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Title A Fixed Dental Prosthesis Supported by a Combination of Implant and Natural Tooth Abutments May Have a Lower Success Rate Than That of a Fixed Dental Prostheses Supported By Only Implants, But It May Be Used as a Secondary Option
Clinical Question What are the successes and survival rates of fixed dental prostheses supported by a combination of implants and natural teeth as compared to a fixed dental prostheses supported by implant abutments?
Clinical Bottom Line Fixed dental prostheses (FDPs) supported by implant and natural tooth abutments have a lower success rate than fixed dental prostheses with only implant abutments, but a combination of implant/natural abutments may be used when considerations indicate it is appropriate.
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) 26435609Muddugangadhar/201514 studies/294 natural tooth and implant-supported FDPs; 26 studies/2340 implant-supported FDPsMeta-Analysis
Key resultsThe meta-analysis was performed on retrospective or prospective cohort studies on survival rates of FDPs supported by implant abutments only, as well as FDPs using combined implant and tooth abutments. Studies were required to have a minimum follow up of 5 years for inclusion in the meta-analysis. For FDPs supported only by implants, the survival rate was 94.525%. For FDPs supported by a combination of natural teeth and implants, the survival rate was 91.27%.
#2) 15533124Pjetursson/200421 studies/1,336 implant-supported FDPsMeta-Analysis
Key resultsThe meta-analysis analyzed 16 prospective studies and 5 retrospective studies on the survival and success rates of implant-supported FDPs. Survival was defined as the FDP remaining in situ despite any complications the patient may have had. The estimated survival rate of FDPs at 5 years was 95% (95% CI: 92.2, 96.8) and 92.8% (95% CI: 90, 94.8) at 10 years follow-up. If success of an FDP is defined as survival with no complications for the patient, the success rate was estimated to be 61.3% (95% CI: 55.3-66.8).
#3) 15533125Lang/200413 studies/538 natural tooth and implant-supported FDPsMeta-Analysis
Key resultsThis meta-analysis was performed by the same team as Pjetursson/2004. The meta-analysis analyzed 9 prospective and 4 retrospective studies on the survival and success rates of FDPs supported by natural teeth and implants. The studies had to have a minimum follow-up of 5 years. Survival was defined as the FDP remaining in situ despite any complications the patient may have had. The estimated survival rate was 94.1% (95% CI: 90.2,96.5) at 5 years and 77.8% (95% CI: 66.4, 85.7) at 10 years.
Evidence Search ("meta-analysis"[Publication Type] OR "meta-analysis as topic"[MeSH Terms] OR "meta-analysis"[All Fields]) AND implant[All Fields] AND ("tooth"[MeSH Terms] OR "tooth"[All Fields]) AND supported[All Fields] AND ("prostheses and implants"[MeSH Terms] OR ("prostheses"[All Fields] AND "implants"[All Fields]) OR "prostheses and implants"[All Fields] OR "prostheses"[All Fields])
Comments on
The Evidence
Validity: All three reviews are meta-analyses on cohort studies only. No randomized control trials were included. While all three authors listed their criteria for inclusion and exclusion of studies in the meta-analysis, none mentioned that they assessed the individual studies for quality (i.e., how well each included study was conducted). It is also important to note that all three reviews only required a 5-year follow-up for inclusion, so the numbers could be skewed from prostheses that survive short term, but may fail long term. Perspective: There are many factors that could be analyzed regarding the survival of a fixed dental prosthesis such as connection type, the number of units in the prosthesis, and the biological status of the patient. Many of the studies included in the reviews did not take these factors into consideration, although they could have significant effect on the success of the prosthesis. This could warrant further research and consideration when deciding what type of prosthesis to use, as an FDP that uses natural teeth and implant abutments could be a great option for the patient if correct techniques and processes are used.
Applicability The specifics of the patients included in the studies were not noted, other than the broad age range being analyzed in each review. The evidence does not apply to a specific patient, so individual factors must be taken into consideration when treatment planning. If an FDP with natural tooth and implant abutments is selected for treatment, the patient should have their expectations managed by informing them of the lower survival rate for this type of prosthesis.
Specialty/Discipline (Periodontics) (Prosthodontics)
Keywords Tooth-/implant-supported prosthesis, bridge, fixed dental prosthesis, survival
ID# 3162
Date of submission: 03/20/2017spacer
E-mail malonejr@livemail.uthscsa.edu
Author Jake Malone
Co-author(s) e-mail
Faculty mentor/Co-author Richard S. Finlayson, DDS
Faculty mentor/Co-author e-mail finlaysonr@uthscsa.edu
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