a systematic review of the survival fdp_i_implant supported fdp

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A systematic review of the survival andcomplication rates of fixed partialdentures (FPDs) after an observation

period of at least 5 yearsI. Implant-supported FPDs

Bjarni E. PjeturssonKen TanNiklaus P. Lang

Urs Bragger

Matthias Egger Marcel Zwahlen

Authors’ affiliations:Bjarni E. Pjetursson, Niklaus P. Lang, Urs Bragger ,School of Dental Medicine, University of Berne,Berne, SwitzerlandKen Tan, National Dental Center, Singapore,SingaporeMatthias Egger, Marcel Zwahlen, Division ofEpidemiology and Biostatistics, Department ofSocial and Preventive Medicine, University ofBerne, Berne, SwitzerlandMatthias Egger , MRC Health Services ResearchCollaboration, Department of Social Medicine,University of Bristol, Bristol, UK

Correspondence to:Bjarni E. PjeturssonDepartment of Periodontology andFixed ProsthodonticsUniversity of Berne

Freiburgstrasse7CH 3010 BerneSwitzerlandTel.: þ41 31 632 2577Fax: +41 31 632 4915e-mail: [email protected]

Key words: biological complications, complication rates, failures, implant dentistry, long-

itudinal, peri-implantitis, success, survival, systematic review, technical complications

Abstract

Objectives: The objective of this systematic review was to assess the 5- and 10-year survival

of implant supported fixed partial dentures (FPDs) and to describe the incidence of

biological and technical complications.

Methods: An electronic MEDLINE search complemented by manual searching was

conducted to identify prospective and retrospective cohort studies on FPDs with a mean

follow-up time of at least 5 years. Patients had to have been examined clinically at the

follow-up visit. Assessment of the identified studies and data abstraction was performed

independently by two reviewers. Failure and complication rates were analyzed using

random-effects Poisson regression models to obtain summary estimates of 5- and 10-year

survival proportions.

Results: The search provided 3844 titles and 560 abstracts. Full-text analysis was performed

for 176 articles resulting in 21 studies that met the inclusion criteria. Meta-analysis of these

studies indicated an estimated survival of implants in implant-supported FPDs of 95.4%

(95 percent confidence interval (95% CI): 93.9–96.5%) after 5 and 92.8% (95% CI: 90–94.8%)

after 10 years. The survival rate of FPDs supported by implants was 95% (95% CI: 92.2–

96.8%) after 5 and 86.7% (95% CI: 82.8–89.8%) after 10 years of function. Only 61.3% (95%

CI: 55.3–66.8%) of the patients were free of any complications after 5 years. Peri-implantitis

and soft tissue complications occurred in 8.6% (95% CI: 5.1–14.1%) of FPDs after 5 years.

Technical complications included implant fractures, connection-related and suprastructure-

related complications. The cumulative incidence of implant fractures after 5 years was

0.4% (95% CI: 0.1–1.2%). After 5 years, the cumulative incidence of connection-related

complications (screw loosening or fracture) was 7.3% and 14% for suprastructure-related

complications (veneer and framework fracture).Conclusion: Despite a high survival of FPDs, biological and technical complications are

frequent. This, in turn, means that substantial amounts of chair time have to be accepted by

the clinician following the incorporation of implant-supported FPDs. More studies with

follow-up times of 10 and more years are needed as only few studies have described the

long-term outcomes.

In earlier days, oral implants were mainly

used for the treatment of edentulous pa-

tients, and numerous studies have reported

successful outcomes for the rehabilitation

of these patients (e.g., Adell et al. 1981). As

the years passed the indications for implant

therapy were broadened and today, the

majority of patients receiving implants areCopyrightr Blackwell Munksgaard 2004

Date:

Accepted 30 June 2004

To cite this article:

Pjetursson BE, Tan K, Lang NP, Bragger U, Egger M,Zwahlen M. A systematic review of the survival andcomplication rates of fixed partial dentures (FPDs) afteran observation period of at least 5 years. I. Implant-supported FPDs.Clin. Oral Impl. Res. 15, 2004; 625–642doi: 10.1111/j.1600-0501.2004.01117.x

625



Data extraction

Of the included 21 studies, information on

the survival proportions of the reconstruc-

tions and on biological and technical comp-

lications was retrieved. Biological complica-

tions included disturbances in the function

of the implant characterized by a biological

process affecting the supporting tissues.

‘Peri-implantitis’ and ‘soft tissue complica-

tions’ were included in this category.

Technical complications denoted me-

chanical damage of implants, implant

components and/or the suprastructures.

Among these, ‘fractures of the implants,

screws or abutments’, ‘fractures of the

luting cement’ (loss of retention), ‘fractures

or deformations of the framework or ve-

neers’, ‘loss of the screw access hole

restoration’ and ‘screw or abutment loosen-

ing’ were included. From the included

studies the number of events for all of

these categories were abstracted and the

corresponding total exposure time of the

reconstruction was calculated.

Results on implant supported and com-

bined tooth–implant-supported FPDs have

been analyzed separately and have been

reported elsewhere (Lang et al. 2004).

Statistical analysis

By definition, failure and complication rates

are calculated by dividing the number ofevents (failures or complications) in the

numerator by the total exposure time (FPD

time and/or implant time) in the denomi-

nator.

The numerator could usually be ex-

tracted directly from the publication. The

total exposure time was calculated by tak-

ing the sum of:

(1) Exposure time of FPDs/implants that

could be followed for the whole

observation time.

(2) Exposure time up to a failure of the

FPDs/implants that were lost due to

failure during the observation time.

(3) Exposure time up to the end of obser-

vation time for FPDs/implants that

did not complete the observation per-

iod due to reasons such as death,

change of address, refusal to partici-

pate, non-response, chronic illnesses,

missed appointments and work com-

mitments.

For the evaluation of complication-free

FPDs the patient was used as unit of

analysis. For these outcomes total patient

exposure time was calculated by applying

the same procedures as for FPD- or implant

exposure time.

For each study, event rates for FPDs and/

or implants were calculated by dividing the

total number of events by the total FPDs orimplant exposure time in years. For further

analysis, the total number of events was

considered to be Poisson distributed for a

given sum of implant exposure years and

Poisson regression with a logarithmic link

function and total exposure time per study

as an offset variable were used (Kirkwood

& Sterne 2003a, 2003b).

Robust standard errors were calculated

to obtain 95 percent confidence intervals

(95% CI) of the summary estimates of the

event rates. To assess heterogeneity of thestudy-specific event rates, the Spearman

goodness-of-fit statistics and associated P-

value were calculated. If the goodness-of-fit

P-value was below 0.05, indicating hetero-

geneity, random-effects Poisson regression

(with g-distributed random effects) was used

to obtain a summary estimate of the event

rates. Five-year and 10-year survival propor-

tions were calculated via the relationship

between event rate and survival function S,

S(T )¼ exp(ÀT Â event rate), by assuming

constant event rates (Kirkwood & Sterne

2003a, 2003b). The 95% CI for the survival

proportions were calculated by using the

95% confidence limits of the event rates.

