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Journal of Conservative Dentistry : JCD 2022Advances in adhesive technologies and escalation in esthetic demands have increased indications for tooth-colored, partial coverage restorations. Recently, material... (Review)
Review
BACKGROUND
Advances in adhesive technologies and escalation in esthetic demands have increased indications for tooth-colored, partial coverage restorations. Recently, material knowledge has evolved, new materials have been developed, and no systematic review has answered the question posed by practitioners: Is the clinical efficacy of resin or ceramic better, for inlay, onlay, and overlay in the long run?
AIM
The aim of this systematic review and meta-analysis was to evaluate the clinical performance of ceramic and resin inlays, onlays, and overlays and to identify the complication types associated with the main clinical outcomes.
MATERIALS AND METHODS
Two reviewers (VN and AJ) searched PubMed, Embase, and Cochrane Central registry of controlled trials for published articles between 1983 and 2020 conforming to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for systematic reviews. Only clinical studies which met the following criteria were included (1) studies regarding ceramic and resin inlays, onlays, and overlays were included; (2) randomized controlled trials, retrospective or prospective studies conducted in humans; (3) studies with a dropout rate <50% 4) studies with a follow-up higher than 5 years.
RESULTS
Of 1718 articles, 21 articles were selected. At 5 years, the estimated survival rates for resin ( = 129) was 86%, feldspathic porcelain ( = 1048) was 90%, and glass ceramic ( = 2218) was 92%; at 10 years, the survival of resin was 75% ( = 115), feldspathic porcelain was 91% ( = 1829), and glass ceramic was 89% ( = 1075).
CONCLUSION
The meta-regression indicated that ceramic partial coverage restorations (feldspathic porcelain and glass-ceramic) outperformed resin partial coverage restorations both at 5-year and 10-year follow-up. When compared between ceramic types, glass ceramics outperformed feldspathic porcelain at 5 years' follow-up and feldspathic porcelain outperformed glass ceramics at 10 years' follow-up. The failures were mostly due to fractures (6.2%), endodontic problems (3%), secondary caries (1.7%), and debonding which was 0.9%.
PubMed: 36187858
DOI: 10.4103/jcd.jcd_184_22 -
BMC Oral Health Sep 2017The continuous development in dental processing ensures new opportunities in the field of fixed prosthodontics in a complete virtual environment without any physical... (Review)
Review
BACKGROUND
The continuous development in dental processing ensures new opportunities in the field of fixed prosthodontics in a complete virtual environment without any physical model situations. The aim was to compare fully digitalized workflows to conventional and/or mixed analog-digital workflows for the treatment with tooth-borne or implant-supported fixed reconstructions.
METHODS
A PICO strategy was executed using an electronic (MEDLINE, EMBASE, Google Scholar) plus manual search up to 2016-09-16 focusing on RCTs investigating complete digital workflows in fixed prosthodontics with regard to economics or esthetics or patient-centered outcomes with or without follow-up or survival/success rate analysis as well as complication assessment of at least 1 year under function. The search strategy was assembled from MeSH-Terms and unspecific free-text words: {(("Dental Prosthesis" [MeSH]) OR ("Crowns" [MeSH]) OR ("Dental Prosthesis, Implant-Supported" [MeSH])) OR ((crown) OR (fixed dental prosthesis) OR (fixed reconstruction) OR (dental bridge) OR (implant crown) OR (implant prosthesis) OR (implant restoration) OR (implant reconstruction))} AND {("Computer-Aided Design" [MeSH]) OR ((digital workflow) OR (digital technology) OR (computerized dentistry) OR (intraoral scan) OR (digital impression) OR (scanbody) OR (virtual design) OR (digital design) OR (cad/cam) OR (rapid prototyping) OR (monolithic) OR (full-contour))} AND {("Dental Technology" [MeSH) OR ((conventional workflow) OR (lost-wax-technique) OR (porcelain-fused-to-metal) OR (PFM) OR (implant impression) OR (hand-layering) OR (veneering) OR (framework))} AND {(("Study, Feasibility" [MeSH]) OR ("Survival" [MeSH]) OR ("Success" [MeSH]) OR ("Economics" [MeSH]) OR ("Costs, Cost Analysis" [MeSH]) OR ("Esthetics, Dental" [MeSH]) OR ("Patient Satisfaction" [MeSH])) OR ((feasibility) OR (efficiency) OR (patient-centered outcome))}. Assessment of risk of bias in selected studies was done at a 'trial level' including random sequence generation, allocation concealment, blinding, completeness of outcome data, selective reporting, and other bias using the Cochrane Collaboration tool. A judgment of risk of bias was assigned if one or more key domains had a high or unclear risk of bias. An official registration of the systematic review was not performed.
