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Long-term Outcomes of Tooth-implant Supported Prostheses - A Systematic Review and Meta-analysis
Abhishek Kumar Gupta1, Gomati Dhandai2, G Anitha3
1Department of Prosthodontics, ESIC Dental College, New Delhi, India.
Background:
Tooth-implant supported prostheses (TISP) combine natural teeth and implants to restore function when full implant support is impractical. Their biomechanical performance remains debated due to differences in tooth and implant mobility.
Objectives:
To evaluate long-term survival, success and complication rates of TISP and assess how connector design, framework material and patient condition affect outcomes.
Data Sources:
PubMed, Scopus, Embase and Web of Science were searched through July 2024, with additional manual reference screening.
Study Eligibility:
Clinical studies with ≥12-month follow-up (short term) reporting survival, success or biological/mechanical complications of fixed TISP were included.
Participants And Interventions:
Twelve studies (732 patients; 840 prostheses) involving rigid or non-rigid connectors (NRCs) and metal-ceramic or zirconia frameworks were analysed.
Study Appraisal:
Two reviewers independently extracted data and assessed bias using Cochrane Risk of Bias 2 and the Newcastle-Ottawa Scale. Pooled proportions were calculated via random-effects meta-analysis.
Results:
The pooled survival rate was 91.7% (95% confidence interval 0.89-0.93) with low heterogeneity. NRCs showed fewer mechanical complications and slightly higher survival (+2.8%). Zirconia frameworks provided aesthetic benefits with survival comparable to metal-ceramic designs. Mechanical (screw loosening, chipping) and biological (marginal bone loss, tooth intrusion) complications were frequent, indicating survival alone does not ensure success.
Limitations:
Few primary studies and variable follow-up restrict generalisability.
Conclusions:
TISP is a conservative, reliable long-term option when multiple implants or grafting are unfeasible. NRCs and monolithic zirconia frameworks enhance biomechanical performance, but larger controlled trials are needed.