Journal of Oral Rehabilitation 2006 33; 833839

Prosthetic complications in fixed endosseous implant-borne

reconstructions after an observations period of at least
40 months
A . L . D E B O E V E R * , K . K E E R S M A E K E R S * , G . V A N M A E L E , T . K E R S C H B A U M ,
G . T H E U N I E R S & J . A . D E B O E V E R * *Former Department of Fixed Prosthetics and Periodontology Dental School,

Department of Biostatistics, Gent University, Gent, Belgium, Department of Preclinical Prosthetics, University of Cologne, Koln, Germany and

Department of Prosthodontics Dental School, Gent University, Gent, Belgium

SUMMARY One hundred and seventy-two fixed reconstructions (317 prosthetic units), made on 283 ITI
implants in 105 patients (age range 2586 years) with
a minimum follow-up period of 40 months, were
taken into the study to analyse technical complication rate, complication type and costs for repair. The
mean evaluation time was 625  253 months.
Eighty were single crowns and 92 different types of
fixed partial dentures (FPDs). In 45 cases the construction was screw retained and in 127 cases
cemented with zinc phosphate cement or an acrylic-based cement. Complications occurred after a
minimum period of 2 months and a maximum
period of 100 months (mean: 359  214 months).
Fifty-five prosthetic interventions were needed on
44 constructions (25%) of which 88% in the molar/
premolar region. The lowest percentage of complications occurred in single crowns (25%), the highest
in 34 unit FPDs (35%) and in FPDs with an exten-

Introduction
Long-term follow-up studies have shown that onestage non-submerged osseointegrated implants used to
replace lost teeth in partially edentulous patients are
very successful (1, 2). Studies show that implants
placed in the maxilla for single-tooth restorations have
a 7-year survival rate of 100% (3). Based on the
analysis of 10 prospective and five retrospective cohort
studies Lang et al. (4) concluded that the cumulative
survival rate of oral implants supporting fixed partial
dentures (FPDs) was 954% after 5 years of function
2006 Blackwell Publishing Ltd

sion (44%). Of the necessary clinical repair, 36% was

recementing and 38% tightening the screws. Of all
interventions, 14% were classified as minor (no
treatment or <10 min chair time), 70% as moderate
(>10 min but <60 min chair time) and 14% as major
interventions (>60 min and additional costs for
replacement of parts and/or laboratory). For seven
patients the additional costs ranged from 28 to 840.
Bruxing seemed to play a significant role in the
frequency of complications. Longer constructions
seemed to be more prone to complications. The
relatively high occurrence of technical complications
should be discussed with the patient before the start
of the treatment.
KEYWORDS: complications, fixed partial dentures,
oral implants, costs for repair
Accepted for publication 28 January 2006

and 928% after 10 years. The overall incidence of

complications as inflammation, bone resorption leading
to implant loss are low (1, 5, 6). Based on an analysis of
the available literature, Lang et al. (4) concluded that
according to the type of technical complication, the
incidence amounted to 162% after 10 years and even
to 249% in combined tooth-implant-supported structures. Prosthetic technical complications do not necessarily lead to implant loss but can be a burden of
maintenance and repair for both the patient and the
practitioner and influence the satisfaction of both
with the selected implant system (79). Technical
doi: 10.1111/j.1365-2842.2006.01638.x

834

A . L . D E B O E V E R et al.
complications can also lead to additional costs and time
investment during the follow-up years.
Pjetursson et al. (10) stressed in their comprehensive
review that little is known about the type and number
of events of technical complications per time interval as
well as the costs required.
Recently, Attard et al. (11) reported on long-term
costs in 90 edentulous patients treated with mandibular
implant-supported prostheses. They found that maintenance costs for implant-borne fixed reconstructions
were higher than for overdenture prostheses.
The present study describes the prosthetic technical
complications, the possible risk factors involved and the
type and costs of the interventions to repair the
complications of fixed restorations on non-submerged
ITI implants* after an observation period of at least
40 months.
We hypothesized that technical complications were
more frequent in longer FPDs than in single crowns, in
cemented than in screw-retained reconstructions and
that complications were more frequent in patients with
bruxing habits.

