Prosthetic Guidelines to Prevent Implant Fracture and Peri-Implantitis: A Consensus Statement from the Osstem Implant Community

Background: While dental implants have become a reliable solution for tooth loss, their long-term success is increasingly challenged by biological and technical complications such as impact fracture and peri-implantitis. These complications significantly impact implant longevity and patient satisfaction. Aim: This consensus conference aimed to identify and standardize clinical guidelines to prevent implant fractures and peri-implant diseases based on current evidence and expert opinions. Methods: A panel of 10 expert clinicians and researchers in prosthodontics participated in the Osstem Global Consensus Meeting. This paper focuses on the prosthetic division. A structured literature review was conducted, and evidence was synthesized to formulate consensus-based clinical recommendations. Participants answered structured questions and discussed discrepancies to achieve consensus. Results: The panel reached consensus on several key prosthetic risk factors, including (1) the role of biomechanical overload in implant fracture, (2) the impact of emergence profile design on peri-implant tissue stability, (3) the influence of implant positioning and connection geometry on marginal bone loss, and (4) the importance of occlusal scheme and restorative material selection, particularly in high-risk patients such as bruxers. Guidelines to prevent implant fracture and peri-implantitis were developed, addressing these factors with practical preventive strategies. Conclusions: Despite the limitations of narrative methodology and reliance on retrospective data and expert opinion, this consensus provides clinically relevant guidelines to aid in the prevention of mechanical failures and peri-implant diseases. The recommendations emphasize prosthetically driven planning, individualized risk assessment, and early intervention to support long-term implant success.