Background: The aim of this systematic review and meta-analysis was to determine the fracture resistance and survival rate of partial indirect restorations inlays, onlays, and overlays fabricated using computer-aided design and computer-aided manufacturing (CAD-CAM) technology from ceramics, composite resin, resin nanoceramic, or hybrid ceramic and to analyze the influence of proximal box elevation on fracture resistance. Materials and methods: This systematic review was based on guidelines proposed by the preferred reporting items for systematic reviews and meta-analyses (PRISMA). An electronic search was conducted in databases US National Library of Medicine National Institutes of Health (PubMed), Scopus, Web of Science (WOS), and Embase. In vitro trials published during the last 10 years were included in the review. Results: Applying inclusion criteria based on the review’s population, intervention, comparison, outcome (PICO) question, 13 articles were selected. Meta-analysis by restoration type estimated the fracture resistance of inlays to be 1923.45 Newtons (N); of onlays 1644 N and of overlays 1383.6 N. Meta-analysis by restoration material obtained an estimated fracture resistance for ceramic of 1529.5 N, for composite resin of 1600 Ne, for resin nanoceramic 2478.7 N, and hybrid ceramic 2108 N. Conclusions: Resin nanoceramic inlays present significantly higher fracture resistance values. Proximal box elevation does not exert any influence on the fracture resistance of indirect restorations.
Purpose: This systematic review set out to investigate the influence of chemical composition and specimen thickness of monolithic zirconia on its optical and mechanical properties. Meta-analysis and meta-regression analyzed the effects of variations in percentages of yttrium, aluminum, and specimen thickness of monolithic zirconia. Study selection: The review followed recommendations put forward in the PRISMA checklist. An electronic search for relevant articles published up to October 2019 was conducted in the Pubmed, Cochrane, Scopus, Scielo, and Web of Science databases, with no language limits and articles published in the last 10 years. From 167 relevant articles; applying inclusion criteria based on the review's PICO question, 26 articles were selected for qualitative synthesis (systematic review) and 24 for quantitative synthesis (meta-analysis). Experimental in vitro studies published were selected and their quality was assessed using the modified Consort scale for in vitro studies of dental materials. Results: The variables yttrium, aluminum and thickness were analyzed in random effects models, observing high heterogeneity (>75%), and finding statistically significant influences on the properties of monolithic zirconia (p<0.05). Conclusions: Within the review's limitations, it may be concluded that variations in the percentage of yttrium and aluminum influence the optical and mechanical properties of monolithic zirconia, making it more or less esthetic and resistant in relation to each variable. The clinical implications of these findings can help select the most appropriate type of zirconia to meet the different clinical needs when restoring different regions (posterior or anterior).
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