Clin Oral Impl Res. 2019;1–11. wileyonlinelibrary.com/journal/clr | 1 © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 1 | INTRODUCTION Dental implants have played an integral role in the management of partially edentulous patients in both the maxilla and mandible (Jung, Zembic, Pjetursson, Zwahlen, & Thoma, 2012). Although long‐term success has been widely established, the outcome is influenced by factors that guide clinicians to select the most appropriate surgical and prosthodontic approach (Flemmig & Beikler, 2009; Grossmann, Finger, & Block, 2005). Among these factors is determining whether to use a prostho‐ dontic component composed of splinted versus non‐splinted crowns (Ravida, Barootchi et al., 2018). Splinted crowns tend to distribute Received: 30 July 2018 | Revised: 2 February 2019 | Accepted: 2 February 2019 DOI: 10.1111/clr.13415 ORIGINAL RESEARCH Comparison of three different types of implant-supported fixed dental prostheses: A long-term retrospective study of clinical outcomes and cost-effectiveness Andrea Ravidà 1 | Mustafa Tattan 2 | Houssam Askar 1 | Shayan Barootchi 1 | Lorenzo Tavelli 1 | Hom-Lay Wang 1 1 Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan 2 Department of Periodontics and Iowa Institute for Oral Health Research, University of Iowa College of Dentistry, Iowa City, Iowa Correspondence Hom‐Lay Wang, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI. Email: homlay@umich.edu Abstract Objective: To study the performance of 2–3 posterior bone‐level dental implants constructed with either three non‐splinted crowns (NSC), three splinted crowns (SC), or a 3‐unit implant‐supported bridge over two implants (ISB). Material and methods: Patients treated with three metal‐ceramic NSC, SC, or an ISB were included in the present retrospective study. Implant survival and success rate as well as all biological and technical complications were collected. The cost associated with each of the treatment options was evaluated in the comparative analysis. Results: One hundred and forty‐five patients (40 NSC, 52 SC, and 53 in the ISB) re‐ ceiving 382 bone‐level implants (120 NSC, 106 ISB, and 156 SC) were included (mean follow‐up of 76.2 months). Lack of success was observed in 33.8% of the total patient sample, being lower in the ISB group. Implant survival rates were 92.5% in the NSC, 100% in the ISB, and 88.5% in the SC, with significant difference noted between the ISB and SC ( p = 0.01). Overall, 9.9% of the total implants were found to have peri‐im‐ plantitis (PI), with 16.7% in the SC, 7.5% in the NSC, and 2.8% in the ISB. Patients presenting prosthodontic complications were significantly higher in NSC (32.5%) than ISB (13.2%) and SC (15.4%). The total cost of the ISB group was significantly lower when compared to the NSC and SC groups ( p < 0.001). Conclusions: An 3‐unit implant‐supported bridge restoring 2 implants seems to pre‐ sent the most ideal long‐term therapeutic solution, among the investigated ap‐ proaches in this study, in rehabilitating a 3‐unit edentulous area. KEYWORDS dental implants, implants, implant‐supported fixed dental prosthesis, partially edentulous, splinted