Ante's (1926) law revisited:: a systematic review on survival rates and complications of fixed dental prostheses (FDPs) on severely reduced periodontal tissue support

Background: In subjects suffering from generalized severe periodontitis, only a few teeth may be treated and used as abutments for fixed dental prostheses (FDPs). Objective: To systematically review the impact of severely reduced, but healthy periodontal tissue support on the survival rate and complications of FDPs after a mean follow-up time of at least 5 years. Search strategy: Publications considered for inclusion were searched in MEDLINE (PubMed) and relevant journals were hand searched. The search was performed in duplicate and was limited to human studies published in the dental literature from 1966 up to and including September 2006. Only publications in English, in peer-reviewed journals, were considered. Abstracts were excluded. Selection criteria: Prospective and retrospective cohort studies were included. The primary outcome measure included survival rates of FDPs and abutment teeth, whereas biological and technical complications of FDPs and abutment teeth represented secondary outcome measures. Data analysis: Summary estimates of survival rates and of biological and technical complications were calculated after 5 and 10 years. Results: The search provided 860 titles of which six publications were included. A total of 579 FDPs were incorporated and followed up to 25 years. Meta-analysis yielded an estimated FDP survival rate of 96.4% [95% confidence interval (95% Cl): 94.6-97.6%] after five and of 92.9% (95% Cl: 89.5-95.3%) after 10 years, respectively. After 10 years, the estimated rate of abutment teeth without endodontic complications amounted to 93% (95% Cl: 62.6-98.9%). The 10-year estimated rate of caries-free abutment teeth was 98.1 % (95% Cl: 88.2-99.7%). FDPs without loss of retention were estimated to occur in 95.4% (95% Cl: 92.6-97.2%) of cases after 10 years. Conclusions: These results showed that (i) masticatory function could be established and maintained in subjects receiving FDPs on abutment teeth with severely reduced but healthy periodontal tissue support and (ii) FDPs survival rates compared favourably with those of FDPs incorporated in subjects without severely periodontally compromised dentitions.