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Purpose:
The purpose of this randomized controlled clinical trial was to investigate the prosthetic outcomes of posterior implant-supported single crowns (SCs) with a modified monolithic zirconia or metal-ceramic design at 1 year of loading.
Materials and methods:
Forty participants with 73 dental implants in need of at least 1 maxillary or mand...
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Context 1
... prosthodontic procedures were as follows. After con- firmation of successful osseointegration, implant level impres- sions were made with poly(vinyl siloxane) (Aquasil Ultra XLV and Aquasil Soft Putty; Dentsply Caulk Milford, DE) with a closed-tray technique for the fabrication of posterior implant- supported SCs. 32 Prefabricated titanium abutments (synOcta Cementable Abutment; Straumann) were used in instances of cement-retained modified monolithic zirconia or metal-ceramic SCs, and customized implant abutments (synOcta Gold Abut- ment; Straumann) were used for the fabrication of screw- retained metal-ceramic SCs. Titanium inserts (Variobase Abut- ment; Straumann) were used as the metal substructures of the screw-retained modified monolithic zirconia SCs. All labora- tory procedures were conducted at a dental laboratory autho- rized by the manufacturers of the material systems. In the MMZ group, fully contoured wax patterns were made first, and cut- backs were performed on the buccal surfaces. The porcelain- zirconia interfaces were designed at the coronal third of the buccal surfaces. The working casts with implant abutments and the cutback wax patterns were scanned in an optical scanner (Ceramill Mind; Amann Girrbach, Charlotte, NC), milled from partially sintered zirconia blocks (Ceramil zi or Ceramill Zolid; Amann Girrbach), and sintered (Ceramill Therm; Amann Gir- rbach) to make the zirconia copings. Then, veneering ceramic was applied on the buccal surfaces of the zirconia copings to make the modified monolithic zirconia SCs (Fig 1). Regarding the screw-retained SCs with modified monolithic zirconia de- sign, the milled zirconia copings were bonded to the titanium inserts with resin cement (RelyX Unicem; 3M ESPE, St Paul, MN) to make 1-piece screw-retained SCs. 29,30,33 In the MC group, the cutback wax patterns were made from fully con- toured ones. The porcelain-metal interfaces were designed at the middle third of the lingual surfaces. Thereafter, traditional lost-wax technique was used to fabricate the metal framework (Argedent 500; Argen), and veneering ceramic was layered on with conventional veneering technique (Fig 2). The screw- retained SCs were inserted intraorally, and the screw-access holes were restored with gutta percha (Temporary stopping; GC, Alsip, IL) and light-polymerized composite resin (Filtek Z250; 3M ESPE). The cement-retained SCs were cemented with a resin-based cement (Premier Implant Cement; Premier Dental, Plymouth Meeting, PA). The screw-retained SCs and the titanium abutments used for cement-retained SCs were all inserted with 35 Ncm ...
