A Systematic Review of Biologic and Technical Complications with Fixed Implant Rehabilitations for Edentulous Patients

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Abstract
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.
102 Volume 27, Number 1, 2012
T
he longitudinal eectiveness of osseointegrated
implants has been demonstrated for both partially
and completely edentulous patients.
1,2
The main focus
of longitudinal studies has been the success of osseo-
integration and the survival of implants. It is commonly
accepted that biologic and technical (mechanical)
complications routinely occur with implant-supported
xed complete dental prostheses (IFCDPs).
3,4
In this
context, material selection, clinical procedures, and
treatment options for this specic implant-prosthetic
design must be based on scientic evidence.
5
A previous systematic review specied two catego-
ries of complications that occur in implant dentistry:
biologic and technical.
6
Biologic complications refer
to disturbances in implant function that aect the
supporting peri-implant tissues. These include early
1
Implant Fellow, Department of Restorative Dentistry and
Biomaterials Sciences, Harvard School of Dental Medicine,
Boston, Massachusetts.
2
Implant Fellow, Department of Restorative Dentistry and Bio-
materials Sciences, Harvard School of Dental Medicine, Boston,
Massachusetts; Clinical Instructor, Department of Dentistry, Chi-
Mei Medical Center, Liouying Campus, Taiwan.
3
Assistant Professor, Department of Oral and Maxillofacial
Surgery, Massachusetts General Hospital, Boston,
Massachusetts; Assistant Professor, Department of Oral and
Maxillofacial Surgery, Harvard School of Dental Medicine,
Boston, Massachusetts.
4
Professor and Chair, Department of Prosthodontics and
Operative Dentistry, Tufts University School of Dental Medicine,
Boston, Massachusetts; Visiting Professor, Department of
Restorative Dentistry and Biomaterials Sciences, Harvard
School of Dental Medicine, Boston, Massachusetts.
5
Director of Oral Implantology, Department of Restorative
Dentistry and Biomaterials Sciences, Harvard School of
Dental Medicine, Boston, Massachusetts.
Correspondence to: Dr German O. Gallucci, Department of
Restorative Dentistry and Biomaterials Sciences, Harvard School
of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115.
Fax: +617-432-0901. Email: german_gallucci@hsdm.harvard.edu
A Systematic Review of Biologic and
Technical Complications with Fixed Implant
Rehabilitations for Edentulous Patients
Panos Papaspyridakos, DDS, MS
1
/Chun-Jung Chen, DDS
2
/Sung-Kiang Chuang, DMD, MD, DMSc
3
/
Hans-Peter Weber, DMD, Dr Med Dent
4
/German O. Gallucci, DMD, Dr Med Dent
5
Purpose: The purpose of this systematic review was to assess the incidence and types of biologic and technical
complications associated with implant-supported xed complete dental prostheses (IFCDPs) for edentulous
patients. Materials and Methods: 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. Results:
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 implant-
related 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). Conclusion: 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 signicant in relation to
the amount of repair and maintenance needed, time, and cost to both the clinician and patient.
Int J Oral
M
axIllOfac IMplants 2012;27:102–110
Key words: biologic complications, edentulism, implant-supported full-arch prosthesis, technical complications
Panos Papaspyridakos and Chun-Jung Chen contributed equally
to the present research.
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Papaspyridakos/Chen et al
The International Journal of Oral & Maxillofacial Implants 103
and late implant failures and adverse reactions in the
peri-implant hard and soft tissues. Technical complica-
tions is a collective term for mechanical damage of the
implant, implant components, and suprastructures. A
review of clinical complications (biologic and techni-
cal) of implant-supported xed partial dentures (FPDs)
concluded that variations in study design and reporting
procedures limited the available data and therefore
precluded proper analysis of certain complications.
7
Prosthetic complications after the denitive pros-
thesis is placed may or may not lead to implant loss
but can result in an increased need for repair and
maintenance. Few studies have attempted to assess
the costs associated with IFCDPs and maintenance.
8,9
From a socioeconomic point of view, the patient pref-
erence for specic treatment options relies on the lon-
gitudinal ecacy of the option, along with associated
costs and maintenance.
10
One systematic review highlighted that as many as
38.7% of all implant-supported FPDs for partially eden-
tulous patients had some type of adverse event during
an observation period of at least 5 years.
3
Moreover, it
is generally accepted that meaningful interpretation of
clinical outcomes of implant treatment requires a time
span of at least 5 years.
5
However, data specically
related to the complications encountered with xed
implant rehabilitations for edentulous patients after an
observation period of at least 5 years are limited.
11–13
The purpose of this article was to systematical-
ly review prospective clinical studies reporting on
complications associated with IFCDPs in edentulous
patients over a period of at least 5 years.
MATERIALS AND METHODS
Search Strategy
An electronic search using the MEDLINE/PubMED
database was performed for articles published in English
between January 1980 and February 2010. The search
strategy included the following key word combinations:
complete edentulous AND implant, complete edentulous
AND full arch, complete implant prostheses OR complete
implant bridge, xed complete prostheses AND implant,
edentulous jaws AND implant, complete edentulous AND
implant AND complications, complete edentulous AND
full arch AND complications, complete implant prostheses
AND biological complications, and complete implant pros-
theses AND technical complications.
The electronic search was supplemented by a manu-
al search of bibliographies of all the full-text articles that
were selected from the initial search. All articles were col-
lected in a reference manager software program (End-
notes, Thomson Reuters) and duplicates were discarded
electronically. The inclusion criteria were as follows.
• The studies should be randomized controlled clini-
cal trials (RCTs) or prospective cohort studies.
• The studies had a follow-up of at least 5 years.
• Denitive prosthesis insertion was set as baseline.
• The studies included at least 10 edentulous patients
with at least one edentulous arch.
• The studies reported on complete-arch xed
implant rehabilitations for edentulous patients.
• The studies reported clearly on both biologic and
technical complications encountered with the xed
rehabilitations in the specic cohort of patients.
• Only studies with solid screw-type implants were
considered. Studies reporting on zygomatic, ptery-
gomaxillary, and transitional implants were excluded.
