Considerations for Conservative, All-Ceramic Prosthodontic Single-Tooth Replacements in the Anterior Region: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Systematic Search Strategy
- P (problem): single-tooth replacement; anterior teeth.
- I (intervention): resin-bonded fixed partial denture; cantilever fixed dental prosthesis.
- C (comparison): three-unit prosthesis; three-unit prosthesis; all-ceramic; lithium disilicate; monolithic; zirconia fixed dental prosthesis.
- O (outcome): survival [MeSH]; success.
2.3. Study Selection
- Studies in English.
- Treatment concepts with one-retainer all-ceramic RBFDPs and three-unit conventional all-ceramic FPDs in the anterior region.
- Clinical studies only.
- Studies with a mean follow-up of at least 1 year.
- Studies reporting on details and outcomes of selected treatments.
2.4. Data Extraction
2.5. Outcome Measures
2.6. Effect Measures for Synthesis
- Survival Rates: the percentage of restorations that remained in situ without major complications during the observation period in both the RBFDP and three-unit FPD groups.
- Success Rates: the percentage of restorations that remained functional, with minimal complications (such as debonding, chipping, or fractures) during the observation period in both groups.
2.7. Risk-of-Bias Assessment
2.8. Data Synthesis
3. Results
3.1. Included Studies
- Studies written in foreign languages (n = 6).
- Studies on implant-supported all-ceramic restorations (n = 128).
- Use of composite or metal–ceramic restorations (n = 60).
- Studies conducted on posterior teeth (n = 5).
- Studies employing different treatment concepts (n = 23) (Table 2).
3.2. Descriptive Analysis
3.3. RBFDPs
3.4. Three-Unit FPDs
3.5. Synthesis of Results
3.6. Reporting Bias
3.7. Certainty of Evidence
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Search Strategy | |
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MEDLINE via PubMed (advanced research) | Title/Abstract single tooth replacement [Title/Abstract] OR anterior teeth cantilever fixed dental prosthesis [Title/Abstract] OR resin bonded fixed partial denture [Title/Abstract] OR three-unit prosthesis [Title/Abstract] OR 3-unit prosthesis [Title/Abstract] OR all-ceramic [Title/Abstract] OR lithium disilicate [Title/Abstract] OR monolithic [Title/Abstract] OR zirconia fixed dental prosthesis [Title/Abstract]) AND (survival [Title/Abstract] [MeSH] OR success [Title/Abstract]) |
Scopus (advanced search) | Title-Abstract-Keywords single AND tooth AND Replacement OR anterior AND teeth AND cantilever AND fixed AND dental AND prosthesis OR resin AND bonded AND fixed AND partial AND denture OR three-unit AND prosthesis OR 3-unit AND prosthesis OR all-ceramic OR lithium AND disilicate OR monolithic OR zirconia AND fixed AND dental AND prosthesis AND survival OR success |
Web of Science (advanced research) | Keywords (AK = (single tooth replacement OR anterior teeth cantilever fixed dental prosthesis OR resin bonded fixed partial denture OR three-unit prosthesis OR 3-unit prosthesis OR all-ceramic OR lithium disilicate OR monolithic OR zirconia fixed dental prosthesis)) AND AK = (success OR survival) |
Inclusion Criteria | Exclusion Criteria |
---|---|
Human trials | Animal trials, in vitro studies, preclinical trials |
Studies in English | Studies in foreign languages |
Study design: clinical studies (RCTs, PCS, RCSs, CCTs) | Study design: case reports, case series, systematic reviews |
Studies with a mean follow-up of at least 1 year | Studies with a mean follow-up of less than 1 year |
Studies reporting on details and outcomes of selected treatments | Studies employing different treatment concepts |
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Author | Type of Study | No of Restorations | Material | Technique | Mean Observation Time | Survival Rate | Success Rate/Failure Rate | Modes of Failure |
---|---|---|---|---|---|---|---|---|
Kern et al. [16] 2005 | PCS | 21 | In-Ceram alumina, zirconia/Vitadur-Alpha | copy milling/veneered | mean 51 ± 17 months | 92.3% | 1 fracture | |
Kern et al. [17] 2011 | PCS | 22 | In-Ceram alumina, zirconia/Vitadur-Alpha | copy milling/veneered | mean 111 ± 44 months | 94.4% | 1 fracture | |
Sasse et al. [21] 2012 | RCT | 30 | IPS e.max ZirCAD/IPS e.max Ceram | milled/veneered | mean 41.7 months | 100% at 3 y 93.1% at 3 y | 2 debondings 1 rotation | |