Context 2
... prosthodontic procedures were as follows. After con- firmation of successful osseointegration, implant level impres- sions were made with poly(vinyl siloxane) (Aquasil Ultra XLV and Aquasil Soft Putty; Dentsply Caulk Milford, DE) with a closed-tray technique for the fabrication of posterior implant- supported SCs. 32 Prefabricated titanium abutments (synOcta Cementable Abutment; Straumann) were used in instances of cement-retained modified monolithic zirconia or metal-ceramic SCs, and customized implant abutments (synOcta Gold Abut- ment; Straumann) were used for the fabrication of screw- retained metal-ceramic SCs. Titanium inserts (Variobase Abut- ment; Straumann) were used as the metal substructures of the screw-retained modified monolithic zirconia SCs. All labora- tory procedures were conducted at a dental laboratory autho- rized by the manufacturers of the material systems. In the MMZ group, fully contoured wax patterns were made first, and cut- backs were performed on the buccal surfaces. The porcelain- zirconia interfaces were designed at the coronal third of the buccal surfaces. The working casts with implant abutments and the cutback wax patterns were scanned in an optical scanner (Ceramill Mind; Amann Girrbach, Charlotte, NC), milled from partially sintered zirconia blocks (Ceramil zi or Ceramill Zolid; Amann Girrbach), and sintered (Ceramill Therm; Amann Gir- rbach) to make the zirconia copings. Then, veneering ceramic was applied on the buccal surfaces of the zirconia copings to make the modified monolithic zirconia SCs (Fig 1). Regarding the screw-retained SCs with modified monolithic zirconia de- sign, the milled zirconia copings were bonded to the titanium inserts with resin cement (RelyX Unicem; 3M ESPE, St Paul, MN) to make 1-piece screw-retained SCs. 29,30,33 In the MC group, the cutback wax patterns were made from fully con- toured ones. The porcelain-metal interfaces were designed at the middle third of the lingual surfaces. Thereafter, traditional lost-wax technique was used to fabricate the metal framework (Argedent 500; Argen), and veneering ceramic was layered on with conventional veneering technique (Fig 2). The screw- retained SCs were inserted intraorally, and the screw-access holes were restored with gutta percha (Temporary stopping; GC, Alsip, IL) and light-polymerized composite resin (Filtek Z250; 3M ESPE). The cement-retained SCs were cemented with a resin-based cement (Premier Implant Cement; Premier Dental, Plymouth Meeting, PA). The screw-retained SCs and the titanium abutments used for cement-retained SCs were all inserted with 35 Ncm ...
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<
6
weeks).
Citations
... During chewing, prosthetic components are constantly exposed to a combination of horizontal, vertical, and oblique loads [26]. In this study, those in vitro studies were included in which both vertical and oblique forces were [27]. Another study evaluating the long-term success of restorations concluded that Cr-Co alloy-supported MC crowns while MZ restorations showed decreased chipping [28]. ...
Despite the success of monolithic zirconia restorations (MZ), metal-ceramic restorations (MC) are still considered the gold standard for fixed prosthetics in the posterior region. This systematic review and meta-analysis aimed to compare the fracture strengths of single-unit MC and MZ in the molar region. This review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA, 2020) statement. All articles were searched from the PubMed and Web of Science databases until November 18, 2022. All in vitro studies evaluating the fracture strengths of MC and MZ were also included. Statistical analysis was performed with the Comprehensive Meta-Analysis program, with a significance level of 0.05. Out of 753 studies, five were selected. The fracture strengths of MZ and MC did not show any statistically significant difference for both tooth (95% CI − 1.589: 2.118, p = 0.779, z = 0.280) and implant (95% CI − 2.215: 2.191, p = 0.992 z = − 0.010) supported restorations. However, different abutment materials (p < 0.001) and aging treatments (p < 0.001) in tooth-supported restorations displayed a significant statistical difference. Additionally, a significant difference was also observed in subgroup analysis considering different cements (p = 0.001) and load speeds (p = 0.001) in implant-supported restorations. Fracture strengths of MZ and MC did not show a significant statistical difference in implant or tooth-supported single-unit posterior restorations. MZ may be a suitable alternative to MC in single-unit posterior restorations. The results should be interpreted with caution, as the included studies were in vitro.
... Extended periods of use may render 3Y-TZP double-layered restorations susceptible to technical complications, prominently including porcelain chipping (Pieralli et al., 2018;Sailer et al., 2018). Although other factors need to be taken into account, eliminating the use of ceramic veneers and opting for the creation of a monolithic restoration is considered the most dependable approach to prolonging the lifespan of zirconia dental restorations (Mühlemann et al., 2020;Cheng et al., 2019;Bergamo et al., 2016). ...
... 9,28 Monolithicddefined as not veneered or minimally veneereddrestorations were introduced to address the technical complications of veneered reconstructions. 14,[29][30][31] They enable faster production through a computeraided design and computer-aided manufacturing (CAD-CAM) workflow, resulting in favorable marginal fit and more efficient restorations. 3,9,14,21,27,[32][33][34][35] Furthermore, they have excellent biocompatibility and may perform better in terms of mechanical strength because of increased thickness. ...
