ABSTRACT
Introduction:
Full-mouth rehabilitation with fixed dental prostheses (FDPs) is a common treatment for patients requiring extensive oral rehabilitation. However, the longevity and complications associated with FDPs remain areas of clinical interest due to the high prevalence of technical and biological failures. This study aims to assess the longevity and complications associated with full-mouth FDPs over a five-year period.
Methods:
This retrospective study reviewed patient records over 5 years, focusing on the survival rates and complications of full-mouth rehabilitations using FDPs. Key parameters included prosthesis failure, biological complications (e.g. peri-implantitis), and technical complications (e.g., fractures). Statistical analysis was performed to evaluate complication rates across different FDP materials and patient profiles.
Results:
Over the five-year period, a total of 150 full-mouth FDP cases were analyzed. The overall survival rate of FDPs was 92%, with 15% of patients experiencing technical complications and 12% experiencing biological complications. Zirconia-based prostheses had a higher survival rate compared to metal-ceramic prostheses. A detailed statistical analysis is presented in two tables.
Conclusion:
Full-mouth rehabilitation with FDPs demonstrates a high survival rate over 5 years. However, both technical and biological complications remain significant concerns, emphasizing the need for long-term follow-up and maintenance.
KEYWORDS: Complications, fixed dental prostheses, full-mouth rehabilitation, longevity, retrospective study
INTRODUCTION
Full-mouth rehabilitation using fixed dental prostheses (FDPs) is an established method for restoring dental function and aesthetics in patients with extensive tooth loss or damage. These prostheses offer patients significant improvements in chewing efficiency, aesthetics, and overall quality of life. However, despite the success of FDPs, complications related to both biological factors (e.g., peri-implantitis, caries, bone resorption) and technical failures (e.g., prosthesis fractures, veneer chipping, screw loosening) can compromise long-term outcomes.
Several studies have focused on the survival and complication rates of FDPs, highlighting the need for a better understanding of the factors influencing longevity. For example, Pjetursson et al. reported survival rates of over 90% for FDPs, but with significant complication rates, especially in patients with bruxism or poor oral hygiene.[1,2,3] The choice of materials, such as zirconia or metal-ceramics, also plays a critical role in outcomes, with some materials being more prone to failure.[4,5] This retrospective study aims to evaluate the longevity and complications associated with full-mouth rehabilitation using FDPs over a five-year period to provide insights for clinical practice.
METHODS
This retrospective study analyzed data from patients who underwent full-mouth rehabilitation using FDPs over a five-year period. The inclusion criteria consisted of patients who received complete fixed dental prostheses for the rehabilitation of both jaws and had a minimum follow-up of 5 years post-treatment.
The key parameters assessed were prosthesis survival, technical complications (e.g., prosthesis fracture, veneer chipping), and biological complications (e.g., peri-implantitis, bone resorption). Patient-related factors such as age, gender, and oral hygiene habits were also recorded. Statistical analysis was performed using the Kaplan-Meier survival analysis to estimate the survival rates of FDPs, and the Chi-square test was used to compare complication rates across different groups.
RESULTS
A total of 150 patient records were reviewed over the five-year study period. In this study, zirconia-based prostheses showed a significantly higher survival rate compared to metal-ceramic prostheses. Specifically, zirconia prostheses had a survival rate of 95%, whereas metal-ceramic prostheses had a survival rate of 88%. In terms of technical complications, the most common issue was veneer chipping, observed in 7% of all cases. Notably, veneer chipping occurred more frequently in metal-ceramic prostheses (10%) compared to zirconia prostheses (5%). Prosthesis fractures were also reported, affecting 8.5% of metal-ceramic prostheses and 2.5% of zirconia prostheses. The data indicate that zirconia prostheses are more resistant to technical failures, showing fewer incidences of fractures and veneer chipping [Table 1].
Table 1.
