Revisão sistemática e meta-análise de implantes pterigoideos. Taxa de sobrevivência e recomendações da prática clínica

Abstract

Dental rehabilitation of patients with atrophic posterior maxilla using osseointegrated implants is considered a great challenge due to the anatomy and pneumatisation of maxillary sinus, insufficient bone volume, bone quality, surgical and prosthetic difficulties in accessing the posterior area of maxilla. Biomechanical factor is another influencing factor on implant survival placed in the posterior maxilla due to the high occlusal forces in molar region. Several treatment options are cited in the literature, and the pterygoid implant technique can provide a posterior anchorage without bone graft procedures and eliminates long distal cantilevers. The purpose of this systematic review was to evaluate clinical studies on the predictability and survival rates of pterygoid implants in the rehabilitation of patients with atrophic posterior maxilla. A second objective of this work is to provide a clinical guide to stimulate and orientate surgeons to accomplish this technique. A comprehensive search of studies published from 1995 to 2017 was conducted by two independent individuals. PubMeD/MEDLINE, Embase, Cochrane Library, Science Direct and Lillacs databases were searched in accordance with the PRISMA statement. This systematic review were registered in the Prospero database. The relevant reports on pterygoid and/or pterygomaxillary implants were selected according to predetermined inclusion and exclusion criteria. All studies were selected based on the PICO questions. The search retrieved 330 references and after filtering 34 articles culminated for complete reading. The eligibility process and quality assessment resulted in 6 studies. The quality of each study included was assessed using the National Health and Medical Research Council. A total of 634 patients received 1.893 pterygoid implants with a mean implant survival rate of 94.87%. The mean prevalence of implant failure was 0.056 with a 95% CI of 0.04 to 0.077. The estimated average prevalence of implant failure was 0.056, which reflects in 5.6% implant rate loss for the included studies. The follow up period ranged from 12months up to 132 months. None of the studies reported significant clinical, surgical or prosthetic complications. Patients with atrophic posterior maxilla can be successfully treated with pterygoid implants