Bjarni E.

Pjetursson A systematic review of the survival and

Ken Tan
Niklaus P. Lang
complication rates of fixed partial
Urs Brägger dentures (FPDs) after an observation
Matthias Egger
Marcel Zwahlen period of at least 5 years
I. Implant-supported FPDs

Authors’ affiliations:
Bjarni E. Pjetursson, Niklaus P. Lang, Urs Brägger,
School of Dental Medicine, University of Berne,
Berne, Switzerland
Ken Tan, National Dental Center, Singapore,
Singapore
Matthias Egger, Marcel Zwahlen, Division of
Epidemiology and Biostatistics, Department of
Social and Preventive Medicine, University of
Berne, Berne, Switzerland
Matthias Egger, MRC Health Services Research
Collaboration, Department of Social Medicine,
University of Bristol, Bristol, UK
Correspondence to:
Bjarni E. Pjetursson
Department of Periodontology and
Fixed Prosthodontics
University of Berne
Freiburgstrasse7
CH 3010 Berne
Switzerland
Tel.: þ 41 31 632 2577
Fax: +41 31 632 4915
e-mail: bjarni.pjetursson@zmk.unibe.ch
Date:
Accepted 30 June 2004
To cite this article:
Pjetursson BE, Tan K, Lang NP, Brägger U, Egger M,
Zwahlen M. A systematic review of the survival and
complication rates of fixed partial dentures (FPDs) after
an observation period of at least 5 years. I. Implant-
supported FPDs.
Clin. Oral Impl. Res. 15, 2004; 625–642
doi: 10.1111/j.1600-0501.2004.01117.x
Copyright r Blackwell Munksgaard 2004
Key words: biological complications, complication rates, failures, implant dentistry, long-
itudinal, peri-implantitis, success, survival, systematic review, technical complications
Abstract
Objectives: The objective of this systematic review was to assess the 5- and 10-year survival
of implant supported fixed partial dentures (FPDs) and to describe the incidence of
biological and technical complications.
Methods: An electronic MEDLINE search complemented by manual searching was
conducted to identify prospective and retrospective cohort studies on FPDs with a mean
follow-up time of at least 5 years. Patients had to have been examined clinically at the
follow-up visit. Assessment of the identified studies and data abstraction was performed
independently by two reviewers. Failure and complication rates were analyzed using
random-effects Poisson regression models to obtain summary estimates of 5- and 10-year
survival proportions.
Results: The search provided 3844 titles and 560 abstracts. Full-text analysis was performed
for 176 articles resulting in 21 studies that met the inclusion criteria. Meta-analysis of these
studies indicated an estimated survival of implants in implant-supported FPDs of 95.4%
(95 percent confidence interval (95% CI): 93.9–96.5%) after 5 and 92.8% (95% CI: 90–94.8%)
after 10 years. The survival rate of FPDs supported by implants was 95% (95% CI: 92.2–
96.8%) after 5 and 86.7% (95% CI: 82.8–89.8%) after 10 years of function. Only 61.3% (95%
CI: 55.3–66.8%) of the patients were free of any complications after 5 years. Peri-implantitis
and soft tissue complications occurred in 8.6% (95% CI: 5.1–14.1%) of FPDs after 5 years.
Technical complications included implant fractures, connection-related and suprastructure-
related complications. The cumulative incidence of implant fractures after 5 years was
0.4% (95% CI: 0.1–1.2%). After 5 years, the cumulative incidence of connection-related
complications (screw loosening or fracture) was 7.3% and 14% for suprastructure-related
complications (veneer and framework fracture).
Conclusion: Despite a high survival of FPDs, biological and technical complications are
frequent. This, in turn, means that substantial amounts of chair time have to be accepted by
the clinician following the incorporation of implant-supported FPDs. More studies with
follow-up times of 10 and more years are needed as only few studies have described the
long-term outcomes.
In earlier days, oral implants were mainly of these patients (e.g., Adell et al. 1981). As
used for the treatment of edentulous pa- the years passed the indications for implant
tients, and numerous studies have reported therapy were broadened and today, the
successful outcomes for the rehabilitation majority of patients receiving implants are

625
Pjetursson et al . Systematic review of FPDs
partially edentulous (e.g., Lekholm et al.
1994; Naert et al. 2002a, 2002b).
Clinical research activities in implant
dentistry have mainly focused on implant
survival, and the incidence of biological
and technical complications have been ad-
dressed only to a minor extent. Besides
reporting on survival proportions, occasion-
ally success proportions were reported in
the studies. However, the latter depend on
the variety of criteria for implant success
chosen by the investigators (Albrektsson
et al. 1986; Buser et al. 1990; Karoussis
et al. 2003) and hence, success is not
identically defined in all studies.
In most studies, results of oral implants
supporting a variety of reconstructions,
such as single crowns, fixed partial den-
tures (FPDs), fixed total bridges and over-
dentures, were usually reported without
providing detailed information on the nat-
ure of the reconstructions.
Longitudinal studies may be conducted
in two different ways: (1) as prospective or
retrospective cohort studies that are char-
acterized by the fact that all patients are
followed for the same observation period
and (2) as prospective or retrospective co-
hort studies in which the follow-up time is
not the same for all patients. Such studies
may include patients with various indivi-
dual observation periods.
Traditionally, life table analyses and Ka-
plan–Maier statistics have been applied in
implant survival studies. Often patient co-
horts were analyzed prospectively or retro-
spectively with periods up to a certain
observation time. As an example, a long-
term evaluation of non-submerged ITIs im-
plants, reported an 8-year life table analysis
(Buser et al. 1997) in which the mean follow-
up time was 3.1 years for individual observa-
tion periods that ranged from 1 to 8 years.
The outcome of implant therapy has
been presented in several traditional re-
views (Cochran 1996; Fritz 1996; Esposito
et al. 1998; Fiorellini et al. 1998; van
Steenberghe et al. 1999). In contrast to
results reported in traditional reviews,
meaningful interpretation of survival
proportions and determination of the inci-
dence of biological and technical com-
plications would require a mean observa-
tion period of at least 5 years. A recent
systematic review (Berglundh et al. 2002)
excluded all studies not fulfilling the re-
quirement of at least 5 years observation
626 | Clin. Oral Impl. Res. 15, 2004 / 625–642
period of the reconstruction and concluded
that implant loss prior to functional loading
is to be expected on average in 2.5% of all
implants placed. However, implant loss
during function over 5 years occured in 2–
3% of implants supporting fixed recon-
structions, while in overdenture therapy,
more than 5% of the implants may be
expected to be lost during a 5-year func-
tional period. Hence, a 92–97% survival of
oral implants may be expected over a
period of at least 5 years.
However, the longevity of the prosthetic
appliances on the implants has not yet
been reviewed systematically. Therefore,
the main objective of this systematic
review was to obtain robust estimates of
the long-term survival of implant-sup-
ported FPDs and of the incidence of speci-
fic biological and technical complications
in partially edentulous patients over an
observation period of at least 5 years.
Material and methods
Search strategy and study selection
A MEDLINE (PubMed) search from 1966
up to and including April 2004 was con-
ducted for English-language articles pub-
lished in the Dental Literature text
searching for ‘fixed partial dentures OR
bridges’, ‘partial edentulism’, ‘implants
AND fixed partial dentures OR bridges’,
‘implants’ AND ‘complications’, ‘im-
plants’ AND ‘failures’, ‘implants’ AND
‘longitudinal’.
Manual searches of the bibliographies of
all full-text articles and related reviews,
selected from the electronic search were
also performed. Furthermore, manual
searching was applied to the following
journals for the years 2001–2003: Clinical
Implant Dentistry & Related Research,
Clinical Oral Implants Research, Interna-
tional Journal of Oral & Maxillofacial
Implants, International Journal of Perio-
dontics & Restorative Dentistry, Interna-
tional Journal of Prosthodontics, Journal of
Clinical Periodontology, Journal of Perio-
dontology and Journal of Prosthetic Den-
tistry.
From this extensive search, it was ob-
vious that there were no randomized con-
trolled clinical trials (RCTs) available
comparing implant therapy with conven-
tional reconstructive dentistry.
Inclusion criteria
In the absence of RCTs, this systematic
review was based on prospective or retro-
spective cohort studies. The additional in-
clusion criteria for study selection were:

that the studies had a mean follow-up
time of 5 years or more,

that the publications reported in Eng-
lish and in the Dental literature,

that the included patients had been
examined clinically at the follow-up
visit, i.e., publications based on patient
records only, on questionnaires or inter-
views were excluded,

that the studies reported details on the
characteristics of the suprastructures,

that publications which combined find-
ings of both fixed partial dentures and
single crowns described at least 2/3 of
the reconstruction as FPDs.
Selection of studies
Titles and abstracts of the searches were
initially screened by two independent re-
viewers (B. E. P., K. T. or U. B.) for possible
inclusion in the review. The full text of all
studies of possible relevance was then ob-
tained for independent assessment by the
two reviewers. Any disagreement was re-
solved by discussion. Agreement between
examiners and reviewers was determined
using k statistics (Fig. 1).
Figure 1 describes the process of identify-
ing the 21 studies selected from an initial
yield of 3844 titles. Data were extracted
independently by two reviewers using a
data extraction form. Disagreement regard-
ing data extraction was resolved by con-
sensus.
Excluded studies
Of the 176 full-text articles examined, 155
were excluded from the final analysis (see
reference list).
The main reasons for exclusion were a
mean observation period of less than 5
years, no distinction between the type of
reconstructions or between totally and par-
tially edentulous patients, no data available
with respect to FPDs, multiple publica-
tions on the same patient cohorts with
the same observation period, and case de-
scriptions of implant losses without rele-
vant information on the entire patient
cohort.

