Skip to main content

Advertisement

Log in

Clinical evaluation of zirconia-based all-ceramic single crowns: an up to 12-year retrospective cohort study

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

This study aims to investigate the incidence of clinical complications with tooth-supported zirconia-based all-ceramic single crowns and identify pertinent risk parameters.

Materials and methods

A retrospective cohort study (May 2004 to April 2016) utilizing clinical records of patients receiving yttrium-oxide–partially stabilized zirconia (Y-TZP)-based all-ceramic crowns placed at Tohoku University Hospital was performed. The length of time of treatment success (complication event-free) and restoration survival (including minor complication events and remaining clinically functional) were estimated using Kaplan–Meier analysis. Multilevel survival analysis was used to identify risk factors.

Results

One hundred thirty-seven crowns were evaluated (mean follow-up time, 7.0 years). A total of 21 crowns experienced at least one complication with fracture of veneering ceramic being the most common (16 crowns). Estimated success and survival rates at 5 years (96.9 and 98.5%, respectively) decreased at 10 years to 62.1 and 67.2%, respectively. The risk of complications was significantly higher for molar crowns compared to anterior crowns (p < 0.01). A significant association of complications with metal antagonist restorations was shown by univariate analysis (p < 0.01).

Conclusions

Given the study limitations, Y-TZP single crowns placed on anterior teeth demonstrated encouraging clinical results over a period of up to 10 years. However, there is a substantial risk of complications with posterior teeth within 10 years of restoration placement.

Clinical relevance

Treatment with zirconia-based all-ceramic crowns for molar teeth with metal antagonist occlusion should be undertaken with caution.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Raigrodski AJ, Chiche GJ (2001) The safety and efficacy of anterior ceramic fixed partial dentures: a review of the literature. J Prosthet Dent 86:520–525

    Article  PubMed  Google Scholar 

  2. Walton TR (2013) The up to 25-year survival and clinical performance of 2,340 high gold-based metal-ceramic single crowns. Int J Prosthodont 26:151–160

    Article  PubMed  Google Scholar 

  3. Ko N, Mine A, Egusa H, Shimazu T, Ko R, Nakano T, Yatani H (2014) Allergic reaction to titanium-made fixed dental restorations: a clinical report. J Prosthodont 23:501–303

    Article  PubMed  Google Scholar 

  4. Hosoki M, Nishigawa K, Miyamoto Y, Ohe G, Matsuka Y (2016) Allergic contact dermatitis caused by titanium screws and dental implants. J Prosthodont Res 60:213–219

    Article  PubMed  Google Scholar 

  5. Sailer I, Makarov NA, Thoma DS, Zwahlen M, Pjetursson BE (2015) All-ceramic or metal-ceramic tooth-supported fixed dental prostheses (FDPS)? A systematic review of the survival and complication rates. Part I: single crowns (SCS). Dent Mater 31:603–623

    Article  PubMed  Google Scholar 

  6. Denry I, Kelly JR (2014) Emerging ceramic-based materials for dentistry. J Dent Res 93:1235–1242

    Article  PubMed  PubMed Central  Google Scholar 

  7. Li RW, Chow TW, Matinlinna JP (2014) Ceramic dental biomaterials and CAD/CAM technology: state of the art. J Prosthodont Res 58:208–216

    Article  PubMed  Google Scholar 

  8. Alghazzawi TF (2016) Advancements in CAD/CAM technology: options for practical implementation. J Prosthodont Res 60:72–84

    Article  PubMed  Google Scholar 

  9. Miyazaki T, Nakamura T, Matsumura H, Ban S, Kobayashi T (2013) Current status of zirconia restoration. J Prosthodont Res 57:236–261

    Article  PubMed  Google Scholar 

  10. Ernst CP, Cohnen U, Stender E, Willershausen B (2005) In vitro retentive strength of zirconium oxide ceramic crowns using different luting agents. J Prosthet Dent 93:551–558

    Article  PubMed  Google Scholar 

  11. Raigrodski AJ, Chiche GJ, Potiket N, Hochstedler JL, Mohamed SE, Billiot S, Mercante DE (2006) The efficacy of posterior three-unit zirconium-oxide-based ceramic fixed partial dental prostheses: a prospective clinical pilot study. J Prosthet Dent 96:237–244

