A prospective 10-year study of metal ceramic single crowns and fixed dental prosthesis retainers in private practice set tings

doi:10.1016/S0022-3913(13)60034-7

The Journal of Prosthetic Dentistry

Volume 109, Issue 3, March 2013, Pages 149-155

https://doi.org/10.1016/S0022-3913(13)60034-7 Get rights and content

Statement of problem

Metal ceramic restorations are widely used in prosthodontics, but long-term data on their clinical performance in private practice settings based on prospective trials are sparse.

Purpose

This clinical trial was designed to provide realistic long-term survival rates for different outcomes related to tooth loss, crown loss, and metal ceramic defect.

Material and methods

Ninety-five participants were provided with 190 noble metal ceramic single crowns and 138 participants with 276 fixed dental prosthesis retainer crowns on vital posterior teeth. Follow-up examinations were scheduled 2 weeks after insertion, annually up to 8 years, and after 10 years. Kaplan-Meier survival analyses, Mantel-Cox logrank tests, and Cox regression analyses were conducted.

Results

Because of variations in the time of the last examinations, the maximum observation period was 12.1 years. For the primary outcome ‘loss of crown or tooth’, the Kaplan-Meier survival rate was 94.3% ±1.8% (standard error) at 8.0 years (last outcome event) for single crowns and 94.4% ±1.5% at 11.0 years for fixed dental prosthesis retainer crowns. The difference between the survival functions was not significant (P>.05). For the secondary outcome ‘metal ceramic defect’, the survival rate was 88.8% ±3.2% at 11.0 years for single crowns and 81.7% ±3.5% at 11.0 years for fixed dental prosthesis retainer crowns. In Cox regression models, the only significant covariates for the outcome event ‘metal ceramic defect’ were bruxism in the medical history (single crowns) and signs and symptoms of bruxism (fixed dental prosthesis retainer crowns) with hazard ratios of 3.065 (95% CI 1.063 – 8.832) and 2.554 (95% CI 1.307 – 4.992).

Conclusions

Metal ceramic crowns provided in private practice settings show good longevity. Bruxism appears to indicate a risk for metal ceramic defects.

Section snippets

Material and Methods

The study was designed as a multicenter clinical trial with 10 private practitioners17, 18 and was approved by the responsible research ethics board (TU Dresden, EK 194062009). The inclusion criteria comprised the need for 2 single crowns or 2 retainer crowns as part of an FDP on vital posterior teeth. Removable dental prostheses in the jaw to be treated, allergies against alloy components, oral mucosal diseases, and psychological disorders were predefined exclusion criteria. After the start of

Results

Because of variations in the time of the last examinations, the maximum observation period was 12.1 years in the SC group and 11.1 years in the RC group. At 10 years, 147 of 190 crowns in the SC group and 208 of 276 crowns in the RC group were still at risk relative to the primary outcome, which is in situ. Thus the drop-out rates over the period of the study were 22.6% (SC) and 24.6% (RC). All the remaining prostheses had been in situ between 10 and 12 years. The numbers of participants who

Discussion

The null hypothesis was not rejected. Originally, the study focused on the differences between differently composed alloys.¹⁷ The alloy type was, therefore, analyzed as a covariate. The 10-year analysis, however, focused on the survival of the restorations and metal ceramic defects. Although the 7-year results were published, the current analysis provides important new information. The previous paper reported only the SC data, making no comparisons between SCs and RCs, and did not include a

Conclusions

Metal ceramic single crowns and FDP retainers on vital posterior teeth showed good longevity in private practice settings. Technical complications leading to removal were rare events with noble metal ceramic crowns. Bruxism appears to be a risk indicator for metal ceramic defects. Metal ceramic crowns offer a reliable treatment option. Screening for bruxism might be helpful in deciding between metal ceramic and metal restorations.

