SYSTEMATIC REVIEW

Clinical performance of single implant-supported ceramic and

metal-ceramic crowns: A systematic review and meta-analysis
of randomized clinical trials
Ahmed Yaseen Alqutaibi, PhD,a Ahmad Abdulkareem Alnazzawi, PhD,b Radwan Algabri, PhD,c
Afaf N. Aboalrejal, MDS,d and Mohammed Hosny AbdElaziz, PhDe

Single implant-supported ABSTRACT

crowns have been shown to
Statement of problem. Evidence relating to the choice of materials for single implant-supported
have a predictable clinical crowns is sparse.
outcome with high survival
rates, making them a reliable Purpose. The purpose of this systematic review and meta-analysis was to assess articles that
compared the clinical performance of ceramic and metal-ceramic (MC) implant-supported single
approach for tooth replace-
1-9 crowns with regard to prosthesis failure, complication rate, and patient satisfaction.
ment. However, the me-
chanical and biological Material and methods. A comprehensive search of databases (PubMed/MEDLINE, Scopus, and
complication rates should be Cochrane Library) was performed. The last search was conducted in December 2019.
Randomized clinical trials comparing ceramic and MC implant-supported single crowns with at
considered, as these will affect
least a 12-month follow-up were included, all of which were published in English. The pooled
the success of implant- effects were presented as both a risk difference (RD) and mean difference according to the type
10
supported prostheses. of data with 95% confidence intervals (CIs).
In addition to the surgical
Results. Seven randomized clinical trials fulfilled the eligibility criteria and were included in the
technique and functional load- meta-analysis. The pooled data did not show any statistically significant differences concerning
bearing capacity of the dental prosthesis failure (RD: 0.000, 95% CI: -0.05 to 0.06), marginal bone loss (mean difference [MD]:
implant, the prosthetic pro- -0.02, 95% CI: -0.75 to 0.35), mechanical complications (RD: -0.06, 95% CI: -0.18 to 0.07),
cesses are of particular impor- biological complications (RD: 0.02, 95% CI: -0.07 to 0.11), or patient satisfaction (MD: 4.86, 95%
tance for attaining an optimal CI: -2.86 to 12.58).
relation between the implant- Conclusions. Ceramic and MC crowns had similar outcomes with regard to prosthesis failure,
supported crown and the soft mechanical and biological complication rates, and patient satisfaction. As a result, the
and hard tissues.11 The metal- selection of single implant crown material depends on the preference of the dentist and
ceramic (MC) crown is an patient. (J Prosthet Dent 2021;126:369-76)
established treatment method
with a low complication and high survival rate.7,12,13 Ceramic materials have been used as an alternative to
However, poor esthetics, high costs, and the fabrication MC restorations.15-19 When compared with the MC
time required are significant drawbacks of MC crown, the ceramic crown offers advantages including
crowns.12,14 superior esthetics, less gingival discoloration,12 and

a
Assistant Professor of Prosthodontics, Substitutive Dental Science Department, College of Dentistry, Taibah University, Al-Madinah, Saudi Arabia; and Assistant Professor of
Prosthodontics, Prosthodontics Department, College of Dentistry, Ibb University, Ibb, Yemen.
b
Associate Professor of Prosthodontics, Substitutive Dental Science Department, College of Dentistry, Taibah University, Al-Madinah, Saudi Arabia.
c
Assistant Professor of Prosthodontics, Prosthodontics Department, College of Dentistry, Ibb University, Ibb, Yemen.
d
Lecturer of Oral Biology, Oral Biology Department, College of Dentistry, Ibb University, IBB, Yemen.
e
Associate Professor of Crown and Bridge Department, Faculty of Dental Medicine, AlAzhar University, Cairo, Egypt; and Associate Professor of prosthodontics, substitutive
dental science Department, College of Dentistry, Taibah University, Al-Madinah, Saudi Arabia.

THE JOURNAL OF PROSTHETIC DENTISTRY 369

370 Volume 126 Issue 3

347 records 2 additional

Clinical Implications identified through records identified
The selection of material for an implant-supported database through other
crown depends on the dentist’s decision and the searching sources
patient’s specific needs as the clinical outcomes of
ceramic and metal-ceramic crowns are similar.

