Clinical evaluation of zirconia-based all-ceramic single crowns: an up to 12-year retrospective cohort study

Clinical Outcome of Indirect Bonded Porcelain Restoration Versus Full-Coverage Crown on Endodontically Treated Teeth in Posterior Areas: A Systematic Review

The significant loss of tooth structure that occurs after dental caries and endodontic therapy is a common clinical challenge. Several methods were discussed in the literature to treat badly damaged teeth. This systematic review aims to compare the clinical outcomes of partial indirect bonded porcelain restorations to full-coverage crowns of endodontically treated teeth in posterior areas. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Data included in the review were identified through bibliographic research on electronic databases (PubMed/Medline, Google Scholar, Cochrane Library, and Web of Science). The strategy was applied by searching for randomized clinical trials (RCTs), cohort studies, and case-control studies using keywords (partial indirect bonded porcelain restoration, partial indirect bonded restoration, inlay and onlay, full convergent crown, and ceramic crown). As a result of a literature search through selected databases using the keywords, 88,421 papers were identified. A total of 671 articles were related and screened for inclusion and exclusion criteria. Four hundred and eighty-two articles that did not meet the inclusion criteria were excluded. A total of 189 full-text papers were assessed, and 20 articles were included in this study. Nineteen cohort studies and one case-control study were included and assessed in this review. This study concludes that both full-coverage crowns and partial indirect bonded restorations demonstrate comparable survival rates. However, limited studies exist regarding partial indirect bonded restorations on endodontically treated teeth, indicating the need for further updated studies.

Advances in zirconia-based dental materials: Properties, classification, applications, and future prospects

OBJECTIVES

Zirconia (ZrO2) ceramics are widely used in dental restorations due to their superior mechanical properties, durability, and ever-improving translucency. This review aims to explore the properties, classification, applications, and recent advancements of zirconia-based dental materials, highlighting their potential to revolutionize dental restoration techniques.

STUDY SELECTION, DATA AND SOURCES

The most recent literature available in scientific databases (PubMed and Web of Science) reporting advances of zirconia-based materials within the dental field is thoroughly examined and summarized, covering the major keywords "dental zirconia, classification, aesthetic, LTD, applications, manufacturing, surface treatments".

CONCLUSIONS

An exhaustive overview of the properties, classifications, and applications of dental zirconia was presented, alongside an exploration of future prospects and potential advances. This review highlighted the importance of addressing challenges such as low-temperature degradation resistance and optimizing the balance between mechanical strength and translucency. Also, innovative approaches to improve the performances of zirconia as dental material was discussed.

CLINICAL SIGNIFICANCE

This review provides a better understanding of zirconia-based dental biomaterials for dentists, helping them to make better choice when choosing a specific material to fabricate the restorations or to place the implant. Moreover, new generations of zirconia are still expected to make progress on key issues such as the long-term applications in dental materials while maintaining both damage resistance and aesthetic appeal, defining the directions for future research.

Effects of plasma surface treatment on the bond strength of zirconia with an adhesive resin luting agent

The purpose of this study was to evaluate the effect of the atmospheric pressure plasma treatment as a surface treatment method on the contact angle and shear bond strength (SBS) of zirconia ceramics and the failure mode between the self-adhesive resin luting agent and zirconia. The zirconia specimens were divided into eight groups based on the surface treatment method: alumina blasting, air plasma, argon plasma (AP), Katana cleaner, ozonated water, ozonated water+AP, Katana cleaner+AP, and tap water+AP. The contact angles, SBS, and fracture modes were tested. AP treatment significantly reduced the contact angle (p<0.0001). The combination of AP and other cleaning methods showed a higher bond strength and more mixed fractures. Our findings indicate that using atmospheric pressure plasma with argon gas, combined with other cleaning methods, results in a stronger bond than when using alumina blasting alone.

Zirconia CAD-CAM Crowns Behavior after Intraoral Digital Impression in Normal versus Dysfunctional Patients: 3 Years Retrospective Study

OBJECTIVES

 The aim of this study was to evaluate the clinical performance and possible complications of single zirconia crowns fabricated using an intraoral digital computer-aided design-computer-aided manufacturing (CAD-CAM) protocol in normal and dysfunctional patients after 3 years of follow-up.

MATERIALS AND METHODS

 Seventy patients were included in this study. The teeth were prepared with a knife-edge marginal design, and temporary crowns were placed. Digital impressions were taken using optical scanning, and the frameworks were milled using the same technology. The veneering process was performed by the same dental technician. The occlusal corrections were made before cementation. The outcomes were evaluated in terms of survival, failures, and complications. The marginal adaptation of the crowns was also assessed.

RESULTS

 The digital protocol for single zirconia crowns resulted in satisfactory outcomes, with high rates of survival and minimal complications after 3 years of follow-up. The marginal adaptation of the crowns was excellent, with 93% of the restorations achieving the ideal marginal adaptation, while 7% had minor deviations. Parafunctions were found in 41.9% of the prosthetic rehabilitation, but no significant differences were observed between the normal and dysfunctional groups regarding the survival and complications of the crowns.

CONCLUSION

 The digital protocol for single zirconia crowns is a reliable and predictable treatment option, even for patients with parafunction, when proper occlusal corrections are performed before cementation. The use of intraoral digital CAD-CAM technologies with optical impressions can simplify procedures, reduce the workflow time, and minimize the variables linked to the human factor.

The effect of restorative material selection and cementation procedures on the durability of endocrowns in the anterior teeth: an in-vitro study

OBJECTIVE

To investigate the fracture resistance and failure modalities of anterior endocrown restorations fabricated employing diverse ceramic materials, and bonded using various cementation methodologies.

MATERIALS AND METHODS

Forty maxillary central incisors were divided into two main groups based on the ceramic materials used; GroupI (Zir): zirconia endocrwons (Zolid HT+, Ceramill, Amanngirrbach) and GroupII (E-Max): e-max endocrowns (IPS e.max CAD, Ivoclar Vivadent). Both groups were further split into two subgroups depending on the cementation protocols; subgroup IA "ZirMDP": endocowns cemented with MDP primer + MDP resin cement, subgroup IB (ZirNon-MDP): cemented with MDP primer + non-MDP resin cement, subgroup IIA (E-maxMDP): cemented with MDP primer + MDP resin cement, subgroup IIB (E-maxNon-MDP): cemented with MDP primer + non-MDP resin cement. (n = 10/subgroup). Endocrowns were manufactured using CAD/ CAM. Teeth were subjected to 10,000 thermal cycles. The fracture test was performed at 45o with a palatal force direction until the fracture occurred. Test results were recorded in Newton. The failure mode was examined using a stereomicroscope. A One-way ANOVA test was utilized to compare different groups regarding fracture strength values. Tukey`s Post Hoc was utilized for multiple comparisons.

