-0.22; P<.01) and better biologic outcomes (risk ratio=0.16; P<.01). Patient satisfaction was similar for both groups, whereas costs and time for the procedure favored short implants. The quality of the evidence was graded as “critically low” (57.1% of the reviews) and “low.” There was a high certainty of evidence for implant survival, whereas marginal bone loss and complications had moderate certainty.

Conclusions

Short implants had a better or equal performance compared with standard implants for all outcomes assessed. However, assumptions were based on reviews with low or critically low quality of the evidence, suggesting the development of high-quality systematic reviews in this field.

中文翻译：

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与窦底抬高相关的短植入物与标准植入物：对多种结果的荟萃分析的总体审查

问题陈述

上颌后牙缺失的骨质流失使种植牙的植入变得复杂。尽管有可用的证据，但关于短种植体对不同结果的益处仍存在不确定性。

目的

本综述的目的是通过对干预研究的荟萃分析中的证据进行总体审查，评估与鼻窦底抬高相关的短种植体和标准种植体的现有证据，包括种植体存活、边缘骨丢失和并发症。

材料与方法

对 Medline、Scopus 和 Cochrane 图书馆进行了搜索，以确定比较短植入物和标准植入物与窦底抬高相关的系统评价和荟萃分析。数据提取和方法学质量 (AMSTAR-2) 由 2 位作者独立评估。结果被分类并制成表格以评估有效性。使用专题综合分析定性数据。证据的确定性通过推荐分级评估、制定和评估 (GRADE) 方法进行评估。

结果

从 2011 年的研究中，根据资格标准纳入了 7 项系统评价（66 项研究）。两组之间的种植体存活率无统计学显着差异（风险比 = 1.08；P = .79），并且定性分析未显示修复结果的差异。在定量分析中，标准种植体与较少的修复并发症相关（风险比 = 3.27；P <.01），但在定性分析中没有发现治疗之间的差异。短种植体显示边缘骨丢失减少（0.98 ±0.12 mm；平均差异=-0.22；P <.01）和更好的生物学结果（风险比=0.16；P<.01）。两组患者的满意度相似，而手术的成本和时间则有利于短种植体。证据质量被评为“极低”（57.1% 的评论）和“低”。种植体存活的证据具有高度确定性，而边缘骨丢失和并发症具有中等确定性。

结论

对于所有评估结果，短种植体与标准种植体相比具有更好或相等的性能。然而，假设是基于证据质量低或极低的评论，这表明该领域正在开发高质量的系统评论。