JJOD 2306 1–14 journal of dentistry xxx (2014) xxx–xxx
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.intl.elsevierhealth.com/journals/jden 1 2 3
Review
Systematic review of short- (5–10 years) and long-term (10 years or more) survival and success of full-arch fixed dental hybrid prostheses and supporting implants
4 5 6 7
8 9 10 11 12 13
Q1
TaeHyun Kwon a, Paul A. Bain b, Liran Levin c,a,* a
Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA b Countway Library of Medicine, Harvard Medical School, Boston, MA, USA c Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Faculty of Medicine, Technion, IIT, Haifa, Israel
article info
abstract
Article history:
Aim: The aim of this systematic review was to investigate the short-term (5–10 year mean
Received 12 March 2014
follow-up) and long-term (10 year or more) survival and success of fixed full arch dental
Received in revised form
hybrid prosthesis and supporting dental implants.
27 May 2014
Methods: Studies reporting interventions with full-arch fixed dental hybrid prostheses were
Accepted 30 May 2014
identified by searching PubMed/Medline (NCBI), Web of Science (Thomson Reuters), the
Available online xxx
Cochrane Register of Controlled Clinical Trials (EBSCO), and Dentistry and Oral Sciences Source (DOSS; EBSCO) from the earliest available dates through July 17, 2013. Through a
Keywords:
series of review process by two examiners, potentially qualifying studies were identified and
All on four
assessed with respect to the inclusion criteria.
Complications
Results: A total of 18 studies were included for the quality assessment and the systematic
Edentulism
review. Within the limitation of available studies, high short-term survival rates of full arch
Fixed complete denture
fixed dental hybrid prostheses (93.3–100%) and supporting implants (87.89–100%) were
Tilted implant
found. However, the availability of studies investigating long-term outcomes seemed scarce. Furthermore, the included studies were subjected to potential sources of bias (i.e. publication, reporting, attrition bias). Conclusion: Despite seemingly high short-term survival, long-term survival of implant supported full arch fixed dental hybrid prosthesis could not be determined due to limited availability of true long-term studies. Although it may be a valuable option for a patient with a completely edentulous ridge(s), the strategic removal of teeth with satisfactory prognosis in sake of delivering an implant supported full-arch dental hybrid prosthesis should be avoided.
16
# 2014 Elsevier Ltd. All rights reserved.
14 15 17 18 * Corresponding author at: Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel. Fax: +972 4 85431717. E-mail address: [email protected] (L. Levin). http://dx.doi.org/10.1016/j.jdent.2014.05.016 0300-5712/# 2014 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Kwon TH, et al. Systematic review of short- (5–10 years) and long-term (10 years or more) survival and success of full-arch fixed dental hybrid prostheses and supporting implants. Journal of Dentistry (2014), http://dx.doi.org/10.1016/j.jdent.2014.05.016
Q2
JJOD 2306 1–14
2
19
journal of dentistry xxx (2014) xxx–xxx
Q3 1.
Table 1 – PICOS (Participants, Interventions, Comparisons, Outcomes, Study Designs).
Introduction
Participants
20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49
Hybrid prosthesis often refers to fixed rehabilitation composed of a metal-based substructure covered with acrylic resin.1 With the advancement in dental implantology over the years, hybrid prosthesis has been successfully utilized to rehabilitate completely edentulous ridges.2 In general, an edentulous arch could be rehabilitated in this method, using four to eight endosseous implant fixtures with screw retained hybrid restoration.3,4 In those cases, a one-piece full-arch hybrid prosthesis consisting of a metal framework, acrylic base and denture teeth is fabricated and screwed onto the implants.3,4 This treatment modality allows patients to have a completely fixed prosthesis, which can only be removed by the dental professional.1 Furthermore, by often utilizing a distally cantilevered prosthesis and angulated implant fixtures, it may require lower number of implant fixtures and complicated surgical procedures such as maxillary sinus augmentation and guided bone regeneration, compared to a conventional method (i.e. rehabilitating with full-arch ceramo-metal implant supported fixed partial dentures).4–7 Previous studies have reported high success rates of the prosthesis as well as supporting dental implants using this concept6–8; however many of these studies had reported minimal-short-term interventions with follow-up of less than 5 years.9–17 Furthermore, to the best of authors’ knowledge, there may be no available literature, systemically evaluating the long-term results of this specific treatment modality. Therefore, the aim of this systematic review was to investigate both short (5–10 years) and long-term (10 years or more) survival and success of fixed dental hybrid prosthesis and supporting dental implants used for rehabilitating a completely edentulous ridge.