RESULTS

The comparative analysis of fracture strength across the diverse groups yielded non-significant differences, as indicated by a p-value exceeding 0.05. Nonetheless, an observable trend emerged regarding the mode of failure. Specifically, a statistically significant prevalence was noted in fractures localized within the endocrown/tooth complex below the cementoenamel junction (CEJ) across all groups, except for Group IIB, "E-max Non-MDP," where fractures within the endocrown/tooth complex occurred above the CEJ.

CONCLUSIONS

Combining an MDP-based primer with an MDP-based resin cement did not result in a significant effect on the anterior endocrown fracture strength.

CLINICAL RELEVANCE

Regardless of the presence of the MDP monomer in its composition, adhesive resin cement achieved highly successful fracture strength when used with MDP-based ceramic primers. Additionally, ceramic materials exhibiting elastic moduli surpassing those of dentin are discouraged due to their propensity to induce catastrophic fractures within the tooth structure.

Evaluation of periodontal parameters on abutment teeth rehabilitated with single-unit crowns: A 12-month follow-up

Purpose

This prospective study evaluated the effects of the metal-free crowns on the periodontal tissues of abutment teeth during a 12-month follow-up.

Materials and Methods

A sample of 24 patients (N = 32 abutment teeth) who needed a single-tooth restoration were enrolled to receive either a metal-ceramic (n = 21) or lithium disilicate (n = 11). The single-unit crowns were evaluated at baseline, 3-and 12-month follow-up. The periodontal parameters were evaluated: plaque index (PI), gingival bleeding index (GBI), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL), radiographically and clinical crown fitting, bone resorption, and marginal finish lines. Statistical analyses were performed using the Exact Fisher and Mann-Whitney tests, and the Wilcoxon signed-rank test as a post hoc test for Friedman (95 % confidence interval).

Results

The marginal finish line showed a statistical difference with a biomaterial type (p =.004). After a 12-months, a significant increase was observed in PI and mean PD for abutment teeth of metal-ceramic crowns. The metal-free crowns presented higher values for GBI and CAL (p2 < 0.05). Only distal cervical evaluation and dental biofilm formation in the abutment teeth showed a statistical difference between the groups at the 12-month follow-up. The supragingival margin metal-ceramic group revealed higher PI values (p2 = 0.005) between the period and the subgingival margin of both biomaterials showed greater GBI scores (p2 < 0.05).

Conclusions

Metal-free crowns showed better periodontal outcomes compared to metal-ceramic crowns. Single-unit crown marginal location affects the periodontal tissue condition of the abutment teeth. The marginal fit was not changed regarding the biomaterial type.

Effect of low-temperature degradation and sintering protocols on the color of monolithic zirconia crowns with different yttria contents

This study investigated the effects of low-temperature degradation (LTD) on the L*, a*, and b* values of highly translucent zirconia crowns. Four types of zirconia disks with different yttria contents (IPS e.max ZirCAD LT, IPS e.max ZirCAD MT, IPS e.max ZirCAD MT Multi, IPS e.max ZirCAD Prime, Ivoclar) and two shades (A2 and BL) were used. A crown was manufactured using four types of zirconia and LTD treated. Color measurements were performed, and the color difference (ΔE00) before and after LTD was calculated. The microstructure was determined through X-ray fluorescence and X-ray diffractometry. Highly translucent zirconia crowns showed greater changes in the a* and b* values than in the L* value after LTD, regardless of the shade. The Multi2 crowns exhibited a discernible color change due to the LTD treatment. The X-ray fluorescence results did not reveal any apparent change in the microstructure between sintering programs for all zirconia specimens.

Biomechanical behavior and Weibull survival of CAD-CAM endocrowns with different marginal designs: A 3D finite element analysis

OBJECTIVES

To evaluate and compare the effect of tooth preparation designs and different CADCAM. materials on stress distribution and Weibull survival probability of endocrowns. applied to root canal-treated lower first permanent molar using the 3D finite element. analysis method.

METHODS

A root canal-treated lower first permanent molar was prepared for endocrowns with a. butt joint or with a ferrule design by placing, circumferentially, a 1-mm wide shoulder. finish line. The prepared molar was scanned for the two designs and modeled on a 3D. Finite element model. Monolithic zirconia (IPS e.max ZirCAD MT, FCZ), lithium. disilicate (IPS e.max CAD, EX), and nano-ceramic resin composite (Lava Ultimate, LU). CAD-CAM materials were used for each preparation to design the virtual endocrown. A. total of six models were built according to the different tooth preparation designs and. endocrown materials. An occlusal load of 600 N and a transverse load of 20 N in. magnitude that simulates the average occlusal load was directed toward the occlusal. surfaces. von Mises and maximum principle values were evaluated Weibull risk-ofrupture. analysis was used to analyze the survival probability of the restorations and. tooth in the different models.

RESULTS

The highest von Mises were found in the butt joint design for FCZ, EX, and LU (45.3. MPa, 35.2 MPa, and 24.2 MPa, respectively) compared to the ferrule design for the. same materials (42.6 MPa, 31.2 MPa, and 23.6 MPa, respectively). For von Mises. stress distribution in the remaining part of tooth structure (dentin), the highest stresses. were found in LUFerrule which was closely similar to LUButt joint (135.4 MPa and. 134.7 MPa, respectively), followed by EXFerrule and FCZFerrule (132.2 MPa and. 131.7 MPa, respectively), while the lowest stresses were found in EXButt joint and. FCZButt joint (129.0 MPa and 128.4 MPa, respectively). Shear stresses within the. resin cement were the highest in FCZ and EX compared to LU. EX was found to be the. most reliable material with the highest survival probability, while FCZ showed the. lowest survival probability according to the Weibull risk-of-fracture results.

