The clinical performance of all‐ceramic implant‐supported single crowns: A systematic review and meta‐analysis

Abstract

Objective This review aimed at evaluating the survival and technical complication rates of all‐ceramic implant‐supported single crowns (SC). Material and Methods Three electronic databases were searched for clinical studies conducted at ≥ 15 patients examining implant‐supported all‐ceramic SCs over ≥ 12 months. Survival rates of implants and restorations plus technical complication rates of SCs were calculated and tested for statistical correlation with confounding variables. Statistical analysis was performed using a negative binomial distribution model to calculate 5‐ and 10‐year survival and complication estimates. Results Forty‐one included studies reported on implant‐supported SCs made of veneered and monolithic high‐strength oxide ceramics, monolithic, and veneered glass‐based ceramics and of a monolithic resin‐nano‐ceramic (RNC). Survival estimates for SCs of 93% (95% CI: 86.6%–96.4%) after 5 years and 94.4% (95% CI: 91.1%–96.5%) after 10 years were calculated, corresponding values for implant survival were 95.3% (95% CI: 90.6%–97.7%) and 96.2% (95% CI: 95.1%–97.1%). Technical complication rates after 5/10 years were as follows: chipping 9.0% (95% CI: 5.4%–14.8%)/2.7% (95% CI: 2.1%–3.5%), framework fractures 1.9% (95% CI: 0.7%–4.9%)/1.2% (95% CI: 1%–1.5%), screw loosening 3.6% (95% CI: 1.6%–8.4%)/5.2% (95% CI: 3.6%–7.5%), and decementations with 1.1% (95% CI: 0.4%–2.8%) after 5 years. Some confounding variables influenced the above‐mentioned estimates significantly. Conclusions All‐ceramic implant‐supported SCs showed—with the exception of a RNC material—high survival rates. However, failures and technical complications occurred which have to be considered when informing patients on the treatment with implant‐supported all‐ceramic SCs.

All‐ceramic single crowns supported by zirconia implants: 5‐year results of a prospective multicenter study

“…In the present investigation, the KM estimate for chipping events was 48.4% after 5 years. As a result, the chipping frequency in the present study was significantly higher than the estimate calculated by Rabel and collaborates (Rabel et al, ). One reason for this might be considered the fact that reconstructions of the present evaluation were located in posterior regions, whereas multiple investigations in the meta‐analyses included a mixture of both anterior and posterior reconstructions (Chappuis et al, ; Nejatidanesh, Moradpoor, & Savabi, ; Paolantoni, Marenzi, Blasi, Mignogna, & Sammartino, ; Tartaglia, Sidoti, & Sforza, ; Wittneben et al, ; Worni, Kolgeci, Rentsch‐Kollar, Katsoulis, & Mericske‐Stern, ).…”

“…A recent systematic review and meta‐analysis screening the nowadays available literature on implant‐supported all‐ceramic single crowns showed that veneered zirconia‐based reconstructions can still be considered the biggest stakeholder for all‐ceramic implant‐supported replacement of single missing teeth (Rabel, Spies, Pieralli, Vach, & Kohal, ). After 5 years of observation, the meta‐analysis revealed a survival estimate of 92.0% for zirconia‐based bi‐layers, ranging from 67.4% (Bömicke, Gabbert, Koob, Krisam, & Rammelsberg, ) to 100% (Hosseini, Worsaae, Schiodt, & Gotfredsen, ; Lops, Bressan, Chiapasco, Rossi, & Romeo, ; Wittneben et al, ).…”

“…One reason for this might be considered the fact that reconstructions of the present evaluation were located in posterior regions, whereas multiple investigations in the meta‐analyses included a mixture of both anterior and posterior reconstructions (Chappuis et al, ; Nejatidanesh, Moradpoor, & Savabi, ; Paolantoni, Marenzi, Blasi, Mignogna, & Sammartino, ; Tartaglia, Sidoti, & Sforza, ; Wittneben et al, ; Worni, Kolgeci, Rentsch‐Kollar, Katsoulis, & Mericske‐Stern, ). It was shown that single crown location has a significant impact on the occurrence of veneer fractures in favor of reconstructions located in the anterior region (Rabel et al, ). Nevertheless, since nearly half of the reconstructions of the present evaluation were affected by minor fractures of the veneering ceramic, the concept of bi‐layered zirconia‐based reconstructions for the replacement of premolars and molars might be questioned.…”

“…Considering susceptibility for fracture events, monolithic reconstructions made from lithium disilicate showed to be less prone for this technical complication (Spies, Pieralli, Vach, & Kohal, ). However, data for the monolithic type of reconstructions supported by implants are still rare (Rabel et al, ).…”

“…Occurrence of this event was calculated to be highly significant over time (p < 0.001). Regrettably, data on roughening of veneering ceramics are only seldom provided in the literature and were, therefore, not included as outcome in the above-mentioned review (Rabel et al, 2018). Several reasons can be assumed for increased roughness of veneering ceramics including a crystalline phase over time in the oral cavity like tooth brushing (Garza, Thompson, Cho, & Berzins, 2016), environmental conditions (Vechiato-Filho et al, 2015), abrasion due to mastication (Lawson, Bansal, & Burgess, 2016), or attrition due to antagonistic wear (Amer, Kürklü, & Johnston, 2015).…”