First electronic search
3844 Titles
Independently selected by 2 reviewers
640 titles
Kappa score 0.62 Discussion
Discarded
80 titles
Agreed by both
560 titles
Abstracts obtained
Discussion
Agreed on 151 abstracts
Full text obtained
Further handsearching
25 studies
Total full text articles
176
67: Mean follow-up time less than 5 years.
42: No detailed information on FPDs.
18: No information on the reconstructions.
14: Reporting on totally edentulous patients.
5: Multiple publications on the same
patient cohort
2: Reporting on failures without considering
the entire patient cohort
7: Reporting only on combined tooth-
implant supported FPDs (Lang et al. 2004)
Final number of studies included
21
Fig. 1. Search strategy. FPDs, fixed partial dentures.
Data extraction corresponding total exposure time of the
Of the included 21 studies, information on reconstruction was calculated.
the survival proportions of the reconstruc- Results on implant supported and com-
tions and on biological and technical comp- bined tooth–implant-supported FPDs have
lications was retrieved. Biological complica- been analyzed separately and have been
tions included disturbances in the function reported elsewhere (Lang et al. 2004).
of the implant characterized by a biological
process affecting the supporting tissues.
Statistical analysis
‘Peri-implantitis’ and ‘soft tissue complica-
By definition, failure and complication rates
tions’ were included in this category.
are calculated by dividing the number of
Technical complications denoted me-
events (failures or complications) in the
chanical damage of implants, implant
numerator by the total exposure time (FPD
components and/or the suprastructures.
time and/or implant time) in the denomi-
Among these, ‘fractures of the implants,
nator.
screws or abutments’, ‘fractures of the
The numerator could usually be ex-
luting cement’ (loss of retention), ‘fractures
tracted directly from the publication. The
or deformations of the framework or ve-
total exposure time was calculated by tak-
neers’, ‘loss of the screw access hole
ing the sum of:
restoration’ and ‘screw or abutment loosen-
ing’ were included. From the included (1) Exposure time of FPDs/implants that
studies the number of events for all of could be followed for the whole
these categories were abstracted and the observation time.
Pjetursson et al . Systematic review of FPDs
(2) Exposure time up to a failure of the
FPDs/implants that were lost due to
failure during the observation time.
(3) Exposure time up to the end of obser-
vation time for FPDs/implants that
did not complete the observation per-
iod due to reasons such as death,
change of address, refusal to partici-
pate, non-response, chronic illnesses,
missed appointments and work com-
mitments.
For the evaluation of complication-free
FPDs the patient was used as unit of
analysis. For these outcomes total patient
exposure time was calculated by applying
the same procedures as for FPD- or implant
exposure time.
For each study, event rates for FPDs and/
or implants were calculated by dividing the
total number of events by the total FPDs or
implant exposure time in years. For further
analysis, the total number of events was
considered to be Poisson distributed for a
given sum of implant exposure years and
Poisson regression with a logarithmic link
function and total exposure time per study
as an offset variable were used (Kirkwood
& Sterne 2003a, 2003b).
Robust standard errors were calculated
to obtain 95 percent confidence intervals
(95% CI) of the summary estimates of the
event rates. To assess heterogeneity of the
study-specific event rates, the Spearman
goodness-of-fit statistics and associated P-
value were calculated. If the goodness-of-fit
P-value was below 0.05, indicating hetero-
geneity, random-effects Poisson regression
(with g-distributed random effects) was used
to obtain a summary estimate of the event
rates. Five-year and 10-year survival propor-
tions were calculated via the relationship
between event rate and survival function S,
S(T) ¼ exp(  T  event rate), by assuming
constant event rates (Kirkwood & Sterne
2003a, 2003b). The 95% CI for the survival
proportions were calculated by using the
95% confidence limits of the event rates.
Multivariable Poisson regression was used
to investigate formally whether event rates
varied by study design (retrospective versus
prospective cohort studies), year of publica-
tion (1999 or before vs. 2000 or after), or
material (ceramic vs. gold–acrylic as veneer
material). All analyses were performed
using Statas (Stata Corporation, College
Station, TX, USA), version 8.2.
627 | Clin. Oral Impl. Res. 15, 2004 / 625–642
Pjetursson et al . Systematic review of FPDs

Results
Included studies
A total of 21 studies of implant-supported
FPDs were included in the analysis. The
characteristics of the selected studies are
shown in Table 1.
All studies were published within the
past 10 years. These studies reported only
on 16 different patient cohorts as five of the
cohorts were examined after an observation
period of both five and 10 years. Instead of
excluding the 5-year data, the studies were
divided into two groups: A group with
around 5-year follow-up and a second
group with a 10-years follow-up time.
Therefore, the same patients were not in-
cluded twice in the same analysis. Sixteen
of the studies were prospective and the
five remaining were retrospective studies
(Table 1).
The studies included a total of 1123
patients between the age of 15 and 86 years.
The proportion of patients with implants
who could not be followed for the complete
study period was available for 16 of the 21
studies and ranged from 0% to 26%.
The studies reported on five commercially
available implant systems: Astras Tech
Implants Dental System (AstrasTech AB,
Möldal, Sweden), Biocerams sapphire im-
plants (Kyocera America, Inc., San Diego,
CA, USA), The Brånemarks System (No-
bel Biocare AB, Göteborg, Sweden), ITIs
Dental Implant System (Straumann AG,
Waldenburg, Switzerland) and Minimatics
implants (Minimatic Implants Technol-
ogy, Boca Raton, FL, USA).
The studies were mainly conducted in
an institutional environment, such as uni-
versity or specialized implant clinics. Five
of the studies were multicenter studies.
In four of the studies, the patients were
randomized into test and control groups to
compare implant-supported FPDs with
combined tooth–implant-supported FPDs
(Olsson et al. 1995; Gunne et al. 1999),
machined implant surfaces with TiO2-
blasted implant surfaces (Gotfredsen &
Karlsson 2001), titanium frameworks
with conventional cast frameworks (Jemt
et al. 2003) and ceramic abutments to
titanium abutments (Andersson et al.
2003). In this review all the data from the
included studies on implant-supported
FPDs were used irrespective of treatment
modalities.
The 21 studies included a total of 1336
FPDs that were supported by 3578 oral
implants, and 299 of the FPDs were ana-
lyzed both after a follow-up time of 5 and
10 years (Table 2). Of the nine studies that
reported on bridge design, 61% of the FPDs

Table 1. Study and patient characteristics of the reviewed studies

Study (year of publication) Implant system Study design Planned Actual Age Mean Setting Drop-out
Sampling method no. of no. of range age (%)
patients patients
in study in study
5-year follow-up
Preiskel & Tsolka (2004) Brånemark implants Retrospective 44 44 64.2 University 0
Andersson et al. (2003) Brånemark implants Prospective 32 30 15–71 53 University 6
Multicenter, 3 centers and specialist
Randomization
Jemt et al. (2003) Brånemark implants Prospective 42 35 25–74 53 Specialist clinics 17
Multicenter, 4 centers
Randomization
Naert et al. (2002a, 2002b) Brånemark implants Retrospective n.r. 333 15–83 50.5 University n.a.
Gotfredsen & Karlsson (2001) Astra implants Prospective 50 50 53 University 0
Multicenter, six centers and specialist
Randomization
Brägger et al. (2001) ITI implants Prospective n.r. 33 23–83 55.7 University n.r.
Mengel et al. (2001) Brånemark implants Prospective 5 5 35–42 University 0
treated for GAP
Behneke et al. (2000) ITI implants Prospective 55 50 17–81 44.2 University 9
Hosny et al. (2000) Brånemark implants Retrospective n.r. 18 37–65 49.5 University n.r.
Wennerberg & Jemt (1999) Brånemark implants Retrospective 137 114 23–86 60.8 Specialist clinic 17
De Leonardis et al. (1999) Minimatic implants Prospective 33 32 University 3
Örtorp & Jemt (1999) Brånemark implants Retrospective 58 52 28–77 59 Specialist clinic 10
Wyatt & Zarb (1998) Brånemark implants Prospective 88 77 15–72 45.1 University 13
Olsson et al. (1995) Brånemark implants Prospective 23 22 58 University 4
Randomization
Lekholm et al. (1994) Brånemark implants Prospective 159 132 17–70 50 University 17
Multicenter, nine centers and private
10-year follow-up
Brägger et al. (2004) ITI implants Prospective n.r. 29 19–78 49.3 University n.r.
Zarb & Zarb (2002) Brånemark implants Prospective 30 25 University 17
Attard & Zarb (2002) Brånemark implants Prospective n.r. 35 20–65 45.1 University n.r.
Lekholm et al. (1999) Brånemark implants Prospective 127 94 18–70 50 University 26
Multicenter, six centers and private
Gunne et al. (1999) Brånemark implants Prospective 23 20 58 University 13
Randomization
Fartash & Arvidson (1997) Bioceram sapphire implants Prospective 13 13 20–73 51.2 Specialist clinic 0

GAP, generalized aggressive periodontitis; n.r., not reported; n.a., not available.

628 | Clin. Oral Impl. Res. 15, 2004 / 625–642

 Pjetursson et al . Systematic review of FPDs

Table 2. Information on implants and FPDs in the reviewed studies

Study Total no. Total no. Metal/ Gold/ Cemented Screw Follow- Mean
(year of publication) of implants of FPDs ceramic resin retained up range follow-up
5-year follow-up
Preiskel & Tsolka (2004) 286 78 78 0 78n 78n 1–12 6.6
Andersson et al. (2003) 105 36 36 0 19 17 5 5
Jemt et al. (2003) 170 63 63 0 0 63 5 5
Naert et al. 1022 409 340 69 n.r. n.r. 0–16 5.5
(2002a, 2002b)
Gotfredsen & Karlsson 133 52 n.r. n.r. n.r. n.r. 5 5
(2001)
Brägger et al. (2001)w 84 40 40 0 30 10 5 5
Mengel et al. (2001) 36 7 n.r. n.r. n.r. n.r. 5 5
Behneke et al. (2000) 114 68 n.r. n.r. 13 55 5–8.3 5.4
Hosny et al. (2000) 49 18 16 2 0 18 1.3–14 6.5
Wennerberg & Jemt 422 133 31 99 0 133 5 5
(1999)
De Loenardis et al. 100 33 n.r. n.r. n.r. n.r. 5 5
(1999)
Örtorp & Jemt (1999) 194 68 57 11 n.r. n.r. 5 5
Wyatt & Zrb (1998)w 230 97 15 82 0 97 1–12 5.4
Olsson et al. (1995)w 46 23 0 23 0 23 5 5
Lekholm et al. (1994)w 558 197 11 152 0 163 5 5
Total 3549 1322 687 438 62 579 5.3
10-year follow-up
Brägger et al. (2004) 69 33 33 0 25 8 8–12 10
Zarb & Zarb (2002) 94 34 n.r. n.r. 0 34 7–16 12
Attard & Zarb (2002) 105 46 n.r. n.r. 0 46 10–15 12.5
Lekholm et al. (1999) 461 163 11 152 0 163 10 10
Gunne et al. (1999) 46 23 0 23 0 23 10 10
Fartash & Arvidson 29 14 7 7 n.r. n.r. 10 10
(1997)
Total 804 313 51 182 25 274 10.6
n
FPDs were both cemented and screw retained.
wPatients included in 10-year follow-up studies were already analyzed in 5-year follow-up reports.
FPDs, fixed partial dentures; n.r., not reported.

were metal ceramic, while the remainder
were of gold–acrylic design. Only 10% of
the FPDs were cemented, and 90% were
screw retained.
Thirteen studies reported on patient co-
horts in which all the patients were fol-
lowed for the same observation period: With
a follow-up time of 5 years (Lekholm et al.
1994; Olsson et al 1995; De Leonardis et al.
1999; Örtorp & Jemt 1999; Brägger et al.
2001; Gotfredsen & Karlsson 2001; Mengel
et al. 2001; Jemt et al. 2003; Andersson
et al. 2003) and 10 years (Fartash & Arvid-
son 1997; Gunne et al. 1999; Lekholm
et al. 1999; Wennerberg & Jemt 1999).
The other eight studies represented stu-
dies with variable individual observation
periods ranging from 0 to 16 years (Table 2).
Survival
Implant survival
All of the 21 studies reported on the survi-
val of the implants (Table 3). The reports
were separated into two groups. The first
consisted of the 15 studies with a mean
follow-up time of about 5 years (range
5–7.1 years) (Table 2). Of the originally 3549
implants placed, 181 implants were known
to be lost. Forty-nine percent (89/181) of
those implants were lost before loading and
51% (92/181) were lost during function.
The estimated study-specific 5-year survi-
val proportion varied between 86.3% and
99% (Table 3).
The estimated failure rate per 100 im-
plant years ranged from 0.2 to 2.94 (Fig. 2),
and the summary estimate, derived from
random-effects Poisson regression, was
0.94 failures per 100 implant years (95%
CI: 0.7–1.26) (Table 3).
The summary estimate for the survival
proportion after 5 years for implants sup-
porting FPDs was 95.4% (95% CI: 93.9–
96.5%) (Table 3).
Implant loss prior to functional loading
was detected in 2.5% of all implants
placed. For failures after loading, the esti-
mated annual failure rate was 0.51 (95%
CI: 0.39–0.67) for studies with 5 years of
follow-up, and 0.43 (95% CI: 0.32–0.6) for
the studies with 10 years of follow-up (no
significant difference).
The 10 prospective studies and the five
retrospective studies were also analyzed
separately. For the prospective studies,
based on 1576 implants, the summary
estimate of the survival proportion was
95.6% (95% CI: 93.3–97.2%) and for the
retrospective studies, based on 1973 im-
plants, the summary estimate of the survi-
val proportion was 95% (95% CI: 93–
96.4%). Formally investigating the differ-
ence in event rates in a Poisson regression
analysis confirmed the absence of a study
design effect (P ¼ 0.64).
Comparing the event rates from studies
published between 2000 and 2004 with
those from studies published between
1994 and 1999 revealed a 48% lower
(95% CI: 17–67%) implant failure rate in
more recent studies (P ¼ 0.006).

