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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 -
The International Journal of... 2014This review aimed to evaluate the documented clinical success of zirconia based crowns in clinical trials. (Review)
Review
PURPOSE
This review aimed to evaluate the documented clinical success of zirconia based crowns in clinical trials.
MATERIALS AND METHODS
Electronic databases were searched for original studies reporting on the clinical performance of tooth- or implant-supported zirconia-based crowns, including PubMed, Cochrane Library, and Science Direct. The electronic search was complemented by manual searches of the bibliographies of all retrieved full-text articles and reviews as well as a hand search of the following journals: International Journal of Prosthodontics, Journal of Oral Rehabilitation, International Journal of Oral & Maxillofacial Implants, and Clinical Oral Implants Research.
RESULTS
The search yielded 3,216 titles. Based on preestablished criteria, 42 full-text articles were obtained. While 16 studies fulfilled the inclusion criteria, only 3 randomized controlled trials were reported. Seven studies reported on tooth-supported and 4 on implant-supported crowns, and 5 studies reported on both types of support. Ten studies on tooth-supported and 7 on implant supported crowns provided sufficient material for statistical analysis. Life table analysis revealed cumulative 5-year survival rates of 95.9% for tooth-supported and 97.1% for implant-supported crowns. For implant-supported crowns, the most common reasons for failure were technical (veneering material fractures). For tooth-supported crowns, technical (veneering material fractures, loss of retention) and biologic (endodontic/ periodontic) reasons for failure were equally common. The most common complications for implant-supported crowns were veneering material fractures and bleeding on probing. For tooth-supported crowns, the most common complications were loss of retention, endodontic treatment, veneering material fractures, and bleeding on probing.
CONCLUSION
The results suggest that the success rate of tooth-supported and implant-supported zirconia-based crowns is adequate, similar, and comparable to that of conventional porcelain-fused-to-metal crowns. These results are, however, based on a relatively small number of studies, many that are not controlled clinical trials. Well-designed studies with large patient groups and long follow-up times are needed before general recommendations for the use of zirconia-based restorations can be provided.
Topics: Clinical Trials as Topic; Crowns; Dental Materials; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Humans; Randomized Controlled Trials as Topic; Treatment Outcome; Zirconium
PubMed: 24392475
DOI: 10.11607/ijp.3647 -
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 -
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 -
Clinical and Experimental Dental... Dec 2022This systematic review aims to investigate the effect of different preparation designs on the marginal fit and fracture strength of ceramic occlusal veneers. (Review)
Review
OBJECTIVES
This systematic review aims to investigate the effect of different preparation designs on the marginal fit and fracture strength of ceramic occlusal veneers.
MATERIALS AND METHODS
Based on the PICO question and the search terms, an electronic search was performed in Google Scholar, PubMed (MEDLINE), Scopus, Cochrane Library, Web of Science, Science Direct, Wiley, Ovid, and SAGE for articles published up to July 2022. After including English in vitro studies that evaluated posterior ceramic occlusal overlays at the posterior with ceramic restorations by following the PRISMA statement, the extracted data was tabulated. The methodological quality of the included studies was evaluated. Risk of bias assessment was done independently by two authors using the modified MINORS scale.
RESULTS
About 3138 search results were screened, of which 22 were selected due to their titles. Twenty-one full-text articles were assessed for eligibility. Seventeen in-vitro studies were finalized for the extraction of quantitative data. All 17 articles had a low risk of bias and were retained. The influencing items for evaluating the research were different in most studies; therefore, qualitative synthesis of the results was feasible. They generally included preparation design, material thickness, depth of preparation in the tooth, internal divergence angle, and finish line. Meta-analysis was not done due to heterogeneity of preparation types and evaluation methods. Results revealed that fracture resistance of occlusal veneers is higher than normal mastication force, and it is sufficient to prepare the occlusal surface, use a self-etching primer for bonding, and an acceptable minimum ceramic thickness. The marginal discrepancy of occlusal veneers is clinically acceptable. However, this systematic review faces some limitations due to the lack of in vivo studies, different preparation designs in included studies, different follow-ups, and lack of comprehensive explanations in articles.
CONCLUSIONS
The preparation design of occlusal veneers influences both marginal adaptation and fracture resistance. Various preparation designs are proven to have clinically acceptable fracture strength and marginal adaptation.
Topics: Dental Porcelain; Dental Veneers; Flexural Strength; Dental Stress Analysis; Materials Testing; Ceramics
PubMed: 36062841
DOI: 10.1002/cre2.653 -
Journal of Clinical Medicine Nov 2022This systematic review and meta-analysis aimed to evaluate the wear of the antagonist tooth in ceramic restorations. (Review)
Review
BACKGROUND
This systematic review and meta-analysis aimed to evaluate the wear of the antagonist tooth in ceramic restorations.
MATERIAL AND METHODS
This study was carried out based on Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) recommendations; it was also registered in PROSPERO (register number: CRD42022316252). Three databases were consulted in the literature search, Embase, Scopus, and Web of Science. The citation searching was conducted by two researchers independently. The clinical studies that evaluated wear in antagonist teeth concerning ceramic restoration were included. Twelve articles were selected after eliminating duplicates ones and applying the inclusion criteria, and two were chosen through citation. Fourteen articles were considered for the qualitative and quantitative analysis (meta-regression and meta-analysis).
RESULTS
The mean linear wear of the antagonist tooth in relation to feldspathic was 8.914 μm, for lithium disilicate it was 0.018 μm, and for zirconia it was 0.257 μm. The mean volumetric wear of the antagonist tooth in relation to feldspathic was 0.273 mm, for hybrid ceramic it was 0.030 mm, for lithium disilicate it was 0.018 mm, and for zirconia it was 0.014 mm. The mean natural tooth wear was 0.7974 μm per month. Tooth wear caused by zirconia at six months was 31.755 μm, at 12 months it was 24.648 μm, and at 24 months it was 20.662 μm.
