The clinical success of tooth‐ and implant‐supported zirconia‐based fixed dental prostheses. A systematic review

The aim was to make an inventory of the current literature on the clinical performance of tooth‐ or implant‐supported zirconia‐based FDPs and analyse and discuss any complications. Electronic databases, PubMed.gov, Cochrane Library and Science Direct, were searched for original studies reporting on the clinical performance of tooth‐ or implant‐supported zirconia‐based FDPs. The electronic search was complemented by manual searches of the bibliographies of all retrieved full‐text articles and reviews, as well as a hand search of the following journals: International Journal of Prosthodontics, Journal of Oral Rehabilitation, International Journal of Oral & Maxillofacial Implants and Clinical Oral Implants Research. The search yielded 4253 titles. Sixty‐eight potentially relevant full‐text articles were retrieved. After applying pre‐established criteria, 27 studies were included. Twenty‐three studies reported on tooth‐supported and 4 on implant‐supported FDPs. Five of the studies were randomised, comparing Y‐TZP‐based restorations with metal–ceramic or other all‐ceramic restorations. Most tooth‐supported FDPs were FDPs of 3–5 units, whereas most implant‐supported FDPs were full arch. The majority of the studies reported on 3‐ to 5‐year follow‐up. Life table analysis revealed cumulative 5‐year survival rates of 93·5% for tooth‐supported and 100% for implant‐supported FDPs. For tooth‐supported FDPs, the most common reasons for failure were veneering material fractures, framework fractures and caries. Cumulative 5‐year complication rates were 27·6% and 30·5% for tooth‐ and implant‐supported FDPs, respectively. The most common complications were veneering material fractures for tooth‐ as well as implant‐supported FDPs. Loss of retention occurred more frequently in FDPs luted with zinc phosphate or glass–ionomer cement compared to those luted with resin cements. The results suggest that the 5‐year survival rate is excellent for implant‐supported zirconia‐based FDPs, despite the incidence of complications, and acceptable for tooth‐supported zirconia‐based FDPs. These results are, however, based on a relatively small number of studies, especially for the implant‐supported FDPs. The vast majority of the studies are not controlled clinical trials and have limited follow‐up. Thus, interpretation of the results should be made with caution. Well‐designed studies with large patient groups and long follow‐up times are needed before general recommendations for the use of zirconia‐based restorations can be provided.