SIGNIFICANCE

Materials with high elastic modulus transfer more stresses to the endocrown and less. to the remaining tooth structure. Endocrown tooth preparation with ferrule design has. better stress distribution and magnitude compared to the butt joint design.

A Narrative Review on Polycrystalline Ceramics for Dental Applications and Proposed Update of a Classification System

Dental zirconias have been broadly utilized in dentistry due to their high mechanical properties and biocompatibility. Although initially introduced in dentistry as an infrastructure material, the high rate of technical complications related to veneered porcelain has led to significant efforts to improve the optical properties of dental zirconias, allowing for its monolithic indication. Modifications in the composition, processing methods/parameters, and the increase in the yttrium content and cubic phase have been presented as viable options to improve zirconias' translucency. However, concerns regarding the hydrothermal stability of partially stabilized zirconia and the trade-off observed between optical and mechanical properties resulting from the increased cubic content remain issues of concern. While the significant developments in polycrystalline ceramics have led to a wide diversity of zirconia materials with different compositions, properties, and clinical indications, the implementation of strong, esthetic, and sufficiently stable materials for long-span fixed dental prostheses has not been completely achieved. Alternatives, including advanced polycrystalline composites, functionally graded structures, and nanosized zirconia, have been proposed as promising pathways to obtain high-strength, hydrothermally stable biomaterials. Considering the evolution of zirconia ceramics in dentistry, this manuscript aims to present a critical perspective as well as an update to previous classifications of dental restorative ceramics, focusing on polycrystalline ceramics, their properties, indications, and performance.

Clinical evaluation of zirconia crowns cemented with two different resin cements: A retrospective study

BACKGROUND

Self-adhesive resin cement has been used extensively with zirconia crowns. Several in vitro studies showed that adhesive resin cementation may increase zirconia crowns' retention and their fatigue resistance.

OBJECTIVES

This retrospective study aimed to evaluate the clinical performance, survival and success rates and complications encountered with zirconia crowns cemented with two different self-adhesive resin cements.

METHODS

A total of 112 patients who received 176 monolithic zirconia crowns were evaluated. Crowns were cemented with RelyX Unicem 2 (n = 74) and Panavia SA (n = 102) self-adhesive resin cements. Clinical assessments of the crowns and supporting periodontal structures were performed following the modified California Dental Association (CDA) criteria. Intraoral photographs and periapical and bitewing radiographs were obtained for further assessment by two evaluators. Descriptive statistics, McNemar, t-test, log rank (Mantel-Cox) tests and Kaplan-Meier survival analyses were performed (a = .05).

RESULTS

The 5-year survival and success rates were 100% and 96.4%, respectively. The complications encountered were recurrent caries (2.2%) and the need for endodontic treatment (0.5%). No technical complications, such as fracture or loss of retention, were observed. The type of cement and patient-related factors did not influence the survival and success rates of the crowns.

CONCLUSIONS

Survival rate of zirconia crowns cemented with two different self-adhesive resin cements was 100% after 5 years.

The effect of low-temperature degradation and building directions on the mechanical properties of additive-manufactured zirconia

This study aimed to investigate the effect of low-temperature degradation (LTD) on the mechanical properties of additive-manufactured zirconia. In addition, the mechanical properties of additive-manufactured were compared with those before aging under similar experimental conditions. This study prepared stereolithography apparatus fabricated zirconia specimens with flexural strength, modulus of elasticity, Vickers hardness, and fracture toughness. The specimen position data were set as parallel (0°), diagonal (45°), and perpendicular (90°) to the direction of the building. The LTD condition was 5 h under 134ºC and 0.2 MPa in an autoclave. It was found that the 0° direction differed significantly from all other conditions before and after aging, and the highest flexural strength was obtained when the additive specimen was manufactured perpendicular to the building direction. However, the results indicate that there is a negligible effect of aging on the mechanical properties of additive-manufactured zirconia.

Mechanical and surface properties of additive manufactured zirconia under the different building directions

PURPOSE

This study investigates the mechanical and surface properties of zirconia manufactured using additive manufacturing (AM) technology and the effect of the building direction on the mechanical and surface properties.

METHODS

Specimens were prepared using ZrO₂ paste (3DMix ZrO₂; 3DCeram) and a three-dimensional printing system (CeraMaker 900; 3DCeram) based on the principles of stereolithography (SLA). The mechanical properties (flexural strength, Vickers hardness, fracture toughness, elastic modulus, and Poisson's ratio) and surface properties (chemical composition and surface observation) were evaluated for three building directions (parallel, diagonal, and perpendicular) to investigate the relationship between the building directions and the anisotropy of the mechanical and surface properties of SLA-manufactured zirconia. Statistical analysis was performed using a one-way analysis of variance and Tukey's honestly significant difference test.

RESULTS

The highest flexural strength was obtained for a perpendicular building direction. The flexural strength was significantly higher in the perpendicular direction than in the parallel and diagonal directions; it was also significantly higher in the diagonal direction than in the parallel direction (P<0.05). The Vickers hardness, fracture toughness, elastic modulus, Poisson's ratio, and chemical composition did not differ significantly. Microstructural observations revealed that the layers, large crystals, and pores were more prominent in the parallel direction.

CONCLUSIONS

The flexural strength and surface structure of the tested SLA-manufactured zirconia were influenced by the building direction; however, other mechanical properties remained unaffected. The layer boundaries affected the anisotropic behavior of the builds to a certain extent, owing to the layer-by-layer production method.

Clinical evaluation of cemented and adhesively resin-bonded monolithic and partially layered zirconia and lithium disilicate crowns

Purpose

Zirconia and lithium disilicate crowns are very popular dental restorations. The cement type and layering technique used can profoundly affect the clinical performance of these crowns.This retrospective study is designed to investigate the success rate of cemented and adhesively bonded monolithic and partially layered zirconia and lithium disilicate crowns placed in faculty practice settings.

Materials and Methods

Patients who had received zirconia or lithium disilicate crowns at the faculty practice were invited for clinical examination. The examiner used the modified United States Public Health Service (MUSPHS) evaluation criteria to evaluate the crowns. The crowns were either glass ionomer cemented zirconia (GIC-Zr), resin-bonded zirconia (Adh-Zr), or resin-bonded lithium disilicate (Adh-LD). The crowns were also divided into monolithic and layered groups. Inferential analysis was used to examine the differences through bivariate analysis using t-testing and one-way ANOVA.

