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A systematic review of the survival and complication rates of resin-bonded bridges after an observation period of at least 5 years

BE Pjetursson, WC Tan, K Tan, U Bragger, M Zwahlen, and NP Lang.

Review published: 2008.

Link to full article: [Journal publisher]

CRD summary

This review of dental reconstruction techniques concluded that although five-year survival rates for resin-bonded bridges were high, technical complications (such as de-bonding) were common. The evidence from observational studies supported these conclusions, but the limited search, lack of consideration of study validity and differences between studies, may undermine the reliability of these conclusions.

Authors' objectives

To evaluate the five-year survival of resin-bonded bridges and the incidence of technical and biological complications.

Searching

MEDLINE was searched for studies published in the dental literature between 1965 and January 2007. Search terms were reported. Reference lists of articles and related reviews were also screened. No language restrictions were applied.

Study selection

Prospective and retrospective cohort studies that evaluated the five-year survival of resin-bonded bridges using clinical examination were eligible for inclusion. Interventions had to describe the characteristics of the suprastructures. Survival was defined as the resin-bonded bridge remaining in situ, without multiple de-bonding, regardless of its condition. Failure was defined as the resin-bonded bridge being lost and needing re-fabrication or multiple re-cementations. The review also assessed biological and technical complications.

The included studies used different tooth preparation techniques, different metal treatment to enhance the resin-to-metal bond, different luting cements and different definitions for survival. Most studies were conducted in universities or specialist clinics. Where reported, patients ranged in age from 13 to 78 years. The mean duration of follow-up ranged from five to 9.1 years.

Two reviewers independently selected studies and resolved disagreements by discussion.

Assessment of study quality

The authors did not state that they assessed validity.

Data extraction

Event rates were calculated as the number of events divided by the total exposure time in years (details were reported).

Two reviewers independently extracted data onto a standardised form. Discrepancies were resolved through discussion.

Methods of synthesis

Event rates per 100 resin-bonded bridge years were pooled in a Poisson regression model with 95% confidence intervals (CI) calculated using robust standard errors. Heterogeneity was assessed using the Spearman goodness-of-fit statistic. If significant heterogeneity was found (p<0.05) then a random-effects Poisson model was used. Five and 10-year survival proportions were estimated using the relationship between event rates and survival times, assuming constant event rates. Multivariable Poisson regression was used to examine the effect of position on resin-bonded bridge survival.

Results of the review

The review included sixteen patient cohorts reported in seventeen studies (approximately 1,500 patients). Nine studies were prospective and eight were retrospective. Dropout rates ranged from 0 to 48% (11 studies).

Resin-bonded bridge survival (12 studies): Five-year resin-bonded bridge survival rates ranged from 63.3 to 98.8%. The estimated failure rate per 100 resin-bonded bridge years ranged from 0.24 to 9.15%. Poisson regression calculated 2.61 failures per 100 resin-bonded bridge years (95% CI: 1.68 to 4.06; random-effects model). Estimated five-year survival of resin-bonded bridges was 87.7% (95% CI: 81.6 to 91.9). The Poisson estimated annual failure rate was non-significantly lower for maxillary resin-bonded bridges (1.07%) compared to mandibular resin-bonded bridges (2.36%; p=0.370).

Dental caries complications (four studies, 1,254 abutments): Random effects Poisson analysis calculated a cumulative abutment caries rate over five years of 1.5% (95% CI: 0.3 to 7.1).

Recurrent periodontitis complications (four studies, 253 resin-bonded bridges): Poisson analysis calculated a cumulative rate of resin-bonded bridges lost due to periodontitis over five years of 2.1% (95% CI: 0.9 to 4.8).

De-bonding technical complications (16 cohorts, 1,693 resin-bonded bridges): The annual complication rate ranged from 1.22 to 12.8. Random-effects Poisson analysis calculated a cumulative rate of de-bonding (loss of retention) over five years of 19.2% (95% CI: 13.8 to 26.3). Results were similar for maxillary and mandibular resin-bonded bridges. The five-year de-bonding rate was non-significantly higher for posterior compared to anterior resin-bonded bridges.

Authors' conclusions

Although five-year survival rates for resin-bonded bridges were high, technical complications, such as de-bonding, were common. Longer term studies, with at least 10-years follow-up, are required.

CRD commentary

The review question was clearly stated and inclusion criteria appeared appropriate. Limiting the search to publications listed in one database plus references raised the possibility of publication bias and may have resulted in the omission of other relevant studies. Appropriate methods were used to minimise reviewer error and bias during the selection of studies and extraction of data. The authors stated that strict inclusion criteria were used, but the only aspect of study validity that was addressed was the dropout rate, so results from these studies and any synthesis may not be reliable. Data were pooled despite apparently wide variations in results between studies; there was no exploration of potential reason for these differences. Evidence appeared to support the authors’ conclusions but the restricted search, use of observational studies, limited assessment of study quality and differences between studies, may undermine the reliability of these conclusions.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that there is an urgent need for prospective cohort studies that report outcomes of resin-bonded bridges at 10 years or more. Studies should report complete follow-up data and follow-up all patients at the same time intervals.

Funding

University of Berne (Switzerland), Clinical Research Foundation for the promotion of Oral Health funded the review. One author received an ITI Foundation educational grant for the year 1006/2007.

Bibliographic details

Pjetursson B E, Tan W C, Tan K, Bragger U, Zwahlen M, Lang N P. A systematic review of the survival and complication rates of resin-bonded bridges after an observation period of at least 5 years. Clinical Oral Implants Research 2008; 19(2): 131-141. [PubMed: 18070120]

Other publications of related interest

Jung RE, Pjetursson BE, Glauser R, et al. A systematic review of the 5-year survival and complication rates of implant supported single crowns. Clin Oral Implants Res 2008;19:119-30.

Pjetursson BE, Tan K, Lang NP, et al. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years .I. Implant-supported FDPs. Clin Oral Implants Res 2004;15:625-42.

Lang NP, Pjetursson BE, Tan K, et al. A systematic review of the survival and complication rates of fixed partial dentures (FDPs) after an observation period of at least 5 years. II. Combined tooth-implant supported FDPs. Clin Oral Implants Res 2004:15:643-53.

Tan K, Pjetursson BE, Lang NP, et al. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. III. Conventional FPDs. Clin Oral Implants Res 2004;15: 654-66.

Pjetursson BE, Tan K, Lang NP, et al. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. IV. Cantilever or extension FDPs. Clin Oral Implants Res 2004;15: 667-76.

Indexing Status

Subject indexing assigned by NLM

MeSH

Dental Bonding /methods; Dental Caries /etiology; Dental Restoration Failure; Denture, Partial /adverse effects /statistics & numerical data; Equipment Failure Analysis; Humans; Periodontal Diseases /etiology; Poisson Distribution; Survival Analysis

AccessionNumber

12008102788

Database entry date

07/10/2009

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 18070120