    Article  PubMed  Google Scholar 

  12. Kimmich M, Stappert CF (2013) Intraoral treatment of veneering porcelain chipping of fixed dental restorations: a review and clinical application. J Am Dent Assoc 144:31–44

    Article  PubMed  Google Scholar 

  13. Rinke S, Schafer S, Lange K, Gersdorff N, Roediger M (2013) Practice-based clinical evaluation of metal-ceramic and zirconia molar crowns: 3-year results. J Oral Rehabil 40:228–237

    Article  PubMed  Google Scholar 

  14. Sax C, Hammerle CH, Sailer I (2011) 10-year clinical outcomes of fixed dental prostheses with zirconia frameworks. Int J Comput Dent 14:183–202

    PubMed  Google Scholar 

  15. Gherlone E, Mandelli F, Cappare P, Pantaleo G, Traini T, Ferrini F (2014) A 3 years retrospective study of survival for zirconia-based single crowns fabricated from intraoral digital impressions. J Dent 42:1151–1155

    Article  PubMed  Google Scholar 

  16. Guncu MB, Cakan U, Muhtarogullari M, Canay S (2015) Zirconia-based crowns up to 5 years in function: a retrospective clinical study and evaluation of prosthetic restorations and failures. Int J Prosthodont 28:152–157

    Article  PubMed  Google Scholar 

  17. Monaco C, Caldari M, Scotti R, Agnini A, Barazzutti F, Bianchessi C, Biscaro L, Billi M, Boni M, Calesini G, Carboncini F, Cortellini D, Maglione M, Manicone PF, Micarelli C, Noe G, Poggio C, Risciotti E, Valenti M, Grp A (2015) Clinical evaluation of tooth-supported zirconia-based fixed dental prostheses: a retrospective cohort study from the AIOP clinical research group. Int J Prosthodont 28:236–238

    Article  PubMed  Google Scholar 

  18. Koenig V, Vanheusden AJ, Le Goff SO, Mainjot AK (2013) Clinical risk factors related to failures with zirconia-based restorations: an up to 9-year retrospective study. J Dent 41:1164–1174

    Article  PubMed  Google Scholar 

  19. Poggio CE, Dosoli R, Ercoli C (2012) A retrospective analysis of 102 zirconia single crowns with knife-edge margins. J Prosthet Dent 107:316–321

    Article  PubMed  Google Scholar 

  20. Monaco C, Caldari M, Scotti R, Agnini A, Barazzutti F, Bianchessi C, Biscaro L, Billi M, Boni F, Calesini G, Carboncini F, Cortellini D, Maglione M, Manicone PF, Micarelli C, Noe G, Poggio C, Risciotti E, Valenti M, Mascarella PD, Grp ACR (2013) Clinical evaluation of 1,132 zirconia-based single crowns: a retrospective cohort study from the AIOP clinical research group. Int J Prosthodont 26:435–442

    Article  PubMed  Google Scholar 

  21. Rinke S, Kramer K, Burgers R, Roediger M (2016) A practice-based clinical evaluation of the survival and success of metal-ceramic and zirconia molar crowns: 5-year results. J Oral Rehabil 43:136–144

    Article  PubMed  Google Scholar 

  22. Passia N, Stampf S, Strub JR (2013) Five-year results of a prospective randomised controlled clinical trial of posterior computer-aided design-computer-aided manufacturing ZrSiO4–ceramic crowns. J Oral Rehabil 40:609–617

    Article  PubMed  Google Scholar 

  23. Aldegheishem A, Ioannidis G, Att W, Petridis H (2017) Success and survival of various types of all-ceramic single crowns: a critical review and analysis of studies with a mean follow-up of 5 years or longer. Int J Prosthodont 30:168–181

    Article  PubMed  Google Scholar 

  24. Hess DR (2004) Retrospective studies and chart reviews. Respir Care 49:1171–1174

    PubMed  Google Scholar 

  25. Nejatidanesh F, Moradpoor H, Savabi O (2016) Clinical outcomes of zirconia-based implant- and tooth-supported single crowns. Clin Oral Investig 20:169–178