Materials and methods

Patient selection
Patients for the present study were selected from a
larger group of 312 consecutive patients with 522
endosseous implants installed ad modum ITI Straumann. They were selected on the following premises:
(i) having implant-borne single crowns, FPD or toothimplant-borne restorations (ii) regular follow-up and
maintenance for at least 40 months. One hundred and
seventy-two reconstructions in a total of 283 ITI
implants in 105 patients (48 males, 46%; 57 females,
54%) were analysed. This represented a total of 317
prosthetic units available for analysis.
The age range of the patients was 2586 years (average: 591 years; s.d. 135 years; median: 62 years).
All implants were at the time of evaluation in
function, fully osseointegrated with no or minimal
signs of bone resorption. Only when complications
occurred, suprastructures were removed at control
sessions. Implant osseo-integration was based on the
lack of visual bone resorption on the peri-apical
radiographs and on the probing depths at four sites
*Straumann, Basel, Switzerland.

per implant. The clinical and radiographic data of the

whole group will be reported elsewhere. The project
was approved by the Ethics Commission of the University Hospital, Gent University, Belgium.

Prosthethic treatment protocol

After 36 months of undisturbed healing, an impression was taken with polyaether impression material
(Impregum Penta) in a full impression tray using a
one-stage impression method or with the help of
accessories as developed by the Straumann company.
For FPDs, all models were mounted on a semi-adjustable articulator Dentatus ARH or Whipmix using a
facebow to mount the upper model. For single crowns
no articulator was used. Before cementation occlusion
and articulation were carefully checked using thin
occlusion paper (Okklusionspruffolie Hanel). In
maximal intercuspation, there was a very slight contact
on closing and more contact on the natural teeth or on
the occlusal surfaces of the bridges and crowns on
natural teeth. Contact was avoided on the crowns on
implants on lateral excursions and anterior guidance
was on natural dentition in all patients. If all lateral
teeth were replaced by an FPD on implants, group
contact was aimed at during lateral excursions. In
accordance with recommendations made in the literature, a narrowed occlusal table and a reduced cusp
inclination were preferred (12, 13). None of the
patients exhibited a cross-bite occlusion.
All reconstructions were either screwed or cemented.
Two types of cement were used: zinc phosphate cement
(Harvard**) or acryl/urethane cement (Improv)
especially developed as cement for prosthetic work on
implants.

Evaluation of prosthetic complications

The following variables were recorded:
1 gender and age of the patients
2 bruxing habits based on clearly visible facets on the
occlusal surfaces and based on the self-report of the
patients and his or her partner.

3M Espe AG, Seefeld, Germany.

Dentatus AB, Stockholm, Sweden.

Hanel GHM, Nurtingen, Germany.

Whipmix Corporation Louisville, KY, USA.

**Harvard Dental GmbH, Berlin, Germany.

Sterioss Nobelbiocare, Yorba Linda, CA, USA.

2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 833839

PROSTHETIC COMPLICATIONS IN IMPLANT-BORNE FIXED RECONSTRUCTIONS

3 length of follow-up period (months)
4 type of reconstruction (single crowns, two-connected
crowns on two implants, three- or four-unit FPD on
two implants, extension FPD on two implants, bridge
on implants connected to natural tooth)
5 type of fixation: screw retained or cemented
6 antagonists: natural dentition, fixed prosthesis,
removable partial or complete dentures

350
300
250

Single crown
IMPL/IMPL connected
IMPL/PONTIC/IMPL
IMPL/IMPL/extension

200

IMPL/natural tooth

150

Reconstructions
Units

100
50

Complications
1 Presence or absence of any mechanical complication
with exclusion of loss of composite stop above fixation
screw.
2 type of complications:
(a) incidence of minor intervention (no treatment
needed or less than 10 min chair time, e.g. polishing
chipped-off porcelain)
(b) incidence of moderate intervention (1060 min
of chair time without laboratory costs, e.g. tightening of
loose screw, recementation)
(c) incidence of major intervention (>60 min chair
time and additional laboratory costs, e.g. new crowns,
new abutments)
3 time lapse between fixation and occurrence of
complication
4 intervention type (e.g. recementing, tightening or
replacing screws or abutment, etc.)
5 duration of the necessary intervention
6 laboratory costs in euros (), if any.

Statistical evaluation
Statistical analysis to test the hypothesis of associations
between categorical variables was performed using the
Chi-squared test for contingency tables (Exact test). For
some data the Fischers Exact Test was used. The
MannWhitney U-test was used to compare continuous
variables between two groups. The significance level
was set at a 005.

