Abstract
Introduction
To minimize trauma and cost of treatment, oral health practitioners have successfully rehabilitated full arches by supporting the prostheses on four implants. However, there is no consensus whether less than four implants supporting full mandibular arches would provide similar clinical outcomes to other well-established all-on-four alternative.
Objective
To identify, summarize, appraise, and compare the clinical outcomes evidence of three-implant fixed full-arch prostheses in completely edentulous mandibular patients.
Materials and methods
This overview of systematic reviews (OoSRs) will include secondary synthesis studies (i.e., systematic reviews with or without a meta-analysis). A three-step search strategy will be conducted in MEDLINE (Ovid), EMBASE (Ovid), Cochrane Database of Systematic Reviews, Scopus, Web of Science (WoS Core Collection), and Google Scholar. Grey literature and a manual search in 12 specialized journals will also be conducted. Three independent reviewers will screen all retrieved articles for eligibility, extract data and assess the methodological quality of the included studies. The results will be presented as tables or narrative synthesis. The studies will be evaluated for risk of bias by ROBIS and methodology quality by the AMSTAR-2 tool. If new primary studies are identified, a meta-analysis will be conducted. Certainty of the evidence will be assessed to answer the following focused research question: In edentulous mandibular patients, what are the implant and prostheses clinical outcomes of three-implant fixed full-arch prostheses compared to other all-on-x solutions?
Discussion
There are some systematic reviews about the use of fixed complete dental prostheses supported by three implants; however, their clinical outcomes related to the other all-on-four plus solutions are conflicting. So, an overview on this topic is required to provide recommendations.
Review registration number
International prospective register of systematic reviews (PROSPERO) ID#: CRD42021262175. National Institute for Health Research (NIHR) and Centre for Reviews and Dissemination, University of York, York, United Kingdom.
Introduction
Edentulism is a global phenomenon that is described as the complete loss of all teeth [1–3]. Edentulism is a common disability within the aging population since edentulism increases with age [4, 5]. An increase overall in the aging population has increased the number of edentulous Americans [6]. It is estimated that the number of edentulous Brazilians is expected by 2040 to increase in their aging population to > 64 million [7]. Consequently, it is globally projected that the need to reconstruct edentulous patients will intensify the future [3].
There is certain grade of alveolar bone atrophy in most edentulous aging population [8]. The mandibular anterior region crucial structures are the extension of the anterior loop, mandibular canal/inferior alveolar nerve, and mental nerve [9]. The mandibular posterior region may present four branching patterns of the inferior alveolar canal (IAC) branches [10]. Consequently, familiarity of the patient’s anatomical structures and variations permit the dental clinician propose an adequate treatment plan [10–12].
Mandibular fixed and removable full-arch implant prostheses present high implant and prosthesis survival rates, even when immediate loaded [13–15]. Indeed, immediate loaded implants may present long-term success rate [16]. Regarding the removable options, a recent consensus statement that provided clinical recommendations for implant-overdentures (IODs) determined 4 implants have been effectively used for mandibular IODs and 2 implants are considered the minimum standard of care treatment [13]. Mandibular implant fixed full-arch prostheses produce high quality of life (QoL) and patient satisfaction concerning retention, stability, and ease of chewing [13, 14, 17]. Interestingly, there are no differences in overall QoL or patient satisfaction between mandibular fixed and removable full-arch implant prostheses [13, 14]. A recent meta-analysis advocate that full-arch prostheses supported by short implants in atrophic edentulous mandibles may be a feasible treatment alternative [18]. However, long-term data is needed to support this recommendation. People mostly prefer a mandibular 4-implant-supported fixed full-arch prostheses when compared to conventional complete dentures or 2-implant-retained overdentures (IOD) [19]. Interestingly, people with less school education and those with lower financial income are less inclined to select implant-supported fixed full-arch prostheses [19].