285 records after duplicates

18 removed
reduced bacterial adhesion. Moreover, the processing
time for a ceramic crown by using computer-aided design
and computer-aided manufacture is faster than the
manual process involved with the MC restoration.16
285 records 271 records
However, ceramic crowns are made of brittle screened excluded
materials.12,20
A recently published systematic review21 evaluated
the effects of the prosthetic materials on the survival rate
of implant-supported fixed prostheses. However, a 14 full-text 7 full-text
robust conclusion could not be reached regarding the articles assessed articles excluded,
selection of prosthetics material for single implant- for eligibility with reasons
supported crowns because of the inclusion of non-
randomized studies.
The purpose of the present study was to assess ran-
domized clinical trials (RCTs) that compared MC and 7 studies
ceramic single implant-supported crowns in terms of included in
prosthesis failure, mechanical and biological complica- qualitative
tions, marginal bone loss, and patient satisfaction. The synthesis
null hypothesis was that no differences would be found
between ceramic and MC restorations.

MATERIAL AND METHODS 7 studies

The current review was performed in accordance with the
Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guidelines.22 The method of the meta-
analysis was registered on the international prospective
register of systematic reviews with the registration
number CRD42019125219.
A specific question was formulated based on the
population, intervention, control, and outcome criteria:
“When restoring a missing tooth with a dental implant,
does the ceramic crown have different effects on pros-
thesis failure, complication rate, and patient satisfaction
than the MC crown?” Participants were those requiring
the restoration of a missing tooth with a dental implant-
supported crown; intervention was ceramic implant-
supported crown; comparator was an MC crown.
Outcome measures were prosthesis failure, biological
and mechanical complications, marginal bone loss, and
patient satisfaction measured with a visual analog scale.
Only RCTs comparing the MC versus ceramic single
implant-supported crown were included.
Medline through the PubMed database, Scopus, and
Cochrane Library were used as electronic databases.
Journal websites specific to the field of dental implants
and prosthetic dentistry were also searched.
included in
quantitative
synthesis
(meta-analysis)
Figure 1. Study selection procedure.
The references of all identified articles relating to the
subject were inspected. Missing, blurred, or unpublished
data were followed up by contacting the authors when-
ever deemed necessary. The final search was conducted
in December 2019. The search was executed indepen-
dently by 2 reviewers (A.Y.A., A.A.A.). Combinations of
controlled terms (MeSH) and keywords were used. For
the detailed search strategy, see Supplementary Table 1
(available online).
Studies were selected if they were published in En-
glish and fulfilled the following criteria: RCTs with at
least of 1-year of follow-up had a minimum sample size
of 10 participants and contained information on the
performance of MC compared with ceramic implant-
supported crowns.
Two reviewers (A.Y.A., A.N.A.) evaluated the rele-
vance of the articles, with the first selection being made
after assessing the title and abstract. Any disagreement

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September 2021 371

Table 1. Summary of included studies

Total No.
Follow-Up Total No. Mean Age of Implants Implant Implant. System Loading Participant per
Study (Mo) of Sub. (Sex) Placed Position Type Time Intervention Group
Bosch et al, 201830 18 29 43.7 (13 M- 16 F) 29 Maxilla and Straumann (internal 10 wk Ceramic crown 12
mandible connection)
Metal-ceramic crown 16

Cheng et al, 201831 12 40 47.9 (17 M-23 F) 73 Maxilla and Straumann (internal NR Ceramic crown 20
mandible connection)
Metal-ceramic crown 20

Gallucci et al, 201032 24 20 NR 20 Maxilla Straumann (internal 8 wk Ceramic crown 10

connection)
Metal-ceramic crown 10

Hosseini et al, 201136 12 36 28.1 (18M-18F) 75 Maxilla and Astra Tech 4-6 mo Ceramic crown 18
mandible

Metal-ceramic crown 18

Mangano and 12 50 52.6 (22M- 28F) 50 Maxilla and Exacone Leone NR Ceramic crown 25
Veronesi, 201833 mandible Implants
Metal-ceramic crown 25