629 | Clin. Oral Impl. Res. 15, 2004 / 625–642

Pjetursson et al . Systematic review of FPDs

Table 3. Annual failure rates and survival of implants

Study Total Mean follow-up No. of Total implant Estimated Estimated Estimated
(year of publication) no. of time failure exposure time failure rate survival after survival after
implants (per 100 5 years (%) 10 years (%)
implant years)
5-year follow-up
Preiskel & Tsolka (2004) 286 6.6 9 1898 0.47 97.7
Andersson et al. (2003) 105 5 3 487 0.61 97
Jemt et al. (2003) 170 7.1 4 1162 0.34 98.3
Naert et al. (2002a, 2002b) 1022 5.5 58 5121 1.13 94.5
Gotfredsen & Karlsson (2001) 133 5 3 604 0.5 97.5
Brägger et al. (2001) 84 5 1 418 0.24 98.8
Mengel et al. (2001) 36 5 2 160 1.25 93.9
Behneke et al. (2000) 114 5.4 5 625 0.8 96.1
Hosny et al. (2000) 49 6.5 2 312 0.64 96.8
Wennerberg & Jemt (1999) 422 5 25 1812 0.14 93.3
De Loenardis et al. (1999) 100 5 1 498 0.2 99
Örtorp & Jemt (1999) 194 5 12 903 1.33 93.6
Wyatt & Zarb (1998) 230 5.4 14 1180 1.19 94.2
Olsson et al. (1995) 46 5 6 204 2.94 86.3
Lekholm et al. (1994) 558 5 36 2365 1.52 92.7
Total 3549 181 17,749
Summary estimate (95% CI)n 0.94 95.4
(0.7–1.26) (93.9–96.5)
10-year follow-up
Brägger et al. (2004) 69 10 1 685 0.15 98.6
Attard & Zarb (2002) 105 12.5 6 1254 0.48 95.3
Zarb & Zarb (2002) 94 12 7 953 0.73 92.9
Lekholm et al. (1999) 461 10 34 3753 0.91 91.3
Gunne et al. (1999) 46 10 6 382 1.57 85.5
Fartash & Arvidson (1997) 29 10 1 286 0.35 96.6
Total 804 55 7313
Summary estimate (95% CI)w 0.75 92.8
(0.54–1.05) (90–94.8)
n
Based on random-effects Poisson regression, test for heterogeneity, P ¼ 0.0007.
wBased on standard Poisson regression, test for heterogeneity, P ¼ 0.081.
FPDs, fixed partial dentures; CI, confidence interval.

Implant Failure Rate The second group consisted of six studies

Andersson et al. with a mean follow-up time of 10.6 years
Jemt et al. (range 10–12.5 years) (Table 2). Of the
Preiskel & Tsolka original 804 implants placed, 55 implants
Naert I et al. were known to be lost. The study-specific
Gotfredsen & Karlsson estimated 10-year survival proportion var-
Braegger et al. ied between 85.5% and 98.6%, and the
Mengel et al. summary estimate of the survival propor-
Behneke et al. tion after 10 years for implants supporting
Study

Hosny et al. FPDs was 92.8% (95% CI: 90–94.8%)

Wennerberg & Jemt (Table 3).
De Loenardis et al.
Örtrop & Jemt
Wyatt & Zarb FPD survival
Olsson et al. FPD survival was defined as the FPD
Lekholm et al. remaining in situ with or without modifi-
Summary Estimate cation for the observation period. Seven-
0.94 (95% CI: 0.70-1.26) teen studies provided data on survival of
the FPDs (Table 4). The reports were di-
0 1 2 3 4 5 6 7 8
vided into two groups: The first group with
Event Rate per 100 Years a total of 1289 FPDs and a mean follow-up
Fig. 2. Annual failure rates (per 100 implants). CI, confidence interval. time of 5.3 years and the second group with

630 | Clin. Oral Impl. Res. 15, 2004 / 625–642

 Pjetursson et al . Systematic review of FPDs

Table 4. Annual failure rate and survival of FPDs

Study (year of publication) Total no. Mean No. of Total FPDs Estimated Estimated Estimated
of FPDs follow-up failure exposure failure rate survival after survival after
time time (per 100 5 years (%) 10 years (%)
FPD years)
5-year follow-up
Preiskel & Tsolka (2004) 78 6.6 2 519 0.39 98.1
Andersson et al. (2003) 36 5 1 164 0.61 97
Jemt et al. (2003) 63 5 3 295 1.02 95
Naert et al. (2002a, 2002b) 409 5.5 15 2049 0.73 96.4
Gotfredsen & Karlsson (2001) 52 5 2 236 0.85 95.9
Brägger et al. (2001) 40 5 1 198 0.51 97.5
Mengel et al. (2001) 7 5 0 33 0 100
Behneke et al. (2000) 68 5.4 1 372 0.27 98.7
Hosny et al. (2000) 18 6.5 0 117 0 100
Örtorp & Jemt (1999) 68 5 3 323 0.93 95.5
Wennerberg & Jemt (1999) 133 5 2 608 0.33 98.4
Wyatt & Zarb (1998) 97 5.4 16 498 3.21 85.2
Olsson et al. (1995) 23 5 4 102 3.92 82.2
Lekholm et al. (1994) 197 5 13 889 1.46 92.9
Total 1289 63 6403
Summary estimate (95% CI)n 1.03 (0.65–1.62) 95 (92.2–96.8)
10-year follow-up
Brägger et al. (2004) 33 10 2 320 0.63 93.9
Lekholm et al. (1999) 163 10 21 1378 1.52 85.9
Gunne et al. (1999) 23 10 4 191 2.09 81.1
Total 219 27 1889
Summary estimate (95% CI)w 1.43 (1.08–1.89) 86.7 (82.8–89.8)
n
Based on random-effects Poisson regression, test for heterogeneity Po0.0001.
wBased on standard Poisson regression, test for heterogeneity P ¼ 0.035.
FPDs, fixed partial dentures; CI, confidence interval.

FPD Failure Rate into a survival proportion after 5 years for

Andersson et al. implant-supported FPDs of 95% (95% CI:
Jemt et al. 92.2–96.8%).
Preiskel & Tsolka The studies in the 5-year observation
Naert et al. group were also divided according to the
Gotfredsen & Karlsson veneer material utilized: A group of seven
Brägger et al. studies with a total of 712 FPDs with
Mengel et al. ceramic as veneer material and a group of
Study

Behneke et al. four studies with a total of 450 FPDs with

Hosny et al. acrylic veneers. The group with metal
Örtrop & Jemt ceramic FPDs showed a significantly
Wennerberg & Jemt higher (P ¼ 0.014) summary estimate of
Wyatt & Zarb the survival proportion after 5 years of
Olsson et al.
96.6% (95% CI: 95.9–97.3%), compared
with a survival of 90.4% (95% CI: 79.8–
Lekholm et al.
95.6%) for the gold–acrylic FPDs.
Summary Estimate In the 10-year observation group, 27 out
1.03 (95% CI: 0.65-1.62)
of 219 FPDs were lost. The study-specific
0 1 2 3 4 5 6 7 8 survival after 10 years varied between
Event Rate per 100 Years 81.1% and 93.9% (Table 4). The summary
estimate of the survival proportion after 10
Fig. 3. Annual failure rates (per 100 fixed partial dentures [FPDs]). CI, confidence interval.
years for implant-supported FPDs was
86.7% (95% CI: 82.8–89.8%).
a total of 219 FPDs and a mean follow-up 100% (Table 4). The estimated failure rate
time of 10 years. per 100 FPD years ranged from 0 to 3.92 Success
In the former group, 63 out 1289 FPDs (Fig. 3) and the summary estimate, derived Success was defined as an FPD being free of
were lost and the study-specific estimated from a random-effects analysis, was 1.03 all complications over the entire observa-
5-year survival varied between 82.2% and (95% CI: 0.65–1.62) (Table 3) translating tion period.

631 | Clin. Oral Impl. Res. 15, 2004 / 625–642

Pjetursson et al . Systematic review of FPDs

Table 5. Any complications in treated patients

Study (year of publication) Total no. Mean No. of Total patient Estimated Estimated
of patients follow-up complications exposure time complication rate success after
time (per 100 patient years) 5 years (%)
5-year follow-up
Jemt et al. (2003) 42 5 22 195 11.28 56.9
Brägger et al. (2001) 33 5 7 163 4.29 80.7
Örtorp & Jemt (1999) 58 5 30 281 10.68 58.6
Wennerberg & Jemt (1999) 133 5 63 608 10.36 59.6
Total 266 122 1247
Summary estimate (95% CI)n 9.78 (8.07–11.86) 61.3 (55.3–66.8)
n
Based on standard Poisson regression, test for heterogeneity P ¼ 0.12.
CI, confidence interval.

Table 6. Biological complications

Study (year of publication) Total no. Mean No. of Total FPDs Estimated failure Estimated cumulative
of FPDs follow-up complications exposure rate (per 100 complication rate
time time FPD years) after 5 years (%)
5-year follow-up
Jemt et al. (2003) 63 5 3 295 1.02 5
Gotfredsen & Karlsson (2001)n 52 5 9 236 3.81 17.4
Brägger et al. (2001) 40 5 4 198 2.02 9.6
Behneke et al. (2000)n 68 5.4 12 372 3.22 14.9
De Leonardis et al. (1999) 33 6.5 1 235 0.42 2.1
Örtorp & Jemt (1999) 68 5 1 323 0.31 1.5
Wennerberg & Jemt (1999) 133 5 15 608 2.48 11.6
Wyatt & Zarb (1998) 97 5.4 13 498 2.61 12.2
Lekholm et al. (1994) 197 5 3 889 0.34 1.7
Total 751 61 3654
Summary estimate (95% CI)w 1.79 (1.05–3.03) 8.6 (5.1–14.1)
n
Incidence of biological complications calculated by adding the incidence after 1 year to half of the events that occurred after that first, assuming that half of
the complications belonged to new patients and the other 50% of the patients that had already experienced a biological complications after 1 year.
wBased on random-effects Poisson regression, test for heterogeneity Po0.0001.
FPDs, fixed partial dentures; CI, confidence interval.