Results

Thirty-five patients, with a combined total of 218 single crowns, agreed to participate in the study. No statistically significant differences in the quality outcome variables considered were found between the groups, except for marginal adaptation, where Adh-Zr achieved significantly higher scores compared to GIC-Zr and Adh-LD. Layered zirconia and lithium disilicate crowns have significantly higher quality outcomes in terms of anatomic form, marginal adaptation, and color match compared to monolithic zirconia and lithium disilicate crowns.

Conclusions

Conventionally cemented zirconia and adhesively bonded zirconia and lithium disilicate crowns are reliable treatment options with high short-term success rates. Clinical studies with longer follow-up times are needed to investigate their long-term success rates.

Survival analysis up to 7 years of 621 zirconia monolithic single crowns with feather-edge margins fabricated with a cast-free workflow starting from intraoral scans: A multicentric retrospective study

STATEMENT OF PROBLEM

Clinical studies on the fabrication of monolithic zirconia restorations with a feather-edge tooth preparation from digital scans and a cast-free fully digital workflow are lacking.

PURPOSE

The purpose of this retrospective multicentric study in private practices was to evaluate the outcomes of monolithic zirconia crowns fabricated with feather-edge margins and a cast-free approach.

MATERIAL AND METHODS

A total of 621 teeth were prepared with feather-edge margins and restored with monolithic zirconia crowns fabricated with a fully digital cast-free workflow. Data were analyzed by using the Kaplan-Meier test and descriptive statistics. The clinical evaluation adopted the California Dental Association-modified criteria after recalling all patients between April and July 2021.

RESULTS

The clinical survival of 619 of 621 crowns, including recemented crowns placed in 427 patients (217 men, 220 women) over 5 years (2014 to 2019 with crowns in service between 12 and 85 months), was analyzed. The 2 excluded crowns were delivered to patients who dropped out of the study. Of the 619 crowns, 5 failed during the follow-up period: 4 teeth were extracted because of fracture and 1 restoration fractured. No other technical or biological failures were observed. The mean overall survival time was 84.4 months (standard error, 0.255; 95% confidence interval for the mean, 83.92 to 84.92). The overall survival probability was 99.1% up to 85 months.

CONCLUSIONS

The clinical outcomes of the monolithic zirconia crowns with feather-edge margins evaluated were comparable with outcomes reported using other margin designs and materials.

Effect of speed sintering of monolithic zirconia with different yttria contents on color and crystal phase

This study evaluated the color and microstructure of monolithic zirconia crowns with different yttrium oxide (Y₂ O₃ ) contents treated by conventional or speed sintering. Four types of zirconia ceramics were assessed: two monolayer zirconia, and two multilayer zirconia. The monolithic zirconia crowns were fabricated using a dental computer-aided design/computer-aided manufacturing (CAD/CAM) system and in two shades (A2 and BL). After milling, the zirconia crowns were sintered using either speed sintering or conventional sintering. For each combination of zirconia (4), shade (2), and sintering condition (2), the color parameters were determined at three positions of each of nine crowns using a non-contact dental spectrophotometer. In addition, the zirconia phases in the specimens were quantified using X-ray diffractometry. Significant differences in the ΔE₀₀ values at different measurement positions were observed for the Multi2 crown of the BL shade group. The color difference resulting from conventional and speed sintering programs was not affected by the difference in yttria content of Mono1, Mono2, and Multi1. However, in Multi2, containing 3Y-TZP and 5Y-PSZ, a color change was caused by the use of speed sintering. Therefore, when performing speed sintering with Multi2, it is necessary to select the color in consideration of these results or take measures for staining.

Clinical outcomes of single crown and 3-unit bi-layered zirconia-based fixed dental prostheses: An upto 6- year retrospective clinical study: Clinical outcomes of zirconia FDPs

OBJECTIVES

The aim of this retrospective clinical study was to evaluate the survival and the occurrence of technical and biological complications in bi-layered zirconia-based (Zi) single crown and 3-unit fixed dental prostheses (FDPs). Also, the study aimed to analyze the effects of tooth vitality (vital versus non-vital), abutment location (anterior versus posterior), and luting cement (self-adhesive resin versus resin-reinforced glass ionomer) on clinical outcomes.

METHODS

A total of 147 prostheses (in 94 patients) placed by undergraduate dental students in a university dental center during the period 2015-2021 were examined clinically using modified United States Public Health Service (USPHS) and California Dental Association (CDA) criteria. The mean duration of follow-up was 37 months (range, 6 - 63 months) for the single crowns (n = 77) and 25 months (range, 6 - 68 months) for the 3-unit FDPs (n = 70). Data were descriptively analyzed to determine the types and rates of complications based on USPHS and CDA criteria. The Kaplan-Meier survival estimation method was used to determine the cumulative survival and success rates of the prostheses (α=0.05). Differences in clinical outcomes (survival or failure) according to tooth vitality, luting cement, and location were statistically analyzed using cross-tabulations and Х² test (α=0.05).

RESULTS

The Kaplan-Meier cumulative survival rate was estimated as 96% for the Zi 3-unit FDPs after 5.5 years, and 90% for the Zi single crowns after 4.8 years. The 5-year estimated success rate was 68% for both 3-unit FDPs and single crowns. Seven (9.1%) 77Zi single crowns and 70 2 (2.9%) Zi 3-unit FDPs were recorded as failures with occlusal roughness being the most commonly-observed complication (crowns: 4 [5.6%]; 3-unit FDPs: 8 [11.4%]). In terms of clinical outcomes, statistically significant differences were found between all included vital and non-vital teeth (p = .006), and cement types (p = .028). Taking single crowns alone, significant differences in clinical outcomes according to tooth vitality were noted (p = .036), but not for PFDPs. The location of the prostheses did not produce any significant differences in the clinical outcomes, for both prostheses types independently or combined (p > .05).

CONCLUSIONS

The estimated cumulative survival rates in this study for single crowns and 3-unit Zi FDPs concurred with the ranges reported in systematic reviews. Zi-based prostheses on vital teeth produced better clinical outcomes than those placed on non-vital teeth, and type of luting cement influenced the final clinical outcome.

