Choosing Between Fixed and Removable Prosthetic Modalities for Completely Edentulous Patients: A Systematic Review of Evidence-Based Outcomes

Complete edentulism significantly impacts masticatory function, aesthetics, and quality of life. The selection between fixed and removable prosthetic modalities is a critical clinical decision. This systematic review aims to compare the clinical and patient-reported outcomes of fixed versus removable prosthetic rehabilitations for completely edentulous patients. A systematic search of PubMed/MEDLINE, Scopus, Embase, and Web of Science databases was conducted up to December 2025. Studies were selected based on predefined PICOS criteria, including randomized controlled trials and observational studies. Risk of bias was assessed using the Cochrane RoB 2 tool and the Newcastle-Ottawa Scale. A narrative synthesis was performed due to significant heterogeneity. Ten studies were included. Fixed implant-supported prostheses demonstrated high long-term survival rates and superior masticatory efficiency and occlusal stability compared to removable options. Patient-reported outcomes, particularly oral health-related quality of life, were significantly better with any implant-supported prosthesis (fixed or removable) than with conventional complete dentures. Fixed prostheses (FPs) were associated with technical complications, while removable overdentures (ODs) presented challenges with occlusal wear. Conventional denture satisfaction was primarily linked to retention, comfort, and aesthetic quality. Implant-supported prostheses offer substantially better clinical and patient-reported outcomes than conventional dentures for completely edentulous patients. The choice between a fixed and removable modality involves a trade-off: FPs provide superior function and stability but require more complex maintenance, whereas removable ODs offer easier hygiene and a favorable balance of benefits. Treatment must be individualized based on anatomical factors, patient priorities, and clinical feasibility.