A Systematic Review of Biologic and Technical Complications with Fixed Implant Rehabilitations for Edentulous Patients

Purpose: The purpose of this systematic review was to assess the incidence and types of biologic and technical complications associated with implant-supported fixed complete dental prostheses (IFCDPs) for edentulous patients. Materials and Methods: An electronic MEDLINE/PubMED search was conducted to identify randomized controlled clinical trials and prospective cohort studies with IFCDPs for edentulous patients. Reports with at least 5 years of follow-up after prosthesis insertion were selected. Pooled data were analyzed statistically, and the cumulative complication rates were calculated by meta-analysis and regression. Results: Of a total of 281 one-piece IFCDPs (mean exposure time of 9.5 years) and 653 complication events, the complication rate was estimated at 24.6% per 100 restoration-years. The cumulative rates of "prosthesis free of complications" after 5 and 10 years were 29.3% and 8.6%, respectively. The most common implantrelated biologic complication was peri-implant bone loss (> 2 mm), at rates of 20.1% after 5 years and 40.3% after 10 years. The most frequent implant-related technical complication was screw fracture, yielding a 5-year complication rate of 10.4% and a 10-year rate of 20.8%. The most frequent prosthesis-related biologic complication was hypertrophy or hyperplasia of tissue around the IFCDPs (13.0% and 26.0% after 5 and 10 years, respectively). The most common prosthesis-related technical complication reported with IFCDPs was chipping or fracture of the veneering material (33.3% at 5 years and 66.6% at 10 years). Conclusion: Biologic and technical complications after the placement of IFCDPs occur continuously over time as a result of fatigue and stress. These events may not lead to implant/prosthetic failures, but they are significant in relation to the amount of repair and maintenance needed, time, and cost to both the clinician and patient. Keywords: biologic complications, edentulism, implant-supported full-arch prosthesis, technical complications