A systematic review of the survival and complication rates of zirconia-ceramic and metal-ceramic single crowns.

Pjetursson, Bjarni E; Valente, Nicola A; Strasding, Malin; Zwahlen, Marcel; Liu, Shiming; Sailer, Irena (2018). A systematic review of the survival and complication rates of zirconia-ceramic and metal-ceramic single crowns. Clinical oral implants research, 29(Suppl 16), pp. 199-214. Wiley-Blackwell 10.1111/clr.13306

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OBJECTIVES The aim of the present systematic review was to analyze the survival and complication rates of zirconia-based and metal-ceramic implant-supported single crowns (SCs). MATERIALS AND METHODS An electronic MEDLINE search complemented by manual searching was conducted to identify randomized controlled clinical trials, prospective cohort and retrospective case series on implant-supported SCs with a mean follow-up time of at least 3 years. Patients had to have been clinically examined at the follow-up visit. Assessment of the identified studies and data extraction was performed independently by two reviewers. Failure and complication rates were analyzed using robust Poisson's regression models to obtain summary estimates of 5-year proportions. RESULTS The search provided 5,263 titles and 455 abstracts, full-text analysis was performed for 240 articles, resulting in 35 included studies on implant-supported crowns. Meta-analysis revealed an estimated 5-year survival rate of 98.3% (95% CI: 96.8-99.1) for metal-ceramic implant supported SCs (n = 4,363) compared to 97.6% (95% CI: 94.3-99.0) for zirconia implant supported SCs (n = 912). About 86.7% (95% CI: 80.7-91.0) of the metal-ceramic SCs (n = 1,300) experienced no biological/technical complications over the entire observation period. The corresponding rate for zirconia SCs (n = 76) was 83.8% (95% CI: 61.6-93.8). The biologic outcomes of the two types of crowns were similar; yet, zirconia SCs exhibited less aesthetic complications than metal-ceramics. The 5-year incidence of chipping of the veneering ceramic was similar between the material groups (2.9% metal-ceramic, 2.8% zirconia-ceramic). Significantly (p = 0.001), more zirconia-ceramic implant SCs failed due to material fractures (2.1% vs. 0.2% metal-ceramic implant SCs). No studies on newer types of monolithic zirconia SCs fulfilled the simple inclusion criteria of 3 years follow-up time and clinical examination of the present systematic review. CONCLUSION Zirconia-ceramic implant-supported SCs are a valid treatment alternative to metal-ceramic SCs, with similar incidence of biological complications and less aesthetic problems. The amount of ceramic chipping was similar between the material groups; yet, significantly more zirconia crowns failed due to material fractures.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Zwahlen, Marcel


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services








Tanya Karrer

Date Deposited:

25 Oct 2018 12:25

Last Modified:

23 Oct 2019 10:18

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

biological complications fixed dental prostheses implant crown meta-analysis metal-ceramics success survival systematic review technical zirconia framework





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