A Systematic Review and Meta-analysis Evaluating the Survival, Failure, and Complication Rates of Metal-Ceramic, Veneered, and Monolithic All-Ceramic Tooth-Supported Single Crowns-Part 1

Clinical Snapshot

Key Findings

• P Value: P<0.0001 for feldspathic ceramic vs lithium-disilicate comparison

• Effect Size: Monolithic lithium-disilicate: 98.5% vs Metal-ceramic: 97.1% survival

• Primary Outcome: Five-year survival rates of single crowns by material type

• Nnt Or Sensitivity: Monolithic designs showed significantly fewer ceramic fractures and chipping compared to veneered alternatives

• Confidence Interval: Not reported in abstract

Clinical Application

High feasibility as all materials are available in Australian dental practice Results support TGA-approved ceramic materials. Lithium-disilicate and zirconia crowns align with contemporary Australian prosthodontic practice standards and may influence PBS item considerations for complex cases Adult patients requiring single crown restorations in anterior and posterior regions

Abstract

PURPOSE: To evaluate five-year survival rates of metal-ceramic, veneered all-ceramic, and monolithic all-ceramic tooth-supported single crowns (SCs) and assess biological and technical complications. MATERIALS AND METHODS: A systematic search of Medline (PubMed), Embase, and CENTRAL (2014-2024) identified clinical studies on tooth-supported fixed dental prostheses (≥3 years mean follow-up). Manual screening and 30 studies from previous reviews were added. Sixty-four studies met inclusion, reporting on 3,509 metal-ceramic and 8,051 all-ceramic SCs. Robust Poisson regression models were used to estimate pooled five-year survival rates. RESULTS: Twelve studies investigated metal-ceramic crowns, 49 all-ceramic crowns, and three both. Five-year survival rates were: 98.5% for monolithic lithium-disilicate reinforced glass-ceramic, 97.3% for veneered densely-sintered zirconia, 97.1% for metal-ceramic, 96.8% for monolithic densely-sintered zirconia, 95.7% for veneered leucite/lithium-disilicate reinforced glass-ceramic, 94.5% for densely-sintered alumina, 94.3% for glass-infiltrated alumina, 90.4% for feldspathic/silica-based ceramic. Survival rates of feldspathic/silica-based ceramic (P<0.0001), glass-infiltrated alumina (P=0.019), densely sintered alumina (P=0.002), and veneered leucite/lithium-disilicate reinforced glass-ceramic (P=0.021) were significantly lower than monolithic lithium-disilicate SCs. Except for feldspathic/silica-based ceramic and metal-ceramic crowns, material/design types performed similarly in anterior and posterior regions. Monolithic lithium-disilicate and monolithic zirconia crowns showed significantly fewer ceramic fractures and chipping compared to veneered alternatives. CONCLUSIONS: Lithium-disilicate and zirconia-based all-ceramic SCs achieve five-year survival rates comparable to metal-ceramic crowns. Monolithic designs reduce fracture and chipping risk, improving long-term clinical outcomes.

References

1. 1.Pjetursson, B. E., Pitta, J., Balet, A., Bjarnadottir, G. R., Sailer, I., & Romandini, P. (2026). A systematic review and meta-analysis evaluating the survival, failure, and complication rates of metal-ceramic, veneered, and monolithic all-ceramic tooth-supported single crowns-Part 1. The International Journal of Prosthodontics. https://doi.org/10.11607/ijp.9633