The Clinical Success Of All-Ceramic Restorations

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ABSTRACT

Background

The authors conducted a comprehensive literature review to compile and compare clinical evidence for the treatment of teeth using all-ceramic restorations.

Types of Studies Reviewed

The authors searched the English-language peer-reviewed literature using MEDLINE and PubMed with a focus on research published between 1993 and 2008. They also conducted a hand search of relevant dental journals. They reviewed randomized controlled trials, nonrandomized controlled studies, longitudinal experimental clinical studies, longitudinal prospective studies and longitudinal retrospective studies.

Results

Evidence suggests that for veneers, intracoronal restorations and complete-coverage restorations for single-rooted anterior teeth, clinicians may choose from any all-ceramic system on the basis of esthetic needs (many systems have had greater than 90 percent success at six years). Well-studied molar restorations include those made of alumina and, increasingly, zirconia and bonded lithium disilicate. Reasonable evidence has shown the effectiveness of anterior three-unit fixed partial dentures made of lithium disilicate, alumina and zirconia. For three-unit restorations involving a molar, expert consensus suggests that only zirconia-based systems are indicated.

Clinical Implications

Available evidence indicates the effectiveness of many all-ceramic systems for numerous clinical applications. Bonding has been shown to increase clinical success. Studies of zirconia prostheses indicate problems with porcelain cracking.

Section snippets

VENEER RESTORATIONS

Ceramics are particularly well-suited for veneer restorations, which have failure rates, including loss of retention or fracture, of less than 5 percent at five years.4,5 In one of the earliest clinical studies, which examined 83 veneers (IPS Empress, Ivoclar Vivadent, Amherst, N.Y. [now IPS Empress Esthetic Veneer]), the authors reported a success rate of 98.8 percent after six years.6 Two recent reports on feldspathic porcelain veneers (n = 3,047 and n = 1,828) showed similar long-term

INLAY AND ONLAY RESTORATIONS

Some of the most extensively studied ceramics in dentistry are used for inlay and onlay restorations; they are made of feldspathic ceramic (Vitablocs Mark I and II, Vita Zahnfabrik, Bad Säckingen, Germany) or mica-filled glass-ceramic (Dicor, Dentsply, York, Pa. [no longer on the market]) by using the CEREC computer-aided design/computer-aided manufacturing (CAD/CAM) system (Sirona Dental Systems GmbH, Bensheim, Germany).9, 10, 11, 12, 13, 14 Another widely studied ceramic is the hot-pressed

SINGLE-UNIT CROWNS

As expected, the first all-ceramic systems to appear on the market have received the most attention in the peer-reviewed literature. These systems are leucite-reinforced glass-ceramic (IPS Empress), glass-infiltrated ceramics (In-Ceram Alumina and In-Ceram Spinell, Vita Zahnfabrik) and polycrystalline alumina (Procera Alumina, Nobel Biocare, Göteborg, Sweden). Despite the differences in their microstructure, composition, processing methods and intraoral area (anterior or posterior), most

MULTIUNIT PROSTHESES

Two manufacturers have recommended their all-ceramic systems for anterior three-unit pros-theses: a glass-infiltrated alumina (In-Ceram Alumina) and a lithium disilicate–based glass-ceramic (IPS Empress 2 [now IPS e.max Press]).3 Some clinical studies also reported using In-Ceram Alumina for fixed partial dentures (FPDs) involving posterior teeth (Table 219,20,40,41,45, 46, 47, 48, 49, 50, 51). In a three-year study of 61 three-unit FPDs (In-Ceram Alumina), Sorensen and colleagues45 reported

CONCLUSIONS

In this review, we presented current evidence suggesting that all-ceramic restorations have an acceptable clinical longevity that accompanies their long-lasting esthetic advantages. Evidence from many clinical studies suggests that clinicians may choose from any all-ceramic system on the basis of patients' esthetic needs for veneers, intracoronal restorations and full-coverage restorations for single-rooted anterior teeth. Only a few systems have been successful for the restoration of molars,

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  • Cited by (0)

    Disclosure. Dr. Kelly has served as a consultant for and received research funding from Ivoclar Vivadent, Amherst, N.Y., and Vita Zahnfabrik, Bad Säckingen, Germany. Dr. Della Bona did not report any disclosures.

    1

    Dr. Kelly is a professor, Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington. He also is the guest editor of this supplement.

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