Only three (Örtorp & Jemt 1999;
Wennerberg & Jemt 1999; Jemt et al.
2003) out of 21 studies reported how
many patients were free of complications.
For one study (Brägger et al. 2001) this
information could be extracted from the
orginal database.
These four studies included 266 patients
with a mean follow-up time of 5 years, and
122 patients had some kind of complica-
tions over the observation period (in total
253 complications). The summary esti-
mate of the proportion of success after 5
years was 61.3% (95% CI: 55.3–66.8%)
(Table 5). In other words, 38.7% of the
patients had minor or major complications
in the first 5 years after implantation.
Biological complications
Peri-implant mucosal lesions were reported
in various ways by the different authors.
Nine studies provided information on soft
tissue complications and peri-implantitis.
One study (Gotfredsen & Karlsson 2001)
compared implants with TiO2-blasted and
-machined surfaces and reported a higher
proportion of implants with signs of in-
flammation (pain, redness swelling and
bleeding) at baseline for the TiO2 group
(5% vs. 0%). After 1 year, similar cumu-
lative complication rates were observed
(12% and 9%, respectively). After 5 years,
finally, similar incidences were described
for both groups.
Brägger et al. (2001) defined peri-implan-
titis as probing pocket depth (PPD)
5 mm and bleeding on probing (BOP)
with 10% of the patients (five patients) or
9.6% of the implants being affected.
Behneke et al. (2000) reported that 4% of
the patients had peri-implantitis at pros-
thesis placement. In addition, 9% of the
patients were diagnosed as having peri-im-
plantitis during the first year. During the
second year and thereafter the annual fre-
quency of peri-implantitis was 2–5%.
Other studies (Lekholm et al. 1994;
Wennerberg & Jemt 1999) reported on
‘soft tissue complications’, defined as fis-
tula, gingivitis or hyperplasia.
One study (Wyatt & Zarb 1998) reported
that 13% of the FPDs (13 out of 97) had at
least one soft tissue complication (infection
and/or inflammation) over the observation
period.
In a random-effects Poisson-model ana-
lysis, the pooled cumulative rate of bio-
logical complications after 5 years for
patients treated with implant-supported
FPDs was 8.6% (95% CI: 5.1–14.1%)
(Table 6).
Technical complications
The most common technical complication
was the fracture of a veneer (acryl, ceramic
and composite). After 5 years, 13.2% (95%
CI: 8.3–20.6%) of the FPDs had fractures
of veneers (Table 7).

632 | Clin. Oral Impl. Res. 15, 2004 / 625–642

 Pjetursson et al . Systematic review of FPDs

The second most common technical

metal framework
Estimated rate of

0.16z (0.07–0.36)

0.8%z (0.4–1.8)
complication, loss of the screw access

100 FPD years)

fracture (per hole restoration, was reported only in one
study (Örtorp & Jemt 1999). This occurred
in 8.2% of the anchors.

0.34

0.16
n.r.

n.r.

n.r.
0.4
The third most common technical com-
0

0
0
plication, abutment or occlusal screw loos-
(per 100 FPD years)
of veneer fracture

13.2%y (8.3–20.6)
2.84y (1.74–4.62)
ening, and its cumulative incidence after
Estimated rate

5 years of follow-up was 5.8% (95% CI:

3.8–8.7%) (Table 7).
Fracture of abutments and occlusal
0.19
0.61
3.39
0.85

2.02
1.88

5.57
2.96

4.62
5.51
n.r.
screws occurred in 1.5% (95% CI: 0.8–
2.8%) (Table 7) of the abutments after a
Total FPD
exposure

follow-up time of 5 years and 2.5% (95%

time

CI: 1.6–4.7%) after 10 years.

519
164
295
236

198
372
117
323
608

498
889
Fracture of implants were a rare compli-
no. of

cation with a cumulative incidence of

Total

FPDs

78
36
63
52

40
68
18
68
133

97
197

0.4% (95% CI: 0.1–1.2%) (Table 7) after

a follow-up time of 5 years and 1.8% (95%
or screws (per 100
Estimated rate of

5.8%y (3.8–8.7)
loose abutments

1.19y (0.77–1.82)

CI: 1.2–2.6%) after 10 years.

implant years)

Two studies, both Brägger et al. (2001,

2004), reported on fractures of the luting
cement (loss of retention). They reported a
0.42

0.77
2.81

1.67
2.08

0.22
1.21

0.85
1.15
n.r.

n.r.

cumulative incidence of 2.9% after 5 years

and 16% after 10 years.
screw fracture (per
100 implant years)
of abutment or

0.3y (0.16–0.57)

1.5%y (0.8–2.8)
Estimated rate

Discussion
0.05
0.21
0.17
0.33

0.11
0.88

0.85
0.38

This systematic review is part of a series of

0
0
0

systematic reviews addressing the survival

Estimated rate of

(per 100 implant

0.07z (0.02–0.23)
implant fracture

0.4%z (0.1–1.2)

and complication rates of fixed partial den-

tures of different design.
Systematic reviews have been used in
years)

medicine for the last two decades to sum-

0.09

0.24

0.21

Mean follow-up time was 7.1 years for the implants and 5 years for the FPDs.
n.r.
0

0
0
0
0

marize the cumulative information on the

implantation

optimal treatment for clinically important

FPDs, fixed partial dentures; CI, confidence interval; n.r., not reported.

questions. This research method has

exposure

wInformation was given on number of patients with complications.

slowly found its way into dental research.

Total

487

604

418
625
312
903
1898

1162

1812

1180
2346
time

Systematic reviews have mainly been used

to analyze RCTs (Egger et al. 2001).
implantations

For this systematic review, no RCTs

Total no. of

were available comparing conventional

fixed prosthodontics to implant-supported
285
103
169
133

114

194
422

230
558
84

49

yBased on random-effects Poisson regression.

fixed prosthodontics. In the absence of

RCTs, a lower level of evidence, prospec-
follow-up

zBased on standard Poisson regression.

tive and retrospective cohort studies were

5–7.1n
Mean

6.6

5.5

5.4
6.5

5.4
Table 7. Technical complications

time

5
5

included in this systematic review in order

to summarize the available information
Summary estimate event
Preiskel & Tsolka (2004)

about survival and complication rates of

Andersson et al. (2003)

Gotfredsen & Karlsson

Lekholm et al. (1994)w

Behneke et al. (2000)

Örtorp & Jemt (1999)

Brägger et al. (2001)
(year of publication)

Wyatt & Zarb (1998)

Wennerberg & Jemt

implant-supported fixed partial dentures

Hosny et al. (2000)

complication rates
Cumulative 5 year
Jemt et al. (2003)
5 year follow-up

after a period of at least 5 years.

rates (95% CI)

The results of longitudinal cohort studies

with a mean follow-up time of at least 5
(95% CI)

years regarding survival and success of

(2001)

(1999)
Study

FPDs and their biological and technical

n

complications were reviewed systemati-

633 | Clin. Oral Impl. Res. 15, 2004 / 625–642

Pjetursson et al . Systematic review of FPDs
cally. Survival was defined as FPD remain-
ing in situ with or without modifications.
Success was defined as the FPDs remaining
in situ free of all complications over the
entire observation period.
When multiple publications with differ-
ent follow-up times on the same cohort
were available, only the publication with
the longest follow-up time is generally
included in a systematic review. For five
out of six studies with a mean follow-up
time of 10 years or more, a 5-year report
was also available. Instead of excluding the
5-year data, the studies were divided into
two groups: A group with about 5 years of
follow-up and a second group with about
10 years of follow-up.
Even with follow-up periods of at least
5 years, some clinicians may argue that
this is still too short to obtain reliable
information on survival and complication
rates. Due to the fact that use of dental
implants for rehabilitation of partially
edentulous patients is relatively new, a
mean follow-up period of at least 5 years
was a necessary compromise. However, it
is acknowledged that information on long-
term survival is still scarce, and the results
of the present review should not be extra-
polated to follow-up times measured in
decades. The present review demonstrated
that the existing longitudinal studies did
not include many patients with a prolonged
follow-up time.
The search of the present review aimed
to identify longitudinal cohort studies re-
porting on FPDs. When titles and abstracts
did not provide sufficient information on
study duration and whether or not infor-
mation on the suprastructure was provided,
a full-text analysis of the articles was
carried out. The majority of longitudinal
implant studies did not address the recon-
structions at all. Nor did they distinguish
between different types of reconstructions.
Therefore, a substantial portion of the pub-
lished literature could not be included in
this systematic review. Moreover, only
English-language publications were in-
cluded. This could be problematic for two
reasons: (a) the precision of summary esti-
mates is reduced if a substantial number of
additional studies published in other lan-
guages exist; (b) bias may be introduced if
the results of studies published in English
differ systematically from those published
in other languages. However, a recent em-
634 | Clin. Oral Impl. Res. 15, 2004 / 625–642
pirical study found little effect of the in-
clusion/exclusion of trials published in
language other than English on combined
effect estimates in meta-analyses of RCTs.
(Egger et al. 2003). The search strategy
performed for this review identified indeed
a few studies reporting in other languages.
It is impossible to judge whether or not the
patient cohorts excluded from the present
review might have differed in terms of
survival, event rates and success.
Instead of performing a formal quality
assessment of the included studies and sen-
sitivity analysis, this review used stringent
inclusion criteria. For example, only studies
with a clinical follow-up examination were
included to avoid the potential inaccuracies
in event description in studies that based
their analysis on patient self-reports.
The studies were mainly conducted in
an institutional environment, such as uni-
versity or specialized implant clinics. Five
of the studies were multicenter studies.
Therefore, the long term outcomes ob-
served here cannot be generalized to dental
service provided in private practice.
The cumulative failure rates of implant-
supporting FPDs were 5% after 5 years,
and 7.2% after 10 years, respectively. Ap-
proximately 2.5% or half of the lost im-
plants were lost prior to functional loading.
This result is in agreement with the result
from a previous systematic review (Ber-
glundh et al. 2002). Clearly, a limitation
of the present review is that the assump-
tion of a constant annual event rate is not
fully met when considering the first and
the subsequent years after implantation.
Nevertheless, the results of the present
analysis should be robust as only informa-
tion of studies with a mean follow-up of 5
years or more were included.
The lower event rates in more recently
published studies are compatible with the
hypothesis of a learning curve over the
years, although a later year of publication
does not necessarily translate to later years
of implantation.
Regarding the different implant systems,
the majority of the studies reported on the
experience with the Brånemark Nobel Bio-
care System that showed results below the
average of the entire review. The other
three implant systems, Astras Tech Sys-
tem, ITIs Dental Implant System and
Minimatic implants all yielded results
above the average.
The cumulative failure rate of the im-
plant supported FPDs was 4.8% after 5
years and 13.3% after 10 years. This in-
crease in the failure proportion over the
second five-year period might be explained
by the different FPD design (gold–acrylic)
in the older studies and, to some extent,
also by increased experience of the clinical
research teams.
To evaluate the influence of different
FPD designs on the failure rate the results
from studies reporting on metal ceramic
FPDs were compared with those from stu-
dies reporting on gold–acrylic FPDs. There
was a significant difference with the former
showing a cumulative failure rate of 3.4%
and the latter one 9.6% over a 5-year
period. The high failure rate of the FPDs
with a gold framework and acrylic veneers
is thought to be due to high numbers of
veneer fractures and esthetic complica-
tions.
Only three studies (Örtorp & Jemt 1999;
Wennerberg & Jemt 1999; Jemt et al. 2003)
reported on success, i.e., number of pa-
tients without any complications at all
during the observation period. There is
definitely a lack of detailed, standardized
information on complications. The sum-
mary estimate of the cumulative complica-
tion rate after an observation period of
5 years was 38.7%. The complications
may be minor, such as screw or abutment
loosening, loss of access hole restorations,
loss of retention or minor acryl/ceramic
chipping, or they may be major, such
as implant fractures, fractures of the
metal framework or veneer material that
require replacement of the entire recon-
struction.
The cumulative incidence of peri-im-
plantitis and soft tissue complication was
8.6% after a follow up time of 5 years. For
the biologic complications the results must
be interpreted with caution, because of
different criteria for soft tissue complica-
tions being used in various studies.
Literature-based systematic reviews of
prognosis and survival outcomes are ham-
pered by a variety of problems (Altman
2001). The present systematic review re-
vealed several shortcomings in the previous
clinical studies. Hence, it appears appro-
priate to make the following recommenda-
tions: Long-term cohort studies on dental
implants should be prospective, have com-
plete follow-up information preferentially

