Comparison of survival and complication rates of tooth-supported fixed dental prostheses (FDPs) and implant-supported FDPs and single crowns (SCs).

OBJECTIVES The objective of this systematic review was to assess and compare the 5- and 10-year survival of different types of tooth-supported and implant-supported fixed dental prosthesis (FDPs) and single crowns (SCs) and to describe the incidence of biological and technical complications. METHODS Three electronic searches complemented by manual searching were conducted to identify prospective and retrospective cohort studies on FDPs and SCs with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Failure and complication rates were analyzed using random-effects Poisson's regression models to obtain summary estimates of 5- and 10-year survival proportions. RESULTS Meta-analysis of the included studies indicated an estimated 5-year survival of conventional tooth-supported FDPs of 93.8%, cantilever FDPs of 91.4%, solely implant-supported FDPs of 95.2%, combined tooth-implant-supported FDPs of 95.5% and implant-supported SCs of 94.5%. Moreover, after 10 years of function the estimated survival decreased to 89.2% for conventional FDPs, to 80.3% for cantilever FDPs, to 86.7% for implant-supported FDPs, to 77.8% for combined tooth-implant-supported FDPs and to 89.4% for implant-supported SCs. Despite high survival rates, 38.7% the patients with implant-supported FDPs had some complications after the 5-year observation period. This is compared with 15.7% for conventional FDPs and 20.6% for cantilever FDPs, respectively. For conventional tooth-supported FDPs, the most frequent complications were biological complications like caries and loss of pulp vitality. Compared with tooth-supported FDPs, the incidence of technical complications was significantly higher for the implant-supported reconstructions. The most frequent technical complications were fractures of the veneer material (ceramic fractures or chipping), abutment or screw loosening and loss of retention. CONCLUSION On the basis of the results of the present systematic review, planning of prosthetic rehabilitations should preferentially include conventional end abutment tooth-supported FDPs, solely implant-supported FDPs or implant-supported SCs. Only for reasons of anatomical structures or patient-centered preferences and as a second option should cantilever tooth-supported FDPs or FDPs supported by combination of implants and teeth be chosen.