RESULTS
The systematic search identified 67 titles, 32 abstracts thereof were screened, and subsequently, three full-texts included for data extraction. Analysed RCTs were heterogeneous without follow-up. One study demonstrated that fully digitally produced dental crowns revealed the feasibility of the process itself; however, the marginal precision was lower for lithium disilicate (LS2) restorations (113.8 μm) compared to conventional metal-ceramic (92.4 μm) and zirconium dioxide (ZrO2) crowns (68.5 μm) (p < 0.05). Another study showed that leucite-reinforced glass ceramic crowns were esthetically favoured by the patients (8/2 crowns) and clinicians (7/3 crowns) (p < 0.05). The third study investigated implant crowns. The complete digital workflow was more than twofold faster (75.3 min) in comparison to the mixed analog-digital workflow (156.6 min) (p < 0.05). No RCTs could be found investigating multi-unit fixed dental prostheses (FDP).
CONCLUSIONS
The number of RCTs testing complete digital workflows in fixed prosthodontics is low. Scientifically proven recommendations for clinical routine cannot be given at this time. Research with high-quality trials seems to be slower than the industrial progress of available digital applications. Future research with well-designed RCTs including follow-up observation is compellingly necessary in the field of complete digital processing.
Topics: Computer-Aided Design; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Humans; Workflow
PubMed: 28927393
DOI: 10.1186/s12903-017-0415-0 -
The Journal of Prosthetic Dentistry Mar 2020The restoration of extensively damaged endodontically treated teeth remains a challenge. The use of post-retained restorations has been questioned because of potential...
STATEMENT OF PROBLEM
The restoration of extensively damaged endodontically treated teeth remains a challenge. The use of post-retained restorations has been questioned because of potential tooth weakening.
PURPOSE
The purpose of this systematic review was to determine whether endocrowns are a reliable alternative to post-retained restorations for extensively damaged endodontically treated teeth and to determine which preparation design is most appropriate and which materials are best adapted for fabricating endocrowns.
MATERIAL AND METHODS
The literature that was analyzed covered endocrowns from 1995 to June 2018. A search was conducted for in vitro and clinical studies in English in 3 research databases (PubMed, Cochrane, and Scopus), and this was complemented by a manual search in the bibliographies of the studies found. Case reports were excluded.
RESULTS
A total of 41 publications consisting of 8 clinical studies and 33 in vitro studies were included in this systematic review. Several analysis parameters were identified: for the clinical studies, survival rate, failure modes, and clinical criteria; for the in vitro studies, fracture resistance, stress distribution, preparation criteria, and materials used.
CONCLUSIONS
Endocrowns are a reliable alternative to post-retained restorations for molars and seem promising for premolars. A certain preparation design and a rigorous adhesion protocol must be respected. Among the available materials, lithium disilicate glass-ceramic and nanofilled composite resin stand out.