CONCLUSIONS
Feldspathic produces greater wear of the antagonist tooth from ceramic restorations linearly and volumetrically. In addition, zirconia generates the least wear that will decrease over time, and it will be equal to or less than the natural wear in the tooth.
PubMed: 36362777
DOI: 10.3390/jcm11216547 -
Clinical Oral Investigations Oct 2023To compare the failure rates and the prevalence of technical complications between full-coverage tooth-supported monolithic zirconia (MZ) and porcelain-veneered zirconia... (Review)
Review
Clinical outcomes of tooth-supported monolithic zirconia vs. porcelain-veneered zirconia fixed dental prosthesis, with an additional focus on the cement type: a systematic review and meta-analysis.
PURPOSE
To compare the failure rates and the prevalence of technical complications between full-coverage tooth-supported monolithic zirconia (MZ) and porcelain-veneered zirconia (PVZ) fixed dental prosthesis, based on a systematic literature review.
METHODS
An electronic search was performed in three databases, supplemented by hand searching. Several statistical methods were used.
RESULTS
Seventy-four publications reported 6370 restorations (4264 PVZ; 2106 MZ; 8200 abutment teeth; 3549 patients), followed up until 152 months. A total of 216 prostheses failed, and survival was statistically significant different between groups. PVZ had higher occurrence of complications than MZ; the difference was especially greater for either minor or major chipping. The difference in prevalence of either minor or major chipping was statistically significant for PVZ prostheses between cementation with glass ionomer and adhesive resin cement (higher), adhesive resin and resin-modified glass ionomer cement (RMGIC, higher), and between RMGIC (higher) and glass ionomer cement. For MZ the difference was significant only for minor chipping between RMGIC (higher) and adhesive resin cement. Abutment teeth to PVZ prostheses more often lost vitality. Decementation was not observed with RMGIC. Air abrasion did not seem to clinically decrease the decementation risk. The 5-year difference in the occurrence of minor or major chipping between MZ and PVZ prostheses was statistically significant, but nor for catastrophic fracture.
CONCLUSION
Tooth-supported PVZ prostheses present higher failure and complication rates than MZ prosthesis. The difference in complications is striking when it comes to chipping.
CLINICAL RELEVANCE
Awareness of the outcome differences between different types of zirconia prostheses is important for clinical practice.
PubMed: 37626273
DOI: 10.1007/s00784-023-05219-4 -
Cureus Nov 2022This study aimed to systematically review the literature to evaluate the marginal adaptation of veneers using different fabrication methods, namely, conventional... (Review)
Review
This study aimed to systematically review the literature to evaluate the marginal adaptation of veneers using different fabrication methods, namely, conventional feldspathic porcelain laminate veneers (PLVs), computer-aided design-computer-aided machining (CAD-CAM) veneers, and pressed veneers. A comprehensive literature search was performed using electronic databases (PubMed and Google Scholar) as well as hand searches to identify all relevant studies related to veneers and marginal adaptation. The identified studies were screened for assessing the inclusion and exclusion criteria. The included articles were then subjected to data extraction and analysis. The search resulted in 130 articles, of which six were included in this systematic review. All included articles were assessed for adaptation of margins. Based on the findings of this systematic review, no significant differences were found in the marginal adaptation of CAD-CAM and conventional feldspathic PLVs. The marginal fidelity of ceramic veneers issuing from the various fabrication techniques was clinically acceptable.
PubMed: 36579272
DOI: 10.7759/cureus.31885 -
Journal of Applied Biomaterials &... 2024Despite the development of implant-supported prostheses, there are still patients for whom conservative treatments such as resin-bonded fixed dental prostheses (RBFDPs)... (Review)
Review
Despite the development of implant-supported prostheses, there are still patients for whom conservative treatments such as resin-bonded fixed dental prostheses (RBFDPs) are more appropriate. This study's objective was to analyze the available research on full-ceramic RBFDPs. In this study, Web of Science, MEDLINE/PubMed, Scopus, Embase, Cochrane Library, and Google Scholar databases were searched for articles published in English between 2010 and 2020. A total of 14 studies were reviewed based on the eligibility criteria. The results showed that using a cantilever design with one abutment had an advantage over two abutments. Additionally, it was proposed that preparations designed with retentive aids, such as a proximal box, groove, and pinhole, could improve RBFDP survival rates. IPS e.max ZirCAD, In-Ceram alumina, and zirconia CAD/CAM were the most commonly used framework materials. Most studies used air abrasion, salinization, or hydrofluoric acid for surface treatment. Adhesive resin cements were the most frequently used type of cement. The survival rate of In-Ceram ceramics (85.3%-94.8%) was lower than that of In-Ceram zirconia and IPS e.max ZirCAD. Debonding, followed by framework fracture, was the leading cause of failure. Following 3-10 years follow-up, the survival percentage of all-ceramic RBFDPs ranged from 76% to 100%. Although RBFDPs have demonstrated satisfactory success as a conservative treatment, long-term follow-ups and higher sample sizes in clinical research are required to gain more reliable outcomes on the clinical success rate of various RBFDP designs.
Topics: Humans; Ceramics; Resin Cements; Dental Porcelain; Dental Prosthesis, Implant-Supported; Denture, Partial, Fixed, Resin-Bonded; Zirconium
PubMed: 38706266
DOI: 10.1177/22808000241250118