A retrospective single cohort study on the 5–13 year clinical outcomes of implant‐supported cross‐arch fixed dental prostheses with monolithic zirconia‐based frameworks

Abstract Purpose To investigate the mid‐to‐long term clinical outcomes of the implant‐supported cross‐arch fixed dental prostheses (IFCDPs) with monolithic zirconia‐based frameworks and related risk factors of success and survival. Materials and Methods This retrospective study encompassed individuals exhibiting terminal dentition or edentulism in the maxilla and/or mandible who underwent treatment involving IFCDPs with monolithic zirconia frameworks. Inclusion criteria required a documented follow‐up period of at least five years post‐definitive prosthesis delivery. Evaluation of outcomes focused on the survival rates of implant and prosthesis, along with the incidence of biological and technical complications. The mixed‐effects Cox regression model was employed to analyze the risk factors associated with prosthesis failure and peri‐implantitis. Results A cohort of 47 patients, consisting of 14 women and 33 men with a mean age of 55.2 ± 12.5 years (range: 25–83), was included in this study. The mean follow‐up period was 71.6 ±13.2 months (mean ± SD, range: 60–147). A total of 51 cross‐arch prostheses supported by 302 implants, distributed between the maxilla (27 prostheses) and mandible (24 prostheses), were assessed. By the end of the follow‐up period, 289 (97.64%) of the 302 implants remained functional. Peri‐implantitis was observed in 27 implants (24 in mandible), yielding an overall implant‐related success rate of 91.06%. Nine frameworks experienced fractures (eight in mandible), resulting in an overall prosthesis‐related survival rate of 82.35%. Subsequent analysis revealed the mandible to be a significant risk factor for framework fracture (HR = 11.64, p = 0.024) and peri‐implantitis (HR = 10.88, p = 0.003). Conclusions The implant‐supported cross‐arch fixed dental prostheses featuring monolithic zirconia‐based frameworks demonstrated favorable clinical outcomes throughout a 5–13‐year observation period. Notably, in the design of monolithic zirconia‐based framework prostheses, the mandible emerged as a significant risk factor for framework fractures and an independent risk factor for peri‐implantitis.