CLINICAL RESEARCH

Implant survival and biologic complications of implant fixed

complete dental prostheses: An up to 5-year retrospective
study
Konstantinos Chochlidakis, DDS, MS,a Carlo Ercoli, DDS, MBA,b Erna Einarsdottir, DDS, MS,c
Davide Romeo, DDS, PhD,d Panos Papaspyridakos, DDS, MS, PhD,e Abdul Basir Barmak, MD, MSc, EdD,f and
Alexandra Tsigarida, DDS, MSg

Implant-supported fixed pros- ABSTRACT

theses have been a successful
treatment for completely
edentulous patients1-3 and
have been used in conjunction
with delayed or immediate
loading protocols.4,5 Longitu-
dinal studies and systematic
reviews have reported high
implant survival rates for
IFCDPs.5,6 Predictably, though,
with the increased adoption of
these prostheses by dentists
and their use in a variety of
clinical situations, complica-
tions have also arisen.5,6 While
complications can be broadly
divided into mechanical and
biologic,3,6-10 the available evi-
dence on the associations be-
tween prosthesis-related
factors and biologic complica-
tions is somewhat
scarce.2,5-7,11-17
According to the consensus
report of the 2017 World
Workshop on the classification
Statement of problem. Limited information is available on the association between prosthesis-
associated risk factors and biologic complications for patients with implant fixed complete dental
prostheses (IFCDPs).
Purpose. The purpose of this retrospective study was to assess the implant survival and biologic
complications of IFCDPs up to 5 years of follow-up.
Material and methods. Patients who had received IFCDPs between August 1, 2009 and August 1,
2014 were identified through an electronic health record review. Those who consented to
participate in the study attended a single-visit study appointment. Clinical and radiographic
examinations, intraoral photographs, and peri-implant hard and soft tissues parameters were
assessed. Only prostheses which could be removed during the study visit were included.
Associations between biologic complications and prosthetic factors, such as time with prosthesis
in place, prosthesis material, number of implants, cantilever length, and type of prosthesis
retention, were assessed.
Results. A total of 37 participants (mean ±standard deviation age 62.35 ±10.39 years) with 43
IFCDPs were included. None of the implants had failed, leading to an implant survival of 100%
at 5.1 ±2.21 years. Ten of the prostheses were metal-ceramic (Group MC) and 33 were metal-
acrylic resin (Group MR). Minor complications were more frequent than major ones. Considering
minor complications, peri-implant mucositis was found in 53% of the implant sites, more often
in the maxilla (P=.001). The most common major biologic complication was peri-implantitis,
which affected 4.0% of the implants, more often in the mandible (P=.025). Peri-implant soft
tissue hypertrophy was present 2.79 times more often (95% CI: 1.35 e 5.76, P<.003) around
implants supporting metal-acrylic resin prostheses than metal-ceramic ones, with the former
type also showing significantly more plaque accumulation (P<.003).
Conclusions. Biologic complications such as soft tissue hypertrophy and plaque accumulation were
more often associated with metal-acrylic resin prostheses. Peri-implant mucositis occurred more
often under maxillary IFCDPs, while peri-implantitis appeared more common around mandibular
implants. (J Prosthet Dent 2021;-:---)

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
a
Associate Professor, Program Director, Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY.
b
Professor, Prosthodontics and Periodontics, Chair, Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY.
c
Assistant Professor, University of Iceland, Reykjavik, Iceland.
d
Resident, Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY; and Adjunct Assistant Professor, Advanced Oral Surgery
Unit, Vita Salute University, San Raffaele Hospital, Milan, Italy.
e
Associate Professor, Department of Prosthodontics, Tufts School of Dental Medicine, Boston, Mass; and Visiting Associate Professor, Eastman Institute for Oral Health,
University of Rochester, Rochester, NY.
f
Assistant Professor, Eastman Institute for Oral Health, University of Rochester, Rochester, NY.
g
Associate Professor, Program Director, Department of Periodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY.

