Influence of Span Length on Long‐Term Complications of Tooth‐Supported Fixed Dental Prostheses

ABSTRACT Aim This retrospective study evaluated the long‐term clinical performance and complication rates of tooth‐supported fixed dental prostheses (FDPs) of different span lengths and assessed the influence of design, span length, material type and location on complication rate. Methods A total of 199 FDPs placed in 199 patients (mean age: 50.3 ± 12.9 years) were examined clinically and radiographically at a mean follow‐up of 9.0 ± 6.3 years. Biological complications (secondary caries, loss of tooth vitality) and technical complications (loss of retention, framework or veneer fracture) were recorded. Biological and technical complications were summarized descriptively. Kaplan–Meier, life‐table and univariate and multivariable Cox proportional hazards analyses were performed. Results The mean observation period was 9.0 ± 6.3 years. At least one complication was detected in 170 FDPs (85.4%); biological complications were detected in 133 (66.8%) and technical complications in 40 (20.1%). Crude total complication frequencies differed by design ( p = 0.002), whereas span length was not associated with complication frequency. In the adjusted Cox model, metal–ceramic restorations had a lower hazard of complication detection than full‐ceramic restorations (hazard ratio [HR] = 0.400; 95% confidence interval [CI], 0.253 to 0.634; p < 0.001). Cantilever FDPs also showed a lower adjusted hazard than conventional FDPs (HR = 0.578; 95% CI, 0.337 to 0.989; p = 0.046); other adjusted associations were not statistically significant. Conclusions Biological complications were more frequent than technical complications in this follow‐up cohort. The findings support structured long‐term maintenance, but comparisons by design and material should be interpreted cautiously because complication onset was approximated by the follow‐up examination, historical resolved complications were not systematically captured, and several subgroups were small.