title: The clinical success of tooth- and implant-supported zirconia-based fixed dental prostheses. A systematic review.
abstract: The aim was to make an inventory of the current literature on the clinical performance of tooth- or implant-supported zirconia-based FDPs and analyse and discuss any complications. Electronic databases, PubMed.gov, Cochrane Library and Science Direct, were searched for original studies reporting on the clinical performance of tooth- or implant-supported zirconia-based FDPs. 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. The search yielded 4253 titles. Sixty-eight potentially relevant full-text articles were retrieved. After applying pre-established criteria, 27 studies were included. Twenty-three studies reported on tooth-supported and 4 on implant-supported FDPs. Five of the studies were randomised, comparing Y-TZP-based restorations with metal-ceramic or other all-ceramic restorations. Most tooth-supported FDPs were FDPs of 3-5 units, whereas most implant-supported FDPs were full arch. The majority of the studies reported on 3- to 5-year follow-up. Life table analysis revealed cumulative 5-year survival rates of 93.5% for tooth-supported and 100% for implant-supported FDPs. For tooth-supported FDPs, the most common reasons for failure were veneering material fractures, framework fractures and caries. Cumulative 5-year complication rates were 27.6% and 30.5% for tooth- and implant-supported FDPs, respectively. The most common complications were veneering material fractures for tooth- as well as implant-supported FDPs. Loss of retention occurred more frequently in FDPs luted with zinc phosphate or glass-ionomer cement compared to those luted with resin cements. The results suggest that the 5-year survival rate is excellent for implant-supported zirconia-based FDPs, despite the incidence of complications, and acceptable for tooth-supported zirconia-based FDPs. These results are, however, based on a relatively small number of studies, especially for the implant-supported FDPs. The vast majority of the studies are not controlled clinical trials and have limited follow-up. Thus, interpretation of the results should be made with caution. 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.
authors.affiliation: Department of Materials Science and Technology, Faculty of Odontology, Malmö University, Malmö, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Le
authors.forename: E
authors.initials: E
authors.lastname: Papia
authors.forename: C
authors.initials: C
authors.lastname: Larsson
mesh_terms: D003764:Dental Materials / Q000627:therapeutic use; D017267:Dental Prosthesis Design; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D003830:Denture, Partial, Fixed; D006801:Humans; D013997:Time Factors; D016896:Treatment Outcome; D015040:Zirconium / Q000627:therapeutic use
chemical_list: D003764:Dental Materials; D015040:Zirconium; C028541:zirconium oxide
keywords: ceramics; dental implants; dental restoration failure; denture; fixed; partial; systematic review; yttria-stabilised tetragonal zirconia