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153
Treatment of Edentulous Mandible with Metal-Acrylic Resin Implant-supported Complete Fixed Dental Prosthesis: A 15- to 20-Year Retrospective Study.

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Introduction

A metal-acrylic resin implant complete fixed dental prosthesis (MRICFDP) is a treatment option commonly used for restoring edentulous arches. Several studies have reported a high success rate with MRICFDPs, making it a reliable treatment option for completely edentulous patients, at least over relatively short-time periods.1-5

 The number of long-term clinical studies assessing the MRICFDP for more than 15 years is limited and clinicians and patients may benefit from knowledge about the outcome of these prostheses in the long term.

 The purpose of this retrospective study was to report the implant and prosthetic complications of mandibular metal-acrylic resin implant complete fixed dental prostheses (MRICFDP) opposing a maxillary complete removable dental prosthesis (CRDP) in a 15 to 20-year, post-placement follow-up period.

Methods and Materials

 Institutional IRB approval was obtained and the dental records of 24 patients (8 males and 16 females) were reviewed retrospectively to find prosthetic and implant complications.  The patients were a subset of a previous prospective study.

21 patients received 5, and 3 patients received 6 standard external hexagon Steri-Oss implants (Nobel Biocare, Yorba Linda, CA) between mental foramina (N=123). The implant dimensions were 3.25 mm or 4.5 mm in diameter, and ranged from 8 mm to 18 mm in length. After the second stage of implant surgery, a mandibular MRIFCDP was fabricated for each patient.
The complications were recorded over 4 reappointment periods: 0 to 5 years, 5 to 10 years, 10 to 15 years, and more than 15 years.
Descriptive statistics were used to report patients’ age, and follow up duration. A cumulative survival rate (CSR) was calculated for the implants and MRICFDPs.
Results
The average follow-up time was 18.5 years (from 15.4 to 20.6 years) post restoration.

5 implants failed to osseointegrate before the second-stage surgery. After the implants were loaded, 6 implants failed. The CSR for the implants in this study was 91.1%.

During the 18.5-year follow up of this study, two mandibular MRICFDPs failed. The CSR of the MRCFDP in this study was 91.7%.
Incidence of Complications
Tooth fracture was the most frequent complication in MRICFDPs.
Re-veneering the entire prosthesis due to wear was the second most frequent complication with MRICFDPs (24 times) and the most prevalent complication of MRICFDPs among the patients (75%).
Tooth Fracture
In both mandibular MRICFDPs and maxillary CRDPs, fractures occurred primarily in the anterior region. Central incisors, canines, and lateral incisors were the most frequently fractured teeth, respectively.

 Re-Veneering

No tooth replacement was required for mandibular MRICFDPs in the first 5-year follow-up period. The frequency of required tooth replacement was evenly distributed in the other 5-year follow-up periods.
Screw Complications
No complications were found in the abutment screws.
Most of the prosthetic screw complications occurred in the most distal implants on each side. 
Other Complications
3 patients (12.5%) experienced bone growth below the distal extension of the mandibular MRICFDPs on both sides (all patients were females). 
Conclusions

1. The CSR for the mandibular MRICFDP was 91.7%. The two failures were because of a framework fracture and failure of the underlying implants due to a tumor resection.

2. The CSR for the implants was 91.1%.

3. Tooth fracture (mainly in the anterior) and wear (mainly in the posterior) were the most common complications with the MRICFDP.

4. Screw complications happened only for the retaining screws and not the abutment screws. Many of these complications occurred in the most distal implant position.

References

1.Priest G, Smith J, Wilson MG. Implant survival and prosthetic complications of mandibular metal acrylic resin implant complete fixed dental prostheses. J Prosthet Dent 2014;111:466-75.
2.Jemt T, Johansson J. Implant treatment in the edentulous maxillae: a 15-year follow-up study on 76 consecutive patients provided with fixed prostheses. Clin Implant Dent Relat Res 2006;8:61-9.
3.Ortorp A, Jemt T. Early laser-welded titanium frameworks supported by implants in the edentulous mandible: a 15-year comparative follow-up study. Clin Implant Oral Relat Res. 2009 ;11:311-22.
4.Lindquist LW, Carlsson GE, Jemt T. A prospective 15-year follow-up study of mandibular fixed prostheses supported by osseointegrated implants. Clinical results and marginal bone loss. Clin Oral Implants Res 1996;7:329-36.
5.Attard NJ, Zarb GA. Long-term treatment outcomes in edentulous patients with implant-fixed prostheses: the Toronto study. Int J Prosthodont 2004;17:417-24.
6.Jeffcoat MK, McGlumphy EA, Reddy MS,Geurs NC, Proskin HM. 2003. A comparison of hydroxyapatite (HA)-coated threaded, HA coated cylindric, and titanium threaded endosseous dental implants. Int J Oral Maxillofac Implants.18:406–410.

 

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