There is often controversy regarding the number if implants needed for mandibular implant fixed full-arch prostheses. However, the number of implants and the distribution are determined by the type of prosthesis. Moreover, the type of prosthesis is heavily influenced by the patients’ finances [13]. Regarding the current literature for mandibular implant fixed full-arch prostheses, there is some evidence for indicating more than 6 implants whereas there is a strong evidence of high survival implant and prosthesis rates for five and four implants [13]. A meta-analysis found similar survival rates of mandibular implant fixed full-arch prostheses supported by < 5 implants when compared to > 4 implants [20]. Fixed full-arch prostheses supported by 4 implants or the all-on-four concept comprises increasing the prosthesis length by tilting the distal implants [21]. Consequently, fewer number of implants are needed in the posterior region, which also compensates for severe bone resorption The same is true for an all-on-three approach introduced in 1999 as the Novum protocol by Brånemark et al. [22]. They reported a mean implant and prothesis survival of 98% after a 3-year follow-up in 50 patients. The reported benefits of an all-on-three approach are lower cost, fewer clinical appointments, and reduced total treatment time [22–26]. Interestingly, a meta-analysis [27] explored the clinical outcomes of fixed full-arch prostheses supported by less than five implants. However, this specific study did not include sufficient primary studies reporting 3-implant solutions data [27]. Therefore, the controversies remain on if three implants are adequate to support fixed full-arch prostheses [28, 29].
In view of the expected growth of fully edentulous arch patients, awareness of the fixed treatment options supported with fewer number of implants than traditionally accepted could contribute to permitting potential patients to have access to full-arch fixed implant prostheses, especially in low- and medium-income population in need. In this manner, a better knowledge of the medium- and long-term survival of mandibular fixed full-arch prostheses supported by a minimum number of dental implants may be helpful in the adoption of interventions to reduce the financial investment burden, and in the reduction of the perpetuated disparities in the access to fixed full-arch prostheses between privileged and underprivileged groups.
Secondary studies have assessed the implant and prosthetic survival of mandibular fixed full-arch prostheses supported by three implants in adult patients compared to similar interventions supported by more than three implants, but the results of such studies seem inconclusive. A preliminary search of PROSPERO, MEDLINE (Ovid), MEDLINE (PubMed), EMBASE (Ovid), Cochrane Database of Systematic Reviews, was conducted, and no overview of systematic reviews (OoSRs) on this subject was found. Therefore, the objective of this OoSRs is to identify, summarize, appraise, and compare the clinical outcomes evidence of three-implant fixed full-arch prostheses in completely edentulous mandibular patients.
Focused review question
In edentulous mandibular patients, what are the implant and prosthetic outcomes of three-implant-supported fixed full-arch prostheses compared to other all-on-4 and plus solutions?
Materials and methods
The proposed OoSRs will be conducted in accordance with Preferred Reporting Items for OoSRs (PRIO-harms) to promote a more balanced reporting of benefits and harms in OoSRs of health care interventions [30]. OsSRs facilitate adequate decision making by comparing systematic reviews and/or meta-analyses and promote a critical analysis of the main viable evidence about a particular issue [31–34]. The Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) checklist [35, 36] was applied for the development of this protocol (S1 Table).
Overview registration number
The protocol has been registered in International prospective register of systematic reviews (PROSPERO: CRD42021262175). A submission identification number (262175) was provided by the National Institute for Health Research (NIHR) on June 20th, 2021.
Inclusion criteria
Participants
The participants or populations being studied by the OoSRs include adults with a fixed dental reconstruction supported by three implants to replace the missing teeth of their edentulous mandible. The participants included in the SRs should be properly described concerning characteristics such as age, sex, sample size, follow-up (mean, standard deviation, range), and clinical conditions (implant [bone quality, bone quantity/volume, medication/drugs, peri-implant bone loss, suppuration, bleeding in probing, peri-implany mucositis absence/presence, peri-implantitis absence/presence] and prosthetic characteristics [screwed/cemented retention, cantilever length, prosthetic material]). Secondary studies investigating implant-supported fixed reconstructions other than complete dental prostheses (i.e., implant-supported fixed partial dentures) will be excluded.
Intervention
In this OoSRs, the nature of the interventions or the exposures to be reviewed are defined as fixed full-arch prostheses supported by three dental implants. SRs will be included if they are detailed in the study design: baseline and implant and prosthetic follow-ups, whether the groups were conducted in parallel or cross-over, and if there were associations with other factors that could interfere with the survival of the treatment (e.g., systemic conditions, low bone quality/quantity, drugs).
