Occlusal rehabilitation in patients with congenitally missing teeth—dental implants, conventional prosthetics, tooth autotransplants, and preservation of deciduous teeth—a systematic review
Identifieur interne : 000C73 ( Pmc/Corpus ); précédent : 000C72; suivant : 000C74Occlusal rehabilitation in patients with congenitally missing teeth—dental implants, conventional prosthetics, tooth autotransplants, and preservation of deciduous teeth—a systematic review
Auteurs : Hendrik Terheyden ; Falk WüsthoffSource :
- International Journal of Implant Dentistry [ 2198-4034 ] ; 2015.
Abstract
Implant patients with congenitally missing teeth share some common charateristics and deserve special attention.
The PICO question was “In patients with congenitally missing teeth, does an early occlusal rehabilitation with dental implants in comparison to tooth autotransplants, conventional prosthetics on teeth or preservation of deciduous teeth have better general outcomes in terms of survival, success and better patient centered outcomes in terms of quality of life, self-esteem, satisfaction, chewing function?”
After electronic database search, a total of 63 relevant studies were eligible, of which 42 qualified for numerical data synthesis, 26 being retrospective studies. A data synthesis was performed by weighted means for survival/success/annual failure rates.
The mean survival of implants was 95.3 % (prosthesis survival 97.8 %), autotransplants 94.4 %, deciduous teeth 89.6 %, and conventional prostheses 60.2 %. The implant survival in children, adolescents, and adults was 72.4, 93.0, and 97.4 %. Annual failure rates of implants 3.317 %, autotransplants 1.061 %, deciduous teeth 0.908 %, and conventional prostheses 5.144 % indicated better results for natural teeth and more maintenance needs for the both prosthetic treatments. The mean OHIP score was 27.8 at baseline and a mean improvement of 14.9 score points was reported after implant prosthetics. The mean satisfaction rates were 93.4 (implants), 76.6 (conventional prostheses), 72.0 (autotransplants), and 65.5 % (orthodontic space closure).
In synopsis of general and patient-centered outcomes, implants yielded the best results, however, not in children <13 years. Autotransplants and deciduous teeth had low annual failure rates and are appropriate treatments in children and adolescents at low costs. Conventional prosthetics had lower survival/success rates than the other options. Due to heterogeneity and low number of studies, patient-reported outcomes in this review have to be interpreted with caution.
Url:
DOI: 10.1186/s40729-015-0025-z
PubMed: 27747652
PubMed Central: 5005685
Links to Exploration step
PMC:5005685Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Occlusal rehabilitation in patients with congenitally missing teeth—dental implants, conventional prosthetics, tooth autotransplants, and preservation of deciduous teeth—a systematic review</title><author><name sortKey="Terheyden, Hendrik" sort="Terheyden, Hendrik" uniqKey="Terheyden H" first="Hendrik" last="Terheyden">Hendrik Terheyden</name><affiliation><nlm:aff id="Aff1">Department of Oral and Maxillofacial Surgery, Red Cross Hospital, Hansteinstr. 29, D-34121 Kassel, Germany</nlm:aff></affiliation></author><author><name sortKey="Wusthoff, Falk" sort="Wusthoff, Falk" uniqKey="Wusthoff F" first="Falk" last="Wüsthoff">Falk Wüsthoff</name><affiliation><nlm:aff id="Aff2">Department of Oral and Maxillofacial Surgery, Schleswig-Holstein University Hospital, Arnold-Heller-Straße 3, Haus 26, 2D-4105 Kiel, Germany</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27747652</idno><idno type="pmc">5005685</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5005685</idno><idno type="RBID">PMC:5005685</idno><idno type="doi">10.1186/s40729-015-0025-z</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000C73</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000C73</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Occlusal rehabilitation in patients with congenitally missing teeth—dental implants, conventional prosthetics, tooth autotransplants, and preservation of deciduous teeth—a systematic review</title><author><name sortKey="Terheyden, Hendrik" sort="Terheyden, Hendrik" uniqKey="Terheyden H" first="Hendrik" last="Terheyden">Hendrik Terheyden</name><affiliation><nlm:aff id="Aff1">Department of Oral and Maxillofacial Surgery, Red Cross Hospital, Hansteinstr. 29, D-34121 Kassel, Germany</nlm:aff></affiliation></author><author><name sortKey="Wusthoff, Falk" sort="Wusthoff, Falk" uniqKey="Wusthoff F" first="Falk" last="Wüsthoff">Falk Wüsthoff</name><affiliation><nlm:aff id="Aff2">Department of Oral and Maxillofacial Surgery, Schleswig-Holstein University Hospital, Arnold-Heller-Straße 3, Haus 26, 2D-4105 Kiel, Germany</nlm:aff></affiliation></author></analytic><series><title level="j">International Journal of Implant Dentistry</title><idno type="eISSN">2198-4034</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Implant patients with congenitally missing teeth share some common charateristics and deserve special attention.</p></sec><sec><title>Methods</title><p>The PICO question was “In patients with congenitally missing teeth, does an early occlusal rehabilitation with dental implants in comparison to tooth autotransplants, conventional prosthetics on teeth or preservation of deciduous teeth have better general outcomes in terms of survival, success and better patient centered outcomes in terms of quality of life, self-esteem, satisfaction, chewing function?”</p><p>After electronic database search, a total of 63 relevant studies were eligible, of which 42 qualified for numerical data synthesis, 26 being retrospective studies. A data synthesis was performed by weighted means for survival/success/annual failure rates.</p></sec><sec><title>Results</title><p>The mean survival of implants was 95.3 % (prosthesis survival 97.8 %), autotransplants 94.4 %, deciduous teeth 89.6 %, and conventional prostheses 60.2 %. The implant survival in children, adolescents, and adults was 72.4, 93.0, and 97.4 %. Annual failure rates of implants 3.317 %, autotransplants 1.061 %, deciduous teeth 0.908 %, and conventional prostheses 5.144 % indicated better results for natural teeth and more maintenance needs for the both prosthetic treatments. The mean OHIP score was 27.8 at baseline and a mean improvement of 14.9 score points was reported after implant prosthetics. The mean satisfaction rates were 93.4 (implants), 76.6 (conventional prostheses), 72.0 (autotransplants), and 65.5 % (orthodontic space closure).</p></sec><sec><title>Conclusions</title><p>In synopsis of general and patient-centered outcomes, implants yielded the best results, however, not in children <13 years. Autotransplants and deciduous teeth had low annual failure rates and are appropriate treatments in children and adolescents at low costs. Conventional prosthetics had lower survival/success rates than the other options. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Implant Dent</journal-id><journal-id journal-id-type="iso-abbrev">Int J Implant Dent</journal-id><journal-title-group><journal-title>International Journal of Implant Dentistry</journal-title></journal-title-group><issn pub-type="epub">2198-4034</issn><publisher><publisher-name>Springer Berlin Heidelberg</publisher-name><publisher-loc>Berlin/Heidelberg</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27747652</article-id><article-id pub-id-type="pmc">5005685</article-id><article-id pub-id-type="publisher-id">25</article-id><article-id pub-id-type="doi">10.1186/s40729-015-0025-z</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Occlusal rehabilitation in patients with congenitally missing teeth—dental implants, conventional prosthetics, tooth autotransplants, and preservation of deciduous teeth—a systematic review</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Terheyden</surname><given-names>Hendrik</given-names></name><address><email>Terheyden@rkh-kassel.de</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Wüsthoff</surname><given-names>Falk</given-names></name><xref ref-type="aff" rid="Aff2">2</xref></contrib><aff id="Aff1"><label>1</label>Department of Oral and Maxillofacial Surgery, Red Cross Hospital, Hansteinstr. 29, D-34121 Kassel, Germany</aff><aff id="Aff2"><label>2</label>Department of Oral and Maxillofacial Surgery, Schleswig-Holstein University Hospital, Arnold-Heller-Straße 3, Haus 26, 2D-4105 Kiel, Germany</aff></contrib-group><pub-date pub-type="epub"><day>18</day><month>11</month><year>2015</year></pub-date><pub-date pub-type="pmc-release"><day>18</day><month>11</month><year>2015</year></pub-date><pub-date pub-type="collection"><month>12</month><year>2015</year></pub-date><volume>1</volume><issue>1</issue><elocation-id>30</elocation-id><history><date date-type="received"><day>25</day><month>7</month><year>2015</year></date><date date-type="accepted"><day>27</day><month>8</month><year>2015</year></date></history><permissions><copyright-statement>© Terheyden and Wüsthoff. 2015</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p>Implant patients with congenitally missing teeth share some common charateristics and deserve special attention.</p></sec><sec><title>Methods</title><p>The PICO question was “In patients with congenitally missing teeth, does an early occlusal rehabilitation with dental implants in comparison to tooth autotransplants, conventional prosthetics on teeth or preservation of deciduous teeth have better general outcomes in terms of survival, success and better patient centered outcomes in terms of quality of life, self-esteem, satisfaction, chewing function?”</p><p>After electronic database search, a total of 63 relevant studies were eligible, of which 42 qualified for numerical data synthesis, 26 being retrospective studies. A data synthesis was performed by weighted means for survival/success/annual failure rates.</p></sec><sec><title>Results</title><p>The mean survival of implants was 95.3 % (prosthesis survival 97.8 %), autotransplants 94.4 %, deciduous teeth 89.6 %, and conventional prostheses 60.2 %. The implant survival in children, adolescents, and adults was 72.4, 93.0, and 97.4 %. Annual failure rates of implants 3.317 %, autotransplants 1.061 %, deciduous teeth 0.908 %, and conventional prostheses 5.144 % indicated better results for natural teeth and more maintenance needs for the both prosthetic treatments. The mean OHIP score was 27.8 at baseline and a mean improvement of 14.9 score points was reported after implant prosthetics. The mean satisfaction rates were 93.4 (implants), 76.6 (conventional prostheses), 72.0 (autotransplants), and 65.5 % (orthodontic space closure).</p></sec><sec><title>Conclusions</title><p>In synopsis of general and patient-centered outcomes, implants yielded the best results, however, not in children <13 years. Autotransplants and deciduous teeth had low annual failure rates and are appropriate treatments in children and adolescents at low costs. Conventional prosthetics had lower survival/success rates than the other options. Due to heterogeneity and low number of studies, patient-reported outcomes in this review have to be interpreted with caution.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Hypodontia</kwd><kwd>Oligodontia</kwd><kwd>Anodontia</kwd><kwd>Tooth aplasia</kwd><kwd>Tooth agenesis</kwd><kwd>Congenitally missing teeth</kwd><kwd>Tooth autotransplantation</kwd><kwd>Deciduous tooth</kwd><kwd>Dental implants</kwd><kwd>Ectodermal dysplasia</kwd></kwd-group><funding-group><award-group><funding-source><institution>German Association of Dental Implantology (Deutsche Gesellschaft für Implantologie im Zahn-, Mund- und Kieferbereich e.V.)</institution></funding-source><award-id>ᅟ</award-id><principal-award-recipient><name><surname>Terheyden</surname><given-names>Hendrik</given-names></name></principal-award-recipient></award-group></funding-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2015</meta-value></custom-meta></custom-meta-group></article-meta></front><body><sec id="Sec1"><title>Background</title><p>Congenitally missing teeth, also called hypodontia, is the most frequent human malformation. The prevalence of hypodontia in white populations is estimated to be 5.5 %, with a higher incidence in women than in men. Hypodontia varies in severity, from a single missing tooth to the absence of all permanent teeth called anodontia. Oligodontia is usually defined as the absence of 6 or more permanent teeth, the third molars excluded, and its prevalence is estimated at 0.14 % in the white population [<xref ref-type="bibr" rid="CR1">1</xref>]. Hypodontia can occur in isolation (non-syndromal) or as a part of numerous inherited syndromes of which the different forms of ectodermal dysplasia are the predominant entity [<xref ref-type="bibr" rid="CR2">2</xref>]. Patients with congenitally missing teeth comprise a special group of patients deserving special attention, especially when dental implants are needed.