50 51
1.1.
52
Objectivesx
53 54 54 55 55 56 56 58 57 57 59 58 60 59 61 62 63
1. To investigate the short and long-term survival of full arch fixed dental hybrid prostheses and their supporting implants. 2. To investigate mean alveolar bone loss around dental implants, incidence of prosthodontics complications, and patient satisfaction.
64 65 66
PICOS questions were pre-determined in order to specifically address and achieve the aforementioned aims and objectives (Table 1).18
67
1.2. PICOS (Participants, Interventions, Comparisons, Outcomes, study Designs)
2.
Materials and methods
2.1.
Search method and identification of studies
68
Interventions Comparisons Outcomes
Study designs
a
The primary objectives of the current study were on prognosis.
and Dentistry and Oral Sciences Source (DOSS; EBSCO) from the earliest available dates through July 17, 2013. The search strategies were assembled from synonyms for All on Four, All on Six, hybrid, or tilted implants and all likely modes of implant or treatment failure (Appendix 1). Medical Subject Headings (MeSH) were included in the PubMed strategy. Supplemental hand-search was conducted by reviewing the reference lists of related papers and review articles. No language limit was applied for the initial search. The authors adhered to the PRISMA standard for reporting systematic reviews.18 The search was developed and conducted by an experienced reference librarian (PAB). Any duplicates were removed. Through title and abstract review by two independent examiners (TK, LL), potentially qualifying studies were identified. Thereafter, these studies received full text assessment with respect to inclusion criteria. Any disagreement between the examiners was resolved by discussion until agreement was reached. The inter-examiner agreement on study selection was evaluated according to kappa statistics.
73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91
2.2.
92
Studies reporting interventions with full-arch fixed dental hybrid prostheses were identified by electronically searching PubMed/Medline (NCBI), Web of Science (Thomson Reuters), the Cochrane Register of Controlled Clinical Trials (EBSCO),
Inclusion criteria
This review was based on reports from randomized controlled studies, prospective cohort studies, retrospective cohort studies, case–control studies and case series, which were identified by the systematic literature searches as described above. The additional inclusion criteria for study selection were:
93 94 95 96 97 98 99
The publications reported in English, Hebrew, Korean or German. The studies involve human subjects. The studies must have a mean follow up time of 5 years or more. The studies must have minimum of 10 subjects who completed 5 year follow-up. All study subjects must have received full arch fixed dental hybrid prosthesis/prostheses.
100 101 101 102 102 104 103 103 106 105 104 107 105 109 108 106 110 107 112 111 108 113 109 114 110 115 111 112 116 113 117 118
2.3. 69 70 71 72
Generally healthy subjects with completely edentulous arch(s) Implant supported full arch fixed dental hybrid prostheses Not applicablea 1. Cumulative survival of prostheses and their supporting implants 2. Mean alveolar bone loss of supporting implants, incidence of prosthodontic complications, patient reported satisfaction Randomized controlled trial, prospective cohort study, retrospective cohort study, case-series
Type of outcome measurements
The primary outcome measurements were cumulative survival rates of dental implants and prostheses. The secondary outcome measurements were mean alveolar bone loss (in mm) around
Please cite this article in press as: Kwon TH, et al. Systematic review of short- (5–10 years) and long-term (10 years or more) survival and success of full-arch fixed dental hybrid prostheses and supporting implants. Journal of Dentistry (2014), http://dx.doi.org/10.1016/j.jdent.2014.05.016
JJOD 2306 1–14 journal of dentistry xxx (2014) xxx–xxx
119 120
dental implants, incidence of prosthetic complications (number of events) and patient reported satisfaction.