Weigl et al, 201934 12 42 48(19M, 23F) 42 Maxilla and Ankylos C implant 3 mo Ceramic crown 21
mandible (Dentsply Sirona)

Metal-ceramic crown 21

Zembic et al, 201235 48 27 41.3 (8M- 14F) 40 Maxilla and Branemark RP (Nobel 4-6 mo Ceramic crown 17
mandible Biocare).
Metal-ceramic crown 10

CR, cement-retained; F, female; M, male; MBL, marginal bone loss; NR, not reported; SR, screw-retained; VAS, visual analog scale.

about whether or not an article should be included for
full assessment was settled by consensus. The final
articles were decided on once agreement between the 2
reviewers had been reached, and any conflicts were
resolved through discussion. If this was not possible, a
third reviewer (M.H.A.) was introduced. Each reviewer
independently extracted data from the studies,
including the authors’ ID, publication year, participants,
interventions, number of implants placed and position,
type of prosthetic materials, and the outcomes of each
study.
Two reviewers (A.Y.A., R.A.) independently con-
ducted the risk of bias assessment for the individual
studies by using the Cochrane Collaboration Tool.23 An
estimate of the intervention effect was expressed as risk
differences (RDs) with 95% confidence intervals (CIs)
concerning dichotomous outcomes, including prosthesis
failure and complication rates. The data of each group
with 95% CIs regarding continuous outcomes, including
marginal bone loss and patient satisfaction, were
summarized by using mean differences (MDs) and
standard deviations. The participant was regarded as the
statistical unit.
Whenever there was any relevant data missing from
the included publications, the corresponding authors
were sent a request for this information through email.
These were followed up by reminder emails if no
response was received.
The statistical tests were carried out by using a soft-
ware program (REVMAN v5.3; The Cochrane Collabo-
ration). Meta-analyses were considered when the
included studies of similar comparisons revealed the
same outcome measures. The weighted means across the
studies were analyzed by using a fixed-effects model.
When statistically significant (P<.1) heterogeneity was
found, a random-effects model evaluating the signifi-
cance of treatment effects was used.
The Cochran test for heterogeneity was used to assess
the impact of any variants in the estimates of treatment
effects from the various trials. If P<.1, the heterogeneity

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Table 1. (Continued) Summary of included studies

Abutment Mode of Implants Participant Prosthesis Mechanical

Used Crown Material/s Retention Placed Analyzed Failure Biological Complication Complication MBL VAS
Zirconia Veneerd zirconia SR 13 12 1 NR 1 (Ceramic veneer 0.05 NR
abutments chipping) ±0.51
Titanium NR CR 16 16 0 NR 0 0.28 NR
abutments ±0.77
Titanium Ceramill Zolid/Modified monolithic CR/SR 36 20 1 NR 1 (Screw NR NR
abutments zirconia (zirconia/veneering ceramic) loosening)
Titanium Metal (Argedent 500; Argen) and CR/SR 37 18 0 NR 7 (4 Screw NR NR
and Gold veneering ceramic loosening, 2
abutments Retention loss,
and 1 Fracture of
ceramic)
Titanium In-Ceram Blank; synOcta (Straumann) CR/SR 10 10 0 0 2 (Ceramic veneer NR 91.78
abutments chipping) ±10.04
Titanium Cast-on gold coping/feldspathic CR/SR 10 10 0 0 0 NR 91.81
abutments ceramic (Straumann) ±5.94
Zirconia KaVo Zirconia (Kavo) and Procera CR 38 18 0 7(1 Buccal marginal sinus, swelling, 0 0.08 84.9
abutments Zirconia (Nobel Biocare)/HeraCeram pain and suppuration, 3 ±0.25 ±18.4
Zirkonia (Kulzer GmbH) and IPS e.max Suppurations on probing, 2 Probing
Ceram (Ivoclar Vivadent AG) pocket depth  5 mm and 1 pain)
Titanium CR 37 18 0 3 (Suppurations and Probing pocket 2 (1 Ceramic 0.10 83.1
and Gold HeraNordic (Kulzer GmbH) and depth  5 mm) veneer chipping ±0.17 ±18.8
abutments ORION WX (Elephant Dental BV)/ and 1 Loss of
HeraCeram (Kulzer GmbH) and IPS retention)
d.SIGN (Ivoclar Vivadent AG)
Zirconia Monolithic CAD-CAM zirconia. CR 25 25 0 1 (Peri-implant mucositis, exudation 1 (Ceramic 0.47 93.5
abutments and bleeding on probing) chipping) ±0.31 ±3.3
Titanium Porcelain fused to zirconium dioxide CR 25 25 0 2 (Peri-implant mucositis, soft tissue 0 0.39 83.6
abutments inflammation and swelling) ±0.29 ±4
Zerconia Yttria-stabilized zirconium dioxide CR 21 21 0 1 (PPD > 5 mm with suppuration) 1 (Chipping of the 0.17 NR
abutments framework, veneered with glass- veneering ±0.1
ceramics ceramic)
Titanium Chromium-cobalt-molybdenum-alloy CR 21 21 0 2 (PPD > 5 mm with suppuration) 2 (Chipping of the 0.2 NR
abutments (CrCoMo), veneered with glass- veneering ±0.1
ceramics ceramic)
Zirconia Alumina/zirconia CR/SR 17 17 1 1 (Peri-implantitis) 0 1.8 NR
abutments ±0.5
Titanium NR CR/SR 10 10 1 1 (Peri-implantitis) 3 (Ceramic veneer 2.0 NR
abutments chipping) ±0.8