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Table 1. Inclusion and exclusion criteria

Clinical Implications Inclusion Criteria
Patients treated at the Eastman
Even though high implant survival rates have been Institute for Oral Health
reported with IFCDPs, biologic complications are Age 18 years at the day of
implant placement
unfortunately quite frequent. Clinicians and patients
Dental implants with rough
should be aware of the increased prevalence of surface
maxillary arch peri-implant mucositis, soft tissue Completely edentulous patients
hypertrophy, and plaque accumulation under with IFCDPs in at least one jaw
metal-acrylic resin prostheses and design the Definitive prosthesis under
functional loading for at least
intaglio surface to allow adequate access for plaque 1 year
removal measures, especially for metal-acrylic resin
IFCDPs.
Exclusion Criteria
Patients treated at different dental
practice locations
Age < 18 years old at the day of
implant placement
Smooth (machined) surface dental
implants
Completely dentate or partially
edentulous patients
Definitive prosthesis under functional
loading for less than 1 year

hypothesis was that biologic complications would not be

of periodontal and peri-implant diseases and conditions,
healthy peri-implant tissues are characterized by the
absence of erythema, bleeding on probing, swelling, and
suppuration.18 Peri-implant mucositis is then considered
present when peri-implant soft tissues bleed on gentle
probing while erythema, swelling, and/or suppuration
may also be present.18 Peri-implantitis is instead defined
as the presence of bleeding and/or suppuration on gentle
probing, probing depths of 6 mm, and bone levels 3
mm apical to the most coronal portion of the intra-
osseous part of the implant.18
A 4-year retrospective study on 378 implants sup-
porting 72 IFCDPs reported a prevalence of 56.9% for
peri-implant mucositis and 14.3% for peri-implantitis.19
In another study, biologic complications affecting the
implants were, in decreasing order of prevalence, soft
tissue recession (7.7% annual rate), inflammation (7.4%
annual rate), peri-implant mucositis (6.3% annual rate),
and peri-implantitis (2.0% annual rate).20
Since peri-implant mucositis and peri-implantitis are
defined as biofilm-mediated diseases,18 it is important to
provide the patient with adequate access for plaque
removal. Therefore, prosthetic-related factors such as
cantilever length, type of prosthesis material, prosthesis
dimensions, and design of the intaglio surface may affect
plaque accumulation and the ability of the patient to
carry out plaque removal and may indirectly influence the
prevalence of biologic complications around implants
supporting IFCDPs.20-27 In addition, from a diagnostic
standpoint, the identification of peri-implant mucositis
and peri-implantitis requires unimpeded access to the
implant site, especially for peri-implant probing; often,
this may not be achievable, especially for bulky pros-
theses, unless the prosthesis is removed.
The primary aim of this retrospective study was to
assess implant survival and the prevalence of biologic
complications for participants treated with IFCDPs after
an up to 5-year observation period. The secondary aim of
this study was to identify prosthesis-related factors
associated with biologic complications. The null
associated with the selected prosthetic risk factors.
MATERIAL AND METHODS
The protocol for patients receiving treatment at the
Eastman Institute for Oral Health (EIOH), University of
Rochester, has included motivation and instruction on
the importance of self-performed plaque removal from
their initial visit, throughout their treatment, and at the
time of prosthesis delivery. They are encouraged to enroll
in an annual maintenance program, where the IFCDP is
removed and ultrasonically cleaned and stains removed,
after which a dental hygienist removes plaque and cal-
culus from the implants and/or the abutments. Oral
hygiene motivation is reinforced at these periodic
maintenance appointments.
The University of Rochester Research Subject Review
Board (RSRB) committee approved the protocol for this
retrospective study (RSRB #58008). The electronic health
records (EHR) of all patients who had received an IFCDP
between August 1, 2009 and August 1, 2014 at EIOH
were reviewed according to the inclusion and exclusion
criteria (Table 1). Patients were informed about the ob-
jectives of the study, and those who agreed to participate
signed a written informed consent form in accordance
with the Declaration of Helsinki.
The study participants attended a single research visit
appointment in which a comprehensive examination of
the soft and hard tissue was completed by 2 calibrated
examiners (E.E., K.C.). The examination consisted of
dental and medical history review, intraoral photographs,
and radiographic and clinical examination. During this
visit, information was recorded for both prosthetic and
biologic complications. The prosthetic findings have been
previously reported.21
Peri-implant parameters were assessed by 2 calibrated
clinicians (A.T., E.E.). These consisted of the presence or
absence of peri-implant suppuration and/or fistula;
modified plaque index (mPLI) and modified sulcus
bleeding index (mSBI) at 6 peri-implant sites (dis-
tobuccal, buccal, mesiobuccal, distolingual, lingual, and

