A Systematic review of the survival and complication rates of all-ceramic and metal-ceramic reconstructions after an observation period of at least 3 years. Part II: Fixed partial prostheses

Clinic for Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland.
Clinical Oral Implants Research (Impact Factor: 3.89). 06/2007; 18 Suppl 3(s3):86-96. DOI: 10.1111/j.1600-0501.2007.01468.x
Source: PubMed


The objective of this systematic review was to assess the 5-year survival rates and incidences of complications of all-ceramic fixed dental prostheses (FDPs) and to compare them with those of metal-ceramic FDPs.
An electronic MEDLINE and Dental Global Publication Research System search complemented by manual searching was conducted to identify prospective and retrospective cohort studies on all-ceramic and metal-ceramic reconstructions with a mean follow-up time of at least 3 years. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data abstraction was performed independently by three reviewers. Failure rates were analyzed using standard and random-effects Poisson regression models to obtain summary estimates of 5-year survival proportions.
The search provided 3473 titles for single crowns and FDPs and resulted in 100 abstracts for all-ceramic FDPs. Full-text analysis was performed for 39 articles, resulting in nine studies of ceramic FDPs that met the inclusion criteria. The data on survival and complication rates of metal-ceramic FDPs were obtained from a previous systematic review of Tan et al. (2004) and the updated version from the same authors (Pjetursson et al. 2007). In Poisson regression meta-analysis, the 5-year survival of metal-ceramic FDPs was significantly (P<0.0001) higher with 94.4% [95 confidence interval (CI): 91.1-96.5%] than the survival of all-ceramic FDPs, being 88.6% (95 CI: 78.3-94.2%). The frequencies of material fractures (framework and veneering material) were significantly (P<0.0001) higher for all-ceramic FDPs (6.5% and 13.6%) compared with those of metal-ceramic FDPs (1.6% and 2.9%). Other technical complications like loss of retention and biological complications like caries and loss of pulp vitality were similar for the two types of reconstructions over the 5-year observation period.
Based on the present systematic review of all-ceramic FDPs, significantly lower survival rates at 5 years were seen compared with metal-ceramic FDPs. The most frequent reason for failure of FDPs made out of glass-ceramics or glass-infiltrated ceramics was fracture of the reconstruction (framework and veneering ceramic). However, when zirconia was used as framework material, the reasons for failure were primarily biological and technical complications other than framework fracture.