</p><p>In cases with congenitally missing teeth, the defect in the dentition occurs very early in life, in contrast to many other implant patients who lost their teeth due to caries or periodontitis at later stages. The early time point has an advantage that the young patients are usually well adapted to the defects. However, prosthetic treatments are often necessary already in childhood. In childhood and adolescence, prosthetic treatments can be complicated, because teeth should not be ground as abutments for crowns due to the large pulp cavity, and dentures may not be splinted if the jaws still grow. It is also questionable whether dental implants can be placed before termination of growth due to the well-known problems of secondary infraocclusion due to the ankylotic healing of osseointegrated implants and due to other biological reasons [<xref ref-type="bibr" rid="CR3">3</xref>]. Furthermore, children and their young parents and families often have a cost problem, since unlike other implant patient groups, the tooth defects appear in early phases of life when the income is low or needed elsewhere. In some public health systems, occlusal rehabilitation in childhood and adolescence is covered by public insurances and has to be finished before the 18th year of life.</p><p>The local implant site can be special, too. A site with aplasia of the primary or secondary tooth usually is different from implant sites in conventional implant patients. Usually, there is a severe lack of alveolar bone width and often height and bone has never been there, since alveolar bone is unlike the basal jaw bone, a development of the erupting tooth. In addition, bone quality can be more cortical and brittle than in conventional implant sites, which can influence implant placement as well as orthodontic tooth movement. The same applies to the fixed masticatory gingiva in a site with tooth aplasia, which can be narrow or missing at all. Due to these common general properties of an implant site with tooth agenesis irrespective of the number of missing teeth, this systematic review includes articles with single or few missing teeth (mild hypodontia), multiple (>6) missing teeth (oligodontia), and also total absence of teeth (anodontia).</p><p>There may be mainly four or five treatment options for occlusal rehabilitation in cases with congenitally missing teeth, including dental implant-borne prosthetics. First option is the preservation of a primary deciduous tooth. Such decision has to be made first, if a primary tooth is still present in the site due to missing eruption of a permanent successor. A second option may be the autotransplantation of other teeth, if such transplants are available. This is a well-accepted method in childhood, since tooth autotransplants can heal with a functional periodontium which enables orthodontic movement and enables the tooth to participate in growth of the alveolar crest. Furthermore, tooth transplants in childhood have a better prognosis, when root development is still incomplete and the apical foramen is still open, compared to mature teeth in adults with closed foramen. A third option is conventional prosthetics on teeth, which in childhood will typically include unsplinted overdentures, which should not interfere with jaw growth or resin-bonded bridges, since juvenile teeth should not be ground for crowns. The fourth option is dental implants. Each of the four options has its advantages and limitations and a differential indication has to be made in every single case of congenitally missing teeth. The fifth option may be orthodontic space closure as a single treatment. Of course, adjunctive orthodontic treatment is a very important part of occlusal rehabilitation in patients with congenitally missing teeth. However, this is not in the focus of this systematic review, because this therapy is not generally applicable to cases with multiple missing teeth.</p><p>To the knowledge of the authors, narrative literature reviews [<xref ref-type="bibr" rid="CR4">4</xref>–<xref ref-type="bibr" rid="CR7">7</xref>] and consensus meetings [<xref ref-type="bibr" rid="CR8">8</xref>–<xref ref-type="bibr" rid="CR10">10</xref>] have been published on the topic in the literature. There is only one systematic review without numerical meta-analysis [<xref ref-type="bibr" rid="CR11">11</xref>]. In the latter, Yap and Klineberg addressed studies on dental implants in patients with ectodermal dysplasia (ED) and tooth agenesis but not on the alternative treatments. They found documented implant survival rates of 88.5–97.6 % in ED cases and 90–100 % in tooth agenesis. The authors concluded that implants placed in adolescent patients with ED do not have a significant negative influence on facial growth and that implants in ED patients younger than 18 years have a high risk of failure.</p><p>The aim of this study is a systematic review of the literature of treatment of patients with congenitally missing teeth and a meta-analysis in from of weighted means of survival and success data. The aim is to elucidate the role of dental implants in the group of patients with congenitally missing teeth in comparison with the other treatment options. In addition to the general treatment outcome parameters, the aim was also to include patient-centered and patient-reported outcome parameters. This paper was prepared as the basis of a consensus meeting of the German Implant Association to be held on 9th–10th of September 2015 in Aerzen, Germany.</p></sec><sec id="Sec2"><title>Methods</title><p>This systematic review was structured and performed according to the preferred reporting items of the PRISMA statement [<xref ref-type="bibr" rid="CR12">12</xref>].</p><sec id="Sec3"><title>Focused question</title><p>The focused question serving for literature search was structured according to the PICO format (Table <xref rid="Tab1" ref-type="table">1</xref>) “In patients with congenitally missing teeth, does an early occlusal rehabilitation with dental implants in comparison to tooth autotransplants, conventional prosthetics on teeth or preservation of deciduous teeth have better general outcomes in terms of survival, success and better patient centered outcomes in terms of quality of life, self-esteem, satisfaction, chewing function?”.<table-wrap id="Tab1"><label>Table 1</label><caption><p>Logical deduction of the literature search phrase from the PICO questionable</p></caption><table frame="hsides" rules="groups"><thead><tr valign="top"><th>Patients</th><th>Intervention</th><th>Control</th><th>Outcomes</th></tr></thead><tbody><tr valign="top"><td rowspan="9">Patients with congenitally missing teeth</td><td>Rehabilitation</td><td>Tooth autotransplants</td><td>General:</td></tr><tr valign="top"><td>Dental implants</td><td>Preservation of deciduous teeth</td><td>Implant/tooth survival/success</td></tr><tr valign="top"><td rowspan="7">Bone augmentation</td><td>Conventional prosthodontic treatment</td><td>Prosthesis survival/success</td></tr><tr valign="top"><td rowspan="6">Orthodontic treatment</td><td>Craniofacial growth</td></tr><tr valign="top"><td>Patient reported:</td></tr><tr valign="top"><td>Quality of life</td></tr><tr valign="top"><td>Self-esteem</td></tr><tr valign="top"><td>Satisfaction</td></tr><tr valign="top"><td>Chewing function</td></tr><tr valign="top"><td colspan="4">Synonyms, search terms, search phrase</td></tr><tr valign="top"><td>• Anodontia (MeSH)</td><td>• Rehabilitation</td><td>• Autotransplan*</td><td>• Survival</td></tr><tr valign="top"><td>• Hypodontia</td><td>• Dental implan* (MeSH)</td><td>• Crown (MeSH)</td><td>• Success</td></tr><tr valign="top"><td>• Oligodontia</td><td>• Alveolar bone grafting (MeSH)</td><td>• Dentur* (MeSH)</td><td>• Growth</td></tr><tr valign="top"><td>• Tooth aplasia</td><td>• Bone augmentation</td><td>• Dental Prosthe* (MeSH)</td><td>• Quality of life (MeSH)</td></tr><tr valign="top"><td>• Tooth agenesis</td><td></td><td>• Orthodonti* (MeSH)</td><td>• Satisfaction</td></tr><tr valign="top"><td>• Congenitally missing teeth</td><td></td><td>• Tooth deciduous (MeSH)</td><td>• Self-esteem</td></tr><tr valign="top"><td>• Developmentally absent teeth</td><td></td><td></td><td>• Chewing</td></tr><tr valign="top"><td>• Birth defects</td><td></td><td></td><td>• Masticat* (MeSH)</td></tr><tr valign="top"><td>• Noncarious defects</td><td></td><td></td><td>• Masticat* (MeSH)</td></tr><tr valign="top"><td>• Ectodermal dysplasia</td><td></td><td></td><td></td></tr><tr valign="top"><td>AND (tooth OR teeth OR dental)</td><td></td><td></td><td></td></tr></tbody></table><table-wrap-foot><p>Boolean operators: (Within column OR, columns AND except intervention and control OR) AND (tooth OR teeth OR dental)</p><p>NOT cancer, ophthalm*, brain, cataract</p><p>Filter: humans</p><p>Search phrase</p><p>(tooth OR teeth OR dental) AND ((anodontia OR aplas* OR agenesis OR oligodontia OR hypodontia OR developmentally absent OR congenitally missing OR noncarious OR birth defect OR ectodermal dysplasia) AND ((rehabilitation OR dental implant* OR bone augment* OR alveolar bone grafting) OR (autotransplan* OR crown OR denture* OR dental prosth* OR orthodont* OR deciduous )) AND (survival OR success OR growth OR quality of life OR satisfaction OR self-esteem OR chewing OR masticat*) NOT cancer NOT ophthalm* NOT brain NOT cataract))</p></table-wrap-foot></table-wrap></p></sec><sec id="Sec4"><title>Search strategy</title><p>PubMed of the US National Library of Medicine and EMBASE were used as electronic databases to perform a systematic search for relevant articles published in the dental literature between 1980 up to 31 May 2015.</p><p>A first probatory screening using only the MeSH terms “anodontia” and “dental implants” yielded too few results. It became clear that there are numerous synonyms of anodontia, which had to be included in the search (Table <xref rid="Tab1" ref-type="table">1</xref>). A search strategy based on the elements of the PICO question was constructed: (tooth OR teeth OR dental) AND ((anodontia OR aplas* OR agenesis OR oligodontia OR hypodontia OR developmentally absent OR congenitally missing OR noncarious OR birth defect OR ectodermal dysplasia) AND ((rehabilitation OR dental implant* OR bone augment* OR alveolar bone grafting) OR (autotransplan* OR crown OR denture* OR dental prosth* OR orthodont* OR deciduous )) AND (survival OR success OR growth OR quality of life OR satisfaction OR self-esteem OR chewing OR masticat*) NOT cancer NOT ophthalm* NOT brain NOT cataract)).</p><p>Screening was performed independently by the two authors. Disagreement regarding inclusion during the first and second stage of study selection was resolved by discussion.</p><p>Electronic search was complemented by an iterative hand-search in the reference lists of the already identified articles. If required, the corresponding authors were contacted and requested to provide missing data or information by email.</p></sec><sec id="Sec5"><title>Study inclusion and exclusion criteria</title><p>During the first stage of study selection, the titles and abstracts were screened and evaluated according to the following inclusion criteria:<list list-type="order"><list-item><p>English language.</p></list-item><list-item><p>Retrospective and prospective clinical trials, observational studies, cross sectional studies, cohort studies, case series.</p></list-item></list></p><p>During this procedure, the pre-selected publications were evaluated according to the following exclusion criteria:<list list-type="order"><list-item><p>Inclusion of minimum 5 patients (exclusion of case reports).</p></list-item><list-item><p>Inadequate case definition or missing follow-up times.</p></list-item><list-item><p>Double publication of the same sample</p></list-item><list-item><p>Lack of clinical data</p></list-item><list-item><p>Studies in cleft lip and palate patients</p></list-item></list></p></sec><sec id="Sec6"><title>Quality and risk of bias assessment of selected studies</title><p>A quality assessment of all selected full-text articles was performed. It made no sense to use the Cochrane collaborations’ tool for assessing risk of bias for randomized controlled studies since the majority of the included studies were retrospective case series. Instead, a system modified from the US Agency for Healthcare Research and Quality Methods Guide for Comparative Effectiveness Reviews was used, which asked for the sources of possible bias [<xref ref-type="bibr" rid="CR13">13</xref>]. The criteria were each judged with low, medium, and high risk of bias: case selection bias and confounding, attrition bias (loss of participants), detection bias (reliable measures?), reporting bias (selective or incomplete reporting), followed by a summary of the risk. Exclusion and quality assessment was performed independently by both authors. Disagreements were resolved by discussion.