ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Internal Connection Implants Preserve More Bone Than External Connection Implants
Clinical Question In patients requiring implant therapy, does the use of an internal connection implant result in less bone loss than an external connection implant?
Clinical Bottom Line For patients receiving implant therapy, internal conical implant connections show reduced bone loss when compared to implants with external connections. A systematic review of 17 critically analyzed studies revealed a clinically significant difference between the two implant connection designs.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 27422232de Medeiros 201617 Studies with 2,708 implants placed in 864 patientsSystematic review of randomized trials
Key resultsTen studies were identified that directly compared internal and external connection types, of which five showed statistically significant reduced bone loss for internal connections. Three of the studies showed no statistically significant difference, one showed reduced bone loss around external connections, and one did not report statistical analysis but showed reduced bone loss around internal connection implants.
Evidence Search External[All Fields] AND internal[All Fields] AND connection[All Fields] AND implant[All Fields] AND ("bone diseases, metabolic"[MeSH Terms] OR ("bone"[All Fields] AND "diseases"[All Fields] AND "metabolic"[All Fields]) OR "metabolic bone diseases"[All Fields] OR ("bone"[All Fields] AND "loss"[All Fields]) OR "bone loss"[All Fields])
Comments on
The Evidence
Validity: Few studies were identified by the authors that directly compared the two connections of interest and also controlled for possible confounding factors. Meta-analysis was not possible due to the heterogeneous nature of the data in the studies. Perspective: A significant proportion of reduced bone loss around internally connected implants is probably due to the platform switching effect. Moving the junction of implant and abutment away from the osseous interface, either medially or vertically, is likely more important than the mechanics of the connection. Other factors such as implant neck design, screw retention vs. cement retention, existing bone quality and quantity, host factors, etc. should also be considered when strategizing maximum bone retention around implants.
Applicability The use of implants with an internal connection should be considered for all implant applications.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords Implant design, marginal bone level
ID# 3126
Date of submission: 11/26/2016spacer
E-mail griseto@uthscsa.edu
Author Neil Griseto, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Stephan Haney, DDS
Faculty mentor/Co-author e-mail haneys2@uthscsa.edu
Basic Science Rationale
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