Results
Twenty-three patients were classified as bruxers
(22%) and 80 non-bruxers (77%). In two patients
bruxing habits were not determined. Forty-three
reconstructions were at risk in the bruxing group
and 126 in the non-bruxing group. The evaluation
time ranged from 40 to 144 months (mean:

0
Type
Fig. 1. Type of reconstructions.

652  253 months). No patients were lost because

of drop out.
Of the 172 prosthetic reconstructions, 46% were
single crowns, 23% were two-crown connected and
22% were three-to-four-unit FPDs. Only 5% and 4%
were FPDs with an extension or FPDs on an implant
connected to a natural tooth (Fig. 1).
For 127 reconstructions (74%), the antagonists were
natural teeth, 39 FPDs (23%) on natural teeth or
implants, in three cases (1%) a complete denture and in
three cases (1%) a removable partial denture.
Twenty-two crowns were made in the frontal region,
35 in the premolar region and 23 in the molar region;
for FPDs the numbers were 26, 50 and 16 respectively
(Table 1). Of the 283 abutments, 10 were individualized abutments, 75 octa abutments, 198 solid abutments. In 45 cases (26%) the construction was screw
retained, in 127 cemented with either zinc phosphate
cement (Harvard**) (n 72; 42%) or with acryl/
urethane-based cement (Improv) (n 55; 32%).
Prosthetic complication occurred after a minimum
period of 2 months and a maximum period of
100 months (mean: 359  214 months)
Fifty-five prosthetic interventions were needed in 44
constructions (25%) of which six (11%) in the frontal
region and 49 (88%) in the molar/premolar region. Of
the available number of prosthetic units, 173% needed
some intervention. Of all reconstructions made in the
frontal region, 14% required some clinical work, of
those made in the premolar and molar region, the
incidence was 36%.
Twenty-five per cent of the single crowns had some
form of complication, 35% of the connected crowns

2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 833839

835

836

A . L . D E B O E V E R et al.
Table 1. Distribution of crowns and FPDs: number and percentages (%)

Crowns
FPDs

Upper front

Lower front

Upper premolar

Lower premolar

Upper molar

Lower molar

Total

20 (250)
16 (174)

2 (25)
10 (109)

22 (275)
16 (174)

13 (62)
34 (377)

2 (25)
5 (54)

21 (262)
11 (120)

80
92

and 44% of the three-to-four-unit FPDs (Table 2).

There were significantly less complications on single
crowns than on three-to-four-unit FPDs and FPDs with
an extension (P < 0048).
Fifty-six per cent of screw-retained constructions
needed some repair and 22% of the cemented restorations (Table 3). Screw-retained reconstructions had
significantly more complications than cemented restorations (P < 0001). However, in 21 of the 26 interventions necessary in screw-retained reconstructions, the
treatment consisted of only tightening the screw.
No difference in complication rate was found
between the different types of antagonistic occlusion
(P < 0687).
Of the reconstructions made in the bruxing group, 17
of the 43 had a complication (39%). In the non-bruxing

group, 29 of the 126 reconstructions needed some

repair (23%). The difference was statistically significant
(P < 0001) (Fig. 2).
Of the clinical interventions, 14% were classified as
minor interventions, 71% as moderate and 14% as
major interventions. Of the major interventions, four
were for single crowns, one on a two-unit FPDs and
three on three-to-four-unit FPDs. If therapy was needed, the minimum time required was 5 min; the
maximum time was 120 min (mean: 474  250 min).
The type of necessary interventions is given in Table 4.
The type and duration of repair was not different
between the bruxing and non-bruxing group
(P < 0688).
100
Complication

Table 2. Number and percentages (%) of complications in

different groups of reconstructions

80

No complication

60
Complications
Type of reconstruction

No

Single crown
Two-connected crowns
Three-to-four-unit FPD
FPD with extension
Tooth/implants FPD
Total

60
25
21
4
7
117

(513)
(214)
(179)
(34)
(60)
(100)

Yes
20
14
17
4
0
55

(364)
(255)
(309)
(73)
(00)
(100)

40

Total
80
39
38
8
7
172

(465)
(227)
(221)
(47)
(41)
(100)

Fischers Exact Test: P 0044. FPD, fixed partial denture.

Table 3. Number and percentages (%) of complications in screwretained and cemented reconstructions
Complications
Type of fixation
Screwed
Harvard
Improv
Total

No
19
56
42
117

(422)
(778)
(764)
(680)

Chi-squared test (exact test): P < 0001.

