Sobrevida de reabilitações fixas de arco completo All-on-6 e All-on-4 em pacientes edêntulos: uma revisão sistemática e meta-análise

Abstract

The rehabilitation of edentulous patients with implant-supported full-arch fixed prostheses represents a predictable alternative in Implant Dentistry. The All -on-4 and All-on-6 protocols are widely used in clinical practice; however, there is still no consensus on whether one protocol is superior to the other. Therefore, the aim of this study was to compare, through a systematic review and meta-analysis, implant survival, prosthetic survival, and marginal bone loss in full-arch fixed rehabilitations performed with the All-on-4 and All-on-6 protocols. For this purpose, the review was conducted in accordance with PRISMA recommendations and registered with PROSPERO. Searches were performed in PubMed/MEDLINE, Web of Science, Scopus, Cochrane, and Embase databases. The studies were selected using the Rayyan platform, considering human clinical studies evaluating full-arch fixed restorations comparing the All-on-4 and All-on-6 protocols, with a minimum follow-up of 12 months. The meta-analysis was conducted using RevMan 5.4 software. A total of 109 studies were identified, of which five were included in the review, comprising 1,248 patients and 7,695 implants. The meta-analysis showed no statistically significant difference between the protocols regarding implant survival (OR: 1.30; 95% CI: 0.66–2.56; P = 0.45), prosthetic survival (OR: 1.09; 95% CI: 0.36–3.26; P = 0.88), and marginal bone loss (SMD: 0.16; 95% CI: -0.12–0.44; P = 0.27). Thus, the results suggest that the All-on-4 and All-on-6 protocols present similar clinical performance in the evaluated outcomes. The choice between the techniques should consider not only the number of implants, but also implant distribution within the arch, bone quality, occlusal control, cantilever extension, and the individual clinical characteristics of each patient.