</p></sec><sec id="Sec7"><title>Data extraction</title><p>A data extraction template was generated and based on the treatment types for the general outcome parameters and for the patient-centered outcome parameters. Due to incomplete reporting, old studies, and changing definitions in some papers, the required data on survival and success were often not found directly listed in the publications. In this case, they had to be retrieved from side informations or recalculated from tables. The following rules were applied: survival meant that the unit (implant, tooth, prosthesis) was reported to be present in the oral cavity. Success definition of an implant followed the criteria of Buser and coworkers [<xref ref-type="bibr" rid="CR14">14</xref>] which are the following: absence of persistent subjective complaints such as pain, foreign body sensation and/or dysesthesia, absence of a peri-implant infection with suppuration, absence of mobility, absence of a continuous radiolucency (severe bone resorption) around the implant. A prosthesis either conventional or implant borne was counted as a success, if there were no complications reported like fracture, soft tissue recessions, or documented treatment needs. A deciduous tooth was counted as a success, if there was no ankylosis and infraocclusion reported. A tooth autotransplant was regarded as a success if there were no reports of ankylosis or severe root resorption, infection, or mobility.</p></sec><sec id="Sec8"><title>Statistics and data synthesis</title><p>For data synthesis, the survival and success data of the individual studies were pooled by the weighted mean method and 95 % confidence intervals were calculated as estimations of variance. A meta-analysis was not possible due to the structure of the underlying survival success data as simple percentages without a measure of variance and without control groups in most studies. The survival/success data were weighted both based on patients and units (either implants/teeth/prostheses). Because the studies showed large differences in follow-up times, these were standardized by calculating annual failure rates by dividing the success and survival data through the follow-up time in years. All spreadsheet calculations and statistics were made with the Microsoft Excel program.</p></sec></sec><sec id="Sec9"><title>Results</title><sec id="Sec10"><title>Study selection</title><p>A total of 1508 potentially relevant titles and abstracts were found by the electronic search. Twelve titles found additionally by evaluation of reference lists of included articles were added. During first screening, 1020 publications were excluded based on database information. One hundred twenty-eight full-text articles were thoroughly evaluated. A total of 65 papers had to be excluded at this stage because they did not fulfill the inclusion criteria of the present systematic review. Sixty-three articles went into qualitative assessment (Fig. <xref rid="Fig1" ref-type="fig">1</xref>). One article had to be excluded or pooled with another because of possible double publication of the same cohort (Grecchi (b) [<xref ref-type="bibr" rid="CR15">15</xref>]), one article because of missing follow-up times (Hvaring [<xref ref-type="bibr" rid="CR16">16</xref>]), one because of missing clinical data (Kjaer [<xref ref-type="bibr" rid="CR17">17</xref>]), and two articles because of missing numerical data (Dellavia [<xref ref-type="bibr" rid="CR18">18</xref>, <xref ref-type="bibr" rid="CR19">19</xref>]). The study of Bergendal [<xref ref-type="bibr" rid="CR20">20</xref>] could be kept in the analysis after contacting the author for clarification (no follow-up time reported). The implants in that study were observed only over the healing period (estimated 6 months in average). Because of too few studies and incompletely reported data studies on orthodontic gap closure, facial growth and masticatory performance were not included into the quantitative data synthesis. Forty-two studies were included in the assessment of general outcome parameter survival and success. For 16 studies on patient-centered variables, also weighted means were calculated.<fig id="Fig1"><label>Fig. 1</label><caption><p>Flow diagram of literature search and inclusion</p></caption><graphic xlink:href="40729_2015_25_Fig1_HTML" id="MO1"></graphic></fig></p></sec><sec id="Sec11"><title>Evaluation of study quality and risk of bias</title><p>The majority (<italic>n</italic> = 25) of the 42 studies were retrospective, 14 were prospective including one RCT 2 were cross sectional studies, and 1 remained unclear. Despite a low evidence level in terms of study design, there were no major concerns about risk of bias. The 30/42 studies were rated with a low risk of bias, and 12/42 had a medium risk. No study had a high risk of bias and consequently no further study was excluded at this stage because of bias (Table <xref rid="Tab2" ref-type="table">2</xref>).<table-wrap id="Tab2"><label>Table 2</label><caption><p>Summary of the selected studies and quality assessement</p></caption><table frame="hsides" rules="groups"><thead><tr valign="top"><th rowspan="2">Author</th><th rowspan="2">Year</th><th rowspan="2">Study type</th><th rowspan="2">Case selection bias (homogeneity and confounders)</th><th rowspan="2">Performance bias (fidelity to protocol)</th><th rowspan="2">Attrition bias (loss of participants)</th><th rowspan="2">Detection bias (reliable measures)</th><th rowspan="2">Reporting bias (selective reporting or conflicting interests)</th><th>Summary assessments</th></tr><tr valign="top"><th>Risk of bias</th></tr></thead><tbody><tr valign="top"><td>Implant studies</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr valign="top"><td> Ledermann [<xref ref-type="bibr" rid="CR40">40</xref>]</td><td>1993</td><td>Retrospect</td><td>M</td><td>M</td><td>L</td><td>M</td><td>H</td><td>M</td></tr><tr valign="top"><td> Kearns [<xref ref-type="bibr" rid="CR41">41</xref>]</td><td>1999</td><td>ProspObs</td><td>L</td><td>L</td><td>L</td><td>L</td><td>M</td><td>L</td></tr><tr valign="top"><td> Thilander [<xref ref-type="bibr" rid="CR3">3</xref>]</td><td>2001</td><td>ProspObs</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td></tr><tr valign="top"><td> Guckes [<xref ref-type="bibr" rid="CR42">42</xref>]</td><td>2002</td><td>ProspObs</td><td>M</td><td>L</td><td>L</td><td>L</td><td>M</td><td>L</td></tr><tr valign="top"><td> Sweeney [<xref ref-type="bibr" rid="CR43">43</xref>]</td><td>2005</td><td>Retrospect</td><td>L</td><td>L</td><td>L</td><td>L</td><td>M</td><td>L</td></tr><tr valign="top"><td> Finnema [<xref ref-type="bibr" rid="CR27">27</xref>]</td><td>2005</td><td>Retrospect</td><td>L</td><td>L</td><td>M</td><td>L</td><td>M</td><td>L</td></tr><tr valign="top"><td> Poggio [<xref ref-type="bibr" rid="CR44">44</xref>]</td><td>2005</td><td>Retrospect</td><td>M</td><td>M</td><td>M</td><td>M</td><td>M</td><td>M</td></tr><tr valign="top"><td> Zarone [<xref ref-type="bibr" rid="CR45">45</xref>]</td><td>2006</td><td>ProspObs</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td></tr><tr valign="top"><td> Becelli [<xref ref-type="bibr" rid="CR46">46</xref>]</td><td>2007</td><td>Retrospect</td><td>L</td><td>L</td><td>L</td><td>L</td><td>M</td><td>L</td></tr><tr valign="top"><td> Bergendal [<xref ref-type="bibr" rid="CR20">20</xref>]</td><td>2008</td><td>Survey</td><td>M</td><td>L</td><td>H</td><td>M</td><td>M</td><td>M</td></tr><tr valign="top"><td> Dueled [<xref ref-type="bibr" rid="CR26">26</xref>]</td><td>2008</td><td>Retrospect</td><td>M</td><td>L</td><td>M</td><td>L</td><td>L</td><td>L</td></tr><tr valign="top"><td> Krieger [<xref ref-type="bibr" rid="CR25">25</xref>]</td><td>2009</td><td>Retrospect</td><td>M</td><td>L</td><td>L</td><td>M</td><td>M</td><td>L</td></tr><tr valign="top"><td> Degidi [<xref ref-type="bibr" rid="CR47">47</xref>]</td><td>2009</td><td>RCT</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td></tr><tr valign="top"><td> Creton [<xref ref-type="bibr" rid="CR1">1</xref>]</td><td>2010</td><td>Retrospect</td><td>L</td><td>L</td><td>M</td><td>L</td><td>M</td><td>L</td></tr><tr valign="top"><td> Grecchi [<xref ref-type="bibr" rid="CR15">15</xref>](a), [<xref ref-type="bibr" rid="CR22">22</xref>](b)</td><td>2010</td><td>Retrospect</td><td>H</td><td>M</td><td>M</td><td>L</td><td>L</td><td>M</td></tr><tr valign="top"><td> Nissan [<xref ref-type="bibr" rid="CR48">48</xref>]</td><td>2011</td><td>Unclear</td><td>H</td><td>L</td><td>M</td><td>M</td><td>M</td><td>M</td></tr><tr valign="top"><td> Heuberer [<xref ref-type="bibr" rid="CR38">38</xref>]</td><td>2012</td><td>Retrospect</td><td>L</td><td>L</td><td>L</td><td>L</td><td>M</td><td>L</td></tr><tr valign="top"><td> Hosseini [<xref ref-type="bibr" rid="CR49">49</xref>]</td><td>2013</td><td>ProspObs</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td></tr><tr valign="top"><td> Zou [<xref ref-type="bibr" rid="CR50">50</xref>]</td><td>2014</td><td>Retrospect</td><td>M</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td></tr><tr valign="top"><td>Autotransplants</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>14/19 L 5/19 M</td></tr><tr valign="top"><td> Kristersson [<xref ref-type="bibr" rid="CR51">51</xref>]</td><td>1991</td><td>Retrospect</td><td>M</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td></tr><tr valign="top"><td> Kugelberg [<xref ref-type="bibr" rid="CR52">52</xref>]</td><td>1994</td><td>ProspObs</td><td>M</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td></tr><tr valign="top"><td> Marcusson [<xref ref-type="bibr" rid="CR53">53</xref>]</td><td>1996</td><td>ProspObs</td><td>M</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td></tr><tr valign="top"><td> Josefsson [<xref ref-type="bibr" rid="CR54">54</xref>]</td><td>1999</td><td>Retrospect</td><td>M</td><td>L</td><td>M</td><td>L</td><td>L</td><td>L</td></tr><tr valign="top"><td> Czochrowska [<xref ref-type="bibr" rid="CR55">55</xref>]</td><td>2002</td><td>Retrospect</td><td>H</td><td>L</td><td>M</td><td>L</td><td>L</td><td>M</td></tr><tr valign="top"><td> Bauss [<xref ref-type="bibr" rid="CR23">23</xref>]</td><td>2004</td><td>prospCT</td><td>M</td><td>L</td><td>M</td><td>M</td><td>M</td><td>M</td></tr><tr valign="top"><td> Jonsson [<xref ref-type="bibr" rid="CR56">56</xref>]</td><td>2004</td><td>ProspObs</td><td>M</td><td>L</td><td>L</td><td>L</td><td>M</td><td>L</td></tr><tr valign="top"><td> Tanaka [<xref ref-type="bibr" rid="CR57">57</xref>]</td><td>2007</td><td>Retrospect</td><td>M</td><td>L</td><td>M</td><td>L</td><td>M</td><td>M</td></tr><tr valign="top"><td> Mensink [<xref ref-type="bibr" rid="CR58">58</xref>]</td><td>2010</td><td>Retrospect</td><td>M</td><td>L</td><td>L</td><td>L</td><td>M</td><td>L</td></tr><tr valign="top"><td> Kvint [<xref ref-type="bibr" rid="CR59">59</xref>]</td><td>2010</td><td>Retrospect</td><td>M</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td></tr><tr valign="top"><td> Bokelund [<xref ref-type="bibr" rid="CR24">24</xref>]</td><td>2013</td><td>Retrospect</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td></tr><tr valign="top"><td> Deciduous teeth</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>8/11 L 3/11 M</td></tr><tr valign="top"><td> Bjerklin [<xref ref-type="bibr" rid="CR60">60</xref>]</td><td>2000</td><td>ProspObs</td><td>M</td><td>L</td><td>M</td><td>L</td><td>L</td><td>L</td></tr><tr valign="top"><td> Ith-Hansen [<xref ref-type="bibr" rid="CR61">61</xref>]</td><td>2000</td><td>ProspObs</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td></tr><tr valign="top"><td> Sletten [<xref ref-type="bibr" rid="CR62">62</xref>]</td><td>2003</td><td>Retrospect</td><td>L</td><td>L</td><td>M</td><td>L</td><td>M</td><td>L</td></tr><tr valign="top"><td> Bjerklin [<xref ref-type="bibr" rid="CR63">63</xref>]</td><td>2008</td><td>ProspObs</td><td>M</td><td>L</td><td>M</td><td>L</td><td>L</td><td>L</td></tr><tr valign="top"><td> Kjaer [<xref ref-type="bibr" rid="CR17">17</xref>]</td><td>2008</td><td>Retrospect</td><td>L</td><td>L</td><td>M</td><td>L</td><td>L</td><td>L</td></tr><tr valign="top"><td> Hvaring [<xref ref-type="bibr" rid="CR16">16</xref>]</td><td>2013</td><td>Cross section</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td><td>L</td></tr><tr valign="top"><td>Convent. Prosth.