Complications in implant supported fixed prosthodontics: classification, management, prevention

OBJECTIVES The purpose of this study is to provide a narrative review of complications in implant-supported fixed prosthodontics, defining their classification, management, and prevention based on data from the literature. The aim is to discuss the main complications and provide practical clinical recommendations. MATERIALS AND METHODS The search was conducted using the PubMed/MEDLINE database. The inclusion criteria led to the analysis of all selected material by the combination of the following key terms: "complications" AND "implant supported fixed prosthesis" OR "implant supported fixed restoration." Limits applied: last 10 years. Exclusion criteria did not allow consider ation of case reports, reviews, and papers that did not address the topic of complications in implant-supported fixed prosthesis, risk factors, and their prevention and management. Only English-language studies were considered. The search "complications" AND "implant supported fixed prosthesis" yielded 829 results. The search "complications" AND "implant supported fixed restoration" produced 501 results. Titles and abstracts were used to identify potentially relevant papers while eligibility was assessed by reading the full text. A total of 91 potentially relevant articles were identified based on the abstracts. Of these, after full review, 48 articles were selected and included in the narrative review based on the inclusion/exclusion criteria. RESULTS Implant-supported fixed prostheses can incur complications that can be classified into biological complications, which mainly affect the peri-implant hard and soft tissues and can be early and late; mechanical and technical complications that affect the prosthetic restoration components and implant structural integrity; aesthetic complications that include all conditions with negative impact on patient aesthetic satisfaction; and functional complications that affect patient function. Complications in implant-prosthodontics are widespread and can range from minimal complications that are easily managed to catastrophic complications that require complex, time-consuming, and economically burdensome management and may result in redoing the restoration. Prevention of complications begins with proper case selection, which first requires assessment of patient compliance and evaluation of systemic health. Accurate surgical and prosthetic planning are the next steps. CONCLUSIONS Implant-supported fixed prosthesis is subject to complications that can be classified into biological, mechanical and technical, aesthetic, and functional. They are widespread problems, can affect all components of the implant-supported prosthesis, and can be minimal and easily managed or require complex and time-consuming and costly management, and not infrequently coincide with the redo of the restoration. Often decisive factors in the occurrence of most complications are implant malpositioning and occlusal overload, which are major contributors to increased biomechanical risk to both the prosthesis and the supporting implants. Implant-supported full-arch fixed prosthesis is the restoration type with the highest risk of complications and the highest risk of remaking. CLINICAL SIGNIFICANCE Adequate knowledge of complications is a determining factor of successful implant-supported restoration, and knowing how toprevent or intercept them early is crucial to patient satisfaction.Implant distribution and angulation, prosthetic design, prosthetic material selection, and occlusion are the key factors: must be properly planned at the preliminary stage to enable effective prevention of possible complications.