Patient-Reported Outcome Measures Focusing on Aesthetics of Implant- and Tooth-Supported Fixed Dental Prostheses
Amsterdam 2018
Patient-Reported Outcome Measures Associated with Implant Dentistry
Consensus Statement
Treatment Outcomes and Continuing Care
Preamble

The aim of this review was to summarize the existing evidence on the aesthetic outcome of implant-supported and tooth-supported fixed dental prostheses (FDPs) in partially edentulous patients according to PROMs. Secondary outcomes were to analyze the influence of restorative material, implant neck design, and the implementation of a provisional phase focusing on PROMs.

In all, 16 publications on implant- supported FDPs, including 19 relevant study cohorts, were identified and met the review inclusion criteria. No publications on tooth-supported FDPs met the inclusion criteria; thus, a comparison could not be performed. However, the group was able to produce consensus statements and clinical recommendations from the studies on implant-supported FDPs.

Consensus Statements
  • The aesthetics of implant-supported FDPs are highly rated by patients (VAS 90; 95%CI: 87.9–92.2).
    This statement was supported by: two RCTs, eight prospective cohort studies, four retrospective studies and two cross-sectional studies, including 867 patients in total.
     
  • Mucosal aesthetics of implant supported FDPs are highly rated by patients (VAS 87; min. 73–max. 92).
    This statement was supported by: one RCT, three prospective cohort studies and one cross-sectional studies, including 315 patients in total.
     
  • Implant neck design, that is, tissue or bone level, has no influence on patients’ ratings of aesthetics: VAS 93 (95% CI: 89–96) versus VAS 89 (95% CI: 86–92)
    This statement was supported by: two RCTs, five prospective cohort studies and two cross-sectional studies, including 443 patients in total.
     
  • Individual restorative materials have no influence on patient ratings of the aesthetics of implant supported FDPs.
    This statement was supported by: two RCTs, five prospective cohort studies, two retrospective studies and two cross-sectional studies, including 556 patients in total.
     
  • The use of a provisional restoration had no effect on patients’ ratings of the aesthetics of definitive restorations on implant supported FDPs.
    This statement was supported by: two RCTs, five prospective cohort studies and two cross-sectional studies, including 359 patients in total.
     
  • No studies were found that reported on PROMs for tooth-supported FDPs in partially edentulous patients.
Clinical Recommendations
  • Can we satisfy the patient’s aesthetic concerns with implant-supported fixed dental prostheses (FDPs)?
    It is possible to achieve high patient satisfaction with aesthetics. It is also possible to achieve highly rated mucosal aesthetics around implants. Hence, implant-supported FDPs can be recommended.
    Based on Consensus Statements 1 and 2.
     
  • Does the selection of tissue or bone level implants influence the patient’s perception regarding aesthetics?
    The individual implant choice of implant-supported FDPs has no influence on ratings of aesthetics. Therefore, the choice of implant type supporting FDPs should be based on factors other than patient ratings of aesthetics.
    Based on Consensus Statement 3.
     
  • Does the restorative material have an impact on the patient’s perception regarding the aesthetic outcome?
    The type of restorative material used in implant-supported FDPs did not influence patient ratings of aesthetics. Therefore, the choice of restorative material for implant-supported FDPs should not be based on PROMs.
    Based on Consensus Statement 4. 
     
  • Do patients perceive an added benefit on the final aesthetic result when a provisional is used for an implant-supported FDP?
    The choice of implementation of a fixed implant-supported provisional should not be only based on PROMs. Regardless, according to the 2014 ITI Consensus Statement, the use of provisional implant-retained restorations in the aesthetic zone is recommended.
    Based on Consensus Statement 5.
Review Paper
Classification Tags
Consensus Statement
Esthetics
FDP
Outcomes
Prosthesis Design
Prosthodontics
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Publication date: November 16, 2018 | Review date: November 09, 2018 | Next review date: November 09, 2021