was considered significant. The I2-statistic was used to
assess the heterogeneity between the studies, which
explains the variation percentage as a result of hetero-
geneity rather than chance.23 An I2-statistic of more than
50% was regarded as moderate to high heterogeneity.
RESULTS
The database search produced 347 papers. An additional 2
records were identified through a manual search. Once all
duplicates had been removed, 285 potentially relevant
articles were selected. After the early screening, 14 articles
that fulfilled the eligibility criteria were chosen for further
assessment of the full-text versions. Seven articles11,24-29
were excluded for various reasons: 5 trials11,24-27
were not RCTs, 1 trial28 was a retrospective study
design, and 1 trial29 compared the abutments, not the
superstructure. The remaining 7 studies30-36 were
selected for data analysis. Figure 1 summarizes the study
selection procedure. Table 1 outlines the details of the 7
eligible RCTs.
In total, 241 participants (123 ceramic, 118 MC) were
included in the 7 trials. Five trials30,33-36 used a titanium
abutment with the MC and a zirconia abutment with the
ceramic restoration, whereas 2 trials31,32 used a titanium
abutment for both groups. Five trials30,32,34-36 used ven-
eered zirconia, and 2 trials31,33 used monolithic zirconia.
For more details regarding the characteristics of the
included studies, see Table 1.
The 7 included RCTs were assessed for risk of bias,
summarized in Figure 2. Four studies30,31,34,35 were
considered to have unclear risk of bias, and 3
studies32,33,36 were at low risk of bias.
The prosthesis failure was reported in the 7 trials.30-36
The pooled result found no statistically significant dif-
ference between the ceramic and MC crowns (P=.86; RD:
0.000; 95% CI: -0.05 to 0.06; heterogeneity: P=.92; I2: 0%)

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September 2021 373

DISCUSSION

Blinding of participants and personnel (performance bias)

MC crowns have been considered the standard in the
rehabilitation of teeth and implants.37 However, ceramic

Blinding of outcome assessment (detection bias)

Random sequence generation (selection bias)
restorations became an appropriate alternative to MC,
especially for those patients with high esthetic demands.

Incomplete outcome data (attrition bias)

Allocation concealment (selection bias)
This meta-analysis aimed to provide information to

Selective reporting (reporting bias)

support clinicians’ treatment decision-making based on
the best available evidence by summarizing the results of
RCTs. The null hypothesis was accepted as the result of
meta-analysis did not show differences between ceramic
and MC restorations concerning prosthesis failure,
complication rates, marginal bone loss, or patient
satisfaction.

