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Research article
Effects of immediate and delayed loading protocols on marginal bone loss around implants in unsplinted mandibular implant-retained overdentures: A systematic review and meta-analysis
Lei Sui
Tianjin Medical University
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3586-9999
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Immediate loading has recently been introduced into unsplinted mandibular implant-retained overdentures for the management of edentulous patients due to their increasing demand on immediate aesthetics and function. However, there is still a scarcity of meta-analytical evidence on the efficacy of immediate loading compared to delayed loading in unsplinted mandibular implant-retained overdentures. The purpose of this study was to compare the marginal bone loss (MBL) around implants between immediate and delayed loading of unsplinted mandibular implant-retained overdentures.
Methods: Randomized controlled trials (RCTs), controlled clinical trials (CCTs), and cohort studies quantitatively comparing the MBL around implants between immediate loading protocol (ILP) and delayed loading protocol (DLP) of unsplinted mandibular overdentures were included. A systematic search was carried out in PubMed, EMBASE, and CENTRAL databases on December 02, 2020. “Grey” literature was also searched. A meta-analysis was conducted to compare the pooled MBL of two different loading protocols of unsplinted mandibular overdentures through weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). The subgroup analysis was performed between different attachment types (i.e. Locator attachment vs. ball anchor). The risk of bias within and across studies were assessed using the Cochrane Collaboration’s tool, the Newcastle-Ottawa scale, and Egger’s test.
Results: Of 328 records, five RCTs and two cohort studies were included and evaluated, which totally contained 191 participants with a follow-up of no less than 12 months. The MBL of ILP group showed no significant difference with that of DLP group (WMD 0.04, CI -0.13 to 0.21, P > .05). The subgroup analysis revealed similar results with Locator attachments or ball anchors (P > .05). Apart from one RCT (20%) with a high risk of bias, four RCTs (80%) showed a moderate risk of bias. Two prospective cohort studies were proved with acceptable quality. Seven included studies have reported ten implant failures in ILP groups and two implant failures in DLP groups in total.
Conclusions: For unsplinted mandibular implant-retained overdentures, the MBL around implants after ILP seems comparable to that of implants after DLP. Immediate loading may be a promising alternative to delayed loading for the management of unsplinted mandibular implant-retained overdentures.
PROSPERO registration number: CRD42020159124
Keywords
Implant-retained overdenture, Immediate loading, Delayed loading, Marginal bone loss, Systematic review, Meta-analysis
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On 28 Nov, 2020
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Received 20 Nov, 2020
Review #3 received
Received 05 Nov, 2020
Reviewer #5 agreed
On 02 Nov, 2020
Reviewer #4 agreed
On 01 Nov, 2020
Reviewer #3 agreed
On 22 Oct, 2020
Review #1 received
Received 07 Oct, 2020
Review #2 received
Received 03 Oct, 2020
Editor assigned
On 29 Sep, 2020
Reviewers invited
Invitations sent on 29 Sep, 2020
Reviewer #1 agreed
On 29 Sep, 2020
Reviewer #2 agreed
On 29 Sep, 2020
Submission checks complete
On 28 Sep, 2020
Editor invited
On 28 Sep, 2020
No comments provided
Editorial decision: Minor revision
On 20 Sep, 2020
Review #2 received
Received 19 Sep, 2020
Review #1 received
Received 16 Sep, 2020
Reviewer #2 agreed
On 11 Sep, 2020
Reviewer #1 agreed
On 09 Sep, 2020
Reviewers invited
Invitations sent on 08 Sep, 2020
Editor assigned
On 18 Aug, 2020
Submission checks complete
On 17 Aug, 2020
Editor invited
On 17 Aug, 2020
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This preprint is under consideration at BMC Oral Health. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Effects of immediate and delayed loading protocols on marginal bone loss around implants in unsplinted mandibular implant-retained overdentures: A systematic review and meta-analysis
Lei Sui
Tianjin Medical University
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3586-9999
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 3
Posted 11 Jan, 2021
No community comments so far
Editor assigned
On 25 Dec, 2020
Submission checks complete
On 25 Dec, 2020
Editor invited
On 25 Dec, 2020
No comments provided
Editorial decision: Major revision
On 28 Nov, 2020
Review #4 received
Received 20 Nov, 2020
Review #3 received
Received 05 Nov, 2020
Reviewer #5 agreed
On 02 Nov, 2020
Reviewer #4 agreed
On 01 Nov, 2020
Reviewer #3 agreed
On 22 Oct, 2020
Review #1 received
Received 07 Oct, 2020
Review #2 received
Received 03 Oct, 2020
Editor assigned
On 29 Sep, 2020
Reviewers invited
Invitations sent on 29 Sep, 2020
Reviewer #1 agreed
On 29 Sep, 2020
Reviewer #2 agreed
On 29 Sep, 2020
Submission checks complete
On 28 Sep, 2020
Editor invited
On 28 Sep, 2020
No comments provided
Editorial decision: Minor revision
On 20 Sep, 2020
Review #2 received
Received 19 Sep, 2020
Review #1 received
Received 16 Sep, 2020
Reviewer #2 agreed
On 11 Sep, 2020
Reviewer #1 agreed
On 09 Sep, 2020
Reviewers invited
Invitations sent on 08 Sep, 2020
Editor assigned
On 18 Aug, 2020
Submission checks complete
On 17 Aug, 2020
Editor invited
On 17 Aug, 2020
First submitted
On 16 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Immediate loading has recently been introduced into unsplinted mandibular implant-retained overdentures for the management of edentulous patients due to their increasing demand on immediate aesthetics and function. However, there is still a scarcity of meta-analytical evidence on the efficacy of immediate loading compared to delayed loading in unsplinted mandibular implant-retained overdentures. The purpose of this study was to compare the marginal bone loss (MBL) around implants between immediate and delayed loading of unsplinted mandibular implant-retained overdentures.
Methods: Randomized controlled trials (RCTs), controlled clinical trials (CCTs), and cohort studies quantitatively comparing the MBL around implants between immediate loading protocol (ILP) and delayed loading protocol (DLP) of unsplinted mandibular overdentures were included. A systematic search was carried out in PubMed, EMBASE, and CENTRAL databases on December 02, 2020. “Grey” literature was also searched. A meta-analysis was conducted to compare the pooled MBL of two different loading protocols of unsplinted mandibular overdentures through weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). The subgroup analysis was performed between different attachment types (i.e. Locator attachment vs. ball anchor). The risk of bias within and across studies were assessed using the Cochrane Collaboration’s tool, the Newcastle-Ottawa scale, and Egger’s test.
Results: Of 328 records, five RCTs and two cohort studies were included and evaluated, which totally contained 191 participants with a follow-up of no less than 12 months. The MBL of ILP group showed no significant difference with that of DLP group (WMD 0.04, CI -0.13 to 0.21, P > .05). The subgroup analysis revealed similar results with Locator attachments or ball anchors (P > .05). Apart from one RCT (20%) with a high risk of bias, four RCTs (80%) showed a moderate risk of bias. Two prospective cohort studies were proved with acceptable quality. Seven included studies have reported ten implant failures in ILP groups and two implant failures in DLP groups in total.
Conclusions: For unsplinted mandibular implant-retained overdentures, the MBL around implants after ILP seems comparable to that of implants after DLP. Immediate loading may be a promising alternative to delayed loading for the management of unsplinted mandibular implant-retained overdentures.
PROSPERO registration number: CRD42020159124
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5