The Prosthetic Complications and the Survival of the Implant-Fixed Complete Dental Prostheses: An Original Study.

Introduction: The implants have brought a paradigm shift in the replacement of lost teeth. The complete dentures that are implant fixed have increased acceptance among patients. Since these are recently introduced, we aim to evaluate the prosthetic complications and the survival of the implant-fixed complete dental prostheses. Materials and
Methods: We piloted a retrospective study among subjects who received "implant-fixed complete dental prostheses (IPs)." We included 100 subjects with different IPs from the department records who complied with the follow-up. Prosthodontic complications and the survival of the IP were noted and presented as percentages.
Results: Of the 100 subjects finalized in our study, 78 had metal acrylic (MA) and 22 metal ceramic (MC). The mean survival of the MC and MA was 5.2 and 5.1 years, respectively. The most common minor and major complications were "loss of screw access hole material, chipping of the veneering material, and chipping events." Parafunctional habits affected the survival of the IP along with the reluctance to wear the night guard. Conclusions: Good survival and only a few prosthetic complications are associated with the IP and showed good patient satisfaction. Copyright:

INTRODUCTION

One of the most common dental procedures is prosthetic rehabilitation. There are removable and fixed types of prosthesis used, however most of the dentists prefer fixed appliances.[123] The advent of the dental implant has changed the game entirely. The “implant-fixed complete dental prostheses (IPs)” are a common dental prosthesis that is suggested recently by clinicians. Various modalities of the implant framework and the assemblies are available that are selected based on the clinical conditions. There is, however, a paucity of the literature for the IP survival and the prosthetic complication.[456] The association of the various risk factors to the IP is also less evaluated. Hence, we aim to evaluate the prosthetic complications and the survival of the implant-fixed complete dental prostheses.

MATERIALS AND METHODS

We piloted a retrospective study among subjects who received “implant-fixed complete dental prostheses (IPs).” The institutional ethics clearance was obtained for the study. We included 100 subjects with different IPs from the department records who complied with the follow-up. We included the patients who attended between the years 2010–2020. The included subjects were recalled and the dental and medical checkup was done after the consent was obtained from them to participate in the study. Prosthodontic complications were noted as major and minor complications. Patient satisfaction, habit of bruxism, and frequency of night guard wear were also noted. The survival of the IP was noted by the “Kaplan–Meier method.” Along with these, the risk factors and the patient satisfaction were also noted. The comparisons were made deliberating P < 0.05 as significant.

RESULTS

We finalized 100 subjects for the study. The male: female ratio was 1:2, with a mean age of 62 ± 9.8 years. The maxillary and mandibular prostheses were 41 and 59, respectively. Two types of prostheses were seen metal acrylic (MA) (79) and metal ceramic (MC) (21) with a mean follow-up of 57 ± 2.5 and 53 ± 2.5 months, respectively. Only 11 prostheses were noted as failed in our study. Hence, the survival was 89%. The failure was reported due to deleterious parafunctional habits like bruxism. The bruxism and the night guard usage were compared for both the IPs. Significant variation was seen for the “loss of access hole material events, chipping of the veneering material, and chipping events” for bruxism. We also observed that the implant prosthesis opposing the natural teeth are more prone to failure. The comparison of the various parameters of the IP is presented in Table 1.

Table 1

Various observations made for the metal acrylic, metal-ceramic type of implant prosthesis

Parameter	Findings		P
	MA	MC
Gender (male: female)	1:2	1:2	NS
Mean age	62±9.8	62±8.6	NS
Mean follow-up (months)	57±2.5	53±2.5	NS
Survival rate (1-10 years) (%)	89	72	NS
Mean	5.2	5.1
With complications (%)	85	89	NS
Complication free (%)	15	11	NS
Failed	5	6	NS
Minor complications
Minor wear of the prosthetic material	14	13
Minor chipping of veneering material	20	18	0.001
Loss of access hole material	16	14	0.02
Fracture of prosthetic material	6	5
Screw loosening	18	16
Wear of prosthetic screw	12	10
Decementation	4	3
Major complications	21	20
Major wear of prosthetic material	15	14
Major chipping of veneering material	6	4
Framework fracture	40	31	0.001
Abutment fracture	3	1
Patient satisfaction (%)	64	78	NS

NS: Not significant, MA: Metal acrylic, MC: Metal ceramic

DISCUSSION

We found that the mean survival was over 5 years and that only two minor and one major complication were seen. The risk factors were natural teeth, bruxism, and reluctance to wear night guard. Only 11% of the prostheses failed among the IPs that have been retained for 10 years. The two types of prostheses were MA and MC. Both the prostheses fared similarly; however, we observed that the MC was slightly well tolerated and preferred than the MA. The chief complication of the MA was the chipping away of the teeth and breakage. The MC can be suggested keeping in mind the economy of the patient. Our observations are similar to previous studies.[234567] There were some limitations for the study. As this was a retrospective study, the recall bias cannot be overlooked as well as the different perceptions of the patients.

CONCLUSIONS

Implant-supported fixed prosthesis has a good survival with very low failure rate. The complications are few. Care should be taken to prescribe IP among patients with bruxism. Patients should be motivated to wear night guards. Accurate treatment planning and thorough follow-up can help in long-term success of the IP.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.