Multivariable Poisson regression was used

to investigate formally whether event rates

varied by study design (retrospective versus

prospective cohort studies), year of publica-

tion (1999 or before vs. 2000 or after), or

material (ceramic vs. gold–acrylic as veneer

material). All analyses were performed

using Statas (Stata Corporation, College

Station, TX, USA), version 8.2.

First electronic search

3844 Titles

Independently selected by 2 reviewers640 titles

Agreed by both560 titles

Abstracts obtained

DiscussionAgreed on 151 abstracts

Full text obtained

Total full text articles176

Final number of studies included

21

DiscussionDiscarded

80 titles

Kappa score 0.62

Further handsearching25 studies

67: Mean follow-up time less than 5 years.42: No detailed information on FPDs.

18: No information on the reconstructions.

14: Reporting on totally edentulous patients.

5: Multiple publications on the same

patient cohort

2: Reporting on failures without considering

the entire patient cohort

7: Reporting only on combined tooth-

implant supported FPDs (Lang et al. 2004)

Fig.1 . Search strategy. FPDs, fixed partial dentures.

Pjetursson et al . Systematic review of FPDs

627 | Clin. Oral Impl. Res. 15, 2004 / 625–642



Results

Included studies

A total of 21 studies of implant-supported

FPDs were included in the analysis. The

characteristics of the selected studies are

shown in Table 1.

All studies were published within the

past 10 years. These studies reported only

on 16 different patient cohorts as five of the

cohorts were examined after an observation

period of both five and 10 years. Instead of

excluding the 5-year data, the studies were

divided into two groups: A group with

around 5-year follow-up and a second

group with a 10-years follow-up time.

Therefore, the same patients were not in-

cluded twice in the same analysis. Sixteen

of the studies were prospective and the

five remaining were retrospective studies

(Table 1).

The studies included a total of 1123

patients between the age of 15 and 86 years.

The proportion of patients with implants

who could not be followed for the complete

study period was available for 16 of the 21

studies and ranged from 0% to 26%.

The studies reported on five commercially

available implant systems: Astras Tech

Implants Dental System (AstrasTech AB,

Moldal, Sweden), Biocerams sapphire im-

plants (Kyocera America, Inc., San Diego,

CA, USA), The Branemarks System (No-

bel Biocare AB, Goteborg, Sweden), ITIs

Dental Implant System (Straumann AG,

Waldenburg, Switzerland) and Minimatics

implants (Minimatic Implants Technol-

ogy, Boca Raton, FL, USA).

The studies were mainly conducted in

an institutional environment, such as uni-

versity or specialized implant clinics. Five

of the studies were multicenter studies.

In four of the studies, the patients were

randomized into test and control groups to

compare implant-supported FPDs with

combined tooth–implant-supported FPDs

(Olsson et al. 1995; Gunne et al. 1999),

machined implant surfaces with TiO2

-

blasted implant surfaces (Gotfredsen &

Karlsson 2001), titanium frameworks

with conventional cast frameworks (Jemt

et al. 2003) and ceramic abutments to

titanium abutments (Andersson et al.

2003). In this review all the data from the

included studies on implant-supported

FPDs were used irrespective of treatment

modalities.

The 21 studies included a total of 1336

FPDs that were supported by 3578 oral

implants, and 299 of the FPDs were ana-

lyzed both after a follow-up time of 5 and

10 years (Table 2). Of the nine studies that

reported on bridge design, 61% of the FPDs

Table1. Study and patient characteristics of the reviewed studies

Study (year of publication) Implant systemSampling method

Study design Plannedno. of

patients

in study

Actualno. of

patients

in study

Agerange

Meanage

Setting Drop-out(%)

5-year follow-up

Preiskel & Tsolka (2004) Branemark implants Retrospective 44 44 64.2 University 0Andersson et al. (2003) Branemark implants Prospective 32 30 15–71 53 University

and specialist

6

Multicenter, 3 centers

RandomizationJemt et al. (2003) Branemark implants Prospective 42 35 25–74 53 Specialist clinics 17

Multicenter, 4 centersRandomization

Naert et al. (2002a, 2002b) Branemark implants Retrospective n.r. $333 15–83 50.5 University n.a.

Gotfredsen & Karlsson (2001) Astra implants Prospective 50 50 53 Universityand specialist

0

Multicenter, six centersRandomization

Bragger et al. (2001) ITI implants Prospective n.r. 33 23–83 55.7 University n.r.

Mengel et al. (2001) Branemark implants

treated for GAP

Prospective 5 5 35–42 University 0

Behneke et al. (2000) ITI implants Prospective 55 50 17–81 44.2 University 9Hosny et al. (2000) Branemark implants Retrospective n.r. 18 37–65 49.5 University n.r.

Wennerberg & Jemt (1999) Branemark implants Retrospective 137 114 23–86 60.8 Specialist clinic 17

De Leonardis et al. (1999) Minimatic implants Prospective 33 32 University 3

Ortorp & Jemt (1999) Branemark implants Retrospective 58 52 28–77 59 Specialist clinic 10Wyatt & Zarb (1998) Branemark implants Prospective 88 77 15–72 45.1 University 13

Olsson et al. (1995) Branemark implants Prospective 23 22 58 University 4

RandomizationLekholm et al. (1994) Branemark implants Prospective 159 132 17–70 50 University

and private17

Multicenter, nine centers

10-year follow-up

Bragger et al. (2004) ITI implants Prospective n.r. 29 19–78 49.3 University n.r.

Zarb & Zarb (2002) Branemark implants Prospective 30 25 University 17Attard & Zarb (2002) Branemark implants Prospective n.r. 35 20–65 45.1 University n.r.

Lekholm et al. (1999) Branemark implants Prospective 127 94 18–70 50 University

and private

26

Multicenter, six centers

Gunne et al. (1999) Branemark implants Prospective 23 20 58 University 13

Randomization

Fartash & Arvidson (1997) Bioceram sapphire implants Prospective 13 13 20–73 51.2 Specialist clinic 0

GAP, generalized aggressive periodontitis; n.r., not reported; n.a., not available.





were metal ceramic, while the remainder

were of gold–acrylic design. Only 10% of

the FPDs were cemented, and 90% were

screw retained.

Thirteen studies reported on patient co-

horts in which all the patients were fol-

lowed for the same observation period: With

a follow-up time of 5 years (Lekholm et al.

1994; Olsson et al 1995; De Leonardis et al.

1999; Ortorp & Jemt 1999; Bragger et al.

2001; Gotfredsen & Karlsson 2001; Mengel

et al. 2001; Jemt et al. 2003; Andersson

et al. 2003) and 10 years (Fartash & Arvid-

son 1997; Gunne et al. 1999; Lekholm

et al. 1999; Wennerberg & Jemt 1999).

The other eight studies represented stu-

dies with variable individual observation

periods ranging from 0 to 16 years (Table 2).

Survival

Implant survival

All of the 21 studies reported on the survi-

val of the implants (Table 3). The reports

were separated into two groups. The first

consisted of the 15 studies with a mean

follow-up time of about 5 years (range

5–7.1 years) (Table 2). Of the originally 3549

implants placed, 181 implants were known

to be lost. Forty-nine percent (89/181) of

those implants were lost before loading and

51% (92/181) were lost during function.