Topics: Composite Resins; Crowns; Dental Porcelain; Dental Restoration Failure; Dental Stress Analysis; Humans; Materials Testing; Tooth, Nonvital
PubMed: 31353111
DOI: 10.1016/j.prosdent.2019.04.009 -
Journal of Dental Research Aug 2016This systematic review and meta-analysis aimed to evaluate the survival rate of ceramic and resin inlays, onlays, and overlays and to identify the complication types... (Meta-Analysis)
Meta-Analysis Review
This systematic review and meta-analysis aimed to evaluate the survival rate of ceramic and resin inlays, onlays, and overlays and to identify the complication types associated with the main clinical outcomes. Two reviewers searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for articles published between 1983 through April 2015, conforming to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Clinical studies meeting the following criteria were included: 1) studies related to resin and ceramic inlays, onlays, and overlays; 2) prospective, retrospective, or randomized controlled trials conducted in humans; 3) studies with a dropout rate of less than 30%; and 4) studies with a follow-up longer than 5 y. Of 1,389 articles, 14 met the inclusion criteria. The meta-regression indicated that the type of ceramic material (feldspathic porcelain vs. glass-ceramic), study design (retrospective vs. prospective), follow-up time (5 vs. 10 y), and study setting (university vs. private clinic) did not affect the survival rate. Estimated survival rates for glass-ceramics and feldspathic porcelain were between 92% and 95% at 5 y (n = 5,811 restorations) and were 91% at 10 y (n = 2,154 restorations). Failures were related to fractures/chipping (4%), followed by endodontic complications (3%), secondary caries (1%), debonding (1%), and severe marginal staining (0%). Odds ratios (95% confidence intervals) were 0.19 (0.04 to 0.96) and 0.54 (0.17 to 1.69) for pulp vitality and type of tooth involved (premolars vs. molars), respectively. Ceramic inlays, onlays, and overlays showed high survival rates at 5 y and 10 y, and fractures were the most frequent cause of failure.
Topics: Ceramics; Composite Resins; Dental Materials; Dental Restoration Failure; Denture, Overlay; Humans; Inlays
PubMed: 27287305
DOI: 10.1177/0022034516652848 -
Journal of Esthetic and Restorative... May 2018This systematic review aimed to evaluate the longevity of ceramic onlays and identify the factors that influence their survival. (Review)
Review
OBJECTIVE
This systematic review aimed to evaluate the longevity of ceramic onlays and identify the factors that influence their survival.
MATERIALS AND METHODS
An electronic search was conducted through PubMed (MEDLINE), Google Scholar and Cochrane Library, up to August 2017. The literature search aimed to retrieve all the clinical studies on the longevity of ceramic onlays. Ceramic onlay was defined as any partial ceramic restoration that covers at least one cusp.
RESULTS
A total of 21 studies met the selection criteria and were deemed suitable for this review. The medium-term studies (2-5 years) indicated a survival rate of 91-100%, and the long term studies (more than 5 years) showed a survival rate of 71-98.5%. The most common reason of failure was fracture, followed by debonding and caries. The most common patterns of deterioration were loss of margin integrity and discoloration. Onlay longevity can be enhanced if the preparation allows for at least 2 mm occlusal ceramic thickness and incorporates additional retentive features. Restoring teeth that are nonvital, teeth in a more posterior region, or teeth for patients with parafunctional habits appears to be associated with greater ceramic failure. Fabrication materials and methods, and adhesive bonding system did not seem to influence onlay longevity.
CONCLUSIONS
The clinical performance of the ceramic onlay appears acceptable regardless of the follow-up duration. Fracture of the ceramic onlay is the predominant cause of failure, and the most observed form of deterioration was associated with the restoration margin.
CLINICAL SIGNIFICANCE
Ceramic onlay appears to be a reliable option to restore posterior teeth. The most common pattern of failure is fracture of the ceramic material. The risk of ceramic onlay failure seems to increase if the restored tooth is nonvital and the patient demonstrates parafunctional habits.
Topics: Ceramics; Dental Porcelain; Dental Restoration Failure; Humans; Inlays; Tooth; Tooth, Nonvital
PubMed: 29676497
DOI: 10.1111/jerd.12384 -
The International Journal of... 2016The aim of this study was to perform a systematic review and meta-analysis based on clinical trials that evaluated the main outcomes of glass-ceramic and feldspathic... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The aim of this study was to perform a systematic review and meta-analysis based on clinical trials that evaluated the main outcomes of glass-ceramic and feldspathic porcelain laminate veneers.
MATERIALS AND METHODS
A systematic search was carried out in Cochrane and PubMed databases. From the selected studies, the survival rates for porcelain and glass-ceramic veneers were extracted, as were complication rates of clinical outcomes: debonding, fracture/chipping, secondary caries, endodontic problems, severe marginal discoloration, and influence of incisal coverage and enamel/dentin preparation. The Cochran Q test and the I(2) statistic were used to evaluate heterogeneity.
