The influence of prosthetic designs on peri‐implant bone loss: An AO/AAP systematic review and meta‐analysis; inclusion bias and the importance of evidence‐based conclusions in prosthodontic research
Year: 2025
Type: review
Abstract: The influence of prosthetic designs on peri-implant bone loss: An AO/AAP systematic review and meta-analysis; inclusion bias and the importance of evidence-based conclusions in prosthodontic researchThe intersection of prosthetic design and peri-implant health continues to be a topic of growing interest and clinical relevance.A recent systematic review and meta-analysis by Lin et al., 1 published in the Journal of Periodontology as part of the 2024 AO/AAP Consensus on Prevention and Management of Peri-implant Diseases, sought to evaluate the influence of various prosthetic design parameters on peri-implantitis and marginal bone loss (MBL).The stated objective of the manuscript was to evaluate "a myriad of prosthetic design concepts and their profound clinical implications on the risk of peri-implantitis and marginal bone loss (MBL)."As noted by the authors, the primary outcome was peri-implant MBL, with secondary outcomes including implant survival percentage, prevalence of periimplantitis, and biological and/or prosthetic complications.Among the prosthodontic parameters examined were the abutment/prosthesis emergence angle (EA) and emergence profile (EP).The authors concluded that abutment/prosthesis emergence angles less than 30 • and concave/straight profiles are associated with a reduced risk of peri-implantitis.In the abstract, they further stated that these features "led to reduced risk of peri-implantitis." 1 While these findings are intriguing and potentially clinically relevant, a closer examination of the review suggests that they may not have been fully supported by the available evidence as of December 2023, which was the cutoff time for the systematic review.The conclusion regarding EA and EP was derived from a meta-analysis of only two studies.Although technically permissible, such limited data sets are prone to imprecision and overestimation of effect sizes.[2][3][4] Pooled estimates derived from such analyses may be unreliable, often yielding artificially narrow confidence intervals.While such analyses may be justified in emerging fields with limited data, this is typically contingent on the methodological robustness and homogeneity of the included studies.Both studies were assessed by the authors as having a serious risk of bias using the ROBINS-I tool (Tables S3 1 and S4 1 ) and demonstrated substantial heterogeneity (I 2 = 89% for EA and 74% for EP), raising concerns about the appropriateness of combining their results.Given the high heterogeneity and serious risk of bias, the result that lower EA and a concave/straight profile "led" to reduced peri-implantitis risk may have been premature.
Source: Journal of Prosthodontics
DOI: 10.1111/jopr.70081
Language: English
Subfield: Oral Surgery
Field: Dentistry
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4417526515