The estimated study-specific 5-year survi-

val proportion varied between 86.3% and

99% (Table 3).

The estimated failure rate per 100 im-

plant years ranged from 0.2 to 2.94 (Fig. 2),

and the summary estimate, derived from

random-effects Poisson regression, was

0.94 failures per 100 implant years (95%

CI: 0.7–1.26) (Table 3).

The summary estimate for the survival

proportion after 5 years for implants sup-

porting FPDs was 95.4% (95% CI: 93.9–

96.5%) (Table 3).

Implant loss prior to functional loading

was detected in 2.5% of all implants

placed. For failures after loading, the esti-

mated annual failure rate was 0.51 (95%

CI: 0.39–0.67) for studies with 5 years of

follow-up, and 0.43 (95% CI: 0.32–0.6) for

the studies with 10 years of follow-up (no

significant difference).

The 10 prospective studies and the five

retrospective studies were also analyzed

separately. For the prospective studies,

based on 1576 implants, the summary

estimate of the survival proportion was

95.6% (95% CI: 93.3–97.2%) and for the

retrospective studies, based on 1973 im-

plants, the summary estimate of the survi-

val proportion was 95% (95% CI: 93–

96.4%). Formally investigating the differ-

ence in event rates in a Poisson regression

analysis confirmed the absence of a study

design effect (P¼0.64).

Comparing the event rates from studies

published between 2000 and 2004 with

those from studies published between

1994 and 1999 revealed a 48% lower

(95% CI: 17–67%) implant failure rate in

more recent studies (P¼0.006).

Table2. Information on implants and FPDs in the reviewed studies

Study(year of publication)

Total no.of implants

Total no.of FPDs

Metal/ ceramic

Gold/ resin

Cemented Screwretained

Follow-up range

Meanfollow-up

5-year follow-up

Preiskel & Tsolka (2004) 286 78 78 0 78n 78n 1–12 6.6

Andersson et al. (2003) 105 36 36 0 19 17 5 5

Jemt et al. (2003) 170 63 63 0 0 63 5 5

Naert et al.

(2002a, 2002b)

1022 409 340 69 n.r. n.r. 0–16 5.5

Gotfredsen & Karlsson

(2001)

133 52 n.r. n.r. n.r. n.r. 5 5

Bragger et al. (2001)w 84 40 40 0 30 10 5 5

Mengel et al. (2001) 36 7 n.r. n.r. n.r. n.r. 5 5

Behneke et al. (2000) 114 68 n.r. n.r. 13 55 5–8.3 5.4

Hosny et al. (2000) 49 18 16 2 0 18 1.3–14 6.5Wennerberg & Jemt

(1999)

422 133 31 99 0 133 5 5

De Loenardis et al.

(1999)

100 33 n.r. n.r. n.r. n.r. 5 5

Ortorp & Jemt (1999) 194 68 57 11 n.r. n.r. 5 5

Wyatt & Zrb (1998)w 230 97 15 82 0 97 1–12 5.4

Olsson et al. (1995)w 46 23 0 23 0 23 5 5

Lekholm et al. (1994)w 558 197 11 152 0 163 5 5

Total 3549 1322 687 438 62 579 5.3

10-year follow-up

Bragger et al. (2004) 69 33 33 0 25 8 8–12 10

Zarb & Zarb (2002) 94 34 n.r. n.r. 0 34 7–16 12

Attard & Zarb (2002) 105 46 n.r. n.r. 0 46 10–15 12.5Lekholm et al. (1999) 461 163 11 152 0 163 10 10

Gunne et al. (1999) 46 23 0 23 0 23 10 10

Fartash & Arvidson

(1997)

29 14 7 7 n.r. n.r. 10 10

Total 804 313 51 182 25 274 10.6

nFPDs were both cemented and screw retained.

wPatients included in 10-year follow-up studies were already analyzed in 5-year follow-up reports.

FPDs, fixed partial dentures; n.r., not reported.





The second group consisted of six studies

with a mean follow-up time of 10.6 years

(range 10–12.5 years) (Table 2). Of the

original 804 implants placed, 55 implants

were known to be lost. The study-specific

estimated 10-year survival proportion var-

ied between 85.5% and 98.6%, and the

summary estimate of the survival propor-

tion after 10 years for implants supporting

FPDs was 92.8% (95% CI: 90–94.8%)(Table 3).

FPD survival

FPD survival was defined as the FPD

remaining in situ with or without modifi-

cation for the observation period. Seven-

teen studies provided data on survival of

the FPDs (Table 4). The reports were di-

vided into two groups: The first group with

a total of 1289 FPDs and a mean follow-up

time of 5.3 years and the second group with

Table3. Annual failure rates and survival of implants

Study(year of publication)

Totalno. of

implants

Mean follow-uptime

No. offailure

Total implantexposure time

Estimatedfailure rate

(per 100

implant years)

Estimatedsurvival after

5 years (%)


10 years (%)

5-year follow-up

Preiskel & Tsolka (2004) 286 6.6 9 1898 0.47 97.7

Andersson et al. (2003) 105 5 3 487 0.61 97

Jemt et al. (2003) 170 7.1 4 1162 0.34 98.3Naert et al. (2002a, 2002b) 1022 5.5 58 5121 1.13 94.5Gotfredsen & Karlsson (2001) 133 5 3 604 0.5 97.5

Bragger et al. (2001) 84 5 1 418 0.24 98.8

Mengel et al. (2001) 36 5 2 160 1.25 93.9

Behneke et al. (2000) 114 5.4 5 625 0.8 96.1Hosny et al. (2000) 49 6.5 2 312 0.64 96.8

Wennerberg & Jemt (1999) 422 5 25 1812 0.14 93.3

De Loenardis et al. (1999) 100 5 1 498 0.2 99Ortorp & Jemt (1999) 194 5 12 903 1.33 93.6

Wyatt & Zarb (1998) 230 5.4 14 1180 1.19 94.2

Olsson et al. (1995) 46 5 6 204 2.94 86.3

Lekholm et al. (1994) 558 5 36 2365 1.52 92.7

Total 3549 181 17,749

Summary estimate (95% CI)n 0.94

(0.7–1.26)

95.4

(93.9–96.5)

10-year follow-up

Bragger et al. (2004) 69 10 1 685 0.15 98.6

Attard & Zarb (2002) 105 12.5 6 1254 0.48 95.3

Zarb & Zarb (2002) 94 12 7 953 0.73 92.9Lekholm et al. (1999) 461 10 34 3753 0.91 91.3

Gunne et al. (1999) 46 10 6 382 1.57 85.5Fartash & Arvidson (1997) 29 10 1 286 0.35 96.6

Total 804 55 7313

Summary estimate (95% CI)w 0.75

(0.54–1.05)

92.8

(90–94.8)

nBased on random-effects Poisson regression, test for heterogeneity, P ¼0.0007.

wBased on standard Poisson regression, test for heterogeneity, P ¼0.081.

FPDs, fixed partial dentures; CI, confidence interval.