with similar length of follow-up for all
patients. This means that data on well-
defined time periods should be reported
for the entire cohort, especially for the
different years after implantation. Due to
various definitions of implant success
authors should report data on implant sur-
vival in combination with incidence of
complications. The events of implant loss
should be grouped into losses that occur
prior to loading and those that take place
during function. Survival and success (free
of all complications) of the suprastructures
should be reported. Well-defined criteria
should be used for the assessment of the
biological and technical complications.
Data from clinical and radiographic assess-
ments should be described as frequency
distributions. Collaborative efforts to con-
duct a pooled individual patient data ana-
lysis of the patients and implants in the
various studies would allow to develop and
use common definitions of complications
and to obtain a clearer picture on true long-
term survival.
Clinical assessments should include
PPD, clinical attachment level (CAL) and
BOP. Biological complications defined
by (1) the threshold level of PPD, (2)
the presence/absence of BOP/suppura-
tion assessed at any examination interval
and (3) crestal bone loss over time must
be described for implants and neighbor-
ing teeth.
Technical complications should be di-
vided into (1) major: such as, implant
fracture, loss of suprastructures, (2) med-
ium: such as, abutment or abutment frac-
ture, veneer or framework fractures,
esthetic and phonetic complications and
(3) minor: such as abutment and screw
loosening, loss of retention, loss of screw
hole sealing, veneer chipping (may be po-
lished) and occlusal adjustments. The type
and number of events of technical compli-
cations per time interval as well as time/
cost required should also be reported.
In conclusion, it may be stated that
despite the high survival of implant-sup-
ported FPDs (95% after 5 years and 86.7%
after 10 years), biological and technical
complications were frequent (38.7% after
5 years). This, in turn, means that sub-
stantial amounts of chair time have to be
accepted by the patient, dental service and
society at large following the incorporation
of implant supporting FPDs.
Acknowledgements: This study has
been supported by the Clinical
Research Foundation (CRF) for the
promotion of Oral Health, University of
Berne, Switzerland. B. E. P. was an ITI
Scholar for the year 2002/2003 (ITI
Foundation grant).
Conflicts of interest: None declared.
Résumé
L’objectif de cette revue systématique a été de revoir
la survie implantaire après cinq et dix ans de proth-
èses partielles fixées sur implants et de décrire l’in-
cidence des complications biologiques et techniques.
Une recherche Medline complétée par une recherche
manuelle ont identifié des études prospectives et
rétrospectives sur ces prothèses avec un temps
moyen de suivi d’au moins cinq années. Les patients
avaient dû subir un examen clinique lors de ce suivi.
Les études et les relevés des données ont été effectués
de manière indépendante par deux personnes. Les
taux de complications et d’échecs ont été analysés en
utilisant les modèles de régression Poisson avec effets
hasard pour obtenir des estimations des proportions
de survie de cinq à dix ans. La recherche a apporté 3
844 titres et 560 résumés. L’analyse des manuscripts
complets a été effectuée pour 176 articles résultant
en 21 études qui atteignaient les critères d’inclusion.
La méta-analyse de ces études a indiqué une estima-
tion de survie de ces implants dans les groupes
combinés implants-dents de 95,4% (intervalle de
confidence de 95% : 93,9 à 96,5%) après cinq années
et de 92,8% (90,0 à 94,8%) après dix années. Le taux
de survie des prothèses sur implants étaient de
95,0% (92,2 à 96,8%) après cinq années et de 86,7
% (82,8 à 89,8%) après dix années. Seul 61,3% (55,3
à 66,8%) des patients n’avaient eu aucune complica-
tion après cinq années. La paroı̈mplantite et les
complications des tissus mous arrivaient dans 8,6%
(5,1 à 14,1%) des cas après cinq années. Les compli-
cations techniques comprenaient les fractures des
implants, des complications de connexion ou bien
reliés à la superstructure. L’incidence cumulative des
fractures d’implants après cinq ans était de 0,4% (0,1
à 1,2%). Après cinq années, l’incidence cumulative
des complications en relation avec la connexion (vis
lâche ou fracturée) était de 7,3% et 14% des super-
structures avaient des complications (fracture de la
masse ou des veneer). Malgré la survie importante
des prothèses fixées, des complications tant techni-
ques que biologiques sont fréquentes. Ceci signifie
que des quantités importantes de temps au fauteuil
doivent être acceptées par le clinicien après l’inser-
tion d’un implant supportant une prothèse fixée.
Davantage d’études avec un temps de recul de dix
ans ou plus sont nécessaires car seul quelques études
ont décrits la situation à si long terme.
Zusammenfassung
Ziel: Ziel dieser systematischen Übersicht war ei-
nerseits die Bestimmung der Überlebenszeit von
implantat-getragenem festsitzendem Zahnersatz
Pjetursson et al . Systematic review of FPDs
(FPDs) nach 5 und 10 Jahren und andererseits die
Häufigkeit von biologischen und technischen Kom-
plikationen zu beschreiben.
Methoden: Man führte eine manuell ergänzte elek-
tronische Medline-Suche durch, um prospektive und
retrospektive Kohortenstudien über FPDs mit einer
durchschnittlichen Beobachtungszeit von mindes-
tens 5 Jahren zu identifiziernen. Die Patienten
mussten bei den Nachkontrollen auch klinisch un-
tersucht worden sein. Die Aufnahme der ausgewähl-
ten Studien und die Abstraktion der Daten wurde
von zwei Personen unabhängig voneinander durch-
geführt. Mit Hilfe eines Possion Regressionsmodells
analysierte man die Misserfolgs- und Komplika-
tionsraten und erhielt so zusammenfassende Schätz-
werte für die überlebenswahrscheinlichkeit nach 5
und 10 Jahren.
Resultate: Die Suche lieferte 3844 Titel und 560
Abstracts. Die Analyse des gesamten Textes erfolgte
bei 176 Artikeln, von denen aus 21 Studien, die
Einschlusskriterien erfüllten. Die Meta-Analyse
dieser Studien ergab eine geschätzte Überlebensrate
der Implantate in gemischt zahn-implantat-getra-
genen FPDs von 95.4% (95 Prozent Zuverlässigkeit-
sintervall (95% CI): 93.9–96.5%) nach 5 Jahren und
92.8% (95% CI: 90–94.8%) nach 10 Jahren. Die
Überlebensrate der FPDs, die nur von Implantaten
getragen werden betrug 95% (95% CI: 92.2–96.8%)
nach 5 Jahren und 86.7% (95% CI: 82.8–89.8%)
nach 10 Jahren in Funktion. Nach 5 Jahren hatten
nur gerade 61.3% (95% CI: 55.3–66.8%) der
Patienten noch nie irgendwelche Komplikationen.
Nach 5 Jahren waren Periimplantitis und Weichge-
webskomplikationen bei den FPDs in 8.6% der
Fälle einmal aufgetreten (95% CI: 5.1–14.1%).
Die technischen Komplikationen berücksichtigten
Implantatfrakturen sowie Probleme bei der Sekun-
därteilverbindung und den Suprastrukturen. Das
kumulative Eintreffen einer Implantatfraktur nach
5 Jahren betrug 0.4% (95% CI: 0.1–1.2%). Ebenfalls
nach 5 Jahren gab es kumulativ bei 7.3% der Sekun-
därteilverbindungen Probleme (gelöste oder fraktur-
ierte Schrauben) und bei 14% der Suprastrukturen
Komplikationen (Porzellan- oder Gerüstfrakturen).
Zusammenfassung: Trotz einer hohen Überlebens-
rate von FPDs sind biologische und technische
Komplikationen häufig. Dies wiederum bedeutet,
dass der Kliniker nach der Eingliederung von
implantat-getragenen FPDs mit beachtlicher Ar-
beitszeit für Reparaturarbeiten rechnen muss. Es
sind vor allem Langzeitstudien von 10 und mehr
Jahren nötig, weil bisher nur wenige Arbeiten die
Langfristfolgen beschreiben.
Resumen
Objetivos: El objetivo de esta revisión sistemática
fue valorar la supervivencia de dentaduras parciales
fijas soportadas por implantes (FPDs) y describir la
incidencia de complicaciones biológicas y técnicas.
Métodos: Se llevó a cabo una búsqueda electrónica
por Medline complementada con una búsqueda
manual para identificar estudios cohorte prospecti-
vos y retrospectivos acerca de FPDs con un tiempo
de seguimiento medio de al menos 5 años. Los
pacientes tenı́an que haber sido examinados clı́nica-
mente en la visita de seguimiento. La valoración de
635 | Clin. Oral Impl. Res. 15, 2004 / 625–642
Pjetursson et al . Systematic review of FPDs
los estudios encontrados y de la abstracción de datos
se llevó a cabo independientemente por dos revi-
sores. Los ı́ndices de fracaso y complicación se
analizaron usando modelos de regresión de efectos
aleatorios de Poisson para obtener estimaciones de
los sumarios de las proporciones de supervivencia a
los 5 y 10 años.
Resultados: Los resultados proporcionaron 3844 tı́-
tulos y 560 resúmenes. Se llevó a cabo análisis de
todo el texto para 176 artı́culos resultando en 21
estudios que coincidieron con los criterios de inclu-
sión. Un meta análisis de estos estudios indicaron
una supervivencia estimada de los implantes en
FPDs soportados por dientes e implantes combina-
dos del 95.4% (Intervalos de confianza del 95 por
ciento (95% DI): 93.9–96.5) tras 5 años y 86.7%
(95% CI: 82.8–89.8%) tras 10 años en función. Solo
el 61.3% (95% CI: 55.3–66.8%) de los pacientes
estuvieron libres de complicaciones tras 5 años.
Periimplantitis y complicaciones de los tejidos blan-
dos ocurrieron en el 8.6% (95% CI 5.1–14.1%) de
los FPDs tras 5 años Las complicaciones técnicas
incluyeron fracturas de implantes, complicaciones
relacionadas con la conexión de la supraestructura.
