A rationale for retrievability of fixed, implant-supported prostheses: a complication-based analysis.

PURPOSE This article presents a rationale for retrievability of fixed, implant-supported prostheses based on the incidence and variety of biologic and technical complications. The etiologies of these complications are also discussed, emphasizing the unpredictability of implant-based prostheses in the oral environment. MATERIALS AND METHODS Electronic searches of the MEDLINE (Ovid) database were initially conducted to find articles in English relating to the incidences and/or etiologies of dental implant complications up to May 2006. These articles were then manually searched and potential papers investigated. Electronic and manual searches of 11 peer-reviewed dental journals completed the research strategy, with a hierarchy of evidence-based information established to support this complication-based analysis. RESULTS Biologic and technical complications appear to be common in all forms of fixed implant-supported dentistry. These complications often jeopardize the functional and/or esthetic features of a given prosthesis, and they occur despite sound prosthetic design and high levels of clinical expertise. Observational studies and systematic reviews dominate this area of the dental literature, leaving the clinician to individually assess the merits of prosthetic retrievability based only on the likelihood of complications and the costs of replacing a permanently cemented prosthesis. These assessments challenge the philosophy of permanent cementation, but there is a need for better, evidence-based information to properly evaluate the costs of prosthetic retrievability against the obvious clinical benefits. CONCLUSION The practice of permanently cementing implant-based prostheses may conflict with the likelihood of biologic and technical failure. The retrievability of fixed, implant-supported prostheses is therefore an important consideration in delivering quality, patient-based treatment outcomes.