Yes
26
16
13
55

(568)
(222)
(236)
(320)

Total
45
72
55
172

(100)
(100)
(100)
(100)

20
0
Bruxing

No bruxing

Fig. 2. Number of complications in bruxing and non-bruxing

group. Chi-squared test (Exact test): P < 0001.
Table 4. Number and percentages of different types of necessary
interventions

Recementing
Screw tightening
New abutment, new crown
Loose + new screws
Loose + new octa abutment
Polishing porcelain
New porcelain
Total restorations

Frequency

Valid per cent

20
21
2
1
1
8
2
55

364
382
36
18
18
145
36
1000

2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 833839

PROSTHETIC COMPLICATIONS IN IMPLANT-BORNE FIXED RECONSTRUCTIONS

In one patient, two-connected crowns on the central
upper incisors were made on two implants. After
6 months the patient had a severe car accident and
the two crowns were broken and had to be replaced.
The implants stayed intact. No complications were
observed over the next 60 months. In five patients, the
construction became loose twice. These five patients
were all classified as bruxers. In one patient, several
complications occurred from retention loss to fracture
of the porcelain crown.
In addition to the chair time costs, in seven cases,
additional costs had to be charged to the patients. No
additional costs were charged for polishing or recementing tightening of the screws and abutment. Additional costs were new screws, new abutments, new
octa-abutments or dental laboratory costs for new FPDs,
new porcelain on the frames. The costs ranged from 28
to 840. Two patients had to pay 120, one patient
201, one patient 210 and another 420. The high cost
of 840 for one patient was due to the remake of two
porcelain crowns in the patient who had a car accident
some months after cementation.

Discussion
The incidence of all technical complications on the
prosthetic unit level (17%) and on the construction
level (25%) in the present study is higher than what
has been found in the literature (1416). McDermott
et al. (5) reported over a median duration of follow-up
of 131 months, a complication rate of 14% of which
3% were classified as prosthetic complications. The
incidence of suprastructures-related complications has
been reported at 14% after 5 years (10). In the present
study, screw or abutment loosening amounted to 12%.
The incidence of connection related complications as
screw loosening has been reported at 29% after 5 years
(10). Eckert & Wollan (17) found the probability of
5-year no occurrence of screw loosening at 838%. Loss
of retention was reported at 7% after 5 years and 16%
after 10 years (18, 19). The higher percentage of loss of
retention (20%) in the present study cannot be attributed to the use of a semi-temporary cement
(Improv) which was chosen because of the easy
retrievability if complications occurred. The choice of
an adequate cement providing enough tensile strength
still allowing some retrievability is not easy. In vitro
studies provided controversial results (2022). Mansour
et al. (21) stressed the fact that because of the difference

in material and surface characteristics of metal abutments and natural teeth, results of studies using teeth as
abutments cannot be applied to implant dentistry. They
concluded that at present conclusive data were not
available and that it is at the clinicians discretion to
choose a certain type of cement based on the clinical
situation.
In contrast to other studies implant fracture was not
observed.
Difference was made between minor, major and
moderate complications based on the necessary chair
time and extra laboratory costs to resolve the problem.
Only 145% of the complications could be classified as
major. The larger the construction, the more frequent
complications occurred.
It has been reported that the incidence of technical
complications is higher in combined tooth/implantsupported FPDs (10). This was not found in the present
study but the number of such type of construction is too
limited to draw any conclusion. In the present study,
intrusion of the natural abutment teeth has not been
observed.
In the present study, all reconstructions were single
crowns and FPDs. McDermott et al. (5) reported a
statistically significant difference in prosthetic complication rate between removable reconstructions and
fixed restorations and between anterior versus posterior
location of the FPDs. Payne & Solomons (7) reported a
high rate of prosthetic complications over a 3-year
period in implant-borne removable dentures: fracture
of retention clips (30%), relining of the denture (40%)
and remake of the denture (21%). FPDs have a smaller
complication rate than removable dentures on implants.
Overload because of a faulty occlusal design has often
been mentioned as an important factor in technical
complications and in peri-implant bone loss in implantsupported FPDs (2325). On small FPDs and single
crowns, the occlusion should be designed to minimize
occlusal forces and to maximize force distribution to
adjacent natural teeth (26, 27). In the present study,
great care was taken to the occlusal design and to follow
generally accepted guidelines (12, 13).
Bruxism has often been mentioned a major cause
for implant fracture and technical complications (23,
2830). This is confirmed in the present study with a
significantly higher complication rate in bruxers. This
is also in accordance with the study by Tosun et al.
(31) who, in six patients diagnosed as bruxers by

2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 833839

837

838

A . L . D E B O E V E R et al.
means of a polysomnographic analysis, found more
mechanical and implant fractures than in non-bruxers.
In the present study, the patients were classified as
bruxers based on the presence of occlusal wear facets
and on self-report. It has been shown in the literature
that this is an acceptable method to classify the
patients but can lead to underscoring of the prevalence
of bruxism (32). The difference in the incidence of
complications between the two groups occurs in spite
of the great attention given to the static and dynamic
occlusion of the reconstructions. Also, most reconstructions were single crowns and small FPDs in
partially edentulous patients, where, in most cases
lateral excursions were guided by the natural teeth
(canine function) and not by the implant-borne
crowns or FPDs.

