Journal CLUB

IMPLANT FIXED COMPLETE DENTAL PROSTHESES

COMPLICATIONS & FAILURES
 INTRODUCTION

• IFCDP common & well accepted Rx for completely edentulous .

• Barry Le Patner: “Good judgment comes from experience, and
experience comes from bad judgment
FAILURE OF IMPLANTS ( Marco eposito
et al)

• BIOLOGICAL FAILURE
• MECHANICAL FAILURE
• ESTHETIC FAILURE
• IATROGENIC FAILURE
 IMPLANT COMPLICATION ( REF)

Hanif A, Qureshi S, Sheikh Z, Rashid H. Complications in implant dentistry. Eur J Dent. 2017;11(1):135-140.

BIOMECHANICAL OVERLOAD
FACTORS ASSOCIATED WITH
FAILURES
Implant related factors
 MECHANICAL COMPLICATIONS ( REF)

FACTORS :

1. Implant Inclination,

2. Inadequate Available Bone

3. The Presence of excessive forces due to the

parafunctional habits, that is, bruxism.

An open tray impression taken using addition cured silicone.

Poor implant angulation can be judged which could lead to a
mechanical failure
Hanif A, Qureshi S, Sheikh Z, Rashid H. Complications in implant dentistry. Eur J Dent. 2017;11(1):135-140.
TECHNICAL COMPLICATIONS
FRAMEWORK FRACTURE VENEERING FRACTURE
COMPLICATION DEFINITION

Implant failure or fracture Any implant failure or fracture resulting in prosthetic

disuse of the implant

Minor wear of prosthetic material Loss of original anatomy of veneering material of

prosthesis

Minor chipping of veneering material Surface deficient but can be polished

chairside without removing prosthesis

Loss of access hole material Material covering prosthetic channel in

screwretained restoration partially or totally missing

Fracture of prosthetic screw Fracture of screw connecting abutment to implant in

cemented restorations or prosthesis to implant and
abutment in screw-retained restorations
 INTRODUCTION

• IFCDP common & well accepted Rx for completely edentulous.

• The fixed prosthesis consists of either a cast or milled framework
cemented or screwed to the implants or abutments, whereas polymeric
(acrylic resin) or ceramic materials are used to replace missing teeth and
gingival tissues.
 Review of literature

• Lindquist et al (1996) reported that the loss of screw access hole material and mobility of
the prosthesis due to screw loosening were the most frequent complications of IFCDPs.
• Ventura ( 2016) reported a high percentage of acrylic resin tooth fracture, with a total of
155 events in 65 prostheses (40% of the total prostheses).
• Fracture of the metal framework can lead to prosthetic failure, but fortunately, this is the
least frequently reported complication.
• After a 22-year, private practice-based, retrospective analysis, Priest et al(2014) reported 6
framework fractures in 3 prostheses and concluded that cantilever fixed dental prostheses
opposed by a fixed prosthesis exhibited a higher risk of complications than frameworks
opposed by complete dentures or removable implant prostheses.
ROL………………….

• In a 10-year prospective study, Fischer and Stenberg (2011)reported

1 fracture of 23 frameworks (4%),
• Ortorp and Jemt (2009) reported fractures of the titanium structure
in 15.5% of participants.
PURPOSE & AIM

Purpose : To assess the prevalence of prosthetic complications

(mechanical and technical) and to identify potentially associated risk
factors.
Aims : To assess patient satisfaction and report on the survival rates of
IFCDPs after a mean observation period of 3.5 years.
The null hypothesis of this study was that prosthetic complications
were not associated with the selected risk factors.
MATERIALS & METHODS

IRB APPROVAL: University of Rochester Research Subject Review

Board committee (RSRB #58008).
STUDY AREA: Eastman Institute for Oral Health, University of
Rochester.
DATES : Aug 1, 2009, and Aug 1, 2014 ( electronic health record
review)
INCLUSION & EXCLUSION CRITERIA

INCLUSION CRITERIA EXCLUSION CRITERIA

Participants treated at Eastman Institute for Oral Participants not treated at Eastman Institute for Oral
Health Health Age
Age >18 years at day of implant placement Age <18 years at day of implant placement

Dental implants with rough surface Dental implants with smooth (machined) surface
Completely edentulous patients with IFCDPs in at least Completely dentate or partially edentulous patients
1 jaw

Definitive prosthesis under functional loading for at Definitive prosthesis under functional loading for less
least 1 y than 1 y
Informed about the objectives of the study

Agreed & ICF

Included patients attended a single visit

2 calibrated examiners (E.E., K.C.).

