Survival and Complications of Partial Coverage Restorations on Posterior Teeth—A Systematic Review and Meta‐Analysis

L S Prott; S Pieralli; P Klein; F A Spitznagel; F Ibrahim; M‐I Metzendorf; A Carrasco‐Labra; M B Blatz; P C Gierthmuehlen

doi:10.1111/jerd.13353

. 2024 Nov 19;37(3):620–641. doi: 10.1111/jerd.13353

Survival and Complications of Partial Coverage Restorations on Posterior Teeth—A Systematic Review and Meta‐Analysis

L S Prott ^1,^2,^✉, S Pieralli ³, P Klein ¹, F A Spitznagel ¹, F Ibrahim ¹, M‐I Metzendorf ⁴, A Carrasco‐Labra ^2,⁵, M B Blatz ², P C Gierthmuehlen ¹

PMCID: PMC12076112 PMID: 39558793

ABSTRACT

Objective

To determine the clinical performance of partial coverage restorations (PCR) (onlays, occlusal veneers, and partial crowns) composed of different ceramic and ceramic‐based materials to treat extended posterior defects.

Materials and Methods

MEDLINE, Scopus, CENTRAL, ClinicalTrials.gov, and the International Clinical Trials Registry Platform were searched (inception‐February 2024) for randomized controlled trials (RCT) comparing posterior PCRs composed of different ceramic and ceramic‐based materials with a minimum follow‐up of 1 year.

Results

Six RCTs were included. Resin matrix ceramic (RMC) and lithium disilicate (LDS) restorations had a 3‐year survival rate of 89.3% (95% CI 76.4–95.3) and 93.7% (95% CI 83.7–97.7), respectively, and leucite‐reinforced glass ceramic (LRGC) restorations a range between 96.1% (95% CI 90.1–98.9) compared with RMC and 98.3% (95% CI 90.8–100) compared with LDS. After 1–3 years of follow‐up, LDS slightly outperformed RMC on restoration failure and loss of retention (1.56 more failures and 1.78 more loss of retentions for RMC per 100 restoration‐years [low certainty evidence]). No statistically significant differences between ceramic and ceramic‐based materials were detected in short‐term follow‐up (1–3 years of follow‐up). The long‐term performance of posterior PCRs is uncertain.

Conclusion

The survival of LDS restorations may slightly outperform RMC restorations after 3 years of follow‐up across outcomes, except for bulk fracture. RCTs providing medium to long‐term data are needed.

Clinical Significance

Ceramic and ceramic‐based PCRs are a reliable treatment option to restore extended posterior defects.

1. Introduction

Advancements in adhesive dentistry and CAD/CAM technology (computer aided‐design/computer‐aided manufacturing) have introduced a paradigm shift in restorative dentistry, moving from full‐coverage crowns to minimally invasive, defect‐oriented restorations [1]. Compared to crowns, partial coverage restorations (PCR) can preserve residual sound tooth structure and achieve a superior bond strength when bonded to enamel [2, 3, 4]. In contrast, full‐coverage crown preparations are more invasive, with an average tooth substance removal between 67.5%–75.6% compared to 35.5%–46.7% for PCRs [5]. The term “partial coverage restoration” includes inlays that do not cover any cusp, onlays that cover at least one or more cusps [6], and partial crowns that cover larger portions of the clinical crown but leave at least one or more axial surfaces uncovered [7]. The type of ceramic material used for the fabrication of PCRs is critically important, as each ceramic group possesses distinct mechanical and physical properties. PCRs in the posterior region require fracture resistance, as opposed to those in the anterior region, which demand superior esthetics [8]. Ceramic systems used for the fabrication of PCRs can be classified into silicate ceramics, polycrystalline ceramics, and resin matrix ceramics (RMC) depending to the phases present in their chemical composition [9, 10]. Silicate ceramics can be further subdivided into feldspar porcelain, leucite‐reinforced glass ceramics (LRGC), and lithium disilicate (LDS) ceramics [9]. Feldspar porcelain and glass ceramics, available for conventional manufacturing or in blocks for CAD/CAM processing, consist of both vitreous and crystalline phases with a glassy matrix that can be etched [11]. LRGC were introduced as early generations of CAD/CAM blocks to increase the strength of glass ceramics by adding of approximately 35% leucite crystals by volume [12, 13]. However, the highest strength in glass ceramics (3–4 times higher than that of original glass‐rich ceramics [118 MPa]) was achieved by precipitating LDS crystals [13, 14, 15]. Pressable versions of these LDS ceramics have been available since the mid 1990's. However, with the development of subtractive machining, CAD/CAM machinable chairside blocks have successively supplemented the injection molding technique [16]. More recently, RMC were developed as a group of CAD/CAM restorative materials combining the advantages of polymers (low antagonist wear and improved flexural strength) with those of ceramics (color stability and structural durability) [9, 17, 18]. Based on their microstructure and industrial polymerization mode, RMC can be further classified in polymer‐infiltrated ceramic network (PICN) with a porous feldspar ceramic network infiltrated by polymers and in resin nano ceramics with a polymeric matrix reinforced by nano or nanohybrid ceramic fillers [17, 19]. Available evidence shows that digital workflows achieve clinical outcomes for PCRs that are superior to those of conventional methods, including better accuracy, fit, time efficiency, and overall success [20, 21]. Multiple factors impact the outcomes of PCRs. These include the complexity of the tooth's topography, preparation design and depth, bonding protocol, digitalization technique, fabrication technique, and material choice, as well as the proficiency of both the dentist and the lab technician [22, 23, 24]. Previous systematic reviews on this topic only compared PCRs with single crowns [25, 26, 27] or with direct composite restorations [8, 28, 29], or failed to apply a comparative effectiveness approach [1, 30]. Thus, the purpose of this systematic review, the first of its kind, was to determine the effect of PCRs composed of different ceramic and ceramic‐based materials on the survival rate and associated technical, biological, and esthetical complications.

2. Materials and Methods

2.1. Study Design

The report of this review follows the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) [31] statement. The protocol was registered in the PROSPERO database (CRD42024542471). To inform the scope of this systematic review, a scoping review including a broad systematic literature search was conducted to obtain a synoptic view of the available evidence (32). The review research question (PICO) was defined as P (Patients): Patients with extended defects treated with PCRs on posterior teeth; I (Intervention): Ceramic and ceramic‐based PCRs (Onlays, occlusal veneers, partial crowns); C (Comparison): Comparison of different ceramic and ceramic‐based materials; O (Outcome): Restoration failure and complications of PCRs; and (S) (Study): Randomized controlled trials (RCT).

2.2. Information Sources and Search Strategy

To identify completed and ongoing studies, a sensitive search strategy was developed by an experienced information scientist based on text analysis of 10 relevant PubMed references known to the authors. The search was run from inception of each database to 19 February 2024 (date of last search for all databases) in the following databases and study registers: MEDLINE (via PubMed), the Cochrane Central Register of Controlled Trials (via Cochrane Library), Scopus, WHO International Clinical Trials Registry Platform and ClinicalTrials.gov without restrictions regarding language or publication type. The full details of our search strategy are provided in Table 1. Potentially eligible studies were also identified manually from the reference list of included articles.

TABLE 1.

Search strategies of included databases.

