Does the Type of Implant Prosthesis Affect Outcomes for the Completely Edentulous Arch?
S. Ross Bryant, DDS, MSc, PhD / David MacDonald-Jankowski, BDS, LLB, MSc, FDSRCPS(UK), DDRRCR / Kwonsik Kim, DMD, MS, PhD
Purpose: A systematic review, including meta-analysis, was conducted to answer the question “Does the type of implant prosthesis affect outcomes for the completely edentulous arch?” The current paper was to assess the impact of fixed or removable prosthesis type on implant survival and success outcomes. Materials and Methods: Pertinent literature was identified through December 31, 2005 using a PubMed search strategy and hand-searching of relevant journals, a personal library, and reference lists from included studies. Inclusion and exclusion criteria were applied to the titles and abstracts and subsequently to the full text of included references. The 72 included studies reported oral implant survival or success, crestal bone levels or loss, and/or prosthesis success or maintenance differentiated by arch and by prosthesis type (fixed or removable, splinted or nonsplinted) established either in 1-year randomized clinical trials or 5-year observational studies. Results: Statistical analysis revealed only a site-specific rather than a design-specific finding that implant survival for mandibular fixed prosthesis groups had a 6.6% greater implant survival than maxillary fixed prostheses groups (P < .001). The observation of greater implant failure for removable over fixed protheses groups in the maxilla appeared likely due to deficient preoperative bone volume in the removable prosthesis groups. Discussion: There is little evidence that implant survival or success is affected directly by prosthesis type based on current designs studied for at least 5 years. Prosthesis maintenance does appear to vary with different prosthesis designs. Conclusion: While this study suggests implant survival and success may not be affected by variation across the established types of implant prostheses, maintenance demands can vary with implant prosthesis type, especially with overdenture attachments. Clinicians should remain diligent in basing implant prosthodontic technique on established protocols. Int J Oral Maxillofac Implants 2007;22(suppl):117–139
Key words: complete edentulism, evidence-based dentistry, fixed prostheses, meta-analysis, oral implants, removable prostheses, success, survival, systematic review