Despite a high survival of FPDs, biological and technical complications are frequent. This, in turn, means that substantial amounts of chair time have to be accepted by the clinician following the incorporation of implant-supported FPDs. More studies with follow-up times of 10 and more years are needed as only few studies have described the long-term outcomes.

The present study was done to determine the long-term success and survival of fixed partial dentures (FPDs) and to evaluate the risks for failures due to specific biological and technical complications. A MEDLINE search (PubMed) from 1966 up to March 2004 was conducted, as well as hand searching of bibliographies from relevant articles. Nineteen studies from an initial yield of 3658 titles were finally selected and data were extracted independently by three reviewers. Prospective and retrospective cohort studies with a mean follow-up time of at least 5 years in which patients had been examined clinically at the follow-up visits were included in the meta-analysis. Publications only based on patients records, questionnaires or interviews were excluded. Survival of the FPDs was analyzed according to in situ and intact failure risks. Specific biological and technical complications such as caries, loss of vitality and periodontal disease recurrence as well as loss of retention, loss of vitality, tooth and material fractures were also analyzed. The 10-year probability of survival for fixed partial dentures was 89.1% (95% confidence interval (CI): 81-93.8%) while the probability of success was 71.1% (95% CI: 47.7-85.2%). The 10-year risk for caries and periodontitis leading to FPD loss was 2.6% and 0.7%, respectively. The 10-year risk for loss of retention was 6.4%, for abutment fracture 2.1% and for material fractures 3.2%.

Survival rates of both implants and reconstructions in combined tooth-implant-supported FPDs were lower than those reported for solely implant-supported FPDs (Pjetursson et al. 2004). Hence, planning of prosthetic rehabilitation may preferentially include solely implant-supported FPDs. However, anatomical aspects, patient centered issues and risk assessments of the residual dentition may still justify combined tooth-implant-supported reconstructions. It was evident from the present search that tooth-implant-supported FPDs have not been studied to any great extent and hence, there is a definitive need for more longitudinal studies examining these reconstructions.

This systematic review on cantilever fixed partial dentures indicated that survival and success rates of cantilever fixed partial dentures were lower than those of conventional end-abutment supported FPDs described in a review by Tan et al. (2004) and biological and technical complications were frequent.

Despite the high survival rate of RBBs, technical complications like debonding are frequent. This in turn means that a substantial amount of extra chair time may be needed following the incorporation of RBBs. There is thus an urgent need for studies with a follow-up time of 10 years or more, to evaluate the long-term outcomes.