Evaluation Of Corticobasal Implants In Atrophic Jaws: A Systematic Review
Alveolar Ridge Atrophy, Bone Resorption, Dental Implants, Immediate Dental Implant Loading, Intraoral Welding, Marginal Bone Loss, Maxillary Atrophy, Corticobasal Implants.
AuthorsAbstractBackground: The rehabilitation of severely atrophic maxillary and mandibular ridges remains a significant challenge in implant dentistry because conventional implant placement may require bone grafting, sinus augmentation, or other invasive procedures. Corticobasal implants are designed to engage dense basal cortical bone, potentially providing high primary stability and permitting immediate functional loading. They have therefore been proposed as a graft-free and less invasive alternative for selected patients with advanced ridge resorption. However, the strength and independence of the evidence supporting these benefits have not been systematically established. Aim: To evaluate the clinical efficacy, implant survival rates, prosthetic outcomes, patient-reported outcomes, and biological and technical complications associated with CBIs used to rehabilitate atrophic jaws. Methodology: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, the Cochrane Library, Google Scholar, ClinicalTrials.gov, and EMBASE were searched from inception to January 2024, without language restrictions at the search stage. Boolean operators and MeSH terms were combined across four concept clusters: implant design, anatomical indication, loading protocol, and clinical outcome. The research question was structured according to the PICOS framework. Of 624 records screened, six studies fulfilled the eligibility criteria. Included investigations comprised prospective clinical trials, retrospective cohort studies, and observational in vivo studies, with follow-up periods ranging from 6 to 60 months. Case reports and case series were excluded a priori to reduce the influence of brand-specific publication patterns identified during preliminary scoping. Data extraction and methodological appraisal were performed independently by three reviewers. Risk of bias was assessed using the Newcastle–Ottawa Scale and ROBINSI, and each study was assigned an Oxford Centre for Evidence-Based Medicine level. Results: Across the included studies, 567 patients received 8,742 CBIs, corresponding to an aggregate of 15.4 implants per patient. Immediate functional loading was used in all studies. Implant survival ranged from 90.67% to 100%, while reported marginal bone loss averaged 1.48 mm. Prosthetic complications, including veneer fractures and ceramic chipping, were uncommon. Biological complications were inadequately characterized; cortical necrosis and retrograde osteolysis were not systematically screened for or consistently reported. Patient-reported outcomes indicated high satisfaction, with oral health-related quality-of-life scores reaching 4.92/5. Conclusion: Short- to mid-term CBI survival was high in the included studies. Nevertheless, the evidence base consisted entirely of observational research, with substantial heterogeneity and concentrated authorship among proponents of specific implant systems. Under-reporting of important biological complications further limits interpretation. CBIs should therefore be considered a selectively applicable, hypothesis-generating treatment option rather than a definitive graft-free alternative for all forms of jaw atrophy. Independent prospective comparative studies with standardized outcome reporting and longer follow-up are required.
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