Abstract
ObjectiveThis review aims to compare peri-implant tissue changes in terms of clinical and radiographic aspects of implant restoration protocol using one-time abutment to repeated abutment connection in platform switched implant.MethodA structured search strategy was applied to three electronic databases, namely, Pubmed, Embase and Web of Science. Eight eligible studies, including seven randomised controlled studies and one controlled clinical study, were identified in accordance with inclusion/exclusion criteria. Outcome measures included peri-implant bone changes (mm), peri-implant soft tissue changes (mm), probing depth (mm) and postsurgical complications.ResultSix studies were pooled for meta-analysis on bone tissue, three for soft tissue, two for probing depth and four for postsurgical complications. A total of 197 implants were placed in one-time abutment group, whereas 214 implants were included in repeated abutment group. The implant systems included Global implants, Ankylos, JDEvolution (JdentalCare), Straumann Bone level and Conelog-Screwline. One-time abutment group showed significantly better outcomes than repeated abutment group, as measured in the standardised differences in mean values (fixed- and random-effect model): vertical bone change (0.41, 3.23) in 6 months, (1.51, 14.81) in 12 months and (2.47, 2.47) in 3 years and soft tissue change (0.21, 0.23). No significant difference was observed in terms of probing depth and complications.ConclusionOur meta-analysis revealed that implant restoration protocol using one-time abutment is superior to repeated abutment for platform switched implant because of less bone resorption and soft tissue shifts in former. However, future randomised clinical trials should be conducted to further confirm these findings because of the small samples and the limited quality of the original research.
Highlights
The focus of dental implant therapy has shifted from functional therapy in the 1980s and prosthetic-driven therapy in the 1990s to biological-driven therapy since the 2000s
Our meta-analysis revealed that implant restoration protocol using one-time abutment is superior to repeated abutment for platform switched implant because of less bone resorption and soft tissue shifts in former
A platform switching implant system was used in dog model, and the abutment shifting protocol was similar to that used in clinics[51]
Summary
The focus of dental implant therapy has shifted from functional therapy in the 1980s and prosthetic-driven therapy in the 1990s to biological-driven therapy since the 2000s. Biologicaldriven implant therapy does recover the function of soft and hard peri-implant tissues and maintains their aesthetics and long-term stability[1]. Biologic width (BW) of dental implant is critical to the quality and stability of peri-implant structure[2]. BW around implant comprises sulcus epithelium, junctional epithelium, and connective tissue, and its physiological formation initiates crestal bone resorption and remodelling once the implant is exposed to the oral environment[3]. Crestal bone remodelling process is a biologic response to create space for new attachment of supracrestal fibres to the implants for biologic soft tissue seal[4]. BW determines the minimum dimension from the junctional epithelium to attainment of connective tissue to ensure an ideal seal and to provide protection from mechanical and external biological agents. Any external agent invading the BW would induce a response from the epithelium that migrates beyond this agent, trying to isolate it[6]
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