Helping the clinician make evidence-based implant selections. A systematic review and qualitative analysis of dental implant studies over a 20 year period

Abstract

With an emerging clinician demand for evidence-based decision making for implant therapy, there is a need for an assessment of the strength and quality of evidence available for different implant systems. To the best of the author's knowledge, there is no such systematic review available which assesses studies over a wide time period. This current report thus seeks to fill this void. A PubMed, Cochrane database, and hand search was conducted for Straumann, Nobel BioCare, 3i and Dentsply using the following limits- English language, RCT, Clinical Trials, Meta- analysis, Date range (Total of 20 years from 1 January 1988-1 January 2008), and using specific search words. Subsequently, a quantitative and qualitative analysis was conducted using risk of bias as a surrogate variable for quality of a study. Although a large difference was found in the number of clinical trials for Nobel Biocare (higher) and Straumann (lower), there was a minimal difference in the number of randomised controlled trials between these companies. There was also a significant gap between the number of studies for both these companies, compared to the much lower number of relevant studies for 3i and Dentsply. The qualitative analysis revealed that Straumann and Nobel Biocare were closely tied behind 3i for the percentage of studies with the least risk of bias; though we need to keep in mind that 3i had far fewer relevant studies compared to both Nobel BioCare and Straumann. This systematic review provides an assessment of the strength and quality of evidence for four leading implant companies. Clinicians should assess the strength of evidence before choosing an implant system. Following the guidelines from the CONSORT statement for future studies might enable standardisation and comparison across different implant systems.