</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>2/6 L 4/6 M</td></tr><tr valign="top"><td> Hobkirk [<xref ref-type="bibr" rid="CR64">64</xref>]</td><td>1989</td><td>Retrospect</td><td>H</td><td>M</td><td>M</td><td>L</td><td>M</td><td>M</td></tr><tr valign="top"><td> Pröbster [<xref ref-type="bibr" rid="CR65">65</xref>]</td><td>1997</td><td>Retrospect</td><td>M</td><td>L</td><td>M</td><td>L</td><td>M</td><td>M</td></tr><tr valign="top"><td> Garnett [<xref ref-type="bibr" rid="CR66">66</xref>]</td><td>2005</td><td>Retrospect</td><td>M</td><td>L</td><td>M</td><td>L</td><td>M</td><td>M</td></tr><tr valign="top"><td> Dueled [<xref ref-type="bibr" rid="CR26">26</xref>]</td><td>2008</td><td>Retrospect</td><td>M</td><td>L</td><td>M</td><td>L</td><td>L</td><td>L</td></tr><tr valign="top"><td> Krieger [<xref ref-type="bibr" rid="CR25">25</xref>]</td><td>2009</td><td>Retrospect</td><td>M</td><td>L</td><td>L</td><td>M</td><td>M</td><td>M</td></tr><tr valign="top"><td> Spinas [<xref ref-type="bibr" rid="CR67">67</xref>]</td><td>2013</td><td>ProspObs</td><td>L</td><td>L</td><td>L</td><td>L</td><td>M</td><td>L</td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>2/6 L 4/6 M</td></tr><tr valign="top"><td>Total</td><td><italic>n</italic> = 42</td><td>25 retrosp 14 prosp</td><td></td><td></td><td></td><td></td><td></td><td>30/42 L12/42 M</td></tr></tbody></table></table-wrap></p></sec><sec id="Sec12"><title>Studies on general outcome parameters</title><sec id="Sec13"><title>Studies on dental implants and implant-supported prosthetics</title><p>A total of 19 studies with a mean follow-up time of 4.6 years (maximum 15.1 years) was included (Table <xref rid="Tab3" ref-type="table">3</xref>). Most studies were of retrospective character. The heterogeneity of the studies concerning survival and success data was low and acceptable for the numerical data synthesis. The studies showed some heterogeneity in patient inclusion, because in some studies, missing single teeth and treatments with single crowns on implants were mixed with severe oligodontia and varying prosthetic treatment including overdentures on implants. Also, management of bone defects and necessity of bone grafting were heterogenous between the studies. This heterogeneity did not lead to exclusion from the present numerical evaluation. The study of Bergendal and coworkers [<xref ref-type="bibr" rid="CR20">20</xref>] was considered important, because a high ratio of implant failures was reported in childhood. It was one of the very few studies in the literature on implantation in childhood. However, no follow-up time was reported because it was a cross-sectional survey. The author was contacted via email and confirmed that all implant losses had occurred during healing time before prosthetic restoration. Since healing time was has usually a maximum of 6 months, the follow-up time was set on arbitrary 0.6 year. The study of Durstberger et al. [<xref ref-type="bibr" rid="CR21">21</xref>] had to be excluded because of vague follow-up data and no information of implant losses during follow-up and most of the mentioned patients were only planned for implant placement but had no implants placed. The studies of Grecchi (a) [<xref ref-type="bibr" rid="CR22">22</xref>] were pooled with Grecchi (b) [<xref ref-type="bibr" rid="CR15">15</xref>] for numerical analysis, because of assumed double publication of the same samples. In most of the studies, implants had been placed in conjunction with bone grafting, but only Grecchi (a) [<xref ref-type="bibr" rid="CR22">22</xref>] had presented outcome data on this aspect. There were no prominent differences for implants placed in grafted bone compared with non-grafted sites. Secondary infraocclusion of approximately 1 mm was a problem of implant placements in the maxillary incisor region in childhood [<xref ref-type="bibr" rid="CR3">3</xref>]. Marginal bone resorption at implants was not a prominent finding and ranged from 0.2 to 1.2 mm in the studies which reported this aspect. The success/survival data and further subgroup analysis for implant survival data is presented below.<table-wrap id="Tab3"><label>Table 3</label><caption><p>Synopsis of included studies on dental implants and prosthetics on dental implants in order of publication year</p></caption><table frame="hsides" rules="groups"><thead><tr valign="top"><th colspan="2">Author</th><th>Year</th><th>Study type</th><th>Population</th><th>Treatment</th><th>Comparison</th><th>Patients</th><th>Implants</th><th>Implant survival [%]</th><th>Implant success [%]</th><th>Prosthes. survival [%]</th><th>Marginal resorpt.[mm]</th><th>Infra occlusion [mm]</th><th>Follow-up [y]</th><th>Risk of bias</th></tr></thead><tbody><tr valign="top"><td>Ledermann [<xref ref-type="bibr" rid="CR40">40</xref>]</td><td colspan="2">1993</td><td>Retrospect</td><td>Agenesis, trauma</td><td>FPD</td><td>9–18 years</td><td>34</td><td>42</td><td>90</td><td>90</td><td>100</td><td></td><td></td><td>3</td><td>M</td></tr><tr valign="top"><td>Kearns [<xref ref-type="bibr" rid="CR41">41</xref>]</td><td colspan="2">1999</td><td>ProspObs</td><td>ED 5–17 years</td><td>Full denture</td><td>All</td><td>6</td><td>41</td><td>97.6</td><td></td><td></td><td></td><td></td><td>7.8</td><td>L</td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td><6 years</td><td>2</td><td>9</td><td>100</td><td>44.4</td><td>0</td><td></td><td></td><td>7.8</td><td></td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>>12 years</td><td>4</td><td>32</td><td>96.9</td><td>96.9</td><td>100</td><td></td><td></td><td>7.8</td><td></td></tr><tr valign="top"><td>Thilander [<xref ref-type="bibr" rid="CR3">3</xref>]</td><td colspan="2">2001</td><td>ProspObs</td><td>Agen,<18 years trauma</td><td>SC, FPD</td><td>All</td><td>18</td><td>47</td><td>100</td><td>100</td><td>93.9</td><td></td><td></td><td>10</td><td>L</td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>Incisors</td><td>12</td><td>26</td><td>100</td><td>100</td><td>88.2</td><td>0.75</td><td>0.98</td><td>10</td><td></td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>Canines</td><td>4</td><td>8</td><td>100</td><td>100</td><td>100</td><td>0.6</td><td>0</td><td>10</td><td></td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>Premolars</td><td>5</td><td>13</td><td>100</td><td>100</td><td>100</td><td>0.5</td><td>0.1–0.6</td><td>10</td><td></td></tr><tr valign="top"><td>Guckes [<xref ref-type="bibr" rid="CR42">42</xref>]</td><td colspan="2">2002</td><td>ProspObs</td><td>ED 5–18 years</td><td>Full denture</td><td>All</td><td>51</td><td>264</td><td>90</td><td></td><td></td><td></td><td></td><td>2</td><td>L</td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>Maxilla</td><td></td><td>21</td><td>71</td><td></td><td></td><td></td><td></td><td>2</td><td></td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>Mandible</td><td></td><td>243</td><td>91</td><td></td><td></td><td></td><td></td><td>2</td><td></td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td><11 years</td><td></td><td>46</td><td>85</td><td></td><td></td><td></td><td></td><td>2</td><td></td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>11–18 years</td><td></td><td>122</td><td>87</td><td></td><td></td><td></td><td></td><td>2</td><td></td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>>18 years</td><td></td><td>96</td><td>95</td><td></td><td></td><td></td><td></td><td>2</td><td></td></tr><tr valign="top"><td>Sweeney [<xref ref-type="bibr" rid="CR43">43</xref>]</td><td colspan="2">2005</td><td>Retrospect</td><td>ED adolesc.</td><td>FPD, full denture</td><td>All</td><td>14</td><td>61</td><td>88.5</td><td></td><td>94</td><td></td><td></td><td>3.33</td><td>L</td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>Maxilla</td><td>4</td><td>15</td><td>80</td><td></td><td></td><td></td><td></td><td>3.33</td><td></td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>Mandible</td><td>14</td><td>46</td><td>91.3</td><td></td><td></td><td></td><td></td><td>3.33</td><td></td></tr><tr valign="top"><td>Finnema [<xref ref-type="bibr" rid="CR27">27</xref>]</td><td colspan="2">2005</td><td>Retrospect</td><td>Oligodont. adults</td><td>FPD</td><td>All</td><td>13</td><td>87</td><td>89.7</td><td></td><td></td><td></td><td></td><td>3</td><td>L</td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>Maxilla</td><td></td><td></td><td>86</td><td></td><td></td><td></td><td></td><td>3</td><td></td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>Mandible</td><td></td><td></td><td>96</td><td></td><td></td><td></td><td></td><td>3</td><td></td></tr><tr valign="top"><td>Poggio [<xref ref-type="bibr" rid="CR44">44</xref>]</td><td colspan="2">2005</td><td>Retrospect</td><td>Oligodont. adults</td><td>SC</td><td>No</td><td>24</td><td>46</td><td>100</td><td></td><td>82.6</td><td></td><td></td><td>5.25</td><td>M</td></tr><tr valign="top"><td>Zarone [<xref ref-type="bibr" rid="CR45">45</xref>]</td><td colspan="2">2006</td><td>ProspObs</td><td>Ag incisors adults</td><td>SC</td><td>No</td><td>30</td><td>34</td><td>97.1</td><td>94.1</td><td></td><td>1.2</td><td></td><td>3.75</td><td>L</td></tr><tr valign="top"><td>Becelli [<xref ref-type="bibr" rid="CR46">46</xref>]</td><td colspan="2">2007</td><td>Retrospect</td><td>Oligodont. adults</td><td>SC, FPD</td><td>No</td><td>8</td><td>60</td><td>96.6</td><td></td><td></td><td></td><td></td><td>8.5</td><td>L</td></tr><tr valign="top"><td>Bergendal [<xref ref-type="bibr" rid="CR20">20</xref>]</td><td colspan="2">2008</td><td>Survey</td><td>ED, adoles children</td><td>n.s.</td><td>All</td><td>26</td><td>47</td><td>76.6</td><td></td><td></td><td></td><td></td><td>0.6</td><td>M</td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>14–15 years</td><td>21</td><td>33</td><td>93.9</td><td></td><td></td><td></td><td></td><td>0.6</td><td></td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td><13 years</td><td>5</td><td>14</td><td>35.7</td><td></td><td></td><td></td><td></td><td>0.6</td><td></td></tr><tr valign="top"><td>Dueled [<xref ref-type="bibr" rid="CR26">26</xref>]</td><td colspan="2">2008</td><td>Retrospect</td><td>Oligodont</td><td>SC, FPD</td><td>Implant supported</td><td>110</td><td>179</td><td>100</td><td>87.3</td><td>99</td><td></td><td></td><td>3.8</td><td>L</td></tr><tr valign="top"><td>Krieger [<xref ref-type="bibr" rid="CR25">25</xref>]</td><td colspan="2">2009</td><td>Retrospect</td><td>Oligodont. adults</td><td>SC, FPD</td><td>All impl</td><td>17</td><td>40</td><td>92.5</td><td></td><td>87.9</td><td></td><td></td><td>15.1</td><td>L</td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>SCImpl</td><td>12</td><td>24</td><td>87.5</td><td>62</td><td>83.3</td><td></td><td></td><td>15.1</td><td></td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>FDP Impl</td><td>6</td><td>16</td><td>100</td><td>100</td><td>100</td><td></td><td></td><td>15.1</td><td></td></tr><tr valign="top"><td>Degidi [<xref ref-type="bibr" rid="CR47">47</xref>]</td><td colspan="2">2009</td><td>RCT</td><td>Ag Incisors adults</td><td>SC</td><td>All</td><td>60</td><td>60</td><td>100</td><td>98.3</td><td>100</td><td></td><td></td><td>3</td><td>L</td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>Imm. load</td><td>30</td><td>30</td><td>100</td><td>100</td><td>100</td><td>0.85</td><td></td><td>3</td><td></td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>Conv. load</td><td>30</td><td>30</td><td>100</td><td>96.6</td><td>93.3</td><td>0.75</td><td></td><td>3</td><td></td></tr><tr valign="top"><td>Creton [<xref ref-type="bibr" rid="CR1">1</xref>]</td><td colspan="2">2010</td><td>Retrospect</td><td>Oligodont. adults</td><td>FPD</td><td>No</td><td>44</td><td>214</td><td>89.8</td><td></td><td></td><td></td><td></td><td>2.9</td><td>L</td></tr><tr valign="top"><td>Grecchi (a) [<xref ref-type="bibr" rid="CR15">15</xref>]</td><td colspan="2">2010</td><td>Retrospect</td><td>ED adults</td><td>FPD</td><td>All</td><td>4</td><td>44</td><td>100</td><td>90.9</td><td></td><td>0.4</td><td></td><td>1.8</td><td>M</td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>Grafted</td><td>3</td><td></td><td>100</td><td></td><td></td><td>0.3</td><td></td><td></td><td></td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>Non-graft</td><td>1</td><td></td><td>100</td><td></td><td></td><td>1.2</td><td></td><td></td><td></td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>Maxilla</td><td></td><td>20</td><td>100</td><td></td><td></td><td>0.2</td><td></td><td></td><td></td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>Mandible</td><td></td><td>24</td><td>100</td><td></td><td></td><td>0.7</td><td></td><td></td><td></td></tr><tr valign="top"><td>Grecchi (b) [<xref ref-type="bibr" rid="CR22">22</xref>]</td><td colspan="2">2010</td><td>Retrospect</td><td>ED adults</td><td>FPD</td><td>No</td><td>8</td><td>78</td><td>98.7</td><td></td><td></td><td>0.5–0.6</td><td></td><td>1.8</td><td>Pooled</td></tr><tr valign="top"><td>Nissan [<xref ref-type="bibr" rid="CR48">48</xref>]</td><td colspan="2">2011</td><td>Unclear</td><td>Agenesis</td><td>SC</td><td>No</td><td>12</td><td>21</td><td>95.2</td><td>95.2</td><td></td><td></td><td></td><td>2.5</td><td>M</td></tr><tr valign="top"><td>Heuberer [<xref ref-type="bibr" rid="CR38">38</xref>]</td><td colspan="2">2012</td><td>Retrospect</td><td>Mixed ED < 12 years</td><td>Full denture</td><td>All</td><td>6</td><td>16</td><td>93.8</td><td></td><td>100</td><td></td><td></td><td>4</td><td>L</td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>Maxilla, onplants</td><td>4</td><td>8</td><td>87.5</td><td></td><td>100</td><td></td><td></td><td>5</td><td></td></tr><tr valign="top"><td></td><td colspan="2"></td><td></td><td></td><td></td><td>Mandible</td><td>3</td><td>8</td><td>100</td><td></td><td>100</td><td></td><td></td><td>3</td><td></td></tr><tr valign="top"><td>Hosseini [<xref ref-type="bibr" rid="CR49">49</xref>]</td><td colspan="2">2013</td><td>ProspObs</td><td>Hypodontia</td><td>SC</td><td>No</td><td>59</td><td>98</td><td>100</td><td>99</td><td>97.2</td><td></td><td></td><td>3</td><td>L</td></tr><tr valign="top"><td>Zou [<xref ref-type="bibr" rid="CR50">50</xref>]</td><td colspan="2">2014</td><td>Retrospect</td><td>ED Adults</td><td>FPD</td><td>No</td><td>25</td><td>169</td><td>98.3</td><td>97.2</td><td>100</td><td>1.4</td><td></td><td>5</td><td>L</td></tr></tbody></table></table-wrap></p></sec><sec id="Sec14"><title>Studies on tooth autotransplantation</title><p>A total of 11 studies with a mean follow-up time of 7.6 years (maximum 26.4 years) were included, all of which qualified also for the numerical analysis (Table <xref rid="Tab4" ref-type="table">4</xref>). The study heterogeneity concerning survival and success data was low and acceptable for numerical data analysis. The studies showed some heterogeneity in patient inclusion, because in most studies a tooth agenesis sample was mixed also with missing teeth due to trauma and other reasons, which did not lead to exclusion from the present evaluation. According to the table, three studies found a better survival between 10 and 46 % of immature teeth compared to mature teeth. The Bauss study [<xref ref-type="bibr" rid="CR23">23</xref>] demonstrated better pulpal and periodontal conditions if a transplantated tooth was not moved orthodontically, in comparison of the different orthodontic treatments derotation was more harmful than extrusion. According to the Bokelund study [<xref ref-type="bibr" rid="CR24">24</xref>], premolar transplants performed better than molars. A preceding primary tooth at the receptor site of a tooth autotransplant was connected with a lower transplant success than a normal primary tooth. The numerical success/survival data are presented below.