A systematic review of the survival and complication rates of zirconia-ceramic and metal-ceramic single crowns

Objectives: The aim of the present systematic review was to analyze the survival and complication rates of zirconia-based and metal-ceramic implant-supported single crowns (SCs). Materials and Methods: An electronic MEDLINE search complemented by manual searching was conducted to identify randomized controlled clinical trials, prospective cohort and retrospective case series on implant-supported SCs with a mean follow-up time of at least 3 years. Patients had to have been clinically examined at the follow-up visit. Assessment of the identified studies and data extraction was performed independently by two reviewers. Failure and complication rates were analyzed using robust Poisson's regression models to obtain summary estimates of 5-year proportions. Results: The search provided 5,263 titles and 455 abstracts, full-text analysis was performed for 240 articles, resulting in 35 included studies on implant-supported crowns. Meta-analysis revealed an estimated 5-year survival rate of 98.3% (95% CI: 96.8–99.1) for metal-ceramic implant supported SCs (n = 4,363) compared to 97.6% (95% CI: 94.3–99.0) for zirconia implant supported SCs (n = 912). About 86.7% (95% CI: 80.7–91.0) of the metal-ceramic SCs (n = 1,300) experienced no biological/technical complications over the entire observation period. The corresponding rate for zirconia SCs (n = 76) was 83.8% (95% CI: 61.6–93.8). The biologic outcomes of the two types of crowns were similar; yet, zirconia SCs exhibited less aesthetic complications than metal-ceramics. The 5-year incidence of chipping of the veneering ceramic was similar between the material groups (2.9% metal-ceramic, 2.8% zirconia-ceramic). Significantly (p = 0.001), more zirconia-ceramic implant SCs failed due to material fractures (2.1% vs. 0.2% metal-ceramic implant SCs). No studies on newer types of monolithic zirconia SCs fulfilled the simple inclusion criteria of 3 years follow-up time and clinical examination of the present systematic review. Conclusion: Zirconia-ceramic implant-supported SCs are a valid treatment alternative to metal-ceramic SCs, with similar incidence of biological complications and less aesthetic problems. The amount of ceramic chipping was similar between the material groups; yet, significantly more zirconia crowns failed due to material fractures

A systematic review of the survival and complication rates of zirconia-ceramic and metal-ceramic multiple-unit fixed dental prostheses

Objectives: The aim of the present review was to compare the outcomes, that is, survival and complication rates of zirconia-ceramic and/or monolithic zirconia implant-supported fixed dental prostheses (FDPs) with metal-ceramic FDPs. Materials and Methods: An electronic MEDLINE search complemented by manual searching was conducted to identify randomized controlled clinical trials, prospective cohort studies and retrospective case series on implant-supported FDPs with a mean follow-up of at least 3 years. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data extraction was performed independently by two reviewers. Failure and complication rates were analyzed using robust Poisson regression models to obtain summary estimates of 5-year proportions. Results: The search provided 5,263 titles and 455 abstracts. Full-text analysis was performed for 240 articles resulting in 19 studies on implant FDPs that met the inclusion criteria. The studies reported on 932 metal-ceramic and 175 zirconia-ceramic FDPs. Meta-analysis revealed an estimated 5-year survival rate of 98.7% (95% CI: 96.8%–99.5%) for metal-ceramic implant-supported FDPs, and of 93.0% (95% CI: 90.6%–94.8%) for zirconia-ceramic implant-supported FDPs (p < 0.001). Thirteen studies including 781 metal-ceramic implant-supported FDPs estimated a 5-year rate of ceramic fractures and chippings to be 11.6% compared with a significantly higher (p < 0.001) complication rate for zirconia implant-supported FDPs of 50%, reported in a small study with 13 zirconia implant-supported FDPs. Significantly (p = 0.001) more, that is, 4.1%, of the zirconia-ceramic implant-supported FDPs were lost due to ceramic fractures compared to only 0.2% of the metal-ceramic implant-supported FDPs. Detailed analysis of factors like number of units of the FDPs or location in the jaws was not possible due to heterogeneity of reporting. No studies on monolithic zirconia implant-supported FDPs fulfilled the inclusion criteria of the present review. Furthermore, no conclusive results were found for the aesthetic outcomes of both FDP-types. Conclusion: For implant-supported FDPs, conventionally veneered zirconia should not be considered as material selection of first priority, as pronounced risk for framework fractures and chipping of the zirconia veneering ceramic was observed. Monolithic zirconia may be an interesting alternative, but its clinical medium- to long-term outcomes have not been evaluated yet. Hence, metal ceramics seems to stay the golden standard for implant-supported multiple-unit FDPs

Soft tissue management at implants: Summary and consensus statements of group 2. The 6th EAO Consensus Conference 2021

