Complications in Full-Arch Implant-Supported Restorations During the Maintenance Phase: A Three-Domain Critical...

Full-arch implant-supported restorations are widely regarded as a predictable treatment modality for edentulous patients, demonstrating high implant survival rates over long-term follow-up. However, the maintenance phase is frequently characterized by a substantial burden of biological, hygienic, and mechanical complications that extend far beyond implant survival alone. Current literature often reports survival outcomes exceeding 90% after 10 years,1 yet these metrics fail to adequately reflect the recurrent maintenance interventions required throughout the lifespan of the prosthesis. This paper proposes a three-domain framework for understanding complications in full-arch implant-supported restorations: biological complications, hygiene-related challenges, and long-term prosthetic wear with recurrent mechanical complications. Rather than treating these events as isolated phenomena, this model emphasizes their interdependence and the central role of prosthetic design, implant positioning, and maintenance accessibility. Biological complications include peri-implant mucositis, peri-implantitis, and marginal bone loss. Hygiene-related challenges arise from prosthetic contours and geometries that compromise plaque control and long-term maintainability. Long-term prosthetic wear includes recurrent technical complications such as screw loosening, screw fracture, material degradation, veneering failure, and implant or abutment fracture. Recent evidence from the Global Consensus for Clinical Guidelines (GCCG) highlights the lack of standardized maintenance protocols and the high prevalence of prosthetic complications in implant-supported fixed complete dentures. A shift toward maintenance-oriented and prosthetically driven treatment planning appears essential to improve long-term outcomes.