Non-Cochrane · intervention · PM42104738
Systematic Review Evaluating the Influence of Veneering Design on the Clinical Outcome of All-Ceramic Implant-Supported 3-4 Units and Full Arch Fixed Dental Prostheses.
Bishti Shaza, Wolfart Stefan, Zwahlen Marcel, et al. · Journal of esthetic and restorative dentistry : official publication of the American Academy of Esthetic Dentistry ... [et al.] · 2026 · PubMed · doi:10.1111/jerd.70177
Findings
31 findings
| Population | ||||
|---|---|---|---|---|
| Partially or completely edentulous patients with posterior implant-supported 3-4 unit all-ceramic FDPs | All-ceramic implant-supported 3-4 unit FDPs (monolithic, micro-veneered or veneered), all designs combined | None (single-arm pooled event rates) | Complications: annual complication rate Annual · University and private clinic | Annual complication rate (%) 3.75 [1.31, 10.7] GRADE not reported 7 studies |
| Partially or completely edentulous patients with posterior implant-supported 3-4 unit all-ceramic FDPs | All-ceramic implant-supported 3-4 unit FDPs (monolithic, micro-veneered or veneered), all designs combined | None (single-arm pooled event rates) | Survival: annual failure rate Annual (mean follow-up 2.8 years) · University and private clinic | Annual failure rate (%) 0.46 [0.24, 0.88] GRADE not reported 9 studies · 330 restorations participants |
| Partially or completely edentulous patients with posterior implant-supported 3-4 unit all-ceramic FDPs | All-ceramic implant-supported 3-4 unit FDPs (monolithic, micro-veneered or veneered), all designs combined | None (single-arm pooled event rates) | Complications: 3-year complication-free (success) rate 3 years · University and private clinic | 3-year complication-free rate (%) 89.36 [72.55, 96.14] GRADE not reported 7 studies |
| Partially or completely edentulous patients with posterior implant-supported 3-4 unit all-ceramic FDPs | All-ceramic implant-supported 3-4 unit FDPs (monolithic, micro-veneered or veneered), all designs combined | None (single-arm pooled event rates) | Chipping: 3-year chipping-free rate 3 years · University and private clinic | 3-year chipping-free rate (%) 93.77 [80.17, 98.14] GRADE not reported 8 studies |
| Partially or completely edentulous patients with posterior implant-supported 3-4 unit all-ceramic FDPs | All-ceramic implant-supported 3-4 unit FDPs (monolithic, micro-veneered or veneered), all designs combined | None (single-arm pooled event rates) | Survival: 3-year survival rate 3 years · University and private clinic | 3-year survival rate (%) 98.64 [97.40, 99.29] GRADE not reported 9 studies · 330 restorations participants |
| Partially or completely edentulous patients with posterior implant-supported 3-4 unit all-ceramic FDPs | All-ceramic implant-supported 3-4 unit FDPs (monolithic, micro-veneered or veneered), all designs combined | None (single-arm pooled event rates) | Chipping: annual chipping rate Annual · University and private clinic | Annual chipping rate (%) 2.15 [0.62, 7.37] GRADE not reported 8 studies |
| Partially or completely edentulous patients with implant-supported full-arch all-ceramic FDPs | All-ceramic implant-supported full-arch FDPs (monolithic, micro-veneered or veneered), all designs combined | None (single-arm pooled event rates) | Chipping: 3-year chipping-free rate 3 years · University and private clinic | 3-year chipping-free rate (%) 81.23 [77.31, 84.55] GRADE not reported 3 studies |
| Partially or completely edentulous patients with implant-supported full-arch all-ceramic FDPs | All-ceramic implant-supported full-arch FDPs (monolithic, micro-veneered or veneered), all designs combined | None (single-arm pooled event rates) | Survival: 3-year survival rate 3 years · University and private clinic | 3-year survival rate (%) 96.45 [88.95, 98.88] GRADE not reported 3 studies · 210 restorations participants |
| Partially or completely edentulous patients with implant-supported full-arch all-ceramic FDPs | All-ceramic implant-supported full-arch FDPs (monolithic, micro-veneered or veneered), all designs combined | None (single-arm pooled event rates) | Complications: annual complication rate Annual · University and private clinic | Annual complication rate (%) 9.34 [6.15, 14.17] GRADE not reported 3 studies |
