Cochrane · intervention · CD009606
Metal‐free materials for fixed prosthodontic restorations
Poggio, CE, Ercoli, C, Rispoli, L, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
48
current version
GRADE rated
29
No studies
7
Included studies
9
as reported
No studies 7 · 14.6%Ungraded 12 · 25%Very low 29 · 60.4%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adult patients (18 years of age or older) who received fixed prosthodontic restorative treatment | 448 adult participants across nine trials (n=448) |
| Intervention | All types of metal-free materials for fixed prosthodontic treatment (single crowns, fixed dental prostheses (FDPs), complete arch prostheses; tooth-supported or implant-supported components including metal-free abutments). Studies comparing implant materials were excluded | Metal-free single crowns full-contour zirconia (n=1); Metal-free FDPs lithium disilicate (n=1); Metal-free FDPs zirconia ceramic (n=1); Metal-free cantilevered FDPs (n=1); Metal-free implant-supported single crowns zirconia (n=1); Metal-free implant abutments zirconia (n=2); Metal-free implant-supported FDPs zirconia-toughened alumina (n=1); Metal-free tooth-supported FDPs pressed veneering (n=1) |
| Comparison | Metal-ceramic (MC) or other conventional all-metal materials; or a different metal-free system (compared among themselves) | Cast gold single crowns (n=1); Metal-ceramic FDPs (n=2); Metal-ceramic cantilevered FDPs (n=1); Metal-ceramic implant-supported single crowns (n=1); Metal implant abutments titanium (n=2); Metal-free implant-supported FDPs yttria-stabilized tetragonal zirconia (n=1); Metal-free tooth-supported FDPs layered veneering (n=1) |
| Outcomes | Primary: failure of the prosthesis; complications; aesthetic evaluation (by dentist, by patient, patient aesthetic preference in split-mouth studies). Secondary: periodontal or peri-implant status (plaque index, bleeding on probing, probing attachment level, gingival recession, marginal bone level); occlusal wear | Failure of the prosthesis (n=9); Complications (n=9); Aesthetic evaluation (n=4); Periodontal or peri-implant status (n=3) |
| Study designs | Randomised controlled trials (RCTs) with a minimum follow-up of 12 months; parallel-group and split-mouth designs; trials in primary or secondary care; quasi-randomised trials excluded | RCT (n=9) |
| Timing | Minimum follow-up of 12 months | Failure and complications assessed at 12 months (all trials) and up to 24, 36, 60, 72 or 120 months depending on the comparison |
Search date: 2017-05. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid
Questions and results
Show all 2 versionsMetal-free single crowns (full-contour zirconia) vs Cast gold (conventional metal) single crowns
Population: Adults (18 years or older) needing a single crown in the molar or premolar region
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Crown failure 12 months | OR 0.83 [0.05, 13.44] | 1 study · 194 participants | Very low Downgraded: risk of bias, imprecision |
Crown complications 12 months | OR 4.31 [0.49, 37.57] | 1 study · 194 participants | Very low Downgraded: risk of bias, imprecision |
Crown complications 60 months | OR 1.44 [0.59, 3.52] | 1 study · 158 participants | Very low Downgraded: risk of bias, imprecision |
Aesthetic evaluation | No data were presented with regard to aesthetics. | 0 studies | No studies |
Crown failure 60 months | OR 17.52 [5.07, 60.54] | 1 study · 158 participants | Very low Downgraded: risk of bias, imprecision |
Periodontal/peri-implant status and occlusal wear (secondary outcomes) | No data were presented for any of the pre-specified secondary outcomes. | 0 studies | No studies |
Metal-free FDPs (lithium disilicate) vs Metal-ceramic FDPs
Population: Adults (18 years or older) needing a three-unit fixed dental prosthesis (FDP)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Bridge complications 72 months | OR 0.07 [0.01, 0.75] | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision |
Bridge failure 72 months | OR 6.86 [0.66, 71.72] | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision |
Aesthetic evaluation | No data were presented with regard to aesthetics. | 0 studies | No studies |