Titles and abstracts were initially screened by two
calibrated reviewers for potential inclusion in this
review. All titles and abstracts selected by the two
reviewers were discussed individually for inclusion for
full-text reading. The full-text reading of related pub-
lications was carried out independently by the two
reviewers. Interreviewer agreement was always deter-
mined with the use of Cohens kappa (κ) statistics. In
cases where information was unclear, the issue was
elucidated by contacting the authors of the study via
email.
Data Extraction
Data were collected at the 5- and 10-year endpoints.
Implant- and prosthesis-based biologic and technical
complications were identied and recorded. Patient
cohort demographics were also collected. The select-
ed studies were divided into two groups; one group
comprised the studies with at least 5 years of follow-
up, and the second group included studies with 10 to
20 years of follow-up.
Statistical Analysis
For each study, event rates for IFCDPs and/or implants
were calculated by dividing the total number of
events by the total IFCDP or implant exposure time
in years. For further analysis, the estimates (complica-
tion eventrates) were used to calculatethe standard
errors of the estimates (standard errors were estimated
by the standardized formula of complication rates
divided by the square root of the number of compli-
cation cases). With each studys estimate and standard
error obtained, further computations were performed
to determine the95% condence intervals (95% CI) of
the summary estimates of the event rates. All statistical
analyses were performed using STATA (Stata Statisti-
cal Software, Version 11.0, StataCorp LP), and the level
of statistical signicance (alpha level) was set at .05.
Using the METAN command in the STATA computing
environment, the heterogeneity of the study-specic
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Papaspyridakos/Chen et al
104 Volume 27, Number 1, 2012
event rates was assessed. The STATA software com-
puted the goodness-of-t statistics, and the associated
P value was calculated. If the goodness-of-t P value
was below .05, indicating heterogeneity, meta-analysis
with random eects was used to obtain a summary
estimate of the event rates. Five-year and 10-year sur-
vival proportions were calculated via the relationship
between event rate and survival function (S): S(T) =
exp(–T × event rate), with an assumption of constant
event rates. The 95% CI for the survival proportions
were calculated by using the 95% condence limits of
the event rates.
14
RESULTS
The initial search yielded 4,563 hits after duplicate
references were discarded. The subsequent search at
the title level produced 2,284 titles (κ = 0.65), of which
625 abstracts were identied for analysis (κ = 0.7).
Independent investigation of the abstracts revealed
190 articles that were eligible for full-text reading (κ
= 0.8). Of the 190 studies selected for full-text reading,
176 did not fulll the inclusion criteria and were nally
excluded. The main reasons for exclusion were a follow-
up period of less than 5 years and no detailed reports of
both technical and biologic complications after deni-
tive prosthesis placement. The authors were contacted
via email when additional information was needed,
and no email response was considered a reason for ex-
clusion. In addition, multiple publications on the same
cohort of patients were also excluded and the most re-
cent was to be included for statistical analysis.
11–13
The electronic and manual searches yielded 1 RCT
and 13 prospective studies that satised the inclusion
criteria and were used for data extraction.
15–28
These
studies were conducted in academic institutions, and
three commercially available implant systems were
used (AstraTech, Nobel Biocare, Straumann). In all
studies, the prosthetic design featured metal–acrylic
resin IFCDPs (MRIFCDP). All MRIFCDPs were one-piece
and screw-retained. Only two articles reported on a
small number of metal-ceramic IFCDPs (MCIFCDPs)
among the MRIFCDPs.
20,26
Seven of the 14 studies selected for analysis were
further excluded from the meta-analysis because they
failed to report detailed information on prosthetic
maintenance events. Reasons for exclusion included:
(1) lack of detailed reporting on technical complica-
tions
23–26
; and (2) lack of detailed reporting on biologic
complications.
27,28
In addition, one longitudinal study
with a mean follow-up of 20 years was excluded since a
signicant percentage of the cohort patients could not
attend the nal recall and/or had passed away.
15
For
this same cohort of patients, a previous report with 12
to 15 years of follow-up was included for meta-analysis
(Table 1a).
16
The nal search yielded one RCT and six prospec-
tive studies that satised the inclusion criteria and
were used for data extraction.
16–22
These studies were
conducted in academic institutions, and the year of
publication ranged from 1996 to 2009 (Table 1b). For
each of the seven included studies, complication rates
for MRIFCDPs were calculated by dividing the total
number of complication events by the total prosthesis
exposure time in years. The summary of random-eects
Table 1a Characteristics of Excluded Studies and Reasons for Exclusion
Study
Study
type
Total no. of
patients
Follow-
up (y)
Implant
system
Type of prostheses/
material Reasons for exclusion
Purcell et al
27
(2008)
PS 46 5~9 Steri-Oss Screw-retained
metal-resin
No report on biologic complica-
tions
Rasmusson et
al
26
(2005)
PS 28 10 Astra Tech Screw-retained
metal-resin/metal
ceramic
No detailed report on technical
complications
Astrand et al
24
(2004)
PS 60 5 Astra Tech/
Brånemark
Screw-retained
metal-resin
No detailed report on technical
complications
Ekelund et al
15
(2003)
PS 30 20 Brånemark Screw-retained
metal-resin
Report only between the 15- and
20-year endpoint, high percent-
age of patient dropout
Murphy et al
28
(2002)
PS 26 5 Astra Tech Screw-retained
metal-resin
No report on biologic complica-
tions
Arvidson et al
23
(1998)
PS 91 5 Astra Tech Screw-retained
metal-resin
No detailed report on technical
complications
Makkonen et
al
25
(1997)
PS 13 5 Astra Tech Screw-retained
metal-resin
No detailed report on technical
complications
PS = prospective study.
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Papaspyridakos/Chen et al
The International Journal of Oral & Maxillofacial Implants 105
meta-analysis using complication rates, condence
intervals, and the weight of each study by exposure
time is shown in Fig 1. The mean prosthesis exposure
time was 9.5 years. A descriptive analysis of the includ-
ed studies and complications is provided in Table 2. The
overall complication rate was 24.6% estimated per 100
restoration-years (95% CI: 22.7% to 27.5%). The cumu-
lative rates for “prosthesis free of complications after
5 and 10 years were 29.3% (95% CI: 26.5% to 32.2%)
and 8.6% (95% CI: 7.1% to 10.3%), respectively. Tables 3
and 4 present details for implant- and prosthesis-relat-
ed complications, divided into biologic and technical
complications for each group.