| Partially or completely edentulous patients with implant-supported full-arch all-ceramic FDPs | All-ceramic implant-supported full-arch FDPs (monolithic, micro-veneered or veneered), all designs combined | None (single-arm pooled event rates) | Chipping: annual chipping rate Annual · University and private clinic | Annual chipping rate (%) 6.93 [5.59, 8.58] GRADE not reported 3 studies |
| Partially or completely edentulous patients with implant-supported full-arch all-ceramic FDPs | All-ceramic implant-supported full-arch FDPs (monolithic, micro-veneered or veneered), all designs combined | None (single-arm pooled event rates) | Complications: 3-year complication-free (success) rate 3 years · University and private clinic | 3-year complication-free rate (%) 75.57 [65.37, 83.14] GRADE not reported 3 studies |
| Partially or completely edentulous patients with implant-supported full-arch all-ceramic FDPs | All-ceramic implant-supported full-arch FDPs (monolithic, micro-veneered or veneered), all designs combined | None (single-arm pooled event rates) | Survival: annual failure rate Annual (mean follow-up 2.4 years) · University and private clinic | Annual failure rate (%) 1.2 [0.37, 3.9] GRADE not reported 3 studies · 210 restorations participants |
| Patients with posterior implant-supported 3-4 unit all-ceramic FDPs | Monolithic (including micro-veneered) zirconia FDPs | Veneered all-ceramic FDPs | Complication rate University and private clinic · 3-4 unit FDPs Unresolved: the two extractors disagree on this row. | Statistically significant difference between monolithic and veneered restorations in terms of complication and failure rate (p < 0.05) GRADE not reported 9 studies |
| Patients with posterior implant-supported 3-4 unit all-ceramic FDPs | Monolithic (including micro-veneered) zirconia FDPs | Veneered all-ceramic FDPs | Chipping incidence University and private clinic · 3-4 unit FDPs | Monolithic and micro-veneered restorations exhibited significantly lower incidence rates for chipping (p < 0.0001) GRADE not reported 9 studies |
| Patients with posterior implant-supported 3-4 unit all-ceramic FDPs | Monolithic (including micro-veneered) zirconia FDPs | Veneered all-ceramic FDPs | Failure rate University and private clinic · 3-4 unit FDPs Unresolved: the two extractors disagree on this row. | Statistically significant difference between monolithic and veneered restorations in terms of complication and failure rate (p < 0.05) GRADE not reported 9 studies |
| Patients with implant-supported all-ceramic FDPs (3-4 unit and full-arch combined) | Micro-veneered all-ceramic FDPs | Monolithic all-ceramic FDPs | Complications (all types combined) University and private clinic · All restoration types (3-4 unit and full-arch) | IRR 2.3 GRADE not reported 12 studies |
| Patients with implant-supported all-ceramic FDPs (3-4 unit and full-arch combined) | Micro-veneered all-ceramic i-FDPs | Monolithic all-ceramic i-FDPs | Chipping 1 to 5 years follow-up | Significantly higher incidence rate ratio for micro-veneered than monolithic; no chipping in monolithic studies; value not reported GRADE not reported Studies not reported |
| Patients with implant-supported all-ceramic FDPs (3-4 unit and full-arch combined) | Micro-veneered all-ceramic i-FDPs | Monolithic all-ceramic i-FDPs | All complications 1 to 5 years follow-up | Incidence rate ratio (IRR) 2.3 GRADE not reported Studies not reported |
| Patients with implant-supported all-ceramic FDPs (3-4 unit and full-arch combined) | Micro-veneered all-ceramic FDPs | Monolithic all-ceramic FDPs | Chipping incidence University and private clinic · All restoration types (3-4 unit and full-arch) | micro-veneered and fully veneered restorations again showed significantly higher incidence rate ratios compared to monolithic designs; no chipping reported in any monolithic study GRADE not reported 12 studies |