Lekholm et al.

Olsson et al.

Wyatt & Zarb

Örtrop & Jemt

De Loenardis et al.

Wennerberg & JemtHosny et al.

Behneke et al.

Mengel et al.Braegger et al.


Naert I et al.Preiskel & Tsolka

Jemt et al.

Andersson et al.

S

t u d y

0 1 2 3 4 5 6 7 8

Event Rate per 100 Years

Implant Failure Rate

Summary Estimate

0.94 (95% CI: 0.70-1.26)

Fig.2 . Annual failure rates (per 100 implants). CI, confidence interval.





a total of 219 FPDs and a mean follow-up

time of 10 years.

In the former group, 63 out 1289 FPDs

were lost and the study-specific estimated

5-year survival varied between 82.2% and

100% (Table 4). The estimated failure rate

per 100 FPD years ranged from 0 to 3.92

(Fig. 3) and the summary estimate, derived

from a random-effects analysis, was 1.03

(95% CI: 0.65–1.62) (Table 3) translating

into a survival proportion after 5 years for

implant-supported FPDs of 95% (95% CI:

92.2–96.8%).

The studies in the 5-year observationgroup were also divided according to the

veneer material utilized: A group of seven

studies with a total of 712 FPDs with

ceramic as veneer material and a group of

four studies with a total of 450 FPDs with

acrylic veneers. The group with metal

ceramic FPDs showed a significantly

higher (P¼0.014) summary estimate of

the survival proportion after 5 years of

96.6% (95% CI: 95.9–97.3%), compared

with a survival of 90.4% (95% CI: 79.8–

95.6%) for the gold–acrylic FPDs.

In the 10-year observation group, 27 out

of 219 FPDs were lost. The study-specific

survival after 10 years varied between

81.1% and 93.9% (Table 4). The summary

estimate of the survival proportion after 10

years for implant-supported FPDs was

86.7% (95% CI: 82.8–89.8%).

Success

Success was defined as an FPD being free of

all complications over the entire observa-

tion period.

Table4. Annual failure rate and survival of FPDs

Study (year of publication) Total no.of FPDs

Meanfollow-up

time

No. offailure

Total FPDsexposure

time

Estimatedfailure rate

(per 100

FPD years)


5 years (%)


10 years (%)

5-year follow-up

Preiskel & Tsolka (2004) 78 6.6 2 519 0.39 98.1

Andersson et al. (2003) 36 5 1 164 0.61 97

Jemt et al. (2003) 63 5 3 295 1.02 95Naert et al. (2002a, 2002b) 409 5.5 15 2049 0.73 96.4

Gotfredsen & Karlsson (2001) 52 5 2 236 0.85 95.9

Bragger et al. (2001) 40 5 1 198 0.51 97.5Mengel et al. (2001) 7 5 0 33 0 100

Behneke et al. (2000) 68 5.4 1 372 0.27 98.7

Hosny et al. (2000) 18 6.5 0 117 0 100

Ortorp & Jemt (1999) 68 5 3 323 0.93 95.5Wennerberg & Jemt (1999) 133 5 2 608 0.33 98.4

Wyatt & Zarb (1998) 97 5.4 16 498 3.21 85.2

Olsson et al. (1995) 23 5 4 102 3.92 82.2

Lekholm et al. (1994) 197 5 13 889 1.46 92.9

Total 1289 63 6403

Summary estimate (95% CI)n 1.03 (0.65–1.62) 95 (92.2–96.8)

10-year follow-up

Bragger et al. (2004) 33 10 2 320 0.63 93.9Lekholm et al. (1999) 163 10 21 1378 1.52 85.9Gunne et al. (1999) 23 10 4 191 2.09 81.1

Total 219 27 1889

Summary estimate (95% CI)w 1.43 (1.08–1.89) 86.7 (82.8–89.8)

nBased on random-effects Poisson regression, test for heterogeneity P o0.0001.

wBased on standard Poisson regression, test for heterogeneity P ¼0.035.


Lekholm et al.

Olsson et al.

Wyatt & Zarb

Wennerberg & Jemt

Örtrop & Jemt

Hosny et al.

Behneke et al.

Mengel et al.

Brägger et al.


Naert et al.Preiskel & Tsolka

Jemt et al.

Andersson et al.

S t u d y

0 1 2 3 4 5 6 7 8

Event Rate per 100 Years

FPD Failure Rate

Summary Estimate1.03 (95% CI: 0.65-1.62)

Fig.3 . Annual failure rates (per 100 fixed partial dentures [FPDs]). CI, confidence interval.





Only three (Ortorp & Jemt 1999;

Wennerberg & Jemt 1999; Jemt et al.

2003) out of 21 studies reported how

many patients were free of complications.

For one study (Bragger et al. 2001) this

information could be extracted from the

orginal database.

These four studies included 266 patients

with a mean follow-up time of 5 years, and

122 patients had some kind of complica-

tions over the observation period (in total

253 complications). The summary esti-

mate of the proportion of success after 5

years was 61.3% (95% CI: 55.3–66.8%)

(Table 5). In other words, 38.7% of the

patients had minor or major complications

in the first 5 years after implantation.

Biological complications

Peri-implant mucosal lesions were reported

in various ways by the different authors.

Nine studies provided information on soft

tissue complications and peri-implantitis.

One study (Gotfredsen & Karlsson 2001)

compared implants with TiO2

-blasted and

-machined surfaces and reported a higher

proportion of implants with signs of in-

flammation (pain, redness swelling and

bleeding) at baseline for the TiO2

group

(5% vs. 0%). After 1 year, similar cumu-

lative complication rates were observed

(12% and 9%, respectively). After 5 years,

finally, similar incidences were described

for both groups.

Bragger et al. (2001) defined peri-implan-

titis as probing pocket depth (PPD)

!5 mm and bleeding on probing (BOP)

with 10% of the patients (five patients) or

9.6% of the implants being affected.

Behneke et al. (2000) reported that 4% of

the patients had peri-implantitis at pros-

thesis placement. In addition, 9% of the

patients were diagnosed as having peri-im-

plantitis during the first year. During the

second year and thereafter the annual fre-

quency of peri-implantitis was 2–5%.

Other studies (Lekholm et al. 1994;

Wennerberg & Jemt 1999) reported on

‘soft tissue complications’, defined as fis-

tula, gingivitis or hyperplasia.

One study (Wyatt & Zarb 1998) reported

that 13% of the FPDs (13 out of 97) had at

least one soft tissue complication (infection

and/or inflammation) over the observation

period.

In a random-effects Poisson-model ana-

lysis, the pooled cumulative rate of bio-

logical complications after 5 years for

patients treated with implant-supported

FPDs was 8.6% (95% CI: 5.1–14.1%)

(Table 6).

Technical complications

The most common technical complication

was the fracture of a veneer (acryl, ceramic

and composite). After 5 years, 13.2% (95%

CI: 8.3–20.6%) of the FPDs had fractures

of veneers (Table 7).