... Of the included studies, 1 study was designed as a split-mouth trial, 43 and the other 3 as parallel-group trials. 30,34,58 All 4 studies investigated the outcomes over a 1-year follow-up period. Three studies reported on monolithic zirconia, 34,43,58 and 1 study reported on minimally veneered zirconia. ...
... Three studies reported on monolithic zirconia, 34,43,58 and 1 study reported on minimally veneered zirconia. 30 At the end of the 1-year follow-up period, 50.0% (n=120) of the single crowns were screw-retained and 50.0% ...
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 e0.11, 95% CI: [e0.25; 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.
... Study characteristics, participant characteristics, and study interventions are presented in Tables 1 and 2. Of the 22 included studies, three studies reported on the 1-, 3-, and 5-year outcomes of the same prospective cohort and were grouped as one [30][31][32]. Among the 20 studies, 12 were RCTs [33][34][35][36][37][38][39][40][41][42][43][44], one was a retrospective cohort study [45], one prospective controlled study [46], two retrospective studies [47,48], and four prospective case series [32,[49][50][51]. Only four RCTs directly compared hybrid abutment crowns and cementretained designs for SCs [36,41,43,44]. ...
... Only four RCTs directly compared hybrid abutment crowns and cementretained designs for SCs [36,41,43,44]. Other RCTs have compared different restorative materials (monolithic zirconia, zirconia-reinforced lithium silicate, hybrid ceramic, and metal-ceramic) [32,39,41], methods of impression [33], color of abutments [34], implant-abutment connection timing [36], implant apical-coronal positioning [37], and internal connections [38]. ...
Purpose: To investigate survival rates and technical and biological complications of one-piece screw-retained hybrid abutments in implant-supported single crowns (SCs).
Study Selection: An electronic search was performed on five databases for clinical studies involving implant-supported single hybrid abutment crowns constructed using titanium-base (Ti base) abutments, with at least 12 months of follow-up. The RoB 2, Robins-I, and JBI tools were used to assess the risk of bias for the different study types. Success, survival, and complication rates were calculated, and a meta-analysis was performed to obtain a pooled estimate. Peri-implant health parameters were extracted and analyzed.
Results: 22 records (20 studies) were included in this analysis. Direct comparisons between screw-retained hybrid abutment SCs and cemented SCs showed no significant differences in the 1-year survival and success rates. For SCs using a hybrid abutment crown design, their 1-year survival rate was 100% (95% CI: 100%-100%, I² = 0.0%, P = 0.984), and a success rate of 99% (95% CI: 97%-100%, I² = 50.3%, P = 0.023) was calculated. No confounding variables significantly affected the estimates. The individual technical complication rate was low at 1-year follow-up. The estimated incidence of all types of complications in hybrid abutment SCs is less than 1%.
Conclusions: Within the limitations of this study, implant-supported SCs using a hybrid abutment crown design showed favorable short-term clinical outcomes. Additional well-designed clinical trials with at least a 5-year observation period are required to confirm their long-term clinical performance.
... In the subgroup analysis performed according to the load direction, it was concluded that MZ and MC showed similar fracture strengths in the studies in which vertical and oblique forces were applied. Cheng and their colleagues, in their randomized controlled clinical study, reported that ceramic fractures seen in MZ and MC restorations after 1 year did not show a signi cant difference [27]. In another study that evaluating the long-term success of restorations, it was concluded that Cr-Co alloy supported metal ceramic crowns and monolithic zircons showed a low risk in terms of chipping GIC are known for their advantages such as chemically bonding to the tooth and releasing uoride and are used in luting the restorations. ...
Background: Despite the increasing popularity of monolithic zirconia restorations (MZ), metal ceramic restorations (MC) are still considered the gold standard in the posterior region. The aim of this systematic review and meta-analysis was to compare the fracture strengths of single unit MC and MZ in the molar region.