La incidencia acumulada de fracturas de implantes a
los 5 años fue del 0.4% (95% CI: 0.1–1.2%). Tras 5
años la incidencia acumulada de complicaciones
relacionadas con la conexión (aflojamiento o fractura
de tornillos) fue del 7.3% y del 14% para las
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tions.
Bergendal, B. & Palmqvist, S. (1999) Laser-welded
titanium frameworks for implant supported fixed
prostheses: a 5-year report. International Journal of
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Block, M.S., Gardinger, D., Kent, J.N., Misiek, D.J.,
Finger, I.M. & Guerra, L. (1996) Hydroxy-
apatite-coated cylindrical implants in the post-
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Journal of Oral & Maxillofacial Implants 11:
626–633.
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Block, M.S. & Kent, J.N. (1992) Prospective review
of integral implants. Dental Clinics of North Amer-
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up on hydroxylapatite-coated cylindrical dental im-
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637 | Clin. Oral Impl. Res. 15, 2004 / 625–642
Pjetursson et al . Systematic review of FPDs
recent periods. Journal of Oral and Maxillofacial
Surgery 52: 937–943.
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Bosker, H & van Dijk, L. (1989) The transmandi-
bular implant: a 12-year follow-up study. Journal of
Oral and Maxillofacial Surgery 47: 442–450.
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Brocard, D., Barthet, P., Baysse, E., Duffort, J.F., Eller,
P., Justumus, P., Marin, P., Oscaby, F., Simonet, T.,
Benque, E. & Brunel, G.A. (2000) A multicenter
report on 1,022 consecutively placed ITI implants: a
7-year longitudinal study. International Journal of
Oral & Maxillofacial Implants 15: 691–700.
Exclusion criteria: mean follow-up time less than
5 years.
Brose, M.O., Avers, R.J., Rieger, M.R. & Duck-
worth J.E. (1989) Submerged aluminia dental root
implants in humans: five-year evaluation. The Jour-
nal of Prosthetic Dentistry 61: 594–601.
Exclusion criteria: no detailed information on FPDs.
Buchmann, R., Khoury, F., Faust, C. & Lange, D.E.
(1999) Peri-implant conditions in periodontally com-
promised patients following maxillary sinus augmen-
tation. Clinical Oral Implants Research 10: 103–110.
Exclusion criteria: no detailed information on FPDs.
Buchs, A.U., Hahn, J. & Vassos, D.M. (1995)
Interim clinical study report: a thereaded, hydroxyl-
apatite-coated implant – five-year post-restoration
safety and efficacy. Journal of Oral Implantology
11: 266–274.
Exclusion criteria: mean follow-up time less than
5 years.
Buchs, A.U., Hahn, J. & Vassos, D.M. (1995)
Efficacy of threaded hydroxyapatite-coted implants
placed in the anterior maxilla. Implant Dentistry 4:
272–275.
Exclusion criteria: mean follow-up time less than
5 years.
Buser, D., Mericske-Stern, R., Dula, K. & Lang,
N.P. (1999) Clinical experience with one-stage non-
submerged implants. Advances in Dental Research
13: 153–161.
Exclusion criteria: no detailed information on FPDs.
Buser, D., Mericske-Stern, R., Bernard, J.P., Beh-
neke, A., Behneke N., Hirt, H.P., Belser, U.C. &
Lang, N.P. (1997) Long-term evaluation of non-
submerged ITI implants. Part 1: 8-year life table
analysis of a multi-center study with 2359 implants.
Clinical Oral Implants Research 8: 161–172.
Exclusion criteria: mean follow-up time less than
5 years.
Campelo, L.D., Camara, J.R. (2002) Flapless im-
plant surgery: a 10-year clinical retrospective analy-
sis. International Journal of Oral & Maxillofacial
Implants 17: 271–276.
Exclusion criteria: no information on the reconstruc-
tions.
Carlson, B., Gunnar, E. & Carlsson, E. (1994)
Prosthodontic complications in osseointergrated
dental implant treatment. International Journal of
Oral & Maxillofacial Implants 9: 90–94.
Exclusion criteria: follow-up time less than 5 years.
638 | Clin. Oral Impl. Res. 15, 2004 / 625–642
Cavicchia, F., & Bravi, F. (1994) Free-standing vs
tooth-connected-implant-supported fixed partial re-
storation: a comparative retrospective clinical study
of the prosthetic results. International Journal of
Oral & Maxillofacial Implants 9: 711–718.
Exclusion criteria: mean follow-up time less than
5 years.
Chanavaz, M. (1996) Sinus grafting related to im-
plantology. Statistical analysis of 15 years of surgical
experience (1979–1994). Journal of Oral Implantol-
ogy 22: 119–130.
Exclusion criteria: no information on the reconstruc-
tions.
Chapman, R.J. & Grippo, W. (1996) The locking
taper attachment for implant abutments: use and
reliability. Implant Dentistry 5: 257–261.
Exclusion criteria: no detailed information on FPDs.
Cosci, F. & Cosci, B. (1997) A 7-year retrospective
study of 423 immediate implants. Compendium of
Continuing Education Dentistry 18: 940–942,
944, 946 passim.
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5 years.
Cummings, J. & Arbree, N.S. (1995) Prosthodontic
treatment of patients receiving implants by predoc-
toral students: five-year follow-up with the IMZ
system. The Journal of Prosthetic Dentistry 74:
56–59.
Exclusion criteria: mean follow-up time less than
5 years.
De Bruyn, H., Collaert, B., Lindén, U., Johansson,
C., Albrektsson, T. (1999) Clinical outcome of
Screw Vent implants. Clinical Oral Implants
Research 10: 139–148.
Exclusion criteria: no detailed information on FPDs.
Denissen, H.W., Kalk, W., Veldhuis A.A.H. & van
den Hooff, A. (1989) Eleven-year study of hydro-
xyapatite implants. The Journal of Prosthetic Den-
tistry 61: 706–712.
Exclusion criteria: includes only single crowns and
overdentures.
Deporter, D.A., Todescan, R., Watson, P.A., Phor-
oah, M., Pillar, R.M. & Tomlinson, G. (2001) A
prospective human clinical trial of Endopore dental
implants in restoring the partially edentulous max-
illa using fixed prostheses. International Journal of
Oral & Maxillofacial Implants 16: 527–536.
Exclusion criteria: mean follow-up time less than
5 years.
Eckert, S.E., Meraw, S.J., Cal, E. & Ow, R.K. (2000)
Analysis of incidence and associated factors with
fractured implants: a retrospective study. Interna-
tional Journal of Oral & Maxillofacial Implants 15:
662–667.
Exclusion criteria: no detailed information on FPDs.
Eckert, S.E. & Wollan, P.C. (1998) Retrospective
review of 1170 implants placed in partially edentu-
lous jaws. The Journal of Prosthetic Dentistry 79:
415–421.
Exclusion criteria: mean follow-up time less than
5 years.
Ellegaard, B., Baelum,V. & Karring T. (1997) Im-
plant therapy in periodontally compromised pa-
tients. Clinical Oral Implants Research 8: 180–188.
Exclusion criteria: mean follow-up time less than
5 years.
Elsubeihi, E.S. & Zarb, G.A. (2002) Implant
prosthodontics in medically challenged patients:
the University of Toronto experience. Journal of
the Canadian Dental Association 68: 103–108.
Exclusion criteria: no detailed information on FPDs.
Engel, E., Gomez-Roman, G. & Axmann-Krcmar
D. (2001) Effect of occlusal wear on bone loss and
periotest value of dental implants. International
Journal of Prosthodontics 14: 444–450.
Exclusion criteria: no detailed information on FPDs.
Ericsson, I., Lekholm, U., Brånemark, P.I., Lindhe,
J., Glantz, P.O. & Nyman, S. (1986) A clinical
evaluation of fixed bridge restorations supported by
combination of teeth and osseointegrated titanium
implants. Journal of Clinical Periodontology 13:
307–312.
Exclusion criteria: mean follow-up time less than
5 years.
Evian, C.I. (1996) A comparison of hydroxyapatite-
coated micro-vent and pure titanium Swede-Vent
implants. International Journal of Oral & Maxillo-
facial Implants 11: 639–644.
Exclusion criteria: mean follow-up time less than
5 years.
Fettig, R.H. & Kay, J.F. (1994) A seven-year clinical
evaluation of soft-tissue effects of hydroxylapatite
coated vs. uncoated subperiosteal implants. Journal
of Oral Implantology 20: 42–48.
Exclusion criteria: totally edentulous patients.
Friberg, B., Nilsson, H., Olsson, M. & Palmquist, C.
(1997) Mk II: the self-tapping Brånemark implant: 5-
year result of a prospective 3-center study. Clinical
Oral Implants Research 8: 279–285.
Exclusion criteria: totally edentulous patients.
Fugazzotto, P.A., Gulbranson, H.J., Wheeler, S.L. &
Lindsay, J.A. (1993) The use of IMZ osseointegrated
implants in partially and completely edentulous
patients: success and failure rates of 2,023 implant
cylinders up to 60 þ months in function. Interna-
tional Journal of Oral & Maxillofacial Implants 8:
617–620.
Exclusion criteria: mean follow-up time less than
5 years.
Fugazzotto, P.A., Kirsch, A., Ackermann, K.L. &
Neuendorff, G. (1999) Implant/tooth-connected re-
storations utilizing screw-fixed attachments: a sur-
vey of 3,096 sites in function for 3 to 14 years.
International Journal of Oral & Maxillofacial Im-
plants 14: 819–823.
Exclusion criteria: no detailed information on FPDs.
Fugazzotto, P.A., Wheeler, S.L. & Lindsay, J.A.
(1993) Success and failure rates of cylinder implants
in Type IV bone. Journal of Periodontology 64:
1085–1087.
Exclusion criteria: mean follow-up time less than
5 years.
Garlini, G., Bianchi, C., Chierichetti, V., Sigurtà,
D., Maiorana, C. & Santoro, F. (2003) Retrospective
clinical study of osseotite implants: zero-to 5-year
results. International Journal of Oral & Maxillofa-
cial Implants 18: 589–593.
Exclusion criteria: mean follow-up time less than 5
years.
Golec, T.S. & Krauser, J.T. (1992) Long-term retro-
spective studies on hydroxyapatite-coated endosteal