    Article  PubMed  Google Scholar 

  26. Takeichi T, Miura S, Kasahara S, Egusa H, Hara M, Sato T, Yoshinari M, Odatsu T, Watanabe I, Sawase T (2015) Update zirconia restorations. J Prosthodont Res 59:81–83

    Article  PubMed  Google Scholar 

  27. Tang X, Nakamura T, Usami H, Wakabayashi K, Yatani H (2012) Effects of multiple firings on the mechanical properties and microstructure of veneering ceramics for zirconia frameworks. J Dent 40:372–380

    Article  PubMed  Google Scholar 

  28. Heintze SD, Rousson V (2010) Survival of zirconia- and metal-supported fixed dental prostheses: a systematic review. Int J Prosthodont 23:493–502

    PubMed  Google Scholar 

  29. Tartaglia GM, Sidoti E, Sforza C (2015) Seven-year prospective clinical study on zirconia-based single crowns and fixed dental prostheses. Clin Oral Investig 19:1137–1145

    Article  PubMed  Google Scholar 

  30. Haff A, Lof H, Gunne J, Sjogren G (2015) A retrospective evaluation of zirconia-fixed partial dentures in general practices: an up to 13-year study. Dent Mater 31:162–170

    Article  PubMed  Google Scholar 

  31. Chaar MS, Passia N, Kern M (2015) Ten-year clinical outcome of three-unit posterior FDPs made from a glass-infiltrated zirconia reinforced alumina ceramic (In-Ceram Zirconia). J Dent 43:512–517

    Article  PubMed  Google Scholar 

  32. Ortorp A, Kihl ML, Carlsson GE (2009) A 3-year retrospective and clinical follow-up study of zirconia single crowns performed in a private practice. J Dent 37:731–736

    Article  PubMed  Google Scholar 

  33. Larsson C, Wennerberg A (2014) The clinical success of zirconia-based crowns: a systematic review. Int J Prosthodont 27:33–43

    Article  PubMed  Google Scholar 

  34. Ortorp A, Kihl ML, Carlsson GE (2012) A 5-year retrospective study of survival of zirconia single crowns fitted in a private clinical setting. J Dent 40:527–530

    Article  PubMed  Google Scholar 

  35. Tanaka S, Takaba M, Ishiura Y, Kamimura E, Baba K (2015) A 3-year follow-up of ceria-stabilized zirconia/alumina nanocomposite (Ce-TZP/A) frameworks for fixed dental prostheses. J Prosthodont Res 59:55–61

  36. Tanimoto Y (2015) Dental materials used for metal-free restorations: recent advances and future challenges. J Prosthodont Res 59:213–215

    Article  PubMed  Google Scholar 

  37. Denry I, Kelly JR (2008) State of the art of zirconia for dental applications. Dent Mater 24:299–307

    Article  PubMed  Google Scholar 

  38. Sailer I, Gottnerb J, Kanelb S, Hammerle CH (2009) Randomized controlled clinical trial of zirconia-ceramic and metal-ceramic posterior fixed dental prostheses: a 3-year follow-up. Int J Prosthodont 22:553–560

    PubMed  Google Scholar 

  39. Anusavice KJ (2012) Standardizing failure, success, and survival decisions in clinical studies of ceramic and metal-ceramic fixed dental prostheses. Dent Mater 28:102–111

    Article  PubMed  PubMed Central  Google Scholar 

  40. Rosentritt M, Steiger D, Behr M, Handel G, Kolbeck C (2009) Influence of substructure design and spacer settings on the in vitro performance of molar zirconia crowns. J Dent 37:978–983

    Article  PubMed  Google Scholar 

  41. Guess PC, Bonfante EA, Silva NR, Coelho PG, Thompson VP (2013) Effect of core design and veneering technique on damage and reliability of Y-TZP-supported crowns. Dent Mater 29:307–316

    Article  PubMed  Google Scholar 

  42. Preis V, Letsch C, Handel G, Behr M, Schneider-Feyrer S, Rosentritt M (2013) Influence of substructure design, veneer application technique, and firing regime on the in vitro performance of molar zirconia crowns. Dent Mater 29:e113–e121