RESULTS
Out of the 899 articles initially identified, 13 were included for analysis. Metaregression analysis showed that the types of ceramics and follow-up periods had no influence on failure rate. The estimated overall cumulative survival rate was 89% (95% CI: 84% to 94%) in a median follow-up period of 9 years. The estimated survival for glass-ceramic was 94% (95% CI: 87% to 100%), and for feldspathic porcelain veneers, 87% (95% CI: 82% to 93%). The meta-analysis showed rates for the following events: debonding: 2% (95% CI: 1% to 4%); fracture/chipping: 4% (95% CI: 3% to 6%); secondary caries: 1% (95% CI: 0% to 3%); severe marginal discoloration: 2% (95% CI: 1% to 10%); endodontic problems: 2% (95% CI: 1% to 3%); and incisal coverage odds ratio: 1.25 (95% CI: 0.33 to 4.73). It was not possible to perform meta-analysis of the influence of enamel/dentin preparation on failure rates.
CONCLUSION
Glass-ceramic and porcelain laminate veneers have high survival rates. Fracture/ chipping was the most frequent complication, providing evidence that ceramic veneers are a safe treatment option that preserve tooth structure.
Topics: Aluminum Silicates; Ceramics; Dental Porcelain; Dental Restoration Failure; Dental Veneers; Humans; Potassium Compounds; Surface Properties; Survival Analysis; Treatment Outcome
PubMed: 26757327
DOI: 10.11607/ijp.4315 -
Clinical Oral Implants Research Jan 2022To analyze the clinical outcomes of all-ceramic single crowns (SCs) and fixed dental prostheses (FDPs) supported by ceramic implants. (Meta-Analysis)
Meta-Analysis Review
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.
Topics: Ceramics; Crowns; Dental Implants; Dental Porcelain; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Humans; Metal Ceramic Alloys; Zirconium
PubMed: 34665900
DOI: 10.1111/clr.13871 -
The Cochrane Database of Systematic... Sep 2015Endodontic treatment involves removal of the dental pulp and its replacement by a root canal filling. Restoration of root filled teeth can be challenging due to... (Review)
Review
BACKGROUND
Endodontic treatment involves removal of the dental pulp and its replacement by a root canal filling. Restoration of root filled teeth can be challenging due to structural differences between vital and non-vital root-filled teeth. Direct restoration involves placement of a restorative material e.g. amalgam or composite, directly into the tooth. Indirect restorations consist of cast metal or ceramic (porcelain) crowns. The choice of restoration depends on the amount of remaining tooth, and may influence durability and cost. The decision to use a post and core in addition to the crown is clinician driven. The comparative clinical performance of crowns or conventional fillings used to restore root-filled teeth is unknown. This review updates the original, which was published in 2012.
OBJECTIVES
To assess the effects of restoration of endodontically treated teeth (with or without post and core) by crowns versus conventional filling materials.
SEARCH METHODS
We searched the following databases: the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE via OVID, EMBASE via OVID, CINAHL via EBSCO, LILACS via BIREME. We also searched the reference lists of articles and ongoing trials registries.There were no restrictions regarding language or date of publication. The search is up-to-date as of 26 March 2015.
SELECTION CRITERIA
Randomised controlled trials (RCTs) or quasi-randomised controlled trials in participants with permanent teeth that have undergone endodontic treatment. Single full coverage crowns compared with any type of filling materials for direct restoration or indirect partial restorations (e.g. inlays and onlays). Comparisons considered the type of post and core used (cast or prefabricated post), if any.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data from the included trial and assessed its risk of bias. We carried out data analysis using the 'treatment as allocated' patient population, expressing estimates of intervention effect for dichotomous data as risk ratios, with 95% confidence intervals (CI).