OBJECTIVES The task of working Group 2 at the 6th Consensus Meeting of the European Association for Osseointegration was to comprehensively assess the effects of soft tissue augmentation procedures at dental implant sites on clinical, radiographic and patient-reported outcome measures (PROMs) including an overview on available outcome measures and methods of assessment. MATERIALS AND METHODS Three systematic reviews and one critical review were performed in advance on (i) the effects of soft tissue augmentation procedures on clinical, radiographic and aesthetic outcomes, (ii) reliability and validity of outcome measures and methods of assessment and (iii) PROMs applied in clinical studies for soft tissue augmentation procedures at dental implant sites. Major findings, consensus statements, clinical recommendations and implications for future research were discussed in the group and approved during the plenary sessions. RESULTS The four reviews predominantly revealed: Soft tissue augmentation procedures in conjunction with immediate and delayed implant placement result in superior aesthetic outcomes compared to no soft tissue augmentation in the zone of aesthetic priority. Soft tissue augmentation procedures have a limited effect on marginal bone level changes compared to implant sites without soft tissue augmentation. Clinically relevant parameters (gingival index, mucosal recession) and plaque control improve at implant sites when the width of keratinised mucosa is increased. A variety of aesthetic indices have been described with good reliability. Pink Esthetic Score and Complex Esthetic Index are the most validated aesthetic indices for single implants, though. Superimposed digital surface scans are most accurate to assess profilometric tissue changes. PROMs following soft tissue augmentation procedures have been assessed using various forms of questionnaires. Soft tissue augmentation had a limited effect on PROMs. CONCLUSIONS Soft tissue augmentation procedures are widely applied in conjunction with implant therapy. Depending on the indication of these interventions, clinical, radiographic and aesthetic outcomes may improve, whereas the effect on PROMs is limited

Consensus Report of Working Group 2:Soft Tissue Management

OBJECTIVES: The task of working Group 2 at the 6th Consensus Meeting of the European Association for Osseointegration was to comprehensively assess the effects of soft tissue augmentation procedures at dental implant sites on clinical, radiographic and patient‐reported outcome measures (PROMs) including an overview on available outcome measures and methods of assessment. MATERIALS AND METHODS: Three systematic reviews and one critical review were performed in advance on (i) the effects of soft tissue augmentation procedures on clinical, radiographic and aesthetic outcomes, (ii) reliability and validity of outcome measures and methods of assessment and (iii) PROMs applied in clinical studies for soft tissue augmentation procedures at dental implant sites. Major findings, consensus statements, clinical recommendations and implications for future research were discussed in the group and approved during the plenary sessions. RESULTS: The four reviews predominantly revealed: Soft tissue augmentation procedures in conjunction with immediate and delayed implant placement result in superior aesthetic outcomes compared to no soft tissue augmentation in the zone of aesthetic priority. Soft tissue augmentation procedures have a limited effect on marginal bone level changes compared to implant sites without soft tissue augmentation. Clinically relevant parameters (gingival index, mucosal recession) and plaque control improve at implant sites when the width of keratinised mucosa is increased. A variety of aesthetic indices have been described with good reliability. Pink Esthetic Score and Complex Esthetic Index are the most validated aesthetic indices for single implants, though. Superimposed digital surface scans are most accurate to assess profilometric tissue changes. PROMs following soft tissue augmentation procedures have been assessed using various forms of questionnaires. Soft tissue augmentation had a limited effect on PROMs. CONCLUSIONS: Soft tissue augmentation procedures are widely applied in conjunction with implant therapy. Depending on the indication of these interventions, clinical, radiographic and aesthetic outcomes may improve, whereas the effect on PROMs is limited

Unterschiede elektroglottographischer Kontaktquotienten zwischen ausgehaltener Phonation und gesprochener Sprache

Hintergrund: In der klinischen Praxis wird für die multidimensionale Stimmanalyse zumeist ausgehaltene Phonation herangezogen. Im Gegensatz hierzu erfolgt die perzeptive Stimmbeurteilung zumeist durch die Beurteilung gesprochener Sprache. Es liegen derzeitig nur wenige Daten hinsichtlich beider Phonationsarten vor.Ergebnisse: Bei 1.216 Probanden (426 mit und 790 ohne Dysphonie) wurden die ausgehaltene Phonation (Vokal /a/ bei angenehmer Tonhöhe und Lautstärke) und Sprechstimme anhand eines normierten Textes mittels des Laryngograph Systems, welches gleichzeitig das Audio und das elektroglottographische Signal aufzeichnet, untersucht. Von den Signalen wurden die Grundfrequenz (fo), der Kontaktquotient (CQ), der Schalldruckpegel (SPL) und die Frequenzperturbation (jitter first für die ausgehaltene Phonation und cFx für den Text) analysiert.Fazit: Die Analyse der Sprechstimme ist nur begrenzt mit der ausgehaltenen Phonation vergleichbar. Insbesondere sollte eine mögliche Registerdivergenz bei weiblichen Stimmen berücksichtigt werden

Zur Beurteilung der Therapieerfolge bei dysphonen Patienten. On the evaluation of therapeutic success in dysphonic patients

Introduction: Multidimensional voice evaluation is considered as gold standard in voice medicine. In this respect, the European Laryngological Society recommended a protocol for standardized evaluation (ELS-Protocol). However, there are only rare data analyzing changes during therapeutical follow-up. Material and methods: Using this protocol, 276 patients (136 after phonosurgery, 81 after voice therapy and as a control group 59 patients without voice impairment) were evaluated with regard to their vocal capacity before and after voice therapy or phonosurgery, respectively. Results: The parameters of the ELS-protocol showed significant improvement under therapy with respect to DSI, VHI, and RBH-scale. It has been confirmed, that these measurements are suitable for the assessment of dysphonic patients with organic as well as functional voice disorders. However, detailed analysis of all the obtained parameters showed only weak or no correlation between all regarding parameters, which should be expected to provide comparable information, such as perturbation parameters or such parameters, that are derived from the acoustical spectrum. Discussion: Multidimensional evaluation of the voice as recommended by the ELS protocol is independent from the therapeutical approach able to document therapeutical success. The lack of sufficient correlations of values which should provide comparable information shows that an optimization or standardization of measuring instruments, computer hardware and software is necessary.</p