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- 2021
Table 2. Prosthesis-related factors
Prosthesis Related Factors
Factor Type
IFCDP material Metal-resin/metal-ceramic
IFCDP retention Screw-retained/cement-retained
IFCDP location Maxilla/mandible
Cantilever extension Yes/no, left/right
Time with IFCDP in place Months
Presence of bruxism Yes/no
Nightguard use Yes/no
Implant connection Internal/external
Implant location Anterior/posterior
mesiolingual); and the probing depths (PDs) (Probe UNC
15; Hu Friedy) recorded to the nearest millimeter at the
same 6 sites around the implant.27,28 In order to perform
accurate measurements of the peri-implant parameters,
especially PDs, only IFCDPs which could be removed
were included in the analysis.
The radiographic examination included periapical ra-
diographs of each implant and the assessment of the
proximal crestal bone levels. Crestal bone levels were
compared with the radiographs made at the delivery
appointment of the definitive prosthesis. The use of a
standardized radiographic device was not possible
because of the retrospective nature of the study. A
diagnosis of peri-implantitis was made when the clinical
and radiographic examination showed hard and soft
tissue findings that were consistent with current diag-
nostic criteria.18
Biologic complications were divided into minor and
major.20 Minor complications included inflammation
under the prosthesis, peri-implant mucositis, and hy-
pertrophy or hyperplasia of the soft tissue, while peri-
implantitis and implant failures were considered major
complications.20
Descriptive statistics (counts and percentages) were
used to report the biologic complication rates. The
Poisson regression analysis was used to evaluate the ef-
fect of selected prosthesis-related factors (Table 2) on the
number of minor and major biologic complications. All
computations were carried out with a statistical software
program (IBM SPSS Statistics, v25; IBM Corp) (a=.05).
RESULTS
A total of 37 individuals (mean ±standard deviation age
62.35 ±10.39 years) agreed to participate. Twenty-four
women (mean ±standard deviation age 64.54 ±8.57
years) and 13 men (mean ±standard deviation age 58.3
±12.47 years) received a total of 271 moderately rough-
surface dental implants and 48 prostheses (24 maxillary
and 24 mandibular).21 Of the 48 prostheses, only 43
could be removed during the research visit, enabling
direct measurements for the peri-implant parameter.
Chochlidakis et al
3
Table 3. Descriptive overview of participants, location, and material of
IFCDPs
Characteristics Number
Participants 37
Female/male 24/13
Maxilla/mandible 23/20
Metal-resin/metal-ceramic 33/10
Screw-retained (SR)/cement-retained (CR) 37/6
Implant level/abutment level 12/31
Number of implants 244
Implants axial/implants distally tilted 231/13
Implants SR IFCDPs/implants CR IFCDP 207/37
Immediately loaded implants/conventionally loaded implants 72/172
Anterior implants/posterior implants 120/124
Mean time with implants in place 5.1 years
Mean time with prostheses in place 3.7 years
These were assessed in the present study, providing data
for 244 implant sites. Descriptive statistics are reported in
Table 3.
The total number of biologic complications was 324
(311 minor and 13 major) and, at the prosthesis level, all
had complications. At the implant level, however, 58 of
244 implants were free of complications (Table 4).
Descriptive statistics for minor complications are pre-
sented in Table 5. Only 13 of 43 IFCDPs (30.2%) were
free of soft tissue inflammation. The most common mi-
nor complication was peri-implant mucositis, observed in
172 of 244 implants (70.5%), followed by peri-implant
hypertrophy in 109 of 244 implants (44.7%).
Of the selected participant- and prosthesis-related
factors, only jaw location was a significant predictor for
the counts of peri-implant mucositis (Beta=0.560, stan-
dard error [SE] =0.163, P=.001). The rate ratio for peri-
implant mucositis sites for the maxilla was 1.75 (95%
confidence interval [CI]: 1.27e2.14) times as compared
with the mandible (114 maxillary versus 58 mandibular
implants). In addition, material type and time from implant
in place were found to be significant predictors for the
counts of peri-implant hypertrophy (Beta=1.028,
SE =0.370, P=.006). The rate ratio of implant for peri-
implant hypertrophy in MR IFCDPs was 2.79 (95% CI:
1.35 e 5.76) times as compared with MC IFCDPs (Table 6).
Descriptive statistics for major complications are pre-
sented in Table 5. None of the 244 implants were lost
during the observation period, leading to 100% implant
survival rate at 5.1 ±2.21 years. However, 13 major com-
plications were recorded. All these were peri-implantitis
events and were observed in 5 anterior and 8 posterior
implants in 6 IFCDPs. Jaw location was found to be the
only significant predictor for the counts of peri-implantitis
(Beta=-1.75, SE =0.785, P=.025) as the rate ratio for peri-
implantitis sites for mandibular implants was 5.79 (95%
CI: 1.24 e 27.02) times compared with that of maxillary
implants (2 maxillary versus 11 mandibular implants).
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Table 4. Summary of minor, major, and total complications

No. of Prostheses No. of Prostheses Total No. of Complications Mean No. of Complications Mean No. of Complications
Complications with Complications Free of Complications (% of Total) per Affected Prostheses per Total Prostheses
Minor complications 43 0 311 (95.99) 7.23 (311/43) 7.23 (311/43)
Major complications 6 37 13 (4.01) 2.17 (13/6) 0.30 (13/43)

Table 5. Details of minor and major biological complications

Complication Total No. of Prostheses, Implants No. of Prostheses with Complications No. of Complications Complication (%)
Minor complications 43 prostheses 43 311 96.0
Peri-implant mucositis 244 implants 40 172 53.1
Hypertrophy/hyperplasia of soft tissue 244 implants 26 109 33.6
Inflammation under the prosthesis 43 prostheses 30 30 9.3
Major complications 43 prostheses 6 13 4.0
Peri-implantitis 244 implants 6 13 4.0
Implant failure 244 implants 0 0 0
Total 43 prostheses 43 324 100

Table 6. Overview of biological complications; comparison between groups

Group Metal-Resin (MR)
Complication Total No of Prostheses, Implants No. of Prostheses with Complications No. of Complications Complication (%)
Minor complications 33 prostheses 33 254 95.5
Peri-implant mucositis 182 implants 33 135 50.7
Hypertrophy/hyperplasia of soft tissue 182 implants 23 96 36.1
Inflammation under the prosthesis 33 prostheses 23 23 8.6
Major complications 33 prostheses 5 12 4.5
Peri-implantitis 182 implants 5 12 4.5
Implant failure 182 implants 0 0 0
TOTAL 33 prostheses 33 266 100

Group Metal-Ceramic (MC)

Complication Total No of Prostheses, Implants No. of prostheses with complications No. of complications Complication (%)
Minor complications 10 prostheses 10 57 98.3
Peri-implant mucositis 62 implants 10 37 63.8
Hypertrophy/hyperplasia of soft tissue 62 implants 3 13 22.4
Inflammation under the prosthesis 10 prostheses 7 7 12.1
Major complications 10 prostheses 1 1 1.7
Peri-implantitis 62 implants 1 1 1.7
Implant failure 62 implants 0 0 0
Total 10 prostheses 10 58 100

Descriptive statistics for peri-implant parameters are
presented in Table 7. No statistically significant associa-
tion between any of the 3 peri-implant indices (PD, BoP,
and mPLI) except for mPLI, which was associated with
MR ISFCDs (P<.003). MR IFCDPs showed significantly
more plaque accumulation than MC IFCDPs in dis-
tobuccal sites (P=.003), as well as buccal sites (P=.005).
DISCUSSION
The null hypothesis of this retrospective study was
rejected, as peri-implant mucositis, peri-implant hyper-
trophy, and peri-implantitis were associated with
prosthetic risk factors. Although no implants were lost,
the survival rate was 100%, similar to that of other
studies.11-17 However, biologic complications were
common, with no prosthesis being complication-free.
A finding that was similar to previously reported
data2,11,15-17,20 and underscores that emphasis should
be placed not only on implant survival but also on the
overall prevalence of complications. Of the minor com-
plications, peri-implant mucositis was prevalent and
more often found than previously reported in a system-
atic review.22 This increased prevalence of peri-implant
mucositis could be partially explained by the methodol-
ogy used in this study, as all IFCDPs were removed