CLINICAL SIGNIFICANCE

Zi crowns and 3-unit PFDPs fabricated using the specific CAD-CAM system used in the controlled environment of this study showed good clinical performance with minimal veneer porcelain chipping. Root canal treated teeth seem to be at higher risk for failure of Zi prostheses compared with vital teeth.

Onlays/partial crowns versus full crowns in restoring posterior teeth: a systematic review and meta-analysis

BACKGROUND

Tooth-colored onlays and partial crowns for posterior teeth have been used increasingly in clinics. However, whether onlays/partial crowns could perform as well as full crowns in the posterior region was still not evaluated thoroughly.

METHODS

A literature search was conducted without language restrictions in Pubmed, Embase, Cochrane Central Register of Controlled Trial and Web of science until September 2021. RCTs, prospective and retrospective observational studies with a mean follow-up of 1 year were selected. Cochrane Collaboration's tool was adopted for quality assessment of the RCT. The quality of observational studies was evaluated following Newcastle-Ottawa scale. The random-effects and fixed-effects model were employed for meta-analysis.

RESULTS

Four thousand two hundred fifty-seven articles were initially searched. Finally, one RCT was identified for quality assessment and five observational studies for qualitative synthesis and meta-analysis. The RCT was of unclear risk of bias while five observational studies were evaluated as low risk. The meta-analysis indicated no statistically significant difference in the survival between onlays/partial crowns and full crowns after 1 year (OR = 0.55, 95% CI: 0.02-18.08; I² = 57.0%; P = 0.127) and 3 years (OR = 0.65, 95% CI: 0.20-2.17; I² = 0.0%; P = 0.747). For the success, onlays/partial crowns performed as well as crowns (OR = 0.58, 95% CI: 0.20-1.72; I² = 0.0%; P = 0.881) at 3 years. No significant difference of crown fracture existed between the two methods (RD = 0.00, 95% CI: - 0.03-0.03; I² = 0.0%; P = 0.972).

CONCLUSIONS

Tooth-colored onlays/partial crowns performed as excellently as full crowns in posterior region in a short-term period. The conclusions should be further consolidated by RCTs with long-term follow-up.

Potential complications of CAD/CAM-produced resin composite crowns on molars: A retrospective cohort study over four years

Purpose

Evaluation of the clinical performance of computer-aided design/computer-aided manufacturing-produced resin composite crowns (CAD/CAM composite crowns) on molars with a particular focus on placement location.

Methods

A retrospective cohort study was performed based on the clinical records of patients with CAD/CAM composite crowns on molars (June 2016 to March 2021). The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated based the Cox proportional hazard model to evaluate the effect of tooth location on complication type and occurrence. Covariates included crown location (maxilla/mandible, distalmost tooth/not distalmost tooth, and first molar/second or third molar) and endodontically treated (nonvital) or untreated (vital) tooth.

Results

Overall, 362 crowns were evaluated (mean follow-up: 378 days, median: 286 days), and 106 crowns (29.3%) showed complications, most frequently crown debonding. The cumulative success and survival rates were 70.9% and 93.7%, respectively, after 1 year and 49.5% and 86.5%, respectively, after 3 years. There was no significant difference in the HRs and log-rank tests in the Kaplan–Meier curves based on crown location parameters (P > 0.05). However, placement on vital teeth was associated with higher risks than on nonvital teeth (HR, 1.55; 95% CI, 1.03–2.23). In addition, the cement as a covariate yielded a high HR.

Conclusions

The location of CAD/CAM composite molar crowns is unlikely a risk factor for complications; therefore, these crowns can be clinically applied to all molars. However, the application of such molar crowns to vital teeth and the use of a cement other than adhesive resin cement present risks.

Prospective Clinical Evaluation of Posterior Third-Generation Monolithic Zirconia Crowns Fabricated with Complete Digital Workflow: Two-Year Follow-Up

Clinical studies on the behavior of posterior translucent monolithic zirconia restorations are lacking. We assessed the clinical outcome and survival rate of posterior third-generation monolithic zirconia crowns over a 2-year period. A total of 24 patients, requiring 30 posterior full-contour restorations were selected. All abutments were scanned, and crowns were milled and cemented with a self-adhesive dual cure cement. Crowns were assessed using the California Dental Association’s criteria. Gingival status was assessed by evaluating the gingival index, plaque index, periodontal probing depth of the abutments and control teeth, and the margin index of the abutment teeth. Statistical analyses were performed using the Friedman and the Wilcoxon signed-rank tests. During the 2-year follow-up, no biological or mechanical complications were observed, and the survival and success rate was 100%. All restorations ranked as satisfactory throughout the follow-up period. The gingival index and plaque index were worse at the end of the 2-year follow-up. The margin index was stable during the 2 years of clinical service. No significant differences were recorded in periodontal parameters between crowns and control teeth. Third-generation monolithic zirconia could be a reliable alternative to posterior metal–ceramic and second-generation monolithic zirconia posterior crowns.

CAD-FEA modeling and fracture resistance of bilayer zirconia crowns manufactured by the rapid layer technology

In the RLT (Rapid Layer Technology), veneering ceramic and framework are fabricated by computer-aided design/computer-aided manufacturing (CAD/CAM) and then cemented to obtain the restoration. This study aimed to evaluate the effect of the thickness of veneering ceramic manufactured by the RLT technique on the fracture resistance (FR) of bilayer crowns with zirconia frameworks. Twenty zirconia frameworks and twenty feldspathic posterior crowns with two different veneering ceramic occlusal thicknesses (1mm=TF1; 2mm=TF2) were manufactured using CAD/CAM system. The specimens were luted to an epoxy resin abutment with resin cement and mechanically cycled (200N and 4.5×105 Pa, 37°C, 2×106 cycles, 3Hz). The FR test was performed (10kN, 0.5mm/min), and the specimens were analyzed in a stereomicroscope. For the stress analysis (finite element analysis, FEA), a 10kN load was equal to the in vitro test, and the principal stress was evaluated. The FR data were analyzed by Student's t-test and Weibull's analysis. The thickness influenced the FR of bilayer crowns. The FR was higher in the TF2 than in the TF1 group. The TF2 group presented the highest characteristic strength compared to the group TF1. The predominant type of failure was delamination. The FEA showed higher stress concentrations below the loading application point at the veneering cement interface in the 1-mm-thick model. The bilayer crowns manufactured using the approach of 2mm of veneering ceramic promoted higher FR compared to the group with 1mm veneering ceramic. Also, the FEA showed that the veneer ceramic thickness has an effect on stress distribution in zirconia-based bilayer crowns.

