Early complications of fixed dental prostheses as predictors of

long-term clinical outcome

Kamilė Poškaitė

1

, Aušra Baltrušaitytė

2

1

Lithuanian University of Health Sciences, Faculty of Odontology, Kaunas, Lithuania

2

Aim. The aim of this study was to systematically review the scientific literature and to evaluate early

complications of fixed dental prostheses (FDPs) and their impact on long-term clinical performance.

Materials and Methods. A systematic literature review was conducted in accordance with the PRISMA

guidelines. The literature search was conducted from July 5, 2017up to February 18, 2026, using the following

electronic databases: PubMed, ScienceDirect and the Cochrane Library. Eight in vivo studies published in English

that evaluated early biological and technical complications of fixed dental prostheses were selected for analysis.

The quality of the studies was also assessed.

Results. The 8 selected in vivo studies were divided into two groups based on the aspect under investigation. The

first group evaluated biological complications of restorations, with secondary caries, periodontal disease, and peri-

implantitis being the most commonly identified. The second group analyzed technical complications of fixed

Keywords. FDPs, biological complications, technical complications, dental prosthesis failure, prosthesis design

complications

Ankstyvosios fiksuotų dantų protezų komplikacijos kaip ilgalaikių

klinikinių rezultatų prognostiniai rodikliai

Kamilė Poškaitė

1

, Aušra Baltrušaitytė

2

1

technologijomis ir pažangiomis keramikos medžiagomis, pavyzdžiui, cirkonio oksidu, taip pagerinant jų

veiksmingumą ir estetiką. Nepaisant aukštų ilgalaikio sėkmės rodiklių, jų rezultatams vis dar daro įtaką biologinės

ir techninės komplikacijos.

Tikslas. Atlikti mokslinės literatūros apžvalgą ir įvertinti ankstyvas fiksuotų dantų protezų komplikacijas ir jų

poveikį ilgalaikiam klinikiniam veiksmingumui.

Metodika. Sisteminė literatūros apžvalga atlikta remiantis PRISMA gairėmis. Literatūra ieškota nuo 2017 liepos

5d., d. iki 2026 m. vasario 18d. , naudojantis elektroninėmis duomenų bazėmis: PubMed, ScienceDirect ir

Cochrane library. Analizei atrinktos 8 anglų kalba publikuotos in vivo studijos, vertinančios ankstyvąsias

biologines ir technines fiksuotų dantų protezų komplikacijas. Taip pat įvertinta tyrimų kokybė.

Rezultatai. Atrinkti 8 in vivo tyrimai buvo suskirstyti į dvi grupes pagal tiriamą aspektą. Pirmoje grupėje vertintos

priklauso nuo burnos higienos ir tinkamo protezavimo planavimo.

Raktažodžiai. FDP, biologinės komplikacijos, techninės komplikacijos, dantų protezų nesėkmės, protezų

konstrukcijos komplikacijos.

1. Introduction

In recent years, the range of restorative materials for

implant-supported reconstructions has expanded

considerably. Although metal–ceramic restorations

were previously considered the gold standard, the

the use of more cost-effective materials and more

efficient manufacturing processes. As a result, the

use of all-ceramic materials, particularly zirconia,

this type of treatment, high expectations are placed

on the long-term success, durability, and clinical

performance of these restorations under functional

conditions [5]. The ongoing demand for improved

aesthetics has driven the development and selection

of advanced restorative materials for both tooth- and

implant-supported prostheses [6,1]. Existing

evidence suggests that FDPs may demonstrate long

survival times, reaching up to 20 years in function.

However, their longevity can be compromised by

definitive failures, particularly when they can be

managed clinically [3 - 9]. In contrast, biological

complications, including caries and the need for

endodontic treatment, are generally considered more

critical, as they may significantly affect the long-

term prognosis of the restoration. A comprehensive

pre-treatment diagnostic assessment is essential for

reducing the risk of complications in prosthetic

treatment. Furthermore, the occurrence of

complications is influenced by multiple factors, such

as oral health conditions, implant positioning,

prosthetic design, the selection of restorative

materials and pathological conditions brought about

by inadequate prosthetic manufacturing or poor oral

studies, outcomes were assessed using clinical and

radiographic examinations, OHI-S index, and

survival analyses such as Kaplan–Meier curves, in

2. Materials and Methods

2.1. Protocol

This systematic review was conducted and reported

following the guidelines of Preferred Reporting

Items for Systematic Reviews and Meta-Analysis

(PRISMA).

2.2. Focus question

According to the PICOS framework, the study

included randomized, prospective, and retrospective

controlled and non-randomized clinical trials

focused on the occurrence of biological and

technical complications and their potential role as

predictors of long-term clinical outcomes.

The developed focus question was : what are the

main early biological and technical complications

associated with treatment using FDPs. .

The literature search was conducted using four

electronic databases: PubMed, Cochrane Library

and Sciences Direct. Medical Subject Headings

(MeSH) terms used were “FDPs” combined with

“biological/ technical complications”.

Inclusion criteria:

1. Randomized, prospective, and

retrospective studies published in English.