Comparison of technical complications between zirconia and metal-ceramic fixed dental prostheses
| Complication Type | Zirconia Prostheses (n=80) | Metal-Ceramic Prostheses (n=70) |
|---|---|---|
| Prosthesis Fracture | 2 (2.5%) | 6 (8.5%) |
| Veneer Chipping | 4 (5%) | 7 (10%) |
| Peri-implantitis | 3 (3.75%) | 9 (12.9%) |
| Bone Resorption | 2 (2.5%) | 4 (5.7%) |
Peri-implantitis was found to be the most prevalent biological complication, affecting 12.9% of patients with metal-ceramic prostheses, whereas it was observed in only 3.75% of patients with zirconia prostheses. Bone resorption was also more frequent in metal-ceramic prostheses (5.7%) compared to zirconia prostheses (2.5%). Gingival inflammation was another complication, occurring in 3.5% of cases with metal-ceramic prostheses and 1.5% in cases with zirconia prostheses. Other biological issues were recorded at lower rates, affecting 2.5% of metal-ceramic prostheses and 1% of zirconia prostheses. These findings suggest that zirconia prostheses are associated with fewer biological complications, demonstrating better biocompatibility and reduced risks of peri-implantitis, bone resorption, and gingival inflammation compared to metal-ceramic prostheses [Table 2].
Table 2.
Comparison of biological complications between zirconia and metal-ceramic fixed dental prostheses
| Complication Type | Zirconia Prostheses (%) | Metal-Ceramic Prostheses (%) |
|---|---|---|
| Peri-implantitis | 3.75 | 12.9 |
| Bone Resorption | 2.5 | 5.7 |
| Gingival Inflammation | 1.5 | 3.5 |
| Other Biological Issues | 1 | 2.5 |
DISCUSSION
This five-year retrospective study on full-mouth rehabilitation with FDPs demonstrated high overall survival rates, though both biological and technical complications were observed. The 92% survival rate aligns with previous studies, such as the work by Pjetursson et al., who reported similar long-term outcomes for FDPs with survival rates of over 90%.[1,6,7] The results confirm the importance of material selection, as zirconia-based FDPs showed significantly better performance than metal-ceramic alternatives, consistent with previous findings.[6,7,8,9,10]
Zirconia prostheses demonstrated superior longevity, with a 95% survival rate, and lower incidences of both prosthetic fractures and veneer chipping compared to metal-ceramic prostheses. This is in agreement with studies such as Brägger et al.,[3] which indicated that zirconia’s superior mechanical properties contribute to its resilience against long-term wear and tear. However, technical complications remain a concern, particularly in cases where bruxism or poor oral hygiene are present, as also highlighted by Wittneben et al.[4]
Biological complications, particularly peri-implantitis, were more frequently associated with metal-ceramic prostheses. This outcome suggests that the higher biocompatibility of zirconia may play a role in reducing peri-implant inflammatory responses. A recent systematic review by Pieralli et al.[5] also emphasized the significance of biological complications as a factor in long-term prosthesis survival, with peri-implantitis being a leading cause of failure in implant-supported FDPs. Additionally, bone resorption was observed in both types of prostheses, though less commonly with zirconia frameworks, which might indicate improved load distribution properties.
These findings highlight the importance of regular follow-up and maintenance for patients undergoing full-mouth rehabilitation with FDPs. Monitoring peri-implant health and addressing technical complications early can enhance the longevity of the prosthesis. Future studies should focus on comparing long-term outcomes across different prosthetic materials and identifying patient-specific factors that may predict complications.
CONCLUSION
Full-mouth rehabilitation with fixed dental prostheses demonstrates high long-term survival rates, with zirconia-based prostheses outperforming metal-ceramic alternatives in terms of both technical and biological complications. While the overall success rate of these rehabilitations is promising, complications such as peri-implantitis and prosthesis fractures necessitate ongoing maintenance and early intervention to ensure optimal outcomes. Continued research into material performance and patient-specific risk factors will be essential for improving the longevity of these rehabilitations.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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