Ten years and beyond: Long-term dental implant survival, success, and biological health-A systematic review and meta-analysis.

Abstract

To update dental implant failure and survival estimates beyond 10 years and examine how success definitions and biological outcomes affect interpretation of long-term performance. Randomized controlled trials, prospective cohorts, and retrospective cohorts with at least 10 years of follow-up were included. Failure proportions were pooled by study design using random-effects models with clustering corrections and prediction intervals. Sensitivity analyses assessed influential studies, risk of bias, surface era, and clustering assumptions. Success, probing depth (PD), marginal bone loss (MBL), and peri-implantitis were summarized descriptively. Thirty-four studies including 7522 patients and 20 445 implants were analyzed. Pooled failure was 5.1% in prospective studies (95% CI, 3.0%-8.7%), 4.9% in retrospective studies (95% CI, 3.3%-7.1%), and 4.8% in randomized trials (95% CI, 3.2%-7.1%), corresponding to survival of approximately 94.9%, 95.1%, and 95.2%, respectively. Success averaged 85.1% across 14 studies, but definitions varied substantially. Descriptive means were 2.99 mm for PD, 1.30 mm for MBL, and 10.8% for implant-level peri-implantitis (range, 3.0%-39.9%). Dental implants are highly durable in terms of retention, with approximately 95% survival after 10-25 years. However, high survival does not establish long-term biological health or true treatment success: success rates were lower and definition-dependent, and peri-implant disease showed substantial variability. Retention is therefore a necessary but insufficient endpoint for judging long-term implant therapy. Long-term assessment should integrate biological, radiographic, technical, functional, and patient-centered outcomes.