Methods: This review was structured based on the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA 2020). Literature search was conducted in PubMed and Web of Science databases until November 18, 2022. In vitro studies that evaluated the fracture strength of MC and MZ were included. Statistical analyzes were performed with CMA (Comprehensive Meta-Analysis) program, with a significance level of 0.05.
Results:Five of 753 studies were selected. Fracture strengths of MZ and MC did not show a statistically significant difference both tooth (95% CI:-1.589: 2.118, p=0.779, z= 0.280) and implant (95% CI: -2.215: 2.191, p=0.992 z= -0.010) supported restorations. However in tooth supported restorations a significant difference was found in the subgroup analysis considering different abutment materials (P<0.001) and aging treatments (P<0.001). Additionally in implant supported restorations a significant difference was found in subgroup analysis considering different cements (p=0.001) and load speeds (p=0.001).
Conclusion:Within the limitations this present study, fracture strengths of MZ and MC did not show a significant difference in implant or tooth supported single unit restorations at posterior region.
Clinical relevance: MZ may be an alternative to MC in posterior single restorations. Present results should be interpreted with caution, as included studies were in vitro.
... It helps to provide the patient with a long-term clinical life of rehabilitated teeth with proper esthetics and function. During the past decades metal-ceramic crown protocols have been extensively used in dentistry [2]. With the development of more resistant ceramics and the widespread availability of new resin composite materials, however, metallic crowns have lost popularity [3]. ...
Objective
This study aimed to evaluate the influence of new resin-based CAD-CAM implant-supported materials on posterior crown restoration stress and strain concentrations.
Methods
A previous 3D implant model was edited to receive a cement-retained posterior crown manufactured with different CAD/CAM materials (Estelite P Block, Estelite Block II or Estelite Layered Block). Each solid model was exported to the computer-aided engineering software and submitted to the finite element analysis of stress and strain. Material properties were assigned to each solid with isotropic and homogeneous behavior according to the manufacturer information. A vertical load of 600 N was applied in the occlusal region of the crown, via a simulated food bolus, and stress was calculated in Von Misses (σVM) for the implant, abutment and screw, Maximum (σMAX) Principal Stresses for the crown and microstrain for the bone.
Results
All simulated materials showed acceptable stresses levels with a similar stress pattern among the models. At the crown intaglio region and cement layer, however, differences were observed: Estelite P Block showed a lower tensile and shear stresses magnitude when compared to other resin-based materials with lower elastic modulus.
Significance
The stress effect of different resin-based CAD-CAM implant-supported crowns is predominant in the crown and cement layer, with Estelite P Block showing 7.4 % versus 9.3 % and 9.2 % for Estelite Block II and Estelite Layered Block of crown failure risk.
... Debonding was the most common problem reported in this research [114]. Survival rates for implant-retained monolithic crowns varied from 97.1% to 100% for two years [115][116][117] and 98.4% for up to three years of follow-up [118]. The reported survival rates of FDPs include 91.7% after two years [116], 100% after three years [118], and 97.4% after five years [119]. ...
The aim of this article is to comprehensively review the revolution of dental zirconia (Zir), including its types, properties, applications, and cementation procedures. A comprehensive search of PubMed and Embase was conducted. The search was limited to manuscripts published in English. The final search was conducted in October 2021. Newly developed monolithic Zir ceramics have substantially enhanced esthetics and translucency. However, this material must be further studied in vitro and in vivo to determine its long-term ability to maintain its exceptional properties. According to the literature, monolithic translucent Zir has had promising results and a high survival rate. Thus, the utilization of this material is indicated when strength and esthetics are needed. Both the materials and methods used for cementation of monolithic Zir have significantly improved, encouraging dentists to use this material, especially when a conservative approach is required. Zir restorations showed promising outcomes, particularly for monolithic Zir crowns supported with implant and fixed dental prostheses.
... LTD is characterized by a time-dependent and progressive tm transformation in the presence of humidity at relatively low temperatures, leading to an increased surface roughness, grain pull-out and microcracking eventually deteriorating the mechanical and optical properties of the material [5,[19][20][21][22]. Although concerns are of multifactorial nature, the elimination of the veneering ceramic and its interface, thus resulting in the full-contour or monolithic restorations, have been considered the most reliable approach to extend the lifetime of the next-generation of zirconia dental protheses [23][24][25]. Hence, the quest for more translucent and stable zirconia systems for full-contour use, without compromising the mechanical properties, has become a driving force for further developments in the biomaterial science. ...
... Similarly, second generation 3Y-TZPs have demonstrated high susceptibility to LTD, where t-m transformation was almost threefold higher than first generation 3Y-TZPS, resulting in altered optical and mechanical properties after artificial laboratory aging [26]. Clinical performance warrants clarification; however, recent short-term evaluations have indicated a lower rate of technical complications for monolithic 3Y-TZP relative to metal ceramics [23,24]. ...
Objectives
To evaluate the effect of the ceramic processing and aging method on the microstructure, optical, and mechanical properties of a third generation ultra-translucent zirconia, yttria partially stabilized zirconia (5Y-PSZ).
Methods
In-house discs were obtained through uniaxial and isostatic pressing an ultra-translucent Y-PSZ powder and sintering at 1450 °C for 2 h. As control, a commercial disc was milled from pre-sintered blocks fabricated with the same 5Y-PSZ powder through isostatic pressing and sintered under the same protocol. Discs were allocated into three groups according to aging condition as immediate (non-aged) and aged using autoclave or hydrothermal reactor at 134ºC for 20 h at 2.2 bar. Crystalline content and microstructure were evaluated using X-ray diffraction (XRD) and scanning electron microscopy (SEM), respectively. Optical properties were determined using reflectance data to calculate the contrast ratio (CR) and translucency parameter (TP). Mechanical properties were assessed by Vickers hardness, fracture toughness and biaxial flexural strength tests.
Results
XRD spectra revealed a prevalence of cubic (70%) and tetragonal (30%) phases, and the SEM images showed a dense fully crystalline ceramic matrix for both materials. Crystalline content and microstructure of the in-house and commercial 5Y-PSZs were not affected by aging. As-sintered 5Y-PSZs demonstrated similar CR (~0.6) and TP (~18) values, as well as Vickers hardness (~14 GPa) and fracture toughness (~3.8 Mpa.m1/2), with no significant alteration after both aging methods. In-house and commercial Y-PSZs Weibull moduli ranged from 3.0 to 5.3. 5Y-PSZ processing methods resulted in similar characteristic strength after sintering (592–618 Mpa). While commercial 5Y-PSZ showed no significant influence of aging on strength, hydrothermal reactor aging significantly decreased the in-house Y-PSZ characteristic strength (474 Mpa). Both 5Y-PSZs demonstrated high reliability up to 300-Mpa strength missions, with no detrimental effect of aging (88–100%).
Significance
Irrespective of the processing method, ultra-translucent 5Y-PSZ showed high aging resistance and translucency stability, as well as strength corresponding to the indication up to short-span anterior prostheses.
... In order to overcome the technical problems experienced with all types of veneered restorations, more recently, monolithic, that is, un-veneered, micro-veneered, or partially veneered, types of restorations were presented (Caramês et al., 2019;Cheng et al., 2019;Rammelsberg et al., 2020). However, a clear distinction between the definitions of monolithic, micro-veneered, and conventionally veneered designs is lacking. ...