Control
The selected SRs should demonstrate that the interventions were compared with a control group composed of anther all-on-4 and plus solutions (e.g., participants who had their edentulous mandibles restored with complete fixed dental prostheses supported by 4, 5, 6, 7, 8 or more osseointegrated implants).
Outcome
This OoSRs will consider as prosthetic and implant survival from baseline to the last available follow-up as main outcomes. Prosthetic and implant success, and complications or adverse events, as well as crestal bone loss and patient satisfaction, will be considered as secondary outcomes. Additionally, secondary predictors of peri-implant disease outcomes (e.g., bleeding index and plaque index) will be reported.
The metric system will be the measurement unit for reporting the data of each of the outcomes of interest of this overview. Conversion will be performed if the included secondary studies have used a different measurement unit (i.e., Imperial system).
Types of studies
SRs and MAs of observational Studies (OSs) and randomized controlled trials (RCTs) will be included. OoSRs, scoping reviews, rapid reviews, critical reviews, mapping reviews, mixed-methods reviews, systematized reviews, systematic search and reviews, state-of-the-art reviews, narrative reviews, letters to the editor, editorials, case reports, and case series will be excluded.
Clinical settings
No restriction will be placed regarding the clinical setting (e.g., private practice or public offices). Studies in low-, middle- and high-income countries will be considered.
Search strategy
For the creation of the search strategy for this OoSRs, three steps were taken. First, a preliminary search was implemented in MEDLINE (PubMed) to detect records that meet the inclusion criteria. Subsequently, the titles and abstracts of these records were used to pinpoint keywords and indexing terms to finalize the definitive search strategy. Secondly, the final search strategy was tailored by KIA for MEDLINE (Ovid) using MeSH terms, entry terms, and synonyms linked with Boolean operators “AND” and “OR” (see S1 File). The search was adjusted for each of the other databases, using controlled vocabulary (MeSH, EMTREE, and others), as well as entry terms. Lastly, the list of references of all records included in the SRs and MAs will be screened. Before final analysis, the searches will be updated. No restrictions are planned to be applied to language or year of publication, and geographic limits.
A manual search for relevant publications in 12 specialized journals, Clinical Oral Implants Research, Clinical Implant Dentistry and Related Research, Japanese Dental Science Review, Journal of Prosthodontic Research, Clinical Oral Investigations, Journal of Prosthetic Dentistry, Journal of Evidence-Based Dental Practice, The International Journal of Oral & Maxillofacial Implants, Journal of Prosthodontics, Implant Dentistry, Journal of Applied Oral Science, and Journal of Periodontal & Implant Science from 2010 up to 2021 will also be performed.
Information sources
Searches will be conducted in the following electronic databases: MEDLINE (via Ovid), EMBASE (via Ovid), Cochrane Database of Systematic Reviews (via Cochrane Library), Scopus, and Web of Science (via WoS Core Collection). Grey literature will be searched in OpenGrey (opengrey.eu), Networked Digital Library of Theses and Dissertations (ndltd.org), and ProQuest Dissertations & Theses Global (via ProQuest). Additionally, a search in Google Scholar limited to the first 100 most relevant studies [37] will also be conducted.
Study selection
All identified citations will be uploaded into EndNote Web (version X9, Clarivate Analytics, PA, USA) and duplicates eliminated. Three reviewers will select the records independently. The reviewers will begin by screening the titles/abstracts. The records that meet the inclusion criteria after consensus will be selected. If the title/abstract does not provide enough data for a decision, the full text of the record will be evaluated. Records whose full text fulfills the eligibility criteria will also be considered. Any disagreements arising during the study selection will be discussed and resolved by consensus. Interrater reliability will be neglected as this does add any benefit to the present OoSRs-harms/interventions. If the OsSRs was focused on a diagnostic outcome, an estimation of kappa Cohen would have been planned. Nevertheless, the levels of agreement will be conducted with 95%CI in the selection process of the secondary studies included.
For a better visualization of each stage of the study selection, a flow diagram will be generated as indicated by the PRISMA (Preferential Reporting Items for Systematic Reviews and Meta-analyses) guidelines [38–41].