| Patients with implant-supported all-ceramic FDPs (3-4 unit and full-arch combined) | Veneered all-ceramic i-FDPs | Monolithic all-ceramic i-FDPs | All complications 1 to 5 years follow-up | Incidence rate ratio (IRR) 2.8 GRADE not reported Studies not reported |
| Patients with implant-supported all-ceramic FDPs (3-4 unit and full-arch combined) | Veneered all-ceramic FDPs | Monolithic all-ceramic FDPs | Chipping incidence University and private clinic · All restoration types (3-4 unit and full-arch) | micro-veneered and fully veneered restorations again showed significantly higher incidence rate ratios compared to monolithic designs; no chipping reported in any monolithic study GRADE not reported 12 studies |
| Patients with implant-supported all-ceramic FDPs (3-4 unit and full-arch combined) | Veneered all-ceramic i-FDPs | Monolithic all-ceramic i-FDPs | Chipping 1 to 5 years follow-up | Significantly higher incidence rate ratio for fully veneered than monolithic; no chipping in monolithic studies; value not reported GRADE not reported Studies not reported |
| Patients with implant-supported all-ceramic FDPs (3-4 unit and full-arch combined) | Veneered all-ceramic FDPs | Monolithic all-ceramic FDPs | Complications (all types combined) University and private clinic · All restoration types (3-4 unit and full-arch) | IRR 2.8 GRADE not reported 12 studies |
| Patients with implant-supported all-ceramic FDPs | Full-arch i-FDPs | 3-4 unit i-FDPs | Complications and failure (any veneering design) 1 to 5 years follow-up Unresolved: the two extractors disagree on this row. | Statistically significant difference between 3-4 unit FDPs and full-arch restorations (p < 0.001); no effect size reported GRADE not reported Studies not reported |
| Patients with implant-supported all-ceramic FDPs (3-4 unit and full-arch combined) | Screw-retained restorations | Cement-retained restorations | Complication or failure rates University and private clinic · All restoration types (3-4 unit and full-arch) | IRR 1.15 GRADE not reported 12 studies |
| Patients with implant-supported all-ceramic FDPs | Full-arch FDPs | 3-4 unit FDPs | Rates reported (outcome not further specified) University and private clinic · Regardless of veneering design Unresolved: the two extractors disagree on this row. | statistically significant difference between 3 and 4-unit FDPs and full-arch restorations (p < 0.001) GRADE not reported 12 studies |
| Patients with implant-supported all-ceramic FDPs | Screw-retained i-FDPs | Cement-retained i-FDPs | Complications and failure 1 to 5 years follow-up | Incidence rate ratio (IRR) 1.15 GRADE not reported Studies not reported |
| Patients with implant-supported all-ceramic 3-4 unit posterior FDPs | Monolithic all-ceramic i-FDPs | Veneered all-ceramic i-FDPs | Complication and failure rate 1 to 5 years follow-up Unresolved: the two extractors disagree on this row. | Statistically significant difference between monolithic and veneered restorations in complication and failure rate (p < 0.05); no effect size or CI reported GRADE not reported Studies not reported |
| Patients with implant-supported all-ceramic FDPs | Micro-veneered all-ceramic i-FDPs (direct comparison) | Monolithic all-ceramic i-FDPs | Survival, success, failure and complications | None of the included studies directly compared micro-veneered with monolithic i-FDPs No studies found 0 studies |
| Patients with anterior implant-supported all-ceramic FDPs | Monolithic or micro-veneered all-ceramic i-FDPs | Veneered all-ceramic i-FDPs | Survival, success, failure and complications | No study reported on anterior i-FDPs No studies found 0 studies |
| Patients with implant-supported all-ceramic FDPs spanning 5 to 12 units | Monolithic or micro-veneered all-ceramic i-FDPs | Veneered all-ceramic i-FDPs | Survival, success, failure and complications | No study reported on spans between 5 and 12 restored units No studies found 0 studies |
Included primary studies 13
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Carames 2019 Full-arch implant-supported rehabilitations: A prospective study comparing porcelain-veneered zirconia frameworks to monolithic zirconia. PMID:30521106 | 2019 | this review only | not stated | not extracted yet |