Bridge failure 12 months | OR 9.00 [0.96, 84.50] | 1 study · 37 participants | Very low Downgraded: risk of bias, imprecision |
Periodontal/peri-implant status and occlusal wear (secondary outcomes) | No data were presented for any of the pre-specified secondary outcomes. | 0 studies | No studies |
Metal-free FDPs (zirconia ceramic) vs Metal-ceramic FDPs
Population: Adults (18 years or older) needing a three-unit fixed dental prosthesis (FDP)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Periodontal/peri-implant status (secondary outcomes) | No data were presented for any of the pre-specified secondary outcomes. The trial registered pocket depth, bleeding on probing and mobility at follow-up visits but did not report the data. | 0 studies | No studies |
Bridge failure 12 and 36 months | At 12 months and at 36 months 34 participants were available for analysis. No FDP failure was reported in either treatment approach at either time. | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision |
Bridge complications 36 months | OR 1.94 [0.38, 9.88] | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision |
Aesthetic evaluation (patient aesthetic satisfaction changes) 36 months | OR 15.40 [0.78, 304.61] | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision |
Metal-free cantilevered FDPs (feldspathic-veneered zirconia) vs Metal-ceramic cantilevered FDPs
Population: Adults (18 years or older) needing replacement of one premolar or incisor with a cantilevered fixed dental prosthesis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cantilevered bridge complications 24 months | OR 5.59 [0.23, 133.61] | 1 study · 19 participants | Very low Downgraded: risk of bias, imprecision |
Cantilevered bridge failure 12, 24 and 36 months | At 12 months 19 participants were available; no failure and no complication were reported in either group. No failure was reported at 24 or 36 months. | 1 study · 19 participants | Very low Downgraded: risk of bias, imprecision |
Gingival index (GI) 24 months | MD 0.03 [-0.75, 0.81] | 1 study · 19 participants | Ungraded |
Plaque index (PI) 24 months | MD -0.10 [-1.04, 0.84] | 1 study · 19 participants | Ungraded |
Cantilevered bridge complications 36 months | OR 2.00 [0.15, 26.73] | 1 study · 19 participants | Very low Downgraded: risk of bias, imprecision |
Aesthetic evaluation (patient VAS) 24 months | MD -0.34 [-0.85, 0.17] | 1 study · 19 participants | Very low Downgraded: risk of bias, imprecision |
Metal-free implant-supported single crowns (zirconia veneered with feldspathic ceramic) vs Metal-ceramic implant-supported single crowns
Population: Adults (18 years or older) with one missing tooth in the aesthetic zone needing an implant-supported single crown
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Aesthetic evaluation (patient satisfaction VAS) 24 months | MD -0.03 [-7.65, 7.59] | 1 study · 18 participants | Very low Downgraded: risk of bias, imprecision |
Aesthetic evaluation (patient satisfaction VAS) 12 months | MD -4.65 [-18.75, 9.45] | 1 study · 18 participants | Very low Downgraded: risk of bias, imprecision |
Marginal bone level (first bone to implant contact, FBIC) 24 months · Mesial to crown | MD -0.01 [-0.93, 0.91] | 1 study · 18 participants | Ungraded |
Marginal bone level (first bone to implant contact, FBIC) 12 months · Mesial to crown | MD -0.03 [-0.42, 0.36] | 1 study · 18 participants | Ungraded |
Aesthetic evaluation (pink and white aesthetic score, PES and WES total) 24 months | MD -0.77 [-3.00, 1.46] | 1 study · 18 participants | Very low Downgraded: risk of bias, imprecision |
Marginal bone level (first bone to implant contact, FBIC) 24 months · Distal to crown | MD -0.18 [-0.89, 0.53] | 1 study · 18 participants | Ungraded |
Implant crown failure 12 and 24 months | At 12 and 24 months 18 participants were available. No failure was reported for the test or control groups at either 12 or 24 months. | 1 study · 18 participants | Very low Downgraded: risk of bias, imprecision |
Marginal bone level (first bone to implant contact, FBIC) 12 months · Distal to crown | MD 0.09 [-0.28, 0.46] | 1 study · 18 participants | Ungraded |