and subperiosteal implants. Dental Clinics of North
America 36: 39–65.
Exclusion criteria: mean follow-up time less than
5 years.
Gomez-Roman, G., Kruppenbacher, M., Weber,
P.A. & Schulte, W. (2001) Immediate postextrac-
tion implant placement with root-analod stepped
implants: surgical procedure and statistical outcome
after 6 years. International Journal of Oral & Max-
illofacial Implants. 16: 503–513.
Exclusion criteria: mean follow-up time less than
5 years.
Goto, M., Jin-Nouchi, S., Ihara, K. & Katsuki, T.
(2002) Longitudinal follow-up of osseointegrated
implants in patients with resected jaws. Interna-
tional Journal of Oral & Maxillofacial Implants 17:
225–230.
Exclusion criteria: no information on the reconstruc-
tions.
Gunne, J., Åstrand, P., Borg, K. & Olsson, M. (1992)
Implants in partially edentulous patients. A long-
itudinal study of bridges supported by both implants
and natural teeth. Clinical Oral Implants Research
3: 49–56.
Exclusion criteria: mean follow-up time less than
5 years.
Gunne, J., Jemt, T. & Lindén, B. (1994) Implant
treatment in partially edentulous patients: a report
on protheses after 3 years. International Journal of
Prosthodontics 7: 143–148.
Exclusion criteria: mean follow-up time less than
5 years.
Guttenberg, S.A. (1993) Longitudinal report on
hydroxyapatite-coated implants and advanced surgical
techniques in a private practice. Compendium of
Continuing Education Dentistry 15 (Suppl.): 549–553.
Exclusion criteria: mean follow-up time less than
5 years.
Haas, R., Haimböck, W., Mailath, G. & Watzek, G.
(1996) The relationship of smoking on peri-implant
tissue: a retrospective study. The Journal of Pros-
thetic Dentistry 76: 592–596.
Exclusion criteria: no detailed information on FPDs.
Haas, R., Mensdorff-Pouilly, N., Mailath, G. &
Watzek, G. (1996) Survival of 1,920 IMZ implants
followed for up to 100 months. International Jour-
nal of Oral & Maxillofacial Implants 11: 581–588.
Exclusion criteria: mean follow-up time less than
5 years.
Hahn, J. & Vassos, D.M. (1997) Long-term efficacy
of hydroxyapatite-coated cylindrical implants. Im-
plant Dentistry 6: 111–115.
Exclusion criteria: mean follow-up time less than
5 years.
Haraldson, T. & Zarb, G. (1988) A 10-year follow-
up study of the masticatory system after treatment
with osseointergrated implant bridges. Scandina-
vian Journal of Dental Research 96: 243–252.
Exclusion criteria: totally edentulous patients.
Hardt, C.R.E., Gröndahl, K., Lekholm, U. & Wenn-
strön, J.L. (2002) Outcome of implant therapy in
relation to experienced loss of periodontal bone
support: a retrospective 5-year study. Clinical Oral
Implants Research 13: 488–494.
Exclusion criteria: no information on the reconstruc-
tions.
Helldén, L., Ericson, G., Elliot, A., Fornell, J.,
Holmgren, K., Nilner, K. & Olsson, C.O. (2003) A
prospective 5-year multisenter study of the cresco
implantology concept. International Journal of
Prosthodontics 16: 554–562.
Exclusion criteria: no detailed information on FPDs.
Heller, A.L. & Heller, R.L. (1996) Clinical evalua-
tions of a porous-surfaced endosseous implant sys-
tem. Journal of Oral Implantology 22: 240–246.
Exclusion criteria: mean follow-up time less than
5 years.
Henry, P.J., Tollman, D.E. & Bolender, C. (1993)
The applicability of osseointegrated implants in the
treatment of partially edentulous patients: three-
year results of a prospective multicenter study.
Quintessence International 24: 123–129.
Exclusion criteria: mean follow-up time less than
5 years.
Herrmann, I., Lekholm, U. & Holm, S. (2003)
Statistical outcome of random versus selected with-
drawal of dental implants. International Journal of
Prosthodontics 16: 25–30.
Exclusion criteria: multiple publications on the
same patient cohorts.
Herrmann, I., Lekholm, U., Holm, S. & Karlsson, S.
(1999) Impact of implant interdependency when
evaluating success rates: a statistical analysis
of multicenter results. International Journal of
Prosthodontics 12: 160–166.
Exclusion criteria: multiple publications on the
same patient cohort.
Higuchi, K.W., Folmer, T. & Kultje, C. (1995)
Implant survival rates in partially edentulous pa-
tients: a 3-year prospective multicenter study. Jour-
nal of Oral and Maxillofacial Surgery 53: 264–268.
Exclusion criteria: mean follow-up time less than
5 years.
Hultin, M., Fischer, J., Gustafsson, A., Kallus, T. &
Klinge, B. (2000) Factors affecting late fixture loss
and marginal bone loss around teeth and dental
implants. Clinical Implant Dentistry and Related
Research 2: 203–208.
Exclusion criteria: no information on the reconstruc-
tions.
Hultin M., Gustafsson, A. & Klinge, B. (2000)
Long-term evaluation of osseointegrated dental im-
plants in the treatment of partly edentulous patients.
Journal of Periodontology 27: 128–133.
Exclusion criteria: multiple publications on the
same patient cohort.
Hurska, A., Borelli, A., Bordanaro, A.C., Marzaduri,
E. & Hruska, K.L. (2002) Immediate loading im-
plants: a clinical report of 1301 implants. Journal of
Oral Implantology 28: 200–209.
Exclusion criteria: no detailed information on FPDs.
Hürzeler, M.B., Kirsch, A., Ackermann, K.L. &
Quinones, C.R. (1996) Reconstruction of the se-
verely resorbed maxilla with dental implants in the
augmented maxillary sinus: a 5-year clinical inves-
Pjetursson et al . Systematic review of FPDs
tigation. International Journal of Oral & Maxillo-
facial Implants 11: 466–475.
Exclusion criteria: mean follow-up less than 5 years.
Ivanoff, C.J., Grondahl, K., Bergström, C., Lekholm
U. & Brånemark P.I. (2000) Influence of bicortical
or monocortical anchorage on maxillary implant
stability: a 15-year retrospective study of Brånemark
implants. International Journal of Oral & Maxillo-
facial Implants 15: 103–110.
Exclusion criteria: totally edentulous patients.
Ivanoff, C.-J., Grondahl, K., Sennerby, L., Berg-
ström, C. & Lekholm, U. (1999) Influence of varia-
tions in implant diameters: a 3- to 5-year
retrospective clinical report. International Journal
of Oral & Maxillofacial Implants 14: 173–180.
Exclusion criteria: mean follow-up less than 5 years.
Jaffin R.A. & Berman C.L. (1991) The excessive loss
of Brånemark fixtures in Type IV bone: a 5-year
analysis. Journal of Periodontology 62: 2–4.
Exclusion criteria: mean follow-up less than 5 years.
Jeffcoat, M.K., McGlumphy, E.A., Reddy, M.S.,
Geurs, N.C. & Proskin, H.M. (2003) A comparison
of hydroxyapatite (HA)-coated threaded, HA-coated
cylindric, and titanium threaded endosseous dental
implants. International Journal of Oral & Maxillo-
facial Implants 18: 406–410.
Exclusion criteria: totally edentulous patients.
Jemt, T. & Lekholm, U. (1993) Oral implant treat-
ment in posterior partially edentulous jaws: a 5-year
follow-up report. International Journal of Oral &
Maxillofacial Implants 8: 635–640.
Exclusion criteria: multiple publications on the
same patient cohort.
Jones, J.D., Lupori, J., Van Sickels, J.E. & Gardner,
W. (1999) A 5-year comparison of hydroxyapatite-
coated titanium plasma-spray and titanium plasma-
sprayed cylinder dental implants. Oral Surgery, Oral
Medicine, Oral Pathology, Oral Radiology, and
Endodontics 87: 649–52.
Exclusion criteria: no information on the reconstruc-
tions.
Kaptein, M.L.A., De Putter, C., De Lange, G.L. &
Blijdorp, P.A. (1999) A clinical evaluation of 76
implant-supported suprastructures in the composite
grafted maxilla. Journal of Oral Rehabilitation 26:
619–623.
Exclusion criteria: mean follow-up time less than
5 years.
Keller, E.E., Tolman, D. & Eckert, S. (1998) En-
dosseous implant and autogenous bone graft recon-
struction of mandibular discontinuity: a 12-year
longitudinal study of 31 patients. International
Journal of Oral & Maxillofacial Implants 13:
767–780.
Exclusion criteria: no detailed information on FPDs.
Keller, E.E., Tolman, D.E. & Eckert, S. (1999)
Surgical–prosthodontic reconstruction of advanced
maxillary bone compromise with autogenous onlay
block bone grafts and osseointegrated endosseous
implants: a 12-year study of 32 consecutive patients.
International Journal of Oral & Maxillofacial Im-
plants 14: 197–209.
Exclusion criteria: no detailed information on FPDs.
Kent, J.N., Block, M.S., Finger, I.M., Guerra, L.,
Larsen, H. & Misiek D.J. (1990) Biointergrated
639 | Clin. Oral Impl. Res. 15, 2004 / 625–642
Pjetursson et al . Systematic review of FPDs
hydroxylapatite-coated dental implants: 5-year clin-
ical observations. Journal of the American Dental
Association 121: 138–144.
Exclusion criteria: mean follow-up time less than
5 years.
Kucey, B.K.S. (1997) Implant placement in prostho-
dontic practice: a five-year retrospective study. The
Journal of Prosthetic Dentistry 77: 171–176.
Exclusion criteria: mean follow-up time less than
5 years.
Lambrecht, J.T., Filippi,A., Rätzer Künzel, A. &
Schiel, H.J. (2003) Long-term evaluation of sub-
merged and nonsubmerged ITI solid-screw titanium
implants: a 10-year life table analysis of 468 im-
plants. International Journal of Oral & Maxillo-
facial Implants 18: 826–834.
Exclusion criteria: mean follow-up time less than
5 years.
Lazzara, R, Siddiqui, AA., Binon, P., Feldman, SA.,
Weiner R., Phillips, RM. & Genshor, A. (1996)
Retrospective multicenter analysis of 3i endosseous
dental implants placed over a five-year period. Clin-
ical Oral Implants Research 7: 73–83.
Exclusion criteria: mean follow-up time less than
5 years.
Ledermann, P.D., Hassel, T.M. & Hefti, A.F. (1993)
Osseointergrated dental implants as alternative ther-
apy to bridge construction or orthodontics in young
patients: seven years of clinical experience. Pediatric
Dentistry 15: 327–333.
Exclusion criteria: mean follow-up time less than
5 years.
Lekholm, U., Sennerby, L., Roos, J. & Becker, W.
(1996) Soft tissue and marginal bone conditions at
osseointegrated implants that have exposed threads:
a 5-year retrospective study. International Journal of
Oral & Maxillofacial Implants 11: 599–604.
Exclusion criteria: no detailed information on FPDs.
Leonhardt, Å., Gröndahl, K., Bergström, C. &
Lekhom, U. (2002) Long-term follow-up of osseoin-
tegrated titanium implants using clinical, radio-
graphic and microbiological parameters. Clinical
Oral Implants Research 13: 127–132.
Exclusion criteria: no detailed information on FPDs.
Lindh, T., Dahlgren, S., Gunnarsson, K., Josefsson,
T., Nilson, H., Wilhelmsson, P. & Gunne, J. (2001)
Tooth–implant supported fixed prostheses: a retro-
spective multicenter study. International Journal of
Prosthodontics 14: 321–328.
Exclusion criteria: mean follow-up time less than
5 years.
Lindquist, L.W., Carlsson, G.E. & Jemt T. (1997)
Association between marginal bone loss around
osseointergrated mandibular implants and smoking
habits. A 10-year follow-up study. Journal of Dental
Research 76: 1667–1674.
Exclusion criteria: totally edentulous patients.
Lorenzoni, M., Pertl, C., Polansky, R.A., Jakse, N.
& Wegscheider, W.A. (2002) Evaluation of implants
placed with barrier membranes: a retrospective fol-
low-up study to five years. Clinical Oral Implants
Research 13: 274–280.
Exclusion criteria: mean follow-up time less than
5 years.
640 | Clin. Oral Impl. Res. 15, 2004 / 625–642
Lozada, J.L., James, R.A. & Boskovic, M. (1993) HA-
coated implants: Warranted or not? Compendium of
Continuing Education Dentistry 15: 539–543.
Exclusion criteria: mean follow-up time less than
5 years.
McDermott, N.E., Chuang, S.K., Woo, V.V. &
Dodson, T.B. (2003) Complications of dental im-
plants: identification, frequency, and associated risk
factors. International Journal of Oral & Maxillo-
facial Implants 18: 848–855.
Exclusion criteria: mean follow-up time less than
5 years.
McGlumphy, E.A., Peterson, L.J., Larsen, P.E. &
Jeffcoat, M.K. (2003) Prospective study of 429 hy-
droxyapatite-coated cylindric omniloc implants
placed in 121 patients. International Journal of
Oral & Maxillofacial Implants 18: 82–92.
Exclusion criteria: no detailed information on FPDs.
Meriske-Stern, R., Aerni, D., Buser, D. & Geering,
A.H. (2001) Long-term evaluation of non-submerged
hollow cylinder implants: clinical and radiographic
results. Clinical Oral Implants Research 12:
252–259.
Exclusion criteria: no detailed information on FPDs.
Naert, I., Duyck, J., Hosny, M., Jacobs, R., Quir-
ynen M. & van Steenberghe, D. (2001) Evaluation of
factors influencing the marginal bone stability
around implants in the treatment of partial edentu-
lism. Clinical Implant Dentistry and Related Re-
search 3: 30–38.
Exclusion criteria: no detailed information on FPDs.
Naert, I., Quirynen, M., van Steenberghe, M.D. &
Darius, P. (1992) A study of 589 consecutive im-
plants supporting complete fixed prostheses. Part II:
prosthetic aspects. The Journal of Prosthetic Den-
tistry 68: 949–956.
Exclusion criteria: totally edentulous patients.
Naert, I., Quirynen, M., van Steenberghe, D. &
Darius P. (1992) A six-year prosthodontic study of
509 consecutively inserted implants for the treat-
ment of partial edentulism. The Journal of Prosthe-
tic Dentistry 67: 236–245.
Exclusion criteria: mean follow-up time less than
5 years.
Nevins, M. & Langer B. (1993) The successful
application of osseointegrated implants to the poste-
rior jaw: a long-term retrospective study. Interna-
tional Journal of Oral & Maxillofacial Implants 8:
428–432.
Exclusion criteria: mean follow-up time less than
5 years.
Noack, N., Willer, J. & Hoffmann, J. (1999) Long-
term results after placement of dental implants:
longitudinal study of 1, 964 implants over 16 years.
International Journal of Oral & Maxillofacial Im-
plants 14: 748–755.
Exclusion criteria: no detailed information on FPDs.
Nyström, E., Ahlqvist, J., Legrell, P.E. & Kahnberg,
K.-E. (2002) Bone graft remodelling and implant
success rate in the treatment of the severely resorbed
maxilla: a 5-year longitudinal study. International
Journal of Oral & Maxillofacial Surgery 31: 158–164.
Exclusion criteria: no detailed information on FPDs.
O’Roark, W.L. (1997) Survival rate of dental im-
plants: an individual practitioner’s anecdotal review
of 25 years of experience. Journal of Oral Implant-
ology 23: 90–103.
Exclusion criteria: no detailed information on FPDs.
Parein, A.M., Ecker, S.E., Wollan, P.C. & Keller
E.E. (1997) Implant reconstruction in the posterior
mandible: a long-term retrospective study. The
Journal of Prosthetic Dentistry 78: 34–42.
Exclusion criteria: mean follow-up time less than
5 years.
Patrick, D., Zosky, J., Lubar, R. & Buchs, A. (1989)
A longitudinal clinical efficacy of Core-Vent dental
implants: a five-year report. Journal of Oral Im-
plantology 15: 95–103.
Exclusion criteria: mean follow-up time less than
5 years.
Piatelli, A., Sacrano, A. & Piatelli M. (1998) Histo-
logical observation on 230 retrieved dental implants:
8 years’ experience (1989–1996). Journal of Perio-
dontology 69:178–184.
Exclusion criteria: only reporting on failure.
Polizzi, G., Grunder, U., Goené, R., Hatano, N.,
Henry, P., Jackson, W.J., Kawamura, K., Renouard,
F., Rosenberg, R., Triplett, G., Werbitt, M. &
Linthner, B. (2000) Immediate and delayed Implant
placement into extraction sockets: a 5-year report.
Clinical Implant Dentistry and Related Research 2:
93–99.
Exclusion criteria: no information on the reconstruc-
tions.
Pylant, T., Triplett, G., Key, M.C. & Brunsvold,
M.A. (1992) Retrospective evaluation of endosseous
titanium implants in the partially edentulous pa-
tient. International Journal of Oral & Maxillofacial
Implants 7:195–202.
Exclusion criteria: mean follow-up time less than
5 years.
Quirynen, M., Naert, I., van Steenberghe, D., De-
keyser, C. & Callens, A. (1992) Periodontal aspects
of osseointegrated fixtures supporting a partial
bridge. An up to a 6-years retrospective study.
Journal of Clinical Periodontology 19: 118–126.
Exclusion criteria: mean follow-up time less than
5 years.
Quirynen, M., Peeters, W., Naert, I., Coucke, W.,
van Steenberghe, D. (2001) Peri-implant health
around screw-shaped c.p. titanium machined im-
plants in partially edentulous patients with or with-
out ongoing periodontitis. Clinical Oral Implants
Research 12: 589–594.
Exclusion criteria: no information on the reconstruc-
tions.
Raghoebar, G.M., Timmenga, N.M., Reintsema,
H., Stegenga, A.V. & Vissink, A. (2001) Maxillary
grafting for insertion of endosseous implants: results
after 12-124 months. Clinical Oral Implants Re-
search 12: 279–286.
Exclusion criteria: no detailed information on FPDs.
Rangert, B., Krogh, P.H.J., Langer, B. & van Roekel,
N. (1995) Bending overload and implant fracture: a
retrospective clinical analysis. International Journal
of Oral & Maxillofacial Implants 10: 326–334.
Exclusion criteria: only reporting on failures.

