ABSTRACT
Background:
Dental implants have been essential to the therapy of patients who are partially edentulous.
Aim:
Clinical evaluation of the long-term survival and success rates of different types of implant-supported prostheses.
Materials and Methods:
Patients who had a healthy edentulous ridge of three missing teeth in the posterior jaw in which two or three dental implants were placed having any of three prostheses, namely, three-unit fixed dental prostheses (FPD) on two implants, three splinted crowns on three implants, and three splinted crowns on three implants were included.
Results:
The survival rate in all patients with dental implants having different types of prostheses was 94.9%. The survival rate in FPD, three splinted crowns, and three nonsplinted crowns was 100, 88.5, and 93.6% respectively.
Conclusion:
FPD loaded on two dental implants was found to have a greater long-term survival rate and success rate with a lower frequency of peri-implantitis and prosthodontic complications.
KEYWORDS: Dental implants, peri-implantitis, prosthesis
INTRODUCTION
In both the maxillary arch and mandibular arch, dental implants have been essential to the therapy of patients who are partially edentulous.[1,2] Even if long-term success has been clearly demonstrated, factors that help clinicians choose the best surgical and prosthodontic technique also have an impact on the outcome. Choosing between using a prosthodontic component made of nonsplinted or splinted crowns is one of these.[3,4] The occlusal pressures applied to the implants are generally distributed by the splinted crowns, which reduces the stress on the surrounding peri-implant bone and makes prosthodontic issues less common.[5,6,7] However, because of ethical restrictions on using occlusal loading on humans, research supporting this therapy option is frequently done using finite and photoelastic studies.[6] This study was conducted with the aim of clinical evaluation of the long-term survival and success rates of different types of implant-supported prostheses.
MATERIALS AND METHODS
This study was a retrospective study (IEC-NHDC and RI/2023/FAC/OMDR.21/SS-8-ECC). The medical records of all patients who underwent dental implant placement along with prosthodontic rehabilitation during the last 24 months were included in the study.
Inclusion criteria
Patients who had a healthy edentulous ridge of three missing teeth in the posterior jaw in which two or three dental implants were placed having any of three prostheses, namely three-unit fixed dental prostheses (FPD) on two implants, three splinted crowns on three implants, and three splinted crowns on three implants.
Exclusion criteria
Patients with bone-related diseases like osteoporosis and other systemic diseases like uncontrolled diabetes, chemotherapy, radiation therapy, and psychological disorders.
Patients with a history of habit of bruxism
Based on inclusion and exclusion criteria, 290 patients with dental implants and different prostheses were included. They were distributed according to the type of prosthesis as follows:
3 unit FPD one two implants = 82 patients
3 splinted crowns on three implants = 94 patients
3 splinted crowns on three implants = 94 patients
Data collection
There was an evaluation of the details of each patient, such as the success rate of dental implants, the survival rate of dental implants, frequency of peri-implantitis, and prosthodontic complications. There was also an evaluation of details like age, gender, and periodontitis.
Statistical analysis
All the data were placed in MS Excel sheet, and SPSS software version 2021 was used for statistical analysis. Data were represented in the form of percentages. Chi-square test and analysis of variance (ANOVA) were used for statistical analysis. P value ≤ 0.005 was considered statistically significant.
RESULTS
The survival rate in all patients with dental implants having different types of prostheses was 94.9%. The survival rate in FPD, 3 splinted crowns, and 3 nonsplinted crowns was 100, 88.5, and 93.6%, respectively. The survival rate and success rate were maximum in FPD as compared to splinted crowns and nonsplinted crowns categories. Furthermore, the survival rate was greater in nonsplinted crowns as compared to splinted crowns (P = 0.01). The overall success rate was 67.3%. The success rate in FPD, 3 splinted crowns, and 3 nonsplinted crowns was 82.2, 52.5, and 61.5%, respectively.
Peri-implantitis was observed in 16.7% of all patients with dental implants. The frequency of peri-implantitis was 5.8, 26.8, and 17.6% in FPD, splinted crowns, and nonsplinted crowns, respectively. The frequency of prosthodontic complications was 13.2, 15.4, and 32.5% in FPD, splinted crowns, and nonsplinted crowns, respectively. The frequency of peri-implantitis and prosthodontic complications was minimum in FPD and maximum in splinted crowns. It was observed that the frequency of peri-implantitis and prosthodontic complications was greater in splinted crowns as compared to nonsplinted crowns. The findings were statistically significant [Table 1].
Table 1.
Survival rate, success rate, peri-implantitis, and prosthodontic complications in all three types of prosthesis
| Survival rate | Success rate | Peri-implantitis | Prosthodontic complications | |
|---|---|---|---|---|
| Overall in all patients with dental implants | 94.9% | 67.3% | 16.7 | 19.4% |
| 3 nonsplinted crowns with three implants | 93.6% | 61.5% | 17.6% | 32.5% |
| 3 splinted crowns with three implants | 88.5% | 52.5% | 26.8% | 15.4% |
| FPD with two implants | 100% | 82.2% | 5.8% | 13.2% |
| P | 0.01 | 0.01 | 0.01 | 0.02 |
DISCUSSION
This study was conducted with the aim of clinical evaluation of the long-term survival and success rates of different types of implant-supported prostheses. The survival rate and success rate were maximum in FPD as compared to splinted crowns and nonsplinted crowns categories. Furthermore, the survival rate and success rate were greater in nonsplinted crowns as compared to splinted crowns (P = 0.01).
In a three-unit splinted crown restoration, Guichet et al. (2002)[1] showed a decreased total maximum stress generation around the central implant; in contrast, in a nonsplinted restoration, the stresses were focused on surrounding all of the prosthesis-laden implants. Nissan et al. (2010)[3] reported similar results, showing that splinted implant restorations placed less load on the crown margin than nonsplinted ones. While there are benefits to splinted restorations, it is crucial to practice proper dental hygiene in the interproximal regions to prevent the occurrence of peri-implantitis. This would make three single crowns a better prosthodontic alternative than splinted crowns, especially for patients with an existing diagnosis of periodontitis and/or restricted cleaning dexterity.[3,4]
The frequency of peri-implantitis and prosthodontic complications was minimum in FPD and maximum in splinted crowns. It was observed that the frequency of peri-implantitis and prosthodontic complications was greater in splinted crowns as compared to nonsplinted crowns. The findings were statistically significant.
Splinting implant-retained crowns has the added drawback of being difficult to fit the framework and provide a suitable appearance profile. The total number of implants needed to restore a partially dentulous area is another deciding factor.[5,6] This creates a dilemma between an implant-retained bridge and one implant for each lost tooth. One implant per extracted tooth appears to be a reasonable clinical option for lowering certain risk factors including overload. Nonetheless, a few studies have shown that full-arch rehabilitation using cross-arch splinted prosthesis backed by a smaller amount of implants than missing teeth is possible.[7]
Lack of room and low-quality bone can make it difficult to use three implants when treating a three-unit edentulous area. One way to get around this restriction is to use a bridge to support two implants. Moreover, the cost is a frequently disregarded influencing aspect. The clinical decision regarding therapy may be influenced by the choice between two and three implants. Nonetheless, it is crucial to evaluate the overall cost of all treatment options, taking into account any potential problems.[3,4,5,6]
CONCLUSION
FPD loaded on two dental implants was found to have a greater long-term survival rate and success rate with a lower frequency of peri-implantitis and prosthodontic complications.
Financial support and sponsorship
The authors extend their appreciation to Prince Sattam bin Abdulaziz University for funding this research work through the project number (PSAU/2023/01/8970).
Conflicts of interest
There are no conflicts of interest.
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