ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Single Premolar-Sized Cantilevers on Implant Fixed Dental Prostheses Supported By Two or More Implants of Regular Diameter or Larger Create No Greater Risk of Implant Loss or Biologic/Technical Complication Than Implant Supported Fixed Dental Prostheses with Terminal Abutments
Clinical Question Is there a difference in implant and implant prostheses failure rates associated with short span cantilever implant supported fixed dental prostheses (ICFDP’s) compared to implant supported fixed dental prostheses (IFDP’s) with terminal abutments?
Clinical Bottom Line There is moderate evidence to show that ICFDP’s have similar implant and implant prosthesis failure rates compared to IFDP’s without cantilevers. This is supported by a meta-analysis of the literature and by several systematic reviews of a limited number of clinical trials. The 5 and 10-year survival rates for ICFDP’s suggest that short span cantilevers with 2 or more supporting implants are a viable treatment option. These conclusions should not be directly extrapolated to ICFDP’s supported by a single implant where the length of the cantilever arm may be a confounding variable.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 23062126Romeo/2012222 ICFDP's on 498 implantsSystematic review of non-randomized trials
Key resultsThis systematic review of the literature up to December 2011 incorporates the 5 studies reviewed by Aglietta in his 2009 meta-analysis and an additional prospective cohort study published later that same year. When the 75 ICFDP’s on 116 implants from that Romeo study were added to Aglietta original findings, the following adjusted conclusions were drawn: - The 5-year survival rate for implants supporting ICFDP’s was estimated to be 98.9%, comparing favorably to reported rates for implant supporting IFDP’s without cantilevers. - The 5-year ICFDP survival rate was estimated to be 97.1%, again comparing favorably to reported rates for IFDP’s without cantilevers. - The available evidence for a single premolar sized cantilever supported by two or more implants suggests there is no increase in biological or technical complication rates due to the presence of the cantilever. - There is limited evidence regarding the use of a cantilevered fixed dental prosthesis supported by a single implant.
#2) 23281736Kim/2014128 ICFDP's on 132 implants and 144 non-cantilevered IFDP's on 203 implants.Case control study
Key resultsThis recent retrospective cohort study provides some evidence base regarding cantilevered fixed dental prostheses supported by a single implant. Most of the 128 ICFDP’s in this study were supported by a single implant. - No significant difference between overall bone loss between ICFDP’s and non-cantilevered IFDP’s. - ICFDP implants did experience greater bone loss in the posterior mandible, however. - Implant survival and success rates for ICFDP’s were found to be 97% and 88%, respectively compared to 100% and 93% for IFDP’s. - The length of the cantilever arm was found to be positively correlated with implant failure, technical complications, and bone loss greater than 1.5 mm.
#3) 19522975Aglietta/2009155 ICFDP’s on 354 implantsMeta-Analysis
Key resultsFive studies met the inclusion criteria: 2 prospective cohort, 1 retrospective cohort, and 2 retrospective controlled studies. - 5-year survival rate for ICFDP’s was 94.3% compared to 98.5% for IFDP’s without a cantilever - 10 year survival of ICFDP’s was 88.9% compared to 97.1% for IFDP’s without a cantilever. - Most common reason for implant loss was implant fracture, as seen with 1 hollow and 2 small diameter implants. - Screw loosening and veneer fracture were the most common complications - No significant difference in bone loss around implants supporting cantilever and terminally bounded IFDP’s was found. Findings are consistent with Zurdo et al in a contemporary meta-analysis (2009).
Evidence Search Dental implant survival, cantilever, implant
Comments on
The Evidence
Validity: There is considerable heterogeneity in the evidence as a result of the variety in implant systems used in the cited studies, i.e., ITI, 3I, Astra, cemented and screw-retained, full arch fixed and partial fixed dental prostheses, short and longer span cantilever, anterior and posterior prostheses, etc. Perspective: The evidence appears sufficient to demonstrate the efficacy of ICFDP’s compared to IFDP’s with terminal implant abutments as long as they are limited in cantilever span and utilize 2 or more regular diameter or larger implants for support.
Applicability Evidence shows that a properly planned cantilevered implant fixed dental prosthesis can be a viable treatment option.
Specialty/Discipline (Endodontics) (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords Dental Implant, Failure, Fixed Dental Prosthesis, Cantilever, Complications
ID# 2952
Date of submission: 10/28/2015spacer
E-mail platts@uthscsa.edu
Author Shawn P. Platt, DMD
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Stephan J. Haney, DDS
Faculty mentor/Co-author e-mail haneys2@uthscsa.edu
Basic Science Rationale
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Comments on the CAT
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