Clinical implications of misfit in multiunit implant-supported fixed dental prostheses: A systematic review.

PURPOSE: This systematic review aimed to evaluate the long-term effects of misfit on the clinical outcomes of multiunit implant-supported fixed dental prostheses (ISFDPs). METHODS: An electronic literature search was conducted up to December 2025 across five databases: MEDLINE (via Ovid), Embase (via Ovid), Web of Science, the Cochrane Library, and Scopus. Eligible articles were selected based on predefined inclusion and exclusion criteria, and relevant data were extracted. The Newcastle-Ottawa Scale was used to evaluate the methodological quality of the included studies. RESULTS: After screening and applying the eligibility criteria, four articles were identified from the initial 2179 records. Two additional articles were identified through a manual search, bringing the total to six. Although quality assessment indicated that all six studies were at low risk of bias, the comparability domain was weak in most due to limited control of confounding factors. Clinical outcomes in the included studies were reported across four domains: implant cumulative survival rate, screw loosening or fracture, prosthesis-related complications, and peri-implant bone loss. Only one study reported a significantly higher incidence of screw complications in ISFDPs with greater misfit (p = 0.005), whereas most studies did not find a consistent association between misfit and clinical outcomes. CONCLUSIONS: Evidence regarding the clinical implications of misfit in multiunit ISFDPs is limited, with few long-term studies and insufficient control for confounding factors. Limited evidence suggests that greater misfit may be associated with screw complications, whereas no clear association was observed between misfit and peri-implant bone loss.