Axel Zöllner Factors influencing survival of

Urs Belser
On behalf of Working
reconstructions
Group 2n Consensus report of Working Group 2

Key words: fixed dental prosthesis, fixed partial denture, implants, natural abutment
teeth, single crowns, survival
Authors’ affiliations:
Axel Zoellner, Department of Prosthodontics,
Abstract: In order to evaluate the level of evidence of factors influencing the survival of
University of Witten/Herdecke, Witten, Germany
Urs C. Belser, Department of Prosthodontics, reconstructions, systematic reviews of the relevant literature were prepared by a group of
University of Geneva, Geneva, Switzerland rapporteurs. The review papers were circulated to the members of the group before the
Correspondence to: conference and formed the basis for group and panel discussions. Subsequently,
Prof. Dr Axel Zöllner modifications were added to the review papers, and suggestions for consensus statements
Department of Prosthodontics
University of Witten/Herdecke
concerning the following topics were prepared and again critically reviewed in the group
Alfred-Herrhausen-Strabe 50 and in the plenum: Impact of (i) periodontal disease on the survival of tooth-supported
58448 Witten reconstructions, (ii) post-surgical factors as supportive therapy on the survival of implant
Germany
Tel.: þ 49 2302 926668 supported reconstructions, (iii) technical and/or biological complications on the survival of
Fax: þ 49 –2302 926661 different types of reconstructions, (iiii) material choice for reconstructions on the survival of
e-mail: axel.zoellner@uni-wh.de
single crowns and fixed dental prostheses.

The working group was asked to evaluate Survival of abutment–reconstruction

n
U. Belser, M. Hultin, M. Lulic, B. E. Pjetursson, G. E.
Salvi, A. Zoellner.
To cite this article:
Zöllner A, Belser U. Factors influencing survival of
reconstructions. Consensus report of Working Group 2.
Clin. Oral Impl. Res. 18 (Suppl. 3), 2007; 114–116
doi: 10.1111/j.1600-0501.2007.01440.x
the available evidence regarding the long-
evity (survival/success/failure/complica-
tion) of different treatment strategies for
the reconstruction of the partially edentu-
lous dentition.
The reviews focussed on the following
main subtopics:
1. Impact of periodontal disease on the
survival of tooth supported reconstruc-
tions,
2. Impact of post-surgical factors as sup-
portive therapy on the survival of im-
plant supported reconstructions,
3. Impact of technical and/or biological
complications on the survival of differ-
ent types of reconstructions,
4. Impact of material choice for recon-
structions on the survival of single
crowns (SC) and fixed dental pros-
theses (FDP).
As there is no generally accepted defini-
tion for success and survival for reconstruc-
tions, the group suggests the following
definitions:
Success of abutment–reconstruction
complex (‘reconstruction’).
Survival without any biological and/or
technical complication.
complex (‘reconstruction’).
On abutment level: Abutment is still in
situ.
On reconstruction level: reconstruction
remaining in situ with or without mod-
ification.
Alternatively: reconstruction remaining
in situ in its original extension with or
without modification.
In addition factors regarded as biological
or technical failures were listed but not
further defined:
Biological complications of abutment-
reconstruction complex (‘reconstruc-
tion’).
Natural abutment tooth: caries, loss of
sensitivity, apical periodontitis, perio-
dontitis.
Implant: peri-implant diseases, implant
mobility, loss of sensitivity of adjacent
tooth.
Technical complications of abutment–
reconstruction complex (‘reconstruc-
tion’).
Tooth supported reconstruction: loss of
retention, fracture of abutment, fracture
of framework, fracture of veneering
material.

114 c 2007 The Authors. Journal compilation

c 2007 Blackwell Munksgaard

Implant supported reconstruction: Loss
of retention/screw loosening/abutment
loosening, loss of access hole restora-
tion, fracture of implant, fracture of
abutment/screws, fracture of frame-
work, fracture of veneering material.
Impact of periodontal disease on
the survival of tooth supported
reconstructions (Lulic, Brägger,
Lang, Zwahlen, Salvi)
In subjects suffering from generalized se-
vere periodontitis, only a few teeth may be
treated and used as abutments for FDPs.
The objectives were to systematically re-
view the impact of severely reduced but
healthy periodontal tissue support on the
survival rate and complications of FDPs
after a mean follow-up time of at least 5
years. Prospective and retrospective cohort
studies were included. The primary out-
come measure included survival rates of
FDPs, whereas biological and technical
complications represented secondary out-
come measures. Survival was defined as
reconstruction remaining in situ in its
original extension with or without modifi-
cation.
Referring to the focussed question from
the outcomes of this systematic review
(Lulic et al. 2007), it was concluded that:
 The masticatory function can be estab-
lished and maintained in subjects re-
ceiving FDPs on abutment teeth with
severely reduced but healthy perio-
dontal tissue support.
 FDP survival rates (92.9% after 10
years) were similar to those of FDPs
incorporated in subjects without se-
verely periodontally compromised den-
tition.
 It has to be kept in mind, however, that
generalization of these outcomes is
limited, as all treatments were provided
in two specialist centres.
Further research should be directed to-
wards the following:
 Expand the generalization of the re-
ported outcomes.
 Determine and compare the cost-effec-
tiveness of this therapeutic modality
with implant supported reconstruc-
tions.
 Assess patient-centred outcomes.
c 2007 The Authors. Journal compilation


