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A systematic review of the survival and complication rates of zirconia‐ceramic and metal‐ceramic single crowns

A systematic review of the survival and complication rates of zirconia‐ceramic and metal‐ceramic single crowns

Title: A systematic review of the survival and complication rates of zirconia‐ceramic and metal‐ceramic single crowns
Author: Pjetursson, Bjarni Elvar   orcid.org/0000-0002-2063-5092
Valente, Nicola A
Strasding, Malin
Zwahlen, Marcel
Liu, Shiming
Sailer, Irena
Date: 2018-10
Language: English
Scope: 199-214
University/Institute: Háskóli Íslands (HÍ)
University of Iceland (UI)
School: Heilbrigðisvísindasvið (HÍ)
School of Health Sciences (UI)
Department: Tannlæknadeild (HÍ)
Faculty of Odontology (UI)
Series: Clinical Oral Implants Research;29(S16)
ISSN: 0905-7161
1600-0501 (eISSN)
DOI: 10.1111/clr.13306
Subject: Biological; Complications; Fixed dental prostheses; Implant crown; Meta­-analysis; Metal-­ceramics; Succes; Survival; Systematic review; Technical; Zirconia framework; Tannlækningar; Tannfyllingarefni
URI: https://hdl.handle.net/20.500.11815/1411

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Pjetursson BE, Valente NA, StrasdingM, Zwahlen M, Liu S, Sailer I. A systematic review of thesurvival and complication rates of zirconia­ceramic and metal­ceramic single crowns. Clin Oral Impl Res. 2018;29(Suppl. 16):199–214. https://doi.org/10.1111/clr.13306


Objectives: The aim of the present systematic review was to analyze the survival and com­plication rates of zirconia ­based and metal ­ceramic implant ­supported single crowns (SCs).Materials and Methods: An electronic MEDLINE search complemented by manual searching was conducted to identify randomized controlled clinical trials, prospectivecohort and retrospective case series on implant ­supported SCs with a mean follow ­up time of at least 3years. Patients had to have been clinically examined at the follow ­up visit. Assessment of the identified studies and data extraction was performedindependently by two reviewers. Failure and complication rates were analyzed using robust Poisson’s regression models to obtain summary estimates of 5­year proportions.Results: The search provided 5,263 titles and 455 abstracts, full ­text analysis was performed for 240 articles, resulting in 35 included studies on implant­supported crowns. Meta ­analysis revealed an estimated 5­year survival rate of 98.3% (95% CI: 96.8–99.1) for metal ­ceramic implant supported SCs (n = 4,363) compared to 97.6% (95% CI: 94.3–99.0) for zirconia implant supported SCs (n = 912). About 86.7% (95% CI: 80.7–91.0) of the metal ­ceramic SCs (n = 1,300) experienced no biological/technical complications over the entire observation period. The corresponding rate for zirconia SCs (n = 76) was 83.8% (95% CI: 61.6–93.8). The biologic outcomes of the two types of crowns were similar; yet, zirconia SCs exhibited less aesthetic complications than metal ­ceramics. The 5­year incidence of chipping of the veneering ceramic was similar between the material groups (2.9% metal ­ceramic, 2.8% zirconia­ceramic). Significantly (p = 0.001), more zirconia­ceramic implant SCs failed due to material fractures (2.1% vs. 0.2% metal ­ceramic implant SCs). No studies on newer types of monolithic zirconia SCs fulfilled the simple inclusion criteria of 3 years follow ­up time and clinical examination of the present systematic review.Conclusion: Zirconia­ceramic implant­supported SCs are a valid treatment alternative to metal ­ceramic SCs, with similar incidence of biological complications and less aesthetic problems. The amount of ceramic chipping was similar between the material groups; yet, significantly more zirconia crowns failed due to material fractures.


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