Are Implant-Supported Monolithic Zirconia Single Crowns a Viable Alternative to Metal-Ceramics? A Systematic Review and Meta-Analysis
Abstract
1. Introduction
2. Materials and Methods
2.1. Protocol and Registration
2.2. Eligibility Criteria
2.3. Search Strategy
2.4. Data Extraction
2.5. Data Synthesis
2.6. Risk of Bias
2.7. Certainty of Evidence
3. Results
3.1. Study Selection
3.2. Characteristics of Included Studies
3.3. Meta-Analysis
3.4. Risk of Bias
3.5. Certainty of Evidence
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Author/Year | Pati-ents, n | Mean Age | Restora-tions, n | Region | Restorative Material | Implant System/Connection/Abutment/Fixation | Prosthetic Complications, n | Survival, n (%) | Peri-Implant Bone Loss (mm) | Follow-Up |
---|---|---|---|---|---|---|---|---|---|---|
Mangano and Veronesi, 2018 [15] | 50 | 52.6 years | ML: 25 MC: 25 | Ant: 0 Post: 50 PM and M | ML: Monolithic Zirconia (Katana, Kuraray Noritake) MC: Custom titanium abutment + feldspathic porcelain. | Exacone, Cone Morse, Ti-Base, Cement-retained | ML: 1 CF MC: 0 | ML: 25 (100%) MC: 25 (100%) | ML: 0.39 ± 0.29 MC: 0.54 ± 0.32 | 1 year |
Cheng et al., 2019 [16] | 40 | 47.8 yeas | ML: 36 MC: 34 | Ant: 0 Post: 70 PM and M | ML: Monolithic Zirconia (Ceramil zi or Ceramill Zolid; Amann Girrbach) MC: Custom Gold Abutment | Straumann, SynOcta Gold Abutment, Screw-retained | ML: 1 SL MC: 5 SL; 2 DB; 1 CF | ML: 34 (97.2%) MC: 34 (100%) | NA | 1 year |
Weigl et al., 2019 [4] | 22 | 43 years | ML: 22 MC: 22 | Ant: 0 Post: 44 PM and M | ML: Monolithic Zirconia (NR) MC: Custom Gold + Felspathic | Ankylos, Internal connection, Ti-Base, ML: Screw-retained; MC: Cement-retained | ML: 1 SL; 2 RFSH MC: 2 CF; 2 DB | ML: 22 (100%) MC: 22 (100%) | ML: 0.78 ± 0.76 MC: 0.82 ± 0.74 | 1 year |
Mühlemann et al., 2020 [17] | 76 | 57 years | ML: 39 MC: 37 | Ant: 0 Post: 76 M | ML: Monolithic Zirconia (Lava Plus, 3M ESPE) MC: Custom Gold + Feldspathic ceramic | Straumann, Regular Neck (RN), external connection, Ti-Base, Screw-retained | ML: 0 MC: 4 CF | ML: 38 (97.4%) MC: 36 (97.3%) | ML: −0.15 ± 0.76 MC: −0.33 ± 0.71 | 1 year |
Zumstein et al., 2023 [18] | 59 | 55.4 years | ML: 32 MC: 27 | Ant: 0 Post: 59 M | ML: Monolithic Zirconia (Lava Plus, 3M ESPE) MC: Custom Gold + Feldspathic ceramic | Straumann, Regular Neck (RN), external connection, Ti-Base, Screw-retained | ML: 0 MC: 4 CF | ML: 27 (80%) MC: 24 (88.8%) | ML: −0.15 ± 0.21 MC: −0.10 ± 0.19 | 3 years |
Malhotra et al., 2025 [19] | 20 | 18 to 40 years | ML: 20 MC: 20 | Ant: 0 Post: 40 M | ML: Monolithic Zirconia (4Y-PSZ; Zir-X Zirconia Block) MC: UCLA/Ni-Cr + Feldspathic ceramic | Internal Hexagon (Tri-lobe) connection, UCLA and Ti-Base, Screw-retained | ML: 2 AF; 2 SL MC: 4 CF; 8 AF; 7 SL | ML: 20 (100%) MC: 20 (100%) | ML: 1.79 ± 0.12 MC: 1.89 ± 0.21 | 2 years |
Certainty Assessment | № of Patients | Effect | Certainty | ||||||||
Number of studies | Study Design | Risk of Bias | Inconsistency | Indirectness | Imprecision | Other Considerations | Monolithic | Metal-Ceramic | Relative (95% CI) | Absolute (95% CI) | |
Prosthetic Complications | |||||||||||
5 | randomized trials | not serious | not serious | not serious | very serious b | none | 9/162 (5.6%) | 39/158 (24.7%) | RR 0.26 (0.14 to 0.47) | 183 fewer per 1000 (from 212 fewer to 131 fewer) | ⨁⨁◯◯ Low |
Implant Survival Rates | |||||||||||
5 | randomized trials | not serious | not serious | not serious | very serious b | none | 8/174 (4.6%) | 4/165 (2.4%) | RR 1.66 (0.56 to 4.94) | 16 more per 1000 (from 11 fewer to 96 more) | ⨁⨁◯◯ Low |
Marginal Bone Loss | |||||||||||
4 | randomized trials | not serious | serious a | not serious | very serious b | none | 138 | 131 | - | MD 0.05 lower (0.11 lower to 0.02 higher) | ⨁◯◯◯ Very low |
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da Mota Fonseca, L.C.; Faé, D.S.; Fernandes, B.N.; da Costa, I.; Miranda, J.S.; Lemos, C.A.A. Are Implant-Supported Monolithic Zirconia Single Crowns a Viable Alternative to Metal-Ceramics? A Systematic Review and Meta-Analysis. Ceramics 2025, 8, 63. https://doi.org/10.3390/ceramics8020063
da Mota Fonseca LC, Faé DS, Fernandes BN, da Costa I, Miranda JS, Lemos CAA. Are Implant-Supported Monolithic Zirconia Single Crowns a Viable Alternative to Metal-Ceramics? A Systematic Review and Meta-Analysis. Ceramics. 2025; 8(2):63. https://doi.org/10.3390/ceramics8020063
Chicago/Turabian Styleda Mota Fonseca, Liandra Constantina, Daniele Sorgatto Faé, Beatriz Neves Fernandes, Izabela da Costa, Jean Soares Miranda, and Cleidiel Aparecido Araujo Lemos. 2025. "Are Implant-Supported Monolithic Zirconia Single Crowns a Viable Alternative to Metal-Ceramics? A Systematic Review and Meta-Analysis" Ceramics 8, no. 2: 63. https://doi.org/10.3390/ceramics8020063
APA Styleda Mota Fonseca, L. C., Faé, D. S., Fernandes, B. N., da Costa, I., Miranda, J. S., & Lemos, C. A. A. (2025). Are Implant-Supported Monolithic Zirconia Single Crowns a Viable Alternative to Metal-Ceramics? A Systematic Review and Meta-Analysis. Ceramics, 8(2), 63. https://doi.org/10.3390/ceramics8020063