A Moderately Favorable Five-Year Success Rate for Resin-Bonded Bridges

Abstract

Systematic review conclusion. The authors’ estimated 87.7 percent survival rate of resin-bonded bridges after five years is complicated by a 19.2 percent debonding rate of the veneers.Critical summary assessment. The authors may have overestimated the survival rate because they inappropriately aggregated the results of prospective and retrospective studies and a significant number of subjects were lost to follow-up.Evidence quality rating: Limited. Systematic review conclusion. The authors’ estimated 87.7 percent survival rate of resin-bonded bridges after five years is complicated by a 19.2 percent debonding rate of the veneers. Critical summary assessment. The authors may have overestimated the survival rate because they inappropriately aggregated the results of prospective and retrospective studies and a significant number of subjects were lost to follow-up. Evidence quality rating: Limited. What is the long-term survival rate of resin-bonded bridges (RBBs)? What is the incidence of specific technical and biological complications across an observation period of at least five years? From a MEDLINE and hand search of the literature from January 1965 through January 2007, two independent reviewers identified 17 studies that met their inclusion criteria. To be included, studies were required to have involved a mean follow-up period of five years or more, have included a clinical examination as part of the follow-up examination and have included a description of suprastructure characteristics. The authors did not identify any randomized controlled trials; nine studies were prospective and eight were retrospective. The authors defined an RBB's survival as remaining in situ at the final examination without multiple debondings, irrespective of its condition. They defined technical complications as the RBB's loss of retention or as a fracture of the veneer with or without loss of the reconstruction. Finally, they defined biological complications as caries in abutment teeth or periodontal disease progression. Four independent reviewers screened the search results, with two reviewers performing the data extraction. The authors grouped the data from all studies and analyzed failure and complication rates using random-effects Poisson regression models to obtain summary estimates of five-year proportions. The search yielded 6,110 titles and 214 abstracts. The authors performed a full-text analysis of 93 articles, which resulted in 17 studies that met the inclusion criteria. Meta-analysis of these studies estimated an RBB survival rate of 87.7 percent (95 percent confidence interval [CI], 81.6–91.9 percent) after five years. The most frequent complication was debonding (loss of retention), which occurred in 19.2 percent (95 percent CI, 13.8–26.3 percent) of RBBs during an observation period of five years. The annual debonding rate for RBBs placed on posterior teeth (5.0 percent) tended to be higher than that for those placed on anterior teeth (3.1 percent). Biological complications, such as caries in abutment teeth and RBBs lost owing to periodontitis, occurred in 1.5 percent of abutments and 2.1 percent of RBBs, respectively. The estimated survival rate of RBBs was compromised by a high debonding rate. Therefore, dentists may need to schedule a substantial amount of extra chair time after the placement of RBBs. Studies with a follow-up of 10 years or more are needed to evaluate the long-term outcomes of RBBs.