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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Are ceramic implants a viable alternative to titanium implants? A systematic literature review

M Andreiotelli, HJ Wenz, and RJ Kohal.

Review published: 2009.

Link to full article: [Journal publisher]

CRD summary

This review concluded that there was insufficient clinical evidence on ceramic implants in general and zirconia implants in particular to recommend ceramic implants for routine clinical use. It was generally well conducted and, given the limited evidence available, the authors' cautious conclusions seem to be appropriate.

Authors' objectives

To assess the clinical data on bone-implant contact and clinical survival or success, to determine whether ceramic oral implants might be viable alternatives to titanium implants.

Searching

PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and the Cochrane Oral Health Group's Trials Register were searched for articles published in English, German, or French, from database inception to December 2008. Search terms were reported and bibliographies of full-text and review articles were manually searched. Manufacturers were also contacted for published and unpublished studies.

Study selection

Clinical studies examining the survival or success rate and bone remodelling or loss rate of wholly ceramic implants in humans were eligible for inclusion if they had a mean follow-up period of one year or more. Case and experience reports were excluded, as were studies of ceramic-coated metal implants.

Included studies used different alumina or zirconia oral implants to examine the cumulative survival rates and bone loss (where reported) in patients with a single missing tooth, some missing teeth, or no teeth (maxillae or mandible).

Two reviewers independently screened studies for inclusion and disagreements were resolved by consensus or by referral to a third reviewer.

Assessment of study quality

Two reviewers independently assessed the quality of the included studies using criteria for allocation concealment, blinding, definition of inclusion and exclusion criteria, adjustment for potential confounders, and completed follow-up. Studies were classed as having a low, moderate, or high risk of bias.

Disagreements were resolved by discussion or by referral to a third reviewer if necessary.

Data extraction

Two reviewers independently extracted the success or survival rates of implants, and bone remodelling or loss (in mm) and these were converted into percentages. Disagreements were resolved by discussion or referral to a third reviewer if necessary.

Methods of synthesis

The percentages were presented in tables and reported in a narrative synthesis, grouped by alumina or zirconia oral implants.

Results of the review

Alumina implants: Ten clinical studies (eight prospective and two retrospective), with 395 patients and 967 implants, were included. Sample size ranged from 15 to 101 patients. The risk of bias in the included studies was moderate to high and the quality was medium to low. Follow-up periods ranged from two to 12 years. The survival or success rate ranged from 23 to 98% for single tooth replacement, partially dentate patients, and edentulous patients.

Zirconia implants: Three clinical studies (all retrospective), with 231 patients and 650 implants, were included. One study included 234 titanium implants. Sample size ranged from 36 to 124 patients. The risk of bias was high in all studies. Follow-up was one year in two studies and 1.8 years in the third. The survival or success rate ranged from 84 to 98%.

Authors' conclusions

There was insufficient clinical evidence on ceramic implants in general and zirconia implants in particular to recommend ceramic implants for routine clinical use.

CRD commentary

The review defined a clear question and was supported by appropriate inclusion criteria. The literature search was adequate and attempted to locate both published and unpublished data, thereby reducing the potential for publication bias. The search was limited by language, which means that language bias cannot be ruled out. Study quality was assessed using appropriate criteria, but no study was rated as high quality. The authors undertook each stage of the process in duplicate to minimise the potential for reviewer error and bias. A narrative synthesis was appropriate, but it was also somewhat limited. Few patient characteristics were reported and the samples were small.

This review was generally well conducted and, given the limited evidence available, the authors' cautious conclusions seem to be appropriate.

Implications of the review for practice and research

The authors did not state any implications for research and practice.

Funding

Not stated.

Bibliographic details

Andreiotelli M, Wenz HJ, Kohal RJ. Are ceramic implants a viable alternative to titanium implants? A systematic literature review Clinical Oral Implants Research 2009; 20(Supplement 4): 32-47. [PubMed: 19663947]

Indexing Status

Subject indexing assigned by NLM

MeSH

Aluminum Oxide; Animals; Dental Implantation, Endosseous; Dental Implants; Dental Porcelain; Dental Restoration Failure; Humans; Osseointegration; Titanium; Zirconium

AccessionNumber

12009109877

Database entry date

30/06/2010

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 19663947