Implant crown complications 24 months | OR 6.33 [0.26, 152.86] | 1 study · 18 participants | Very low Downgraded: risk of bias, imprecision |
Metal-free implant abutments (zirconia) vs Metal implant abutments (titanium)
Population: Adults (18 years or older) with one missing tooth in the aesthetic zone needing an implant-supported single crown on an abutment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Gingival/mucosal recession (REC) 12 months | MD 0.00 [-0.22, 0.22] | 2 studies · 47 participants | Ungraded |
Implant probing pocket depth (PPD) 12 months | MD -0.22 [-0.60, 0.16] | 2 studies · 47 participants | Ungraded |
Marginal bone level change (MBLC) 12 months · Distal | MD -0.05 [-0.15, 0.04] | 2 studies · 47 participants | Ungraded |
Abutment failure 12 months | OR 7.63 [0.33, 177.14] | 2 studies · 47 participants | Very low Downgraded: risk of bias, imprecision |
Marginal bone level change (MBLC) 12 months · Mesial | MD -0.39 [-0.43, -0.35] | 2 studies · 47 participants | Ungraded |
Complications 12 months | At 12 months no complications were reported in either group. | 2 studies · 47 participants | Very low Downgraded: risk of bias, imprecision |
Aesthetic evaluation (Implant Crown Aesthetic Index, ICAI) 12 months | Primary outcome aesthetic evaluation data were reported as the frequency of distribution of the Implant Crown Aesthetic Index (ICAI); no comparative summary estimate was presented. | 2 studies · 47 participants | Very low Downgraded: risk of bias, imprecision |
Metal-free implant-supported FDPs (zirconia-toughened alumina; In-Ceram Zirconia) vs Metal-free implant-supported FDPs (yttria-stabilized tetragonal zirconia; Denzir)
Population: Adults (18 years or older) needing an implant-supported fixed dental prosthesis in the posterior region
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Periodontal/peri-implant status (secondary outcomes) | No data were presented for any of the pre-specified secondary outcomes. Follow-up visits registered pocket depth, bleeding on probing and mobility but the data were not reported. | 0 studies | No studies |
Aesthetic evaluation | No data were presented with regard to aesthetics. | 0 studies | No studies |
Bridge complications 60 months | OR 0.02 [0.00, 0.42] | 1 study · 18 participants | Very low Downgraded: risk of bias, imprecision |
Bridge complications 36 months | OR 0.02 [0.00, 0.30] | 1 study · 18 participants | Very low Downgraded: risk of bias, imprecision |
Bridge failure 12, 36, 60 and 120 months | No FDP failures were reported in either group at 12, 36, 60 or 120 months (18 participants; 17 at 120 months). | 1 study · 18 participants | Very low Downgraded: risk of bias, imprecision |
Bridge complications 12 months | OR 0.04 [0.00, 0.48] | 1 study · 18 participants | Very low Downgraded: risk of bias, imprecision |
Bridge complications 120 months | OR 0.02 [0.00, 0.48] | 1 study · 17 participants | Very low Downgraded: risk of bias, imprecision |
Metal-free tooth-supported FDPs (pressed veneering ceramic) vs Metal-free tooth-supported FDPs (layered veneering ceramic)
Population: Adults (18 years or older) needing a three-unit tooth-supported fixed dental prosthesis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Aesthetic evaluation | No comparative data were presented with regard to aesthetics. Aesthetics evaluated by the patient was reported dichotomously (yes/no) in the trial but no between-group estimate was presented. | 1 study | Ungraded |
Periodontal/peri-implant status (secondary outcomes) | No comparative data were presented for the pre-specified secondary outcomes. The trial analyzed and reported plaque index, bleeding on probing and pocket probing depth but no between-group estimate was presented in the… | 1 study | Ungraded |
Bridge failure 12 and 36 months | At 12 months 40 participants were available and at 36 months 36 participants were available. No FDP failures were reported in either group at either time. | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision |
Bridge complications 36 months | OR 2.80 [0.66, 11.92] | 1 study · 36 participants | Very low Downgraded: risk of bias, imprecision |