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- 2021
before peri-implant measurements were recorded, unlike
in previous studies.11,15-17,20,22 Removing the prostheses
was done to ensure that access to the implant site was
not impeded by the prosthesis, potentially skewing the
peri-implant measurements. The authors are unaware of
a previous study that evaluated peri-implant indices
directly at 6 sites around each implant after the removal
of the IFCDPs.
Strong evidence from animal and human experi-
mental studies indicates that plaque is the etiological
factor for peri-implant mucositis.7,20,22,23 In the present
study, peri-implant mucositis was more often found
under the maxillary prosthesis, consistent with a micro-
biological and immunological study on patients with
complete-arch fixed implant prostheses.29 In maxillary
arches, the prosthesis may be designed with tissue con-
tact to avoid or minimize phonetic problems, to hide the
prosthesis-tissue junction, and to avoid saliva visibly
protruding in the peri-implant areas. While it is impor-
tant to design the intaglio surface of the maxillary pros-
thesis to minimize these relevant patient concerns, the
design should not hinder plaque removal by the patient.
An appropriate design should have prosthesis contact
with the soft tissue similar to that of a modified ridge lap
pontic design, specifically by designing prosthesis contact
with the soft tissue toward the buccal aspect of the
prosthesis yet maintaining a flat or convex intaglio design
toward the palatal side that allows unimpeded plaque
removal measures.20,30-32 In the present study, the
prosthetic design was not always consistent with these
guidelines, because different residents and dental labo-
ratory technicians were involved in the fabrication of the
IFCDPs. It is therefore likely that less than ideal pros-
thesis design led to an increased prevalence of peri-
implant mucositis. In addition, periodic maintenance
and supportive periodontal therapy is important to
minimize biofilm-mediated complications.30-35 While
regular hygiene and recall protocols were in place,
compliance with maintenance appointments and self-
performed plaque removal in this study cohort was less
than ideal. Indeed, few patients attended their mainte-
nance visits as scheduled. This relative lack of compliance
likely exposed the study cohort to an increased preva-
lence of biologic complications such as peri-implant
mucositis. While this lack of compliance can affect and
skew the results for biologic complications, the authors
believe that the overall results are descriptive of the
effectiveness rather than the efficacy of the reported
prosthetic intervention, because this patient cohort was
treated under real world conditions rather than in strict
and ideal controlled conditions related to self-performed
plaque removal and compliance with periodic
maintenance.
The plaque accumulation (mPLI) index values were
significantly different between MC and MR prostheses,
Chochlidakis et al
5
Table 7. Details of implants with probing depth higher than 5 mm and
positive evidence for plaque accumulation (mPLI) and bleeding on
probing (BoP)
Maxilla Mandible
Anterior/ Posterior/ Anterior/ Posterior/
Peri-implant Indices Total (%) Total (%) Total (%) Total (%)
PD>5 mm 11/120 (9.2) 4/124 (3.2) 2/120 (1.7) 5/124 (4.0)
mPLI positive 40/120 (33.3) 57/124 (46.0) 38/120 (31.7) 34/124 (27.4)
BoP positive 51/120 (42.5) 61/124 (49.2) 33/120 (27.5) 28/124 (22.6)
with the latter showing significantly more plaque accu-
mulation (P<.003). In addition, peri-implant hypertrophy
was 2.79 (95% CI: 1.35 e 5.76) and more often present for
MR IFCDPs, presumably because of the generally larger
dimensions of MR prostheses, which may have partially
hindered effective self-performed plaque removal. This
finding is consistent with the findings of previous articles
showing that inability to perform plaque removal was
associated with biologic complications.36 In addition,
acrylic resin materials degrade and have increased plaque
accumulation.20
Peri-implantitis is a biofilm mediated process which is
characterized by tissue inflammation and bone loss. In
the present study, the prevalence of peri-implantitis was
5.80% (13/224) at the implant level, which is lower than
previously reported.20,22,23,37 A meta-analysis of previous
studies reported that the mean prevalence of 5-year
implant-level peri-implantitis was 9.25%.22 This meta-
analysis showed that peri-implant diseases were preva-
lent and the prevalence of peri-implantitis increased over
time.22 In the present study, jaw location was found as
the only significant predictor for the counts of peri-
implantitis (Beta=-1.75, SE =0.785, P=.025). The rate
ratio for peri-implantitis in the mandible was 5.79 (95%