Acknowledgments

The authors thank general dental practitioners D. Bracke, M. Eltzschig, S. Focke, B. Fuchs, K. Gäbler, M. Günzel, J. Hartmann, C. Hofmann, D. Lode, M. Wunsch for their participation and valuable contributions.

References (25)

MS Scurria et al.
Meta-analysis of fixed partial denture survival: prostheses and abutments
J Prosthet Dent
(1998)
J Coornaert et al.
Long-term clinical study of porcelain-fused-to-gold restorations
J Prosthet Dent
(1984)
RJ Crisp et al.
A clinical evaluation of all-ceramic bridges placed in patients attending UK general dental practices: three-year results
Dent Mater
(2012)
B Reitemeier et al.
Effect of posterior crown margin placement on gingival health
J Prosthet Dent
(2002)
A Eliasson et al.
A clinical evaluation of cobalt-chromium metal-ceramic fixed partial dentures and crowns: A three- to seven-year retrospective study
J Prosthet Dent
(2007)
RP Kinsel et al.
Retrospective analysis of porcelain failures of metal ceramic crowns and fixed partial dentures supported by 729 implants in 152 patients: patient-specific and implant-specific predictors of ceramic failure
J Prosthet Dent
(2009)
A Johansson et al.
Bruxism and prosthetic treatment: a critical review
J Prosthodont Res
(2011)
A Pergamalian et al.
The association between wear facets, bruxism, and severity of facial pain in patients with temporomandibular disorders
J Prosthet Dent
(2003)
BE Pjetursson et al.
Comparison of survival and complication rates of tooth-supported fixed dental prostheses (FDPs) and implant-supported FDPs and single crowns (SCs)
Clin Oral Implants Res
(2007 Jun)
H De Backer et al.
Long-term survival of complete crowns, fixed dental prostheses, and cantilever fixed dental prostheses with posts and cores on root canal-treated teeth
Int J Prosthodont
(2007)

NH Creugers et al.

A meta-analysis of durability data on conventional fixed bridges

Community Dent Oral Epidemiol

(1994)

I Sailer et al.

A systematic review of the survival and complication rates of all-ceramic and metal-ceramic reconstructions after an observation period of at least 3 years. Part II: Fixed dental prostheses

Clin Oral Implants Res

(2007)

Cited by (46)

