Selection criteria: Approximately 50 articles were included in this review based on a MEDLINE and PubMed search of English-language peer-reviewed literature focused on research published between 1993 and 2008. The authors also hand searched relevant dental journals. Randomized controlled trials, nonrandomized controlled trials, longitudinal experimental clinical studies, longitudinal prospective studies, and longitudinal retrospective studies were all eligible for inclusion in this review.
Key study factor: Treatment of teeth with an all-ceramic restoration in the form of a veneer, inlay, onlay, crown, or fixed dental prosthesis, and the subsequent clinical success or failure of these restorations.
Main outcome measure: Restoration survival rate (in percent) as a function of observation period and fabrication method, reported by restoration type. Specific fabrication methods for single-tooth restorations included InCeram Alumina, InCeram Spinell, Procera, IPS Empress, IPS Empress 2, and Dicor crowns. Fabrication methods for fixed partial dentures included InCeram, InCeram Zr, IPS Empress 2, and Cercon Zr, respectively. The reported Kaplan-Meier survival rates were grouped by restoration type rather than by ceramic system.
Main results: For porcelain veneers, less than 5% failure was reported at 5 years and less than 10% failure rate at 10 years (n ranging from 83 to 3047). For ceramic inlay and onlay restorations, 10-year failure rates were found to be less than 10% (n ranging from 200 to 1588). Greater success rates were reported for anterior crowns. Kaplan-Meier survival rates were calculated for end points ranging in duration from 1 to 4 years (6 studies), 5 to 6 years (12 studies), 7 to 8 years (5 studies), and 10 years or more (2 studies). The results for multiunit prostheses included 11 studies, fewer prostheses, and generally higher failure rates. As with single crowns, failure rates for multiunit prostheses were reported to be consistently higher in the posterior region than anteriorly. Kaplan-Meier survival rates were reported for 3-unit fixed partial dentures for end points ranging from 1 to 10 years, with a mean end point of approximately 5.6 years.
Conclusions: The authors suggest that many all-ceramic restorations were found to demonstrate acceptable longevity compared with conventional restorations (eg, metal-ceramic crowns). For single-rooted anterior teeth, broad support was found for the premise that clinicians may select from any all-ceramic system for laminate veneers, intracoronal restorations such as inlays and onlays, and for full-coverage restorations. For restoration of molar teeth, the review suggests that relatively few all-ceramic systems will provide predictable long-term success. The number of clinical complications with all-ceramic fixed dental prostheses (multiunit) remains high, even with increased connector size. Although zirconium systems offer the advantage of favorable material characteristics for substructures, the clinical problem of chipping of the weaker esthetic veneer persists.