Full-arch implant complications: how often things need fixing
Implants and bridges usually survive. Getting through the years without any repair is less usual. Here are the technical and biological complication rates reported in the research, with the definitions behind them.
Medically reviewed by Dt. Hüseyin Yavuz Özbek, implant surgeon · Updated October 2026Complications are common but mostly repairable. In a review of implant bridges, only 66.4% of patients had no complication at all after five years; the commonest problem was fracture of the tooth surface (13.5%). In one full-arch cohort, 85.5% of bridges were free of major technical problems at five years but only 30.1% at ten. Gum inflammation around implants (mucositis) affects around four in ten patients and peri-implantitis around one in five, depending on the definition used.
Two kinds of complication
Researchers split problems into two groups. Technical complications are mechanical: a chipped or worn tooth, a loose or broken screw, a cracked framework, a lost filling over a screw hole. Biological complications happen in the living tissue: inflamed gum, infection, bone loss around an implant. The two need different prevention.
Technical complications: the first five years
The broadest figures come from a 2012 systematic review of 32 studies on implant-supported bridges. After five years, only 66.4% of patients were free of any complication Pjetursson et al., 2012. The commonest problems are charted below.
Show the numbers as a table
| Item | 5-year rate | Source |
|---|---|---|
| Veneer (tooth surface) fracture | 13.5% | Pjetursson et al., 2012 |
| Peri-implantitis, soft tissue | 8.5% | Pjetursson et al., 2012 |
| Lost screw-hole filling | 5.4% | Pjetursson et al., 2012 |
| Abutment or screw loosening | 5.3% | Pjetursson et al., 2012 |
| Cemented bridge came loose | 4.7% | Pjetursson et al., 2012 |
Includes partial and full-arch bridges. Only 66.4% of patients had no complication at all after five years.
That review included partial bridges as well as full arches. Full-arch bridges are longer and carry more chewing force, so their technical complication rates tend to be higher, as the next section shows.
Full-arch bridges over ten years
A university cohort followed 71 full-arch bridges on 457 implants for an average of 5.2 years, some for up to 12 Papaspyridakos et al., 2020. Bridge survival was 91.6%. But the share of bridges that had never needed a repair fell steeply with time.
Show the numbers as a table
| Item | Free of complications | Range | Source |
|---|---|---|---|
| No major problem, 5 years | 85.5% | 73–92.5% | Papaspyridakos et al., 2020 |
| No minor problem, 5 years | 60.5% | 47.2–71.3% | Papaspyridakos et al., 2020 |
| No major problem, 10 years | 30.1% | 12–50.6% | Papaspyridakos et al., 2020 |
| No minor problem, 10 years | 8.9% | 2.9–18% | Papaspyridakos et al., 2020 |
Major: fracture of tooth material, screw or framework. Minor: wear, loss of screw-hole filling, de-cementation. Bridge survival in the same cohort was 91.6%.
Wear of the tooth material was the commonest minor problem, with an annual rate of 7.3% for porcelain bridges and 19.4% for metal-resin bridges. The commonest major problem was fracture of the tooth material (annual rate 1.9%); broken screws and frameworks were rare (0.3% a year each). Bruxism and not wearing a night guard raised the risk of chipping.
The 18-year four-implant study tells a similar story from a different angle: the incidence of mechanical complications over the follow-up was 36.7%, and metal-acrylic and metal-ceramic bridges had lower odds of mechanical problems than the reference material in that analysis Maló et al., 2019.
Chipping and the choice of material
Most chipping happens in a layer of porcelain fired over a metal or zirconia framework. Bridges milled from a single block of zirconia, called monolithic zirconia, have no such layer to chip.
Show the numbers as a table
| Item | Bridges with chipping | Source |
|---|---|---|
| Metal-ceramic, 10 years | 39.3% | Wong et al., 2019 |
| Veneered zirconia, 5 years | 34.8% | Pieralli et al., 2018 |
| Metal-ceramic, 5 years | 22.1% | Wong et al., 2019 |
| Zirconia, short term | 14.7% | Bidra et al., 2017 |
Different designs and follow-up, so read each bar on its own. The pattern across studies is that layered porcelain chips more than monolithic zirconia.