Single crown vs. composite for glass fiber post-retained restorations: An 8-year randomized clinical trial
2024, Journal of Dentistry
This study aimed to compare the success and survival rates of metal-ceramic crowns and composite resin restorations applied in root filled teeth that received a glass fiber post.
A prospective, randomized controlled trial, with equivalent parallel groups was designed. Eighty-two teeth were randomly allocated to the metal-ceramic or composite resin groups. Multivariate Cox regression analysis with shared frailty for patients and Kaplan-Meier curves were performed using success and survival rates (p<0.05).
Seventy-five post-retained restorations (34 metal-ceramic crowns and 41 composite restorations) in 62 patients were analyzed. The median follow-up was 8.1 years [IQR 4.0–9.9]. Twenty-seven failures were observed. Twenty-two failures (81.5 %) were observed in the composite resin group, of which six (27.3 %) were not repairable. Five failures (18.5 %) were observed in the metal-ceramic crown group, of which three (66.6 %) were non-repairable. The cumulative success rate at 8 years was 85.0 % for crowns (AFR=1.31 %) and 43.2 % for composite resins (AFR=6.58 %), while the survival rate was 93.8 % for crowns (AFR=0.52 %) and 97.6 % for composite resins (AFR=0.20 %). Considering the success rates, adjusted multivariate Cox regression showed that composite resin had a Hazard Ratio of 5.07 (95 %CI, 1.99–12.89) greater than the metal-ceramic crown. No significant difference in the failure risk was observed when the survival rates were considered (HR=0.38, 95 %CI (0.10 – 1.44), p = 0.156). Co-variables did not affect the success and survival rates (p>0.05).
Metal-ceramic crowns showed a higher success rate than composite restorations. The survival rates were similar, but composite restorations presented a higher need for repairs.
Post-retained composite restorations may need more reinterventions during the lifecycle, although more preservation of sound tooth structure is expected with a large restoration of resin post-and-core. These aspects have to be discussed with the patient for decision-making planning.
Performance of fixed dental prostheses up to 6 years—A massive data analysis
2022, Journal of Prosthetic Dentistry
Metal and metal-ceramic fixed dental prostheses (FDPs) have been clinically determined to provide long-term durable restorations. However, data on their performance under practice conditions are sparse.
The purpose of this clinical study was to evaluate the longevity of FDPs under practice conditions by analyzing a large insurance claims database.
Data were extracted from the data warehouse of a major German national health insurance company (BARMER). The analysis focused on the FDP types with the lowest deductibles in the insurance system. All metal-based FDPs replacing up to 3 adjacent teeth were included. Ceramic veneering was optional and only approved on the labial surfaces of maxillary teeth mesial to the first molar and mandibular teeth mesial to the second premolar. Fee codes allowed clinical courses to be traced on a day count basis. Three groups with FDPs replacing 1 tooth, 2 teeth, and 3 teeth were formed. Kaplan-Meier survival analyses were conducted for the target events removal or extraction, indicating FDP failure and extraction of an abutment tooth.
The sample comprised 124 660 FDPs that replaced 1 tooth (76.5%), 2 teeth (19.8%), or 3 teeth (3.7%). The cumulative survival rates for removal or extraction at 6 years differed significantly, with 83.0% for 1-pontic FDPs, 78.1% for 2-pontic FDPs, and 74.0% for 3-pontic FDPs. Thus, approximately 1 of 6 one-pontic FDPs, 1 of 5 two-pontic FDPs, and 1 of 4 three-pontic FDPs failed. The cumulative survival rates for extraction of an abutment tooth at 6 years showed no significant difference, with 96.0% for 1-pontic FDPs, 95.6% for 2-pontic FDPs, and 95.1% for 3-pontic FDPs.
The survival rates of FDPs according to insurance data were lower than those reported by clinical studies, indicating a gap between efficacy and effectiveness.
Up to 10 years clinical performance of zirconia ceramic and metal-ceramic fixed partial dentures: A retrospective study
2022, Journal of Prosthetic Dentistry
Completely veneered zirconia ceramic (ZC) fixed partial dentures (FPDs) have been reported to have a higher incidence of ceramic chipping than the standard metal-ceramic FPDs. However, data from comparative long-term studies are sparse.
The purpose of this retrospective study was to compare the long-term survival, chipping-free survival, and success of ceramic-veneered high noble metal alloy (HN), base metal alloy (cobalt-chromium alloy) (CC), and ZC FPDs and to isolate risk factors for the incidence of failure, veneer chipping, and overall complications.