Table5 . Any complications in treated patients

Study (year of publication) Total no.of patients

Meanfollow-up

time

No. ofcomplications

Total patientexposure time

Estimatedcomplication rate

(per 100 patient years)

Estimatedsuccess after

5 years (%)

5-year follow-up

Jemt et al. (2003) 42 5 22 195 11.28 56.9

Bragger et al. (2001) 33 5 7 163 4.29 80.7

Ortorp & Jemt (1999) 58 5 30 281 10.68 58.6

Wennerberg & Jemt (1999) 133 5 63 608 10.36 59.6

Total 266 122 1247

Summary estimate (95% CI)n 9.78 (8.07–11.86) 61.3 (55.3–66.8)

nBased on standard Poisson regression, test for heterogeneity P ¼0.12.

CI, confidence interval.

Table6 . Biological complications

Study (year of publication) Total no.

of FPDs

Mean

follow-up

time

No. of

complications

Total FPDs

exposure

time

Estimated failure

rate (per 100

FPD years)

Estimated cumulative

complication rate

after 5 years (%)

5-year follow-up

Jemt et al. (2003) 63 5 3 295 1.02 5

Gotfredsen & Karlsson (2001)n 52 5 9 236 3.81 17.4Bragger et al. (2001) 40 5 4 198 2.02 9.6

Behneke et al. (2000)n 68 5.4 12 372 3.22 14.9

De Leonardis et al. (1999) 33 6.5 1 235 0.42 2.1

Ortorp & Jemt (1999) 68 5 1 323 0.31 1.5

Wennerberg & Jemt (1999) 133 5 15 608 2.48 11.6Wyatt & Zarb (1998) 97 5.4 13 498 2.61 12.2

Lekholm et al. (1994) 197 5 3 889 0.34 1.7

Total 751 61 3654

Summary estimate (95% CI)w 1.79 (1.05–3.03) 8.6 (5.1–14.1)

nIncidence of biological complications calculated by adding the incidence after 1 year to half of the events that occurred after that first, assuming that half of

the complications belonged to new patients and the other 50% of the patients that had already experienced a biological complications after 1 year.

wBased on random-effects Poisson regression, test for heterogeneity P o0.0001.






The second most common technical

complication, loss of the screw access

hole restoration, was reported only in one

study (Ortorp & Jemt 1999). This occurred

in 8.2% of the anchors.

The third most common technical com-

plication, abutment or occlusal screw loos-

ening, and its cumulative incidence after

5 years of follow-up was 5.8% (95% CI:

3.8–8.7%) (Table 7).

Fracture of abutments and occlusal

screws occurred in 1.5% (95% CI: 0.8–

2.8%) (Table 7) of the abutments after a

follow-up time of 5 years and 2.5% (95%

CI: 1.6–4.7%) after 10 years.

Fracture of implants were a rare compli-

cation with a cumulative incidence of

0.4% (95% CI: 0.1–1.2%) (Table 7) after

a follow-up time of 5 years and 1.8% (95%

CI: 1.2–2.6%) after 10 years.

Two studies, both Bragger et al. (2001,2004), reported on fractures of the luting

cement (loss of retention). They reported a

cumulative incidence of 2.9% after 5 years

and 16% after 10 years.

Discussion

This systematic review is part of a series of

systematic reviews addressing the survival

and complication rates of fixed partial den-

tures of different design.Systematic reviews have been used in

medicine for the last two decades to sum-

marize the cumulative information on the

optimal treatment for clinically important

questions. This research method has

slowly found its way into dental research.

Systematic reviews have mainly been used

to analyze RCTs (Egger et al. 2001).

For this systematic review, no RCTs

were available comparing conventional

fixed prosthodontics to implant-supported

fixed prosthodontics. In the absence of

RCTs, a lower level of evidence, prospec-

tive and retrospective cohort studies were

included in this systematic review in order

to summarize the available information

about survival and complication rates of

implant-supported fixed partial dentures

after a period of at least 5 years.

The results of longitudinal cohort studies

with a mean follow-up time of at least 5

years regarding survival and success of

FPDs and their biological and technical

complications were reviewed systemati- T a b l e 7 .

T e c h n i c a l c o m p l i c a t i o n s

S t u d y

( y e a r o f p u b l i c a t i o n )

M e a n

f o l l o w - u p

t i m e

T o t a l n o . o f

i m p l a n t a t i o n s

T o t a l

i m p l a n t a t i o n

e x p o s u r e

t i m e

E s t i m a t e d

r a t e o f

i m p l a n t f r a c t u r e

( p e r 1 0 0 i m p l a n t

y e a r s )

E s t i m a t e d r a t e

o f a b u t m e n t o r

s c r e w f r a c t u r e ( p e r

1 0 0 i m p l a n t y e a r s )

E s t i m a t e d r a t e o f

l o o s e a b u t m

e n t s

o r s c r e w s ( p

e r 1 0 0

i m p l a n t y e a

r s )

T o t a l

n o . o f

F P D s

T o t a l F P D

e x p o s u r e

t i m e

E s t i m a t e d r a t e

o f v e n e e r f r a c

t u r e

( p e r 1 0 0 F P D y e a r s )

E s t i m a t e d r a t e o f

m e t a l f r a m e w o r k

f r a c t u r e ( p e r

1 0 0 F P D y e a r s )

5 y e a r f o l l o w - u p

P r e i s k e l & T s o l k a ( 2 0 0 4 )

6 . 6

2 8 5

1 8 9 8

0

0 . 0 5

0 . 4 2

7 8

5 1 9

0 . 1 9

n . r .

A n d e r s s o n e t a l . ( 2 0 0 3 )

5

1 0 3

4 8 7

n . r .

0 . 2 1

n . r .

3 6

1 6 4

0 . 6 1

0

J e m t e t a l . ( 2 0 0 3 )

5 – 7 . 1

n

1 6 9

1 1 6 2

0 . 0 9

0 . 1 7

0 . 7 7

6 3

2 9 5

3 . 3 9

0 . 3 4

G o t f r e d s e n & K a r l s s o n

( 2 0 0 1 )

5 . 5

1 3 3

6 0 4

0

0 . 3 3

2 . 8 1

5 2

2 3 6

0 . 8 5

0

B r a ¨ g g e r e t a l . ( 2 0 0 1 )

5

8 4

4 1 8

0 . 2 4

0

1 . 6 7

4 0

1 9 8

2 . 0 2

0

B e h n e k e e t a l . ( 2 0 0 0 )

5 . 4

1 1 4

6 2 5

0

0

2 . 0 8

6 8

3 7 2

1 . 8 8

n . r .

H o s n y e t a l . ( 2 0 0 0 )

6 . 5

4 9

3 1 2

0

0

n . r .

1 8

1 1 7

n . r .

0

O ¨ r t o r p & J e m t ( 1 9 9 9 )

5

1 9 4

9 0 3

0

0 . 1 1

0 . 2 2

6 8

3 2 3

5 . 5 7

0

W e n n e r b e r g & J e m t

( 1 9 9 9 )

5

4 2 2

1 8 1 2

0

0 . 8 8

1 . 2 1

1 3 3

6 0 8

2 . 9 6

0 . 1 6

W y a t t & Z a r b ( 1 9 9 8 )

5 . 4

2 3 0

1 1 8 0

0

0 . 8 5

0 . 8 5

9 7

4 9 8

4 . 6 2

0 . 4

L e k h o l m e t a l . ( 1 9 9 4 ) w

5

5 5 8

2 3 4 6

0 . 2 1

0 . 3 8

1 . 1 5

1 9 7

8 8 9

5 . 5 1

n . r .

