How to treat two adjacent missing teeth with dental implants. A systematic review on single implant‐supported two‐unit cantilever FDP's and results of a 5‐year prospective comparative study in the aesthetic zone

To conduct a systematic review on the clinical outcome of single implant‐supported two‐unit cantilever FDP's and to conduct a 5‐year prospective comparative pilot study of patients with a missing central and lateral upper incisor treated with either a single implant‐supported two‐unit cantilever FDP or two implants with solitary implant crowns in the aesthetic zone. Medline, Embase and the Cochrane Central Register of Controlled Trials were searched (last search 1 August 2016) for eligible studies. In the comparative pilot study, an implant‐cantilever group of five patients with a single implant‐supported two‐unit cantilever FDP (NobelReplace Groovy Regular Platform) was compared with an implant‐implant group of five patients with two adjacent single implant‐supported crowns (NobelReplace Groovy Regular Platform) in the aesthetic zone. Implant survival, marginal bone level (MBL) changes, pocket probing depth, papilla index and patient satisfaction were assessed during a 5‐year follow‐up period. Five of 276 articles were considered eligible for data extraction. Implant survival ranged from 96·6% to 100%. Marginal bone level changes were higher in the anterior region than in the posterior region. Technical complications occurred more often in the posterior than anterior region. In the 5‐year comparative pilot study, no clinically significant differences in hard and soft peri‐implant tissue levels occurred between both groups. Single implant‐supported two‐unit cantilever FDP’s can be a viable alternative to the placement of two adjacent single implant crowns in the aesthetic zone. Due to technical complications, placement of two‐unit cantilever crowns in the posterior region can be considered unwise.