RESUMO
STATEMENT OF PROBLEM: While rehabilitation with implant-supported crowns in the posterior region is widely practiced, guidance on clinical considerations when choosing between splinted or nonsplinted implant-supported crowns is limited. PURPOSE: The purpose of this systematic review with meta-analysis was to assess whether adjacent implants with internal connections in the posterior region should be treated with splinted or nonsplinted crowns. MATERIAL AND METHODS: The systematic review was registered on the prospective register of systematic reviews (PROSPERO) under the code, CRD42021248525. Two authors searched 4 electronic databases (PubMed, Cochrane Library, Scopus, and Web of Science) independently for articles published up to December 2023. Additionally, a hand search was conducted in the nonpeer-reviewed literature and the reference lists of included articles. Only clinical studies comparing splinted and nonsplinted hexagonal or conical internal connection adjacent implants in the posterior region were considered. A single-arm meta-analysis was conducted using RevMan. Risk of bias and quality were assessed using the Cochrane Collaboration's Tool for Assessing Risk and the Newcastle-Ottawa scale. RESULTS: Qualitative synthesis included 17 studies, and quantitative synthesis involved 13 studies. A total of 2085 implants (1244 splinted and 841 nonsplinted) were inserted in 1027 participants, with observation times ranging from 5 months to 16 years. Thirteen studies related the type of crown retention (cemented or screw-retained). Only 2 studies related annual bone loss results considering the type of crown retention, but whether they were splinted or nonsplinted crowns and significant differences were not specified. The meta-analysis revealed no statistical differences between splinted and nonsplinted implants for biological complications (P=.95, I2=0%). However, the nonsplinted implants exhibited significantly more mechanical complications than the splinted implants (P<.001, I2=1%, RR 0.37; 95% IC [0.26-0.54]). The studies included demonstrated a low risk of bias and were of good quality. CONCLUSIONS: Splinting was not found to affect the incidence of biological complications in posterior adjacent implants. However, more mechanical complications occurred in nonsplinted crowns than splinted ones.
RESUMO
Objetivo: Avaliar o efeito a curto prazo da laser acupuntura na dor, ansiedade e depressão em pacientes com DTM. Métodos: Foi realizado um ensaio clínico randomizado cego com portadores de DTM, diagnosticados pelo Critério de Diagnóstico de DTM (RDC/TMD). 60 pacientes foram alocados de forma aleatória em quatro grupos distintos: aconselhamento (AC), placa Oclusal (PO), fisioterapia (FP) e laser acupuntura (LA) e foram avaliados no baseline, e com 1 mês após a terapia. Para avaliação da ansiedade foram utilizados HADS, BAI, e o IDATE. Para a depressão foi BDI e HADS. Para dor foi utilizada a EVA. Foi utilizado o teste Kruskal-Wallis com nível de confiança de 95% para análise entre grupos. O pós teste de Mann-Whitney, para verificar onde estava a diferença encontrada entre os grupos. E o teste de classificações assinadas por Wilcoxon, para análise entre os tempos analisados. Resultados: Ao longo do tempo houve redução na sintomatologia dolorosa nos grupos PL (p=0,001), FP (p= 0,014) e grupo LA ficou no limiar de significância (p= 0,08). Após 30 dias de terapia houve redução significativa entre os grupos FP versus AC (p=0,004) e FP versus LA (p=0,006). O grupo FP foi o único grupo que reduziu os sintomas de ansiedade pelo BAI (p=0,09) e pelo IDATE-E (p=0,042). Nos parâmetros depressivos houve diferença estatisticamente significativa ao longo do tempo pelo BDI nos grupos PO (p=0,044) e LA (p=0,009). Entre os grupos houve diferença estatisticamente significativa pelo BDI, entre PO versus LA (p=0,004), e FP versus LA (p=0,005). E pelo HADS, entre FP versus LA (p=0,012). Conclusão: Para pacientes com ansiedade e depressão, a laser acupuntura não é a terapia mais indicada para diminuição da sintomatologia dolorosa a curto prazo (AU).
Objective: To evaluate the short-term effect of laser acupuncture compared with counseling, occlusal plaque, and physiotherapy treatments on pain, anxiety, and depression in TMD patients. Methods: A randomized clinical trial was performed with patients with TMD, diagnosed by the TMD (RDC / TMD). 60 patients were randomly allocated to four distinct groups: counseling (AC), Occlusal Plaque (PO), physical therapy (PF) and laser acupuncture (LA) and were evaluated at baseline, and at 1 month after therapy. To evaluate anxiety, HADS, BAI, and STAI were used. For depression was BDI and HADS. For pain, VAS was used. The Kruskal-Wallis test with a 95% confidence level was used for intergroup analysis. The Mann-Whitney post-test, to verify where was the difference found between the groups. And the Wilcoxon signed rank test for analysis between the times analyzed. Results: Over time there was a reduction in pain symptoms in the PL (p = 0.001), PF (p = 0.014) and LA groups were at the significance threshold (p = 0.08). After 30 days of therapy there was a significant reduction between the PF versus AC (p = 0.004) and FP versus LA (p = 0.006) groups. The FP group was the only group that reduced anxiety symptoms by BAI (p = 0.09) and by STAI-E (p = 0.042). In depressive parameters there was a statistically significant difference over time by BDI in the PO (p = 0.044) and LA (p = 0.009) groups. Between groups there was a statistically significant difference by BDI, between PO versus LA (p = 0.004), and PF versus LA (p = 0.005). And by HADS, between FP versus LA (p = 0.012). Conclusion: For patients with anxiety and depression, laser acupuncture is not the most appropriate therapy to reduce pain symptoms in the short term (AU).