S u m m a r y e s t i m a t e e v e n t

r a t e s ( 9 5 %

C I )

0 . 0 7 z

( 0 . 0 2 – 0 . 2 3 )

0 . 3

y

( 0 . 1 6 – 0 . 5 7 )

1 . 1 9 y

( 0 . 7 7 – 1 . 8 2 )

2 . 8 4 y

( 1 . 7 4 – 4 . 6 2 )

0 . 1 6 z

( 0 . 0 7 – 0 . 3 6 )

C u m u l a t i v e 5 y e a r

c o m p l i c a t i o n r a t e s

( 9 5 %

C I )

0 . 4 % z

( 0 . 1 – 1 . 2 )

1 . 5 % y

( 0 . 8 – 2 . 8 )

5 . 8 % y

( 3 . 8

– 8 . 7 )

1 3 . 2 % y

( 8 . 3 – 2 0 . 6 )

0 . 8 % z

( 0 . 4 – 1 . 8 )

n M e a n f o l l o w - u p t i m e w a s 7 . 1 y e a r s f o r

t h e i m p l a n t s a n d 5 y e a r s f o r t h e F P D s .

w I n f o r m a t i o n w a s g i v e n o n n u m b e r o f p

a t i e n t s w i t h c o m p l i c a t i o n s .

z B a s e d o n s t a n d a r d P o i s s o n r e g r e s s i o n .

y B a s e d o n r a n d o m - e f f e c t s P o i s s o n r e g r e s s i o n .

F P D s , fi x e d p a r t i a l d e n t u r e s ; C I , c o n fi d e n c e i n t e r v a l ; n . r . , n o t r e p o r t e d .





cally. Survival was defined as FPD remain-

ing in situ with or without modifications.

Success was defined as the FPDs remaining

in situ free of all complications over the

entire observation period.

When multiple publications with differ-

ent follow-up times on the same cohort

were available, only the publication with

the longest follow-up time is generally

included in a systematic review. For five

out of six studies with a mean follow-up

time of 10 years or more, a 5-year report

was also available. Instead of excluding the

5-year data, the studies were divided into

two groups: A group with about 5 years of

follow-up and a second group with about

10 years of follow-up.

Even with follow-up periods of at least

5 years, some clinicians may argue that

this is still too short to obtain reliable

information on survival and complicationrates. Due to the fact that use of dental

implants for rehabilitation of partially

edentulous patients is relatively new, a

mean follow-up period of at least 5 years

was a necessary compromise. However, it

is acknowledged that information on long-

term survival is still scarce, and the results

of the present review should not be extra-

polated to follow-up times measured in

decades. The present review demonstrated

that the existing longitudinal studies did

not include many patients with a prolongedfollow-up time.

The search of the present review aimed

to identify longitudinal cohort studies re-

porting on FPDs. When titles and abstracts

did not provide sufficient information on

study duration and whether or not infor-

mation on the suprastructure was provided,

a full-text analysis of the articles was

carried out. The majority of longitudinal

implant studies did not address the recon-

structions at all. Nor did they distinguish

between different types of reconstructions.

Therefore, a substantial portion of the pub-

lished literature could not be included in

this systematic review. Moreover, only

English-language publications were in-

cluded. This could be problematic for two

reasons: (a) the precision of summary esti-

mates is reduced if a substantial number of

additional studies published in other lan-

guages exist; (b) bias may be introduced if

the results of studies published in English

differ systematically from those published

in other languages. However, a recent em-

pirical study found little effect of the in-

clusion/exclusion of trials published in

language other than English on combined

effect estimates in meta-analyses of RCTs.

(Egger et al. 2003). The search strategy

performed for this review identified indeed

a few studies reporting in other languages.

It is impossible to judge whether or not the

patient cohorts excluded from the present

review might have differed in terms of

survival, event rates and success.

Instead of performing a formal quality

assessment of the included studies and sen-

sitivity analysis, this review used stringent

inclusion criteria. For example, only studies

with a clinical follow-up examination were

included to avoid the potential inaccuracies

in event description in studies that based

their analysis on patient self-reports.

The studies were mainly conducted in

an institutional environment, such as uni-versity or specialized implant clinics. Five

of the studies were multicenter studies.

Therefore, the long term outcomes ob-

served here cannot be generalized to dental

service provided in private practice.

The cumulative failure rates of implant-

supporting FPDs were 5% after 5 years,

and 7.2% after 10 years, respectively. Ap-

proximately 2.5% or half of the lost im-

plants were lost prior to functional loading.

This result is in agreement with the result

from a previous systematic review (Ber-glundh et al. 2002). Clearly, a limitation

of the present review is that the assump-

tion of a constant annual event rate is not

fully met when considering the first and

the subsequent years after implantation.

Nevertheless, the results of the present

analysis should be robust as only informa-

tion of studies with a mean follow-up of 5

years or more were included.

The lower event rates in more recently

published studies are compatible with the

hypothesis of a learning curve over the

years, although a later year of publication

does not necessarily translate to later years

of implantation.

Regarding the different implant systems,

the majority of the studies reported on the

experience with the Branemark Nobel Bio-

care System that showed results below the

average of the entire review. The other

three implant systems, Astras Tech Sys-

tem, ITIs Dental Implant System and

Minimatic implants all yielded results

above the average.

The cumulative failure rate of the im-

plant supported FPDs was 4.8% after 5

years and 13.3% after 10 years. This in-

crease in the failure proportion over the

second five-year period might be explained

by the different FPD design (gold–acrylic)

in the older studies and, to some extent,

also by increased experience of the clinical

research teams.

To evaluate the influence of different

FPD designs on the failure rate the results

from studies reporting on metal ceramic

FPDs were compared with those from stu-

dies reporting on gold–acrylic FPDs. There

was a significant difference with the former

showing a cumulative failure rate of 3.4%

and the latter one 9.6% over a 5-year

period. The high failure rate of the FPDs

with a gold framework and acrylic veneers

is thought to be due to high numbers of

veneer fractures and esthetic complica-tions.

Only three studies (Ortorp & Jemt 1999;

Wennerberg & Jemt 1999; Jemt et al. 2003)

reported on success, i.e., number of pa-

tients without any complications at all

during the observation period. There is

definitely a lack of detailed, standardized

information on complications. The sum-

mary estimate of the cumulative complica-

tion rate after an observation period of

5 years was 38.7%. The complications

may be minor, such as screw or abutmentloosening, loss of access hole restorations,

loss of retention or minor acryl/ceramic

chipping, or they may be major, such

as implant fractures, fractures of the

metal framework or veneer material that

require replacement of the entire recon-

struction.

The cumulative incidence of peri-im-

plantitis and soft tissue complication was

8.6% after a follow up time of 5 years. For

the biologic complications the results must

be interpreted with caution, because of

different criteria for soft tissue complica-

tions being used in various studies.