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Available from: Marcel Zwahlen
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    • "Problematically, such structures are prone to 'adhesive failures' – between the core and the veneering ceramic (delamination) – or 'cohesive failures -within the veneer (chipping). This type of complications is the major risk incurred with zirconia-based, multilayer restorations [4] [5] [6] [7] [8]. To reduce the chances of fracture, monolithic restorations, that is, zirconia without veneering ceramic, have been recently introduced to decrease the risk of delamination and chipping [9] [10] [11] [12] [13]. "
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    ABSTRACT: Objectives: The purpose of the study was to assess the hydrothermal resistance of a translucent zirconia with two clinical relevant surface textures by means of accelerated tests (LTD) and to compare predicted monoclinic fractions with experimental values measured after two years aging at 37°C. Methods: Polished (P) and ground (G) specimens were subjected to hydrothermal degradation by exposure to water steam at different temperatures and pressures. The t-m phase transformation was quantified by grazing incidence X-ray diffraction (GIXDR). The elastic modulus and hardness before- and after LTD were determined by nanoindentation. Results: G specimens presented a better resistance to hydrothermal degradation than P samples. Activation energies of 89 and 98kJ/mol and b coefficients of 2.0×10(-5) and 1.8×10(-6) were calculated for P and G samples respectively. The coefficients were subsequently used to predict transformed monoclinic fractions at 37°C. A good correlation was found between the predicted values and the experimental data obtained after aging at 37°C during 2 years. Hydrothermal degradation led to a significant decrease of the elastic moduli and hardness in both groups. Significance: The dependency of the t-m phase transformation rate on temperature must be determined to accurately predict the hydrothermal behavior of the zirconia ceramics at oral temperatures. The current prevailing assumption, that 5h aging at 134°C corresponds to 15-20 years at 37°C, will underestimate the transformed fraction of the translucent ceramic at 37°C. In this case, the mechanical surface treatment influences the ceramic's transformability. While mild grinding could potentially retard the hydrothermal transformation, polishing after occlusal adjustment is recommended to prevent wear of the antagonist teeth and maintain structural strength.
    Full-text · Article · Jan 2016 · Dental materials: official publication of the Academy of Dental Materials
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    • "The poor marginal fit leads to plaque accumulation and secondary caries, induces periodontal disease, and creates microleakage.15,21,22,23,24,25,26 It was reported that the highest rate of marginal discoloration was found in zirconia FDP.16 This may be resulted from the marginal inaccuracy of those zirconia frameworks. "
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    ABSTRACT: PURPOSE To compare marginal and internal gaps of zirconia substructure of single crowns with those of three-unit fixed dental prostheses. MATERIALS AND METHODS Standardized Co-Cr alloy simulated second premolar and second molar abutments were fabricated and subsequently duplicated into type-III dental stone for working casts. After that, all zirconia substructures were made using Lava™ system. Marginal and internal gaps were measured in 2 planes (mesial-distal plane and buccal-palatal plane) at 5 locations: marginal opening (MO), chamfer area (CA), axial wall (AW), cusp tip (CT) and mid-occlusal (OA) using Replica technique. RESULTS There were significant differences between gaps at all locations. The mean ± SD of marginal gap in premolar was 43.6 ± 0.4 µm and 46.5 ± 0.5 µm for single crown and 3-unit bridge substructure respectively. For molar substructure the mean ± SD of marginal gap was 48.5 ± 0.4 µm and 52.6 ± 0.4 µm for single crown and 3-unit bridge respectively. The largest gaps were found at the occlusal area, which was 150.5 ± 0.5 µm and 154.5 ± 0.4 µm for single and 3-unit bridge premolar substructures respectively and 146.5 ± 0.4 µm and 211.5 ± 0.4 µm for single and 3-unit bridge molar substructure respectively. CONCLUSION Independent-samples t-test showed significant differences of gap in zirconia substructure between single crowns and three-unit bridge (P<.001). Therefore, the span length has the effect on the fit of zirconia substructure that is fabricated using CAD/CAM technique especially at the occlusal area.
    Full-text · Article · Aug 2014 · The journal of advanced prosthodontics
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    • "There are many types of ceramic materials being used for the fabrication of all-ceramic restorations. The higher-strength ceramics serve as substructure materials upon which more translucent glass is veneered to achieve highly esthetic prostheses.1 Several studies showed that crack or chipping of glass veneer from core ceramics was one of the most common failure modes of glass-ceramic and zirconia all-ceramic fixed dental prostheses,2,3,4,5,6 thus the bond between core and veneer might be one of the weaknesses in all-ceramic restorations and plays a significant role in their long-term success.7 There is some information available on the bond strength values between the core and veneering materials, however, no standardized bond strength test for core-veneer all-ceramic materials has been proposed.8 "
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    ABSTRACT: PURPOSE To investigate the microtensile bond strength between two all-ceramic systems; lithium disilicate glass ceramic and zirconia core ceramics bonded with their corresponding glass veneers. MATERIALS AND METHODS Blocks of core ceramics (IPS e.max® Press and Lava™ Frame) were fabricated and veneered with their corresponding glass veneers. The bilayered blocks were cut into microbars; 8 mm in length and 1 mm2 in cross-sectional area (n = 30/group). Additionally, monolithic microbars of these two veneers (IPS e.max® Ceram and Lava™ Ceram; n = 30/group) were also prepared. The obtained microbars were tested in tension until fracture, and the fracture surfaces of the microbars were examined with fluorescent black light and scanning electron microscope (SEM) to identify the mode of failure. One-way ANOVA and the Dunnett's T3 test were performed to determine significant differences of the mean microtensile bond strength at a significance level of 0.05. RESULTS The mean microtensile bond strength of IPS e.max® Press/IPS e.max® Ceram (43.40 ± 5.51 MPa) was significantly greater than that of Lava™ Frame/Lava™ Ceram (31.71 ± 7.03 MPa)(P<.001). Fluorescent black light and SEM analysis showed that most of the tested microbars failed cohesively in the veneer layer. Furthermore, the bond strength of Lava™ Frame/Lava™ Ceram was comparable to the tensile strength of monolithic glass veneer of Lava™ Ceram, while the bond strength of bilayered IPS e.max® Press/IPS e.max® Ceram was significantly greater than tensile strength of monolithic IPS e.max® Ceram. CONCLUSION Because fracture site occurred mostly in the glass veneer and most failures were away from the interfacial zone, microtensile bond test may not be a suitable test for bonding integrity. Fracture mechanics approach such as fracture toughness of the interface may be more appropriate to represent the bonding quality between two materials.
    Full-text · Article · Jun 2014 · The journal of advanced prosthodontics
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