Search strategy
MEDLINE via PubMed	#1 crown[tw] OR onlay[tw] OR overlay[tw] OR inlay[tw] OR veneer[tw] #2 “Dental Restoration, Permanent”[mh] OR restor[tw] #3 “Dental Restoration Failure”[mh] OR “Survival Analysis”[mh] OR “Survival Rate”[mh] OR survival[tw] OR fractures[tw] #4 #1 AND #2 AND #3 = 5840
Scopus (advanced search)	TITLE‐ABS‐KEY((crown* OR onlay* OR overlay* OR inlay* OR veneer) AND restor AND (failure OR survival OR fractures) AND (random* OR trial OR placebo OR groups) OR (cohort OR (control AND study) OR (control AND group*) OR {follow‐up} OR {follow up} OR {time factors} OR CI)) = 5609
Cochrane Central Register of Controlled Trials (via Cochrane Library), Issue 2 of 12, February 2024	(crown* OR onlay* OR overlay* OR inlay* OR veneer):ti,ab,kw [mh “Dental Restoration, Permanent”] OR restor:ti,ab,kw [mh “Dental Restoration Failure”] OR [mh “Survival Analysis”] OR [mh “Survival Rate”] OR (survival OR fractures):ti,ab,kw #1 AND #2 AND #3 = 894
ClinicalTrials.gov	((crown OR crowns OR onlay OR onlays OR overlay OR overlays OR inlay OR inlays OR veneer OR veneers) AND (restore OR restored OR restoring OR restoration OR restorations) AND (failure OR survival OR fractures)) = 219
WHO ICTRP	((crown* OR onlay* OR overlay* OR inlay* OR veneer) AND (restor) AND (failure OR survival OR fractures)) = 30
10 relevant PubMed records (PMIDs) used to develop the search strategy	23342329[PMID] OR 26891618[PMID] OR 24600653[PMID] OR 28689915[PMID] OR 33012530[PMID] OR 22372380[PMID] OR 34415434[PMID] OR 34624421[PMID] OR 29214376[PMID] OR 32500864[PMID]

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2.3. Study Selection

Reviewers participating in the screening process were calibrated to ensure optimal application of eligibility criteria. Two reviewers (P.K. and S.P.) independently conducted title and abstract screening using a pre‐piloted form, including variables compatible with the eligibility criteria (Table 2). Potentially eligible articles from the title and abstract screening were then evaluated using full texts (L.P. and S.P.). Discrepancies in screening processes were resolved by discussion or with a third reviewer serving as arbiter (P.G.).

TABLE 2.

Eligibility criteria.

Inclusion criteria

Exclusion criteria

Human trials
Language: English
Peer‐reviewed articles
Study design: RCTs
Studies with a mean follow‐up time of at least 12 months
Studies including at least 10 patients
Clinical examination of patients at follow‐up visit
Material composition is still commercially available
- ○
  Silicate ceramics
  - Feldspar
  - Leucite‐reinforced
  - Lithium disilicate
  - Lithium silicate/phosphate glass ceramics
- ○
  Resin matrix ceramics (materials contain ceramic particles)
- ○
  Zirconia
Restorations on permanent teeth
Separate outcome for ceramic, various ceramic compositions, and composite restorations reported
Separate outcome for PCRs, inlays, and full crowns reported

Case reports and case series, expert opinions, animal studies
In vitro studies
Poster abstracts, interviews, or protocols
Article not written in English
Studies with the same sample
Data extracted based on charts (no clinical examination of patients)
Cast restorations (e.g., gold, metal oxides)
Inlays and direct composite restorations
Studies not meeting the inclusion criteria

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2.4. Data Extraction

Two reviewers (L.P. and S.P.) independently extracted relevant information from the included studies. Variables for data extraction were: Study design, number of participants at baseline, number of participants at follow‐up, number of drop‐outs, tooth vitality, restoration type, restoration material, preparation design and thickness, restoration thickness, workflow, follow‐up time, placed number of restorations, number of restorations at follow‐up, total number of failed units, survival rate definition, total number of survived units, survival rates, and complications.

2.5. Outcome Measures

Restoration failure was the primary outcome of this review. Different types of biological, technical, and esthetical complications, as well as preparation design and thickness, were analyzed as secondary outcomes:

Survival rate: Number of restorations remaining in situ at the final follow‐up visit with or without the need for maintenance.
Failure rate: Number of restorations lost, removed, or remade.
Bulk fracture rate: Number of restoration failures due to catastrophic bulk fractures.
Chipping rate: Number of restorations with minor or major chippings.
Loss of retention rate: Number of restorations with one or more cementation failures.
Endodontic complication rate: Number of teeth with endodontic problems after the restoration placement.
Tooth fracture rate: Number of teeth with a tooth fracture after the restoration placement.
Secondary caries rate: Number of teeth presenting a caries lesion associated with the restoration.
Marginal adaptation: Score of teeth presenting a vertical distance between the finish line of the prepared tooth and the margin of the restoration.
Esthetic and surface properties: Score of teeth presenting surface luster, marginal staining, color match, surface roughness, and wear.
Preparation design and thickness: Type of preparation design, geometry, reduction, and extension of the preparation.

2.6. Certainty of the Evidence

Two reviewers (A.C.‐L. and L.P.) independently assessed the certainty of the body of evidence using the Grades of Recommendation, Assessment, Development, and Evaluation approach (GRADE). In GRADE, five domains are assessed to rate down the certainty of the evidence from RCTs (i.e., Risk of bias, inconsistency, indirectness, imprecision, and publication bias) [33, 34]. The software GRADEpro (www.gradepro.org) was used to generate a summary‐of‐findings table. The risk of bias of the included studies was assessed using the Cochrane risk‐of‐bias tool for randomized trials (RoB 2.0) [35]. Five domains were assessed: Bias arising from the randomization process, bias due to deviations from the intended intervention, bias due to missing outcome data, bias in the measurement of the outcome, and bias in the selection of the reported result. The risk of bias was judged as high, low, or some concerns.

2.7. Data Analysis

For individual studies, survival rates and incidence rates (IR per 100 years) of restoration failures and complications were estimated assuming a Poisson distribution. Effect sizes and their 95% confidence intervals for comparisons of IR between two a priori defined subgroups (vital versus non‐vital teeth) were calculated. Effect estimates from included studies were pooled using a random‐effects model, and incidence rate ratios (IRR) and 95% confidence intervals were calculated and presented in tables and forest plots. Between‐study heterogeneity, such as the test of homogeneity (level of significance = 0.10), variance between studies (τ2), and I ² statistic were calculated. Statistical tests were two‐sided at a significance level of significance = 0.05. Stata 16.1/IC for Unix was used for statistical analysis. Narrative statements summarizing study results were created for the outcomes of marginal adaptation, esthetic properties, preparation design, and restoration thickness.

3. Results

3.1. Study Selection

A total of 12,592 records were identified by the search. After duplicate removal using Deduklick [36], 7912 records were identified, which were selected for title/abstract screening (Figure 1). 123 full‐text articles remained for full‐text screening, and 117 references were excluded. The main reasons for exclusion were the reporting of aggregated data combining outcomes for inlays and onlays, anterior and posterior restorations or other types of ceramic restorations (n = 51), references identified as interim reports of eligible studies with the same population (n = 16), and studies not using an RCT design (n = 22). Six RCTs reporting head‐to‐head comparisons among different ceramic and ceramic‐based materials were included in this review (Table 3) [37, 38, 39, 40, 41, 42].

Prisma Flow chart for article selection.

TABLE 3.

Summary of included RCTs.

No.	Author, year	Study type	Initial no. of patients	Final no. of patients	Drop‐outs	FU (month)	Restoration type	Material	Workflow	Luting agent
1.1	Fasbinder et al. 2020	RCT	86 (total)	86	0	60	Onlay	LRGC (IPS Empress CAD, Ivoclar)	Digital	Dual‐curing resin cements (RelyX Ultimate, 3MESPE or Variolink II (Ivoclar)
1.2	Fasbinder et al. 2020	RCT	86 (total)	86	0	60	Onlay	RMC (Lava Ultimate, 3MESPE)	Digital	Dual‐curing resin cements (RelyX Ultimate, 3MESPE or Variolink II (Ivoclar)
2.1	Guess et al. 2013	RCT	25	14	11	84	Partial Crown	LDS (IPS e.max) Press (Ivoclar)	Conventional	Resin‐based composite materials (Tetric, Ivoclar)
2.2	Guess et al. 2013	RCT	25	14	11	84	Partial Crown	LRGC (Pro CAD, Ivoclar)	Conventional‐digital	Resin‐based composite materials (Tetric, Ivoclar)
3.1	Hassan et al. 2024	RCT	20	20	0	24	Onlay	LDS (IPS e. max CAD, Ivoclar)	Conventional‐digital	Dual‐curing resin cement (Duo Link Universal, Bisco)
3.2	Hassan et al. 2024	RCT	20	20	0	24	Onlay	RMC (Grandio CAD, Voco Dental)	Conventional‐digital	Dual‐curing resin cement (Duo Link Universal, Bisco)
4.1	Schlichting et al. 2022	RCT	6	6	0	27	Occlusal veneer	LDS (e.max CAD, Ivoclar)	Digital	Resin‐based composite materials (Filtek Z100, 3MESPE)
4.2	Schlichting et al. 2022	RCT	5	5	0	27	Occlusal veneer	RMC (Lava Ultimate, 3MESPE)	Digital	Resin‐based composite materials (Filtek Z100, 3MESPE)
5.1	Souza et al. 2021	RCT	20	20	0	12	Onlay	LDS (IPS e. max CAD, Ivoclar)	Conventional‐digital	Dual‐curing resin cement (RelyX Ultimate, 3 M Oral Care)
5.2	Souza et al. 2021	RCT	20	20	0	12	Onlay	RMC (Lava Ultimate, 3 M Oral Care)	Conventional‐digital	Dual‐curing resin cement (RelyX Ultimate, 3 M Oral Care)
6.1	Zhang et al. 2022	RCT	64	59	5	36	Onlay	LDS CAD (brand nr)	Digital	Etch‐and‐rinse adhesive system (Variolink N, Ivoclar) or self‐etching adhesive‐system (Multilink N, Ivoclar)
6.2	Zhang et al. 2022	RCT	64	62	2	36	Onlay	RMC (brand nr)	Digital	Etch‐and‐rinse adhesive system (Variolink N, Ivoclar) or self‐etching adhesive‐system (Multilink N, Ivoclar)

No.	Tooth vitality	Placed no. of restorations	No. of restorations in FU	Total no. of failed units	Total no. of survived units	Definition of survival or failure	Survival/failure rate	Preparation (occlusal/axial and occlusal)	Preparation thickness	Restoration thickness
1.1	Vital	60	60	4	56	nr	Kaplan–Meier probability for fracture: 5y: Empress CAD: 0.068 (0.026; 0.171)	Occlusal and axial	Occlusal reduction: functional cusp at least 2 mm, non‐functional cusp at least 1.5 mm	nr
1.2	Vital	60	60	3	57	nr	Kaplan–Meier probability for fracture: 5y: Lava Ultimate: 0.083 (0.036; 0.189)	Occlusal and axial	Occlusal reduction: functional cusp at least 2 mm, non‐functional cusp at least 1.5 mm	nr
2.1	Vital	40	24	0	24	Absolute failure was defined by clinical unacceptable fracture and crack development which required a replacement of the entire restoration, and/or secondary caries as well as endodontic complications	Survival rate: 7y: e.max Press: 100%	Occlusal and axial	Occlusal reduction: 2 mm	At least 1.5 mm occlusal thickness
2.2	Vital	40	24	1	24	Absolute failure was defined by clinical unacceptable fracture and crack development which required a replacement of the entire restoration, and/or secondary caries as well as endodontic complications	Survival rate: 7y: Pro CAD: 97%	Occlusal and axial	Occlusal reduction: 2 mm	At least 1.5 mm occlusal thickness
3.1	Vital	20	18	2	18	nr	Functional survival rate: 2y: e.max CAD: 90%	nr	Occlusal reduction: functional cusps 2 mm, non‐functional cusps 1.5 mm	nr
3.2	Vital	20	18	2	18	nr	Functional survival rate: 2y: Grandio CAD: 90%	nr	Occlusal reduction: functional cusps 2 mm, non‐functional cusps 1.5 mm	nr
4.1	Vital	24	24	1	23	Failure was considered whenever a restoration received a score 4 or 5. Restorations graded 4 were considered unacceptable but still repairable, while restorations graded 5 were considered failures with immediate need of replacement	Estimated 3y survival rate: e.max CAD: 100%; Pooled survival rate: 88.4%	Occlusal	0.4–0.6 mm (central groove) to 1.0–1.3 mm (cusp tips)	0.55 mm at the central groove, 0.89 mm at the internal cusp slope, 1.00 mm at the cusp tip, and 0.78 mm at the marginal ridge
4.2	Vital	36	36	0	36	Failure was considered whenever a restoration received a score 4 or 5. Restorations graded 4 were considered unacceptable but still repairable, while restorations graded 5 were considered failures with immediate need of replacement	Estimated 3y survival rate: Lava Ultimate: 84.7%; Pooled survival rate: 88.4%	Occlusal	0.4–0.6 mm (central groove) to 1.0–1.3 mm (cusp tips)	0.55 mm at the central groove, 0.89 mm at the internal cusp slope, 1.00 mm at the cusp tip, and 0.78 mm at the marginal ridge
5.1	Vital	20	20	0	20	nr	Survival rate: 1y: e.max CAD: 100%	nr	Occlusal reduction: at least 1.5–2 mm	Occlusal thickness: at least 1.5–2 mm
5.2	Vital	20	20	0	20	nr	Survival rate: 1y: Lava Ultimate: 100%	nr	Occlusal reduction: at least 1.5–2 mm	Occlusal thickness: at least 1.5–2 mm
6.1	Non‐vital	66	51	4	51	nr	Survival rate: 3y: LDS: 93.5% (95% CI, 90.4%–96.6%)	Defect‐oriented (occlusal and axial)	Occlusal reduction: 2 mm at functional cusps and at least 1.5 mm at non‐functional cusps	nr
6.2	Non‐vital	66	47	11	46	nr	Survival rate: 3y: RMC: 83.1% (95% CI, 78.4%–87.8%)	Defect‐oriented (occlusal and axial)	Occlusal reduction: 2 mm at functional cusps and at least 1.5 mm at non‐functional cusps	nr

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Abbreviations: CAD/CAM: Computer aided‐design/computer‐aided manufacturing; FC: Feldspar ceramic; FU: Follow‐up; LDS: Lithium disilicate; LRGC: Leucite‐reinforced glass ceramic; LS: Lithium silicate; No: Number; nr: Not reported; PVS: Polyvinyl siloxane; RCT: Randomized controlled trial; RMC: Resin matrix ceramic.

3.2. Study Characteristics and Risk of Bias Assessment

All studies were conducted in academic settings. A total number of 472 PCRs was placed in 324 participants. The dropout rate varied between 0% and 44%. Four RCTs investigated onlays [37, 39, 40, 41], one partial crowns [38], and one occlusal veneers [42]. Due to a similar extension of the preparation, the study reporting on occlusal veneers was included as an onlay in the meta‐analysis. Four studies compared RMC and LDS [37, 39, 40, 42], one LRGC and LDS [38], and one study RMC and LRGC [41]. No PCRs fabricated from zirconia were identified in the included studies. Four studies reported short‐term (1–3 years) [37, 39, 40, 42], one study mid‐term (4–6 years) [41], and one study long‐term (≥ 7 years) [38] follow‐ups. Three studies applied a fully digital workflow [37, 41, 42], and two studies applied a hybrid conventional‐digital workflow [39, 40]. One study compared Press (LDS) and CAD (LRGC) ceramics and used a conventional impression method; hence, a conventional and conventional‐digital workflow was performed [38]. Two studies performed cementation with resin‐based composite materials [38, 42]. Three studies used dual‐curing resin cement [39, 40, 41] and one study used two different types of cement; however, it was not reported whether they used dual or light‐curing [37]. Due to large clinical heterogeneity of adhesion protocols (adhesives, cements, and surface pretreatment), the influence of the cementation technique was not analyzed in this review. The risk of bias assessment across studies showed concerns about limitations arising from the randomization process and deviation from the intended intervention (Figure 2).