121
2.4.
122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140
The following information were collected from each included study and inserted into a specifically designed electronic spreadsheet: names of the authors, year of publication, study design, total number of subjects at baseline, total number of implants at baseline, total number of subjects at follow-up, total number of implants at follow-up, number of implant fixtures per arch, years of mean follow-up, loading protocols (immediate; loading within 24 h following implant placement, early; loading after 24 h and before 2 months following implant placement, delayed; loading after 2 months following implant placement), types, surface (machined/rough), manufacturer of inserted implants, cumulative implant survival, cumulative prosthesis survival, mean alveolar bone loss (mm/ years of follow-up), incidence of prosthetic complications (number of events), and patient-reported satisfaction. Lastly, based on mean follow-up years, the studies were categorized into either short-term (mean follow-up between 5–10 years) or long-term (mean follow up of 10 years or longer) group, and their results were presented separately.
141
2.5.
142 143 144 145 146 147 149 148 151 150 151 152 152 154 153 153 156 155 154 158 157 155 160 159 156 162 161 157 164 163 158 166 165 159 167 160 169 168 161 170 162 171 163 172 164 173 165 174 166 175 167 176 168 169 177
The quality and risk for bias of the included studies were assessed by the authors (TK, LL). A 9-question checklist, which was modified from Annibali et al.19 was completed for each study. The following quality criteria were assessed. Any disagreement between the examiners was resolved by discussion until agreement was reached. The inter-examiner agreement was evaluated according to kappa statistics. 1. Number of study centre (single-centre study; multi-centre study) 2. Setting of study centre (university; private clinic) 3. Clear description of study aim (yes; no) 4. Clear definition of inclusion and exclusion criteria (yes; no) 5. Clear definition of study outcome measures (yes; no) 6. Prospective data collection (yes; no) 7. Clear description of main study findings (yes; no) 8. Completeness of follow-ups and explanations for dropouts/ withdrawals (yes; no) 9. Conflicts of interest/industrial support (yes; no)
Data collection
Fig. 1 – Search strategy and history.
Quality and risk for bias assessment
The examiners assessed the presence of conflict of interest by reviewing the authors’ disclosures and acknowledgements in the manuscript according to the criterion used by Friedman and Richter.20 The conflict of interest was defined as all financial relationships with companies whose products the researchers are evaluating in the manuscript.20
3.
Results
3.1.
Search results
178
179 180
3
Fig. 1 describes the flow chart of the search results. A total of 1992 records were identified using the four databases. Thirty-nine
studies were identified for full-text assessment after duplicate removal, and title and abstract assessment. Bibliography or references of these 39 studies were reviewed, and additional 5 studies were identified for full-text assessment. Therefore, a total of 44 studies received full-text assessment, after which twenty-six studies were excluded (Table 2). The remaining 18 studies were finally included for the quality assessment and the systematic review (Table 3). Among 18 studies, the results from two studies were combined as they reported implant and prosthetic outcomes from the same cohort of the subjects in two phases.21,22 The agreement between the two examiners on the study selection as evaluated by kappa statistics was 0.82.
181 182 183 184 185 186 187 188 189 190 191 192
3.2. Quality and risk for bias assessment of included studies
193 194
The agreement between the two examiners as evaluated by kappa statistics was 0.91. The detailed assessment of quality and risk of bias for all included studies are presented in Table 4. It was noteworthy that eleven studies were conducted in a private setting,21–31 among which five studies were conducted in a clinic, specializing in implant supported full arch dental hybrid prosthesis.25,27–29,31 Eleven studies were believed to have potential conflict of interest related to their studies.2,4,5,21,22,25–29,31,32
195 196 197 198 199 200 201 202 203
3.3.
Systematic assessment of included studies
204
3.3.1.
