Abstract
To report the rate of technical complications and prosthesis survival in a cohort of edentulous patients treated with implant-supported fixed complete dental prostheses (IFCDPs) after a mean observation period of at least 1 year.
The single-visit examination included clinical and radiographic assessment, occlusal analysis, photographs and questionnaire assessing patient satisfaction in a cohort of 52 patients rehabilitated with 71 IFCDPs (supported by 457 implants). The IFCDPs were assessed for technical complications, number of implants and cantilever extension, retention type and prosthetic material type. Comparison was made between ceramic IFCDPs (Group 1) and metal-resin IFCDPs (Group 2). Kaplan-Meier survival curve analysis was carried out for assessment of prosthesis survival and was done for both Groups 1 and 2 separately. The Cox proportional hazard model was used for survival analysis, adjusting for a number of potential confounders, to evaluate the association between prosthesis survival and several risk factors such as type of opposing occlusion, nightguard use, and presence of bruxism. Responses to patient satisfaction questions were compared with Fisher's exact test.
Out of 71 edentulous arches (52 patients) restored with IFCDPs, 6 IFCDPs had failed, yielding a cumulative prosthesis survival rate of 91.6 % after a mean observation period of 5.2 years (range: 1-12 years) after definitive prosthesis insertion. Three IFCDPs were lost due to implant failures after 5.8 to 11 years of functional loading. Additionally, 3 metal-resin IFCDPs failed due to technical complications. Minor complications were the most frequent complications observed, namely wear of the prosthetic material (9.8% annual rate) being the most common, followed by decementation of cement-retained IFCDPs (2.9%), and loss of the screw access filing material of the screw-retained IFCDPs (2.7%). The most frequently observed major complication was fracture of the prosthetic material (1.9% annual rate), followed by fracture of occlusal screw (0.3%), and fracture of framework (0.3%). The annual rate of wear of prosthetic material was 7.3% for porcelain IFCDPs (n = 19/55) and 19.4% for metal-resin IFCDPs (n = 13/16), yielding a statistically significant difference between the 2 groups (p = 0.01).
After a mean exposure time of 5.2 years, 91.6% prosthesis survival rates were achieved (65 out of 71 IFCDPs). The most frequent minor technical complication was wear of the prosthetic material with estimated 5-year rate of 49.0%, while the most frequent major complication was fracture of the prosthetic material with estimated 5-year dental unit-based rate of 9.5%. The cumulative rates for "prosthesis free of minor complications" at 5- and 10-years were 60.5% (95% CI: 47.2-71.3%) and 8.9% (95% CI: 2.9-18.0%), respectively. The cumulative rates for "prosthesis free of major technical complications" at 5- and 10-years were 85.5% (95% CI: 73.0-92.5%) and 30.1% (95% CI: 12.0-50.6%), respectively. Presence of bruxism, and absence of a nightguard were associated with increased risk for chipping of the prosthetic material of the IFCDPs.