Risk of bias assessment summary according the Revised Cochrane risk‐of‐bias tool for randomized trials (Rob2).

3.3. Outcomes

3.3.1. Survival and Failure Rates

Four studies reported data suitable for meta‐analysis [37, 39, 40, 42], and two studies meeting eligibility criteria were not included in the pooled estimate [38, 41]. None of the six included studies provided a formal definition of survival. Instead, two studies delivered a definition of failure [38, 42]. One of these studies defined a failure as restoration replacement [38] and the other study as both restoration replacement and unacceptable complications that were reparable [42]. Four studies with short‐term follow‐up (1–3 years) reported study‐specific survival rates between 83.1%–100% for RMC and 90%–100% for LDS [37, 39, 40, 42]. Survival rates of 97% for LRGC and 100% for LDS were reported after 7 years of follow‐up [38]. A study with mid‐term follow‐up did not provide any survival rates; instead, the probability of fracture was specified [41] (Table 3). The failure incidence rate estimate was 3.69 per 100 restoration‐years (95% CI 1.59–8.57) for RMC and 2.13 per 100 restoration‐years (95% CI 0.79–5.74) for LDS onlays. Translated into overall survival rates, estimated annual survival rates were 96.3% (95% CI 91.4–98.4) for RMC and 97.9% (95% CI 94.3–99.2) for LDS and 3‐year survival rates were 89.3% (95% CI 76.4–95.3) for RMC and 93.7% (95% CI 83.7–97.7) for LDS. Two additional studies not included in the meta‐analysis (n = 85 restorations, 5–7 years follow‐up) suggested an estimated 3‐year survival rate for LRGC of 96.1% (95% CI 90.1–98.9) compared with RMC [41] and of 98.3% (95% CI 90.8–100) compared with LDS (Table 4) [38]. For the outcome of restoration failure after 1–3 years follow‐up, the meta‐analysis including 252 restorations showed an IRR of 1.74 (95% CI 0.54–5.57; I ² = 0.00; p = 0.228) [37, 39, 40, 42] (Table 5 and Figure 3). In absolute terms, RMC restorations may experience 1.56 more failures per 100 restoration‐years compared to LDS (low certainty of evidence) (Table 6). Two additional studies not included in the meta‐analysis (n = 169 restorations) suggested that RMC restorations compared to LRGC show an IRR of 0.75 (95% CI: 0.17–3.35) [41] and LRGC compared to LDS of 1.92 (95% CI 0.06–57.23) [38] (Table 5).

TABLE 4.

Events, failuresp, and estimated survival rates of all included studies.

		No. of rest.	Mean FU (month)	Total FU (years)	No. of failures	No. of survived u.	Estimated survival rates ^a		Failure—incidence rate (IR) ^a
Study	Material	No. of rest.	Mean FU (month)	Total FU (years)	No. of failures	No. of survived u.	After 1 year (95% CI)	After 3 years (95% CI)	Per 100 years (95% CI) ^a
Fasbinder et al. 2020	LRGC	60	60.0	300.0	4	56	98.7 (96.6–99.6)	96.1 (90.1–98.9)	1.33 (0.36–3.41)
Fasbinder et al. 2020	RMC	60	60.0	300.0	3	57	99.0 (97.1–99.8)	97.0 (91.5–99.4)	1.00 (0.21–2.92)
Guess et al. 2013	LDS	24	84.0	168.0	0	24	100 (97.8–100)	100 (93.6–100)	0 (0–2.20)
Guess et al. 2013	LRGC	25	84.0	175.0	1	24	99.4 (96.8–100)	98.3 (90.8–100)	0.57 (0.01–3.18)
Hassan et al. 2024	LDS	20	24.0	40.0	2	18	95.0 (81.9–99.4)	85.7 (55.0–98.2)	5.00 (0.61–18.06)
Hassan et al. 2024	RMC	20	24.0	40.0	2	18	95.0 (81.9–99.4)	85.7 (55.0–98.2)	5.00 (0.61–18.06)
Schlichting et al. 2022	LDS	24	27.1	54.2	1	23	98.2 (89.7–99.9)	94.6 (72.2–99.9)	1.85 (0.05–10.28)
Schlichting et al. 2022	RMC	36	27.1	81.3	0	36	100 (95.5–100)	100 (87.0–100)	0 (0–4.54)
Souza et al. 2021	LDS	20	12.0	20.0	0	20	100 (81.6–100)	100 (54.2–100)	0 (0–18.44)
Souza et al. 2021	RMC	20	12.0	20.0	0	20	100 (81.6–100)	100 (54.2–100)	0 (0–18.44)
Zhang et al. 2022	LDS	55	36.0	165.0	4	51	97.6 (93.8–99.3)	92.9 (82.5–98.0)	2.42 (0.66–6.21)
Zhang et al. 2022	RMC	57	36.0	171.0	11	46	93.6 (88.5–96.8)	81.9 (69.3–90.7)	6.43 (3.21–11.51)
Summary ^b
	LDS	119		279.2	7	112	97.9 (94.3–99.2)	93.7 (83.7–97.7)	2.13 (0.79–5.74)
	RMC	133		312.3	13	120	96.3 (91.4–98.4)	89.3 (76.4–95.3)	3.69 (1.59–8.57)

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Abbreviations: CI: Confidence interval; FU: Follow‐up; LDS: Lithium disilicate; LRGC: Leucite‐reinforced glass ceramic; No. of failures: Number of failures; No. of rest.: Number of restorations; No. of survived u.: Number of survived units; RMC: Resin matrix ceramic.

^{^a}

Assuming Poisson distributed failures, confidence interval of IR are one‐sided when no failures were observed.

^{^b}

Studies with RMC and LDS (Hassan, Schlichting, Souza, Zhang) estimation by random‐effects Poisson regression.

TABLE 5.

Results for the outcome restoration failure; RMC versus LDS, single studies and meta‐analysis summary.

Study	IRR (95% CI)	Weight
Fasbinder et al. 2020 ^b	0.75 (0.17–3.35)	—
Guess et al. 2013 ^c	1.92 (0.06–57.23)	—
Hassan et al. 2024 ^d	1.00 (0.14–7.10)	22.14%
Schlichting et al. 2022 ^d	0.33 (0.01–9.94)	7.38%
Souza et al. 2021 ^d	1.00 (0.02–50.40)	5.54%
Zhang et al. 2022 ^d	2.65 (0.84–8.33)	64.94%
Overall ^a	1.74 (0.54–5.57)
Test of overall effect = 1	1.51, p = 0.228
tau²	0.00
I ²	0.00
H ²	1.00
Test of homogeneity (Q)	1.82, p = 0.611

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Abbreviations: LDS: Lithium disilicate; LRGC: Leucite‐reinforced glass ceramic; RMC: Resin matrix ceramic.

^{^a}

Random‐effects model, REML.

^{^b}

RMC versus LRGC.

^{^c}

LRGC versus LDS.

^{^d}

RMC versus LDS, standard continuity correction when no failures were observed.

Forest plot on the outcome of restoration failure including four RCTs with a comparison of RMC and LDS.

TABLE 6.

Summary of findings table with GRADE assessment.