... Twenty of the included studies were RCTs (Table 2; Table S2) comparing directly veneered zirconia customized and stock F I G U R E 2 Search strategy-For summary of the excluded full-text articles see Table S1 zirconia abutments with cemented ceramic SCs (Wittneben et al., 2020), esthetic outcomes for screw-retained SCs with or without using provisional crowns for tissue conditioning (Furze et al., 2019), metal-ceramic and resin-matrix ceramic SCs (Agustín-Panadero et al., 2020), monolithic zirconia and porcelain-fused-to-metal (PFM) implant-supported SCs (Mühlemann et al., 2020), cemented and screw-retained SCs on customized zirconia abutments (Heierle et al., 2019), 11 mm implants used in combination with sinus floor elevation and 6mm implants without bone augmentation (Guljé et al., 2019b), screw-retained monolithic zirconia and cemented PFM SCs (Weigl, Saarepera, et al., 2019), submucosal veneered zirconia abutments and non-veneered zirconia abutments (Laass et al., 2019), immediate, non-detached glass-ceramic individualized abutments and dis-/ reconnections (Erhan Çömlekoğlu et al., 2018), monolithic zirconia SCs and short-span FDPs (Cheng et al., 2019), cemented and screwretained zirconia-based implant-supported SCs (Kraus et al., 2019), tooth-and implant-supported veneered zirconia single SCs (Cantner et al., 2019), cemented and screw-retained CAD/CAM zirconia abutments for esthetically located implant-supported SCs (Amorfini et al., 2018), digital and analog procedures for manufacturing of implantsupported SCs (Mangano & Veronesi, 2018), customized zirconia and titanium abutments (Bösch et al., 2018), immediately loaded one-and two-piece implants (Bomicke et al., 2017), two-piece and one-piece zirconia abutments (Paolantoni et al., 2016), bonding of a RMC restorative material to zirconia stock abutments and zirconia customized abutments (Schepke et al., 2016), zirconia and titanium abutments (Zembic et al., 2013), and zirconia and metal-ceramic implant-supported SCs (Hosseini et al., 2011) (Table S2). The remaining 29 studies were prospective cohort studies (Andersson et al., 1998;Cantner et al., 2019;Canullo, 2007;Cheng et al., 2019;Cooper et al., 2016;Fenner et al., 2016;Gierthmuehlen et al., 2020;Guarnieri et al., 2015;Guljé et al., 2019a;Guncu et al., 2016;Henriksson & Jemt, 2003;Hosseini et al., 2011;Hosseini et al., 2013;Joda et al., 2017;Kolgeci et al., 2014;Koller et al., 2020;Linkevicius et al., 2018;Ma et al., 2019;Meijndert et al., 2020;Nothdurft et al., 2014;Ormianer & Schiroli, 2006;Peron & Romanos, 2020;Pieri et al., 2013;Pol et al., 2020;Rammelsberg et al., 2020;Teichmann et al., 2017;Vandeweghe et al., 2012;Vanlioglu et al., 2012;Zembic et al., 2013;Zembic et al., 2015). As none of the included RCTs address the focused question of the present systematic review, they were addressed as prospective studies and analyzed as such. ...
Objective
To assess the survival, failure, and complication rates of veneered and monolithic all-ceramic implant-supported single crowns (SCs).
Methods
Literature search was conducted in Medline (PubMed), Embase, and Cochrane Central Register of Controlled Trials until September 2020 for randomized, prospective, and retrospective clinical trials with follow-up time of at least 1 year, evaluating the outcome of veneered and/or monolithic all-ceramic SCs supported by titanium dental implants. Survival and complication rates were analyzed using robust Poisson's regression models.
Results
Forty-nine RCTs and prospective studies reporting on 57 material cohorts were included. Meta-analysis of the included studies indicated an estimated 3-year survival rate of veneered-reinforced glass-ceramic implant-supported SCs of 97.6% (95% CI: 87.0%–99.6%). The estimated 3-year survival rates were 97.0% (95% CI: 94.0%–98.5%) for monolithic-reinforced glass-ceramic implant SCs, 96.9% (95% CI: 93.4%–98.6%) for veneered densely sintered alumina SCs, 96.3% (95% CI: 93.9%–97.7%) for veneered zirconia SCs, 96.1% (95% CI: 93.4%–97.8%) for monolithic zirconia SCs and only 36.3% (95% CI: 0.04%–87.7%) for resin-matrix-ceramic (RMC) SCs. With the exception of RMC SCs (p < 0.0001), the differences in survival rates between the materials did not reach statistical significance. Veneered SCs showed significantly (p = 0.017) higher annual ceramic chipping rates (1.65%) compared with monolithic SCs (0.39%). The location of the SCs, anterior vs. posterior, did not influence survival and chipping rates.