| Cheng 2018 Clinical Results and Technical Complications of Posterior Implant-Supported Modified Monolithic Zirconia Single Crowns and Short-Span… PMID:29086467 | 2018 | this review only | not stated | not extracted yet |
| Degidi 2018 The Conometric Concept: A 5-Year Follow-up of Fixed Partial Monolithic Zirconia Restorations Supported by Cone-in-Cone Abutments. PMID:29641625 | 2018 | this review only | not stated | not extracted yet |
| Degidi 2021 Fixed Partial Restorations Made of a New Zirconia-Reinforced Lithium Silicate Material: A 2-Year Short-Term Report. PMID:33570518 | 2021 | this review only | not stated | not extracted yet |
| Derksen 2021 A Randomized Clinical Trial comparing the clinical fit of CAD/CAM monolithic zirconia Fixed Dental Prostheses (FDP) on ti-base abutments… PMID:33662051 | 2021 | this review only | not stated | not extracted yet |
| Esquivel-Upshaw 2020 Factors influencing the survival of implant-supported ceramic-ceramic prostheses: A randomized, controlled clinical trial DOI:10.1016/j.jjodo.2020.100017 | 2020 | this review only | not stated | not extracted yet |
| Esquivel-Upshaw 2020 Factors influencing the survival of implant-supported ceramic-ceramic prostheses: A randomized, controlled clinical trial. PMID:34059304 | 2020 | this review only | not stated | not extracted yet |
| Ferrini 2018 Digital versus Traditional Workflow for Posterior Maxillary Rehabilitations Supported by One Straight and One Tilted Implant: A 3-Year… PMID:30534562 | 2018 | this review only | not stated | not extracted yet |
| Koenig 2019 Clinical behavior of second-generation zirconia monolithic posterior restorations: Two-year results of a prospective study with Ex vivo… PMID:31722238 | 2019 | this review only | not stated | not extracted yet |
| Limmer 2014 Complications and patient-centered outcomes with an implant-supported monolithic zirconia fixed dental prosthesis: 1 year results. PMID:24393461 | 2014 | this review only | not stated | not extracted yet |
| Papaspyridakos 2013 Computer-assisted design/computer-assisted manufacturing zirconia implant fixed complete prostheses: clinical results and technical… PMID:22413889 | 2013 | this review only | not stated | not extracted yet |
| Pol 2020 Implant-Supported Three-Unit Fixed Dental Prosthesis Using Coded Healing Abutments and Fabricated Using a Digital Workflow: A 1-Year… PMID:33284902 | 2020 | this review only | not stated | not extracted yet |
| Spies 2018 Clinical and patient-reported outcomes of zirconia-based implant fixed dental prostheses: Results of a prospective case series 5 years… PMID:28940708 | 2018 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Partially or completely edentulous patients restored with implant-supported reconstructions with at least one inter-implant pontic | Patients with posterior 3-4 unit implant-supported FDPs (9 studies, 330 restorations) and full-arch implant-supported FDPs (3 studies, 210 restorations) |
| Intervention | Dental implants restored with monolithic or micro-veneered all-ceramic fixed dental prostheses | Monolithic (233 restorations), micro-veneered (118) and veneered (181) all-ceramic (3Y-TZP zirconia, one zirconia-reinforced lithium disilicate) i-FDPs |
| Comparison | Dental implants restored with veneered all-ceramic fixed dental prostheses | Veneered all-ceramic i-FDPs; only one study directly compared monolithic with veneered i-FDPs |
| Outcomes | Survival, success, failure and complication rates (biological and technical) | Annual failure rate, 3-year survival, annual complication rate, annual chipping rate, 3-year complication-free and chipping-free rates |
| Study designs | Randomized clinical trials and prospective cohort studies (at least 10 participants, follow-up of at least 1 year) | 2 RCTs and 10 prospective cohort studies (n=12) |
| Timing | Minimum follow-up of 1 year | Mean follow-up 2.8 years (3-4 unit) and 2.4 years (full-arch); range 1 to 5 years |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | No | No | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |