| Title |
Full-Arch Implant-Supported Fixed Dental Prosthesis (Hybrid Prosthesis) are Linked to an Increased Risk of Peri-Implant Diseases |
| Clinical Question |
In fully edentulous patients, does treatment with full-arch implant-supported fixed dental prostheses (FP) (aka hybrid prostheses and All-on-4™) increase patient risk for developing peri-implant diseases compared to other full-arch restoration options? |
| Clinical Bottom Line |
Full-arch implant-supported fixed dental prostheses provide higher patient satisfaction and function than do other full arch options. However, FP can lead to increased plaque accumulation, which could, in susceptible patients, lead to peri-implantitis. Treatment planning should include the following: spread implants apart as much as possible, limit extensions of the prosthesis in order to improve hygiene access, and establish a life-long recall maintenance regimen focused on patient-specific mechanical and biological care. |
| Best Evidence |
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| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| 26711217 | Bidra/2016 | 20 studies/1088 patients assessing various implant supported restorations; 3 studies/147 patients looking specifically at full arch fixed prostheses | Systematic review of non-randomized trials | | Key results | Maintenance visits have been found to exhibit Peri-implantitis at a rate more than twice that of patients who do attend regular maintenance appointments.
Home care recommendations:
- Manual = electric toothbrush
- Most effective dentifrice contained 0.3% Triclosan
- Chlorhexidine (in-office and at home) is beneficial in peri-implant mucositis patients (0.2% rinse vs 1% gel results equivocal)
- Water “flossing” oral hygiene aids reduce bleeding on probing compared to stringed floss
| | 24461161 | Abi Nader/2015 | 1 study/20 patients, 20 maxillary prostheses | Case series | | Key results | 6-month recall and staining of the fitting (intaglio) surface of the prostheses revealed an average of 28.3 ±8.4% of each prostheses was covered in plaque. Regarding the location of the plaque: 1) palatal surfaces had 3x more than buccal, 2) posterior ≈ anterior, and 3) anterior inter-implant ≈ posterior inter-implant. A statistically significant correlation exists between inter-implant distance and plaque accumulation: the closer the distance the higher the accumulation. High plaque levels predispose patients to peri-implant mucositis, which in susceptible patients could progress into peri-implantitis. Optimum hygiene is key in reducing risk of peri-implant disease. Recommendations: increase inter-implant distance (3mm min) and minimize palatal extension of prosthesis. | |
| Evidence Search |
Pubmed.gov Clinical Trials search: (Therapy/Broad[filter]) AND (implant-supported fixed dental prosthesis AND oral hygiene)
Pubmed.gov search: implant-supported fixed dental prosthesis AND oral hygiene
|
Comments on
The Evidence |
Validity: Research methods from the review and the study are clearly presented, sound, and repeatable. Perspective: The current literature is high quality, but gaps still exist in regard to idealized prosthesis design, maintenance regimens, and adaptable oral hygiene aids. As this treatment modality continues to gain popularity, additional research should seek to address these areas. |
| Applicability |
The clinical use of full arch implant-supported fixed dental prostheses is rapidly increasing. To ensure predictable outcomes and long-term success, current literature stresses that clinicians placing these restorations create cleansable prostheses of ideal material and dictate maintenance regimens paired with meticulous at-home oral hygiene. |
| Specialty |
(Periodontics) (Prosthodontics) (Restorative Dentistry) |
| Keywords |
Hybrid Prosthesis, Implant-Supported Fixed Dental Prosthesis, All-on-4™, Oral hygiene, Peri-Implant Diseases, Prognosis, Peri-Implantitis, Peri-Implant Mucositis
|
| ID# |
3300 |
| Date of submission |
11/28/2017 |
| E-mail |
vess@livemail.uthscsa.edu |
| Author |
Joshua A Vess, DMD, MPH, MS, ABGD |
| Co-author(s) |
Joshua M Nardone, DDS |
| Co-author(s) e-mail |
Nardone@livemail.uthscsa.edu |
| Faculty mentor |
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| Faculty mentor e-mail |
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Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
| None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
| None available | |