Availability of literature
205 206 207 208 209
There were twelve short-term (Table 5) and six long-term studies (Table 6), which fulfilled the pre-determined inclusion criteria. Ten studies were prospective cohort studies while the remaining six studies were retrospective cohort studies. There
Please cite this article in press as: Kwon TH, et al. Systematic review of short- (5–10 years) and long-term (10 years or more) survival and success of full-arch fixed dental hybrid prostheses and supporting implants. Journal of Dentistry (2014), http://dx.doi.org/10.1016/j.jdent.2014.05.016
JJOD 2306 1–14
4
journal of dentistry xxx (2014) xxx–xxx
Table 2 – Excluded studies and reasons for the exclusion. Author
Reason for exclusion 9
Balshi et al. (2005) Browaeys et al. (2011)40 Cavalli et al. (2012)10 Ferrigno et al. (2002)41 Fischer et al. (2008)42 Francetti et al. (2008)11 Francetti et al. (2010)12 Gualini et al. (2009)43 Heydecke et al. (2012)8 Ibanez et al. (2005)44 Ji et al. (2012)13 Larsson and Von Steyern (2013)45 Lethaus et al. (2011)46 Malo et al. (2003)14 Menini et al. (2012)6 Miglioranca et al. (2011)15 Minoretti et al. (2012)47 Papaspyridakos et al. (2012)35 Patzelt et al. (2013)7 Pen˜arrocha et al. (2012)48 Polizzi and Cantoni (2013)49 Pomares (2009)50 Real-Osuna et al. (2012) 1 Schwarz et al. (2010) 16 Testori et al. (2004)17 Wolfinger et al. (2003)51
Mean follow up < 5 years Not specific for full-arch fixed dental hybrid prosthesis Mean follow up < 5 years Not specific for full-arch fixed dental hybrid prosthesis The same cohort subjects as Fischer and Stenberg 21,22 Mean follow up < 5 years Mean follow up < 5 years < 10 subjects analyzed at minimum of 5 years Review Not specific for full-arch fixed dental hybrid prosthesis Mean follow up < 5 years Not specific for full-arch fixed dental hybrid prosthesis Not specific for full-arch fixed dental hybrid prosthesis Mean follow up
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.intl.elsevierhealth.com/journals/jden 1 2 3
Review
Systematic review of short- (5–10 years) and long-term (10 years or more) survival and success of full-arch fixed dental hybrid prostheses and supporting implants
4 5 6 7
8 9 10 11 12 13
Q1
TaeHyun Kwon a, Paul A. Bain b, Liran Levin c,a,* a
Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA b Countway Library of Medicine, Harvard Medical School, Boston, MA, USA c Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Faculty of Medicine, Technion, IIT, Haifa, Israel
article info
abstract
Article history:
Aim: The aim of this systematic review was to investigate the short-term (5–10 year mean
Received 12 March 2014
follow-up) and long-term (10 year or more) survival and success of fixed full arch dental
Received in revised form
hybrid prosthesis and supporting dental implants.
27 May 2014
Methods: Studies reporting interventions with full-arch fixed dental hybrid prostheses were
Accepted 30 May 2014
identified by searching PubMed/Medline (NCBI), Web of Science (Thomson Reuters), the
Available online xxx
Cochrane Register of Controlled Clinical Trials (EBSCO), and Dentistry and Oral Sciences Source (DOSS; EBSCO) from the earliest available dates through July 17, 2013. Through a
Keywords:
series of review process by two examiners, potentially qualifying studies were identified and
All on four
assessed with respect to the inclusion criteria.
Complications
Results: A total of 18 studies were included for the quality assessment and the systematic
Edentulism
review. Within the limitation of available studies, high short-term survival rates of full arch
Fixed complete denture
fixed dental hybrid prostheses (93.3–100%) and supporting implants (87.89–100%) were
Tilted implant
found. However, the availability of studies investigating long-term outcomes seemed scarce. Furthermore, the included studies were subjected to potential sources of bias (i.e. publication, reporting, attrition bias). Conclusion: Despite seemingly high short-term survival, long-term survival of implant supported full arch fixed dental hybrid prosthesis could not be determined due to limited availability of true long-term studies. Although it may be a valuable option for a patient with a completely edentulous ridge(s), the strategic removal of teeth with satisfactory prognosis in sake of delivering an implant supported full-arch dental hybrid prosthesis should be avoided.
