Comparison of Dental Implant Systems: Quality of Clinical Evidence and Prediction of 5-Year Survival
Howard E. Strassler, DMD
Eckert SE, Choi Y, Sanchéz A, Koka S. Int J of Oral Maxillofac Implants. 2005;20(3):406-415.
PURPOSE: This literature review was conducted to evaluate the quality of current evidence of clinical performance provided by American Dental Association–certified dental implant manufacturers and manufacturers with strong market penetration in the United States. The study also compared the clinical performance of different dental implant systems. MATERIALS AND METHODS: A letter was sent to 6 implant manufacturers requesting 10 references each that validated the manufacturer’s implant system in a variety of clinical applications. References were reviewed and classified relative to strength of evidence. Data extraction was then performed. Comparisons of implant survival data from 5-year studies were made, and data were pooled to establish an overall 5-year survival rate with confidence intervals (CIs). RESULTS: A total of 69 references were provided by the 6 implant manufacturers (Astra Tech, Centerpulse, Dentsply/Friadent, Implant Innovations, Nobel Biocare, and Straumann), but only 59 articles were available for review. Of those references, most were level-4 (case series) or level-5 (expert opinion) articles. Five-year survival data were extracted from 17 articles demonstrating overlap of CIs from the weighted average of the pooled data from each specific manufacturer; substantial equivalence of all implant systems was demonstrated based upon survival alone at 5 years. When all data were pooled, the 5-year survival rate of 96% (CI: 93% to 98%) was observed for a total of 7,398 implants. DISCUSSION: No obvious differences in implant survival were observed when comparing implant systems. CONCLUSIONS: The evidence supporting implant therapy is generally derived from level-4 case series rather than higher-level cohort or controlled clinical trials. Articles that directly compared different implant systems were not found. Five-year implant survival rates easily exceeded the minimums recommended by the American Dental Association certification program.
Over the past 15 years, there has been much discussion of evidence-based dentistry (EBD). The goal of EBD has been to provide the dentist with evidence to help make sound clinical decisions. Of interest, in the same issue of this journal there is an editorial that makes a case for the fact that EBD for implants may be a bit myopic in its premise. It notes consideration to value-based dentistry as well as for decision-making. This editorial is one worth reading.
In this article, the focus of a comparison of implant systems using an EBD approach used survey-like methodology to ascertain the evidence that dental implant manufacturers are using for persuading dentists to use their systems. The letter sent to the six dental implant manufacturers was very specific for the type of references to be submitted, with the highest level of evidence being randomized, controlled clinical trials, even though this type of study is not the standard in the dental implant industry. Although the evidence presented by the manufacturers was not at the highest level, the number of implants placed and followed for 5 years with a survival rate of 96% is reassuring. With this support, dentists can be confident that patients receiving dental implants can expect excellent success from their restorations. Comparing evidence-based medicine to EBD as a sole determining factor may not be realistic to the multifactoral conditions that exist and need to be considered.
|About the Author|
Howard E. Strassler, DMD