<table-wrap id="Tab4"><label>Table 4</label><caption><p>Synopsis of included studies on tooth autotransplantation in order of publication year</p></caption><table frame="hsides" rules="groups"><thead><tr valign="top"><th>Author</th><th>Year</th><th>Study type</th><th>Population</th><th>Comparison</th><th>Patients</th><th>Transplants</th><th>Transplant survival [%]</th><th>Transplant success [%]</th><th>Pulp vitality [%]</th><th>Intact periodont. [%]</th><th>Follow-up [y]</th><th>Risk of bias</th></tr></thead><tbody><tr valign="top"><td>Kristersson [<xref ref-type="bibr" rid="CR51">51</xref>]</td><td>1991</td><td>Retrosp.</td><td>Agen, incis, trauma</td><td>All</td><td>50</td><td>50</td><td>98</td><td>82</td><td></td><td></td><td>7.5</td><td>L</td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>Immature</td><td></td><td>41</td><td></td><td>90</td><td></td><td></td><td>7.5</td><td></td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>Mature</td><td></td><td>9</td><td></td><td>44</td><td></td><td></td><td>7.5</td><td></td></tr><tr valign="top"><td>Kugelberg [<xref ref-type="bibr" rid="CR52">52</xref>]</td><td>1994</td><td>Prosp.Ob</td><td>Ag, Tr</td><td>All</td><td>40</td><td>45</td><td>96</td><td>89</td><td></td><td></td><td>4</td><td>L</td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>Immature</td><td></td><td>23</td><td></td><td>96</td><td>100</td><td>96</td><td>4</td><td></td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>Mature</td><td></td><td>22</td><td></td><td>82</td><td>0</td><td>82</td><td>4</td><td></td></tr><tr valign="top"><td>Marcusson [<xref ref-type="bibr" rid="CR53">53</xref>]</td><td>1996</td><td>Prosp.Ob</td><td>Ag, missing</td><td>No</td><td>29</td><td>31</td><td>87</td><td></td><td></td><td></td><td>8</td><td>L</td></tr><tr valign="top"><td>Josefsson [<xref ref-type="bibr" rid="CR54">54</xref>]</td><td>1999</td><td>Retrosp.</td><td>Oligodontia</td><td>All</td><td>80</td><td>110</td><td>91</td><td></td><td></td><td></td><td>4</td><td>L</td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>Immature</td><td></td><td>11</td><td></td><td>92</td><td></td><td></td><td>4</td><td></td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>Mature</td><td></td><td>99</td><td></td><td>82</td><td></td><td></td><td>4</td><td></td></tr><tr valign="top"><td>Czochrowska [<xref ref-type="bibr" rid="CR55">55</xref>]</td><td>2002</td><td>Retrosp.</td><td>Agenesis</td><td>No</td><td>28</td><td>33</td><td>90</td><td>79</td><td></td><td></td><td>26.4</td><td>M</td></tr><tr valign="top"><td>Bauss [<xref ref-type="bibr" rid="CR23">23</xref>]</td><td>2004</td><td>Retrosp.</td><td>Ag, missing</td><td>All</td><td>88</td><td>91</td><td>100</td><td>84.6</td><td></td><td></td><td>4</td><td>M</td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>OrthDerot</td><td>27</td><td>28</td><td>100</td><td></td><td>71.4</td><td>67.8</td><td>4</td><td></td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>OrthExtru</td><td>20</td><td>21</td><td>100</td><td></td><td>90.5</td><td>85.7</td><td>4</td><td></td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>NoOrthod</td><td>41</td><td>42</td><td>100</td><td></td><td>97.6</td><td>95.2</td><td>4</td><td></td></tr><tr valign="top"><td>Jonsson [<xref ref-type="bibr" rid="CR56">56</xref>]</td><td>2004</td><td>Prosp.Ob</td><td>Ag, missing</td><td>No</td><td>32</td><td>40</td><td>92.5</td><td></td><td>76</td><td>100</td><td>10</td><td>L</td></tr><tr valign="top"><td>Tanaka [<xref ref-type="bibr" rid="CR57">57</xref>]</td><td>2007</td><td>Retrosp.</td><td>Ag, missing</td><td>No</td><td>24</td><td>28</td><td>100</td><td></td><td>60.7</td><td></td><td>4</td><td>M</td></tr><tr valign="top"><td>Mensink [<xref ref-type="bibr" rid="CR58">58</xref>]</td><td>2010</td><td>Retrosp.</td><td>Ag, missing</td><td>No</td><td>44</td><td>63</td><td>100</td><td></td><td>89</td><td></td><td>1</td><td>L</td></tr><tr valign="top"><td>Kvint [<xref ref-type="bibr" rid="CR59">59</xref>]</td><td>2010</td><td>Retrosp.</td><td>Ag, missing</td><td>No</td><td>215</td><td>215</td><td>88.4</td><td>81</td><td></td><td></td><td>4.8</td><td>L</td></tr><tr valign="top"><td>Bokelund [<xref ref-type="bibr" rid="CR24">24</xref>]</td><td>2013</td><td>Retrosp.</td><td>Agenesis</td><td>All</td><td>157</td><td>211</td><td>100</td><td></td><td></td><td></td><td>10</td><td>L</td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>Premolar</td><td></td><td>162</td><td></td><td>93</td><td></td><td>93</td><td>10</td><td></td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>Molars</td><td></td><td>49</td><td></td><td>60</td><td></td><td>60</td><td>10</td><td></td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>NormalPrim</td><td></td><td>71</td><td></td><td>95</td><td></td><td>95</td><td>10</td><td></td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>InfraoccPrim</td><td></td><td>140</td><td></td><td>87</td><td></td><td>87</td><td>10</td><td></td></tr></tbody></table></table-wrap></p></sec><sec id="Sec15"><title>Studies on preservation of deciduous teeth</title><p>A total of 6 studies with a mean follow-up time of 12.5 years (maximum 16.5 years) was included, of which only 4 qualified for the numerical analysis (Table <xref rid="Tab5" ref-type="table">5</xref>). The studies were homogenous in terms of outcome parameters and inclusion of only tooth agenesis patients. Two studies (Kjaer [<xref ref-type="bibr" rid="CR17">17</xref>], Hvaring [<xref ref-type="bibr" rid="CR16">16</xref>] ) contained no data on follow-up times. The Kjaer study made an important statement that in patients in whom the dentitions shows morphological signs of ectodermal dysplasia (screw driver shaper incisors, taurodontism, invaginations of incisors or slim incisors, typical ED sites of aplasia), the risk of root resorption fatal prognosis of a deciduous tooth was elevated by the factor 1.46 compared to patients with normal tooth appearance. In general, root resorption, ankylosis, and consecutive infraocclusion were a problem of preservation of deciduous second molars at the site of a secondary premolar aplasia. The absence of root resorption was interpreted as success criterion in most studies, therefore, in contrast to high survival figures, the success of deciduous teeth was lower. The numerical success/survival data are presented below.<table-wrap id="Tab5"><label>Table 5</label><caption><p>Synopsis of included studies on preservation of deciduous teeth in order of publication year</p></caption><table frame="hsides" rules="groups"><thead><tr valign="top"><th>Author</th><th>Year</th><th>Study type</th><th>Population</th><th>Comparison</th><th>Patients</th><th>Deciduous teeth</th><th>Deciduous tooth survival [%]</th><th>No Infra-occlusion (success) [%]</th><th>No root resorption [%]</th><th>Odds ratio</th><th>Follow-up [y]</th><th>Risk of bias</th></tr></thead><tbody><tr valign="top"><td>Bjerklin [<xref ref-type="bibr" rid="CR60">60</xref>]</td><td>2000</td><td>ProspObs</td><td>Agenes</td><td>no</td><td>41</td><td>59</td><td>88</td><td>45</td><td>40</td><td></td><td>9</td><td>L</td></tr><tr valign="top"><td>Ith-Hansen [<xref ref-type="bibr" rid="CR61">61</xref>]</td><td>2000</td><td>ProspObs</td><td>Agenes</td><td>no</td><td>18</td><td>26</td><td>89.6</td><td>88.4</td><td>88.4</td><td></td><td>16.5</td><td>L</td></tr><tr valign="top"><td>Sletten [<xref ref-type="bibr" rid="CR62">62</xref>]</td><td>2003</td><td>Retrospect</td><td>Agenes</td><td>No</td><td>20</td><td>28</td><td>86</td><td></td><td></td><td></td><td>12.4</td><td>L</td></tr><tr valign="top"><td>Bjerklin [<xref ref-type="bibr" rid="CR63">63</xref>]</td><td>2008</td><td>ProspObs</td><td>Agenes</td><td>No</td><td>99</td><td>149</td><td>91</td><td>48</td><td>16.7</td><td></td><td>12.2</td><td>L</td></tr><tr valign="top"><td>Kjaer [<xref ref-type="bibr" rid="CR17">17</xref>]</td><td>2008</td><td>Retrospect</td><td>Agenes</td><td>ED shaped versus normal</td><td>105</td><td>n.s.</td><td></td><td></td><td></td><td>1.46</td><td>No</td><td>L</td></tr><tr valign="top"><td>Hvaring [<xref ref-type="bibr" rid="CR16">16</xref>]</td><td>2013</td><td>Cross section</td><td>Agenes</td><td>No</td><td>111</td><td>188</td><td></td><td>57.4</td><td>66.6</td><td></td><td>No</td><td>L</td></tr></tbody></table></table-wrap></p></sec><sec id="Sec16"><title>Studies on conventional prosthetics on teeth</title><p>A total of 6 studies with a mean follow-up time of 7.2 years (maximum 15.1 years) was included, all of which qualified for the numerical analysis (Table <xref rid="Tab6" ref-type="table">6</xref>). This relatively small group of studies showed a high level of heterogeneity in patient inclusion, because this group comprised various indications from single missing incisors up to severe hypodontia treated with overdentures on teeth. Nevertheless, it was decided to keep these results in the numerical analysis, because of relatively consistent success and survival data across the different prosthetic therapies. The numerical success/survival data are presented below.<table-wrap id="Tab6"><label>Table 6</label><caption><p>Synopsis of included studies on conventional prosthetics on teeth in order of publication year</p></caption><table frame="hsides" rules="groups"><thead><tr valign="top"><th>Author</th><th>Year</th><th>Study type</th><th>Population</th><th>Treatment</th><th>Comparison</th><th>Patients</th><th>Teeth</th><th>Prostheses</th><th>Prosthesis survival [%]</th><th>Prosthesis success [%]</th><th>Follow-up [y]</th><th>Risk of bias</th></tr></thead><tbody><tr valign="top"><td>Hobkirk [<xref ref-type="bibr" rid="CR64">64</xref>]</td><td>1989</td><td>Retrospect</td><td>Hypodontia</td><td>Overdenture</td><td>All</td><td>138</td><td></td><td>138</td><td>51.5</td><td></td><td>6</td><td>M</td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td></td><td>Mandible</td><td>48</td><td></td><td>48</td><td>33</td><td></td><td>6</td><td></td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td></td><td>Maxilla</td><td>90</td><td></td><td>90</td><td>61</td><td></td><td>6</td><td></td></tr><tr valign="top"><td>Pröbster [<xref ref-type="bibr" rid="CR65">65</xref>]</td><td>1997</td><td>Retrospect</td><td>HypodTrauma</td><td>Single crown</td><td>No</td><td>264</td><td>392</td><td>325</td><td>60</td><td></td><td>10</td><td>M</td></tr><tr valign="top"><td>Garnett [<xref ref-type="bibr" rid="CR66">66</xref>]</td><td>2005</td><td>Retrospect</td><td>Hypodontia</td><td>Single incis crown</td><td></td><td>45</td><td>73</td><td>73</td><td>59</td><td></td><td>6</td><td>M</td></tr><tr valign="top"><td>Dueled [<xref ref-type="bibr" rid="CR26">26</xref>]</td><td>2008</td><td>Retrospect</td><td>Oligodont adults</td><td>SC, FPD</td><td>On teeth</td><td>19</td><td></td><td>30</td><td>89.5</td><td>80</td><td>3.8</td><td>L</td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>SC, FPD</td><td>On implants</td><td>110</td><td></td><td>179</td><td>99</td><td>91</td><td>3.8</td><td></td></tr><tr valign="top"><td>Krieger [<xref ref-type="bibr" rid="CR25">25</xref>]</td><td>2009</td><td>Retrospect</td><td>Hypodontia</td><td>All</td><td>On teeth</td><td>5</td><td></td><td>25</td><td>85.7</td><td>42</td><td>15.1</td><td>M</td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>Single Cr.