MAIN RESULTS
We included one trial, which was judged to be at high risk of performance, detection and attrition bias. The 117 participants with a root-filled, premolar tooth restored with a carbon fibre post, were randomised to either a full coverage metal-ceramic crown or direct adhesive composite restoration. None experienced a catastrophic failure (i.e. when the restoration cannot be repaired), although only 104 teeth were included in the final, three-year assessment. There was no clear difference between the crown and composite group and the composite only group for non-catastrophic failures of the restoration (1/54 versus 3/53; RR 0.33; 95% CI 0.04 to 3.05) or failures of the post (2/54 versus 1/53; RR 1.96; 95% CI 0.18 to 21.01) at three years. The quality of the evidence for these outcomes is very low. There was no evidence available for any of our secondary outcomes: patient satisfaction and quality of life, incidence or recurrence of caries, periodontal health status, and costs.
AUTHORS' CONCLUSIONS
There is insufficient evidence to assess the effects of crowns compared to conventional fillings for the restoration of root-filled teeth. Until more evidence becomes available, clinicians should continue to base decisions about how to restore root-filled teeth on their own clinical experience, whilst taking into consideration the individual circumstances and preferences of their patients.
Topics: Adult; Crowns; Dental Restoration, Permanent; Female; Humans; Male; Middle Aged; Post and Core Technique; Randomized Controlled Trials as Topic; Tooth Root; Tooth, Nonvital
PubMed: 26403154
DOI: 10.1002/14651858.CD009109.pub3 -
The Journal of Prosthetic Dentistry Feb 2021The polycrystalline nature of zirconia hinders its ability to bond to tooth structure. Consequently, durable bonding to zirconia has been challenging. In vitro studies... (Review)
Review
STATEMENT OF PROBLEM
The polycrystalline nature of zirconia hinders its ability to bond to tooth structure. Consequently, durable bonding to zirconia has been challenging. In vitro studies have evaluated various methods of bonding to zirconia, but clinical data are sparse.
PURPOSE
The purpose of this systematic review was to critically appraise clinical studies investigating the survival rate of resin-bonded zirconia fixed partial dentures (FPDs), inlay-retained zirconia FPDs, and zirconia veneers.
MATERIAL AND METHODS
Searches were performed in MEDLINE, EMBASE, PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar. Clinical studies of over 12 months duration involving bonded zirconia restorations between 1990 and July 2018 were reviewed. All suitable studies were assessed for quality by using a "Questionnaire for selecting articles on Dental Prostheses".
RESULTS
Eight studies were ultimately included. Three studies examined posterior inlay-retained FPDs with estimated survival rates of 12.1% at 10 years, 95.8% at 5 years, and 100% at 20 months. Five studies reviewed anterior, resin-bonded FPDs, all of which had a 3- to 10-year survival rate of 100%. Debonds occurred in all studies, but the prostheses could usually be rebonded.
CONCLUSIONS
With correctly designed buccal and lingual coverage retainers and minimal if any veneering porcelain, zirconia-based, posterior, inlay-retained FPDs seem to have a high clinical survival rate. The role of bonding efficacy in this survival rate is unknown. Anterior, cantilevered, resin-bonded zirconia FPDs seem to have a high clinical survival rate. While these prostheses can debond, fracture of the entire prosthesis is unlikely, so they may be rebonded. To bond zirconia, the use of airborne-particle abrasion with 50-μm alumina (AlO) at 0.1 to 0.25 MPa in combination with a phosphate monomer-containing adhesive resin is recommended until further studies become available. Dental dam isolation is also recommended during zirconia bonding.
Topics: Dental Bonding; Dental Materials; Dental Porcelain; Denture Design; Denture, Partial, Fixed; Treatment Outcome; Zirconium
PubMed: 32115220
DOI: 10.1016/j.prosdent.2019.12.017 -
Operative Dentistry Jan 2021Composite resin or ceramic inlays, onlays, and overlays can achieve high long-term survival and success rates. (Meta-Analysis)
Meta-Analysis
CLINICAL RELEVANCE
Composite resin or ceramic inlays, onlays, and overlays can achieve high long-term survival and success rates.
Topics: Ceramics; Composite Resins; Dental Porcelain; Inlays
PubMed: 33882133
DOI: 10.2341/19-107-LIT