Biologic Complications
Biologic complications for the MRIFCDPs encompassed
the following: soft tissue dehiscence, peri-implant
bone loss exceeding 2 mm, peri-implant mucositis,
inammation under the xed prosthesis, and hypertro-
phy/hyperplasia of soft tissue (Tables 3 and 4).
Table 1b Characteristics of Included Studies
Study
Study
type
Total no. of
patients/implants
Follow-
up (y)
Implant
system
Type of prostheses/
material Treated arch
Opposing
arch
Ortorp and
Jemt
22
(2009)
PS 74/422 10 Brånemark Screw-retained
metal-resin
Both CD/FCD
Gallucci et al
20
(2009)
PS 45/237 5 Straumann Screw-retained
metal-resin or
metal-ceramic
Mandible CD
Friberg et al
19
(2008)
PS 10/50 5 Brånemark Screw-retained
metal-resin
Mandible CD/RPD/
FCD/FPD
Fischer et al
18
(2008)
RCT 23/139 5 Straumann Screw-retained
metal-resin
Maxilla CD/RPD/
FPD/natural
Attard and
Zarb
17
(2004)
PS 31/180 18–23 Brånemark Screw-retained
metal-resin
Both CD/FCD
Jemt et al
21
(2002)
PS 50/297 5 Brånemark Screw-retained
metal-resin
Maxilla FCD/natural/
RPD
Lindquist et al
16
(1996)
PS 45/271 12–15 Brånemark Screw-retained
metal-resin
Mandible CD
PS = prospective study; RCT = randomized controlled trial; CD = complete denture; FCD = xed complete denture; RPD = removal partial denture;
FPD = xed partial denture.
0 1 2 3 4 5 6
0.32 (0.28−0.36)
Study ES (95% CI) % weight
Friberg et al
19
Jemt et al
21
Ortorp and Jemt
22
Gallucci et al
20
Fischer et al
18
Attard and Zarb
17
Lindquist et al
16
0.14 (0.04−0.24)
0.23 (0.17−0.29)
0.28 (0.21−0.35)
0.39 (0.28−0.51)
0.23 (0.20−0.27)
0.14 (0.11−0.17)
0.25 (0.23−0.26)
28.22
1.88
9.41
8.47
4.33
24.84
22.86
100.00
Overall (I-squared = 91.5%,
P = .000)
Exposure time (y)
Fig 1 Summary of random-effects meta-analysis using complication rates, condence intervals (CI), and the weight of each study
by exposure time. ES = estimated event rate.
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Papaspyridakos/Chen et al
106 Volume 27, Number 1, 2012
The most frequent biologic implant-related com-
plication was excessive peri-implant crestal bone loss
exceeding 2 mm. Four studies reported on this specic
complication.
18,20–22
From a total of 1,392 supporting
implants analyzed, this complication occurred in 54
implants. The estimated annual complication rate was
therefore 4% (95% CI: 3.0% to 5.1%). The 5- and 10-year
complication rates were 20.1% (95% CI: 17.7% to 22.6%)
and 40.3% (95% CI: 36.9% to 43.7%), respectively.
The second most common implant-related bio-
logic complication was peri-implant mucositis. Two
studies reported on this complication.
20,21
Of the
534 supporting implants analyzed, this complication
occurred in 10 implants, yielding an estimated annual
complication rate of 2.1% (95% CI: 0.8% to 3.4%). This
resulted in 5- and 10-year estimated complication
rates of 10.5% (95% CI: 7.6% to 13.4%) and 21.1% (95%
CI: 16.9% to 25.2%), respectively.
The most frequent biologic prosthesis-related
complication was hypertrophy/hyperplasia of the
soft tissue, and the second most frequent was tis-
sue inammation under the MRIFCDPs. Two studies
reported on each of these two complications.
20,21
Of
the 78 prostheses analyzed, hypertrophy/hyperplasia
of soft tissue occurred in 23. The estimated annual
complication rate was 2.6% (95% CI: 1.5% to 3.7%).
The 5- and 10-year complication rates were 13.0%
(95% CI: 10.6% to 15.4%) and 26.0% (95% CI: 22.6%
Table 2 Description and Analysis of Complications
Follow-up/
study
No. of
patients
No. of
prostheses
No. of
implants
Exposure
time (y)
Mean exposure
time (y)
No. of
complications
Estimated complication
rate per 100
prostheses-years* (95% CI)
Estimated “prosthesis free
of complications” rate after
5 y (%) (95% CI)
Estimated “prosthesis free
of complications” rate after
10 y (%) (95% CI)
5 y
Gallucci et
al
20
(2009)
45 45 237 225 5 63 28.0 (21.1–34.9) 24.7 (17.434.8) 6.1 (3.0–12.1)
Friberg et al
19
(2008)
10 10 50 50 5 7 14.0 (3.6–24.3) 49.7 (29.683.4) 24.7 (8.769.6)
Fischer et al
18
(2008)
23 23 139 115 5 45 39. 1 (27.7 50. 6) 14.1 (8.0–25.0) 2.0 (0.66.3)
Jemt et al
21
(2002)
50 50 297 250 5 58 23.2 (17.2–29.2) 31.3 (23.342.3) 9.8 (5.4–17.6)
10 y
Ortorp and
Jemt
22
(2009)
74 75 719 750 10 239 31.9 (27.835.9) 20.3 (16.6–24.9) 4.1 (2.86.2)
Attard and
Zarb
17
(2004)
31 33 244 660 20 155 23.4 (19.8–27.2) 3 0.9 (2 5.7 37. 1) 9.6 (6.6–13.8)
Lindquist et
al
16
(1996)
45 45 271 6 07. 5 13.5 86 14.2 (11.2–17.1) 49.3 (42.457.2) 24.3 (18.032.7)
Total summary 278 281 1,957 2,6 57. 5 9.5 653 24.6 (22.7–27.5) 29.3 (26.632.2) 8. 6 (7.110.3)
*Based on pooled effect size (ES) estimate of the random-effects meta-analysis weighted by exposure time.
