Implant-supported fixed complete dentures restore the fully edentulous jaw with impressive reliability, but reliability is not the same as freedom from trouble. This retrospective cohort followed 91 such prostheses on 498 implants in 72 patients, placed between 2003 and 2023, with a mean observation of 6.8 years and a maximum of 17.

Survival was high. Seven prostheses failed, for a cumulative prosthesis survival of 92.3%, and only 21 of 498 implants (4.2%) were explanted. Yet the complication burden was substantial: 169 complications were recorded over the period, and only 49.5% of prostheses remained complication-free. The trouble was overwhelmingly technical rather than biological. Veneer fracture was the single most frequent event, while peri-implantitis and implant loss were comparatively rare.

Material choice drove much of the risk. Resin-veneered and ceramic-veneered prostheses showed equivalent overall survival, but veneer fracture-free survival was significantly better for ceramic-veneered restorations. Compared with base metal alloy-ceramic prostheses, titanium-resin frameworks carried a markedly higher overall complication risk (hazard ratio 4.25) and a steeply higher risk of veneer fracture (hazard ratio 7.11).

For the implantologist and prosthodontist, the takeaway is that the framework and veneering material are not neutral. The implants will likely osseointegrate and survive; whether the patient returns repeatedly for chipped veneers is decided largely at the planning and material-selection stage. Counsel patients that the prosthesis, not the implant, is the more likely source of long-term maintenance, and weigh ceramic veneering and framework material accordingly.