Assessment of the certainty of the evidence (GRADE)
Patient or population: Patients with extended defects treated with PCRs on posterior teeth Meta‐analysis: RMC compared to LDS onlays Intervention: RMC (Resin matrix ceramic) Comparison: LDS (Lithium disilicate)
Outcomes	№ of restorations (studies)	Certainty of the evidence (GRADE)	Relative effect (95% CI)	Anticipated absolute effects
Outcomes	№ of restorations (studies)	Certainty of the evidence (GRADE)	Relative effect (95% CI)	Risk with LDS	Risk with RMC
Restoration failure follow‐up: Range 1–3 years ^a	252 (4 RCTs)	⨁⨁◯◯ Low ^b , ^c	Rate ratio 1.74 (0.54–5.57)	2.13 failures per 100 restoration‐years	3.69 failures per 100 restoration‐years
Bulk fracture follow‐up: Range 1–3 years ^d	252 (4 RCTs)	⨁⨁◯◯ Low ^e , ^f	Rate ratio 0.53 (0.20–1.37)	1.07 fractures per 100 restoration‐years	0.32 fractures per 100 restoration‐years
Chipping follow‐up: Range 1–3 years ^g	252 (4 RCTs)	⨁⨁◯◯ Low ^c , ^e	Rate ratio 1.10 (0.26–4.57)	1.89 chippings per 100 restoration‐years	2.29 chippings per 100 restoration‐years
Loss of retention follow‐up: Range 2–3 years ^h	212 (3 RCTs)	⨁⨁◯◯ Low ^e , ⁱ	Rate ratio 1.54 (0.01–196.50)	0.98 debondings per 100 restoration‐years	2.76 debondings per 100 restoration‐years
Endodontic complication follow‐up: Range 1–3 years ^j	252 (4 RCTs)	⨁⨁◯◯ Low ^b , ^k	Rate ratio 1.16 (0.20–6.79)	0.53 endodontic compl. per 100 restoration‐years	0.92 endodontic compl. per 100 restoration‐years
Tooth fracture follow‐up: Range 1–7 years	421 (6 RCTs)	⨁◯◯◯ Very low ^b , ^f	Fasbinder et al. reported an incidence rate per 100 years for tooth fracture in the RMC arm of 0.67 (95% CI 0.08–2.41) and no events in the LRGC arm. Zhang et al. reported an incidence rate per 100 years for tooth fracture in the RMC arm of 0.58 (95% CI 0.01–3.26) and no events in the LDS arm. No tooth fractures were observed in the four other included studies (Hassan et al., Schlichting et al., Souza et al., and Guess et al.)
Secondary caries follow‐up: Range 1–7 years	421 (6 RCTs)	⨁◯◯◯ Very low ^b , ^f	No events were observed in the included studies
Marginal adaptation follow‐up: Range 1–7 years	421 (6 RCTs)	⨁◯◯◯ Very low ^b , ^f	No statistically significant difference was observed between RMC and LDS in the included short‐term studies (Zhang et al., Schlichting et al., Hassan et al., Souza et al.). One study with a comparison of RMC and LRGC onlays reported scores greater than 93% alfa over an observation period of 5 years (Fasbinder et al.). In contrast, LRGC and LDS partial crowns revealed significantly decreasing alfa ratings for the marginal adaptation of both groups over time (baseline to 7 years) (Guess et al.)
Esthetic and surface properties follow‐up: Range 1–7 years	421 (6 RCTs)	⨁◯◯◯ Very low ^b , ^f	Two short‐term studies (Souza et al. and Hassan et al.) did not observe a statistically significant difference between RMC and LDS onlays. Significant deteriorations in surface luster of RMC compared to LDS were reported by two other short‐term studies (Zhang et al. and Schlichting et al.). One study with a comparison of RMC and LRGC onlays reported scores greater than 93% alfa for all parameters of esthetic properties over an observation period of 5 years (Fasbinder et al.). LRGC and LDS partial crowns revealed deteriorations of color match and surface roughness over time (baseline to 7 years) that were significantly more prevalent for LDS compared to LRGC (Guess et al.)
Preparation thickness follow‐up: Range 1–7 years	309 (5 RCTs)	⨁◯◯◯ Very low ^b , ^f	One study reported an occlusal reduction of at least 2 mm (Guess et al.) and three studies of 1.5–2 mm (Fasbinder et al., Hassan et al., Souza et al.). The lowest occlusal reduction of 0.4–0.6 mm at the central groove and 1.0–1.3 mm at the cusp tips was performed for occlusal veneers composed of RMC and LDS (Schlichting et al.)
Restoration thickness follow‐up: Range 1–7 years	149 (3 RCTs)	⨁◯◯◯ Very low ^b , ^f	Two of the included studies specified a restoration thickness of 1.5–2 mm (Souza et al.) and 1.5 mm (Guess et al.). One study on RMC and LDS occlusal veneers applied a minimally invasive restoration thickness of 0.55 mm at the central groove, 0.89 mm at the internal cusp slope, 1 mm at the cusp tip, and 0.78 mm at the marginal ridge. No bulk fracture occurred after a mean follow‐up of 2.3 years, however, five chipping fractures in the RMC arm were observed (Schlichting et al.)

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Note: The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

Note: GRADE Working Group grades of evidence. High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

Abbreviation: CI: Confidence interval.

^{^a}

Two additional studies not included in this meta‐analysis (n = 169 restorations) suggest that restorations composed of RMC compared with LRGC show an IRR of 0.75 (95% CI 0.17–3.35) and LRGC compared to LDS show an IRR of 1.92 (95% CI 0.06–57.23).

^{^b}

Studies that carried large weight for the overall effect estimate rated as high risk of bias due to bias associated with deviations from the intended intervention, missing outcome data, and measurement of the outcome.

^{^c}

Serious issues of imprecision. 95% CI for the absolute effect consistent with the possibility of negligible benefit and large harm.

^{^d}

Two additional studies not included in this meta‐analysis (n = 169 restorations) suggest that restorations composed of RMC compared with LRGC show an IRR of 0.25 (95% CI 0.03–2.24) and LRGC compared to LDS show an IRR of 1.92 (95% CI 0.06–57.23).

^{^e}

Studies that carried large weight for the overall effect estimate rated as high risk of bias due to bias associated with deviations from the intended intervention and missing outcome data.

^{^f}

Serious issues of imprecision due to a small number of events.

^{^g}

Two additional studies not included in this meta‐analysis (n = 169 restorations) suggest that restorations composed of RMC compared with LRGC show an IRR of 1.00 (95% CI 0.06–15.99) and LRGC compared to LDS show an IRR of 0.64 (95% CI 0.11–3.83).

^{^h}

Two additional studies not included in this meta‐analysis (n = 169 restorations) suggest that restorations composed of RMC compared with LRGC show an IRR of 1.00 (95% CI 0.02–50.40) and LRGC compared to LDS show an IRR of 0.96 (95% CI 0.02–48.38).

^ⁱ

Serious issues of imprecision. 95% CI for the absolute effect consistent with the possibility of a small but important benefit and a large harm.

^{^j}

Two additional studies not included in this meta‐analysis (n = 169 restorations) suggest that restorations composed of RMC compared with LRGC show an IRR of 4.00 (95% CI 0.18–88.70) and LRGC compared to LDS show an IRR of 0.96 (95% CI 0.02–48.38).

^{^k}

Serious issues of imprecision. 95% CI for the absolute effect consistent with the possibility of negligible benefit and small but important harm.

3.3.2. Bulk Fracture

The bulk fracture incidence rate was 0.32 per 100 restoration‐years (95% CI 0.05–2.27) for RMC and 1.07 per 100 restoration‐years (95% CI 0.35–3.33) for LDS (Table 7). For the outcome of bulk fracture after 1–3 years follow‐up, the meta‐analysis including 252 restorations shows an IRR of (0.53 (95% CI 0.20–1.37); I ² = 0.00; p = 0.124) [37, 39, 40, 42] (Figure 4). In absolute terms, RMC restorations may experience 0.75 fewer bulk fractures per 100 restoration‐years compared to LDS (low certainty of evidence) (Table 6). Two additional studies not included in this meta‐analysis (n = 169 restorations) suggested that RMC restorations compared to LRGC show an IRR of 0.25 (95% CI 0.03–2.24) and LRGC compared to LDS of 1.92 (95% CI 0.06–57.23) [38, 41].

TABLE 7.

Events and bulk fracture rates of all included studies.