Conclusions
From the present study the following conclusions can
be drawn:
1 during the observation period of, on average
652 months, the incidence of technical complications
was 26% at the construction level and 17% at the
prosthetic unit level
2 only 14% of the complications needed major interventions with additional laboratory cost or extra cost
for spare parts
3 84% of the needed interventions were minimal or
moderate requiring <60 min chair time without additional laboratory cost
4 except for one patient the additional laboratory costs
were limited
5 loss of retention even with the use of a semitemporary cement was less frequent than in screwretained restorations
6 the larger the construction, the higher the incidence
of complications
7 bruxing habits are a risk for more complications.
The patient should be advised to have regular
maintenance to avoid complications and should accept
the possibility that technical complications leading to
additional maintenance cost, can occur with implantborne crowns and FPDs.

Acknowledgment
The authors thank all colleagues of the former Department of Fixed Prosthodontics and Periodontology, Gent

University, Gent, Belgium, for their clinical contribution to the study.

References
1. Buser D, Mericske-Stern R, Bernard JP et al. Long-term
evaluation of non-submerged ITI implants. Part 1. 8-year life
table analysis of a prospective multicenter study with 2359
implants. Clin Oral Implants Res. 1997;8:161172.
2. Lambrecht JT, Filippi A, Kunzel AR, Schiel HJ. Long-term
evaluation of submerged and nonsubmerged ITI solid screw
Titanium implants: a 10 year life table analysis of 468
implants. Int J Maxillofac Implants. 2003;18:826834.
3. Romeo E, Chiapasco M, Ghisolfi M, Vogel G. Long-term
clinical effectiveness of oral implants in the treatment of
partial edentulism. Seven-year life table analysis of a prospective study with ITI dental implants system used for singletooth restorations. Clin Oral Implants Res. 2002;13:133143.
4. Lang NP, Pjetursson BE, Tan K, Bragger U, Egger M, Zwahlen
MA. Systematic review of the survival and the complications
rates of fixed partial dentures (FPDs) after an observation
period of at least 5 years. II. Combined tooth-implant supported FPDs. Clin Oral Implants Res. 2004;15:643653.
5. McDermott NE, Chuang SK, Woo VV, Dodson TB. Complications of dental implants, frequency and associated risk factors.
Int J Maxillofac Implants. 2003;18:848855.
6. Lang NP, Berglundh T, Heitz-Mayfield L, Pjetursson BE, Salvi
GE, Sanz M. Consensus statement and recommended clinical
procedures regarding implant survival and complications. Int
J Oral Maxillofac Implants. 2004;19:150154. Supplement.
7. Payne AG, Solomons YF. Mandibular implant supported
overdentures: a prospective evaluation of the burden of
prosthodontic maintenance with 3 different attachment systems. Int J Prosthodont. 2000;13:246253.
8. Levi A, Psoter WJ, Agar JR, Reisine ST, Taylor TD. Patient selfreported satisfaction with maxillary anterior dental implant
treatment. Int J Oral Maxillofac Implants. 2003;18:113120.
9. Pjetursson BE, Karoussis J, Burgin W, Bragger U, Lang NP.
Patients satisfaction following implant therapy. A 10 year
retrospective cohort study. Clin Oral Implants Res.
2005;16:185193.
10. Pjetursson BE, Tan K, Lang NP, Bragger U, Egger M, Zwahlen
MA. Systematic review of the survival and the complications
rates of fixed partial dentures (FPDs) after an observation
period of at least 5 years. Clin Oral Implant Res. 2004;15:625
642.
11. Attard NJ, Zarb GA, Laporte A. Long-term treatment costs
associated with implant supported mandibular prostheses in
edentulous patients. Int J Prosthodont. 2005;18:117123.
12. Misch CE, Bediz MW. Implant protected occlusion: a biomechanical rationale. Compendium. 1994;15:13301344.
13. Lundgren D, Laurell L. Biomechanical aspects of fixed
bridgework by natural teeth and endosseous implants. Periodontology 2000. 1994;4:2340.
14. Berglundh T, Persson L, Klinge B. A systematic review of the
incidence of biological and technical complications in implant

2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 833839

PROSTHETIC COMPLICATIONS IN IMPLANT-BORNE FIXED RECONSTRUCTIONS

15.