16
# 2014 Elsevier Ltd. All rights reserved.
14 15 17 18 * Corresponding author at: Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel. Fax: +972 4 85431717. E-mail address: [email protected] (L. Levin). http://dx.doi.org/10.1016/j.jdent.2014.05.016 0300-5712/# 2014 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Kwon TH, et al. Systematic review of short- (5–10 years) and long-term (10 years or more) survival and success of full-arch fixed dental hybrid prostheses and supporting implants. Journal of Dentistry (2014), http://dx.doi.org/10.1016/j.jdent.2014.05.016
Q2
JJOD 2306 1–14
2
19
journal of dentistry xxx (2014) xxx–xxx
Q3 1.
Table 1 – PICOS (Participants, Interventions, Comparisons, Outcomes, Study Designs).
Introduction
Participants
20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49
Hybrid prosthesis often refers to fixed rehabilitation composed of a metal-based substructure covered with acrylic resin.1 With the advancement in dental implantology over the years, hybrid prosthesis has been successfully utilized to rehabilitate completely edentulous ridges.2 In general, an edentulous arch could be rehabilitated in this method, using four to eight endosseous implant fixtures with screw retained hybrid restoration.3,4 In those cases, a one-piece full-arch hybrid prosthesis consisting of a metal framework, acrylic base and denture teeth is fabricated and screwed onto the implants.3,4 This treatment modality allows patients to have a completely fixed prosthesis, which can only be removed by the dental professional.1 Furthermore, by often utilizing a distally cantilevered prosthesis and angulated implant fixtures, it may require lower number of implant fixtures and complicated surgical procedures such as maxillary sinus augmentation and guided bone regeneration, compared to a conventional method (i.e. rehabilitating with full-arch ceramo-metal implant supported fixed partial dentures).4–7 Previous studies have reported high success rates of the prosthesis as well as supporting dental implants using this concept6–8; however many of these studies had reported minimal-short-term interventions with follow-up of less than 5 years.9–17 Furthermore, to the best of authors’ knowledge, there may be no available literature, systemically evaluating the long-term results of this specific treatment modality. Therefore, the aim of this systematic review was to investigate both short (5–10 years) and long-term (10 years or more) survival and success of fixed dental hybrid prosthesis and supporting dental implants used for rehabilitating a completely edentulous ridge.
50 51
1.1.
52
Objectivesx
53 54 54 55 55 56 56 58 57 57 59 58 60 59 61 62 63
1. To investigate the short and long-term survival of full arch fixed dental hybrid prostheses and their supporting implants. 2. To investigate mean alveolar bone loss around dental implants, incidence of prosthodontics complications, and patient satisfaction.
64 65 66
PICOS questions were pre-determined in order to specifically address and achieve the aforementioned aims and objectives (Table 1).18
67
1.2. PICOS (Participants, Interventions, Comparisons, Outcomes, study Designs)
2.
Materials and methods
2.1.
Search method and identification of studies
68
Interventions Comparisons Outcomes
Study designs
a
The primary objectives of the current study were on prognosis.
and Dentistry and Oral Sciences Source (DOSS; EBSCO) from the earliest available dates through July 17, 2013. The search strategies were assembled from synonyms for All on Four, All on Six, hybrid, or tilted implants and all likely modes of implant or treatment failure (Appendix 1). Medical Subject Headings (MeSH) were included in the PubMed strategy. Supplemental hand-search was conducted by reviewing the reference lists of related papers and review articles. No language limit was applied for the initial search. The authors adhered to the PRISMA standard for reporting systematic reviews.18 The search was developed and conducted by an experienced reference librarian (PAB). Any duplicates were removed. Through title and abstract review by two independent examiners (TK, LL), potentially qualifying studies were identified. Thereafter, these studies received full text assessment with respect to inclusion criteria. Any disagreement between the examiners was resolved by discussion until agreement was reached. The inter-examiner agreement on study selection was evaluated according to kappa statistics.