Study	Material	No. of rest.	Mean FU (month)	Total FU (years)	No. of complications	Incidence rate (IR) ^a per 100 years (95% CI) ^a
Fasbinder et al. 2020	LRGC	60	60.0	300.0	4	1.33 (0.36–3.41)
Fasbinder et al. 2020	RMC	60	60.0	300.0	1	0.33 (0.01–1.86)
Guess et al. 2013	LDS	24	84.0	168.0	0	0 (0–2.20)
Guess et al. 2013	LRGC	25	84.0	175.0	1	0.57 (0.01–3.18)
Hassan et al. 2024	LDS	20	24.0	40.0	0	0 (0–9.22)
Hassan et al. 2024	RMC	20	24.0	40.0	0	0 (0–9.22)
Schlichting et al. 2022	LDS	24	27.1	54.2	0	0 (0–6.81)
Schlichting et al. 2022	RMC	36	27.1	81.3	0	0 (0–4.54)
Souza et al. 2021	LDS	20	12.0	20.0	0	0 (0–18.44)
Souza et al. 2021	RMC	20	12.0	20.0	0	0 (0–18.44)
Zhang et al. 2022	LDS	55	36.0	165.0	3	1.82 (0.37–5.31)
Zhang et al. 2022	RMC	57	36.0	171.0	1	0.58 (0.01–3.26)
Summary ^b
	LDS	119		279.2	3	1.07 (0.35–3.33)
	RMC	133		312.3	1	0.32 (0.05–2.27)

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Abbreviations: CI: Confidence interval; FU: Follow‐up; LDS: Lithium disilicate; LRGC: Leucite‐reinforced glass ceramic; No. of complications: Number of complications; No. of rest.: Number of restorations; RMC: Resin matrix ceramic.

^{^a}

Assuming Poisson distributed complications, confidence interval of IR are one‐sided when no complications were observed.

^{^b}

Studies with RMC and LDS (Hassan, Schlichting, Souza, Zhang) estimation by random‐effects Poisson regression.

Forest plot on the outcome of bulk fracture including four RCTs with a comparison of RMC and LDS.

3.3.3. Chipping

The chipping incidence rate was 2.29 per 100 restoration‐years (95% CI 0.97–5.40) for RMC and 1.89 per 100 restoration‐years (95% CI 0.70–5.09) for LDS (Table 8). For the outcome chipping after 1–3 years follow‐up, the meta‐analysis including 252 restorations revealed an IRR of (1.10 (95% CI 0.26–4.57); I ² = 0.00; p = 0.849) [37, 39, 40, 42] (Figure 5). In absolute terms, RMC restorations may experience 0.4 more chippings per 100 restoration‐years compared to LDS (low certainty of evidence) (Table 6). Two additional studies not included in the meta‐analysis (n = 169 restorations) suggested that RMC restorations compared to LRGC show an IRR of 1.00 (95% CI 0.06–15.99) and LRGC compared to LDS of 0.64 (95% CI 0.11–3.83) [38, 41].

TABLE 8.

Events and chipping rates of all included studies.

Study	Material	No. of rest.	Mean FU (month)	Total FU (years)	No. of complications	Incidence rate (IR) ^a per 100 years (95%‐CI) ^a
Fasbinder et al. 2020	LRGC	60	60.0	300.0	1	0.33 (0.01–1.86)
Fasbinder et al. 2020	RMC	60	60.0	300.0	1	0.33 (0.01–1.86)
Guess et al. 2013	LDS	24	84.0	168.0	3	1.79 (0.37–5.22)
Guess et al. 2013	LR GC	25	84.0	175.0	2	1.14 (0.14–4.13)
Hassan et al. 2024	LDS	20	24.0	40.0	0	0 (0–9.22)
Hassan et al. 2024	RMC	20	24.0	40.0	0	0 (0–9.22)
Schlichting et al. 2022	LDS	24	27.1	54.2	1	1.85 (0.05–10.28)
Schlichting et al. 2022	RMC	36	27.1	81.3	5	6.15 (2.00–14.35)
Souza et al. 2021	LDS	20	12.0	20.0	1	5.00 (0.13–27.86)
Souza et al. 2021	RMC	20	12.0	20.0	0	0 (0–18.44)
Zhang et al. 2022	LDS	55	36.0	165.0	3	1.82 (0.37–5.31)
Zhang et al. 2022	RMC	57	36.0	171.0	2	1.17 (0.14–4.22)
Summary ^b
	LDS	119		279.2	5	1.89 (0.70–5.09)
	RMC	133		312.3	7	2.29 (0.97–5.40)

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^{^a}

Assuming Poisson distributed complications, confidence interval of IR are one‐sided when no complications were observed.

^{^b}

Studies with RMC and LDS (Hassan, Schlichting, Souza, Zhang) estimation by random‐effects Poisson regression.

Forest plot on the outcome of chipping including four RCTs with a comparison of RMC and LDS.

3.3.4. Loss of Retention

The loss of retention incidence rate was 2.76 per 100 restoration‐years (95% CI 0.93–8.24) for RMC and 0.98 per 100 restoration‐years (95% CI 0.23–4.14) for LDS (Table 9). For the outcome loss of retention after 1–3 years follow‐up, the meta‐analysis including 212 restorations showed an IRR of (1.54 (95% CI: 0.01–196.50); I ² = 49.74; p = 0.740) [37, 40, 42] (Figure 6). In absolute terms, RMC restorations may experience 1.78 more loss of retentions per 100 restoration‐years compared to LDS (low certainty of evidence) (Table 6). Two additional studies not included in this meta‐analysis (n = 169 restorations) suggested that RMC restorations compared to LRGC show an IRR of 1.00 (95% CI 0.02–50.40) and LRGC compared to LDS of 0.96 (95% CI 0.02–48.38) [38, 41].

TABLE 9.

Events and loss of retention rates of all included studies.

Study	Material	No. of rest.	Mean FU (month)	Total FU (years)	No. of complications	Incidence rate (IR) ^a per 100 years (95%‐CI) ^a
Fasbinder et al. 2020	LRGC	60	60.0	300.0	0	0 (0–1.23)
Fasbinder et al. 2020	RMC	60	60.0	300.0	0	0 (0–1.23)
Guess et al. 2013	LDS	24	84.0	168.0	0	0 (0–2.20)
Guess et al. 2013	LRGC	25	84.0	175.0	0	0 (0–2.11)
Hassan et al. 2024	LDS	20	24.0	40.0	2	5.00 (0.61–18.06)
Hassan et al. 2024	RMC	20	24.0	40.0	0	0 (0–9.22)
Schlichting et al. 2022	LDS	24	27.1	54.2	0	0 (0–6.81)
Schlichting et al. 2022	RMC	36	27.1	81.3	0	0 (0–4.54)
Zhang et al. 2022	LDS	55	36.0	165.0	1	0.61 (0.02–3.38)
Zhang et al. 2022	RMC	57	36.0	171.0	9	5.26 (2.41–9.99)
Summary ^b
	LDS	99		259.2	3	0.98 (0.23–4.14)
	RMC	113		292.3	9	2.76 (0.93–8.24)

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^{^a}

Assuming poisson distributed complications, confidence interval of IR are one‐sided when no complications were observed.

^{^b}

Studies with RMC and LDS (Hassan, Schlichting, Souza, Zhang) estimation by random‐effects poisson regression.

Forest plot on the outcome of loss of retention including three RCTs with a comparison of RMC and LDS.

3.3.5. Endodontic Complications

The endodontic complication incidence rate was 0.92 per 100 restoration‐years (95% CI 0.14–5.98) for RMC and 0.53 per 100 restoration‐years (95% CI 0.05–5.39) for LDS (Table 10). For the outcome endodontic complication after 1–3 years follow‐up, the meta‐analysis including 252 restorations revealed an IRR of 1.16 (95% CI 0.20–6.79; I ² = 0.00; p = 0.811) [37, 39, 40, 42] (Figure 7). In absolute terms, RMC restorations may experience 0.39 more endodontic complications per 100 restoration‐years compared to LDS (low certainty of evidence) (Table 6 ). Two additional studies not included in this meta‐analysis (n = 169 restorations) suggested that RMC restorations compared to LRGC show an IRR of 4.00 (95% CI 0.18–88.70) and LRGC compared to LDS of 0.96 (95% CI: 0.02–48.38) [38, 41].