    Article  PubMed  Google Scholar 

  43. Ferrari M, Sorrentino R, Cagidiaco C, Goracci C, Vichi A, Gherlone E, Zarone F (2015) Short-term clinical performance of zirconia single crowns with different framework designs: 3-year clinical trial. Am J Dent 28:235–240

    PubMed  Google Scholar 

  44. Ferrari M, Giovannetti A, Carrabba M, Bonadeo G, Rengo C, Monticelli F, Vichi A (2014) Fracture resistance of three porcelain-layered CAD/CAM zirconia frame designs. Dent Mater 30:e163–e168

    Article  PubMed  Google Scholar 

  45. Okabayashi S, Nomoto S, Sato T, Miho O (2013) Influence of proximal supportive design of zirconia framework on fracture load of veneering porcelain. Dent Mater J 32:572–577

    Article  PubMed  Google Scholar 

  46. Oilo M, Kvam K, Gjerdet NR (2016) Load at fracture of monolithic and bilayered zirconia crowns with and without a cervical zirconia collar. J Prosthet Dent 115:630–636

    Article  PubMed  Google Scholar 

  47. Wolfart S, Harder S, Eschbach S, Lehmann F, Kern M (2009) Four-year clinical results of fixed dental prostheses with zirconia substructures (Cercon): end abutments vs. cantilever design. Eur J Oral Sci 117:741–749

    Article  PubMed  Google Scholar 

  48. Guazzato M, Walton TR, Franklin W, Davis G, Bohl C, Klineberg I (2010) Influence of thickness and cooling rate on development of spontaneous cracks in porcelain/zirconia structures. Aust Dent J 55:306–310

    Article  PubMed  Google Scholar 

  49. Benetti P, Kelly JR, Della Bona A (2013) Analysis of thermal distributions in veneered zirconia and metal restorations during firing. Dent Mater 29:1166–1172

    Article  PubMed  Google Scholar 

  50. Tholey MJ, Swain MV, Thiel N (2011) Thermal gradients and residual stresses in veneered Y-TZP frameworks. Dent Mater 27:1102–1110

    Article  PubMed  Google Scholar 

  51. Habib SR, Asiri W, Hefne MJ (2014) Effect of anatomic, semi-anatomic and non-anatomic occlusal surface tooth preparations on the adaptation of zirconia copings. J Adv Prosthodont 6:444–450

    Article  PubMed  PubMed Central  Google Scholar 

  52. Miura S, Inagaki R, Kasahara S, Yoda M (2014) Fit of zirconia all-ceramic crowns with different cervical margin designs, before and after porcelain firing and glazing. Dent Mater J 33:484–489

    Article  PubMed  Google Scholar 

  53. Wang X, Fan D, Swain MV, Zhao K (2012) A systematic review of all-ceramic crowns: clinical fracture rates in relation to restored tooth type. Int J Prosthodont 25:441–450

    PubMed  Google Scholar 

  54. Guncu MB, Cakan U, Aktas G, Guncu GN, Canay S (2016) Comparison of implant versus tooth-supported zirconia-based single crowns in a split-mouth design: a 4-year clinical follow-up study. Clin Oral Investig 20:2467–2473

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful to Dr. Masanobu Yoda for his valuable support to initiate and accomplish this work. The authors thank Dr. Shihoko Koyama and Dr. Masahiro Yamada for providing us with helpful comments on this study, as well as colleagues in our department for their invaluable assistance in the conduct of the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hiroshi Egusa.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Funding

This work was supported by Grant-in Aids for Scientific Research (C: 26462908, C: 15K11145, and C: 17K11739) from the Japan Society for the Promotion of Science.

Ethical approval

This study was performed following a protocol approved by the Research Ethics Committee of Tohoku University, Graduate School of Dentistry (approved number 25-3).

Informed consent

Informed consent of patients was verbally obtained to conduct this study. This study was a retrospective, non-interventional clinical study without the need for a formal consent in accordance with the ethical standards of the institutional and/or national research committee.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Miura, S., Kasahara, S., Yamauchi, S. et al. Clinical evaluation of zirconia-based all-ceramic single crowns: an up to 12-year retrospective cohort study. Clin Oral Invest 22, 697–706 (2018). https://doi.org/10.1007/s00784-017-2142-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-017-2142-y

Keywords

Navigation