Abstract
Objectives To identify whether there is a relationship between different implant shoulder positions/orientations/designs and prosthetic and/or implant failures, biological or mechanical complications, radiographic marginal bone loss (MBL), peri-implant buccal recession (RC), aesthetic scores (Papilla Index, PES, and WES), and patient satisfaction after a minimum of 1 year function in the aesthetic zone, compared to the two-piece, conventional implant neck architecture. Materials and Methods The systematic review was written according to the PRISMA guidelines. The search strategy encompassed the English literature from 1967 to September 2016 and was performed online (in the PubMed database of the U.S. National Library of Medicine, Embase, and the Cochrane Library) to identify relevant studies that met the inclusion criteria. The assessment of quality and risk of bias of the selected manuscripts was performed according to the guidelines provided by CONSORT and STROBE statements. Results A total of 16 articles (7 randomized controlled trials, 4 observational comparative studies, and 5 systematic reviews) were selected to fulfill the inclusion criteria. A trend of higher implant failure and prosthetic complications were experienced in the one-piece group compared to the two-piece group, although no statistically significant differences were found. Higher marginal bone loss was found in the test group (one-piece, scalloped implants) compared to the control group (two-piece, flat implants). No comparative studies reporting data on sloped implants were found that fulfilled the inclusion and exclusion criteria of this systematic review. No differences were experienced between groups regarding aesthetic outcomes and patient satisfaction. Conclusions There was sufficient evidence that different implant shoulder positions/orientations/designs (scalloped, sloped, and one piece) offer no benefit when compared to two-piece, conventional flat implants. Current evidence is limited due to the quality of available studies.
Highlights
Stability of the peri-implant soft and hard tissues is a prerequisite for a long-term aesthetic and function of implantsupported restoration [1]
Platform switching is done whenever an abutment is used that is smaller in diameter than the implant platform. is concept has been proposed as an effective prosthetic concept to reduce the amount of peri-implant bone loss around dental implants [10]. e concept of horizontal offset has made it possible to place implant shoulders at the crestal bone level with predictable minimal marginal bone resorption [10]
Scalloped and sloped implants represent other design changes that advocate for maintaining marginal bone levels [11,12,13]. e scalloped implant was designed with a modified platform that mirrors the natural cement-enamel junction of the anterior teeth and follows the anatomic contour of the anterior alveolar bone crest. e scalloped implants were developed with the intent of preserving interdental bony peaks, supporting the soft tissue, thereby maintaining or creating interimplant papillae [11, 12]
Summary
To identify whether there is a relationship between different implant shoulder positions/orientations/designs and prosthetic and/or implant failures, biological or mechanical complications, radiographic marginal bone loss (MBL), peri-implant buccal recession (RC), aesthetic scores (Papilla Index, PES, and WES), and patient satisfaction after a minimum of 1 year function in the aesthetic zone, compared to the two-piece, conventional implant neck architecture. A total of 16 articles (7 randomized controlled trials, 4 observational comparative studies, and 5 systematic reviews) were selected to fulfill the inclusion criteria. Higher marginal bone loss was found in the test group (one-piece, scalloped implants) compared to the control group (two-piece, flat implants). No comparative studies reporting data on sloped implants were found that fulfilled the inclusion and exclusion criteria of this systematic review. Ere was sufficient evidence that different implant shoulder positions/orientations/designs (scalloped, sloped, and one piece) offer no benefit when compared to twopiece, conventional flat implants. Current evidence is limited due to the quality of available studies
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