</td><td>On teeth</td><td>5</td><td></td><td>5</td><td>80</td><td>80</td><td>15.1</td><td></td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>FDP</td><td>On teeth</td><td>10</td><td></td><td>20</td><td>84.1</td><td>72.8</td><td>15.1</td><td></td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>All</td><td>On implants</td><td>17</td><td></td><td>33</td><td>87.9</td><td>53</td><td>15.1</td><td></td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>SC</td><td>On implants</td><td>12</td><td></td><td>24</td><td>83.3</td><td>62.5</td><td>15.1</td><td></td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td>FDP</td><td>On implants</td><td>6</td><td></td><td>9</td><td>100</td><td>66.7</td><td>15.1</td><td></td></tr><tr valign="top"><td>Spinas [<xref ref-type="bibr" rid="CR67">67</xref>]</td><td>2013</td><td>Prosp.Obs.</td><td>Hypodontia</td><td>Resin bridge single Incis</td><td></td><td>30</td><td>32</td><td>32</td><td>93.8</td><td></td><td>5</td><td>L</td></tr></tbody></table></table-wrap></p></sec></sec><sec id="Sec17"><title>Data synthesis</title><sec id="Sec18"><title>Comparison of the four treatments</title><p>The results of the weighted mean method and annual failure rates are presented in Table <xref rid="Tab7" ref-type="table">7</xref>. In addition, the results are visualized in Figs. <xref rid="Fig2" ref-type="fig">2</xref>, <xref rid="Fig3" ref-type="fig">3</xref>, <xref rid="Fig4" ref-type="fig">4</xref>, <xref rid="Fig5" ref-type="fig">5</xref>, <xref rid="Fig6" ref-type="fig">6</xref>, <xref rid="Fig7" ref-type="fig">7</xref>, <xref rid="Fig8" ref-type="fig">8</xref>, and <xref rid="Fig9" ref-type="fig">9</xref>.<table-wrap id="Tab7"><label>Table 7</label><caption><p>Numerical results of general outcome parameters (weighted mean values)</p></caption><table frame="hsides" rules="groups"><thead><tr valign="top"><th>[%]</th><th>Survival patient weighted</th><th>95 % confid. interval</th><th>Success patient weighted</th><th>95 % confid. interval</th><th>Survival impl/tooth/unit weighted</th><th>95 % confid. interval</th><th>Success impl/tooth/unit weighted</th><th>95 % confid. interval</th><th>Annual failure rate survival patient weighted</th><th>95 % confid. interval</th><th>Annual failure rate success patient weighted</th><th>95 % confid. interval</th><th>annual failure rate survival impl/tooth/unit weighted</th><th>95 % confid. interval</th><th>Annual failure rate success impl/tooth/unit weighted</th><th>95 % confid. interval</th></tr></thead><tbody><tr valign="top"><td colspan="17">Treatment comparisons</td></tr><tr valign="top"><td> Implants</td><td>95.3</td><td>1.9</td><td>92.7</td><td>4.6</td><td>94.1</td><td>1.8</td><td>95.6</td><td>4.1</td><td>3.317</td><td>0.196</td><td>0.815</td><td>0.055</td><td>3.280</td><td>0.150</td><td>1.987</td><td>0.159</td></tr><tr valign="top"><td> AutoTX</td><td>94.4</td><td>4.1</td><td>82.5</td><td>11.7</td><td>94.8</td><td>4.0</td><td>85.0</td><td>4.0</td><td>1.061</td><td>0.112</td><td>1.832</td><td>0.638</td><td>1.167</td><td>0.100</td><td>2.334</td><td>0.184</td></tr><tr valign="top"><td> Deciduous</td><td>89.6</td><td>19.1</td><td>51.8</td><td>12.6</td><td>89.7</td><td>19.8</td><td>51.7</td><td>13.1</td><td>0.908</td><td>0.157</td><td>2.928</td><td>1.472</td><td>0.903</td><td>0.161</td><td>4.333</td><td>1.494</td></tr><tr valign="top"><td> ConvProsth</td><td>60.2</td><td>9.4</td><td>59.4</td><td>44.3</td><td>62.6</td><td>7.6</td><td>59.4</td><td>44.3</td><td>5.144</td><td>0.851</td><td>5.368</td><td>4.947</td><td>11.098</td><td>1.477</td><td>9.863</td><td>6.895</td></tr><tr valign="top"><td colspan="17">Implant subgroup analysis</td></tr><tr valign="top"><td> Children</td><td>72.4</td><td>18.8</td><td>44.4</td><td>n.a.</td><td>80.1</td><td>17.6</td><td>44.4</td><td>n.a.</td><td>50.177</td><td>32.083</td><td>7.128</td><td>n.a.</td><td>25.532</td><td>9.836</td><td>7.128</td><td>n.a.</td></tr><tr valign="top"><td> Adolescents</td><td>93.0</td><td>9.5</td><td>93.7</td><td>27.0</td><td>82.0</td><td>8.3</td><td>95.7</td><td>7.5</td><td>4.610</td><td>1.029</td><td>2.052</td><td>1.313</td><td>4.626</td><td>0.712</td><td>1.262</td><td>0.724</td></tr><tr valign="top"><td> Adults</td><td>97.4</td><td>4.0</td><td>92.2</td><td>7.5</td><td>95.6</td><td>3.3</td><td>91.4</td><td>6.8</td><td>0.670</td><td>0.001</td><td>1.850</td><td>0.272</td><td>1.280</td><td>0.122</td><td>2.188</td><td>0.276</td></tr><tr valign="top"><td> Ectod.Dyspl.</td><td>89.6</td><td>8.4</td><td>93.4</td><td>30.3</td><td></td><td></td><td></td><td></td><td>11.665</td><td>2.520</td><td>1.431</td><td>0.219</td><td></td><td></td><td></td><td></td></tr><tr valign="top"><td> Hypo/oligodo</td><td>97.2</td><td>3.9</td><td>92.4</td><td>5.4</td><td></td><td></td><td></td><td></td><td>0.864</td><td>0.067</td><td>1.899</td><td>0.199</td><td></td><td></td><td></td><td></td></tr><tr valign="top"><td> Prosthesis on implants</td><td>97.8</td><td>2.3</td><td>94.5</td><td>2.4</td><td></td><td></td><td></td><td></td><td>0.864</td><td>0.032</td><td>0.884</td><td>0.029</td><td></td><td></td><td></td><td></td></tr><tr valign="top"><td> Prosthesis on teeth</td><td>61.4</td><td>7.9</td><td>77.9</td><td>19.2</td><td>62.1</td><td>7.7</td><td>77.4</td><td>20.6</td><td>5.060</td><td>0.726</td><td>3.666</td><td>1.695</td><td>12.111</td><td>1.496</td><td>3.046</td><td>1.650</td></tr><tr valign="top"><td> Sing. crowns</td><td>98.5</td><td>24.5</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr valign="top"><td> FPD</td><td>96.3</td><td>7.7</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr valign="top"><td> Full dentures</td><td>90.6</td><td>9.0</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr valign="top"><td> Maxilla</td><td></td><td></td><td></td><td></td><td>84.2</td><td>8.3</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr valign="top"><td> Mandible</td><td></td><td></td><td></td><td></td><td>91.9</td><td>30.3</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr valign="top"><td> Single aplas</td><td>99.1</td><td>14.5</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr valign="top"><td> Mild hypodo</td><td>94.6</td><td>5.3</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr valign="top"><td> Severe Oligo</td><td>93.1</td><td>11.0</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></tbody></table></table-wrap><fig id="Fig2"><label>Fig. 2</label><caption><p>The diagram shows survival and success data of implants, tooth autotransplants, preserved deciduous teeth, and conventional prostheses on teeth. The means of the underlying studies are displayed either weighed on patients’ base (=PatWeigSurv, PatWeigSucc) or on units’ base (implant, tooth, or prosthesis) (=UnitWeigSurv, UnitWeigSucc)</p></caption><graphic xlink:href="40729_2015_25_Fig2_HTML" id="MO2"></graphic></fig><fig id="Fig3"><label>Fig. 3</label><caption><p>The diagram shows annual failure rates of the four treatments (implants, tooth autotransplants, preserved deciduous teeth, and conventional prostheses on teeth). The data are differentiated as in Fig. <xref rid="Fig2" ref-type="fig">2</xref>, either weighed on patients’ base (=PAnFailSurv, PAnFailSucc) or on units’ base (implant, tooth, or prosthesis) (=UnAnFaiSurv, UnAnnFaiSucc)</p></caption><graphic xlink:href="40729_2015_25_Fig3_HTML" id="MO3"></graphic></fig><fig id="Fig4"><label>Fig. 4</label><caption><p>The diagram shows the same data types as Fig. <xref rid="Fig2" ref-type="fig">2</xref>, however here differentiated according to three age groups, children <13 years, adolescents <18 years, and adults >18 years</p></caption><graphic xlink:href="40729_2015_25_Fig4_HTML" id="MO4"></graphic></fig><fig id="Fig5"><label>Fig. 5</label><caption><p>Only slight differences in implant prognosis were observed between studies with syndromic (ED) and non-syndromic cases</p></caption><graphic xlink:href="40729_2015_25_Fig5_HTML" id="MO5"></graphic></fig><fig id="Fig6"><label>Fig. 6</label><caption><p>Prostheses on implants had a better prognosis than prostheses on teeth</p></caption><graphic xlink:href="40729_2015_25_Fig6_HTML" id="MO6"></graphic></fig><fig id="Fig7"><label>Fig. 7</label><caption><p>Compared to the difference between prostheses on implants and teeth (Fig. <xref rid="Fig6" ref-type="fig">6</xref>), the type of prosthesis plays a minor role on implant survival</p></caption><graphic xlink:href="40729_2015_25_Fig7_HTML" id="MO7"></graphic></fig><fig id="Fig8"><label>Fig. 8</label><caption><p>Implants in the maxilla had a lower prognosis than implants placed in the mandible</p></caption><graphic xlink:href="40729_2015_25_Fig8_HTML" id="MO8"></graphic></fig><fig id="Fig9"><label>Fig. 9</label><caption><p>Compared to the difference between prostheses on implants and teeth (Fig. <xref rid="Fig6" ref-type="fig">6</xref>), the size of the defect either single missing teeth or mild or severe hypodontia plays a minor role for implant survival</p></caption><graphic xlink:href="40729_2015_25_Fig9_HTML" id="MO9"></graphic></fig></p><p>There is a marked difference in survival data if implants, autotransplants, and preservation of deciduous teeth are compared with conventional prosthetics on teeth, which has only a prosthesis survival of 60.2 % (CI 9.4) at a mean follow-up of 8.4 years. If not the patient but implants/teeth or prosthetic units are used to weigh the means, the results do not change markedly (Fig. <xref rid="Fig2" ref-type="fig">2</xref>).</p><p>Looking upon the success data, both deciduous teeth and autotransplants have markedly lower success than survival, which is mainly due to the high rate of ankyloses and root resorption in both treatment options using the natural teeth (Fig. <xref rid="Fig2" ref-type="fig">2</xref>).</p><p>Implants have higher annual failure rates than the natural tooth alternatives. This is also an effect of the shorter follow-up times in implants (4.6 years) compared to autotransplants (7.6 years) and deciduous teeth (12.5 years) (Fig. <xref rid="Fig3" ref-type="fig">3</xref>).</p><p>A direct comparison of implant and conventional prosthetics was made in two retrospective studies of Krieger and coworkers [<xref ref-type="bibr" rid="CR25">25</xref>] and Dueled and coworkers [<xref ref-type="bibr" rid="CR26">26</xref>]. In both studies, prostheses on implants had better survival than on teeth. In the Dueled study, the difference of the prosthesis survival rates between implants and teeth was 9.5 % and the success rates differed by 11 % in favor of implants. The respective differences in the Krieger study were a survival difference of 2.2 % and a prosthesis success difference of 11 %. Krieger and coworkers observed also marked differences of >40 % between prosthesis success and survival, as an indicator for prosthetic maintenance and repair needs over a very long follow-up time of 15.1 years.</p></sec></sec><sec id="Sec19"><title>Subgroup analysis of dental implant treatment</title><sec id="Sec20"><title>Children versus adolescents versus adults</title><p>There is a clearly lower implant survival with 72.4 % (CI 18.8) when dental implants are used in childhood below the age of 13 (Fig. <xref rid="Fig4" ref-type="fig">4</xref>). In most included studies, implant losses in children occurred early during the healing phase. Also in adolescents below the age of 18 years with a success of 93.0 % (CI 9.5) dental implants performed slightly lower than in adults with a success of 97.4 % (CI 4.0) (Fig. <xref rid="Fig3" ref-type="fig">3</xref>). The annual implant failure rates in children were 50.177 % (CI 32.083), in adolescents 4.610 % (CI 1.029) and in adults 0.670 % (CI 0.001) (Table <xref rid="Tab7" ref-type="table">7</xref>). The mean observation time of the here included studies in children was 4.1 year, in adolescents 4.9 years, and in adults with congenitally missing teeth 6.4 years.</p></sec><sec id="Sec21"><title>ED versus non-syndromic congenitally missing teeth (oligodontia)</title><p>The implant success/survival data of ED patients are slightly lower than of non-syndromic patients (Fig. <xref rid="Fig5" ref-type="fig">5</xref>). The difference is more marked looking upon annual failure rates (Table <xref rid="Tab7" ref-type="table">7</xref>), indicating that these losses occurred after short observation times. These losses were observed mainly during healing time in children suffering from ED.</p></sec><sec id="Sec22"><title>Prosthesis survival on teeth versus implants</title><p>The prosthesis survival on teeth is 61.4 % (CI 7.9) after a mean observation time of 7.2 years. On implants, this figure is markedly higher with 97.8 % (CI 2.3) prosthesis survival after a mean observation of 4.6 years (Fig. <xref rid="Fig6" ref-type="fig">6</xref>).</p></sec><sec id="Sec23"><title>Prosthesis type</title><p>The survival data of implants restored with single crowns are slightly higher than restored with fixed partial dentures than restore with full dentures (Fig. <xref rid="Fig7" ref-type="fig">7</xref>).</p></sec><sec id="Sec24"><title>Maxilla versus mandible</title><p>The mandible shows with 91.9 % (CI 30.3) a better implant prognosis in patients with congenitally missing teeth than the maxilla with 84.2 % (CI 8.3) (Fig. <xref rid="Fig8" ref-type="fig">8</xref>).