title: Practice-based evidence from 29-year outcome analysis of management of the edentulous jaw using osseointegrated dental implants.
abstract: OBJECTIVE
  The aim of this retrospective study was to summarize practice-based evidence associated with long-term outcomes (>20 years) in the management of edentulous patients. The patient population was managed with implant-supported prostheses, following the original osseointegration protocol, provided over the period from 1983 to 1991 in the group prosthodontics practice at the Mayo Clinic. The data are an example of practice quality assurance monitoring and are used to refine care delivery when needed and to provide information regarding expected outcomes in a shared decision-making interaction with prospective patients.
  
  
  METHODS
  Two hundred and sixty four patients with at least one edentulous jaw were identified. Of these, 255 completed their care and follow-up at the Mayo Clinic (209 mandible only, 35 maxilla only, 11 mandible and maxilla). Prosthodontic outcomes categorized as anticipated or unanticipated prosthetic and biologic events and the respective interventions required for each were recorded to assess follow-up event dynamics for this care modality.
  
  
  RESULTS
  The mean duration of follow-up for 190 of the 255 patients (65 died at a mean follow-up of 12.6 years) was 13.0 years (median 13.6; range 0.3 to 28). At least one prosthetic event was experienced by 148 patients (58%), and 81 (32%) experienced at least one biologic event. Overall, patients experienced 3.8 times more prosthetic events than biologic events. Twenty-four (9%) patients experienced 35 implant failures. Overall survival rates at 20 years were 86% for prostheses, 15% survived free of any event, and 92% experienced survival free of implant failure (95% confidence interval).
  
  
  CONCLUSIONS
  Anticipated and unanticipated prosthetic events occur throughout the life of the hybrid prosthesis. Prosthetic events significantly surpass (four times more) biologic events and occur significantly later in the follow-up. For this patient group, 8.6% (22/255) had implant-supported prostheses remade during follow-up in this patient population. These findings support the recommendation that prosthodontic care for missing teeth be thought of in a "chronic condition" context, recognizing that long-term outcome monitoring to provide realistic care expectations is important for demonstrating care value in oral health promotion.
authors.affiliation: Assistant Professor, Mayo Clinic College of Medicine and Chief Resident, Prosthodontics and Maxillofacial Prosthetics, Department of Dental Specialties, Division of Prosthetic and Esthetic Dentistry, Mayo Clinic, Rochester, MN.
authors.forename: Matilda
authors.initials: M
authors.lastname: Dhima
authors.forename: Vladimira
authors.initials: V
authors.lastname: Paulusova
authors.forename: Christine
authors.initials: C
authors.lastname: Lohse
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Salinas
authors.forename: Alan B
authors.initials: AB
authors.lastname: Carr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D015921:Dental Implants / Q000706:statistics & numerical data*; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure / Q000706:statistics & numerical data; D003779:Denture Design / Q000706:statistics & numerical data; D055094:Evidence-Based Dentistry / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007575:Jaw, Edentulous / Q000534:rehabilitation* / Q000601:surgery; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015921:Dental Implants
keywords: Edentulous jaw; complications; dental implants; follow-up; hybrid; implant-retained dental prosthesis; management; outcome analysis; practice-based evidence