Data extraction
Data extraction will be conducted independently by two reviewers (RAW, AWF), and this will be revised by one reviewer (KIA). If disagreements between reviewers arise, a discussion until consensus is reached will be performed. Data extracted will include study details (author, year, journal, number of primary studies included, funding, language, and databases searched), study methods (design, setting, sample, recruitment, intervention, comparators), dropouts (reason for dropouts and dropout rate), assessment of the implant and prosthetic outcomes (survival rate, success rate) the patient-reported outcome measures (PROMs), and main adverse events. The form developed for data extraction is displayed as supporting information (S2 File). The primary studies analyzed in SRs will be consulted for completion if some important data is missing.
Assessment of methodological quality
Three reviewers will assess the risk of bias and methodological quality of the included records independently [42, 43]. The risk of bias will be appraised using the ROBIS tool, according to specific guidelines for SRs related to interventions [44]. The methodological quality of the SRs will be assessed using the AMSTAR 2 tool (https://amstar.ca/docs/AMSTAR-2.pdf). Differences occurring during will be discussed until a resolution is reached by consensus.
All studies will be submitted to data extraction and synthesis. The influence of risk of bias and methodological quality will be considered when generating conclusions and recommendations. The levels of agreement will be performed with 95%CI in both quality assessment tools used of the secondary studies included.
The ROBIS tool
The ROBIS tool consists of three phases [44, 45]. Phase 1 is the assessment of relevance, which is considered optional. The phase 2 is the identification of bias during the review conduction, which is performed by four domains: study eligibility criteria, identification and selection of studies, data collection and study appraisal, and synthesis and findings. Phase 3 is the judgment of the risk of bias through the summary of phase 2 findings. All phases except phase 1, have five options to answer each sub-area of the domains that vary in (Y) “yes,” (PY) “probably yes,” (PN) “probably not,” (N) “no,” and (NI) “not informed.” The reason for concern is the risk of bias classified as high, low, or unclear.
The AMSTAR-2 tool
The AMSTAR 2 tool consists of 16 domains where seven are considered critical for the reliability of SRs findings (i.e., domains 2, 4, 7, 9, 11, 13, and 15), ranking the SR in high, moderate, low, and critically low [46, 47]. For each domain, the answers will vary in “yes” (the domain criteria have been fulfilled), “partially yes” (the domain criteria have been partially fulfilled), and “no” (the domain criteria have not been fulfilled). Several weaknesses (i.e., more than 3) in non-critical domains will reduce confidence in results. Thus, in this case, the classification starts from moderate instead of high level.
Data synthesis
In the first step of data synthesis, the results of the studies selection process will be displayed using the PRISMA flowchart [40, 41]. In the second step of data synthesis, the findings of the SRs and MAs will be summarized, and the characteristics of the variables will be described in tables or in narrative form where each one will be classified and, if suitable, allocated as a statistical measure. This will facilitate the of studies comparison, effects visualization and findings critical interpretation aided by the RevMan 5.4 (Copenhagen, The Nordic Cochrane Centre, Cochrane) [48]. The overlap of studies among the SRs included will be estimated using the calculation of the corrected covered area (CCA) [48]. If there is a high overlap of studies among the SRs, the most recent SRs will be kept and the impact of such findings on the evidence will be discussed.
A search for primary studies will be conducted at the end of this project and if new relevant trials are identified, a meta-analysis will be conducted. In this case, effect measures will be displayed as mean differences (for continuous data) or odds ratio/risk ratio (for dichotomous data) and the 95% confidence interval (CI) will be calculated. Retrospective and prospective primary studies will separately be analyzed for each method [49]. Heterogeneity will be reported by applying the standard x2 and I2 tests. If heterogeneity is equal to or greater than 40%, a random effect model will be chosen, whereas if heterogeneity is less than 40%, a fixed-effect model would be selected. To reduce heterogeneity, sensitivity analysis would be conducted removing studies one by one. Subgroup analyses will be conducted if possible. The included studies design will also be considered during the subgroup’s analysis. Forest plots will visually aid presenting the meta-analysis findings and a funnel plot to presenting the publication bias [50–52].