Table 3 Summary of Implant-Related Complications
Complication type
No. of
implants
No. of
events
Total
exposure
time (y)
Estimated
event rates
(95% CI)
Cumulative 5-y
estimated complication
rates (95% CI)
Cumulative 10-y
estimated complication
rates (95% CI)
Biologic
Bone loss
(> 2 mm)
1,392 54 1,340 4.0 (3.05.1) 20.1 (17.7–22.6) 40.3 (36.9 43.7)
Peri-implant
mucositis
534 10 475 2.1 (0.83.4) 10.5 (7.6–13.4) 21.1 (16.9–25.2)
Technical
Screw fracture 752 31 1,492.5 2.1 (1.3–2.8) 10.4 (8.8–12.0) 20.8 (18.5–23.1)
Screw loosening 1,713 37 1, 997. 5 1.9 (1.3–2.4) 9.3 (7.9–10.6) 18.5 (16.6–20.4)
Others 2,254 36 3,320 1.1 (0.7–1.4) 5.4 (4.96.0) 10.8 (9.7–12.0)
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Papaspyridakos/Chen et al
The International Journal of Oral & Maxillofacial Implants 107
to 29.3%). From a total of 120 MRIFCDPs analyzed, tis-
sue inammation under the MRIFCDPs occurred in 11
prostheses.
20,22
The estimated annual incidence rate
was 1.1% (95% CI: 0.5% to 1.8%). The 5- and 10-year
complication rates were 5.6% (95% CI: 4.2% to 7.1%)
and 11.3% (95% CI: 9.2% to 13.4%), respectively.
Technical Complications
Technical/mechanical complications encountered
were: screw loosening/fracture, veneering material
chipping/fracture, wear and/or total replacement of
acrylic resin teeth, framework fracture, loss of screw
access lling material, fracture of the opposing resto-
ration, conversion of the IFCDP to an overdenture or
complete denture (CD), patient dissatisfaction, and
other complications. These were further categorized as
implant-related and prosthesis-related (Tables 3 and 4).
The most frequent (as a percentage of implants)
implant-related technical complication reported
with the MRIFCDPs was abutment/occlusal screw
loosening. Three studies reported on incidences of
screw loosening.
15,17,20
Of the 752 implants analyzed,
screw loosening was reported to occur in 31 implants.
The estimated annual complication rate was 2.1%
(95% CI: 1.3% to 2.8%). The 5- and 10-year estimated
complication rates were 10.4% (95% CI: 8.8% to 12.0%)
and 20.8% (95% CI: 18.5% to 23.1%), respectively.
The second most common implant-related tech-
nical complication was screw fracture; parafunction
resulting in occlusal overload, cyclic stress loading
fatigue from occlusal forces, and framework mist
have been suggested as reasons of screw fracture. Six
studies reported on screw loosening.
15,18–22
Of 1,713
implants, fracture events were encountered in 37
implants, resulting in an annual incidence rate of 1.9%
(95% CI: 1.3% to 2.4%). This translated into 5- and 10-
year estimated complication rates of 9.3% (95% CI:
7.9% to 10.6%) and 18.5% (95% CI: 16.6% to 20.4%),
respectively.
The most frequent prosthesis-related technical
complication reported with MRIFCDPs was veneering
material chipping/fracture. All seven included stud-
ies reported on veneering material chipping/frac-
ture.
16–22
Of a total of 281 MRIFCDPs analyzed, 177
events of veneer chipping/fracture were reported. This
yielded an estimated annual complication rate of 6.7%
(95% CI: 5.7% to 7.6%). Meta-analysis revealed esti-
mated complication rates of 33.3% (95% CI: 31.1% to
35.5%) at 5 years and 66.6% (95% CI: 63.5% to 69.7%)
at 10 years.
The second most common prosthesis-related tech-
nical complication was loss of screw access lling
material. Two studies reported on this complica-
tion.
16,17
A total of 58 events were recorded with 78
MRIFCDPs, yielding an annual rate of 4.6% (95% CI:
3.4% to 5.8%). The 5- and 10-year complication rates
were 22.9% (95% CI: 20.2% to 25.5%) and 45.8%
(95% CI: 42.0% to 49.5%), respectively.
Another prosthesis-related technical complication
was fracture of the opposing CD. Two studies reported
on this complication.
17,20
Of a total of 78 MRIFCDPs ana-
lyzed, opposing denture fracture was reported to occur
15 times, translating into an estimated annual complica-
tion rate of 1.7% (95% CI: 0.8% to 2.6%). The 5- and 10-year
estimated complication rates were 8.5% (95% CI: 6.6% to
10.4%) and 16.9% (95% CI: 14.2% to 19.7%), respectively.
Three studies reported on framework frac-
ture, which occurred in 16 of 153 MRIFCDPs.
17,20,22
The framework fracture annual incidence rate was 1%
(95% CI: 0.5% to 1.5%), yielding 5- and 10-year estimat-
ed complication rates of 4.9% (95% CI: 3.8% to 6.0%)
and 9.8% (95% CI: 8.3% to 11.3%).
A total of two studies
17,22
reported that 7 of 108
MRIFCDPs were converted into implant overdentures
because of late implant losses. The annual incidence
rate was 0.5% (95% CI: 0.1% to 0.9%), and the 5- and 10-
year rates were 2.5% (95% CI: 1.7% to 3.3%) and 5.0%
(95% CI: 3.8% to 6.1%). In addition, of the same 108
MRIFCDPs, two were converted into complete dentures,
yielding a 5-year rate of 0.7% (95% CI: 0.3% to 1.1%) and
a 10-year rate of 1.4% (95% CI: 0.8% to 2.0%).
17,22
Moreover, in two studies and of 90 prostheses
analyzed, three MRIFCDPs were unsatisfactory to the
patients and had to be remade, resulting in 5- and
10-year rates of 1.8% (95% CI: 0.9% to 2.7%) and 3.6%
(95% CI: 2.3% to 4.9%), respectively.