Soft & hard tissue examinations

VISIT INCLUDED

1. Dental And Medical History Reviews,

2. Clinical And Radiographic Examination &

3. Intraoral Photographs Following Standard Procedures.

4. The Intraoral Photographs Were Used To Identify Prosthetic Complications Of

The Prostheses.
Prosthodontic Parameter:
1. Jaw And Location;

2. Number Of Abutments And

3. Prosthetic Teeth;

4. Implant Location;

5. Prosthetic Material;

6. Type Of Prosthesis Retention;

7. Presence And Length Of Cantilever;

8. Nightguard Use; Bruxism,

9. As Assessed By Presence Of Wear Facets;

10. Type Of Opposing Dentition;

11. Occlusal Scheme;

12. Wear Of Veneering Material; And

13. Fracture Of Veneering material (chipping).

• During the research visit, all IFCDPs were examined for either prosthetic
complications or failures.
• Prosthetic complications were divided into minor and major
• After the study visit, the investigators reviewed each patient’s electronic health
record and recorded complications or failures that had occurred since the
installation of the definitive prosthesis.
• After the examination, each patient completed a questionnaire subjectively
evaluating the esthetics, phonetics, function, effect on taste perception, and
general satisfaction.
OPERATIONAL DEFINITIONS
• Prosthesis survival : prosthesis remaining in situ with or without
modifications during the entire observation period
• Prosthesis failure : as the loss of the prosthesis, the need to replace
the entire veneering material, or the loss of the implant(s) with
subsequent loss of the prosthesis.
• Veneering material fracture was categorized as minor (could be
polished intraorally) or major chipping (leading to laboratory-based
repair or replacement of the material)
 STATISTICAL ANALYSIS
STATISTICAL ANALYSIS SIGNIFICANCE

Kaplan-Meier Prosthesis survival rates.

Poisson regression Effect of selected patient-based and prosthesis-based

risk factors

Descriptive statistics Patient satisfaction

All computations were carried out with statistical software (IBM SPSS Statistics, v25; IBM Corp) (a=.05).
RESULTS
 Electronic health record

88 eligible pts

contacted.

37 pts

mean age 62.35 ±10.39 years

13 M
24 F
58.3 ±12.47 yrs
64.54 ±8.57 yrs

total of 271 moderately rough surface dental

implants and 48 prostheses (24 maxillary
and 24 mandibular arches)
 271 Mod ROUGH SURFACE IMPLANT

48 prosthesis

24 Maxillary arches
24 Mandibular arches

total of 271 moderately rough surface dental

implants and 48 prostheses (24 maxillary
and 24 mandibular arches)
 271 Mod ROUGH SURFACE IMPLANT

48 prosthesis

10 were metal-
38 were metalacrylic
ceramic
resin prostheses

7 MAXILLARY 3 MANDIBULAR 21 MANDIBULAR

17 MAXILLARY
RESULTS………….

• All IFCDPs in the MR group except one were screw-retained, whereas in the
MC group, there were 5 cement-retained and 5 screwretained prostheses.
• Twenty-three prostheses opposed mixed dentitions (natural teeth and
fixed implantsupported restorations), 16 opposed implant-supported fixed
complete dental prostheses, and 9 complete dentures.
• Observed occlusal schemes at the time of examination consisted of
mutually protected occlusion and group function in 42% and 58% of the
participants, respectively
DICUSSION

• The primary aim of this study was to assess the prostheses survival
rates, as well as the prosthetic complications of IFCDPs after an
average observational period of 3.5 years.
• However, all failures clustered in only 2 patients who experienced
multiple complications likely due to bruxism. Even though all failures
occurred in MR prostheses, the overall comparison of survival rates
during the study period found no statistically significant difference
between MR and MC groups (Chi-square=0.29, P=.59)
DISCUSSIONS………..

• The most frequent prosthetic complication was major wear of the

prosthetic material (40% of the prostheses).
• The most common minor prosthetic complication was loss of access
hole material, which is consistent with the findings of Lindquist et al.
• In the current study, there were significantly more minor
complications than major ones, which is consistent with previous
studies.
DISCUSSION……….

• Veneering material fracture may be related to different factors.

• In the current study, major chipping was significantly associated with the
presence of an IFCDP in the opposing arch, which is consistent with previous
data.
• The Poisson regression analysis also revealed a significant positive
association between minor chipping of the veneering material and bruxism.
• This result is consistent with that of a systematic review which concluded that
bruxism might be a risk factor for mechanical complications.
DISCUSSION……..

