Complications and clinical solutions in implant prosthodontics: a narrative review

Abstract

Objective: This narrative review synthesizes the current literature on complications in implant prosthodontics, focusing on the management and prevention of the most common issues in implant-supported fixed restorations. Its objective is to offer practical guidance for clinicians in their decision-making processes.  

Method: A non-systematic literature review was conducted using PubMed/MEDLINE and Scopus. The following keywords were used: “complications” AND “implant” AND “prosthesis” OR “restoration”. Filters applied: from 1 January 2016 to 31 December 2025 (last 10 years). Subject area: Dentistry. This study focused on articles, clinical studies, and in vitro studies concerning complications in implant prosthodontics, with particular reference to the management and prevention of complications in implant-supported fixed restorations.

Results and discussion: Implant-supported fixed restorations can present various complications, which can be divided into main categories. Biological complications affect the hard and soft tissues surrounding the implant and are classified as early or late. Mechanical and technical complications, on the other hand, involve the components of the prosthetic restoration and the structure of the implant itself. Aesthetic complications concern all aspects that negatively impact the patient’s aesthetic satisfaction, while functional complications compromise masticatory and biomechanical function. Issues related to implant-supported prostheses are fairly common. They can range from minor, easily resolvable situations to serious and complex complications requiring significant intervention, both in terms of time and cost, sometimes necessitating a complete redo of the restoration. Preventing such complications begins with a meticulous selection of the clinical case, which first and foremost involves assessing the patient’s compliance and their systemic health. Accurate surgical and prosthetic planning is then the next crucial step in minimizing the risk of complications. Implant placement and angulation, prosthetic design, selection of prosthetic materials, and occlusion are key factors that must be carefully planned during the preliminary phase to effectively prevent potential complications.

Conclusion: A comprehensive understanding of complications in implant prosthodontics is a key factor in clinical success, and knowing how to prevent them or detect them early is crucial to patient satisfaction. Implant-supported fixed restorations can be subject to various complications, which are primarily categorized as biological, mechanical, and technical, in addition to those of an aesthetic and functional nature. These fairly common issues can affect all components of the implant-prosthesis system and range from minor, easily manageable situations to more complex circumstances that require interventions that are more demanding in terms of both cost and time. In some cases, a complete redo of the restoration is necessary. Among the main causes that increase the likelihood of complications are implant malposition and occlusal overload, factors that significantly impact biomechanical risk, placing a heavy strain on both the prosthesis and the supporting implants. Full-arch implant-supported fixed prostheses are considered to be at the highest risk of complications and the need for re-treatment compared to other types of restorations.