16,20
Table 2 Description and Analysis of Complications
Follow-up/
study
No. of
patients
No. of
prostheses
No. of
implants
Exposure
time (y)
Mean exposure
time (y)
No. of
complications
Estimated complication
rate per 100
prostheses-years* (95% CI)
Estimated “prosthesis free
of complications” rate after
5 y (%) (95% CI)
Estimated “prosthesis free
of complications” rate after
10 y (%) (95% CI)
5 y
Gallucci et
al
20
(2009)
45 45 237 225 5 63 28.0 (21.1–34.9) 24.7 (17.434.8) 6.1 (3.0–12.1)
Friberg et al
19
(2008)
10 10 50 50 5 7 14.0 (3.6–24.3) 49.7 (29.683.4) 24.7 (8.769.6)
Fischer et al
18
(2008)
23 23 139 115 5 45 39. 1 (27.7 50. 6) 14.1 (8.0–25.0) 2.0 (0.66.3)
Jemt et al
21
(2002)
50 50 297 250 5 58 23.2 (17.2–29.2) 31.3 (23.3–42.3) 9.8 (5.4–17.6)
10 y
Ortorp and
Jemt
22
(2009)
74 75 719 750 10 239 31.9 (27.835.9) 20.3 (16.624.9) 4.1 (2.86.2)
Attard and
Zarb
17
(2004)
31 33 244 660 20 155 23.4 (19.8–27.2) 3 0.9 (2 5.7 37. 1) 9.6 (6.6–13.8)
Lindquist et
al
16
(1996)
45 45 271 6 07. 5 13.5 86 14.2 (11.2–17.1) 49.3 (42.457.2) 24.3 (18.032.7)
Total summary 278 281 1,957 2,6 57. 5 9.5 653 24.6 (22.7–27.5) 29.3 (26.632.2) 8. 6 (7.110.3)
*Based on pooled effect size (ES) estimate of the random-effects meta-analysis weighted by exposure time.
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Papaspyridakos/Chen et al
108 Volume 27, Number 1, 2012
The incidence of other unspecied technical com-
plications was 55 events of a total of 450 analyzed
MRIFCDPs, yielding an annual estimated complica-
tion rate of 1.5% (95% CI: 1.1% to 1.9%). The 5-year
complication rate for nonspecied incidents was 7.3%
(95% CI: 6.5% to 8.2%) and the 10-year rate was 14.6%
(95% CI: 13.4% to 15.9%).
DISCUSSION
The objective of this systematic review was to describe
the biologic and technical complications encountered
with IFCDPs for edentulous patients. For the treatment
of edentulous patients, MRIFCDPs opposed by remov-
able CDs have been used most frequently.
11,12,23–30
Survival criteria have been well described in the lit-
erature, but no success criteria have been universally
accepted since 1986.
31
In a previous systematic review,
success was dened as a prosthesis that remained
unaltered and free of all complications throughout the
entire observation period,
3
ie, no interventions were
required during the clinical follow-up. However, the
advances in contemporary implant dentistry coupled
with patients high esthetic expectations emphasize
the necessity for more factors to be included in the
success criteria. A previous clinical study proposed suc-
cess criteria for both MRIFCDPs and MCIFCDPs based
on implant, peri-implant tissue, prosthodontics, and
subjective parameters. The authors reported a 95.5%
survival rate, versus an 86.7% success rate when the
proposed success criteria were applied.
20
MRIFCDPs
and MCIFCDPs were deemed successful when four or
fewer complications (mild or moderate severity) were
encountered and could be addressed chair side in a
single visit. Additionally, patient satisfaction with the
overall treatment had to be rated as good or excellent
for the treatment to be considered successful.
There is a lack of uniformity in the dental litera-
ture in how complications are reported as well with
Table 4 Summary of Prosthesis-Related Complications
Type of complication
No. of
prostheses
No. of
events
Total
exposure time
(y)
Estimated
event rates
(95% CI)
Cumulative 5-y
estimated complication
rates (95% CI)
Cumulative 10-y
estimated complication
rates (95% CI)
Biologic
Hypertrophy or
hyperplasia of tissue
78 23 885 2.6 (1.5 3.7) 13.0 (10.6–15.4) 26.0 (22.629.3)
Inammation under
prosthesis
120 11 975 1.1 (0.5–1.8) 5.6 (4.1–7.1) 11.3 (9.2–13.4)
Technical
Veneering material
chipping/fracture
281 177 2 ,6 57. 5 6.7 (5.7–7.6) 33.3 (31.1–35.5) 66.6 (63.5 69.7)
Fabrication of new
opposing denture
33 40 660 6.1 (4.2 7.9) 30.3 (26.1–34.5) 60.6 (54.7– 66.5)
Loss of access hole
lling
78 58 1, 26 7.5 4.6 (3.45.8) 22.9 (20.2–25.5) 45.8 (42.049.5)
Total replacement of
acrylic resin teeth
120 44 1, 357. 5 3.2 (2.34.2) 16.2 (14.1–18.3) 32.4 (29.4–35.4)
Lab reline of
opposing denture
33 19 660 2.9 (1.64.2) 14.4 (11.5–17.3) 28.8 (24.732.9)
Wear of acrylic resin
teeth
75 15 750 2.0 (1.03.0) 10.0 (7.71 2. 3) 20.0 (16.8–23.2)
Fracture of opposite
denture
78 15 885 1.7 (0.8–2.6) 8.5 (6.6–10.4) 16.9 (14.219.7)
Framework fracture 153 16 1,635 1.0 (0.5–1.5) 4.9 (3.86.0) 9.8 (8.3–11.3)
Conversion to
overdenture
108 7 1,410 0.5 (0.1–0.9) 2.5 (1.7–3.3) 5.0 (3.86.1)
Patient
dissatisfaction
90 3 832.5 0.4 (00.8) 1.8 (0.9–2.7) 3.6 (2.34.9)
Conversion to CD 108 2 1,410 0.1 (00.3) 0.7 (0.3–1.1) 1.4 (0.8–2.0)
Other 450 55 3,757.5 1.5 (1.11.9) 7.3 (6.58.2) 14.6 (13.4–15.9)
CD = conventional complete denture.
