title: Factors affecting the complexity of dental implant restoration - what is the current evidence and guidance?
abstract: Objectives The aim of this paper is to identify the factors that affect the complexity of implant restoration and to explore the indices that help us to assess it. With this knowledge the growing number of clinicians restoring dental implants will have a better understanding of the available guidance and evidence base, and the differing levels of competence required.Study design A literature review was conducted. The selection of publications reporting on complexity was based on predetermined criteria and was agreed upon by the authors. After title and abstract screening 17 articles were reviewed. The articles that were utilised to form the ITI SAC tool and Cologne Risk Assessment we also included.Assessing complexity Two key guides are available: International Team for Implantology's Straight-forward Advanced Complex tool and the Cologne ABC risk score. While these guides help identify treatment complexity they do not provide a strong enough evidence base from which to solely base clinical decisions. The key patient factors are expectation, communication, the oral environment, aesthetic outcome, occlusion, soft tissue profile and the intra-arch distance, whereas the key technical factors are impression taking, type of retention, loading protocol and the need for provisional restorations. Human factors also have a significant effect on complexity, specifically, the experience and training of the clinician, team communication and the work environment.Conclusions There are many interconnecting factors that affect the complexity of dental implant restoration. Furthermore the two widely used indices for the assessment of complexity have been investigated, and although these offer a good guideline as to the level of complexity, there is a lack evidence to support their use. The development of evidence-based treatment and protocols is necessary to develop the current indices further, and these need to be expanded to include other critical areas, such as human factors. A practical guide to aid practitioners in reducing complexity has been proposed.
authors.affiliation: Edge Hill University, Faculty of Health and Social Care, St Helens Rd, Ormskirk, L39 4QP.
authors.forename: S P
authors.initials: SP
authors.lastname: Wright
authors.affiliation: Edge Hill University, Faculty of Health and Social Care, St Helens Rd, Ormskirk, L39 4QP.
authors.forename: J
authors.initials: J
authors.lastname: Hayden
authors.affiliation: Edge Hill University, Faculty of Health and Social Care, St Helens Rd, Ormskirk, L39 4QP.
authors.forename: J A
authors.initials: JA
authors.lastname: Lynd
authors.affiliation: Edge Hill University, Faculty of Health and Social Care, St Helens Rd, Ormskirk, L39 4QP.
authors.forename: K
authors.initials: K
authors.lastname: Walker-Finch
authors.affiliation: Edge Hill University, Faculty of Health and Social Care, St Helens Rd, Ormskirk, L39 4QP.
authors.forename: J
authors.initials: J
authors.lastname: Willett
authors.affiliation: Edge Hill University, Faculty of Health and Social Care, St Helens Rd, Ormskirk, L39 4QP.
authors.forename: C
authors.initials: C
authors.lastname: Ucer
authors.affiliation: Edge Hill University, Faculty of Health and Social Care, St Helens Rd, Ormskirk, L39 4QP.
authors.forename: S D
authors.initials: SD
authors.lastname: Speechley
mesh_terms: D003729:Dental Care; D003758:Dental Implantation, Endosseous; D015921:Dental Implants; D003766:Dental Occlusion; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D006801:Humans
chemical_list: D015921:Dental Implants