Supporting information
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Acknowledgments
The publication of this study is supported by the Ajman University (AU) Dean of Research and Graduate Studies (DRG). The AU DRG had no role in study design, data collection and decision to publish, or preparation of the manuscript.
Funding Statement
The authors have not received funding for generating the present protocol study.
References
- 1.The Glossary of Prosthodontic Terms: Ninth Edition. J Prosthet Dent. 2017;117(5S):e1–e105. doi: 10.1016/j.prosdent.2016.12.001 . [DOI] [PubMed] [Google Scholar]
- 2.Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996;40(1):1–18. [PubMed] [Google Scholar]
- 3.Lee DJ, Saponaro PC. Management of Edentulous Patients. Dent Clin North Am. 2019;63(2):249–61. doi: 10.1016/j.cden.2018.11.006 . [DOI] [PubMed] [Google Scholar]
- 4.Roberto LL, Crespo TS, Monteiro-Junior RS, Martins A, De Paula AMB, Ferreira EF, et al. Sociodemographic determinants of edentulism in the elderly population: A systematic review and meta-analysis. Gerodontology. 2019;36(4):325–37. doi: 10.1111/ger.12430 . [DOI] [PubMed] [Google Scholar]
- 5.Jahangiry L, Bagheri R, Darabi F, Sarbakhsh P, Sistani MMN, Ponnet K. Oral health status and associated lifestyle behaviors in a sample of Iranian adults: an exploratory household survey. BMC Oral Health. 2020;20(1):82. doi: 10.1186/s12903-020-01072-z ; PubMed Central PMCID: PMC7082917. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Slade GD, Akinkugbe AA, Sanders AE. Projections of U.S. Edentulism prevalence following 5 decades of decline. J Dent Res. 2014;93(10):959–65. doi: 10.1177/0022034514546165 ; PubMed Central PMCID: PMC4212322. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Cardoso M, Balducci I, Telles Dde M, Lourenco EJ, Nogueira Junior L. Edentulism in Brazil: trends, projections and expectations until 2040. Cien Saude Colet. 2016;21(4):1239–46. doi: 10.1590/1413-81232015214.13672015 . [DOI] [PubMed] [Google Scholar]
- 8.Cordaro M, Donno S, Ausenda F, Cordaro L. Influence of Bone Anatomy on Implant Placement Procedures in Edentulous Arches of Elderly Individuals: A Cross-Sectional Study on Computed Tomography Images. Int J Oral Maxillofac Implants. 2020;35(5):995–1004. doi: 10.11607/jomi.8297 . [DOI] [PubMed] [Google Scholar]
- 9.Ramanauskaite A, Becker J, Sader R, Schwarz F. Anatomic factors as contributing risk factors in implant therapy. Periodontol 2000. 2019;81(1):64–75. doi: 10.1111/prd.12284 . [DOI] [PubMed] [Google Scholar]
- 10.Luangchana P, Pornprasertsuk-Damrongsri S, Kitisubkanchana J, Wongchuensoontorn C. Branching patterns of the inferior alveolar canal in a Thai population: a novel classification using cone beam computed tomography. Quintessence Int. 2019;50(3):224–31. doi: 10.3290/j.qi.a41600 . [DOI] [PubMed] [Google Scholar]
- 11.Safi Y, Amid R, Vasegh Z, Ghazizadeh Ahsaie M. Anatomical variations in the interforaminal regions of candidates for implant-assisted overdentures: a cross-sectional CBCT analysis. Gen Dent. 2020;68(6):11–6. . [PubMed] [Google Scholar]
- 12.Yang JW, Liu Q, Yue ZG, Hou JX, Afrashtehfar KI. Digital Workflow for Full-Arch Immediate Implant Placement Using a Stackable Surgical Guide Fabricated Using SLM Technology. J Prosthodont. 2021. doi: 10.1111/jopr.13375 . [DOI] [PubMed] [Google Scholar]
- 13.Schwarz F, Schar A, Nelson K, Fretwurst T, Flugge T, Ramanauskaite A, et al. Recommendations for Implant-Supported Full-Arch Rehabilitations in Edentulous Patients: The Oral Reconstruction Foundation Consensus Report. Int J Prosthodont. 2021;34:s8–s20. doi: 10.11607/ijp.consensusreport . [DOI] [PubMed] [Google Scholar]
