Dental News - Metal ceramics remain gold standard, review study suggests

Dental Tribune International

Wed. 19. December 2018

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GENEVA, Switzerland: Despite the large selection of materials available on the implant market today, selecting the best possible restorative solution remains difficult for clinicians. Up until now, the most investigated restorative material in prosthodontic literature is metal ceramics. Clinicians, however, increasingly tend to use zirconia for the production of implant‐supported single crowns and fixed dental prostheses (FDPs). A review study, conducted by the University of Geneva, aimed to compare the long-term outcomes of zirconia ceramics and monolithic zirconia with metal ceramics before they could be considered a standard choice of dental care.

For the review study, a full‐text analysis was performed with 240 articles, resulting in 19 studies on implant FDPs that met the criteria. The criteria included, among others, a mean follow-up of at least three years and a clinical examination of patients at the follow‐up visit.

The studies reported on 932 metal‐ceramic and 175 zirconia‐ceramic FDPs. Meta‐analysis revealed an estimated 5‐year survival rate of 98.7 per cent for the metal‐ceramic, implant-supported FDPs, and 93 per cent for the zirconia‐ceramic, implant-supported FDPs. Thirteen studies, including 781 metal‐ceramic, implant‐supported FDPs estimated a 5‐year rate of ceramic fractures and chippings to be 11.6 per cent compared to a significantly higher complication rate for zirconia-ceramic implant‐supported FDPs of 50 per cent, was reported in a small study with 13 zirconia-ceramic implant‐supported FDPs. Significantly more of the zirconia‐ceramic implant‐supported FDPs—4.1 per cent—were lost due to ceramic fractures compared to only 0.2 per cent of the metal‐ceramic implant‐supported FDPs. A detailed analysis of factors, such as the number of units of the FDPs or the location in the jaws was not possible due to the heterogeneous nature of the reporting.

For implant‐supported FDPs, conventionally veneered zirconia should not be considered the material of choice, as the pronounced risk for framework fractures and chipping of the zirconia veneering ceramic was observed. No studies on monolithic zirconia implant‐supported FDPs met the criteria and were therefore not included in the present review. Therefore, it may be an interesting alternative, but its clinical medium‐ to long‐term outcomes have not been evaluated, yet. Hence, metal ceramics seem to remain the industry standard for implant‐supported, multiple‐unit FDPs.

The study, titled “A systematic review of the survival and complication rates of zirconia‐ceramic and metal‐ceramic multiple‐unit fixed dental prostheses”, was published in the October 2018 issue of Clinical Oral Implants Research.

The study was conducted in collaboration with the University of Bern and Peking University.

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