Other bias
The prosthesis failure rate for both types of restora-
tions was low, and the pooled data did not show a sig-
nificant difference. Prosthesis failure can result from
Bosch et al 2018 + ? + + + + + implant loss after infection, overload, excess cement,31,35
or an unrestorable prosthesis fracture.30
Cheng et al 2018 + ? + ? + + + The ceramic restoration experienced a mechanical
Gallucci et al 2010 + + + + + + + complication rate similar to that of the MC restorations as
indicated by the meta-analysis. The similar performance
Hosseini et al 2011 + + + + + + +
may be attributed to the use of zirconia that is charac-
Mangano and Veronesi 2018 + + + + + + + terized by high flexural strength and fracture tough-
ness.31,33 Another explanation is that most of the selected
Weigl et al 2019 + ? + ? + + +
studies had a short follow-up, which may hide
Zembic et al 2012 + ? + ? + + + differences.
The most frequent complication associated with
Figure 2. Quality assessment of included randomized clinical trials. ceramic crowns was veneer chipping.30,32,33 The precise
cause of chipping is unknown, as noted by Anusavice,18
(Fig. 3). With regard to marginal bone loss, the pooled and multiple reasons may be in play. For example, the
data from 5 trials30,33-36did not show differences between interface bond between copings and ceramic is believed
the 2 restorations (P=.37; MD: -0.02; 95% CI: -0.07 to to be a contributing factor,38 as too is the residual stress
0.03; heterogeneity: P=.55; I2: 0%) (Fig. 4). resulting from the cooling of zirconia and the phenom-
With respect to the mechanical complications re- enon of aging.39 The material property, design, and
ported in all of the included trials,30-36 the most com- thickness of the ceramic veneer should all be sufficient;
mon reported complication was the minor chipping of otherwise, the use of monolithic zirconia is preferred to
veneered ceramics. The meta-analysis of overall me- bilayered ceramic restoration to avoid ceramic chipping.40
chanical complication revealed a nonsignificant differ- The results of 1 included study31 by using monolithic
ence between the ceramic and MC crown (P=.86; RD: zirconia as ceramic material reported a high occurrence of
-0.06; 95% CI: -0.18 to 0.07; heterogeneity: P=.005; I2: mechanical complications with MC restorations. Ac-
67%) (Fig. 5). As for biological complications, 5 trials32- cording to the authors, this result maybe because of the
36
compared implant-supported MC versus ceramic different MC prosthesis types included. However, this
crowns, and the forest plot did not show statistically finding is not related only to the type of material because
significant difference (P=.70; RD: 0.02; 95% CI: -0.07 to the authors reported that most of the complications were
0.11; heterogeneity: P=.44; I2: 0%) (Fig. 6). The most found in bruxers.
common reported biological complication was In the present review, the type of crown material did
suppuration. not affect the rate of biological complications or marginal
The quantitative analysis of patient satisfaction in 3 bone loss, and the meta-analysis did not show a statis-
trials32,33,36 reported no difference between the 2 resto- tically significant difference. The most commonly
ration types (P=.22; MD: 4.86; 95% CI: -2.86 to 12.58; encountered biological complication of both restorations
heterogeneity: P=.02; I2: 75%) (Fig. 7). As only 7 articles was suppuration on probing. The ceramic restoration
were involved in this review, the sample size was not recorded an overall biological complication rate of 11%
adequate to assess publication bias. compared with 9.5% for the MC restorations.

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Ceramic Metal-Ceramic Risk Difference Risk Difference

Study or Subgroup Events Total Events Total Weight M-H, Fixed, 95% CI M-H, Fixed, 95% CI
Bosch et al 2018 1 12 0 16 11.5% 0.08 [–0.11, 0.27]
Cheng et al 2018 1 20 0 18 15.9% 0.05 [–0.08, 0.18]
Gallucci et al 2010 0 10 0 10 8.4% 0.00 [–0.17, 0.17]
Hosseini et al 2011 0 18 1 18 15.1% –0.06 [–0.20, 0.09]
Mangano and Veronesi 2018 0 25 0 25 21.0% 0.00 [–0.07, 0.07]
Weigl et al 2019 0 21 0 21 17.6% 0.00 [–0.09, 0.09]
Zembic et al 2012 1 17 1 10 10.6% –0.04 [–0.26, 0.18]

Total (95% CI) 123 118 100.0% 0.00 [–0.05, 0.06]

Total events 3 2
Heterogeneity: χ2=2.01, df=6 (P=.92); I2=0%
–1 –0.5 0 0.5 1
Test for overall effect: Z=0.18 (P=.86)
Favors [Ceramic] Favors [Metal-Ceramic]

Figure 3. Forest plot of prosthesis failure of ceramic compared with MC implant-supported crown. CI, confidence interval; MC, metal-ceramic.

