Changes in the outcome of metal-ceramic tooth-supported single crowns and FDPs following the introduction of osseointegrated implant dentistry into a prosthodontic practice.
OBJECTIVE
The aim of this study was to prospectively analyze the effect that the incorporation of osseointegrated implant dentistry had on the outcome of metal-ceramic tooth-supported prostheses that had been in situ for 5 to 10 years.


METHODS
The 10-year estimated (Kaplan-Meier) cumulative survival of metal-ceramic tooth-supported single crowns (TSCs) and metal-ceramic tooth-supported fixed dental prostheses (TFDPs) provided for all patients treated at two time periods was determined and statistically compared (log-rank test). Prostheses in group 1 (404 TSCs and 433 TFDP abutments in 189 TFDPs) were cemented between January 1989 and December 1993, with the outcome determined in 1998. Prostheses in group 2 (539 TSCs and 354 TFDP abutments in 142 TFDPs) were cemented between January 1997 and December 2001, with the outcome determined in 2006. A 500% increase in implants restored occurred between the end of group 1 and group 2 time periods.


RESULTS
For TSCs, comparison between groups showed a significantly better survival in group 2 than in group 1 for nonvital TSCs (P = .001), nonvital maxillary anterior teeth (P = .003), nonvital maxillary lateral incisors (P = .008), and nonvital premolars (P = .013). Comparison within groups showed nonvital TSCs had a significantly decreased survival compared to vital TSCs in group 1 (P < .001), but not in group 2 (P = .48). Overall, the estimated cumulative 10-year survival of TSCs in group 2 was 94% +/- 3%. For TFDPs, comparison between groups showed a significantly better survival for nonvital abutments in group 2 than in group 1 (P = .049). Comparison within groups showed nonvital TFDP abutments had a significantly decreased survival compared to vital TFDP abutments in group 1 (P = .001), but not in group 2 (P = .377). Overall, group 2's estimated cumulative 10-year survival for all TFDPs was 90% +/- 6% and for three-unit TFDPs was 97% +/- 2%. Teeth in group 2 failed less through fracture and periodontal disease than those in group 1.


CONCLUSIONS
The incorporation of osseointegrated implant dentistry has resulted in a significant improvement in the survival of TSCs and TFDP abutments, nonvital and vital teeth having equivalent survivals for TSCs and TFDPs, and a decrease in supporting-tooth failure through fracture and periodontal disease.
Walton
Terry R
TR
Faculty of Dentistry, University of Sydney, Sydney, Australia. twalton@mail.usyd.edu.au
D000293:Adolescent; D000328:Adult; D000368:Aged; D001641:Bicuspid / Q000473:pathology; D002484:Cementation; D003442:Crowns; D000044:Dental Abutments; D015921:Dental Implants; D003776:Dental Porcelain; D017267:Dental Prosthesis Design; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D003779:Denture Design; D003830:Denture, Partial, Fixed; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007180:Incisor / Q000473:pathology; D008297:Male; D016876:Metal Ceramic Alloys; D008875:Middle Aged; D016348:Osseointegration / Q000502:physiology*; D011446:Prospective Studies; D016019:Survival Analysis; D019553:Tooth, Nonvital / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult
D015921:Dental Implants; D016876:Metal Ceramic Alloys; D003776:Dental Porcelain