ReviewImplants for life? A critical review of implant-supported restorations☆
Introduction
The success of implants is widely proclaimed in the literature and by dentists when discussing outcome with their patients. Patients and dentists perceptions of implants are trouble free tooth replacements but does the literature support this? Whilst implant fixtures have a good record of success and longevity, the restorations used to replace teeth can develop problems which are often overlooked and underestimated. This clinically based article reviews the literature on implant-supported restorations and appraises current techniques. It is not aimed to be a comprehensive and will briefly review and critically appraise the longevity of other fixed restorations used to replace teeth.
Considering the time implants have been available as an option for tooth replacements there have been surprisingly little research on the restoration of the implant fixture. In an OVID database search conducted in March 2007 using the search phrases listed in Table 1 a total of 131 references specifically related to prosthodontic applications for implants were found. By comparison that for composites and materials testing revealed 3771.
Section snippets
Implant fixtures
Ever since Brånemark et al. proposed that implants could reliably integrate with bone both manufacturer's and dentists have attempted to push the frontiers of development.2, 3, 4, 5 But a closer look at Brånemark's work shows the meticulous scientific methodology which has rarely been repeated in dental clinical research. Few researchers have the patience and confidence to publish a new clinical technique with longevity data approaching 10 years. What was so unique about Brånemark's work was
Longevity of implant-supported and other restorations
The options for tooth replacement have traditionally been tooth-supported restorations. Since the introduction of implants the role of the conventional bridge has been somewhat questioned. However, recently a series of papers systematically reviewed the longevity and success of fixed–fixed and simple cantilever designed conventional bridges. Tan et al.9 reported that the median survival of conventional bridges after 10 years was 89.1% (95% confidence interval between 81% and 93.8%). The most
Comparison of implant-supported to conventional restorations
An interesting study by Walton and MacEntee.21 reported the outcome of a questionnaire based study which investigated the perceived barriers to implants. Surprisingly, 36% out of a sample of 101 elderly Canadians refused free implants. The most commonly quoted reason for refusal was fear of surgery. The most common reasons quoted by those choosing free implants were those concerned with poor chewing function, poor speech and dissatisfaction with their appearance. This relatively small study
Overdentures
There is comparatively little published research to guide practitioners on how the design of abutments influences outcome of the restoration. In a study by Nedir et al.29 236 patients were treated with 538 implants over an 8 years study. Subjects received 55 implant-supported overdentures and 265 implant-supported bridges with an overall success of 99.2% for the fixtures, however, 66% of the removable and 13% of the fixed prostheses development complications. The authors reported no differences
Conclusion
The introduction of implants revolutionised prosthodontics. The expansion of the commercial world and the business of dentistry have to some extent drawn away from the meticulous research principles developed by Brånemark. However, whilst research continues to be proactive for fixtures the same cannot be said for their prosthodontic rehabilitation. There is comparatively little research to guide practitioners on how to restore implants. Considering the vast numbers of implant systems and
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The main findings in the manuscript were presented at the annual meeting of the British Society for Restorative Dentistry in Brighton 2007.