Clinical outcomes of all‐ceramic single crowns and fixed dental prostheses supported by ceramic implants: A systematic review and meta‐analyses

• Published in: Clinical oral implants research Vol. 33; no. 1; pp. 1 - 20
• Main Authors: Spitznagel, Frank Akito, Balmer, Marc, Wiedemeier, Daniel B., Jung, Ronald Ernst, Gierthmuehlen, Petra Christine
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01-01-2022; John Wiley and Sons Inc
• Subjects: Ceramics; Chipping; Clinical outcomes; Complications; Confidence intervals; Crowns; Dental Implants; Dental materials; Dental Porcelain; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental prosthetics; Dental Restoration Failure; Humans; implant‐supported dental prosthesis; Lithium; Meta-analysis; Metal Ceramic Alloys; Prostheses; Reconstruction; Review; Surgical implants; Survival; survival analysis; systematic review; Transplants & implants; treatment outcome; Zirconia; Zirconium; Zirconium dioxide; ceramics; survival analysis; meta-analysis; implant-supported dental prosthesis; zirconia; systematic review; treatment outcome; dental implants
• ISSN: 0905-7161; 1600-0501
• DOI: 10.1111/clr.13871

Objective
To analyze the clinical outcomes of all‐ceramic single crowns (SCs) and fixed dental prostheses (FDPs) supported by ceramic implants.
Materials and Methods
Based on a focused question and customized PICO framework, electronic (Medline/EMBASE/Cochrane) and manual searches for studies reporting the clinical outcomes of all‐ceramic SCs and FDPs supported by ceramic implants ≥12 months were performed. The primary outcomes were reconstruction survival and the chipping proportion. The secondary outcomes were implant survival, technical complications, and patient‐related outcome measurements. Meta‐analyses were performed after 1, 2, and 5 years using random‐effect meta‐analyses.
Results
Eight of the 1,403 initially screened titles and 55 full texts were included. Five reported on monolithic lithium disilicate (LS2) SCs, one on veneered zirconia SCs, and two on veneered zirconia SCs and FDPs, which reported all on cement‐retained reconstructions (mean observation: 12.0–61.0 months). Meta‐analyses estimated a 5‐year survival rate of 94% (95% confidence interval [CI]: 82%–100%) for overall implant survival. Reconstruction survival proportions after 5 years were: monolithic LS2, 100% (95%CI: 95%–100%); veneered zirconia SCs, 89% (95%CI: 62%–100%); and veneered zirconia FDPs 94% (95%CI: 81%–100%). The chipping proportion after 5 years was: monolithic LS2, 2% (95%CI: 0%–11%); veneered zirconia SCs, 38% (95%CI: 24%–54%); and veneered zirconia FDPs, 57% (95%CI: 38%–76%). Further outcomes were summarized descriptively.
Conclusions
Due to the limited data available, only tendencies could be identified. All‐ceramic reconstructions supported by ceramic implants demonstrated promising survival rates after mid‐term observation. However, high chipping proportions of veneered zirconia SCs and, particularly, FDPs diminished the overall outcome. Monolithic LS2 demonstrated fewer clinical complications. Monolithic reconstructions could be a valid treatment option for ceramic implants.