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Papaspyridakos/Chen et al
The International Journal of Oral & Maxillofacial Implants 109
respect to the dierent types of complications. Clini-
cal implications must therefore be made cautiously in
implant prosthodontics because of these variations in
reported complications. The absence of well- dened
criteria might lead to overlooking relevant clinical
implications, such as frequent complications asso-
ciated with a specic implant prosthetic design. In
this context, well-dened criteria should be used for
reporting and assessing biologic and technical compli-
cations. A previous systematic review concluded that
biologic complications were considered in only 40%
to 60% and technical complications in only 60% to
80% of the included studies.
6
Moreover, the causes of
many biologic and technical complications are not yet
fully understood, leading clinicians to select treatment
options based on personal experience and observa-
tional studies because of the scarcity of evidence-
based information.
Table 2 presents a descriptive analysis of all encoun-
tered cumulative complications. A mean prosthesis ex-
posure time of 9.5 years was calculated. A total of 653
complication events was recorded, translating to an
estimated complication rate of 24.6% per 100 restora-
tion years (95% CI: 22.7% to 27.5%), and the cumula-
tive rates of prosthesis free of complications” after 5
and 10 years were 29.3% (95% CI: 26.5% to 32.2%) and
8.6% (95% CI: 7.1% to 10.3%), respectively. This is in
accordance with the ndings of previous studies indi-
cating that complications occurred in 20% to 90% of
patients treated with MRIFCDPs.
27,32
Tables 3 and 4 present the rates of the most com-
mon types of complications. The most common
implant-related biologic complication was peri-
implant bone loss exceeding 2 mm during clinical
follow- up of at least 5 years, with an estimated annual
rate of 4%. However, this rate may vary according to
dierent implant designs, which may have led to a
favorable outcome.
23–26
Moreover, the most frequent
implant-related technical complication was abutment
screw fracture. Three studies reported on the incidence
of screw fracture.
15,17,20
Forces of greater magnitude
than the clamping force of the screw joint can even-
tually cause screw loosening and/or fracture.
33
Newer
abutment screw designs have focused on increasing
the screw joint preload. In this context, the replace-
ment of gold screws with screws that feature improved
surface coatings such as titanium have reduced the
incidence of screw loosening, which eventually leads
to screw fracture. On the other hand, the most frequent
prosthesis-related biologic complication was hypertro-
phy or hyperplasia of tissue around the IFCDPs.
The ndings of this systematic review indicate that
the most common prosthesis-related technical compli-
cation was chipping or fracture of the veneering ma-
terial. All seven studies included in the meta- analysis
reported on this specic complication.
16–22
Veneer
fracture has been attributed to material failure (accu-
mulated fatigue, plastic deformation), prosthetic de-
sign issues (framework mist, inadequate prosthetic
space, excessive cantilevers), patient characteristics
(parafunctional activity), and laboratory errors (casting
errors, ring failures).
7
Most publications reported on
screw-retained MRIFCDPs.
32–34
The high incidence of
acrylic resin chipping/fractures in xed implant pros-
theses may indicate that this complication cannot be
completely avoided; however, it can be repaired easily.
For partially edentulous patients treated with
implant-supported FPDs, it was found that 38.7% pre-
sented with some type of complication during the
5-year follow-up period.
3
For completely edentulous
patients treated with MRIFCDPs, the present study
found a similar 5-year “prosthesis free of complications”
rate of 29.3% (95% CI: 26.5% to 32.2%) and a 10-year
complication rate of 8.6% (95% CI: 7.1% to 10.3%). The
use of ceramic materials could represent a long-lasting
alternative to acrylic resin.
35,36
The longitudinal eec-
tiveness of MRIFCDPs has been demonstrated in the
literature, and technical complications such as chip-
ping encountered with this type of prostheses may be
easily xable.
32
However, there is a paucity of reports
on complications with MCIFCDPs for edentulous
patients with observation periods of at least 5 years.
The aforementioned 10-year cumulative rate of pros-
thesis free of complications of 8.6% (95% CI: 7.1% to
10.3%) presented in this study raises questions about
the advantage of retrievability that screw-retained
MCIFCDPs present over cement-retained MCIFCDPs.
Cement-retained MCIFCDPs may be dicult to remove
if necessary. In this context, cementation of MCIFCDPs
with provisional cement has been proposed.
37,38
Ideally, longitudinal studies should report on com-
plications and adverse clinical outcomes to provide
clinicians with reliable and thorough information for
evidence-based treatment planning.
5
CONCLUSION
Fracture of prosthesis resin, gold frameworks, and den-
ture teeth; functional and occlusal wear; and chipping of
veneering material are the most common complications
associated with metal-resin and metal-ceramic implant-
supported xed complete dental prostheses (IFCDPs)
in edentulous patients. The 5- and 10-year estimated
complication rates with all IFCDPs clearly demonstrate
that biologic and technical complications after denitive
prosthesis placement occur frequently. These events
may not result in implant loss but can lead to numerous
repair and maintenance sessions. Edentulous patients
treated with IFCDPs should be informed about the high
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Papaspyridakos/Chen et al
110 Volume 27, Number 1, 2012
incidence of complications when considering an initial
treatment plan that includes fees for denitive prosthe-
sis placement and about the need and responsibility to
continue with a customized maintenance protocol for
the long-term stability and maintenance of their IFCDPs.
REFERENCES
1. Åstrand P, Ahlqvist J, Gunne J, Nilson H. Implant treatment of pa-
tients with edentulous jaws: A 20-year follow-up. Clin Implant Dent
Relat Res 2008;10:207–217.
2. Lekholm U, Gröndahl K, Jemt T. Outcome of oral implant treatment
in partially edentulous jaws followed 20 years in clinical function.
Clin Implant Dent Relat Res 2006;8:178186.