3. Clinical studies in humans (in vivo);

4. Studies involving adult patients;

5. Studies in patients with a fixed dental

prostheses.

9. Selection of studies

Scientific literature was searched from July 5, 2017

up to February 18, 2026. . After removing

duplicates, the abstracts were evaluated based on

inclusion and exclusion criteria. An independent

reviewer conducted the selection, with a senior

reviewer making the final decision. Full-text articles

were screened, and eligible studies were included. A

search in PubMed, Cochrane library and Science

inappropriate abstracts or incomplete texts.

Ultimately, 8 studies were selected for final analysis.

The study selection process is shown in Figure 1.

Data extraction

The study characteristics, including study design,

sample size, follow-up period, and outcome

measures, were independently extracted by the

author.

recommends using the Newcastle-Ottawa Scale

(NOS) as a tool for assessing the quality of

observational studies. This scale assigns a maximum

of nine points (stars) across three domains to

indicate the lowest risk of bias: (1) selection of study

groups (four points), (2) comparability of groups

(two points), and (3) outcome ascertainment (three

points).

Kaplan–Meier analysis, Kruskal–Wallis, Mann–

Whitney U, Wilcoxon signed-rank tests, linear

mixed models, and the Scheffé method, using data

from interviews as well as clinical and radiographic

examinations. The inclusion criteria required

patients to be older than 18 years, to have at least

one missing tooth requiring FDP treatment, and to

rehabilitation, including sufficient intra- and inter-

arch space. Partially edentulous patients treated with

screw-retained FDPs were also included. Patients

3.2. Fixed dental prostheses biological

complications

Several studies have examined the biological

complications of fixed dental prostheses (FDP's) as

predictors of long-term clinical outcomes [13 - 18],

affecting both tooth-supported and implant-

supported restorations. Across the included studies,

the most frequently reported biological

complications were secondary caries, periodontal

disease, and peri-implant disease. These

biological factors in complex restorative designs. In

a study by Simon Dahlgren and co - authors [13],

among the 58 prostheses remaining in function,

secondary caries were observed in almost 19 % of

all prostheses, endodontic complications in four

prostheses, and peri-implantitis in seven prostheses

highlighting the persistence of biologically mediated

failures over a mean follow-up period of 11.2 years.

These findings indicate that biological factors play a

critical role in determining the longevity and clinical

success of combined tooth–implant restoration.

Consistent with these findings, a study by M. Sad

Chaar and co - authors [14] reported that biological

complications in implant-retained fixed dental

secondary caries, which demonstrated a measurable

impact on long-term outcomes. Secondary caries

affected 5 restorations which is approximately 15 %

Zafar and co - authors [15] within this cohort of

tooth supported metal‑ceramic fixed dental

prostheses secondary caries occurred in 6.5 % of the

FDPs, pulpal pathology in 7.9 %, periodontal

disease was observed in 23.7 %, and the highest

percentage - 41,7 % was found in decementation of

FDPs presenting with complications. The authors

noted that most of the decemented FPDs were fitted

on abutments with inadequate resistance and

retention forms. This study found that periodontal

with poor oral hygiene (18.4 %), male patients (14.2

%), and PFM restorations (10.8 %) compared to full

ceramic prostheses (3.6 %). Similar findings have

been reported in the study by Arwa U. Alsaggaf

other authors [18] where caries were observed that

caries were observed in 7.04 %, and periodontal

problems in 2.82 % of all resin bonded FDPs. Sarah

Aloqayli and co - authors [17] reported that

prostheses without posts had a slightly higher

biological complication rate (54.1 %) than those

with posts (53.9 %) (p = 0.381). These findings

highlight that, although secondary caries does not

invariably lead to restoration failure, it represents a

significant biological complication with the

survival. These results are summarized in Table 1.

3.3. Fixed dental prostheses technical

complications

[13, 14, 16, 17 - 20]. In the study by Simon Dahlgren

and co - authors [13], reported 25 % of veneer

fracture while cement failure was around 15 % and

fracture of screw was found in only one of all cases.

Consistent with these findings, the study by M. Sad

Chaar and co - authors [14], the most common

complication was chipping of the veneering ceramic

20.1 %, while debonding was only one of all cases.

As reported in the study by Ali Alenezi and co -

authors [16], results were quite similar, it showed

that fracture (or chipping) was in 7.6 % cases,

whereas debonding was detected in 0,3 % cases. The

study by Irena Sailer and co - authors [19] found that

chipping of veneering ceramics is a common

technical complication of fixed implant prostheses,

depending on the framework material. They also

mentioned that loss of retention due to

decementation is a common technical complication

Aloqayli and co - authors [17] reported 8,4 %

fractures and 8,4 % debonding of all FDPs. Similar

findings have been reported in the study by Arwa U.

Alsaggaf other authors [18] where biggest part of

technical complications took debonding 37.32 %,

also followed by re-cementation 21.83%, fracture of

the prosthesis framework 8.45 % and chipping 7.04

% off all resin bonded FDPs. These results are

summarized in Table 2.

on prosthesis survival than technical complications.

While technical issues mainly ceramic chipping or

framework fractures occur frequently, they are less

critical to long-term success compared to

biologically driven failures.

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