TABLE 10.

Events and endodontic complication rates of all included studies.

Study	Material	No. of rest.	Mean FU (month)	Total FU (years)	No. of complications	Incidence rate (IR) ^a per 100 years (95%‐CI) ^a
Fasbinder et al. 2020	LRGC	60	60.0	300.0	0	0 (0–1.23)
Fasbinder et al. 2020	RMC	60	60.0	300.0	2	0.67 (0.08–2.41)
Guess et al. 2013	LD	24	84.0	168.0	0	0 (0–2.20)
Guess et al. 2013	LRGC	25	84.0	175.0	0	0 (0–2.11)
Hassan et al. 2024	LD	20	24.0	40.0	0	0 (0–9.22)
Hassan et al. 2024	RMC	20	24.0	40.0	2	5.00 (0.61–18.06)
Schlichting et al. 2022	LD	24	27.1	54.2	1	1.85 (0.05–10.28)
Schlichting et al. 2022	RMC	36	27.1	81.3	0	0 (0–4.54)
Souza et al. 2021	LD	20	12.0	20.0	0	0 (0–18.44)
Souza et al. 2021	RMC	20	12.0	20.0	0	0 (0–18.44)
Zhang et al. 2022	LD	55	36.0	165.0	0	0 (0–2.24)
Zhang et al. 2022	RMC	57	36.0	171.0	0	0 (0–2.16)
Summary ^b
	LDS	119		279.2	1	0.53 (0.05–5.39)
	RMC	133		312.3	2	0.92 (0.14–5.98)

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^{^a}

Assuming Poisson distributed complications, confidence interval of IR are one‐sided when no complications were observed.

^{^b}

Studies with RMC and LDS (Hassan, Schlichting, Souza, Zhang) estimation by random‐effects Poisson regression.

Forest plot on the outcome of endodontic complication including four RCTs with a comparison of RMC and LDS.

3.3.6. Tooth Fracture

For the outcome tooth fracture after 1–3 years follow‐up, one study suggested an IR of 0.67 (95% CI 0.08–2.41) per 100 restoration‐years for RMC and no events for LRGC [41]. Another study revealed an IR of 0.58 per 100 restoration‐years (95% CI 0.01–3.26) for RMC and no events for LDS [37]. No tooth fractures were observed in the other four included studies after 1–3 years follow‐up [38, 39, 40, 42] (Table 11).

TABLE 11.

Events and tooth fracture rates of all included studies.

Study	Material	No. of rest.	Mean FU (month)	Total FU (years)	No. of tooth fractures	Incidence rate (IR) ^a per 100 years (95%‐CI) ^a
Fasbinder et al. 2020	LRGC	60	60.0	300.0	0	0 (0–1.23)
Fasbinder et al. 2020	RMC	60	60.0	300.0	2	0.67 (0.08–2.41)
Guess et al. 2013	LDS	24	84.0	168.0	0	0 (0–2.20)
Guess et al. 2013	LRGC	25	84.0	175.0	0	0 (0–2.11)
Hassan et al. 2024	LDS	20	24.0	40.0	0	0 (0–9.22)
Hassan et al. 2024	RMC	20	24.0	40.0	0	0 (0–9.22)
Schlichting et al. 2022	LDS	24	27.1	54.2	0	0 (0–6.81)
Schlichting et al. 2022	RMC	36	27.1	81.3	0	0 (0–4.54)
Souza et al. 2021	LDS	20	12.0	20.0	0	0 (0–18.44)
Souza et al. 2021	RMC	20	12.0	20.0	0	0 (0–18.44)
Zhang et al. 2022	LDS	55	36.0	165.0	0	0 (0–2.24)
Zhang et al. 2022	RMC	57	36.0	171.0	1	0.58 (0.01–3.26)
Summary not performed	—	—	—	—	—	—
Summary not performed	—	—	—	—	—	—

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^{^a}

Assuming Poisson distributed complications, confidence interval of IR are one‐sided when no complications were observed.

3.3.7. Secondary Caries

No secondary caries was reported in any of the studies.

3.3.8. Marginal Adaptation

At 1‐year follow‐up, RMC and LDS showed deteriorations in marginal adaptation from baseline assessment of 100% excellent to 90% [39]. At 2‐year follow‐up, deterioration was noticed in both ceramic materials, with better scores for RMC compared to LDS; however, no statistically significance was detected between both materials after two years [40, 42]. At 3‐year follow‐up, RMC and LDS onlay restorations were both assessed as clinically excellent [37]. A study comparing RMC and LRGC onlays reported scores greater than 93% alfa for all restorations over a 5‐year observation period [41]. In contrast, LRGC and LDS partial crowns revealed significantly decreasing alfa ratings for the marginal adaptation of both groups over 7 years of follow‐up [38]. Marginal adaptation seems to be high in short and mid‐term, while deteriorations are noticeable in long‐term (low certainty of evidence) (Table 6).

3.3.9. Esthetic and Surface Properties

The evidence on esthetics and surface properties is heterogeneous across individual studies, with the evidence rated as very low certainty for all these outcomes (Table 6). For RMC, statistically significant deteriorations were detected after 6 months of follow‐up for surface luster, marginal staining, and color match. In contrast, for LDS no statistically significant differences were detected, except for marginal staining [37]. At 1 year follow‐up, both LDS and RMC were considered clinically acceptable, with no statistically significant differences in color match or marginal staining between both materials [39, 40]. However, a study reported a slight deterioration in surface luster in the LDS group, which was statistically significant [39]. At a 3‐year follow‐up, esthetic properties of RMC and LDS presented deteriorations with no statistically significant difference [37]. Another study, including occlusal veneers composed of RMC, exhibited significantly more deterioration in surface roughness than their LDS counterparts [42]. The same study found that color match and marginal staining were also slightly better for LDS; however, no statistical significance was detected [42]. Two studies detected broader wear facets in RMC restorations up to 5 years follow‐up [37, 41]. However, only a limited number of restorations were affected. Most studies did not find a significant difference between RMC and LDS regarding wear [39, 40, 41], except for one study with significantly more deterioration in the RMC group after 3 years of follow‐up [37]. One study comparing RMC and LRGC onlays reported scores greater than 93% alfa concerning all evaluated esthetic properties (surface luster, marginal staining, color match) over a 5‐year observation period [41]. LRGC and LDS partial crowns revealed deteriorations of color match and surface roughness over 7 years of follow‐up, which were significantly more frequent in LDS than LRGC [38].

3.3.10. Preparation Design and Thickness

Different preparation designs were described in the included studies concerning geometry, reduction, and extension of the preparation. One study applied a non‐retentive preparation design with occlusal reduction solely [42]. Regarding preparation thickness, one study reported an occlusal reduction of at least 2 mm [38], and three studies of 1.5–2 mm [39, 40, 41]. The lowest occlusal reduction was 0.4–0.6 mm at the central groove and 1.0–1.3 mm at the cusp tips, which was performed for occlusal veneers composed of RMC and LDS [42]. One study did not provide any information about preparation thickness [37]. Two of the included studies specified a restoration thickness of 1.5–2 mm [39] and 1.5 mm [38]. Only the aforementioned study on RMC and LDS occlusal veneers applied a minimally invasive restoration thickness of 0.55 mm at the central groove, 0.89 mm at the internal cusp slope, 1 mm at the cusp tip, and 0.78 mm at the marginal ridge [42]. After 2.3 years of follow‐up the study (n = 60 restorations) did not identify any bulk fracture; however, five chipping fractures in the RMC arm were observed [42]. The certainty of the evidence for preparation and restoration thickness was rated as very low (Table 6).