For metal-ceramic full arches, veneer fractures reached 22.1% at five years and 39.3% at ten; in two all-ceramic studies, success was 90.9% with mostly monolithic zirconia against 60.4% with layered zirconia Wong et al., 2019. A review of veneered zirconia full arches estimated 97.7% survival but a 34.8% chipping complication rate at five years, which its authors called clinically unacceptable Pieralli et al., 2018. Short-term data on zirconia full arches show a 1.4% failure rate, with most complications limited to chipped porcelain Bidra et al., 2017. More on the materials in zirconia and acrylic and PMMA.
Biological complications: definitions first
Before 2017, studies used so many different definitions that peri-implantitis prevalence ranged from 1% to 47% Derks, 2015. The 2017 World Workshop agreed common ones Berglundh et al., 2018 Renvert et al., 2018:
| Condition | What the dentist sees | Bone |
|---|---|---|
| Peri-implant health | No redness, swelling, pus or bleeding on probing | No further bone loss after initial healing |
| Peri-implant mucositis | Bleeding on gentle probing; redness, swelling or pus may be present | No additional bone loss after initial healing |
| Peri-implantitis | Signs of inflammation, bleeding and/or pus, increasing probing depth | Bone loss on X-ray after initial healing. Without earlier X-rays: bone level of 3 mm or more with bleeding and probing depths of 6 mm or more |
The workshop recommended taking baseline X-rays and probing measurements once the final bridge is fitted, so later changes can be judged. This is one reason your implant passport and copies of your X-rays matter.
How common is inflammation around implants?
Show the numbers as a table
| Item | Prevalence | Range | Source |
|---|---|---|---|
| Mucositis, review (weighted) | 43% | 32–54% | Derks, 2015 |
| Peri-implantitis, review | 22% | 14–30% | Derks, 2015 |
| Any peri-implantitis, Sweden | 45% | – | Derks et al., 2016 |
| Moderate/severe, Sweden | 14.5% | – | Derks et al., 2016 |
The review pools studies with different definitions; the Swedish figures are per patient, nine years after treatment. Not comparable bar to bar.
A random sample of 588 Swedish patients examined nine years after treatment found peri-implantitis in 45% and moderate or severe disease in 14.5% Derks et al., 2016. People with periodontitis and with four or more implants had higher odds of moderate or severe disease, which matters for full-arch patients, who by definition have several implants.
The workshop's review of peri-implantitis found strong evidence for three risk factors: a history of chronic periodontitis, poor plaque control and no regular maintenance after treatment. The evidence for smoking and diabetes as risk factors for peri-implantitis specifically was inconclusive. Disease can start early and tends to speed up rather than progress evenly Schwarz et al., 2018. Firm, keratinised gum around implants is associated with less plaque and inflammation Lin et al., 2013.
Zygomatic implants: the sinus
With cheekbone implants, the main complication is sinusitis. One systematic review reported 2.4%, with soft-tissue infection at 2.0%, numbness at 1.0% and oro-antral fistula at 0.4%, while warning these may be underestimates Chrcanovic et al., 2016. The 2023 ITI consensus reported a total sinusitis prevalence of 14.2% over a mean 65.4 months Al-Nawas et al., 2023. The difference comes largely from how carefully studies looked for it.
What this means for you
- Budget time, and some money, for maintenance: check-ups, hygiene visits and the occasional repair. Ask how a clinic handles repairs and what its guarantee covers in writing.
- Cleaning under a fixed bridge needs the right tools and some practice. Plaque control is the factor most strongly linked with peri-implantitis.
- If you grind your teeth, say so. A night guard and a suitable material can reduce chipping. See risk factors.
Common questions
What is the most common problem with a full-arch bridge?
Wear and chipping of the tooth surface. In one cohort, wear of the prosthetic material had an estimated 5-year rate of 49.0% and fracture of the tooth material 9.5%. Chipping is more frequent with porcelain layered over a framework than with monolithic zirconia.
Is a complication the same as failure?