- 14.Tsigarida A, Chochlidakis K. A Comparison Between Fixed and Removable Mandibular Implant-Supported Full-Arch Prostheses: An Overview of Systematic Reviews. Int J Prosthodont. 2021;34:s85–s92. doi: 10.11607/ijp.6911 . [DOI] [PubMed] [Google Scholar]
- 15.Afrashtehfar KI, Cardenas-Bahena JT, Afrashtehfar CD. Predictable immediate loading of mandibular implants. Tex Dent J. 2013;130(7):596–607. . [PubMed] [Google Scholar]
- 16.Del Fabbro M, Testori T, Kekovic V, Goker F, Tumedei M, Wang HL. A Systematic Review of Survival Rates of Osseointegrated Implants in Fully and Partially Edentulous Patients Following Immediate Loading. J Clin Med. 2019;8(12). doi: 10.3390/jcm8122142 ; PubMed Central PMCID: PMC6947536. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Afrashtehfar KI, Schimmel M. Muscular activity may improve in edentulous patients after implant treatment. Evid Based Dent. 2016;17(4):119–20. doi: 10.1038/sj.ebd.6401207 . [DOI] [PubMed] [Google Scholar]
- 18.Pauletto P, Ruales-Carrera E, Goncalves T, Philippi AG, Donos N, Mezzomo LA. Fixed and Removable Full-Arch Restorations Supported by Short (</ = 8-mm) Dental Implants In the Mandible: A Systematic Review and Meta-Analysis. Int J Oral Maxillofac Implants. 2019;34(4):873–85. doi: 10.11607/jomi.7241 . [DOI] [PubMed] [Google Scholar]
- 19.Leles CR, Dias DR, Nogueira TE, McKenna G, Schimmel M, Jordao LMR. Impact of patient characteristics on edentulous subjects’ preferences for prosthodontic rehabilitation with implants. Clin Oral Implants Res. 2019;30(3):285–92. doi: 10.1111/clr.13414 . [DOI] [PubMed] [Google Scholar]
- 20.Daudt Polido W, Aghaloo T, Emmett TW, Taylor TD, Morton D. Number of implants placed for complete-arch fixed prostheses: A systematic review and meta-analysis. Clin Oral Implants Res. 2018;29 Suppl 16:154–83. doi: 10.1111/clr.13312 . [DOI] [PubMed] [Google Scholar]
- 21.Afrashtehfar KI. The all-on-four concept may be a viable treatment option for edentulous rehabilitation. Evid Based Dent. 2016;17(2):56–7. doi: 10.1038/sj.ebd.6401173 . [DOI] [PubMed] [Google Scholar]
- 22.Branemark PI, Engstrand P, Ohrnell LO, Grondahl K, Nilsson P, Hagberg K, et al. Branemark Novum: a new treatment concept for rehabilitation of the edentulous mandible. Preliminary results from a prospective clinical follow-up study. Clin Implant Dent Relat Res. 1999;1(1):2–16. doi: 10.1111/j.1708-8208.1999.tb00086.x . [DOI] [PubMed] [Google Scholar]
- 23.Engstrand P, Nannmark U, Martensson L, Galeus I, Branemark PI. Branemark Novum: prosthodontic and dental laboratory procedures for fabrication of a fixed prosthesis on the day of surgery. Int J Prosthodont. 2001;14(4):303–9. . [PubMed] [Google Scholar]
- 24.Menini M, Bagnasco F, Pera P, Tealdo T, Pesce P. Branemark Novum Immediate Loading Rehabilitation of Edentulous Mandibles: Case Series with a 16-Year Follow-up. Int J Periodontics Restorative Dent. 2019;39(5):729–35. doi: 10.11607/prd.4340 . [DOI] [PubMed] [Google Scholar]
- 25.Chow J, Hui E, Liu J, Li D, Wat P, Li W, et al. The Hong Kong Bridge Protocol. Immediate loading of mandibular Branemark fixtures using a fixed provisional prosthesis: preliminary results. Clin Implant Dent Relat Res. 2001;3(3):166–74. doi: 10.1111/j.1708-8208.2001.tb00137.x . [DOI] [PubMed] [Google Scholar]
- 26.Afrashtehfar KI, Esfandiari S. Five things to know about teeth in a day with dental implants. J N J Dent Assoc. 2014;85(1):24–5. . [PubMed] [Google Scholar]