Ceramic Metal-Ceramic Mean Difference Mean Difference

Study or Subgroup Mean SD Total Mean SD Total Weight IV, Fixed, 95% CI IV, Fixed, 95% CI

Bosch et al 2018 0.05 0.05 12 0.28 0.77 16 1.8% –0.23 [–0.61, 0.15]
Hosseini et al 2011 0.08 0.2 18 0.1 0.17 18 17.5% –0.02 [–0.14, 0.10]
Mangano and Veronesi 2018 0.47 0.31 25 0.39 0.29 25 9.3% 0.08 [–0.09, 0.25]
Weigl et al 2019 0.17 0.1 21 0.2 0.1 21 70.5% –0.03 [–0.09, 0.03]
Zembic et al 2012 1.8 0.5 17 2 0.8 10 0.9% –0.20[–0.75, 0.35]

Total (95% CI) 93 90 100.0% –0.02 [–0.07, 0.03]

Heterogeneity: χ2=3.07, df=4 (P=.55); I2=0%
Test for overall effect: Z=0.89 (P=.37) –0.2 –0.1 0 0.1 0.2
Favors [Ceramic] Favors [Metal-Ceramic]

Figure 4. Forest plot of marginal bone loss of ceramic compared with MC implant-supported crown. CI, confidence interval; MC, metal-ceramic; SD,
standard deviation.

Ceramic Metal-Ceramic Risk Difference Risk Difference

Study or Subgroup Events Total Events Total Weight M-H, Random, 95% CI M-H, Random, 95% CI
Bosch et al 2018 1 12 0 16 14.7% 0.08 [–0.11, 0.27]
Cheng et al 2018 1 20 7 18 12.0% –0.34 [–0.58, –0.09]
Gallucci et al 2010 2 10 0 10 10.6% 0.20 [–0.08, 0.48]
Hosseini et al 2011 0 18 2 18 16.0% –0.11 [–0.28, 0.06]
Mangano and Veronesi 2018 1 25 0 25 19.6% 0.04 [–0.06, 0.14]
Weigl et al 2019 1 21 2 21 16.8% –0.05 [–0.20, 0.11]
Zembic et al 2012 0 17 3 10 10.3% –0.30 [–0.59, –0.01]

Total (95% CI) 123 118 100.0% –0.06 [–0.18, 0.07]

Total events 6 14
Heterogeneity: τ2=0.02; χ2=18.36, df=6 (P=.005); I2=67%
Test for overall effect: Z=0.89 (P=.37) –1 –0.5 0 0.5 1
Favors [Ceramic] Favors [Metal-Ceramic]

Figure 5. Forest plot of mechanical complications of ceramic compared with MC implant-supported crown. CI, confidence interval; MC, metal-ceramic.

Ceramic Metal-Ceramic Risk Difference Risk Difference

Study or Subgroup Events Total Events Total Weight M-H, Fixed, 95% CI M-H, Fixed, 95% CI
Gallucci et al 2010 0 10 0 10 11.5% 0.00 [–0.17, 0.17]
Hosseini et al 2011 7 18 3 18 20.8% 0.22 [–0.06, 0.51]
Mangano and Veronesi 2018 1 25 2 25 28.9% –0.04 [–0.17, 0.09]
Weigl et al 2019 1 21 2 21 24.3% –0.05 [–0.20, 0.11]
Zembic et al 2012 1 17 1 10 14.5% –0.04 [–0.26, 0.18]

Total (95% CI) 91 84 100.0% 0.02 [–0.07, 0.11]

Total events 10 8
Heterogeneity: χ2=3.72, df=4 (P=.44); I2=0%
–1 –0.5 0 0.5 1
Test for overall effect: Z=0.38 (P=.70)
Favors [Ceramic] Favors [Metal-Ceramic]

Figure 6. Forest plot of biological complications of ceramic compared with MC implant-supported crown. CI, confidence interval; MC, metal-ceramic.

