A systematic review of biologic and technical complications with fixed implant rehabilitations for edentulous patients

Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA, USA.
The International journal of oral & maxillofacial implants (Impact Factor: 1.45). 01/2012; 27(1):102-10.
Source: PubMed


The purpose of this systematic review was to assess the incidence and types of biologic and technical complications associated with implant-supported fixed complete dental prostheses (IFCDPs) for edentulous patients.
An electronic MEDLINE/PubMED search was conducted to identify randomized controlled clinical trials and prospective cohort studies with IFCDPs for edentulous patients. Reports with at least 5 years of follow-up after prosthesis insertion were selected. Pooled data were analyzed statistically, and the cumulative complication rates were calculated by meta-analysis and regression.
Of a total of 281 one-piece IFCDPs (mean exposure time of 9.5 years) and 653 complication events, the complication rate was estimated at 24.6% per 100 restoration-years. The cumulative rates of "prosthesis free of complications" after 5 and 10 years were 29.3% and 8.6%, respectively. The most common implantrelated biologic complication was peri-implant bone loss (> 2 mm), at rates of 20.1% after 5 years and 40.3% after 10 years. The most frequent implant-related technical complication was screw fracture, yielding a 5-year complication rate of 10.4% and a 10-year rate of 20.8%. The most frequent prosthesis-related biologic complication was hypertrophy or hyperplasia of tissue around the IFCDPs (13.0% and 26.0% after 5 and 10 years, respectively). The most common prosthesis-related technical complication reported with IFCDPs was chipping or fracture of the veneering material (33.3% at 5 years and 66.6% at 10 years).
Biologic and technical complications after the placement of IFCDPs occur continuously over time as a result of fatigue and stress. These events may not lead to implant/prosthetic failures, but they are significant in relation to the amount of repair and maintenance needed, time, and cost to both the clinician and patient.

Download full-text


Available from: Panos Papaspyridakos, Aug 28, 2014
146 Reads
  • Source
    • "Implant loss, in the context of mechanical complications, includes of course implant fracture, which is considered a severe complication requiring extraction of the implant and its supporting bone (Snauwaert et al., 2000; Simonis et al., 2010; Gealh et al., 2011; Papaspyridakos et al., 2012). A series of recent systematic reviews, based on several clinical studies with at least 5 and 10 year follow up periods, reported a high incidence of such mechanical complications' (Pjetursson et al., 2010, 2014; Papaspyridakos et al., 2012) with a 5-year complication rate for a total number of mechanical complications ranging from 16.3% to 53.4%. Pjetursson et al. (2014) Fracture of the fixation screw is one of the most common mechanical complication, with a 5 and 10 year estimated complication rate of 9.3% and 18.5%, respectively. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this work is to investigate the potential state of mechanical damage in used, albeit mechanically intact, dental implants, after their retrieval from the oral cavity because of progressive bone loss (peri-implantitis). 100 retrieved dental implants were characterized with no medical record made available prior to the analysis. The implants' composition, dimensions, and surface treatments were characterized using energy dispersive X-ray analysis and scanning electron microscopy (SEM-EDX). Each implant was thoroughly examined for signs of mechanical defects and damage. The implants represent a random combination of two materials, titanium alloy (Ti-6Al-4V) and commercially pure titanium (CP-Ti), surface treatments and geometries. Two kinds of surface defects were identified: crack-like defects and full cracks that were arbitrarily divided according to their length and appearance. We found that over 60% of the implants contained both crack-like defects and full cracks. In the retrieved sample, we observed that the CP-Ti implants contained more defects and cracks than the Ti-6Al-4V ones. For the various surface roughening treatments, a general correlation with the presence of defects was observed, but without a clear differentiation between the treatments. The high incidence of embedded particles among the observed defect further strengthens the role played by the particles upon defects generation, some of which later evolve into full cracks. It was also found that the dimensions of the implant (width and length) were not correlated with the observed defects, for this specific sample. Our observations indicate that early retrieval of biologically failed implants, many of which contain early signs of mechanical failure as shown here, does actually hinder the later occurrence of implant fracture. It seems that once biological complications will be successfully overcome, such defects might grow later into full cracks as a result of cyclic mastication loads (fatigue). In such a case, the occurrence of implants' fracture is likely to markedly increase. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of the Mechanical Behavior of Biomedical Materials 09/2015; 49. DOI:10.1016/j.jmbbm.2015.05.014 · 3.42 Impact Factor
    • "Nevertheless, there is only limited midand long-term data up to 10 years available. Concerning the prosthetic rehabilitation of edentulous jaws, several systematic reviews reported on prosthesis survival and technical complications (Lambert et al. 2009; Papaspyridakos et al. 2012). Complete fixed conventional prostheses in the maxilla showed a survival rate of 96.4% for 10 or more years in clinical service (Lambert et al. 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this systematic review was to identify and summarize the available literature related to CAD/CAM-fabricated implant-supported restorations. A systematic review of the literature was conducted using the Cochrane Library and the US Library of Medicine, National Institute of Health databases (Pubmed). Several search runs with specific search terms were performed and combined. All published papers available on the databases up to January 15, 2015 were considered with primarily no restrictions. About 12 of 3484 identified papers met the inclusion criteria and were analyzed in the present review. One paper reported results on implant-supported single crowns (SCs), one on partial fixed dental prostheses (FDPs), and 10 papers reported results on full-arch screw-retained FDPs. Publications on SCs and FDPs were very limited but it was possible to identify 10 papers reporting adequate results on full-arch screw-retained FDPs. Survival rates ranged between 92% and 100% with observation times of 1-10 years. The available data provided promising results for CAD/CAM-fabricated implant-supported restorations; nonetheless, current evidence is limited due to the quality of available studies and the paucity of data on long-term clinical outcomes of 5 years or more. In the sense of an evidence-based dentistry, the authors recommend further studies designed as randomized controlled clinical trials and reported according to the CONSORT statement. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
    Clinical Oral Implants Research 06/2015; DOI:10.1111/clr.12633 · 3.89 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: The peri-implant diseases, namely peri-implant mucositis and peri-implantitis, have been extensively studied. However, little is known about the true magnitude of the problem, owing mainly to the lack of consistent and definite diagnostic criteria used to describe the condition. The objective of the present review is to systematically estimate the overall frequency of peri-implant diseases in general and high-risk patients. Methods: The systematic review is prepared according to the Meta-analysis of Observational Studies in Epidemiology statement. Studies were searched in four electronic databases, complemented by manual searching. The quality of the studies was assessed according to Strengthening the Reporting of Observational Studies in Epidemiology, and the data were analyzed using statistical software. Results: Of 504 studies identified, nine studies with 1,497 participants and 6,283 implants were included. The summary estimates for the frequency of peri-implant mucositis were 63.4% of participants and 30.7% of implants, and those of peri-implantitis were 18.8% of participants and 9.6% of implants. A higher frequency of occurrence of peri-implant diseases was recorded for smokers, with a summary estimate of 36.3%. Supportive periodontal therapy seemed to reduce the rate of occurrence of peri-implant diseases. Conclusions: Peri-implant diseases are not uncommon following implant therapy. Long-term maintenance care for high-risk groups is essential to reduce the risk of peri-implantitis. Informed consent for patients receiving implant treatment must include the need for such maintenance therapy.
    Journal of Periodontology 12/2012; 84(11). DOI:10.1902/jop.2012.120592 · 2.71 Impact Factor
Show more