The restoration of partial edentulism remains a cornerstone of contemporary prosthodontics, with fixed dental prostheses (FPDs) and implant-supported prostheses serving as two primary treatment modalities. Conventional tooth-supported FPDs have been widely used for decades due to their predictable outcomes and cost-effectiveness [1]. However, the advent of osseointegrated dental implants has revolutionized restorative dentistry, offering patients the possibility of replacing missing teeth without compromising adjacent natural dentition [2]. With advances in implant design, surface modifications, and surgical protocols, implant-supported FPDs have emerged as a viable long-term alternative to traditional fixed prostheses [3].

Despite the widespread clinical use of both modalities, questions remain about their long-term survival and the nature and frequency of complications associated with each. Several studies suggest that implant-supported FPDs may have superior longevity compared to their tooth-supported counterparts, largely because they are not susceptible to caries and may better distribute occlusal forces [4,5]. On the other hand, implant-supported restorations can develop biological complications such as peri-implant mucositis or peri-implantitis, which may ultimately jeopardize implant survival [6].

Conventional tooth-supported FPDs, while cost-effective and less invasive in terms of surgical procedures, rely on the integrity of the abutment teeth. Complications such as secondary caries, endodontic failures, and loss of abutment teeth have been identified as major contributors to FPD failure [7]. Furthermore, the need for tooth preparation, which often leads to the removal of sound tooth structure, may negatively impact the long-term prognosis of these restorations [8]. Conversely, implant-supported prostheses preserve adjacent teeth and provide support through direct bone anchorage, but they demand strict patient compliance, sufficient bone volume, and precise surgical planning [9].

Comparative clinical trials and systematic reviews have attempted to evaluate survival rates and complication profiles of both implant-supported and tooth-supported FPDs. A meta-analysis by Pjetursson et al. reported 5-year survival rates of 94.5% for implant-supported FPDs and 89.1% for tooth-supported FPDs, indicating slightly higher longevity with implant restorations [6]. However, survival alone may not capture the full clinical picture, as mechanical and biological complications such as screw loosening, porcelain fracture, and peri-implant diseases in implants or recurrent caries and loss of retention in tooth-supported FPDs also significantly affect outcomes and patient satisfaction.

Given the evolving landscape of prosthodontic rehabilitation and patient-centered treatment planning, it is imperative to reassess the clinical performance of these modalities in diverse populations and practice settings. This retrospective study aims to evaluate and compare the survival rates and complication profiles of implant-supported versus tooth-supported fixed dental prostheses over a 5-year period, offering insight into their long-term predictability and guiding evidence-based clinical decisions.

Study Design and Setting

This retrospective observational study was conducted in the Department of Prosthodontics at a tertiary dental care center over a five-year. The study aimed to evaluate and compare the survival rates and complication profiles of implant-supported and tooth-supported fixed dental prostheses (FPDs).

Ethical Considerations

The study protocol was approved by the Institutional Ethical Review Board. Patient confidentiality was maintained throughout the study, and only anonymized data were used for analysis.

Sample Selection

Patient records were screened. Inclusion criteria were:

• Patients aged 20–70 years.
• Received either implant-supported FPDs or tooth-supported FPDs with a minimum follow-up of 12 months.
• Complete documentation available, including clinical and radiographic evaluations.

Exclusion criteria included:

• Medically compromised patients contraindicated for implants.
• FPDs placed in irradiated jaws or grafted sites.
• Patients lost to follow-up within one year of prosthesis delivery.

Data Collection

A total of 120 cases were selected: 60 patients with implant-supported FPDs and 60 with conventional tooth-supported FPDs. Data were extracted from clinical records, radiographs, and maintenance logs. Variables collected included:

• Demographic data (age, gender).
• Type of prosthesis (implant- or tooth-supported).
• Arch location (maxilla/mandible, anterior/posterior).
• Number of units in FPD.
• Follow-up duration.
• Complications (biological and mechanical).
• Prosthesis survival status.

Definitions

• Survival was defined as the prosthesis remaining in situ and functional at the end of the observation period, regardless of complications.
• Failure referred to prosthesis loss or irreparable damage.
• Biological complications included peri-implant mucositis, peri-implantitis, secondary caries, or loss of abutment vitality.
• Mechanical complications included screw loosening, framework fracture, veneering ceramic chipping, or debonding.

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to present frequency and percentage distributions. The Kaplan-Meier survival analysis was used to estimate prosthesis survival probability over five years. The Chi-square test was applied to compare complication rates between groups. A p-value of <0.05 was considered statistically significant.

The study included 120 patients, evenly distributed between the implant-supported and tooth-supported FPD groups (60 each). The mean age of participants was comparable between the groups (45.8 ± 9.7 vs. 47.3 ± 10.1 years, p = 0.328), with a slight male predominance in both cohorts. There was no statistically significant difference in the gender ratio or the arch distribution (maxilla vs. mandible) between groups. Most prostheses were placed in posterior regions in both groups, accounting for 80% and 83.3% of cases in the implant and tooth-supported groups, respectively (p = 0.637). This demographic balance suggests a homogenous baseline, reducing the likelihood of confounding variables affecting the survival outcomes. (Table 1)

Over a 5-year follow-up period, implant-supported FPDs demonstrated a higher survival rate (93.3%) compared to tooth-supported FPDs (85.0%), a statistically significant difference (p = 0.031). Additionally, the mean survival time was longer for implant-supported prostheses (57.1 ± 4.2 months) than for tooth-supported ones (52.8 ± 6.3 months), indicating superior longevity with implant-supported restorations under real-world conditions. (Table 2)