3. Pjetursson BE, Brägger U, Lang NP, Zwahlen M. Comparison of
survival and complication rates of tooth-supported xed dental
prostheses (FDPs) and implant-supported FPDs and single crowns
(SCs). Clin Oral Implants Res 2007;18(suppl 3):97–113.
4. Pjetursson BE, Tan K, Lang NP, Brägger U, Egger M, Zwahlen M. A
systematic review of the survival and complication rates of xed
partial dentures (FPDs) after an observation period of at least 5
years. Clin Oral Implants Res 2004;15:625642.
5. Eckert SE, Choi YG, Sanchez AR, Koka S. Comparison of dental im-
plant systems quality of clinical evidence and prediction of 5-year
survival. Int J Oral Maxillofac Implants 2005;20:406-415.
6. Berglundh T, Persson L, Klinge B. A systematic review of the
incidence of biological and technical complications in implant
dentistry reported in prospective longitudinal studies of at least 5
years. J Clin Periodontol 2002;29:197–212.
7. Goodacre CJ, Bernal G, Rungcharassaeng K, Kan JY. Clinical com-
plications with implants and implant prostheses. J Prosthet Dent
2003;90:121–132.
8. Attard NJ, Zarb GA, Laporte A. Long-term treatment costs associ-
ated with implant-supported mandibular prostheses in edentulous
patients. Int J Prosthodont 2005;18:117–123.
9. Walton JN, McEntee MI. A prospective study on the maintenance of
implant prostheses in private practice. Int J Prosthodont 1997;10:
453–458.
10. Kreissl ME, Gerds T, Muche R, Heydecke G, Strub JR. Technical com-
plications of implant-supported xed partial dentures in partially
edentulous cases after an average observation period of 5 years.
Clin Oral Implants Res 2007;18:720–726.
11. Zarb GA, Schmitt A. Osseointegration and the edentulous predica-
ment: The 10-year-old Toronto study. Br Dent J 1991;170:439444.
12. Zarb GA, Schmitt A. The edentulous predicament. I: A prospective
study of the eectiveness of implant-supported xed prostheses.
J Am Dent Assoc 1996;127:59–65.
13. Ortorp A, Jemt T. Clinical experiences of computer numeric control-
milled titanium frameworks supported by implants in the edentulous
jaw: A 5-year prospective study. Clin Implant Dent Relat Res 2004;6:
199–209.
14. Kirkwood BR, Sterne JAC. Survival analysis: Displaying and com-
paring survival patterns. In: Essential Medical Statistics. Oxford:
Blackwell Science, 2003.
15. Ekelund JA, Lindquist LW, Carlsson GE, Jemt T. Implant treatment
in the edentulous mandible: A prospective study on Brånemark
system implants over more than 20 years. Int J Prosthodont
2003;16:602–608.
16. Lindquist LW, Carlsson GE, Jemt T. A prospective 15-year follow-up
study of mandibular xed prostheses supported by osseointe-
grated implants: Clinical results and marginal bone loss. Clin Oral
Implants Res 1996;7:329–336.
17. Attard NJ, Zarb GA. Long-term treatment outcomes in edentulous
patients with implant-xed prostheses: The Toronto study. Int J
Prosthodont 2004;17:417–424.
18. Fischer K, Stenberg T, Hedin M, Sennerby L. Five-year results from
a randomized, controlled trial on early and delayed loading of
implants supporting full-arch prosthesis in the edentulous maxilla.
Clin Oral Implants Res 2008;19:433–441.
19. Friberg B, Raghoebar GM, Grunert I, Hobkirk JA, Tepper G. A 5-year
prospective multicenter study on 1-stage smooth-surface Bråne-
mark System implants with early loading in edentulous mandibles.
Int J Oral Maxillofac Implants 2008;23:481–486.
20. Gallucci GO, Doughtie CB, Hwang JW, Fiorellini JP, Weber HP. Five-
year results of xed implant-supported rehabilitations with distal
cantilevers for the edentulous mandible. Clin Oral Implants Res
2009;20:601607.
21. Jemt T, Bergendal B, Arvidson K, et al. Implant-supported welded
titanium frameworks in the edentulous maxilla: A 5-year prospec-
tive multicenter study. Int J Prosthodont 2002;16:415421.
22. Ortorp A, Jemt T. CNC-milled titanium frameworks supported by
implants in the edentulous jaw: A 10-year comparative clinical study.
Clin Implant Dent Relat Res 2009 Aug 17 [epub ahead of print].
23. Arvidson K, Bystedt H, Frykholm A, von Konow L, Lothigius E.
Five-year prospective follow-up report of the Astra Tech Dental
Implant System in the treatment of edentulous mandibles. Clin Oral
Implants Res 1998;9:225234.
24. Åstrand P, Engquist B, Dahlgren S, Gröndahl K, Engquist E, Feld-
mann H. Astra Tech and Brånemark system implants: A 5-year
prospective study of marginal bone reactions. Clin Oral Implants
Res 2004;15:413420.
25. Makkonen TA, Holmberg S, Niemi L, Olsson C, Tammisalo T, Peltola
J. A 5-year prospective clinical study of Astra Tech dental implants
supporting xed bridges or overdentures in the edentulous man-
dible. Clin Oral Implants Res 1997;8:469475.
26. Rasmusson L, Roos J, Bystedt H. A 10-year follow-up study of titanium
dioxide-blasted implants. Clin Implant Dent Relat Res 2005;7:3642.
27. Purcell BA, McGlumphy EA, Holloway JA, Beck FM. Prosthetic com-
plications in mandibular metal-resin implant-xed complete dental
prostheses: A 5- to 9-year analysis. Int J Oral Maxillofac Implants
2008;23:847–857.
28. Murphy WW, Absi EG, Gregory MC, Williams KR. A prospective
5-year study of two cast framework alloys for xed implant-sup-
ported mandibular prostheses. Int J Prosthodont 2002;15:133138.
29. Zarb GA, Schmitt A. The longitudinal clinical eectiveness of os-
seointegrated dental implants: The Toronto study. Part III: Problems
and complications encountered. J Prosthet Dent 1990;64:185194.
