Cantilevers in full-arch prostheses

Clinical questions

When treating edentulous patients, can I avoid placing posterior implants? Are cantilevers a reliable treatment option?
Full-arch prostheses on intermental or intersinus implants with cantilevers have been shown to be a good solution for reducing treatment complexity. This concept works in both jaws, either with traditional parallel implants or with two tilted distal implants (provided that cantilevers do not exceed 20mm and do not replace more than two occlusal units).

Consensus viewpoint
Full-arch cantilevered reconstructions were found to have high implant and prosthesis survival rates at 5–10 years of follow-up (97% and 99% respectively). However, the rate of complications was as high as 39% with prostheses and mostly consisted of fractures of the veneering material, especially when resin was used.

This is clinically significant as it may have an impact on patient satisfaction. Clinicians should be aware of the potential problems and discuss them with patients from the very beginning of the treatment.

However, there have been no studies comparing full-arch reconstructions with or without cantilevers. We therefore do not know if cantilevers can or cannot be considered a specific risk factor for technical complications. There is still a lack of evidence on this matter.
Key points
  • 1. Full-arch reconstructions with cantilevers up to 20mm (two units) long perform well in the long term on both edentulous jaws
  • 2. Full-arch implant-supported reconstructions have a very high rate of chipping, but it is still unknown whether cantilevers present an additional level of risk for technical complications