Biological complications differed significantly between the two groups. Among implant-supported FPDs, peri-implant mucositis and peri-implantitis were observed in 10% and 6.7% of patients, respectively. In contrast, the tooth-supported group showed a significantly higher incidence of secondary caries (18.3%, p < 0.01) and abutment vitality loss (11.7%, p = 0.042). These findings emphasize the susceptibility of natural abutments to caries and pulpal complications, while implants are more prone to soft tissue inflammation and peri-implant bone loss. (Table 3)

Mechanical complications also varied between groups. Implant-supported prostheses exhibited screw loosening (8.3%) and porcelain chipping (5.0%), while framework fractures were infrequent in both groups. Notably, debonding was exclusive to the tooth-supported group, with 15% of cases affected (p = 0.012), suggesting inferior retention in cemented or bonded natural tooth-supported prostheses compared to screw-retained implant restorations. Overall, while both modalities presented with mechanical complications, the nature and frequency differed, highlighting distinct maintenance challenges for each type. (Table 4)

Table 1. Demographic Distribution of the Study Population (N = 120)

Table 2. 5-Year Survival Rates of FPDs

    *Statistically significant (p < 0.05)

Table 3. Biological Complications Observed During Follow-Up

Table 4. Mechanical Complications Encountered

             *Statistically significant (p < 0.05)

The replacement of missing teeth through fixed dental prostheses (FPDs) has evolved significantly, with both implant-supported and conventional tooth-supported options widely employed. This study aimed to compare the 5-year survival and complication rates associated with these two modalities. The findings indicated superior survival and lower complication rates in the implant-supported FPD group, aligning with trends reported in prior studies.

Implant-supported FPDs demonstrated a survival rate of 93.3% over the 5-year follow-up, which is consistent with the findings of Jung et al., who reported a survival range between 92% and 95% for implant-supported prostheses in prospective studies [5]. In contrast, the 85% survival rate observed for tooth-supported FPDs in the current study reflects challenges posed by caries, endodontic failure, and loss of retention—factors also emphasized by Tan et al. in their systematic review of tooth-supported FPDs [7].

Biological complications were markedly different between the groups. In implant-supported prostheses, peri-implant mucositis and peri-implantitis were the predominant biological issues. These inflammatory conditions of peri-implant tissues are influenced by oral hygiene status, prosthetic design, and patient compliance [8]. Derks and Tomasi emphasized that peri-implant diseases are highly prevalent, affecting nearly 43% of implant patients at some point post-restoration [9]. However, with timely management, the majority of these complications do not progress to implant failure.

Tooth-supported FPDs were more susceptible to complications such as secondary caries (18.3%) and abutment tooth devitalization (11.7%). This is in line with Goodacre et al., who found secondary caries to be the most common cause of failure in traditional FPDs, especially in cases where marginal adaptation was suboptimal [10]. Endodontic failure in abutments may also be attributed to excessive occlusal forces or thermal trauma during prosthetic preparation [11]. Such complications not only compromise prosthesis longevity but also reduce patient satisfaction and increase treatment costs.

Mechanical complications, though present in both groups, differed in type and impact. Implant-supported prostheses experienced issues like screw loosening and porcelain chipping. Screw loosening, observed in 8.3% of cases, has been widely documented in the literature and is commonly associated with inadequate torque application, occlusal overload, or lack of passive fit [12]. Porcelain fracture is another frequent complication, particularly in the posterior zone where masticatory forces are higher [13].

Conversely, debonding was a significant complication exclusive to tooth-supported FPDs (15%), which can be linked to limitations in cement retention, especially when abutments are short or over-tapered. Inadequate bonding protocols or saliva contamination during cementation also contribute to increased failure risk. These findings underscore the importance of optimal preparation design and adhesive protocol selection in conventional prosthodontics [14].

The current study adds to the growing body of evidence favoring implant-supported restorations, particularly for posterior edentulous spaces where biomechanical demands are higher. Furthermore, by avoiding the need to prepare adjacent natural teeth, implants preserve biological width and offer better support distribution. However, this advantage is counterbalanced by the requirement for sufficient bone volume, higher costs, surgical risks, and more extensive chair time [15].

While implant-supported FPDs appear to offer superior longevity and fewer biologically-related failures, they are not free from complications. The present study highlights that while survival may be better, the occurrence of peri-implantitis or mechanical issues like screw loosening needs careful long-term monitoring. On the other hand, tooth-supported FPDs—though initially less invasive and more cost-effective—carry risks tied to the health of natural abutments, including caries and pulp necrosis.

Limitations of the present study include its retrospective nature, reliance on available records, and lack of standardization in follow-up intervals. Additionally, the effect of variables like occlusion type, oral hygiene maintenance, prosthetic material, and parafunctional habits were not analyzed in depth. Future prospective studies with larger sample sizes and controlled variables are warranted to better evaluate long-term comparative outcomes.

In clinical decision-making, patient-specific factors such as bone availability, periodontal health, esthetic concerns, financial considerations, and willingness to undergo surgery should be weighed against the survival and complication rates demonstrated by each prosthetic modality.

Implant-supported fixed dental prostheses showed a significantly higher 5-year survival rate and fewer biological complications compared to tooth-supported FPDs. While mechanical complications were present in both groups, the nature of failures differed, with screw loosening in implants and debonding in teeth being prominent. These findings support the use of implant-supported FPDs as a durable and predictable option, particularly in posterior edentulous spaces, although individual patient considerations remain paramount in treatment planning.

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