A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years II. Combined tooth–implant-supported FPDs Niklaus P. Lang Bjarni E. Pjetursson Ken Tan Urs Bra ¨gger Matthias Egger Marcel Zwahlen Authors’ affiliations: Niklaus P. Lang, Bjarni E. Pjetursson, Urs Bra ¨gger, School of Dental Medicine, University of Berne, Berne, Switzerland Ken Tan, National Dental Center, Singapore Matthias Egger, Marcel Zwahlen, Division of Epidemiology and Biostatistics, Department of Social & Preventive Medicine, University of Berne, Berne, Switzerland Matthias Egger, MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Bristol, UK Correspondence to: Prof. Niklaus P. Lang Department of Periodontology and Fixed Prosthodontics University of Berne Freiburgstrasse7 CH 3010 Berne Switzerland Tel.: þ 41 31 632 2577 Fax: þ 41 31 632 4915 e-mail: nplang@dial.eunet.ch Key words: biological complications, combined tooth–implant-supported fixed partial dentures, implant dentistry, complication rates, failures, fixed partial dentures, longitudi- nal, peri-implantitis, success, survival, systematic review, technical complications Abstract Objectives: The objective of this systematic review was to assess the 5- and 10-year survival of combined tooth–implant-supported fixed partial dentures (FPDs) and the incidence of biological and technical complications. Methods: An electronic MEDLINE search supplemented by manual searching was conducted to identify prospective and retrospective cohort studies on FPDs with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data abstraction was performed independently by two reviewers. Failure and complication rates were analyzed using random-effects Poisson regression models to obtain summary estimates of 5- and 10-year survival proportions. Results: From a total of 3844 titles and 560 abstracts, 176 articles were selected for full-text analysis, and 13 studies met the inclusion criteria. Meta-analysis of these studies indicated an estimated survival of implants in combined tooth–implant-supported FPDs of 90.1% (95 percent confidence interval (95% CI): 82.4–94.5%) after 5 and 82.1% (95% CI: 55.8–93.6%) after 10 years. The survival rate of FPDs was 94.1% (95% CI: 90.2– 96.5%) after 5 and 77.8% (95% CI: 66.4–85.7%) after 10 years of function. There was no significant difference in survival of tooth and implant abutments in combined tooth– implant FPDs. After an observation period of 5 years, 3.2% (95% CI: 1.5–7.2%) of the abutment teeth and 3.4% (95% CI: 2.2–5.3%) of the functionally loaded implants were lost. After 10 years, the corresponding proportions were 10.6% (95% CI: 3.5–23.1%) for the abutment teeth and 15.6% (95% CI: 6.5–29.5%) for the implants. After a 5 year observation period, intrusion was detected in 5.2% (95% CI: 2–13.3%) of the abutment teeth. Intrusion of abutment teeth were almost exclusively detected among non-rigid connections. Conclusion: 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. Copyright r Blackwell Munksgaard 2004 Date: Accepted 30 June 2004 To cite this article: Lang NP, Pjetursson BE, Tan K, Bra ¨gger U, Egger M, Zwahlen M. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. II. Combined tooth–implant-supported FPDs. Clin. Oral Impl. Res. 15, 2004; 643–653 doi: 10.1111/j.1600-0501.2004.01118.x 643