Sasse et al. [22] 2013 | RCT | 30 | IPS e.max ZirCAD/IPS e.max Ceram | milled/veneered | mean 64.2 months | 100% | failure free rate 93.3% | 2 debondings 1 rotation secondary caries |
Sailer et al. [23] 2013 | RCS | 20 | IPS e.max Press and IPS Empress/IPS e.max Ceram | pressed/ veneered | 60 months | 100% | chipping rate 5% | 1 chipping |
Sailer et al. [24] 2014 | RCT | 15 | IPS e.max ZirCAD/GC Initial | milled/veneered | mean 53.3 ± 23 months | 100% at 4 y | 2 debondings | |
Sasse et al. [25] 2014 | PCS | 39 | zirconia/IPS e.max Ceram | milled/veneered | mean 61.6 months | 100% 6 y | failure-free rate 94.8% after 6 y success rate 97.4% after 6 y | 1 debonding secondary caries |
Saker et al. [26] 2014 | CCT | 20 | In-Ceram alumina/ | not reported | mean 34 months | 90% after 5 y | annual failure rate 0.05% | 2 fractures 3 debondings |
Klink et al. [27] 2016 | PCS | 23 | zirconia (diff) | milled/veneered | mean 35 ± 15 months | 100% at 36 m | success rate 82.4% at 36 m | 2 chippings 1 debonding 1 tooth movement |
Kern et al. [28] 2017 | RCS | 108 | zirconia | milled/ veneered | mean 92.2 ± 33 months | 100% | success rate 92% after 10 y | 6 debondings 1 lost restoration |
Kern et al. [29] 2017 | PCS | 22 | In-Ceram alumina, zirconia/ Vitradur-Alpha | copy milling/veneered | mean 188.7 ± 47.6 months | 95.4% after 10 y 95.4% after 15 y 81.8% after 18 y | 2 framework fractures | |
Naenni et al. [30] 2020 | RCT | 10 | IPS e.max ZirCAD/Initial | milled/veneered | mean 11 y | 100% after 10 y | 2 debondings | |
Saker et al. [31] 2020 | RCS | 20 | In-Ceram alumina/VM7 | slip casting/ veneered | mean 106.7 ± 24.4 months | 85% after 10 y | clinical retention rate 70% after 10 y | 3 fractures 6 debondings |
Candea et al. [32] 2021 | PCS | 18 (position not defined) | Zenotec/Zirox Lava Plus/IPS e.max Ceram | milled/ veneered | mean 5.11 ± 1.18 y | 100% both anterior and posterior | ||
Sato et al. [33] 2024 | RCS | 28 | zirconia (unspecified) | unspecified | 3 y | 91.7% | 1 debonding |
Author | Type of Study | No of Restorations | Material | Technique | Observation Time | Survival Rate | Failure Rate/Success Rate | Modes of Failure |
---|---|---|---|---|---|---|---|---|
Probster et al. [34] 1993 | PCS | 5 | In-Ceram alumina Vitradur-Alpha | slip casting/veneered | mean 16.3 months | 100% | ||
Pang et al. [35] 1995 | PCS | 3 | In-Ceram alumina/Vitadur-Alpha | slip casting/ veneered | 21 months | 100% | localised mild gingivitis (position not clear) | |
Wolfart et al. [36] 2005 | PCS | 6 | IPS e.max Press | pressed monolithic | mean 48 months | 100% | ||
Taskonak et al. [37] 2006 | PCS | 12 | Empress 2 | pressed | 24 months | satisfactory rate 50% | 2 chippings 4 fractures | |
Kern et al. [38] 2012 | PCS | 6 | IPS e.max Press | pressed monolithic | 60 months | 100% | ||
Sola-Ruiz et al. [39] 2015 | PCS | 10 | Lava/Lava Ceram | milled/veneered | 84 months | 90% | 1 removal (secondary caries) | |
Alfadhli et al. [40] 2022 | RCS | 8 | KaVo Everest ZS/IPS e.max Ceram | milled/veneered | mean 25 months | 87.5% | 1 framework fracture | |
Homa et al. [41] 2025 | PCS | 16 | IPS e.max CAD LT | milled/ veneered | 10 y | 81.3% | 87.5% | 1 framework facture 2 removals (pain) 1 chipping |
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Knezović Zlatarić, D.; Soldo, M. Considerations for Conservative, All-Ceramic Prosthodontic Single-Tooth Replacements in the Anterior Region: A Systematic Review. Dent. J. 2025, 13, 219. https://doi.org/10.3390/dj13050219
Knezović Zlatarić D, Soldo M. Considerations for Conservative, All-Ceramic Prosthodontic Single-Tooth Replacements in the Anterior Region: A Systematic Review. Dentistry Journal. 2025; 13(5):219. https://doi.org/10.3390/dj13050219
Chicago/Turabian StyleKnezović Zlatarić, Dubravka, and Mirko Soldo. 2025. "Considerations for Conservative, All-Ceramic Prosthodontic Single-Tooth Replacements in the Anterior Region: A Systematic Review" Dentistry Journal 13, no. 5: 219. https://doi.org/10.3390/dj13050219
APA StyleKnezović Zlatarić, D., & Soldo, M. (2025). Considerations for Conservative, All-Ceramic Prosthodontic Single-Tooth Replacements in the Anterior Region: A Systematic Review. Dentistry Journal, 13(5), 219. https://doi.org/10.3390/dj13050219