CI: 1.24 e 27.02) times that of the maxilla (95% CI: 0.03 e
0.80) (11 mandibular versus 2 maxillary implants). This
finding was consistent with the findings of previous
studies reporting that the prevalence of peri-implantitis
was greater for mandibular implants and for
IFCDPs38,39 but not with those of other studies where the
prevalence of peri-implantitis was greater in the maxillary
arches.40,41 A possible explanation for the greater prev-
alence of peri-implantitis in the mandible, is related to
the potentially smaller width of the keratinized mucosa
present in mandibular edentulous arches.18 While the
evidence for the importance of peri-implant keratinized
mucosa for peri-implant health is equivocal,18 an
adequate band of keratinized mucosa has been reported
to facilitate comfortable, self-performed measures of
plaque removal, thereby decreasing the presence of a
biofilm.42-44 However, in the present study, the width of
peri-implant mucosa was not assessed, so a definitive
conclusion about the greater prevalence of peri-
implantitis for mandibular implants cannot be drawn.
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6 Volume
Analysis of the peri-implant indices (PD, BoP, mPLI)
and crestal bone remodeling showed no significant dif-
ference between either axially or distally tilted implants
or anterior and posterior implants.45,46 This is consistent
with a systematic review that reported no differences in
clinical performance between implants that were placed
in an axial position relative to the residual alveolar ridge
when compared with implants that were intentionally
tilted toward the distal aspect of edentulous jaws.45,47
That all IFCDPs were removed before the soft tissues
parameters were assessed and recorded was a strength of
the present study. While mean peri-implant indices and
measurements such as probing depths and bleeding on
probing may not necessarily correlate with mean bone
loss,48,49 assessing them correctly at the implant level in
such a way that adequate diagnosis can be formulated for
each implant is important.18 While patients with IFCDPs
should be enrolled in a maintenance protocol and peri-
odically attend dental appointments, the ability to
perform a comprehensive evaluation correctly, including
the assessment of soft tissue parameters (probing depths,
bleeding, suppuration, swelling), can be affected by the
dimensions and retrievability of the prostheses. The
presence of a nonremovable prosthesis, especially if
relatively bulky, may significantly hinder the clinical
assessment of the peri-implant soft tissues during
maintenance appointments. Additional protocols aimed
at reducing plaque accumulation, including antiseptic
mouth rinses, use of ultrasonic devices, short interval
follow-up appointments as previously described in the
literature may also reduce the prevalence of biologic
complications.18,50
Limitations of the present retrospective study may
include inaccurate reporting from the residents’ chart
notes throughout the observational period as well as no
standardized and strict maintenance protocol for all the
included participants. Another limitation was that only
37 out of the 88 potential eligible patients contacted
agreed to participate in the study. The patients who did
not agree to participate in the study may have possibly
experienced fewer biologic complications than those who
participated in the study.
CONCLUSIONS
Based on the findings of this retrospective study, the
following conclusions were drawn:
1. IFCDPs presented with 100% implant survival rates
at 5.1 ±2.21 years, irrespective of the type of pros-
thesis material.
2. The prevalence of complications, especially minor
ones, was common and affected all prostheses and a
large portion of the supporting implants.
3. The most common minor biologic complication was
peri-implant mucositis (53.1% complication rate),
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while the most common major biologic complica-
tion was peri-implantitis (4.0% complication rate).
4. Maxillary implants were more often surrounded by
tissues affected by hypertrophy and peri-implant
mucositis, while peri-implantitis was more often
found associated with mandibular implants.
5. Metal-acrylic resin prostheses were more often
associated with tissue hypertrophy and plaque
accumulation than metal-ceramic prostheses.
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Corresponding author:
Dr Konstantinos Chochlidakis
Department of Prosthodontics
Eastman Institute for Oral Health, University of Rochester
625 Elmwood Ave
Rochester, NY 14620
Email: kchochlidakis@urmc.rochester.edu
Copyright © 2020 by the Editorial Council for The Journal of Prosthetic Dentistry.
https://doi.org/10.1016/j.prosdent.2020.12.011
THE JOURNAL OF PROSTHETIC DENTISTRY