Literature-based systematic reviews of

prognosis and survival outcomes are ham-

pered by a variety of problems (Altman

2001). The present systematic review re-

vealed several shortcomings in the previous

clinical studies. Hence, it appears appro-

priate to make the following recommenda-

tions: Long-term cohort studies on dental

implants should be prospective, have com-

plete follow-up information preferentially





with similar length of follow-up for all

patients. This means that data on well-

defined time periods should be reported

for the entire cohort, especially for the

different years after implantation. Due to

various definitions of implant success

authors should report data on implant sur-

vival in combination with incidence of

complications. The events of implant loss

should be grouped into losses that occur

prior to loading and those that take place

during function. Survival and success (free

of all complications) of the suprastructures

should be reported. Well-defined criteria

should be used for the assessment of the

biological and technical complications.

Data from clinical and radiographic assess-

ments should be described as frequency

distributions. Collaborative efforts to con-

duct a pooled individual patient data ana-

lysis of the patients and implants in thevarious studies would allow to develop and

use common definitions of complications

and to obtain a clearer picture on true long-

term survival.

Clinical assessments should include

PPD, clinical attachment level (CAL) and

BOP. Biological complications defined

by (1) the threshold level of PPD, (2)

the presence/absence of BOP/suppura-

tion assessed at any examination interval

and (3) crestal bone loss over time must

be described for implants and neighbor-ing teeth.

Technical complications should be di-

vided into (1) major: such as, implant

fracture, loss of suprastructures, (2) med-

ium: such as, abutment or abutment frac-

ture, veneer or framework fractures,

esthetic and phonetic complications and

(3) minor: such as abutment and screw

loosening, loss of retention, loss of screw

hole sealing, veneer chipping (may be po-

lished) and occlusal adjustments. The type

and number of events of technical compli-

cations per time interval as well as time/

cost required should also be reported.

In conclusion, it may be stated that

despite the high survival of implant-sup-

ported FPDs (95% after 5 years and 86.7%

after 10 years), biological and technical

complications were frequent (38.7% after

5 years). This, in turn, means that sub-

stantial amounts of chair time have to be

accepted by the patient, dental service and

society at large following the incorporation

of implant supporting FPDs.

Acknowledgements: This study has

been supported by the Clinical

Research Foundation (CRF) for the

promotion of Oral Health, University of

Berne, Switzerland. B. E. P. was an ITI

Scholar for the year 2002/2003 (ITI

Foundation grant).

Conflicts of interest : None declared.

Resume

L’objectif de cette revue systematique a ete de revoir

la survie implantaire apres cinq et dix ans de proth-

eses partielles fixees sur implants et de decrire l’in-

cidence des complications biologiques et techniques.

Une recherche Medline completee par une recherche

manuelle ont identifie des etudes prospectives et

retrospectives sur ces protheses avec un temps

moyen de suivi d’au moins cinq annees. Les patients

avaient du subir un examen clinique lors de ce suivi.

Les etudes et les releves des donneesont ete effectues

de maniere independante par deux personnes. Lestaux de complications et d’echecs ont ete analyses en

utilisantles modeles deregression Poisson aveceffets

hasard pour obtenir des estimations des proportions

de survie de cinq a dix ans. La recherche a apporte 3

844 titres et 560 resumes. L’analysedes manuscripts

complets a ete effectuee pour 176 articles resultant

en 21 etudes qui atteignaient les criteres d’inclusion.

La meta-analyse de ces etudes a indique une estima-

tion de survie de ces implants dans les groupes

combines implants-dents de 95,4% (intervalle de

confidencede 95% : 93,9 a 96,5%) apres cinqannees

et de 92,8% (90,0 a 94,8%) apres dix annees. Le taux

de survie des protheses sur implants etaient de

95,0% (92,2 a 96,8%) apres cinq annees et de 86,7

% (82,8 a 89,8%) apres dix annees. Seul 61,3% (55,3

a 66,8%) des patients n’avaient eu aucune complica-

tion apres cinq annees. La paroımplantite et les

complications des tissus mous arrivaient dans 8,6%

(5,1 a 14,1%) des cas apres cinq annees. Les compli-

cations techniques comprenaient les fractures des

implants, des complications de connexion ou bien

relies a la superstructure. L’incidence cumulative des

fractures d’implants apres cinqans etait de 0,4% (0,1

a 1,2%). Apres cinq annees, l’incidence cumulative

des complications en relation avec la connexion (vis

lache ou fracturee) etait de 7,3% et 14% des super-

structures avaient des complications (fracture de la

masse ou des veneer). Malgre la survie importante

des protheses fixees, des complications tant techni-

ques que biologiques sont frequentes. Ceci signifie

que des quantites importantes de temps au fauteuil

doivent etre acceptees par le clinicien apres l’inser-

tion d’un implant supportant une prothese fixee.

Davantage d’etudes avec un temps de recul de dix

ans ou plus sont necessaires car seul quelques etudes

ont decrits la situation a si long terme.

Zusammenfassung

Ziel: Ziel dieser systematischen Ubersicht war ei-

nerseits die Bestimmung der Uberlebenszeit von

implantat-getragenem festsitzendem Zahnersatz

(FPDs) nach 5 und 10 Jahren und andererseits die

Haufigkeit von biologischen und technischen Kom-

plikationen zu beschreiben.

Methoden: Man fuhrte eine manuell erganzte elek-

tronische Medline-Suche durch, um prospektive und

retrospektive Kohortenstudien uber FPDs mit einer

durchschnittlichen Beobachtungszeit von mindes-

tens 5 Jahren zu identifiziernen. Die Patienten

mussten bei den Nachkontrollen auch klinisch un-

tersucht worden sein. Die Aufnahme der ausgewahl-ten Studien und die Abstraktion der Daten wurde

von zwei Personen unabhangig voneinander durch-

gefuhrt. Mit Hilfe eines Possion Regressionsmodells

analysierte man die Misserfolgs- und Komplika-

tionsraten und erhielt so zusammenfassende Schatz-

werte fur die uberlebenswahrscheinlichkeit nach 5

und 10 Jahren.

Resultate: Die Suche lieferte 3844 Titel und 560

Abstracts. Die Analyse des gesamten Textes erfolgte

bei 176 Artikeln, von denen aus 21 Studien, die

Einschlusskriterien erfullten. Die Meta-Analyse

dieser Studien ergab eine geschatzte Uberlebensrate

der Implantate in gemischt zahn-implantat-getra-

genen FPDs von 95.4% (95 Prozent Zuverlassigkeit-

sintervall (95% CI): 93.9–96.5%) nach 5 Jahren und92.8% (95% CI: 90–94.8%) nach 10 Jahren. Die

Uberlebensrate der FPDs, die nur von Implantaten

getragen werden betrug 95% (95% CI: 92.2–96.8%)

nach 5 Jahren und 86.7% (95% CI: 82.8–89.8%)

nach 10 Jahren in Funktion. Nach 5 Jahren hatten

nur gerade 61.3% (95% CI: 55.3–66.8%) der

Patienten noch nie irgendwelche Komplikationen.