- 27.de Luna Gomes JM, Lemos CAA, Santiago Junior JF, de Moraes SLD, Goiato MC, Pellizzer EP. Optimal number of implants for complete-arch implant-supported prostheses with a follow-up of at least 5 years: A systematic review and meta-analysis. J Prosthet Dent. 2019;121(5):766–74 e3. doi: 10.1016/j.prosdent.2018.06.001 . [DOI] [PubMed] [Google Scholar]
- 28.Sadowsky SJ. Comments regarding: de Luna Gomes et al. Optimal number of implants for complete-arch implant supported prostheses with a follow-up of at least 5 years: A systematic review and meta-analysis. J Prosthet Dent 2019;121:766–74. J Prosthet Dent. 2021;125(2):375. doi: 10.1016/j.prosdent.2020.01.043 . [DOI] [PubMed] [Google Scholar]
- 29.De Bruyn H, Kisch J, Collaert B, Linden U, Nilner K, Dvarsater L. Fixed mandibular restorations on three early-loaded regular platform Branemark implants. Clin Implant Dent Relat Res. 2001;3(4):176–84. doi: 10.1111/j.1708-8208.2001.tb00139.x . [DOI] [PubMed] [Google Scholar]
- 30.Bougioukas KI, Liakos A, Tsapas A, Ntzani E, Haidich AB. Preferred reporting items for overviews of systematic reviews including harms checklist: a pilot tool to be used for balanced reporting of benefits and harms. J Clin Epidemiol. 2018;93:9–24. doi: 10.1016/j.jclinepi.2017.10.002 . [DOI] [PubMed] [Google Scholar]
- 31.Afrashtehfar KI, Del Fabbro M. Clinical performance of zirconia implants: A meta-review. J Prosthet Dent. 2020;123(3):419–26. doi: 10.1016/j.prosdent.2019.05.017 . [DOI] [PubMed] [Google Scholar]
- 32.Besnier E, Thomson K, Stonkute D, Mohammad T, Akhter N, Todd A, et al. Which public health interventions are effective in reducing morbidity, mortality and health inequalities from infectious diseases amongst children in low- and middle-income countries (LMICs): An umbrella review. PLoS One. 2021;16(6):e0251905. doi: 10.1371/journal.pone.0251905 ; PubMed Central PMCID: PMC8191901. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Mei Z, Feng Q, Du P, Li B, Fang C, Gu J, et al. Surgical treatment for cryptoglandular and Crohn’s perianal fistulas: Protocol of an umbrella review. PLoS One. 2021;16(5):e0251460. doi: 10.1371/journal.pone.0251460 ; PubMed Central PMCID: PMC8118242. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Doufas AG, Panagiotou OA, Ioannidis JP. Concordance of sleep and pain outcomes of diverse interventions: an umbrella review. PLoS One. 2012;7(7):e40891. doi: 10.1371/journal.pone.0040891 ; PubMed Central PMCID: PMC3398909. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;350:g7647. doi: 10.1136/bmj.g7647 . [DOI] [PubMed] [Google Scholar]
- 36.Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1. doi: 10.1186/2046-4053-4-1 ; PubMed Central PMCID: PMC4320440. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Haddaway NR, Collins AM, Coughlin D, Kirk S. The Role of Google Scholar in Evidence Reviews and Its Applicability to Grey Literature Searching. PLoS One. 2015;10(9):e0138237. doi: 10.1371/journal.pone.0138237 ; PubMed Central PMCID: PMC4574933. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38.Knobloch K, Yoon U, Vogt PM. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and publication bias. J Craniomaxillofac Surg. 2011;39(2):91–2. doi: 10.1016/j.jcms.2010.11.001 . [DOI] [PubMed] [Google Scholar]
