Analysis of Complications Related to the Clinical and Technological Process that Arise in the Long-Term Functioning of Fixed Orthopedic Structures Supported by Dental Implants

Abstract

Summary. The article is devoted to the analysis of complications associated with clinical and technological processes that arise over the long-term functioning of fixed orthopedic structures supported by dental implants, as well as their impact on the success of these structures.
Objective: to quantitatively assess the prevalence of complications associated with clinical and technological processes that arise in the long-term period of functioning, depending on the manufacturing method and method of fixation of fixed orthopedic structures supported on dental implants.
Material and methods. A study was conducted on 204 patients aged 18 to 55 years: 112 women and 92 men (54.9% and 45.1%, respectively) with short-range Kennedy class II and III dentition defects, who were manufactured with orthopedic structures supported by one or two dental implants with an internal cone of the suprastructure of 11 degrees, who were divided into groups depending on the type of fixation and the method of manufacturing orthopedic structures: analog method—91 patients (44.6%) and digital method—113 (55.4%). Clinical cases were analyzed according to the complications that arose: screw loosening, suprastructure detachment, fractures of orthopedic structures, and fractures of implants in periods of up to 1 year, from 1 to 3 years, and over 3 years. An ­analysis of patient satisfaction with the orthopedic construct was also conducted using the NPS (Net Promoter System) system.
Results. According to the analysis of study results, 129 (63.2%) patients over the past 3 years did not have any problems with the function of orthopedic structures supported by dental implants. The remaining patients, namely 75 (36.8%), had certain complications that arose at different periods during the functioning of orthopedic structures supported by dental implants. Thus, during the first year, the number of complications associated with the clinical and technological processes was 20.3%, and the most common complication was screw loosening (11.3%). During the next study period of 1 to 3 years, the percentage of complications increased to 30.9%, and screw loosening accounted for 14.5% and loosening of orthopedic structures for 10.5% of the total number of complications. Over 3 years, the number of complications in the studied groups increased to 55.3%, while in patients who underwent orthopedic restorations using the analog protocol, the frequency of complications was 1.5 times higher than with the digital protocol. The increase in the number of cases of screw loosening was 23.3%, which is 1.5 times more than in the previous period. The frequency of loosening did not increase significantly, remaining at 12.9%. Analysis of patient satisfaction with screw-type fixation: the NPS index was 73% among men and 75% among women; in the cement-type fixation group, the NPS index was 69% among men and 65% among women, indicating relatively high satisfaction with this type of rehabilitation. Patients who underwent orthopedic procedures using the digital method: in the screw-type fixation group, the NPS index was 77% among men and 69% among women; in the cement-type fixation group, the NPS index was 75% among men and 76% among women.
Conclusions. The results of the conducted studies confirm the relevance of this problem and indicate high complication rates (36.8%) that occurred during the long-term operation of orthopedic structures supported by dental implants and were associated with the clinical and technological processes. The highest complication rate was observed with screw fixation of the orthopedic structure (58.6%), and this complication occurred more often in patients with a class II dentition defect according to Kennedy (69.6%). The most common long-term complication in the operation of orthopedic structures was screw loosening, which occurred in 49.1% of cases and increased with increasing observation periods. No significant difference in the quantitative indicators of complications was found between the group of patients who had an orthopedic structure manufactured according to the digital and analog protocols. The patient satisfaction index NPS at the stages of the study ranged from 65 to 77%, which can be considered high, and did not differ significantly depending on the manufacturing method and method of fixation of the fixed orthopedic device supported on dental implants.