Nach 5 Jahren waren Periimplantitis und Weichge-

webskomplikationen bei den FPDs in 8.6% der

Falle einmal aufgetreten (95% CI: 5.1–14.1%).

Die technischen Komplikationen berucksichtigten

Implantatfrakturen sowie Probleme bei der Sekun-

darteilverbindung und den Suprastrukturen. Das

kumulative Eintreffen einer Implantatfraktur nach

5 Jahren betrug 0.4% (95% CI: 0.1–1.2%). Ebenfallsnach 5 Jahren gab es kumulativ bei 7.3% der Sekun-

darteilverbindungen Probleme (geloste oder fraktur-

ierte Schrauben) und bei 14% der Suprastrukturen

Komplikationen (Porzellan- oder Gerustfrakturen).

Zusammenfassung: Trotz einer hohen Uberlebens-

rate von FPDs sind biologische und technische

Komplikationen haufig. Dies wiederum bedeutet,

dass der Kliniker nach der Eingliederung von

implantat-getragenen FPDs mit beachtlicher Ar-

beitszeit fur Reparaturarbeiten rechnen muss. Es

sind vor allem Langzeitstudien von 10 und mehr

Jahren notig, weil bisher nur wenige Arbeiten die

Langfristfolgen beschreiben.

Resumen

Objetivos: El objetivo de esta revision sistematica

fue valorar la supervivencia de dentaduras parciales

fijas soportadas por implantes (FPDs) y describir la

incidencia de complicaciones biologicas y tecnicas.

Metodos: Se llevo a cabo una busqueda electronica

por Medline complementada con una busqueda

manual para identificar estudios cohorte prospecti-

vos y retrospectivos acerca de FPDs con un tiempo

de seguimiento medio de al menos 5 anos. Los

pacientes tenıan que haber sido examinados clınica-

mente en la visita de seguimiento. La valoracion de





los estudios encontrados y de la abstraccion de datos

se llevo a cabo independientemente por dos revi-

sores. Los ındices de fracaso y complicacion se

analizaron usando modelos de regresion de efectos

aleatorios de Poisson para obtener estimaciones de

los sumarios de las proporciones de supervivencia a

los 5 y 10 anos.

Resultados: Los resultados proporcionaron 3844 tı-

tulos y 560 resumenes. Se llevo a cabo analisis de

todo el texto para 176 artıculos resultando en 21estudios que coincidieron con los criterios de inclu-

sion. Un meta analisis de estos estudios indicaron

una supervivencia estimada de los implantes en

FPDs soportados por dientes e implantes combina-

dos del 95.4% (Intervalos de confianza del 95 por

ciento (95% DI): 93.9–96.5) tras 5 anos y 86.7%

(95% CI: 82.8–89.8%) tras 10 anos en funcion. Solo

el 61.3% (95% CI: 55.3–66.8%) de los pacientes

estuvieron libres de complicaciones tras 5 anos.

Periimplantitis y complicaciones de los tejidos blan-

dos ocurrieron en el 8.6% (95% CI 5.1–14.1%) de

los FPDs tras 5 anos Las complicaciones tecnicas

incluyeron fracturas de implantes, complicaciones

relacionadas con la conexion de la supraestructura.

La incidencia acumulada de fracturas de implantes alos 5 anos fue del 0.4% (95% CI: 0.1–1.2%). Tras 5

anos la incidencia acumulada de complicaciones

relacionadas con la conexion (aflojamiento o fractura

de tornillos) fue del 7.3% y del 14% para las

complicaciones relacionadas con las supraestruc-

turas (fracturas de las coronas o de las estructuras).

Conclusion: A pesar de una alta tasa de superviven-

cia de los FPDs, las complicaciones biologicas y

tecnicas son frecuentes. Esto, en cambio, significa

que se debe aceptar por parte de los clınicos que se

produciran una cantidades significativas de tiempo

de sillon tras la incorporacion de FPDs implantoso-

portados. Se necesitan mas estudios de seguimiento

de 10 o mas anos ya que solo unos pocos estudioshan descrito los resultados a largo plazo.

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5 years.

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5 years.

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5 years.

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5 years.

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617–620.


5 years.

Fugazzotto, P.A., Kirsch, A., Ackermann, K.L. &

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International Journal of Oral & Maxillofacial Im-

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Fugazzotto, P.A., Wheeler, S.L. & Lindsay, J.A.

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5 years.

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5 years.

Gomez-Roman, G., Kruppenbacher, M., Weber,

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5 years.

Goto, M., Jin-Nouchi, S., Ihara, K. & Katsuki, T.

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implants in patients with resected jaws. Interna-


225–230.


tions.

Gunne, J., Astrand, P., Borg, K. & Olsson, M. (1992)

Implants in partially edentulous patients. A long-

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5 years.

Gunne, J., Jemt, T. & Linden, B. (1994) Implant

treatment in partially edentulous patients: a report

on protheses after 3 years. International Journal of

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5 years.

Guttenberg, S.A. (1993) Longitudinal report on

hydroxyapatite-coated implants and advanced surgical

techniques in a private practice. Compendium of

Continuing Education Dentistry 15 (Suppl.): 549–553.


5 years.

Haas, R., Haimbock, W., Mailath, G. & Watzek, G.

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tissue: a retrospective study. The Journal of Pros-

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Haas, R., Mensdorff-Pouilly, N., Mailath, G. &

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followed for up to 100 months. International Jour-

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5 years.

Hahn, J. & Vassos, D.M. (1997) Long-term efficacy

of hydroxyapatite-coated cylindrical implants. Im-

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5 years.

Haraldson, T. & Zarb, G. (1988) A 10-year follow-

up study of the masticatory system after treatment

with osseointergrated implant bridges. Scandina-

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relation to experienced loss of periodontal bone

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Hellden, L., Ericson, G., Elliot, A., Fornell, J.,

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Heller, A.L. & Heller, R.L. (1996) Clinical evalua-

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5 years.

Henry, P.J., Tollman, D.E. & Bolender, C. (1993)

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treatment of partially edentulous patients: three-

year results of a prospective multicenter study.

Quintessence International 24: 123–129.


5 years.

Herrmann, I., Lekholm, U. & Holm, S. (2003)

Statistical outcome of random versus selected with-

drawal of dental implants. International Journal of


Exclusion criteria: multiple publications on the

same patient cohorts.

Herrmann, I., Lekholm, U., Holm, S. & Karlsson, S.

(1999) Impact of implant interdependency when

evaluating success rates: a statistical analysis

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5 years.

Hultin, M., Fischer, J., Gustafsson, A., Kallus, T. &

Klinge, B. (2000) Factors affecting late fixture loss

and marginal bone loss around teeth and dental

implants. Clinical Implant Dentistry and Related

Research 2: 203–208.


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5 years.

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5 years.

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5 years.

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5 years.

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5 years.

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5 years.

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5 years.

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van Steenberghe, D., Lekholm, U., Bolender, C.,

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5 years.

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5 years.

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a systematic review of the survival fdp_i_implant supported fdp

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