Data sourcesPubMed (1966–April 2004) provided the primary data source along with the bibliographies from identified articles and reviews. A manual search of eight relevant journals (Clinical Implant Dentistry and Related Research, Clinical Oral Implants Research, International Journal of Oral & Maxillofacial Implants, International Journal of Periodontics and Restorative Dentistry, International Journal of Prosthodontics, Journal of Clinical Periodontology, Journal of Periodontology and Journal of Prosthetic Dentistry; published 2001–2004) provided a further source of data.Study selectionBecause no randomised controlled trials (RCT) were published in English language journals, it was necessary to include controlled clinical trials that compared tooth–implant reconstructions with solely implant-supported reconstructions. Prospective or retrospective cohort studies with a mean follow-up time of at least 5 years were also included.Data extraction and synthesisAssessment of the identified studies and data abstraction was performed independently by two reviewers. Failure and complication rates were analysed using random-effects Poisson regression models to obtain summary estimates of 5- and 10-year survival.ResultsThirteen studies met the inclusion criteria. Meta-analysis indicated an estimated survival of implants in combined tooth–implant-supported fixed partial dentures (FPD) of, after 5 years, 90.1% [95% confidence interval (CI), 82.4–94.5], and of 82.1% (95% CI, 55.8–93.6) after 10 years. The survival rate of FPD was 94.1% (95% CI, 90.2–96.5) after 5 years and 77.8% (95% CI, 66.4–85.7) after 10 years of function. There was no significant difference in survival of tooth and implant abutments in combined tooth–implant FPD. After an observation period of 5 years, 3.2% (95% CI, 1.5–7.2) of the abutment teeth and 3.4% (95% CI, 2.2–5.3) of the functionally loaded implants were lost. After 10 years, the corresponding proportions were 10.6% (95% CI, 3.5–23.1) for the abutment teeth and 15.6% (95% CI, 6.5–29.5) for the implants. After a 5-year observation period, intrusion was detected in 5.2% (95% CI, 2.0–13.3) of the abutment teeth. Intrusion of abutment teeth were almost exclusively detected in nonrigid connections.ConclusionsSurvival rates of both implants and reconstructions in combined tooth–implant-supported FPD were lower than those reported for solely implant-supported FPD. Hence, planning of prosthetic rehabilitation may preferentially include solely implant-supported FPD. Anatomical aspects, patient-centred issues and risk assessments of the residual dentition, however, may still justify combined tooth–implant-supported reconstructions. It was evident from the present search that tooth–implant-supported FPD have not been studied to any great extent: more longitudinal studies examining them are urgently required.