Monolithic zirconia implant-supported restorations connected to titanium bases or titanium inserts are increasing in popularity due to their application in a full digital workflow. These prefabricated abutments are connected to the all-ceramic superstructure by adhesive cementation. Although limited clinical data on the outcomes of this type of restoration are available, a few laboratory studies have shown possible debonding issues. This case report presents a bonding failure of a fixed dental prosthesis supported by titanium bases after short clinical use. A treatment alternative is also proposed using the available digital dental technology.

Objectives: Long-term retrospective evaluation of the survival rate and the technical and biologic outcomes of all-ceramic inlays and onlays in premolars and molars. Method and materials: Fifty-four patients treated as part of a prospective clinical trial and having received 157 inlays and 27 onlays made out of a leucite-reinforced glass-ceramic (IPS Empress) in premolars and molars, were invited to the present follow-up examination. The survival of the restorations was evaluated. The biologic outcomes were assessed by measuring the pocket probing depth (PPD), the Plaque Index (PI), and the Sulcus Bleeding Index (SBI). The technical behavior was evaluated using modified US Public Health Service criteria (modUSPHS). Finally, patient satisfaction was recorded with a questionnaire. Data of patients and restored teeth were analyzed descriptively, and continuous variables were given in mean values and standard deviations. For the analysis of the restoration survival over time, the Kaplan-Meier survival estimate was calculated. The level of statistical significance was set at P .05. Results: Thirty-six patients (20 women, 16 men; mean age 50.9 years) with 132 restorations, 107 inlays and 25 onlays, were examined after a mean observation time of 11.2 ± 4.3 years. The overall 11-year survival rate of the 132 restorations was 80.3%. Inlays exhibited an 11-year survival rate of 80.4% and onlays of 80.0%. Twenty-two technical complications occurred. Ceramic fractures (10.6%) and chipping (2.3%) were the most frequent complications. Six biologic complications occurred (4.5%). Conclusion: Glass-ceramic inlays and onlays presented favorable long-term clinical survival and success rates. Technical complications were predominant, and biologic problems remained rare. More clinical long-term data are needed. Keywords: adhesive cementation, all-ceramic restoration, glass-ceramic, long-term, minimally invasive

Die Auswahl des am besten geeigneten Rekonstruktionsmaterials fällt Klinikern wie auch Technikern heute aufgrund der Vielfalt der Möglichkeiten und Indikationen immer schwerer. Die Industrie hat in sehr kurzer Zeit die Materialindikationen insbesondere für hochtransluzentes Zirkonoxid, das monolithisch zum Einsatz gebracht werden kann, stark erweitert. Somit wurden auf der einen Seite neue vielversprechende rekonstruktive Optionen ermöglicht, jedoch auf der anderen Seite ohne klinische Daten und Langzeiterfahrungen darüber, wie die neuen Werkstoffe am sinnvollsten eingesetzt werden können. Vorgestellt wird eine systematische Evaluierung, die dem behandelnden Team aus Zahnarzt und Zahntechniker als Leitfaden durch die unterschiedlichen neuen Möglichkeiten in der Materialwahl und dem Abwägen zwischen vollständig monolithischen und bukkal verblendeten Rekonstruktionen dienen soll. Bei der Auswahl werden neben den materialspezifischen Indikationen auch die ästhetischen Eigenschaften und die wenigen, derzeit verfügbaren klinischen Überlebensdaten berücksichtigt. Keywords: Monolithisch, Verblendkeramik, Vollkeramik, Kronen, Brücken, Zirkonoxid, Lithiumdisilikat, transluzent, mulitlayer, Chipping, CAD/CAM, Politur, Abrasionsverhalten, Implantologie

Aim: The impact of prosthetic material selection on implant survival is not clear. The current criteria for choosing a prosthetic material seem to be based on clinician preferences. This systematic review aims to evaluate the impact of restorative materials on the mid- and long-term survival of implants supporting single crowns and fixed partial dentures. Materials and methods: Hand and MEDLINE searches were performed to identify relevant literature for single crowns (SC) and fixed partial dentures (FPD). Further inclusion criteria were a mean follow-up period of at least 3 years, the inclusion of at least 10 patients in a relevant study cohort, and a clear description of prosthesis type and prosthetic material. Results: A total of 63 studies for the SC group and 11 studies for the FPD group were included. Full arch restorations were not included. The materials utilised in the SC group were metal-ceramic (precious and non-precious), lithium-disilicate, veneered zirconia, veneered alumina, and nanoceramics. The materials used in the FPD group were metal-ceramic (precious), veneered titanium, metal-resin (precious), and veneered zirconia. No significant impact on the prosthetic material relating to mid- or long-term implant survival was identified. Furthermore, there were no statistically significant differences between the survival rates of the dental prostheses made from different materials (SC and FPD group). Single crowns made of nanoceramics showed a higher risk for decementation relative to other materials (0.80, 95% CI [0.67; 0.89]; P 0.0001), whereas metal-resin FPDs showed a higher risk for chipping (0.36, 95% CI [0.23; 0.52]; P = 0.0072). Conclusion: The current evidence suggests that prosthetic material selection has no influence on mid- and long-term survival of implants restored with single crowns and fixed partial dentures. Similarly, the prosthetic material seems to have no significant impact on prosthetic survival rates. Further research is required to provide more evidence regarding the impact of the prosthetic material on long-term outcome. Keywords: fixed partial dentures, implants, material selection, meta-analysis, single crowns, systematic review Conflict-of-interest statement: The authors declare that they have no conflict of interest.