Abstract
Statement of problem
The decision to splint or to restore independently generally occurs during the planning
stage, when the advantages and disadvantages of each clinical situation are considered
based on the proposed treatment. However, clinical evidence to help clinicians make
this decision is lacking.
Purpose
The purpose of this systematic review and meta-analysis was to assess the marginal
bone loss, implant survival rate, and prosthetic complications of splinted and nonsplinted
implant restorations.
Material and methods
This study was designed according to the Cochrane criteria for elaborating a systematic
review and meta-analysis and adopted the Preferred Reporting Items for Systematic
Reviews and Meta-analyses (PRISMA) statement. Also, this review was registered at
the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42017080162).
An electronic search in the PubMed/MEDLINE, Cochrane Library, and Scopus databases
was conducted up to November 2017. A specific clinical question was structured according
to the population, intervention, comparison, outcome (PICO) approach. The addressed
focused question was “Should the restoration of adjacent implants be splinted or nonsplinted?”
The meta-analysis was based on the Mantel-Haenszel and inverse variance methods to
assess the marginal bone loss, implant survival, and prosthetic complications of splinted
and nonsplinted implant restorations.
Results
Nineteen studies were selected for qualitative and quantitative analyses. A total
of 4215 implants were placed in 2185 patients (splinted, 2768; nonsplinted, 1447);
the mean follow-up was 87.8 months (range=12-264 months). Quantitative analysis found
no significant differences between splinted and nonsplinted restorations for marginal
bone loss. The assessed studies reported that 75 implants failed (3.4%), of which
24 were splinted (99.1% of survival rate) and 51 were nonsplinted (96.5% of survival
rate). Quantitative analysis of all studies showed statistically significant higher
survival rates for splinted restorations than for nonsplinted restorations. Ceramic
chipping, screw loosening, abutment screw breakage, and soft tissue inflammation were
reported in the selected studies. The quantitative analysis found no statistically
significant difference in the prosthetic complications of splinted and nonsplinted
restorations.
Conclusions
Within the limitations of this systematic review and meta-analysis, it was concluded
that there was no difference in the marginal bone loss and prosthetic complications
of splinted and nonsplinted implant restorations; this is especially true for restorations
in the posterior region. However, splinted restorations were associated with decreased
implant failure.
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Article info
Publication history
Published online: June 28, 2018
Footnotes
Supported by grant 2015/07383-8 from the São Paulo Research Foundation, Brazil.
Identification
Copyright
© 2018 by the Editorial Council for The Journal of Prosthetic Dentistry.
