Long-term clinical performance and complications of zirconia-based tooth- and implant-supported fixed prosthodontic restorations: A summary of systematic reviews

Abstract

To present an overview on systematic reviews on prosthodontic zirconia restorations and to discuss long-term complications as well as information on anatomical and functional changes to the masticatory system. Data/Sources: MEDLINE, EMBASE, Trip medical, and Cochrane Library databases were searched for systematic reviews up to February 2021. Bias was assessed and clinical survival and complications were analyzed. Study selection: 38 eligible articles published between 2006 and 2021 were included. The reviews were based on 128 in vivo studies on approximately 10,000 zirconia restorations. 5-year cumulative survival rates varied between 91.2% and 95.9% for tooth-supported (TS) single crowns (SC), 89.4% and 100% for TS multi-unit fixed dental prostheses (FDP), 97.1% and 97.6% for implant-supported (IS) SCs and 93.0% and 100% for IS FDPs. Chipping was the most often technical complication, followed by framework fracture, loss of retention, marginal discrepancies/discoloration, occlusal roughness and abutment/ screw loosening. Color mismatch was the only esthetic complication. Biological complications were caries, endodontic complications, tooth fracture, periodontal disease, abrasion/attrition, persisting pain, high sensitivity, peri-implantitis and soft tissue issues. Patients with bruxism were only examined sporadically. Conclusions: 5-year results for zirconia restorations were satisfactory. The predominant technical problem of veneering fractures could be overcome with adapted design or fabrication and application of monolithic restorations, but reviews of clinical studies on this subject are rare. The impact of zirconia restorations on the masticatory system remains unclear. Clinical significance: Zirconia restorations are experiencing a rapidly increasing use in dental practice. Being highly wear-resistant, hard and durable, it can be assumed that they do not follow natural abrasion and changes in the masticatory system. Possible long-term effects on the stomatognathic system as a whole should therefore be considered.

Survival and Success Rates of Monolithic Zirconia Restorations Supported by Teeth and Implants in Bruxer versus Non-Bruxer Patients: A Retrospective Study

“…In the literature, tooth-and implant-born monolithic zirconia restorations in nonbruxers have presented promising treatment outcomes for single crowns and multiunit fixed partial dentures [10,20]. A summary of systematic reviews on the long-term clinical performance and complications of zirconia-based tooth and implant-supported fixed prosthodontic restorations reported excellent 5-year cumulative survival rates despite a number of biological and technical complications [10].…”

“…A recent overview of systematic reviews on zirconia-based tooth and implant-supported restorations reported a 5-year satisfactory result with the predominant technical problem being veneering fractures [10]. However, the authors noted that patients with bruxism were examined only sporadically and that most of the studies to evaluate the survival and success of ceramic restorations have excluded bruxer patients as bruxism is considered a potential cause of restoration fracture [11,12].…”

Fit, Precision, and Trueness of 3D-Printed Zirconia Crowns Compared to Milled Counterparts

“…Today, monolithic zirconia is a popular material for the fabrication of single crowns, short- and long-span fixed dental prostheses, and full-arch restorations [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Zirconia has been advocated as a valid treatment option for single-tooth restoration [ 2 , 3 , 4 , 5 , 8 ]. This is owing to its inherent esthetic and mechanical properties [ 9 , 10 , 11 ].…”

Impact of the material and sintering protocol, layer thickness, and thermomechanical aging on the two-body wear and fracture load of 4Y-TZP crowns

“…The material loss of the 4Y-TZP was noted to be considerably lower than that of the natural enamel antagonists. While minimum wear may in theory be desirable, the lower 2BW reported between enamel and zirconia in comparison with enamel-enamel contact points [ 32 ] may disbalance occlusion schemes and should be taken into account when planning a prosthetic restoration [ 33 ]. In contrast to earlier findings that reported high-speed sintering to result in less 2BW of 4Y-TZP than seen for a conventionally sintered control group [ 18 ], the choice of material/sintering protocol did not influence the reported material loss in the present investigation.…”