c 2007 Blackwell Munksgaard
Zöllner & Belser . Factors influencing survival of reconstructions
Impact of post-surgical factors
as supportive therapy on the
survival of implant supported
reconstructions (Hultin,
Komiyama, Klinge)
The objective was to systematically review
if supportive implant treatment during a
follow-up of at least 10 years after func-
tional loading is effective in prevention of
biological tissue complications and fixture
loss. A total of 749 fixtures were included
and followed for more than 10 years of
functional load. Five of the included stu-
dies gave no detailed information of the
assessments or the treatment at follow-up
visits during the 10 years. Only in two of
the included studies were patients enrolled
in an individualized supportive program on
3–6 months recall interval. None of the
included studies comprised untreated con-
trols, i.e. also including patients who re-
ceived little or no supportive treatment
during follow-up. Referring to the focussed
question from the outcomes of this sys-
tematic review (Hultin et al. 2007), it was
concluded that:
 Despite the fact that the effectiveness
of supportive therapy is well estab-
lished for the long term survival (>10
years) of teeth, this is to date less well
documented for the survival of oral
implants.
Further research should be directed to-
wards the following:
 Define clinical parameters for implant
supportive treatment strategies.
 Include clinical parameters for implant
supportive treatment strategies into
long-term clinical studies.
 Assess the long-term effectiveness of
specific implant supportive treatment
protocols.
 Introduce risk assessment based recom-
mendations for recall intervals.
Impact of technical and/or
biological complications on the
survival of different types of
reconstructions (Pjetursson,
Brägger, Lang, Zwahlen)
The objective of this paper was to analyse
the survival and success rates by different
115 |
types of tooth and implant supported fixed
reconstructions and to evaluate the inci-
dence of complications. Survival was de-
fined as reconstruction remaining in situ
with or without modification. The review
focussed on tooth and/or implant sup-
ported FDPs and on implant supported
single crowns. Resin bonded FDPs were
not included. Referring to the focussed
question ‘What is the impact of biological
and/or technical complications on the
survival of a reconstruction?’ from the
outcomes of this systematic review (Pje-
tursson et al. 2007a), it was concluded that:
 The estimated 10-year overall survival
rates of the following three treatment
modalities for the replacement of miss-
ing teeth were similar: Tooth supported
conventional FDPs (89.2%), implant
supported FDPs (86.7%), implant sup-
ported SC (89.4%).
 The estimated 10-year overall survival
rates of the following two treatment
modalities for the replacement of miss-
ing teeth were lower when compared
with the previous ones: Tooth sup-
ported cantilever FPDs (80.3%),
tooth–implant supported FPDs
(77.8%).
Further research should be directed to-
wards the following:
 Data with long-term observation period
(410 years) is lacking for metal–cera-
mic reconstructions.
 Studies should distinguish between dif-
ferent types of reconstructions report-
ing on survival.
 Detailed information on complications
should always be reported.
Impact of material choice for
reconstructions on the survival
of SC and FDPs (Pjetursson,
Sailer, Zwahlen, Hämmerle)
The objective of this systematic review was
to assess the 5-year survival of all-ceramic
SCs and all-ceramic FDPs compare it with
survival rates of metal–ceramic reconstruc-
tions. Survival was defined as reconstruc-
tion remaining in situ with or without
modification. The search provided 3473
titles and 177 abstracts. Full-text analysis
was performed for 86 articles resulting in
Clin. Oral Impl. Res. 18 (Suppl. 3), 2007 / 114–116
Zöllner & Belser . Factors influencing survival of reconstructions
34 studies that met the inclusion criteria.
Referring to the focussed question from the
outcomes of this systematic review (Pje-
tursson et al. 2007b; Sailer et al. 2007), it
can be concluded that:
 The estimated 5-year survival rates for
of the following four treatment modal-
ities for SC were similar: metal–ceramic
SC (95.6%), densely sintered alumina
References
Hultin, M., Komiyama, A. & Klinge, B. (2007)
Supportive therapy and the longevity of dental im-
plants: a systematic review of the literature. Clinical
Oral Implants Research 18 (Suppl. 3): 50–62.
Lulic, M., Brägger, U., Lang, N.P., Zwahlen, M. &
Salvi, G.E. (2007) Ante’s (1926) law revisited–a
systematic review on survival rates and complica-
tions of fixed dental prostheses (FDPs) on severely
reduced periodontal tissue support. Clinical Oral
Implants Research 18 (Suppl. 3): 63–72.
116 | Clin. Oral Impl. Res. 18 (Suppl. 3), 2007 / 114–116
SC (96.4%), reinforced glass-ceramic
SC (95.4%) and InCeram SC (94.5%).
 The estimated 5-year survival rates
of metal-ceramic FDPs (94.4%) were
higher compared with estimated survi-
val rates of all-ceramic FDPs (88.6%).
Further research should be directed
towards the following:
Pjetursson, B.E., Brägger, U., Lang, N.P. & Zwah-
len, M. (2007a) Comparison of survival and com-
plication rates of tooth-supported fixed dental
prostheses (FDPs) and implant-supported FDPs
and single crowns (SCs). Clinical Oral Implants
Research 18 (Suppl. 3): 97–113.
Pjetursson, B.E., Sailer, I., Zwahlen, M. & Häm-
merle, C.H.F. (2007b) A systematic review of the
survival and complication rates of all-ceramic and
metal–ceramic reconstructions after an observa-
c 2007 The Authors. Journal compilation


c 2007 Blackwell Munksgaard
 Data with long-term observation period
(45 years) is lacking for all-ceramic
reconstructions.
 Studies should distinguish between dif-
ferent types of reconstructions report-
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 Studies should distinguish between dif-
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 Report of detailed information on com-
plications.
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crowns. Clinical Oral Implants Research 18
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Sailer, I., Pjetursson, B.E., Zwahlen, M. & Häm-
merle, C.H.F. (2007) A systematic review of
survival and complication rates of all-ceramic
and metal–ceramic reconstructions after an obser-
vation period of at least 3 years. Part II: fixed
dental protheses. Clinical Oral Implants Re-
search 18 (Suppl. 3): 86–96.