</p></sec><sec id="Sec25"><title>Size of defect</title><p>Patients with single tooth aplasias (99.1 % (CI 14.5)) had better implant survivals than patients with mild hypodontias (94.6 (CI 5.3) and patients with severe hypodontias (93.1 (CI 11.0)) (Fig. <xref rid="Fig9" ref-type="fig">9</xref>).</p></sec></sec><sec id="Sec26"><title>Studies on patient-centered outcome parameters</title><sec id="Sec27"><title>Studies on quality of life, self-esteem, and patient satisfaction</title><p>A total of 16 retrieved studies included numerical assessment data of patient-centered parameters (Table <xref rid="Tab8" ref-type="table">8</xref>). Many studies were cross-sectional studies with description of a baseline situation in hypodontia patiendraw 1ts. The patient inclusion was relatively homogenous between the studies. However, the studies were relatively heterogenous in the outcome parameters and study treatments because implant, conventional prosthetism, autotransplants, and orthodontic gap closure were included in this table. The number of studies in each treatment was in some cases <italic>n</italic> = 1 making numerical comparisons difficult.<table-wrap id="Tab8"><label>Table 8</label><caption><p>Synopsis of included studies on patient centered outcome parameters in order of publication year</p></caption><table frame="hsides" rules="groups"><thead><tr valign="top"><th>Autor</th><th>Year</th><th>Study type</th><th>Population</th><th>Treatment</th><th>Comparison</th><th>Patients</th><th>Implants/missing tooth units</th><th>Baseline OHIP [scores]</th><th>OHIP improvement [scores]</th><th>OHIP esthetic [scores]</th><th>Rosenberg self-esteem [scores]</th><th>Self-esteem improvement [%]</th><th>CPQ [scores]</th><th>Satisfact [% sample or vas [%]</th><th>Risk of bias</th></tr></thead><tbody><tr valign="top"><td>Marcusson [<xref ref-type="bibr" rid="CR53">53</xref>]</td><td>1996</td><td>Retrospective</td><td>Agenesis missing</td><td>AutoTX</td><td>no</td><td>29</td><td>31</td><td></td><td></td><td></td><td></td><td></td><td></td><td>75</td><td>M</td></tr><tr valign="top"><td>Robertsson [<xref ref-type="bibr" rid="CR29">29</xref>]</td><td>2000</td><td>Cross section</td><td>Agen lat inc</td><td>Orthod versus bridge</td><td>Orthod clos</td><td>30</td><td>30</td><td></td><td></td><td></td><td></td><td></td><td></td><td>66.5</td><td>L</td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td></td><td>Orthod open</td><td>20</td><td>20</td><td></td><td></td><td></td><td></td><td></td><td></td><td>69.5</td><td></td></tr><tr valign="top"><td>Finnema [<xref ref-type="bibr" rid="CR27">27</xref>]</td><td>2005</td><td>Retrospective</td><td>Oligodontia</td><td>FPD implants</td><td>Posttreatment</td><td>13</td><td>87</td><td></td><td></td><td></td><td></td><td>61</td><td></td><td>80</td><td>M</td></tr><tr valign="top"><td>Wong [<xref ref-type="bibr" rid="CR68">68</xref>]</td><td>2006</td><td>Cross section</td><td>Oligodontia</td><td>n.r.</td><td>No</td><td>25</td><td>93</td><td></td><td></td><td></td><td></td><td></td><td>29</td><td></td><td>M</td></tr><tr valign="top"><td>Stanford [<xref ref-type="bibr" rid="CR69">69</xref>]</td><td>2008</td><td>Cross section</td><td>ED</td><td>FPD implants</td><td>Posttreatment</td><td>109</td><td>624</td><td></td><td></td><td></td><td></td><td></td><td></td><td>91</td><td>M</td></tr><tr valign="top"><td>Dueled [<xref ref-type="bibr" rid="CR26">26</xref>]</td><td>2008</td><td>Retrospective</td><td>Oligodont</td><td>SC, FPD</td><td>All</td><td>129</td><td>215</td><td>13.4</td><td></td><td></td><td></td><td></td><td></td><td></td><td>M</td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td></td><td>Control</td><td></td><td></td><td>8.2</td><td></td><td>14</td><td></td><td></td><td></td><td>96</td><td></td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td></td><td>Implants</td><td>110</td><td></td><td></td><td></td><td>41</td><td></td><td></td><td></td><td>98</td><td></td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td></td><td>Convent.</td><td>19</td><td></td><td></td><td></td><td>47</td><td></td><td></td><td></td><td>84</td><td></td></tr><tr valign="top"><td>Locker [<xref ref-type="bibr" rid="CR70">70</xref>]</td><td>2010</td><td>Cross section</td><td>Oligodontia</td><td>n.r.</td><td>No</td><td>36</td><td>245</td><td></td><td></td><td></td><td></td><td></td><td>22.3</td><td></td><td></td></tr><tr valign="top"><td>Laing [<xref ref-type="bibr" rid="CR71">71</xref>]</td><td>2010</td><td>Cross section</td><td>Oligodontia</td><td>n.r.</td><td>Oligodontia all</td><td>62</td><td></td><td></td><td></td><td></td><td></td><td></td><td>26.8</td><td></td><td>L</td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td></td><td>Normal control</td><td>61</td><td></td><td></td><td></td><td></td><td></td><td></td><td>28.5</td><td></td><td></td></tr><tr valign="top"><td>Goshima [<xref ref-type="bibr" rid="CR28">28</xref>]</td><td>2010</td><td>ProspObs</td><td>Hypodontia</td><td>Implant SC</td><td>No</td><td>18</td><td>37</td><td>35.2</td><td>−26.3</td><td></td><td></td><td></td><td></td><td></td><td>L</td></tr><tr valign="top"><td>Kohli [<xref ref-type="bibr" rid="CR72">72</xref>]</td><td>2011</td><td>Cross section</td><td>ED</td><td>n.r.</td><td>11–14 years</td><td>35</td><td>n.g.</td><td></td><td></td><td></td><td></td><td></td><td>25.1</td><td></td><td>L</td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td></td><td>15–19 years</td><td>14</td><td></td><td></td><td></td><td></td><td></td><td></td><td>35.9</td><td></td><td></td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td></td><td>Self perceived</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>31.6</td><td></td><td></td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td></td><td>By caregivers</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>35.0</td><td></td><td></td></tr><tr valign="top"><td>Meaney [<xref ref-type="bibr" rid="CR73">73</xref>]</td><td>2012</td><td>Cross section</td><td>ED</td><td>n.g.</td><td>no</td><td>10</td><td>n.g.</td><td>61</td><td></td><td></td><td></td><td></td><td></td><td></td><td>L</td></tr><tr valign="top"><td>Hosseini [<xref ref-type="bibr" rid="CR49">49</xref>]</td><td>2013</td><td>ProspObs</td><td>Hypodontia</td><td>Implant SC</td><td>No</td><td>59</td><td>98</td><td>16.2</td><td>−8.3</td><td></td><td></td><td></td><td></td><td></td><td>L</td></tr><tr valign="top"><td>Hashem [<xref ref-type="bibr" rid="CR37">37</xref>]</td><td>2013</td><td>Cross section</td><td>Oligodontia</td><td>n.g.</td><td>ED</td><td>41</td><td>n.g.</td><td>62</td><td></td><td></td><td>22</td><td></td><td></td><td></td><td>M</td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td></td><td>Normal control</td><td>41</td><td>n.g.</td><td>31</td><td></td><td></td><td>22.3</td><td></td><td></td><td></td><td></td></tr><tr valign="top"><td>Anweigi (a) [<xref ref-type="bibr" rid="CR74">74</xref>]</td><td>2013</td><td>Long Prosp Obs</td><td>Hypodontia</td><td>Bridges orthod.</td><td>FPD completed</td><td>40</td><td>n.g.</td><td>35</td><td>−19.5</td><td></td><td></td><td></td><td></td><td></td><td>L</td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td></td><td>Orthodontic phase</td><td>37</td><td>n.g.</td><td>32</td><td>22</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr valign="top"><td>Anweigi (b) [<xref ref-type="bibr" rid="CR75">75</xref>]</td><td>2013</td><td>Cross section</td><td>NonsyndrOligodonti</td><td>n.g.</td><td>16–18 years</td><td>40</td><td>n.g.</td><td>28</td><td></td><td></td><td></td><td></td><td></td><td></td><td>L</td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td></td><td>19–34 years</td><td>42</td><td>n.g.</td><td>33.5</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr valign="top"><td>Zou [<xref ref-type="bibr" rid="CR50">50</xref>]</td><td>2014</td><td>Retrospective</td><td>ED</td><td>Implants</td><td>No</td><td>25</td><td>169</td><td></td><td></td><td></td><td></td><td></td><td></td><td>91</td><td>M</td></tr></tbody></table></table-wrap></p><p>Nevertheless, a numerical evaluation using the weighted mean method of the parameters OHIP49 (Oral Health Impact Profile), CPQ11-14 (Child Perceptions Questionnaire), and patient satisfaction was performed. The results are displayed in Table <xref rid="Tab9" ref-type="table">9</xref>. The mean baseline score of the Oral Health Impact Profile 49 in prosthetically not treated adults was 27.8 (CI 0.9) points of a possible maximum of 196 points (14.1 % of maximum) indicating that the patients were not strongly limited by the disease. The baseline scores of the Children Perceptions Questionnaire 11–14 in untreated children with oligodontia was 26.2 (CI 2.2) of 148 maximum score points (17.7 % of maximum). A mean improvement of 14.9 OHIP points after prosthetic treatment and occlusal rehabilitation was calculated from three reporting studies. The reported improvement with conventional prosthetics was 19.5 points (only one study), with implant prosthetics 12.5 score points (only two studies). Patient satisfaction rates after treatment was 66.5 % (one study) with orthodontic space closure 75 % in autotransplants (one study), 76.6 % with conventional prosthetics (two studies), and 93.4 % with implant prosthetics (3 studies) in hypodontia patients (Table <xref rid="Tab9" ref-type="table">9</xref>).<table-wrap id="Tab9"><label>Table 9</label><caption><p>Numerical results of patient-centered outcome parameters (weighted mean values)</p></caption><table frame="hsides" rules="groups"><thead><tr valign="top"><th>OHIP</th><th>Baseline OHIP</th><th>95 % confid. interval</th><th>OHIP improvement general</th><th>95 % confid. interval</th><th>OHIP improvement implants</th><th>95 % confid. interval</th><th>OHIP improvement conventional</th><th>95 % confid. interval</th></tr></thead><tbody><tr valign="top"><td>[Score units]</td><td>27.8</td><td>0.9</td><td>14.9</td><td>1.7</td><td>12.5</td><td>0.2</td><td>19.5</td><td>n.a.</td></tr><tr valign="top"><td>CPQ</td><td>Baseline CPQ</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr valign="top"><td>[Score units]</td><td>26.6</td><td>2.2</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr valign="top"><td>Patient satisfaction</td><td>Satisfaction orthod. clos</td><td></td><td>Satisfaction AutoTX</td><td></td><td>Satisfaction conventional</td><td></td><td>Satisfaction implants</td><td></td></tr><tr valign="top"><td>[%]</td><td>66.5</td><td>n.a.</td><td>75.0</td><td>n.a.</td><td>76.6</td><td>5.2</td><td>93.4</td><td>19.3</td></tr></tbody></table></table-wrap></p><p>Two assessments of self-esteem were available. Hashem found self-esteem not significantly affected in hypodontia patients compared to normal control patients. Finnema observed an improvement of patients' self-esteem in 61 % of cases after treatment with dental implants (Table <xref rid="Tab9" ref-type="table">9</xref>).</p></sec><sec id="Sec28"><title>Studies on chewing efficacy</title><p>Two studies were retrieved on chewing efficacy data after prosthetic treatment of hypodontia with implants. Both studies used different methods of assessment. In the study of Finnema and coworkers [<xref ref-type="bibr" rid="CR27">27</xref>], the mandibular function impairment questionnaire (MFIQ) dropped from 2.23 (44.6 % of maximum scoring range of 5) at baseline to 0.31 after occlusal rehabilitation. The study of Goshima and coworkers [<xref ref-type="bibr" rid="CR28">28</xref>] reported a marked improvement of bite force, masticatory index and functional impairment index, reduced chewing time, and increased occlusal contact area after prosthetic treatment with dental implants (Table <xref rid="Tab10" ref-type="table">10</xref>).<table-wrap id="Tab10"><label>Table 10</label><caption><p>Synopsis of studies of chewing performance before and after treatment with dental implants</p></caption><table frame="hsides" rules="groups"><thead><tr valign="top"><th>Autor</th><th>Year</th><th>Study type</th><th>Population</th><th>Treatment</th><th>Comparison</th><th>Patients</th><th>Replaced teeth</th><th>Bite force [N]</th><th>Color change chew.gum [a*]</th><th>Chewing time [s]</th><th>Occlusal contact area [mm<sup>2</sup>]</th><th>Masticatory index 0–3</th><th>MFIQ</th><th>Study quality</th></tr></thead><tbody><tr valign="top"><td>Finnema [<xref ref-type="bibr" rid="CR27">27</xref>]</td><td>2005</td><td>Retrospect.