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A systematic review of the survival and complication rates of zirconia‐ceramic and metal‐ceramic multiple‐unit fixed dental prostheses
Author(s) -
Sailer Irena,
Strasding Malin,
Valente Nicola Alberto,
Zwahlen Marcel,
Liu Shiming,
Pjetursson Bjarni Elvar
Publication year - 2018
Publication title -
clinical oral implants research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.407
H-Index - 161
eISSN - 1600-0501
pISSN - 0905-7161
DOI - 10.1111/clr.13277
Subject(s) - dentistry , medicine , implant , surgery
Objectives The aim of the present review was to compare the outcomes, that is, survival and complication rates of zirconia‐ceramic and/or monolithic zirconia implant‐supported fixed dental prostheses ( FDP s) with metal‐ceramic FDP s. Materials and Methods An electronic MEDLINE search complemented by manual searching was conducted to identify randomized controlled clinical trials, prospective cohort studies and retrospective case series on implant‐supported FDP s with a mean follow‐up of at least 3 years. Patients had to have been examined clinically at the follow‐up visit. Assessment of the identified studies and data extraction was performed independently by two reviewers. Failure and complication rates were analyzed using robust Poisson regression models to obtain summary estimates of 5‐year proportions. Results The search provided 5,263 titles and 455 abstracts. Full‐text analysis was performed for 240 articles resulting in 19 studies on implant FDP s that met the inclusion criteria. The studies reported on 932 metal‐ceramic and 175 zirconia‐ceramic FDP s. Meta‐analysis revealed an estimated 5‐year survival rate of 98.7% (95% CI : 96.8%–99.5%) for metal‐ceramic implant‐supported FDP s, and of 93.0% (95% CI : 90.6%–94.8%) for zirconia‐ceramic implant‐supported FDP s ( p < 0.001). Thirteen studies including 781 metal‐ceramic implant‐supported FDP s estimated a 5‐year rate of ceramic fractures and chippings to be 11.6% compared with a significantly higher ( p < 0.001) complication rate for zirconia implant‐supported FDP s of 50%, reported in a small study with 13 zirconia implant‐supported FDP s. Significantly ( p = 0.001) more, that is, 4.1%, of the zirconia‐ceramic implant‐supported FDP s were lost due to ceramic fractures compared to only 0.2% of the metal‐ceramic implant‐supported FDP s. Detailed analysis of factors like number of units of the FDP s or location in the jaws was not possible due to heterogeneity of reporting. No studies on monolithic zirconia implant‐supported FDP s fulfilled the inclusion criteria of the present review. Furthermore, no conclusive results were found for the aesthetic outcomes of both FDP ‐types. Conclusion For implant‐supported FDP s, conventionally veneered zirconia should not be considered as material selection of first priority, as pronounced risk for framework fractures and chipping of the zirconia veneering ceramic was observed. Monolithic zirconia may be an interesting alternative, but its clinical medium‐ to long‐term outcomes have not been evaluated yet. Hence, metal ceramics seems to stay the golden standard for implant‐supported multiple‐unit FDP s.