Publication: Fiabilidad y resultados de la cirugía guiada en implantología: revisión sistemática y metaanálisis
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2018
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Abstract
Objetivo: El objetivo de esta revisión sistemática fue evaluar la literatura científica
respecto a la precisión y resultados clínicos de la cirugía guiada en implantología basados en la utilización de guías quirúrgicas.
Materiales y métodos: Para recopilar información relevante sobre la precisión y los
resultados clínicos de la cirugía implantológica, se realizó una búsqueda electrónica de literatura científica en las bases de datos The National Library of Medicine (MEDLINE vía Pubmed) y Cochrane Central Register of controlled Trials. Los resultados clínicos referentes a las complicaciones y grado de satisfacción de los pacientes se evaluaron mediante un análisis descriptivo. Para la evaluación de precisión se realizó el
metanálisis en el que se compararon los tres tipos de guías quirúrgicas según el tipo de tejido de soporte (mucosoportada, oseosoportada y dentosoportada).
Resultados: Realizada la búsqueda bibliográfica, se incluyeron un total de 44 estudios de 4.019 publicaciones encontradas. Los estudios que cumplieron los criterios de
inclusión respecto a la precisión de la cirugía guiada fueron 30 y al rendimiento clínico. Todos los estudios fueron de calidad metodológica media. En 14 estudios se
informaron sobre 43 complicaciones clínicas intraoperatorias y 56 postoperatorias. La tasa de supervivencia de los implantes se informó en 11 estudios y varió de un 88% a un 100% en un periodo de seguimiento de 12 a 60 meses. El grado de satisfacción de
los pacientes fue muy favorable. El metanálisis de esta revisión sistemática reveló que comparando las guías mucosoportadas vs las dentosoportadas no existen diferencias estadísticamente significativas en la desviación apical, coronal y apical (P=0.34, P=0.35,
P=0.95), sin embargo en la comparación de las guías oseosoportadas con las dentosoportadas hubo una diferencia estadísticamente significativa a favor de las guías oseosoportadas, siendo estas más precisas en los tres puntos de desviación evaluados
(P<0.0001, P=0.01, P=0.001).
Conclusiones: La cirugía guiada implantológica ofrece a los pacientes una forma menos traumática y más rápida de tratamiento con tasas de supervivencia comparables a la cirugía convencional. Las guías quirúrgicas dentosoportadas mostraron mayor precisión que las
guías oseosoportadas y mucosoportadas. Sin embargo, la valoración de la fiabilidad de los sistemas de cirugía guiada no depende únicamente de la colocación precisa de los implantes, sino también de un diagnóstico y planificación minuciosos. La calidad de los
estudios evaluados es limitada, por lo que se son necesarios más trabajos que contemplen medidas estandarizadas para evaluar la precisión de la cirugía guiada.
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