Renouard, F., Arnoux, J-P. & Sarment, D.P. (1999)
Five-mm-diameter implants without a smooth sur-
face collar: report on 98 consecutive placements.
International Journal of Oral & Maxillofacial Im-
plants 14: 101–107.
Exclusion criteria: mean follow-up time less than
5 years.
Roos, J., Sennerby, L., Lekholm, U., Jemt, T.,
Gröndahl, K. & Albrektsson, T. (1997) A qualitative
and quantitative method for evaluating implant
success: a 5-year retrospective analysis of the Bråne-
mark implant. International Journal of Oral &
Maxillofacial Implants 12: 504–514.
Exclusion criteria: no detailed information on FPDs.
Saadoun, A.P. & Le Gall, M.G. (1996) An 8-year
compilation of clinical results obtained with steri-
oss endosseous implants. Compendium of Continu-
ing Education Dentistry 17: 669–674.
Exclusion criteria: mean follow-up time less than
5 years.
Salonen, M.A.M., Raustia, AM., Kainulainen,V. &
Oikarinen, KS. (1997) Factors related to Periotest
values in endosseal implants: a 9-year follow-up.
Journal of Clinical Periodontology 24: 272–227.
Exclusion criteria: no detailed information on FPDs.
Sbordone, L., Barone, A., Ciaglia, R.N., Ramaglia,
L. & Iacono V.J. (1999) Longitudinal study of dental
implants in periodontally compromised population.
Journal of Periodontology 70: 1322–1329.
Exclusion criteria: mean follow-up time less than
5 years.
Schliephake, H., Neukam, F.W., Schmelzeisen, R.
& Wichmann, M. (1999) Long-term results of en-
dosteal implants used for restoration of oral function
after oncologic surgery. International Journal of
Oral & Maxillofacial Surgery 28: 260–265.
Exclusion criteria: mean follow-up time less than
5 years.
Schliephake, H., Neukam, F.W. & Wichmann, M.
(1997) Survival analysis of endosseous implants in
bone grafts used for the treatment of severe alveolar
ridge atrophy. Journal of Oral and Maxillofacial
Sugery 55: 1227–1233.
Exclusion criteria: no detailed information on FPDs.
Schliephake, H., Schmelzeisen, R., Husstedt, H. &
Schmidt-Wondera, L-U. (1999) Comparison of the
late results of mandibular reconstruction using non-
vascularized or vascularized grafts and dental implant.
Journal of Oral and Maxillofacial Surgery 57:
944–950.
Exclusion criteria: mean follow-up time less than
5 years.
Schnitman, P.A., Wöhrle, P.S., Rubenstein, J.E., Da
Silva, J.D. & Wang, N-H. (1997) Ten-year results for
Brånemark implants immediately loaded with fixed
prostheses at implant placement. International Jour-
nal of Oral & Maxillofacial Implants 12: 495–503.
Exclusion criteria: no detailed information on FPDs.
Schwartz-Arad, D. & Chaushu, G. (1997) Place-
ment of implants into fresh extraction sites: 4 to 7
years retrospective evaluation of 95 immediate im-
plants. Journal of Periodontology 24: 272–277.
Exclusion criteria: no detailed information on FPDs.
Sethi, A. & Kaus, T. (2000) Maxillary ridge expan-
sion with simultaneous implant placement: 5-year
results of an ongoing clinical study. International
Journal of Oral & Maxillofacial Implants 15: 491–499.
Exclusion criteria: no detailed information on FPDs.
Sethi, A., Kaus, T., Sochor, P., Axmann-Krcmar, D.
& Chenavaz, M. (2002) Evolution of the concept
of angulated abutments in implant dentistry:
14-year clinical data. Implant Dentistry 11: 41–51.
Exclusion criteria: no detailed information on FPDs.
Smithloff, M. & Fritz, M.F. (1982) The use of blade
implants in a selected population of partially eden-
tulous adults: a ten-year report. Journal of Perio-
dontology 53: 413–418.
Exclusion criteria: no information on the reconstruc-
tions.
Smithloff, M. & Fritz, M.F. (1987) The use of blade
implants in a selected population of partially eden-
tulous adults: a 15-year report. Journal of Perio-
dontology 58: 589–593.
Exclusion criteria: no information on the reconstruc-
tions.
Snauwaert, K., Duyck, J., van Steenbergh, D., Quir-
ynen, M. & Naert, I. (2000) Time dependent failure
rate and marginal bone loss of implants supported
prostheses: a 15-year follow-up study. Clinical Oral
Investigations 4: 13–20.
Exclusion criteria: mean follow-up time less than
5 years.
Sonoyama, W., Kuboki, T., Okamoto, S., Suzuki,
H., Kanyama, M., Yatani, H. & Yamashita, A.
(2002) Quality of life assessment in patients with
implant-supported and resin bonded fixed prosthesis
for bounded edentulous spaces. Clinical Oral Im-
plants Research 13: 359–364.
Exclusion criteria: no information on the reconstruc-
tions.
van Steenberghe, D. (1989) Retrospective multicen-
ter evaluation of the survival rate of osseointegrated
fixtures supporting fixed partial prostheses in the
treatment of partial edentulism. The Journal of
Prosthetic Dentistry 61: 217–223.
Exclusion criteria: mean follow-up time less than
5 years.
van Steenberghe, D., Klinge, B., Lindén U., Quir-
ynen, M., Herrmann, I. & Garpland, C. (1993)
Periodontal indices around natural and titanium
abutments: a longitudinal multicenter study. Jour-
nal of Periodontology 64: 538–541.
Exclusion criteria: mean follow-up time less than
5 years.
van Steenberghe, D., Lekholm, U., Bolender, C.,
Folmer, T., Henry, P., Herrmann, I., Higuchi, K.,
Laney, W., Lindén, U. & Åstrand P. (1990) The
applicability of osseointegrated oral implants in the
rehabilitation of partial edentulism: a prospective
multicenter study on 558 implants. International
Journal of Oral & Maxillofacial Implants 5: 272–281.
Exclusion criteria: mean follow-up time less than
5 years.
van Steenberghe, D., Sullivan, D.Y. & Liström, R.
(1989) A retrospective multicenter evaluation of the
survival rate of osseointergrated fixture supporting
bridges in the treatment of partial edentulism. The
Journal of Prosthetic Dentistry 61: 217–223.
Exclusion criteria: mean follow-up time less than
5 years.
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