73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91
2.2.
92
Studies reporting interventions with full-arch fixed dental hybrid prostheses were identified by electronically searching PubMed/Medline (NCBI), Web of Science (Thomson Reuters), the Cochrane Register of Controlled Clinical Trials (EBSCO),
Inclusion criteria
This review was based on reports from randomized controlled studies, prospective cohort studies, retrospective cohort studies, case–control studies and case series, which were identified by the systematic literature searches as described above. The additional inclusion criteria for study selection were:
93 94 95 96 97 98 99
The publications reported in English, Hebrew, Korean or German. The studies involve human subjects. The studies must have a mean follow up time of 5 years or more. The studies must have minimum of 10 subjects who completed 5 year follow-up. All study subjects must have received full arch fixed dental hybrid prosthesis/prostheses.
100 101 101 102 102 104 103 103 106 105 104 107 105 109 108 106 110 107 112 111 108 113 109 114 110 115 111 112 116 113 117 118
2.3. 69 70 71 72
Generally healthy subjects with completely edentulous arch(s) Implant supported full arch fixed dental hybrid prostheses Not applicablea 1. Cumulative survival of prostheses and their supporting implants 2. Mean alveolar bone loss of supporting implants, incidence of prosthodontic complications, patient reported satisfaction Randomized controlled trial, prospective cohort study, retrospective cohort study, case-series
Type of outcome measurements
The primary outcome measurements were cumulative survival rates of dental implants and prostheses. The secondary outcome measurements were mean alveolar bone loss (in mm) around
Please cite this article in press as: Kwon TH, et al. Systematic review of short- (5–10 years) and long-term (10 years or more) survival and success of full-arch fixed dental hybrid prostheses and supporting implants. Journal of Dentistry (2014), http://dx.doi.org/10.1016/j.jdent.2014.05.016
JJOD 2306 1–14 journal of dentistry xxx (2014) xxx–xxx
119 120
dental implants, incidence of prosthetic complications (number of events) and patient reported satisfaction.
121
2.4.
122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140
The following information were collected from each included study and inserted into a specifically designed electronic spreadsheet: names of the authors, year of publication, study design, total number of subjects at baseline, total number of implants at baseline, total number of subjects at follow-up, total number of implants at follow-up, number of implant fixtures per arch, years of mean follow-up, loading protocols (immediate; loading within 24 h following implant placement, early; loading after 24 h and before 2 months following implant placement, delayed; loading after 2 months following implant placement), types, surface (machined/rough), manufacturer of inserted implants, cumulative implant survival, cumulative prosthesis survival, mean alveolar bone loss (mm/ years of follow-up), incidence of prosthetic complications (number of events), and patient-reported satisfaction. Lastly, based on mean follow-up years, the studies were categorized into either short-term (mean follow-up between 5–10 years) or long-term (mean follow up of 10 years or longer) group, and their results were presented separately.
141
2.5.
142 143 144 145 146 147 149 148 151 150 151 152 152 154 153 153 156 155 154 158 157 155 160 159 156 162 161 157 164 163 158 166 165 159 167 160 169 168 161 170 162 171 163 172 164 173 165 174 166 175 167 176 168 169 177
The quality and risk for bias of the included studies were assessed by the authors (TK, LL). A 9-question checklist, which was modified from Annibali et al.19 was completed for each study. The following quality criteria were assessed. Any disagreement between the examiners was resolved by discussion until agreement was reached. The inter-examiner agreement was evaluated according to kappa statistics. 1. Number of study centre (single-centre study; multi-centre study) 2. Setting of study centre (university; private clinic) 3. Clear description of study aim (yes; no) 4. Clear definition of inclusion and exclusion criteria (yes; no) 5. Clear definition of study outcome measures (yes; no) 6. Prospective data collection (yes; no) 7. Clear description of main study findings (yes; no) 8. Completeness of follow-ups and explanations for dropouts/ withdrawals (yes; no) 9. Conflicts of interest/industrial support (yes; no)
Data collection
Fig. 1 – Search strategy and history.