16.

17.

18.

19.

20.

21.

22.

23.

dentistry reported in prospective longitudinal studies of

at least 5 years. J Clin Periodontol. 2002;29(Suppl. 3):197
212.
Carr AB, Choi YG, Eckert S, Desjardins RP. Retrospective
cohort study of the clinical performance of 1-stage dental
implants. Int J Oral Maxillofac Implants. 2003;18:399405.
Duncan JP, Nazarova E, Vogiatzi T, Taylor T. Prosthodontic
complications in a prospective clinical trial of single-stage
implants at 36 months. Int J Oral Maxillofac Implants.
2003;18:561565.
Eckert SE, Wollan PC. Retrospective review of 1170 endosseous implants placed in partially edentulous jaws. J Prosthet
Dent. 1998;79:415421.
Bragger U, Aeschlimann S, Burgin W, Hammerle CHF, Lang
NP. Biological and technical complications and failures with
fixed partial dentures (FPD) on implants and teeth after 4 to
5 years of function. Clin Oral Implants Res. 2001;12:2634.
Bragger U, Karoussis I, Persson R, Pjetursson BE, Salvi G, Lang
NP. Technical and biological complications and failures with
single crowns and fixed partial dentures on implant of the ITI
dental implant system: a 10 year prospective cohort study.
Clin Oral Implants Res. 2005;16:186193.
Michalakis KX, Pissiotis AL, Hiryama H. Cement failure loads
of 4 provisional luting agents used for the cementation of
implant supported fixed partial dentures. Int J Oral Maxillofac
Implants. 2000;15:545549.
Mansour A, Ercoli C, Graser G, Tallents R, Moss M. Comparative evaluation of casting retention using the ITI solid
abutment with six cements. Clin Oral Implants Res.
2002;13:343348.
Akashia AE, Francischone CE, Tokutsune E, da Silva W Jr.
Effects of different types of temporary cements on the tensile
strength and marginal adaptation of crowns on implants.
J Adhes Dent. 2000;4:309315.
Quirynen M, Naert IE, van Steenberghe D. Fixture design and
overload influence marginal bone loss and fixture success in

24.

25.
26.

27.

28.

29.

30.

31.

32.

the Branemark system. Clin Oral Implant Res. 1992;3:104

111.
Rangert BR, Krogh PH, Langer B, Van Roekel N. Bending
overload and implant fracture: a retrospective clinical analysis.
Int J Oral Maxillofac Implants. 1995;10:326344.
Isidor F. Loss of osseointegration due to occlusal load of oral
implants. Clin Oral Implants Res. 1996;7:143152.
Rangert BR, Sullivan RM, Jemt TM. Load factor control for
implants in the posterior partially edentulous segment. Int J
Oral Maxillofac Implants. 1997;12:360370.
Kim Y, Oh T-J, Misch C, Wanh HL. Occlusal considerations in
implant therapy: clinical guidelines with biomechanical
rationale. Clin Oral Res Implants. 2004;16:2536.
Naert IE, Quirynen M, van Steenberghe D, Darius P. A study
of 589 consecutive implants supporting complete fixed prostheses. Part II. Prosthetic aspects. J Prosthet Dent.
1992;68:949956.
Olsson M, Friberg B, Nilson H, Kultje C. MkII a modified
self-tapping Branemark implant: 3-year results of a controlled
prospective pilot study. Int J Oral Maxillofac Implants.
1995;10:1520.
Balshi TJ. An analysis and management of fractures implants:
a clinical report. Int J Oral Maxillofac Implants. 1996;11:660
666.
Tosun T, Karabuda C, Cuhadaroglu C. Evaluation of sleep
bruxism by polysomnographic analysis in patients with dental
implants. Int J Oral Maxillofac Implants. 2003;18:286292.
Ahlberg J, Savolainen A, Rantala M, Lindholm H, Kononen
M. Reported bruxism and biopsychosocial symptoms. A
longitudinal study. Community Dent Oral Epidemiol.
2004;32:307311.

Correspondence: Annemarie De Boever, Former Department of Fixed

Prosthetics and Periodontology Dental School, Gent University, Gent,
Eeuwfeestlaan 34, B 9840 De Pinte, Belgium.
E-mail: j.deboever@skynet.be

2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 833839

839