Implant-supported cantilevered fixed partial dentures

Abstract

Data sources: Medline was used to search for relevant material for the review. Study selection: Systematic reviews and longitudinal prospective/ retrospective studies (randomised controlled trials, controlled clinical trials and cohort studies) were chosen that reported outcomes following treatment with implant-supported fixed partial denture prostheses (FPDP) with cantilever extensions, after a mean function time of at least 5 years. Two independent reviewers preformed screening and data abstraction. Data extraction and synthesis: Five-year survival and technical complication rates were extracted, which included: loss of prosthesis, loss of implants, complications with supra-construction (fractures or deformations of the framework or veneers, loss of retention and screw or abutment loosening) and marginal bone loss. Data from included studies were pooled and summarised as a weighted mean. Disagreement regarding data extraction was resolved by discussion and consensus. Results: Only three studies met the inclusion criteria for final analysis. Two of the studies had a prospective or retrospective case-control design, whereas the third was a prospective cohort study. The 5-year survival rate of cantilever FPDP varied between 89.9 and 92.7% (weighted mean, 91.9%), with implant fracture as the main cause for failure. The corresponding survival rate for FPDP without cantilever extensions was 95.3 to 96.2% (weighted mean, 95.8%). Technical complications related to the supra-construction in the three included studies were reported to occur at a frequency of 13-26% (weighted mean, 20.3%) for cantilever FPDP, compared with 0-12% (weighted mean, 9.7%) for noncantilever FPDP. The most common complications were minor porcelain fractures and bridge-screw loosening. For cantilever FPDP, the 5-year event-free survival rate varied between 66.7 and 79.2% (weighted mean, 71.7%) and between 83.1 and 96.3% (weighted mean, 85.9%) for noncantilever FPDP. No statistically significant differences were reported with regard to peri-implant bone-level change between the two prosthetic groups, either at the prosthesis or at the implant level. Conclusions: Data on implant-supported FPDP with cantilever extensions are limited and therefore survival and complication rates should be interpreted with caution. The incorporation of cantilevers into implant-borne prostheses may be associated with a higher incidence of minor technical complications. © EBD 2010.