- 39.Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097 ; PubMed Central PMCID: PMC2707599. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLoS Med. 2021;18(3):e1003583. doi: 10.1371/journal.pmed.1003583 ; PubMed Central PMCID: PMC8007028 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 41.Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:n160. doi: 10.1136/bmj.n160 ; PubMed Central PMCID: PMC8005925 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42.Hasuike A, Ueno D, Nagashima H, Kubota T, Tsukune N, Watanabe N, et al. Methodological quality and risk-of-bias assessments in systematic reviews of treatments for peri-implantitis. J Periodontal Res. 2019;54(4):374–87. doi: 10.1111/jre.12638 . [DOI] [PubMed] [Google Scholar]
- 43.Gates M, Gates A, Duarte G, Cary M, Becker M, Prediger B, et al. Quality and risk of bias appraisals of systematic reviews are inconsistent across reviewers and centers. J Clin Epidemiol. 2020;125:9–15. doi: 10.1016/j.jclinepi.2020.04.026 . [DOI] [PubMed] [Google Scholar]
- 44.Whiting P, Savovic J, Higgins JP, Caldwell DM, Reeves BC, Shea B, et al. ROBIS: A new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol. 2016;69:225–34. doi: 10.1016/j.jclinepi.2015.06.005 ; PubMed Central PMCID: PMC4687950. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 45.Gomez-Garcia F, Ruano J, Gay-Mimbrera J, Aguilar-Luque M, Sanz-Cabanillas JL, Alcalde-Mellado P, et al. Most systematic reviews of high methodological quality on psoriasis interventions are classified as high risk of bias using ROBIS tool. J Clin Epidemiol. 2017;92:79–88. doi: 10.1016/j.jclinepi.2017.08.015 . [DOI] [PubMed] [Google Scholar]
- 46.Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008. doi: 10.1136/bmj.j4008 ; PubMed Central PMCID: PMC5833365 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 47.Chugh A, Patnana AK, Kumar P, Chugh VK, Khera D, Singh S. Critical analysis of methodological quality of systematic reviews and meta-analysis of antibiotics in third molar surgeries using AMSTAR 2. J Oral Biol Craniofac Res. 2020;10(4):441–9. doi: 10.1016/j.jobcr.2020.07.011 ; PubMed Central PMCID: PMC7453117. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 48.Pieper D, Antoine SL, Mathes T, Neugebauer EA, Eikermann M. Systematic review finds overlapping reviews were not mentioned in every other overview. J Clin Epidemiol. 2014;67(4):368–75. doi: 10.1016/j.jclinepi.2013.11.007 . [DOI] [PubMed] [Google Scholar]
- 49.Afrashtehfar KI, Ahmadi M, Emami E, Abi-Nader S, Tamimi F. Failure of single-unit restorations on root filled posterior teeth: a systematic review. Int Endod J. 2017;50(10):951–66. doi: 10.1111/iej.12723 . [DOI] [PubMed] [Google Scholar]
- 50.Afrashtehfar KI, Katsoulis J, Koka S, Igarashi K. Single versus splinted short implants at sinus augmented sites: A systematic review and meta-analysis. J Stomatol Oral Maxillofac Surg. 2021;122(3):303–10. doi: 10.1016/j.jormas.2020.08.013 . [DOI] [PubMed] [Google Scholar]
- 51.Hasanzade M, Aminikhah M, Afrashtehfar KI, Alikhasi M. Marginal and internal adaptation of single crowns and fixed dental prostheses by using digital and conventional workflows: A systematic review and meta-analysis. J Prosthet Dent. 2021;126(3):360–368. doi: 10.1016/j.prosdent.2020.07.007 . [DOI] [PubMed] [Google Scholar]
- 52.Hasanzade M, Shirani M, Afrashtehfar KI, Naseri P, Alikhasi M. In vivo and in vitro comparison of internal and marginal fit of digital and conventional impressions for full-coverage fixed restorations: A systematic review and meta-analysis. J Evid Based Dent Pract. 2019;19(3):236–54. doi: 10.1016/j.jebdp.2019.04.003 . [DOI] [PubMed] [Google Scholar]
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