09 June 2021

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A systematic review and meta-analysis on survival rate and complications of monolithic ceramic tooth-supported prostheses

Co-authors: A. Comba, F. Del Bianco

Lorenzo Breschi

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Introduction

Nowadays metal free restorations are widely used as an alternative to metal ceramic. However, ceramic chipping is a common complication of Zirconia layered restorations and, for that reason monolithic zirconia or lithium disilicate crowns have become a popular solution to avoid complications . 

Despite  the great use in clinical practice, survival and complication rate of monolithic restorations  remains unclear and consensus on the use of monolithic crowns is lacking in literature.

In this context, Dr Cerri Mazza and a group of Brazilian authors performed a systematic review to evaluate clinical studies investigating the survival rate and the biological and technical complications of monolithic restorations.

Material & Methods

Two independent researchers from the authors group conducted an electronic search on PubMed/MEDLINE, Scopus, and Cochrane Library databases including human clinical trials with at least 10 participants and 12 months follow-up. Dr. Cerri Mazza et al. employed the Newcastle-Ottawa scale and Cochrane risk of bias tool to assess the quality and risk of bias of the included studies. Meta-analysis was performed using the R software program.

Results 

The search conducted by the authors identified 763 articles, 18 of which met the eligibility criteria. Dr Cerri Mazza et al. included 1061 monolithic single crowns (524 lithium disilicate, 461  zirconia, and 76 polymer- infiltrated ceramic network [PICN]) and 104 fixed partial dentures (FPDs) (36 lithium disilicate and 68 zirconia). The results of the meta-analysis of single-arm studies indicated the proportion of survival, biological, and technical complication rates of 1% (95% confidence interval [CI]: 0% to 3%), 1% (CI: 0% to 4%), and 2% (CI: 1% to 4%), respectively, for single crowns, independently from the material used, and 3% (CI: 0% to 34%), 5% (CI: 1% to 21%), and 5% (CI: 1% to 21%) for FPDs, respectively. 

Conclusions

From the results obtained the Brazilian researchers concluded that monolithic ceramic restorations can be considered a favorable material for single crowns and FPDs, with high survival and low complication rates. Nevertheless, the authors suggested that further randomized controlled trials are needed in order to compare directly monolithic restorations performances with layered restorations. 

For more informations: Mazza, L. C., Lemos, C. A. A., Pesqueira, A. A., & Pellizzer, E. P. (2021). Survival and complications of monolithic ceramic for tooth-supported fixed dental prostheses: A systematic review and meta-analysis. Journal of Prosthetic Dentistry, 1–9. https://doi.org/10.1016/j.prosdent.2021.01.020