Data from 289 study participants (58.7% women; mean age, 57.97 ±11.51 years) provided with a total of 400 FPDs comprising 197 (49.3%) HN FPDs, 121 (30.3%) CC FPDs, and 82 (20.5%) ZC FPDs fabricated from presintered 3 mol% yttria-stabilized zirconia (mean time of service, 6.85 ±3.25 years) were evaluated. Of these, 278 (69.5%) FPDs were provided by dentists and 122 (30.5%) by dental students. Five- and 10-year survival, chipping-free survival, and success rates were calculated using the Kaplan–Meier method and compared with the log-rank test. Risk factors were assessed using Cox regression analysis. The study was exploratory, so all P values were considered exploratory and descriptive.
The 5- and 10-year survival rates were 94.7% and 77.8% for HN, 93.7% and 81.2% for CC, and 92.9% and 53.3% for ZC FPDs, respectively, indicating no clear difference in survival among the framework materials. The 5- and 10-year chipping-free rates were 94.1% and 82.8% for HN, 96.1% and 78.9% for CC, and 82.6% and 62.2% for ZC FPDs, respectively, indicating a difference between HN and ZC, and CC and ZC restorations. The 5- and 10-year success rates were 83.7% and 55.3% for HN, 86.5% and 51.4% for CC, and 68.9% and 30.2% for ZC FPDs, respectively, indicating a difference between HN and ZC, and CC and ZC restorations. The Cox regression model indicated framework material as an influencing risk factor for success, and this influence persisted when chipping was investigated. Compared with zirconia, the use of a metal alloy reduced the risk of chipping or the occurrence of complications by up to one-third.
All FPDs showed high 5-year survival rates and acceptable 10-year survival rates with no strong differences among the materials. Higher success and chipping-free rates were observed for both HN and CC restorations compared with ZC restorations. Metal frameworks had a lower risk for complications or veneer chipping than zirconia frameworks.
Outcome measurements and quality of randomized controlled clinical trials of tooth-supported fixed dental prostheses: A systematic review and qualitative analysis
2022, Journal of Prosthetic Dentistry
Citation Excerpt :
The overall numbers of records screened, identified, selected, excluded, and included are presented in a PRISMA flow diagram (Fig. 1). A total of 64 potentially relevant trials from 79 publications (agreement=94.50%; kappa=.867; 95% CI=0.764 to 0.970) were included.15-21,30-101 The outcome measurements identified in RCTs to assess tooth-supported FDPs are shown in Table 1.
The lack of consensus regarding a standardized set of outcome measurements and noncompliance with current reporting guidelines in clinical trials of tooth-supported fixed dental prostheses (FDPs) hamper interstudy comparability, compromise scientific evidence, and waste research effort and resources in prosthetic dentistry.
The primary objective of this systematic review was to identify all primary and secondary outcome measurements assessed in randomized controlled trials (RCTs) of tooth-supported FDPs. Secondary objectives were to assess their methodological quality by using the Cochrane Collaboration's risk of bias tool (RoB, v2.0) and their reporting quality by means of a standardized 16-item CONSORT assessment tool through published reports.
An electronic search was conducted in MEDLINE, EMBASE, and Cochrane library to identify all RCT-related articles published in the past 10 years. Differences in RoB were tested with the Pearson chi-square test, and those in CONSORT score with the Student t test.
A total of 64 RCTs from 79 publications were deemed eligible. The diversity of outcome measures used in the field is apparent. Twenty percent of the included studies had a low RoB, 79% showed some concerns, and 1% had a high RoB. The mean ±standard deviation CONSORT compliance score was 22.56 ±3.17. Trials adhered to the CONSORT statement reported lower RoB than those that did not adhere (P<.001). RCTs with a low RoB reported more comprehensive adherence to CONSORT guidelines than those with some concerns (MD 4 [95% CI 1.52-6.48]; P=.004).
A standardized core outcome reporting set in clinical research on tooth-supported FDPs remains evident. Adherence to the CONSORT statement continues to be low, with some RoB concerns that can be improved.
A retrospective comparison of the survival of vital teeth adjacent to single, bounded edentulous spaces rehabilitated using implant-supported, resin-bonded, and conventional fixed dental prostheses
2022, Journal of Dentistry
Citation Excerpt :
Balasubramaniam reported that no occlusal contact on the pontic in lateral excursion yields better survival rates of RBFPD [21]. In addition, parafunctional habits (e.g., bruxism) have harmful effects on the survival of prostheses [22,23]. Although occlusal conditions may change over the course of the follow-up period, future studies identifying the initial occlusal factors at the onset of the study would help to clarify this point.
