The BIO–MECH–ESTH–MAINT Model: A Structured Decision-Making Framework for Implant Prosthesis Retention

Abstract

Background

The selection of retention mechanisms for implant-supported restorations remains a topic of ongoing debate in prosthodontics. Although both systems show similar survival outcomes, they present distinct complication patterns and maintenance requirements. The current literature presents a descriptive comparison of advantages and disadvantages, offering limited guidance for structured, reproducible clinical decision-making.

Purpose

The aim of this article is to propose a structured, clinically applicable, risk-based framework to guide clinicians in selecting the most appropriate implant prosthesis retention method.

Methods

A narrative review of the literature was conducted, addressing biological, mechanical, esthetic, and maintenance considerations associated with implant prosthesis retention. Based on current evidence and clinical principles, a conceptual decision-making model was developed.

Results / Framework Description

The BIO–MECH–ESTH–MAINT (BMEM) framework integrates biological risk, mechanical considerations, esthetic demands, and long-term maintenance requirements, enabling clinicians to evaluate patient- and case-specific risks and select the most appropriate retention strategy.

Conclusion

This framework offers a structured and reproducible method for implant prosthesis retention selection. Emphasizing biological safety, retrievability, and long-term maintenance, this model provides evidence-informed decision-making and may enhance clinical outcomes. Future prospective studies are recommended to validate its clinical effectiveness.