RISK FACTORS IN FIXED AND REMOVABLE PROSTHETIC THERAPY: A NARRATIVE REVIEW

Cămăruţă Roxana, Forna Norina, Topoliceanu Claudiu, Murariu Alice

DOI: 10.62610/RJOR.2026.2.18.4

Abstract

Objectives. The aim of this narrative review was to identify and evaluate the main risk factors influencing the outcomes of fixed and removable prosthetic therapy, encompassing both biological and mechanical determinants, patient-related variables, and clinical management factors across the principal prosthetic modalities. Materials and Methods. A structured literature search was conducted in PubMed/MEDLINE, PubMed Central, Scopus, and Web of Science. Systematic reviews, meta-analyses, randomized controlled trials, and cohort studies published between 2000 and 2025 were included. Outcomes of interest were prosthetic survival rate, prosthetic success rate, biological and mechanical complication rates, abutment tooth loss, marginal bone loss in implant-supported restorations, and patient-reported outcomes. Data were synthesized narratively due to heterogeneity across included studies. Results. Risk factors in prosthetic therapy operate at multiple levels: patient-related factors — including systemic disease, parafunctional habits, oral hygiene, and smoking — interact with treatment-related variables such as prosthetic design, material selection, occlusal loading, and abutment tooth condition. Biological complications, including caries, periodontal disease, and pulpal pathology, represent the leading cause of abutment tooth loss and fixed prosthesis failure, while mechanical complications — fracture, debonding, and wear — are predominantly material- and design-dependent. In removable prosthetics, mucosal health, residual ridge resorption, and denture hygiene emerge as the principal determinants of long-term outcomes. Conclusions. Risk factor identification and stratification prior to prosthetic treatment planning is essential for optimizing long-term outcomes. A multidisciplinary, patient-centered approach that addresses modifiable risk factors before and throughout prosthetic rehabilitation remains the most effective strategy for improving treatment predictability in both fixed and removable prosthetic therapy.