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September 2021
Ceramic Metal-Ceramic
Study or Subgroup Mean SD Total Mean
Gallucci et al 2010 91.78 10.04 10 91.81
Hosseini et al 2011 84.9 18.4 18 83.1
Mangano and Veronesi 2018 93.5 3.3 25 83.6
Total (95% CI) 53
Heterogeneity: τ2=33.21; χ2=8.09, df=2 (P=.02); I2=75%
Test for overall effect: Z=1.23 (P=.22)
Figure 7. Forest plot of patient satisfaction of ceramic compared with MC implant-supported crown. CI, confidence interval; MC, metal-ceramic; SD,
standard deviation.
A high incidence of biological complications with
ceramic restorations was reported in 1 of the included
studies.36 The authors clarified that this finding might be
related to the poor marginal fit of ceramic crowns,
leading perhaps to more bacterial accumulation and
subsequently chronic inflammation.36 Therefore, for the
long-term performance of implant-supported crowns, it
is essential to control the risk factors contributing to peri-
implant diseases and to ensure the patient receives an
adequate maintenance program.41
The meta-analysis of the visual analog scale scores
indicated no difference between the restoration types.
This finding was presumably because the selected studies
evaluated the posterior area of the mouth, which may
have less impact on patient satisfaction.32,33,36
The current meta-analysis included only RCTs
considered to provide substantial evidence. Additionally,
this review included studies that compared ceramic and
MC crowns within the same study to avoid indirect
comparisons. Nevertheless, this systematic review has
limitations, including the limited number of included
studies and that 4 of the 7 included trials had an unclear
risk of bias. Additionally, most of the studies had a
follow-up period of just 12 months, which is insufficient
to determine implant success or complication rate.
Therefore, to overcome these problems, well-designed
RCTs with follow-up periods of 5 years and more are
recommended to evaluate the long-term influence of the
prosthesis material.
CONCLUSIONS
Based on the findings of this systematic review and meta-
analysis, the following conclusions were drawn:
1. The pooled data revealed that the materials
analyzed (ceramic and MC) have similar effects with
regard to prosthesis failure, complication rates, and
patient satisfaction in patients restored with single
implant-supported crowns.
2. The selection of material for single implant crowns
depends on the dentist’s decision and the patient’s
individual needs.
Alqutaibi et al
375
Mean Difference Mean Difference
SD Total Weight IV, Random, 95% CI IV, Random, 95% CI
5.94 10 33.1% –0.03 [–7.26, 7.20]
18.8 18 21.6% 1.80 [–10.35, 13.95]
4 25 45.2% 9.90 [7.87, 11.93]
53 100.0% 4.86[–2.86, 12.58]
–100 –50 0 50 100
Favors [Ceramic] Favors [Metal-Ceramic]
3. Well-designed RCTs with long-term assessments
are needed to gain further insight.
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Corresponding author:
Dr Ahmed Yaseen Alqutaibi
Prosthodontics Department
Substitutive Dental Sciences Department
College of Dentistry
Taibah University
Al Shefaa Bint Amr AL Ansareya St
From Al Hezam St, Almadinah Almunawwarah 41511
SAUDI ARABIA
Email: Alqutaibiprosthodontist@gmail.com
CRediT authorship contribution statement
Ahmed Yaseen Alqutaibi: Conceptualization, Formal analysis, Data curation,
Writing - original draft, Visualization. Ahmad Abdulkareem Alnazzawi:
Conceptualization, Writing - review & editing. Radwan Algabri: Writing - review
& editing. Afaf N. Aboalrejal: Formal analysis, Data curation, Writing - review &
editing. Mohammed Hosny AbdElaziz: Writing - review & editing,
Visualization.
Copyright © 2020 by the Editorial Council for The Journal of Prosthetic Dentistry.
https://doi.org/10.1016/j.prosdent.2020.06.011
Alqutaibi et al