Ten-year clinical performance of zirconia posterior fixed partial dentures

BACKGROUND

With the constantly increasing demand for metal-free solutions in dental therapy, numerous ceramic restorations have found their way into everyday clinical practice, but long-term clinical data are limited.

OBJECTIVE

The aim of this prospective clinical study was to evaluate three- and four-unit fixed partial dentures in the posterior region made of zirconium dioxide frameworks veneered with feldspathic porcelain after 10 years in clinical use.

METHODS

Based on the two studies published in 2009 and 2012, in which the all-ceramic FDPs were evaluated after 3 and 5 years of function, a clinical evaluation of a total of 17 restorations after 10 years with regard to their condition and long-term stability was carried out in the course of this study. The restorations were fabricated using feldspathic ceramic-veneered, yttria-stabilised, tetragonal zirconium dioxide as the framework material. The data collection was based on modified CDA criteria and included, for example, the shape, shade, surface condition and the success and survival rates of the restorations.

RESULTS

The all-ceramic prostheses embodied excellent biocompatibility and colour reproduction. As a result of an increased incidence of chipping fractures, the success rate was 60%. The survival rate, however, was 88.2%, as 2 of the 17 restorations were lost.

CONCLUSION

All-ceramic concepts for FDP constructions in the posterior region achieved satisfactory results in terms of durability after 10 years. The main problem was chipping, as has been generally recognised. Nevertheless, the materials were characterised by excellent aesthetics and biocompatibility, which ultimately makes them a good alternative to conventional restorative options.

TRIAL REGISTRATION

This study is registered in DRKS-German Clinical Trials Register with the register number DRKS00021743.

Five-year clinical performance of monolithic and partially veneered zirconia single crowns-a prospective observational study

PURPOSE

The purpose of this study was to prospectively evaluate the medium-term clinical performance and esthetics of monolithic and partially (i.e., facially) veneered zirconia single crowns (MZ-SC and PZ-SC, respectively).

METHODS

Between September 2011 and June 2013, 68 participants received 90 MZ-SC and 72 PZ-SC. Clinical study documentation was performed at crown cementation (baseline), at 6-month follow-up, and then yearly thereafter using standardized report forms. Three participants with four MZ-SC dropped out during clinical follow-up. Thus, 65 participants (n = 31, 47.7% men) fitted with 158 restorations (86 MZ-SC, 72 PZ-SC) were evaluated. The mean observation period of the restorations was 5.8 ±2.5 years; 6.3 ±2.2 for MZ-SC and 5.2 ±2.6 for PZ-SC.

RESULTS

The 5-year rate of complication-free survival (success) was 87.0% for MZ-SC and 95.8% for PZ-SC (log-rank test, p = 0.026). The 5-year failure-free survival rate was 93.1% for MZ-SC and 96.2% for PZ-SC (log-rank test, p = 0.111), and the 5-year ceramic fracture-free survival rate was 100% for MZ-SC and 98.6% for PZ-SC (log-rank test, p = 0.274). Crowns of both designs were awarded excellent scores for esthetics by participants and dentists.

CONCLUSIONS

Monolithic and partially veneered zirconia crowns can be used clinically with high medium-term survival and success and uncompromised esthetic results.

Effects of abutment tooth and luting agent colors on final color of high-translucent zirconia crowns

PURPOSE

This study aimed to evaluate the effects of the tooth portion evaluated and the colors of the abutment tooth and resin luting agent on the final color of monolithic zirconia crowns.

METHODS

Monolithic zirconia crowns were fabricated for left maxillary central incisors using two shades (A2 and A3) of highly translucent monolithic zirconia disks. A model of the abutment tooth was fabricated using resin core materials (white: W; dentin: D). The color of the crowns was measured with try-in pastes (clear: C; brown: B) as a resin-luting agent substitute. The measurement was performed after placing the crown on the model with the attached abutment tooth with try-in paste. The color of three labial portions (cervical, body, and incisal) was evaluated using a dental spectrophotometer. The color difference (ΔE) between the CIELab values of the zirconia disks and the final me asurement of zirconia crowns was calculated.

RESULTS

The ΔE between the crown of the A2 shade and the zirconia disk of the A2 shade had the highest ΔE value in the body portion with W-B (ΔE=3.92). Similarly, the A3 shade had the highest ΔE value in the cervical portion, with W-B (ΔE=4.27). The results of three-way ANOVA showed that the ΔE values were influenced by the tooth portion evaluated and the color of the abutment tooth.

CONCLUSIONS

The final color of the monolithic zirconia crowns was significantly in fluenced by the tooth portion evaluated and the color of the abutment tooth.

Glass Ionomer Versus Self-adhesive Cement and the Clinical Performance of Zirconia Coping/Press-on Porcelain Crowns

OBJECTIVE

This split-mouth clinical study investigated the effect of luting cement on the performance of veneered yttrium-stabilized tetragonal zirconia polycrystal (Y-TZP) zirconia crowns.

METHODS AND MATERIALS

A total of 60 crowns prepared with Y-TZP coping and press-on porcelain were made with a split-mouth design in 30 participants. The crowns were cemented either with glass ionomer cement (GIC) (Meron, Voco) or with self-adhesive resin cement (Bifix-SE, Voco). The restorations were assessed immediately after treatment and after 6, 12, 24, 36, and 48 months using the modified United States Public Health Service criteria. The parameters analyzed were retention, color stability, marginal discoloration, marginal adaptation, surface roughness, anatomic form, and secondary caries. The differences between the groups were analyzed by the Fisher exact test in each period of evaluation. The survival rate was analyzed with the Kaplan-Meier and log-rank test (α=0.05).

RESULTS

After 48 months, 20 participants attended the recall. During the period of evaluation, 1 crown cemented with glass ionomer cement and 1 crown cemented with resin cement lost retention. Color match, marginal discoloration and adaptation, surface roughness, and anatomic form did not change in any of the periods evaluated, and no secondary caries was observed. No significant differences were found between the 2 luting cements for any of the clinical parameters analyzed, nor for the survival rates during the study.

CONCLUSIONS

The type of cement did not influence the performance of the crowns after 48 months of clinical use. Both cements resulted in adequate retention rates, aesthetic and functional outcomes, and biological response.

Survey of clinically used adhesive ceramic bonding methods - follow up after 12 years

OBJECTIVES

This survey evaluated dentists' use of adhesive bonding methods of all-ceramic restorations over a period of twelve years. This is a follow-up survey which had been undertaken in 2007, 2011, and in 2015 [1].

METHODS

A multiple choice questionnaire regarding adhesive bonding methods for all-ceramic restoration was developed and handed out in 2007 and 2019 to dentist participating in a local annual dental meeting in Northern Germany. The questionnaires were evaluated on the basis of evidence-based techniques from the scientific literature.

RESULTS

Data from 93 questionnaires (2019) were compared with 90 evaluated questionnaires from 2007. Bonding of oxide ceramic had improved over the years of observation (7% to 62%) whereas evidence-based bonding of silicate ceramic restorations decreased from 66% to 38%; common mistakes were using air abrasion on silicate surface. Females showed better values for correct adhesive cementation than males (f: 39-50%, m: 22%-41%). A correlation between correct cementation and years of professional experience could not be revealed.

CONCLUSION

Incorrect bonding of oxide ceramic restorations decreased within the 12 years investigated whereas there was no improvement of evidence-based bonding procedures of silicate ceramics. Still a high number of survey participants need additional training in bonding techniques.

Influence of Margin Designs on Crack Initiation of High Translucency Monolithic Zirconia Crowns

PURPOSE

Zirconia crowns often crack at the margin. This study determined the loads and the times at which cracks are initiated in high-translucency monolithic zirconia crowns with different margin designs.

MATERIALS AND METHODS

A total of 90 crowns were fabricated from Zirconia blanks. The fabricated crowns had different margin thicknesses (light-chamfer, C_L and heavy-chamfer, C_H ) and collar heights (no-collar, N_C ; low-collar, L_C ; high-collar, H_C ). They were grouped as C_L N_C , C_L L_C , C_L H_C , C_H N_C , C_H L_C , and C_H H_C (15 crowns/group). The crowns were seated on a metal model and loaded vertically through round end punch (Φ = 10 mm) at 0.2 mm/min crosshead speed until cracks began to be seen. Videos of the crack initiation were recorded at the rate of 50 frames/second. Load-initiated cracks and durability time were compared for significant differences using analysis of variance.

RESULTS

The mean ± standard deviation values of load (N) and time (s) taken to initiate cracks were 3190 ±775, 212 ±47 for C_L N_C ; 2754 ±1109, 180 ±42 for C_L L_C ; 2887±832, 191±27 for C_L H_C ; 4082 ±896, 241 ±36 for C_H N_C ; 4180 ±1029, 220 ±28 for C_H L_C ; 4119 ±1124, 222 ±39 for C_H H_C . This indicates that the thickness of the margin has a significant influence on load-withstanding crack initiation capacity and durability time (p < 0.05). No significant impact of collar height was observed on either load-withstanding capacity or durability time (p > 0.05). No interaction was observed among these factors.

CONCLUSION

Heavy chamfer margin provided a stronger zirconia crown than the light chamfer margin, but both of them were capable of withstanding crack-initiated load higher than the theoretical maximum masticatory force. The presence or absence of a collar did not have any impact on the crack initiation. Fabrication of zirconia crowns with either a heavy or light chamfer margin and with or without the presence of a collar should be generated by considering the relevant emergence profile.

Clinical evaluation of monolithic zirconia crowns: a failure analysis of clinically obtained cases from a 3.5-year study

PURPOSE

The primary purpose of this study was to examine the clinical performance of monolithic zirconia single crowns in terms of short-term failure or complications. The secondary purpose was to detect the originating flaws of clinically failed monolithic zirconia crowns to find the causes of failure.

METHODS

A short-term prospective cohort study based on record evaluation and clinical examination of patients treated with tooth-supported monolithic zirconia crowns was performed in the Department of Fixed Prosthodontics, Tohoku University Hospital, Japan. The crowns were prepared during the follow-up period from April 2014 to July 2018. The 3.5-year cumulative success and survival rates were set as primary endpoints. Fractures of the crown or fragments were inspected under a scanning electron microscope for descriptive fractography.

RESULTS

During the study period, 40 monolithic zirconia crowns were placed. Four crowns experienced clinical complications, including: 1) fracture of the crown (two crowns), 2) abrasion of the crown (one crown), and 3) fracture of the antagonist tooth (one crown). The estimated Kaplan-Meier 3.5-year success and survival rates were 90.5% (95% confi dence interval [CI]: 73.1-97.1) and 92.8% (95% CI: 74.1-98.3), respectively. Fractography revealed that all fractures were initiated from the wear phase on the occlusal surface.

CONCLUSIONS

The results of this study suggest that the molar application of monolithic zirconia crowns requires detailed attention to interocclusal clearance and the restoration of the antagonist tooth.

Effect of Repairing Endodontic Access Cavities on Survival of Single Crowns and Retainer Restorations

INTRODUCTION

This retrospective study aimed to analyze the effect of repairing endodontic access cavities with composite on the survival of single crowns and retainer restorations of fixed or removable dental prostheses.

METHODS

Dental records of patients attending a university dental clinic were retrospectively screened for single crowns and retainer restorations receiving endodontic treatment after crown placement. Survival (no further intervention) and failure (removal, loss or replacement of crown, replacement of access restoration, or recementation of restoration) of crowns and retainers with repaired endodontic access cavities were recorded. The mean annual failure rates were calculated, and the effect of individual-, tooth-, and restoration-related variables on survival was assessed by univariate log-rank tests and multivariate Cox regression analyses with shared frailty (P < .05).

RESULTS

One hundred eighty repaired crowns/retainers placed in 151 patients were included (4.5 ± 3.3 years follow-up). Survival after 2, 5, 7, and 10 years amounted to 82.7%, 71.5%, 67.3%, and 48.8% (mean annual failure rate = 9.0%, 6.5%, 5.5%, and 6.9%), respectively. Although tooth type, kind of restoration, endodontic irrigant, repair conditioning methods, and kind of composite affected survival in the univariate regression analyses, only the kind of restoration (single crown vs retainer restoration) remained significant in the multivariate Cox regression model.

CONCLUSIONS

Repairing endodontic access cavities with composite increases the longevity of single crowns and retainer restorations.

Clinical evaluation of monolithic zirconia crowns for posterior teeth restorations

Although all-ceramic crowns have excellent biocompatibility and esthetic appearance, chipping may occur. The mechanical properties of monolithic zirconia restorative material are superior to those of all-ceramic restorative materials, and chipping caused by chewing hard foods could be avoided. This study aimed to evaluate the clinical efficacy of monolithic zirconia crowns for posterior teeth restorations.A total of 46 patients requiring posterior teeth restorations involving 49 teeth were treated with monolithic zirconia crown procedure. The treatment results were evaluated according to the modified California Dental Association criteria immediately after the procedure, and at 2, 24, 48, and 96 weeks after the procedure. The plaque index, gingival index, probing depth, crown marginal integrity, and attrition of the abutment teeth, antagonist teeth, corresponding contralateral teeth, and antagonist of the corresponding contralateral teeth were assessed. The patients were followed for up to 96 weeks.The marginal adaptation results of all 46 patients were evaluated as excellent, resulting in an excellent rate of 100%. Regarding the crown color match, only 3 cases (6.1%) were evaluated as acceptable. Marginal adaptation, anatomic form, crown margin integrity, color match, and gross fracture did not show significant differences compared with the different time points (P = .999). Surface texture at different time did not change significantly (P = .807). During the 96-week follow-up, 1 crack in the antagonist teeth was found in 1 patient. There were no significant differences in wear of the antagonist teeth at different time points (P = .972). The rate of "excellent" evaluation for crown restorations was 93.9% to 100%.The monolithic zirconia crown had no detectable adverse effects on the periodontal tissues, and the antagonist teeth attrition was small. Therefore, it has good potential in the clinical application of posterior teeth restorations in the short term.

IPS e.max for All-Ceramic Restorations: Clinical Survival and Success Rates of Full-Coverage Crowns and Fixed Partial Dentures

The IPS e.max system by Ivoclar Vivadent, offering a variety of products and indications, is widely used for all-ceramic restorations. We analyzed the clinical track record of these products in daily clinical practice, associating their restorative survival rate with various parameters to define recommendations for long-term stability. A total of 1058 full-coverage crowns and fixed partial dentures (FPDs) were evaluated retrospectively over up to 66.48 (37.05 ± 18.4) months. All were made of IPS e.max Press, IPS e.max CAD, IPS e.max Ceram or IPS e.max ZirPress and had been delivered by a private dental practice within three years. Uses not recommended by the manufacturer were also deliberately included. The five-year cumulative survival was 94.22% (i.e., 94.69% or 90.58% for glass-ceramic crowns or FDPs and 100% or 90.06% for zirconia-based crowns or FDPs). Significantly superior outcomes emerged for conventional vs. adhesive cementation and for vital vs. non-vital abutment teeth, but not for recommended vs. non-recommended uses. Caution is required in restoring non-vital teeth, but the spectrum of recommended uses should generally be reconsidered and expanded, given our finding of high survival and success rates for IPS e.max ceramics, even for uses not currently recommended by the manufacturer.

A possible risk of CAD/CAM-produced composite resin premolar crowns on a removable partial denture abutment tooth: a 3-year retrospective cohort study

PURPOSE

To evaluate the early performance of computer-aided design/computer-aided manufacturing (CAD/CAM)-produced composite resin crown (CAD/CAM composite crown) treatment on premolars, specifically, placement on a removable partial denture (RPD) abutment tooth, and the distalmost tooth in the dental arch, as possible clinical risk factors.

METHODS

A retrospective cohort study (April 2014 to July 2017) was performed utilizing the clinical records of patients who received a premolar CAD/CAM composite crown treatment. The variables of time of treatment for (1) successful crowns (complication event-free) and (2) surviving crowns (clinically functional including re-luted) were estimated using Kaplan-Meier analysis. Survival distributions regarding "RPD abutment tooth" and "distalmost tooth" were analyzed with the log-rank test. Multilevel survival analyses were used to identify hazard ratios and associated risk factors.

RESULTS

Five hundred and forty-seven crowns were evaluated (mean follow-up time 1.3±0.9years) in 327 patients. A total of 87 crowns had at least one complication, with loss of crown retention being the most common (70 crowns). Estimated success and survival rates at 3 years were 71.7% and 96.4%, respectively. The risk of complications was significantly higher for an RPD abutment tooth than for a non-RPD abutment tooth. There was no significant difference between the distalmost tooth and non-distalmost tooth in the dental arch.

CONCLUSIONS

The demonstrated complication rate for CAD/CAM composite crowns placed on premolars was 15.9% over a period of up to 3 years. There was a substantial risk of complications with placement of such a crown on an RPD abutment tooth.

A thick frame decreases the fracture toughness of veneering ceramics used for zirconia-based all-ceramic restorations

PURPOSE

To investigate the influence of firing condition and thickness of a yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) frame on the fracture toughness of veneering ceramics.

METHODS

Layering and pressable ceramics without frames or on 0.8- and 1.2-mm-thick Y-TZP frames were fired with 5 schedules (normal and 4 customized conditions). The fracture toughness of the ceramics was measured at 0.5-2.5mm from the frame by the indentation fracture method. Crystal structures at the measurement points were evaluated by X-ray diffraction (XRD) and scanning electron microscopy (SEM).

RESULTS

Under customized firing conditions, the fracture toughness of the layering ceramic significantly decreased, particularly near the frame. Use of a 1.2-mm-thick frame significantly decreased the fracture toughness of both layering and pressable ceramics compared to ceramics without the frame. The decreased fracture toughness only occurred close (0.5 and 1.0mm) to the frame. XRD analysis showed identical diffraction patterns between points near and far from the frame, suggesting that the decreased fracture toughness was not due to crystal defects or impurities. SEM revealed many microcracks and large crystals in layering ceramic near the 1.2-mm-thick frame, possibly resulting from the thermal properties of the zirconia frame, such as large heat capacity and low thermal conductivity.

CONCLUSIONS

Modification of the firing conditions from the manufacturer's instructions and inclusion of a thick Y-TZP frame decreased the fracture toughness of veneering ceramics at the interface, suggesting that a thick frame would pose a potent fracture risk in veneering ceramics used for zirconia-based all-ceramic restorations.