Monolithic zirconia as a valid alternative to metal-ceramic for implant-supported single crowns in the posterior region: A systematic review and meta-analysis of randomized controlled trials

Péter Tajti; Eleonora Solyom; László Márk Czumbel; Bence Szabó; Réka Fazekas; Orsolya Németh; Péter Hermann; Gábor Gerber; Péter Hegyi; Krisztina Mikulás

doi:10.1016/j.prosdent.2023.05.006

Monolithic zirconia as a valid alternative to metal-ceramic for implant-supported single crowns in the posterior region: A systematic review and meta-analysis of randomized controlled trials

J Prosthet Dent. 2023 Jun 21:S0022-3913(23)00336-0. doi: 10.1016/j.prosdent.2023.05.006. Online ahead of print.

Authors

Affiliations

¹ Resident, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; PhD student, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
² Clinical Specialist, Department of Periodontology, Semmelweis University, Budapest, Hungary; PhD student, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
³ Resident, Department of Periodontology, Semmelweis University, Budapest, Hungary; Scientific Methodology Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
⁴ Biostatistician, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
⁵ Assistant Professor, Department of Conservative Dentistry, Semmelweis University, Budapest, Hungary; Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
⁶ Director, Associate Professor, Department of Community Dentistry, Semmelweis University, Budapest, Hungary; Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
⁷ Director, Full Professor, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
⁸ Associate Professor, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary; Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
⁹ Strategic Director, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Strategic Director, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
¹⁰ Assistant Professor, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary. Electronic address: dr.mikulas@gmail.com.

PMID: 37349158
DOI: 10.1016/j.prosdent.2023.05.006

Abstract

Statement of problem: Technical complication rates of standard metal-ceramic implant-supported posterior restorations are relatively high. Whether monolithic zirconia crowns represent a more successful alternative is unclear.

Purpose: The purpose of this systematic review and meta-analysis was to compare the clinical outcomes of posterior monolithic zirconia and metal-ceramic implant-supported single crowns.

Material and methods: A search was conducted in MEDLINE, Scopus, Embase, Web of Science, and CENTRAL databases for randomized controlled trials up to April 2023 with a follow-up time of at least 1 year. Restoration and implant survival and failure rates, marginal bone loss (MBL), bleeding on probing (BOP), and technical complications were analyzed by 2 reviewers. Statistical analyses were conducted using the R-statistics software program. The risk of bias was assessed by the Cochrane Risk of Bias Tool 2 (RoB 2), and the certainty of evidence by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Results: A total of 11 out of 2030 records were identified by title and abstract, and 4 records were included after full-text analysis. The statistical analysis revealed no significant difference in MBL (MD -0.11, 95% CI: [-0.25; 0.03]), BOP (OR 0.66, 95% CI: [0.25; 1.77]), or implant failure (OR 1.30, 95% CI: [0.24; 7.08]). Monolithic zirconia presented significantly less chipping over 1 year (OR 0.17, 95% CI: [0.03; 0.99]). The chipping rate was 0% for monolithic zirconia and 7.61% for metal-ceramic. Based on a narrative review, the restoration survival rate was 97.5% in the monolithic zirconia group and 99.1% in the metal-ceramic group.

Conclusions: Monolithic zirconia showed favorable short-term survival rates and had significantly less chipping over 1 year. Regarding MBL, BOP, and failure rates, both restoration types presented similar results at the 1-year follow-up.

Publication types

Review