• Patient satisfaction and quality of life are also important measures to

consider in treating edentulous patients with implant-supported
prostheses.
• However, few studies have measured the quality of life and patient
satisfaction with IFCDPs.
• When the MR and MC groups were compared, there was no significant
difference in patient satisfaction.
• Similar results regarding MR IFCDPs were reported by Oh et al
 LIMITATIONS
• Possible bias during the assessment of complications. Additionally, data
acquisition from residents’ notes can also result in inaccurate reporting.
• Another limitation is that only 37 of the 88 potential eligible patients
contacted to be part of this study agreed to participate. The 51 patients
who did not agree to participate may be presumed to experience fewer
complications than those who participated.
• If this is true, this could have influenced the results, and the prosthetic
complication rates would have been significantly lower than those
reported.
LIMITATIONS

• There was no control during the observed period as to whether all

patients were attending regular recall appointments. The compliance
of the patients and their adherence to the maintenance and recall
appointments is important because this could help clinicians to
locate problems early and possibly prevent major complications.
• this study is the mean observational period of 3.5 years, which is
considered short-term and should not be used to draw long-term
conclusions
 CONCLUSIONS
Based on the findings of this retrospective clinical study, the following conclusions were
drawn:
• IFCDPs presented high cumulative survival rates (88%) after an observation period of 3.5
years.
• No significant difference was found in the survival rates or patient satisfaction of the MR
and MC groups (P>.05).
• The most common minor complication was loss of access hole material with an estimated
5-year rate of 25.88%, whereas the most common major complication was major wear of
the prosthetic material with an estimated 5-year rate of 29.27%.
• When the opposing dentition was an IFCDP, the total number of prosthetic complications
significantly increased as compared with an opposing removable prosthesis (P=.001).
• Not wearing a nightguard ( Pt with bruxism) was significantly associated with increased
complication rates of minor chipping, loss of access hole material, and framework
fracture (P<.001)
STROBE CHECK LIST
CRITICAL EVALUATION
TITLE
• Indicate the study’s design with a commonly used term in the title or
the abstract :
Survival rates and prosthetic complications of implant fixed complete
dental prostheses: An up to 5-year retrospective study
• Provide in the abstract an informative and balanced summary of what was
done and what was found
Background/rationale

• Explain the scientific background and rationale for the investigation being
reported :
To assess the prevalence of prosthetic complications (mechanical and technical)
and to identify potentially associated risk factors.
Objectives

• State specific objectives, including any prespecified hypotheses

OBJECTIVE : To assess patient satisfaction and

report on the survival rates of IFCDPs after a mean
observation period of 3.5 years.
Methods

Study design :

Present key elements of study design early in the paper:MENTIONED

• 1.place and recuirement of study is reported
• 2.inclusion & exclusion criteria
• 3.systematic design of study is mentioned
 Setting

• Describe the setting, locations, and relevant dates, including periods of recruitment,
exposure, follow-up, and data collection:
IRB APPROVAL: University of Rochester Research Subject Review Board committee (RSRB #58008).
STUDY AREA: Eastman Institute for Oral Health, University of Rochester.
DATES : Aug 1, 2009, and Aug 1, 2014 ( electronic health record review)
Participants

• Give the eligibility criteria, and the sources and methods of selection of
participants. Describe methods of follow-up

Inclusion and exclusion criteria

included .
Sources :
Electronic health record.
Method of follow uo for 3.5 yrs
mentioned
Variables

• Clearly define all outcomes, exposures, predictors, potential confounders, and effect modifiers.
Give diagnostic criteria, if applicable

All diagnostic parameters for

accessing implant failures are
given
Data sources/ measurement

• For each variable of interest, give sources of data and details of methods
of assessment (measurement). Describe comparability of assessment
methods if there is more than one group

Assessment method b/w the MC & MR

group
Bruxism and night guard
Bias

• Describe any efforts to address potential sources of bias

Resident notes inaccuracies

Many confounding factors are not reported
 Describe all statistical methods, including those used to control for confounding

STATISTICAL ANALYSIS SIGNIFICANCE

Kaplan-Meier Prosthesis survival rates.

Poisson regression Effect of selected patient-based and prosthesis-based

risk factors

Descriptive statistics Patient satisfaction

All computations were carried out with statistical software (IBM SPSS Statistics, v25; IBM Corp) (a=.05).
RESULTS

Summarise key results with reference to study objectives , LIMITATIONS ,

INTERPRETATIONS

SUMMARIZED THE KEY RESULTS WITH REF

TO STUDY OBJECTS WITH LIMITATIONS &
INTERPRETATIONS
DISCUSSION

Summarise key results with reference to study objectives , LIMITATIONS ,

INTERPRETATIONS

SUMMARIZED THE KEY RESULTS WITH REF

TO STUDY OBJECTS WITH LIMITATIONS &
INTERPRETATIONS
OTHER INFORMATION

FUNDING

NONOT MENTIONED
 REFERENCES
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