Prognosis of dental implants in patients with low bone density: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Osteoporosis is a risk factor for implant success. Evidence for the prognosis of dental implants in patients with osteoporosis is still unclear. PURPOSE: The purpose of this systematic review was to compare implant success in patients with low versus normal bone density and to evaluate special techniques used to enhance implant success in these patients. MATERIAL AND METHODS: Searches were performed electronically in 4 databases (PubMed, LILACS, Cochrane, and Grey Literature) through July 2017 and manually to identify studies addressing the subject. Randomized and nonrandomized clinical trials and cohort studies were included. RESULTS: Eleven studies met the eligibility criteria, with a total of 1071 participants. Seven studies compared implant success in low and normal bone density, and 4 compared implant success in special and conventional techniques of implant placement. The risk of bias in the assessment of cohort studies was critical; of nonrandomized clinical trials, serious; and of randomized clinical trials, high. The meta-analysis showed no significant difference between implant survival in patients with low and normal bone density 5 years after implant placement. CONCLUSIONS: Implant survival in patients with low bone density seems to be feasible with special precautions. Implant placement using special adopted techniques might provide equivalent implant stability, survival, and marginal bone loss to normal bone. The quality of evidence is still unclear.

No clear evidence on the clinical performance of different removable prosthetic options in partially edentulous patients.

Data sourcesMedline/PubMed, Embase, BIOSIS/Ovid, SciSearch/DIMDI, Cochrane library, FIZ Technik Web and hand searches of the journals; Clinical Oral Investigations, International Journal of Prosthodontics, Journal of Prosthetic Dentistry, Deutsche Zahnärztliche Zeitschrift, Swiss Dental Journal, Journal of Dentistry and the Journal of Dental Research.Study selectionRandomised controlled trials, prospective and retrospective studies on survival rates of removable dental prostheses in the moderately reduced dentition with at least 15 participants having an observation period of at least two years, and a dropout rate of less than 25% were considered.Data extraction and synthesisTwo reviewers abstracted data. A qualitative summary of the included studies was carried out. Studies providing data that permitted a Kaplan-Meier analysis were included in meta-analysis.ResultsThe review included 19 studies, six of which were in multiple publications. Cast-metal framework dentures showed failure rates of 33% and 50% after five years. One study with a 25-year observation period reported failure rates of 50%. Proper pretreatment and a good recall scheme improve the results. Bilateral attachment prostheses showed failure rates of 11% and 30% after five years. Unilateral attachment prostheses showed failure rates of 75% after five years. Double-crown prostheses dentures show failure rates of 0% to 21.7% after three to six years.ConclusionsWithin the limitations of this study, it seems that removable partial dentures, (RPD), given suitable pretreatment and follow-up regimes, can provide a satisfactory treatment option. Based on only one paper, they revealed acceptable results even over a very long observation period (25 years).