This review concluded that survival rates of dental implants placed using the osteotome technique were comparable to implants placed using conventional techniques. Given the methodological limitations of the review, these conclusions should be interpreted with extreme caution.

To estimate the survival rate of dental implants placed using the osteotome technique.

MEDLINE was searched from 1953 to December 2005 using the term 'osteotome'. The references of included studies were screened to identify additional relevant studies.

Study designs of evaluations included in the review

Clinical studies or reports were eligible for inclusion. Descriptive studies (preliminary reports, case studies and pilot studies), in vitro and in vivo animal experiments, and systematic reviews were excluded. The study designs included were prospective and retrospective studies and a clinical report.

Specific interventions included in the review

Studies of dental implants placed using the osteotome technique for site preparation with or without sinus floor elevation were eligible for inclusion. Studies using the osteotome technique for sinus floor elevation only were excluded. Most of the studies followed Summers' description of the osteotome technique; one used a calibrated trephine drill in addition to the osteotome technique. The loading time ranged from 0 to 80 months. The mean follow-up time ranged from 6 to 56 months.

Participants included in the review

Inclusion criteria were not defined in terms of the participants, but appear to have been patients receiving dental implants. Where recorded, 44% of the patients were male.

Outcomes assessed in the review

The outcomes eligible for inclusion were not clearly defined. The primary outcome was the survival rate of dental implants. Other outcomes recorded were the number of implant failures and complications.

How were decisions on the relevance of primary studies made?

Two reviewers independently screened studies for selection, and any differences were resolved by discussion. Inter-rater reliability was calculated using Cohen's kappa coefficient and a high level of agreement was found.

The authors did not state that they assessed validity.

The authors did not state how the data were extracted for the review, or how many reviewers performed the data extraction. Data on the survival of implants before and after loading were extracted.

How were the studies combined?

The data were pooled in a cumulative Kaplan-Meier survival curve and 95% confidence intervals (CIs) calculated.

How were differences between studies investigated?

Differences in some study characteristics were discussed in the text.

Five studies were included (244 patients, 365 implants).

The survival rate of implants was 98% (95% CI: 97.2, 100) before loading and 99% (95% CI: 94, 100) at 56 months after loading. At 56 months, 41 implants were still at risk in 18 patients. Complications were recorded in 4 patients, 1 implant and 3 sites; details of these complications were not reported.

The survival rate of dental implants placed using the osteotome technique was similar to that of implants placed using conventional methods.

Inclusion criteria were reported for the interventions and study designs but were not defined clearly for the outcomes and patients. One database was searched, unpublished research does not appear to have been sought, and it was unclear whether any language restrictions were imposed. It is therefore possible that some studies might have been missed and that publication bias might have been introduced. A validity assessment was not carried out and there was incomplete reporting in the included studies of data such as bone type, length of implant and post-operative management; this makes it difficult to draw conclusions about the reliability and generalisability of the results. Although the study selection was carried out independently, there was insufficient information on how the data were extracted to rule out the possibility of bias and error.

Given the clinical heterogeneity and apparent poor quality of the included studies, it would have been more appropriate to have discussed the results in a narrative synthesis rather than combining them in a statistical analysis. In light of the methodological limitations of the review and the apparent poor quality of the included studies, the authors' conclusions should be interpreted with extreme caution.

Practice: The authors did not state any implications for practice.

Research: The authors stated that randomised controlled trials solely studying maxillary implants using the osteotome technique are needed.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.