In this study, we aimed to compare the long-term survival of vital teeth adjacent to bounded edentulous spaces rehabilitated using an implant-supported prosthesis (ISP), a resin-bonded fixed partial denture (RBFPD), or a conventional fixed partial denture (CFPD). The risk factors for complications in teeth adjacent to the edentulous space (TAES) were also investigated.
We followed-up a consecutive series of 514 patients who underwent rehabilitation of a single bounded edentulous space with vital TAES (ISP: 103; RBFPD: 216; and CFPD: 195) from 2008 to 2017. Cumulative survival rates of prosthesis and TAES, and complication-free rates of TAES, were evaluated using the Kaplan−Meier analysis and log-rank test. Risk factors were evaluated using a Cox proportional hazards model.
Cumulative complication-free rates of TAES showed no significant differences among the three groups. The cumulative survival rate of TAES in CFPD was significantly lower than that of ISP (p = 0.037); no significant differences were observed between ISP and RBFPD (p = 0.513), and RBFPD and CFPD (p = 0.076). Older age (p = 0.027) was the only independent significant risk factor for complications in TAES. Installation of CFPD (p = 0.019), ceramic prosthesis in edentulous space (p = 0.026), and deeper periodontal probing depth (p = 0.018) of TAES were significant risk factors for non-surviving TAES.
Rehabilitating a single bounded edentulous space with CFPD could increase the risk for TAES loss compared with ISP. Risk of TAES loss remained similar between ISP and RBFPD, which can minimize the loss of coronal tooth structure during tooth preparation.
Teeth adjacent to edentulous space show equivalent longevity when rehabilitating a single bounded edentulous space with resin-bonded fixed partial dentures or single standing implant-supported prosthesis, at least 10 years post-installation.
Six-year survival of single crowns — A massive data analysis
2020, Journal of Dentistry
Numerous clinical trials have proven the long-term stability of metal and metal-ceramic crowns. However, data on their performance under practice conditions are rare.
To evaluate the longevity of crowns by means of massive data analyses.
The data were extracted from the data warehouse of a major German national health insurance company (BARMER, Berlin, Germany). The analysis focused on crown types with the lowest deductibles. Metal crowns and metal-ceramic crowns with ceramic veneering on the vestibular aspects of teeth 15–25 and 34–44 placed from 2012 to 2017 were included. The placement of the crowns, crown removals and tooth extractions were identified using the corresponding fee codes. Kaplan–Meier survival analyses were conducted for the outcomes “crown removal or extraction” and for “extraction”.
The cumulative six-year survival rates were 88.0 % for the outcome “crown removal or extraction” and 92.5 % for the outcome “extraction” (N = 192,868). The survival functions had slightly steepening but close to linear courses.
The outcome of the treatment with metal and metal-ceramic crowns was moderately inferior in comparison to clinical trials. However, treatment with metal and metal-crowns is judged to be a reliable and safe option under practice conditions.
Clinicians must inform patients about potential treatment outcomes. Therefore, additional knowledge about single crown outcomes under general practice settings based on large database analyses is important.

View all citing articles on Scopus

View full text

A prospective 10-year study of metal ceramic single crowns and fixed dental prosthesis retainers in private practice set tings

Statement of problem

Purpose

Material and methods

Results

Conclusions

Section snippets

Material and Methods

Results

Discussion

Conclusions

Acknowledgments

J Prosthet Dent

J Prosthet Dent

Dent Mater

J Prosthet Dent

J Prosthet Dent

J Prosthet Dent

J Prosthodont Res

J Prosthet Dent

Comparison of survival and complication rates of tooth-supported fixed dental prostheses (FDPs) and implant-supported FDPs and single crowns (SCs)

Clin Oral Implants Res

Long-term survival of complete crowns, fixed dental prostheses, and cantilever fixed dental prostheses with posts and cores on root canal-treated teeth

Int J Prosthodont

A meta-analysis of durability data on conventional fixed bridges

Community Dent Oral Epidemiol

A systematic review of the survival and complication rates of all-ceramic and metal-ceramic reconstructions after an observation period of at least 3 years. Part II: Fixed dental prostheses

Clin Oral Implants Res