Long-term chipping and failure rates of implant-supported and combined tooth–implant-supported metal-ceramic and ceramic fixed dental prostheses: A cohort study

doi:10.1016/j.prosdent.2020.05.020

The Journal of Prosthetic Dentistry

Volume 126, Issue 2, August 2021, Pages 196-203

https://doi.org/10.1016/j.prosdent.2020.05.020 Get rights and content

Abstract

Statement of problem

Combined tooth–implant-supported fixed dental prostheses have been associated with an increased risk of long-term failure. Furthermore, high chipping rates have been reported for ceramic fixed dental prostheses. However, clinical data are sparse.

Purpose

The purpose of this observational cohort study was to evaluate the chipping and failure rates of metal-ceramic and ceramic implant-supported and combined tooth–implant-supported fixed dental prostheses.

Material and methods

Four hundred thirty-four fixed dental prostheses placed in 324 patients (mean age: 60.8 years) were selected from a prospective clinical long-term study comprising 213 implant-supported fixed dental prostheses, 66 implant-supported cantilever fixed dental prostheses, and 155 tooth–implant-supported fixed dental prostheses. Metal-ceramic fixed dental prostheses (n=260) were fabricated with a high noble metal alloy (n=225) or Co-Cr base metal alloy (n=35) frameworks. Ceramic fixed dental prostheses (n=174) were all zirconia based and had monolithic (n=68), completely veneered (n=43), or partially veneered frameworks (n=63). Kaplan-Meier curves were used to estimate the survival probability and the chipping-free survival rate of the fixed dental prostheses.

Results

During the observation period of 0.5 to 12.6 years (mean: 4.26 years), 17 fixed dental prostheses failed because of implant failure (n=6), tooth loss (n=5), major chipping (n=5), or abutment screw loosening (n=1). Survival probability was 96% after 5 years and 91% after 10 years. Cox regression analysis showed that age, sex, fixed dental prosthesis location, type of fixed dental prosthesis support, and fixed dental prosthesis material had no significant effect on fixed dental prosthesis failure. Chipping (n=61) was significantly affected by the framework material and type of veneer (P=.001). After 5 years, the greatest incidence of chipping (39%) was observed for zirconia fixed dental prostheses with a complete veneer compared with an 18% incidence of chipping for metal-ceramic fixed dental prostheses with a high noble metal framework. A lower incidence of chipping was observed for zirconia fixed dental prostheses with a partial veneer or monolithic design.

Conclusions

Implant–implant-supported and combined tooth–implant-supported fixed dental prostheses have promising long-term survival rates. Chipping seems to occur less frequently in monolithic or partially veneered fixed dental prostheses than in fixed dental prostheses with complete veneers.

Section snippets

Material and methods

This observational cohort study was conducted in accordance with the World Medical Association Declaration of Helsinki and was approved by the local review board (approval number: 027/2005). All participants gave their informed and written consent to scientific use of the recorded data.

All implant-supported or tooth–implant-supported FDPs placed by members of the Department of Prosthodontics with an observation period of at least 6 months formed the primary data set. In the further selection

Results

In a mean observation period of 4.26 years (maximum: 12.6 years), 17 FDPs failed. Reasons for failure were loss of implants (n=6), loss of abutment teeth (n=5), loosening of an abutment screw (n=1), and extended chipping of veneers (n=5). The FDP with the loosened abutment had to be removed to gain access to the abutment screw under the definitively cemented FDP and was then replaced. Extended chipping was diagnosed if functional or esthetic problems resulted in replacement of the FDP (Fig. 2).

Discussion

The research hypothesis that the incidence of chipping would be greater for ceramic FDPs than for metal-ceramic FDPs was accepted but only for ceramic FDPs with complete veneers. In contrast, a lower incidence of chipping was observed for zirconia FDPs without a veneer (monolithic design) or with partial veneers.

Implant failure (n=6) and loss of abutment teeth (n=5) were the most common reasons for FDP failure in this study, meaning that failures were predominately biological in nature.

Conclusions

Based on the findings of this clinical study, the following conclusions were drawn:

1.
Survival was not affected by the framework material, but zirconia was a significant risk factor for chipping with a hazard ratio of 2.76 for FDPs with a complete veneer.
2.
The incidence of chipping of zirconia FDPs can be reduced by the use of monolithic zirconia or partial veneers. However, long-term performance cannot be predicted because the observation period for these types of zirconia FDPs was restricted to a

Acknowledgments

The authors thank the participants involved in the study for their patience during the follow-up appointments. We also thank Hazel Davies, medical copy editor, for English language revision.

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Clinical ResearchLong-term chipping and failure rates of implant-supported and combined tooth–implant-supported metal-ceramic and ceramic fixed dental prostheses: A cohort study

Abstract

Statement of problem

Purpose

Material and methods

Results

Conclusions

Section snippets

Material and methods

Results

Discussion

Conclusions

Acknowledgments

J Prosthet Dent

Dent Mater

J Dent

Impact of prosthetic material on mid- and long-term outcome of dental implants supporting single crowns and fixed partial dentures: a systematic review and meta-analysis

Eur J Oral Implant

Prosthetic treatment planning on the basis of scientific evidence

J Oral Rehabil

Comparison of survival and complication rates of tooth supported fixed dental prostheses (FDPs) and implant-supported FDPs and single crowns (SCs)

Clin Oral Implants Res

A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years

Clin Oral Implants Res

Clinical outcomes of partial and full-arch all-ceramic implant-supported fixed dental prostheses. A systematic review and meta-analysis

Clin Oral Implants Res

A systematic review of the survival and complication rates of zirconia-ceramic and metal-ceramic multiple-unit fixed dental prostheses

Clin Oral Implants Res

Short-term complications of implant-supported and combined tooth-implant-supported fixed dental prostheses

Clin Oral Implants Res

The effect of rigid and non-rigid connections between implants and teeth on biological and technical complications: a systematic review and a meta-analysis

Clin Oral Implants Res

Clinical Research
Long-term chipping and failure rates of implant-supported and combined tooth–implant-supported metal-ceramic and ceramic fixed dental prostheses: A cohort study