Conclusions
With the exception of RMC SCs, veneered and monolithic implant-supported ceramic SCs showed favorable short-term survival and complication rates. Significantly higher rates for ceramic chipping, however, were reported for veneered compared with monolithic ceramic SCs.
... In order to overcome the technical problems experienced with all types of veneered restorations, more recently, monolithic, that is, un-veneered, micro-veneered, or partially veneered, types of restorations were presented (Caramês et al., 2019;Cheng et al., 2019;Rammelsberg et al., 2020). However, a clear distinction between the definitions of monolithic, micro-veneered, and conventionally veneered designs is lacking. ...
... Twenty of the included studies were RCTs (Table 2; Table S2) comparing directly veneered zirconia customized and stock F I G U R E 2 Search strategy-For summary of the excluded full-text articles see Table S1 zirconia abutments with cemented ceramic SCs (Wittneben et al., 2020), esthetic outcomes for screw-retained SCs with or without using provisional crowns for tissue conditioning (Furze et al., 2019), metal-ceramic and resin-matrix ceramic SCs (Agustín-Panadero et al., 2020), monolithic zirconia and porcelain-fused-to-metal (PFM) implant-supported SCs (Mühlemann et al., 2020), cemented and screw-retained SCs on customized zirconia abutments (Heierle et al., 2019), 11 mm implants used in combination with sinus floor elevation and 6mm implants without bone augmentation (Guljé et al., 2019b), screw-retained monolithic zirconia and cemented PFM SCs (Weigl, Saarepera, et al., 2019), submucosal veneered zirconia abutments and non-veneered zirconia abutments (Laass et al., 2019), immediate, non-detached glass-ceramic individualized abutments and dis-/ reconnections (Erhan Çömlekoğlu et al., 2018), monolithic zirconia SCs and short-span FDPs (Cheng et al., 2019), cemented and screwretained zirconia-based implant-supported SCs (Kraus et al., 2019), tooth-and implant-supported veneered zirconia single SCs (Cantner et al., 2019), cemented and screw-retained CAD/CAM zirconia abutments for esthetically located implant-supported SCs (Amorfini et al., 2018), digital and analog procedures for manufacturing of implantsupported SCs (Mangano & Veronesi, 2018), customized zirconia and titanium abutments (Bösch et al., 2018), immediately loaded one-and two-piece implants (Bomicke et al., 2017), two-piece and one-piece zirconia abutments (Paolantoni et al., 2016), bonding of a RMC restorative material to zirconia stock abutments and zirconia customized abutments (Schepke et al., 2016), zirconia and titanium abutments (Zembic et al., 2013), and zirconia and metal-ceramic implant-supported SCs (Hosseini et al., 2011) (Table S2). The remaining 29 studies were prospective cohort studies (Andersson et al., 1998;Cantner et al., 2019;Canullo, 2007;Cheng et al., 2019;Cooper et al., 2016;Fenner et al., 2016;Gierthmuehlen et al., 2020;Guarnieri et al., 2015;Guljé et al., 2019a;Guncu et al., 2016;Henriksson & Jemt, 2003;Hosseini et al., 2011;Hosseini et al., 2013;Joda et al., 2017;Kolgeci et al., 2014;Koller et al., 2020;Linkevicius et al., 2018;Ma et al., 2019;Meijndert et al., 2020;Nothdurft et al., 2014;Ormianer & Schiroli, 2006;Peron & Romanos, 2020;Pieri et al., 2013;Pol et al., 2020;Rammelsberg et al., 2020;Teichmann et al., 2017;Vandeweghe et al., 2012;Vanlioglu et al., 2012;Zembic et al., 2013;Zembic et al., 2015). As none of the included RCTs address the focused question of the present systematic review, they were addressed as prospective studies and analyzed as such. ...