No. A loose screw, a chipped tooth or a worn surface is usually repaired in one visit and the bridge carries on. In the same cohort where most bridges had some technical problem by year ten, 91.6% of bridges were still in use.
What is the difference between mucositis and peri-implantitis?
Mucositis is inflammation of the gum around an implant with no bone loss; the main sign is bleeding on gentle probing and it is usually reversible. Peri-implantitis adds progressive loss of the bone that supports the implant. Both are caused by plaque.
Can I lower my risk of complications?
Yes, in part. The 2017 World Workshop found strong evidence linking peri-implantitis to poor plaque control, a history of periodontitis and missing regular maintenance. If you grind your teeth, wearing a night guard was associated with less chipping in one cohort.
Who repairs complications if I live abroad?
Many repairs can be done by a local dentist with your implant passport, which lists the parts used. Ask any clinic, including us, how repairs and guarantee claims work before you book. Our travel guides cover aftercare by country.
Sources
- Pjetursson BE, Thoma D, Jung R, Zwahlen M, Zembic A. A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years. Clin Oral Implants Res 2012. PMID 23062125
- Papaspyridakos P, Bordin TB, Kim YJ, El-Rafie K, Pagni SE, Natto ZS, Teixeira ER, Chochlidakis K, Weber HP. Technical Complications and Prosthesis Survival Rates with Implant-Supported Fixed Complete Dental Prostheses: A Retrospective Study with 1- to 12-Year Follow-Up. J Prosthodont 2020. PMID 31650669
- Wong CKK, Narvekar U, Petridis H. Prosthodontic Complications of Metal-Ceramic and All-Ceramic, Complete-Arch Fixed Implant Prostheses with Minimum 5 Years Mean Follow-Up Period. A Systematic Review and Meta-Analysis. J Prosthodont 2019. PMID 29665177
- Pieralli S, Kohal RJ, Rabel K, von Stein-Lausnitz M, Vach K, Spies BC. Clinical outcomes of partial and full-arch all-ceramic implant-supported fixed dental prostheses. A systematic review and meta-analysis. Clin Oral Implants Res 2018. PMID 30306694
- Bidra AS, Rungruanganunt P, Gauthier M. Clinical outcomes of full arch fixed implant-supported zirconia prostheses: A systematic review. Eur J Oral Implantol 2017. PMID 28944367
- Maló P, de Araújo Nobre M, Lopes A, Ferro A, Botto J. The All-on-4 treatment concept for the rehabilitation of the completely edentulous mandible: A longitudinal study with 10 to 18 years of follow-up. Clin Implant Dent Relat Res 2019. PMID 30924309
- Derks J, Tomasi C. Peri-implant health and disease. A systematic review of current epidemiology. J Clin Periodontol 2015. PMID 25495683
- Derks J, Schaller D, Håkansson J, Wennström JL, Tomasi C, Berglundh T. Effectiveness of Implant Therapy Analyzed in a Swedish Population: Prevalence of Peri-implantitis. J Dent Res 2016. PMID 26701919
- Berglundh T, Armitage G, Araujo MG, et al. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol 2018. PMID 29926491
- Renvert S, Persson GR, Pirih FQ, Camargo PM. Peri-implant health, peri-implant mucositis, and peri-implantitis: Case definitions and diagnostic considerations. J Clin Periodontol 2018. PMID 29926496
- Schwarz F, Derks J, Monje A, Wang HL. Peri-implantitis. J Clin Periodontol 2018. PMID 29926484
- Lin GH, Chan HL, Wang HL. The significance of keratinized mucosa on implant health: a systematic review. J Periodontol 2013. PMID 23451989
- Chrcanovic BR, Albrektsson T, Wennerberg A. Survival and Complications of Zygomatic Implants: An Updated Systematic Review. J Oral Maxillofac Surg 2016. PMID 27422530
- Al-Nawas B, Aghaloo T, Aparicio C, et al. ITI consensus report on zygomatic implants: indications, evaluation of surgical techniques and long-term treatment outcomes. Int J Implant Dent 2023. PMID 37698775
Checked October 2026. Where we give our own view as a clinic, we say so.
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