</td><td>Oligodontia</td><td>Implant FPD</td><td>Before treatment</td><td>13</td><td>156</td><td></td><td></td><td></td><td></td><td></td><td>2.23</td><td>M</td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td></td><td>After treatment</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>0.31</td><td></td></tr><tr valign="top"><td>Goshima [<xref ref-type="bibr" rid="CR28">28</xref>]</td><td>2009</td><td>ProspObs</td><td>Oligodontia</td><td>Implant sing. crown</td><td>Before treatment</td><td>18</td><td>37</td><td>1087.3</td><td>18.8</td><td>21.1</td><td>34.3</td><td>0.3</td><td></td><td>L</td></tr><tr valign="top"><td></td><td></td><td></td><td></td><td></td><td>After treatment</td><td></td><td></td><td>1383</td><td>23.2</td><td>17.9</td><td>44.9</td><td>0</td><td></td><td></td></tr></tbody></table></table-wrap></p></sec></sec><sec id="Sec29"><title>Further studies</title><sec id="Sec30"><title>Studies on orthodontic treatments in patients with congenitally missing teeth</title><p>The literature search according to the applied criteria revealed four relevant studies on orthodontic therapy. Since orthodontic therapy is in most cases a supportive therapy and no competing therapy orthodontics were not included into the numerical evaluation. Robertsson and Mohlin [<xref ref-type="bibr" rid="CR29">29</xref>] compared directly in a cross-sectional study of 50 patients with missing lateral incisors, orthodontic space closure with orthodontic gap opening, and a bridge. The patients were slightly more satisfied with the esthetics of the space closure. There were slight differences in general patient satisfaction (see there) in favor of the bridge and no differences in any functional parameters. A remarkable finding in two studies of Uribe and coworkers [<xref ref-type="bibr" rid="CR30">30</xref>] was that after orthodontic opening of a gap of an agenesis of a lateral incisor, the alveolar ridge lost 1.6 mm ridge width and 0.6 mm ridge height, measured retrospectively in stone models of 31 patients. In their second study [<xref ref-type="bibr" rid="CR31">31</xref>], the same problem was measured with cone beam CT and a shrinkage of the width of the alveolar of 0.9 mm and no height reduction was measured in 11 patients. Dueled [<xref ref-type="bibr" rid="CR26">26</xref>] observed in severe hypodontia the patients’ root resorption in 36 % of oligodontia cases, who received adjunctive orthodontic therapy, which was not found in patients without orthodontic therapy. According to the authors, possible explanations for this finding may have been narrower and more cortical alveolar ridges in edentulous sites of tooth agenesis patients and different tooth root morphology (taurodontism).</p></sec><sec id="Sec31"><title>Studies on craniofacial growth</title><p>In this group, 3 studies were retrieved according to the search criteria. The two studies of Dellavia and coworkers [<xref ref-type="bibr" rid="CR18">18</xref>, <xref ref-type="bibr" rid="CR19">19</xref>] contained drawings (polar diagrams) but not the underlying numerical data. Their evaluation of facial photographies demonstrated that patients with ectodermal dysplasia had a slightly reduced global facial growth in comparison with normal reference peers, with a delay of about 2 years in mandibular and maxillary peak developments. The cross-sectional study of Johnson and coworkers [<xref ref-type="bibr" rid="CR32">32</xref>] analyzed lateral cephalograms of 50 ED patients without treatment with dental implants and compared them with 45 ED patients, who had received dental implants. Craniofacial morphology did not differ significantly between implant-treated and non-treated ED patients.</p></sec></sec></sec><sec id="Sec32"><title>Discussion</title><p>This systematic review of the literature made a few noticeable findings. Dental implants and implant-borne prostheses demonstrated high survival and success data with approximately 30 % higher survival/success figures than conventional prostheses on teeth. However, in children implant and prosthesis, success was 20 % lower and success 40 % lower than in adults and adolescents. The factor severity of hypodontia, syndromal versus non-syndromal tooth defects, size and type of the prosthesis, maxilla versus mandible, were in comparison to the age group of minor significance for the implant prognosis. The two other non-prosthetic treatment options using natural teeth, tooth autotransplants, and preservation of the deciduous teeth had survival rates in the range of dental implants but lower success rates due to a considerable incidence of ankylosis, root resorption, and infraocclusion. Also, patient satisfaction rates were higher for dental implants compared to the other treatment options.</p><p>According to the present data, dental implants in patients with congenitally missing teeth have an excellent documented prognosis with survival rates of 95.3 % after a mean follow-up of 4.6 years. The prognosis even rises to 97.4 %, if only adults are considered taking into account the higher failure rates in children as discussed below. These figures are well lined with currently published data on implant prognosis in conventional dental implant patients. For example, a 95.5–96.3 % 5-year survival rate has been published in a recent meta-analysis [<xref ref-type="bibr" rid="CR33">33</xref>].</p><p>The pictures changes slightly in favor of autotransplants and preservation of deciduous teeth when annual failure rates are calculated by dividing the survival/success data through the years of observation. Still, conventional prosthetics have the highest annual failure rates with approximately 5 %, 5 times higher than the annual failure rates after tooth autotransplantation and preservation of natural teeth with approximately 1 %. The annual failure rate is first of all the mathematical result of the 2–3 times longer observation time in the included studies on the treatment options using natural teeth. On the other hand, this finding confirms the clinical experience that a once healed autotransplant or a once preserved deciduous tooth has in contrast to prosthetic components causes hardly any maintenance and repair expenditures. The latter problem is even more evident, if in the present data, the annual survival-based failure rate of 5 % for conventional prosthetics is compared with the annual success-based failure rate of conventional prosthetics of 11 %. Survival means that the prosthetic component is still in the oral cavity whereas success can be much lower due to prosthetic complications and treatment needs. Here, the presented 3 % annual failure rate for dental implants ranges in the middle between conventional prosthetics and treatments with natural teeth. Again, this figure is pretty much in line with recent findings on annual failure rates in implants in conventional dental implant patients. A recently published meta-analysis on implants in conjunction with sinus floor augmentations reported an annual failure rate of 3.5 % [<xref ref-type="bibr" rid="CR34">34</xref>].</p><p>The low prognosis of dental implants in children (72.4 %) compared to adolescents (93.0 %) and adults (97.4 %) was not surprising. Also, the systematic review of Yap and Klineberg [<xref ref-type="bibr" rid="CR11">11</xref>] came to this conclusion. But the large difference of 25 % was remarkable and is clinically relevant. The high annual failure rates of implants in children according to the included studies of 50.2 % compared to 4.6 % in adolescents and 0.7 % in adults with congenitally missing teeth can be alarming. This is in part again an effect of the lower observation times in the included studies (factor 1.5). At this point, also the inclusion of the observation of Bergendal and coworkers [<xref ref-type="bibr" rid="CR20">20</xref>] has to be discussed, who observed in a survey in Swedish specialist dental clinics an implant loss rate of 6.1 in adolescents and 64.3 % in children under the age of 13. She reported only healing failures of the implants and no long-term problems in children. The data have been included in this systematic review of the literature here, although it is not a true clinical study and the observation time of 6 months is arbitrary and short. The relevance of the observation of Bergendal has already been discussed elsewhere in the literature [<xref ref-type="bibr" rid="CR35">35</xref>]. The study was also included because the finding fits to other studies in this review. A biological explanation of healing problems of dental implants in young children may be the brittle cortical bone structure and a more active immune system in children compared to adults and adolescents. An international Delphi consensus group, too, did not reach consensus on the use of dental implants in growing children affected by hypodontia [<xref ref-type="bibr" rid="CR9">9</xref>, <xref ref-type="bibr" rid="CR10">10</xref>]. Decision making for dental implants in children and adolescents cannot only be based on survival data. It includes also secondary infraocclusion of restorations on implants which can account for the upper incisor region up to 2.2mm [<xref ref-type="bibr" rid="CR3">3</xref>]. Less infraocclusion had been observed for teeth in the lower jaw and upper canines [<xref ref-type="bibr" rid="CR3">3</xref>].</p><p>According to the setting of the second consensus conference of the German Implant Association, in this systematic review, special emphasis had to be laid on patient-reported and patient-centered outcomes. In summary, the retrieved studies showed that patients with hypodontia are less disabled than expected, as demonstrated by the moderate OHIP and CPQ scores. For example, according to a study in edentulous wearers of full dentures before implant stabilization, the baseline OHIP score was much higher (54.2) [<xref ref-type="bibr" rid="CR36">36</xref>], compared to a mean baseline score in the studies included here of 27.8. This observation may be explained by the adaptation of the juvenile hypodontia patients to the situation from early childhood. Patients do not know it differently. This has also an impact on measurements of self-esteem, which according to Hashem and coworkers was not significantly different between hypodontia patients and control patients [<xref ref-type="bibr" rid="CR37">37</xref>]. Nevertheless, an effect of occlusal rehabilitation was measurable with quality of life data in three available studies on that topic in the present data. Obviously, there is a lack of clinical studies using quality of life data in the field of congenitally missing teeth. Due to heterogeneity and low number of studies, data with patient-reported outcomes in this review have to be interpreted with caution. The same restrictions apply to interpretations of the presented data on the effect of occlusal rehabilitation on masticatory performance in hypodontia patients.</p><p>The PICO question asked whether an early occlusal rehabilitation with dental implants in comparison to tooth autotransplants, conventional prosthetics on teeth, or preservation of deciduous teeth has a better outcome. Based on the presented data here, the question can be answered with yes.</p><p>However, each treatment has its time. Preservation of deciduous teeth and autotransplantation is an ideal option in children and adolescents, when dental implants have reduced success rates. The latter option can also be used as a temporary solution until completion of growth. As shown here by the OHIP and self-esteem data and facial growth data, patients with severe oligodontia benefit from early occlusal rehabilitation. A practicable way to safe application of implants in children affected by severe oligodontia may be the proposal by Heuberer and coworkers [<xref ref-type="bibr" rid="CR38">38</xref>], who used with good success onplants in the maxilla placed in the palate behind the teeth to fix an overdenture prosthesis. In this region, less infraocclusion and less interference with transversal palatal growth are expected. Accordingly for the same reasons, implants can be placed in the mandibular canine region. Also, costs play a role in clinical decision-making with tooth autotransplantation being the most cost-effective option [<xref ref-type="bibr" rid="CR39">39</xref>] along with preservation of primary teeth, which virtually causes no costs. If the costs are manageable, in clinical decision-making, conventional tooth-borne prosthetic solutions should be thoroughly weighted against implants.</p></sec><sec id="Sec33"><title>Conclusion</title><p>In synopsis of general and patient-centered outcomes, implants yielded the best results, however, not in children younger than 13 years. Autotransplants and deciduous teeth had low annual failure rates and are appropriate treatments in children and adolescents at low costs. Conventional prosthetics had lower survival/success rates than the other options. Due to heterogeneity and low number of studies, patientreported outcomes in this review have to be interpreted with caution.</p></sec></body><back><fn-group><fn><p><bold>Competing interests</bold></p><p>HT received lecture fees and/or unrestricted research grants from Geistlich Biomaterials, Wolhusen, Switzerland; Osteology Foundation, Lucerne, Switzerland; Straumann, Freiburg, Germany; Dentsply Implants, Mannheim, Germany; and Camlog Biotechnologies, Wimsheim, Germany. The authors declare that they have no competing interests related to this systematic review.</p></fn><fn><p><bold>Authors’ contributions</bold></p><p>HT has written the manuscript and calculated the statistics. FW has managed the literature search and collected the original literature. Both have made substantial contributions to study conception, interpretation of data as well as manuscript preparation. 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