Quality and risk for bias assessment
The examiners assessed the presence of conflict of interest by reviewing the authors’ disclosures and acknowledgements in the manuscript according to the criterion used by Friedman and Richter.20 The conflict of interest was defined as all financial relationships with companies whose products the researchers are evaluating in the manuscript.20
3.
Results
3.1.
Search results
178
179 180
3
Fig. 1 describes the flow chart of the search results. A total of 1992 records were identified using the four databases. Thirty-nine
studies were identified for full-text assessment after duplicate removal, and title and abstract assessment. Bibliography or references of these 39 studies were reviewed, and additional 5 studies were identified for full-text assessment. Therefore, a total of 44 studies received full-text assessment, after which twenty-six studies were excluded (Table 2). The remaining 18 studies were finally included for the quality assessment and the systematic review (Table 3). Among 18 studies, the results from two studies were combined as they reported implant and prosthetic outcomes from the same cohort of the subjects in two phases.21,22 The agreement between the two examiners on the study selection as evaluated by kappa statistics was 0.82.
181 182 183 184 185 186 187 188 189 190 191 192
3.2. Quality and risk for bias assessment of included studies
193 194
The agreement between the two examiners as evaluated by kappa statistics was 0.91. The detailed assessment of quality and risk of bias for all included studies are presented in Table 4. It was noteworthy that eleven studies were conducted in a private setting,21–31 among which five studies were conducted in a clinic, specializing in implant supported full arch dental hybrid prosthesis.25,27–29,31 Eleven studies were believed to have potential conflict of interest related to their studies.2,4,5,21,22,25–29,31,32
195 196 197 198 199 200 201 202 203
3.3.
Systematic assessment of included studies
204
3.3.1.
Availability of literature
205 206 207 208 209
There were twelve short-term (Table 5) and six long-term studies (Table 6), which fulfilled the pre-determined inclusion criteria. Ten studies were prospective cohort studies while the remaining six studies were retrospective cohort studies. There
Please cite this article in press as: Kwon TH, et al. Systematic review of short- (5–10 years) and long-term (10 years or more) survival and success of full-arch fixed dental hybrid prostheses and supporting implants. Journal of Dentistry (2014), http://dx.doi.org/10.1016/j.jdent.2014.05.016
JJOD 2306 1–14
4
journal of dentistry xxx (2014) xxx–xxx
Table 2 – Excluded studies and reasons for the exclusion. Author
Reason for exclusion 9
Balshi et al. (2005) Browaeys et al. (2011)40 Cavalli et al. (2012)10 Ferrigno et al. (2002)41 Fischer et al. (2008)42 Francetti et al. (2008)11 Francetti et al. (2010)12 Gualini et al. (2009)43 Heydecke et al. (2012)8 Ibanez et al. (2005)44 Ji et al. (2012)13 Larsson and Von Steyern (2013)45 Lethaus et al. (2011)46 Malo et al. (2003)14 Menini et al. (2012)6 Miglioranca et al. (2011)15 Minoretti et al. (2012)47 Papaspyridakos et al. (2012)35 Patzelt et al. (2013)7 Pen˜arrocha et al. (2012)48 Polizzi and Cantoni (2013)49 Pomares (2009)50 Real-Osuna et al. (2012) 1 Schwarz et al. (2010) 16 Testori et al. (2004)17 Wolfinger et al. (2003)51
Mean follow up < 5 years Not specific for full-arch fixed dental hybrid prosthesis Mean follow up < 5 years Not specific for full-arch fixed dental hybrid prosthesis The same cohort subjects as Fischer and Stenberg 21,22 Mean follow up < 5 years Mean follow up < 5 years < 10 subjects analyzed at minimum of 5 years Review Not specific for full-arch fixed dental hybrid prosthesis Mean follow up < 5 years Not specific for full-arch fixed dental hybrid prosthesis Not specific for full-arch fixed dental hybrid prosthesis Mean follow up