30. Wennerberg A, Carlsson GE, Jemt T. Inuence of occlusal factors
on treatment outcome: A study of 109 consecutive patients with
mandibular implant-supported xed prostheses opposing maxil-
lary complete dentures. Int J Prosthodont 2001;14:550–555.
31. Albrektsson T, Zarb GA, Worthington P, Eriksson AR. The long-term
ecacy of currently used dental implants: A review and proposed
criteria of success. Int J Oral Maxillofac Implants 1986;1:11–25.
32. Gothberg C, Bergendal T, Magnusson T. Complications after treat-
ment with implant-supported xed prostheses: A retrospective
study. Int J Prosthodont 2003;16:201–207.
33. Khraisat A, Hashimoto A, Nomura S, Miyakawa O. Eect of lateral cy-
clic loading on abutment screw loosening of an external hexagon
implant system. J Prosthet Dent 2004;91:326–334.
34. Lambert FE, Weber HP, Susarla SM, Belser UC, Gallucci GO. Descrip-
tive analysis of implant and prosthodontic survival rates with xed
implant-supported rehabilitations in the edentulous maxilla.
J Periodontol 2009;80:1220–1230.
35. Papaspyridakos P, Lal K. Immediate loading of the maxilla with pre-
fabricated interim prosthesis using interactive planning software,
and CAD/CAM rehabilitation with denitive zirconia prosthesis:
2-year clinical follow-up. J Esthet Restor Dent. 2010;22:223232.
36. Papaspyridakos P, Benic GI, Hogsett VL, White GS, Lal K, Gallucci GO.
Accuracy of implant casts generated with splinted and non-splinted
impression techniques for edentulous patients: an optical scanning
study. Clin Oral Implants Res. 2011 Jun 2 [epub ahead of print].
37. Cordaro L, Torsello F, Ercoli C, Gallucci GO. Transition from failing
dentition to a xed implant-supported restoration: A staged ap-
proach. Int J Periodontics Restorative Dent 2007;27:481487.
38. Gallucci GO, Mavropoulos A, Bernard JP, Belser UC. Inuence of imme-
diate implant loading on peri-implant soft tissue morphology in the
edentulous maxilla. Int J Oral Maxillofac Implants 2007;22:595–602.
© 2012 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART OF MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
    • "Currently, the primary materials that have been used for bone fracture repair include bone, bone cement, metal, ceramic, and polymer. The advantages and disadvantages of these materials are compared and shown in Table 2[31][32][33][34][35] . Scanning electron microscopy (SEM) images of several polymers are also provided in Fig. 4. Note that fracture healing may be achieved by implants, for instance, made from stainless steel; materials like bone cement are typically used as void fillers and drug delivery vehicles which may reduce possible implant-associated infection and speed bone heal- ing. "
    [Show abstract] [Hide abstract] ABSTRACT: Nanomaterials mimicking the nano-features of bones and offering unique smart functions are promising for better bone fracture repair. This review provides an overview of the current state-of-the-art research in developing and using nanomaterials for better bone fracture repair. This review begins with a brief introduction of bone fracture repair processes, then discusses the importance of vascularization, the role of growth factors in bone fracture repair, and the failure of bone fracture repair. Next, the review discusses the applications of nanomaterials for bone fracture repair, with a focus on the recent breakthroughs such as nanomaterials leading to precise immobilization of growth factors at the molecular level, promoting vascularization without the use of growth factors, and re-loading therapeutic agents after implantation. The review concludes with perspectives on challenges and future directions for developing nanomaterials for improved bone fracture repair.
    Full-text · Article · Jan 2016
    • "Although high survival rate of a fixed detachable prosthesis over a 15 year period has been reported [9], but complications do exist. Panos Papaspyridakos [10] et al did a systematic review on biological and technical complications with fixed implant rehabilitations for edentulous patients. He stated that there were both kinds of complications associated with these kinds of prosthesis. "
    [Show abstract] [Hide abstract] ABSTRACT: Oral rehabilitation for a patient with severe loss of alveolar bone and soft tissue resulting from severe periodontitis presents a challenge to clinicians. The use of dental implants for replacement of teeth has become a routine procedure also in the periodontally compromised patient .The presence of periodontal inflammation and periapical infection often delay the placement of bone grafts as well as dental implants. When transitioning from a failing dentition to complete-arch implant rehabilitation, significant treatment planning is required. In this report a patient with severe chronic periodontitis underwent a full mouth reconstruction with staged approach. The oral function and esthetics was restored with fixed screw retained implant supported prosthesis. However supportive periodontal therapy becomes the most important aspect for survival of complex prosthesis.
    Full-text · Article · Jan 2016 · Materials Today
    • "Since this review article is concerned with mechanical reliability of dental implants, the issue of mechanical failure will be developed next in detail. A series of recent systematic reviews, based on clinical studies with 5-and 10-year follow-up periods, reported a high incidence of such mechanical complications [16, 21, 22], with a 5-year complication rate for a total number of mechanical complications ranging from 16.3% to 53.4% [22]. Screw fracture is most commonly encountered with a 5-and 10-year rate of 9.3% and 18.5%, respectively. "
    [Show abstract] [Hide abstract] ABSTRACT: With the growing use of dental implants, the incidence of implants’ failures grows. Late treatment complications, after reaching full osseointegration and functionality, include mechanical failures, such as fracture of the implant and its components. Those complications are deemed severe in dentistry, albeit being usually considered as rare, and therefore seldom addressed in the clinical literature. The introduction of dental implants into clinical practice fostered a wealth of research on their biological aspects. By contrast, mechanical strength and reliability issues were seldom investigated in the open literature, so that most of the information to date remains essentially with the manufacturers. Over the years, implants have gone through major changes regarding the material, the design, and the surface characteristics aimed at improving osseointegration. Did those changes improve the implants’ mechanical performance? This review article surveys the state-of-the-art literature about implants’ mechanical reliability, identifying the known causes for fracture, while outlining the current knowledge-gaps. Recent results on various aspects of the mechanical integrity and failure of implants are presented and discussed next. The paper ends by a general discussion and suggestions for future research, outlining the importance of mechanical considerations for the improvement of their future performance.
    Full-text · Article · Nov 2015
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