3.4. Subgroup Analysis

3.4.1. Tooth Vitality

Subgroup comparisons of onlay restorations placed on vital versus non‐vital teeth were performed for the outcomes of restoration failure, bulk fracture, chipping, loss of retention, and endodontic complication including 140 restorations on vital [39, 40, 42] and 112 on non‐vital teeth [37]. When comparing RMC and LDS, no statistically significant differences were identified for onlay restorations placed on vital versus non‐vital teeth (restoration failure: p = 0.22, bulk fracture: p = 0.54, chipping: p = 0.43, loss of retention: p = 0.05, endodontic complication: p = 0.92) (Supporting Information).

4. Discussion

This is the first systematic review, including meta‐analysis based on RCTs comparing PCRs composed of different ceramic and ceramic‐based materials (RMC, LRGC, and LDS). The results suggest that PCRs, either composed of RMC or LDS, have 3‐year survival rates of 89.3% (95% CI 76.4–95.3) and 93.7% (95% CI 83.7–97.7), respectively [37, 39, 40, 42]. Studies not included in the meta‐analysis also show similar results [38, 41]. After 1–3 years of follow‐up, LDS slightly outperforms RMC regarding the outcomes of restoration failure and loss of retention (1.56 more failures and 1.78 more loss of retentions for RMC per 100 restoration‐years). A small, insignificant difference was detected in favor of RMC compared to LDS for the outcome of bulk fracture (0.75 fewer bulk fractures for RMC per 100 restoration‐years). For the outcome of chipping, little to no difference was found (0.4 more chippings and 0.4 more endodontic complications for RMC per 100 restoration‐years). None of these short‐term follow‐up differences between restoration materials were statistically significant. Bulk fractures and loss of retention were the most common mechanical complications reported, whereas endodontic complications and tooth fractures were the most frequently reported biological complications. The evidence was rated as very uncertain for the outcomes of tooth fracture, secondary caries, marginal adaptation, esthetic properties, preparation, and restoration thickness.

A previous systematic review on the longevity of ceramic onlays reported survival rates ranging between 91% and 100% after 2–5 years follow‐up [1]. Two additional systematic reviews on the performance of PCRs estimated a 5‐year survival rate of 92% [8, 30] for glass ceramic and 90% [8] to 95% [30] for feldspar ceramic. Available systematic reviews on this topic differ from the present one since they did not compare ceramic materials but assessed them against single crowns [25, 26, 27] or direct composite restorations [8, 28, 29], or did not implement a comparative effectiveness framework to determine treatment effects [1, 30]. Furthermore, most systematic reviews did not distinguish the extent of the restoration (inlay or onlay) [8, 27, 43]. The only available systematic review with a similar comparison among ceramic and ceramic‐based materials (RMC and all‐ceramic PCRs) [17], did not include a meta‐analysis and only reported success rates. A previous systematic review stated that the elastic and flexible properties of RMC are the most probable reason for the superiority of RMC regarding bulk fractures, which might result in greater resilience and improved ability of stress absorption compared to brittle ceramics [17]. This assumption is confirmed by one study not included in the meta‐analysis (n = 120 restorations) that also observed slightly more bulk fractures (four LGRC, one RMC) for LGRC compared with RMC after 5 years [41]. In alignment with the present review findings, other studies also identified bulk fracture and loss of retention as the most common causes of PCR failures [1, 29, 30]. Loss of retention occurred as a failure of the cementation interface and might therefore be associated with a lower bond strength of RMC compared to LDS [1]. A previous study investigating the influence of surface treatment on the bond strength of different CAD/CAM restorative materials revealed the highest bond strength (100.31 ± 10.7 MPa) for LDS (IPS e.max CAD, Ivoclar) pretreated with hydrofluoric acid in combination with universal adhesive (Scotch Bond Universal, 3MEspe) luted with a dual‐curing adhesive cement (Variolink N, Ivoclar) [44]. The lowest bond strength (23.63 ± 9.0 MPa) was detected for RMC (Lava Ultimate, 3MEspe) without any surface pretreatment, while sandblasting in combination with the application of the universal adhesive (Scotch Bond Universal, 3MEspe) was identified as the most effective pretreatment method for Lava Ultimate (100.19 ± 19.7 MPa). In contrast, the bond strength of LDS (IPS e.max CAD, Ivoclar) was 64.48 ± 10.3 MPa without any surface pretreatment [44]. Hence, RMC might be more susceptible to bonding failure if the bonding protocol is not applied properly [17]. Besides ceramic fracture, loss of retention and chipping were identified as the most common mechanical complications, which is in line with the current literature [26]. Chipping was reported to be more prevalent in posterior than in anterior teeth due to greater masticatory loads and lateral forces on the balancing cusps [21, 27]. Regarding maintenance, RMC restorations may be slightly superior to all‐ceramic restorations since minor chipping fractures might be repairable with composite resin, avoiding the need for an immediate restoration replacement [42]. Only one included study in this review, including RMC and LDS occlusal veneers, applied a minimally invasive restoration thickness of 0.55 mm at the central groove, 0.89 mm at the internal cusp slope, 1 mm at the cusp tip, and 0.78 mm at the marginal ridge [42]. No bulk fracture occurred after a mean follow‐up of 2.3 years; however, five chipping fractures in the RMC arm were observed. Although a review article [24] and several in vitro studies [45, 46, 47] on the performance of occlusal veneers suggested that the ceramic thickness can be successfully reduced up to 0.7 mm and above, a previous RCT comparing lithium silicate (LS) partial crowns with 0.5–0.74 and 0.75–1.0 mm thickness observed a higher number of fractures in the thinner (0.5–0.74 mm) restoration group [48]. More RCTs on the performance of PCRs with minimally invasive restoration thicknesses and precise descriptions of the applied preparation designs are needed. Some previous studies identified loss of tooth vitality as a significant risk factor for the restorations' survival [30, 49]. The present short‐term results do not support these findings since no statistically significant differences were detected in the subgroup analysis of different outcomes. Inferior survival may be related to the lack of the remaining tooth substance and, hence, the lower capacity to support the ceramic restoration [1, 43]. One of the included studies compared Press and CAD ceramics and observed similar favorable results (e.maxPress:100%, ProCAD:97%) after 7 years of follow‐up [38]. Surface properties (e.g., microstructure, topography, roughness, and fractal dimension) and adaptation (marginal and internal fit) of CAD and Press ceramics were reported to be considerably different [50]. A previous systematic review suggested that the risk of restoration failure may be 1.84 times higher for CAD/CAM fabricated ceramic restorations compared to their conventional manufactured counterparts [21]. In a recently conducted systematic review, 11 studies showed better results (marginal and internal fit, accuracy, fracture resistance, and long‐term clinical performance) for PCRs fabricated with the conventional workflow, 10 with the digital workflow, and two studies reported similar outcomes [20].

The strength of this systematic review resides in the rigor of the methods, the use of meta‐analytical techniques, and Poisson modeling to estimate incidence rates across studies. Another strength is the use of the GRADE approach to assess the certainty of the evidence across outcomes and its presentation using a GRADE summary‐of‐findings table, which is unique to this review. Although the certainty of the body of evidence was found to be low to very low, the present results represent the best available evidence to inform the performance of PCRs on posterior teeth. The RCT design is considered the gold standard for assessing the effect of clinical interventions since they are designed as comparative studies aiming to minimize confounding and other types of bias [17, 51]. This review also has limitations as the majority of the included studies assessed clinical outcomes in a short‐term follow‐up. In addition, studies reported in languages other than English were excluded. Nonetheless, it is expected that the body of evidence included in this review is a reliable representation of the best available evidence on the topic.

With regard to implications for future clinical research, RCTs, including the use of split‐mouth designs and larger sample sizes with longer follow‐up periods, are needed. In addition, the application of standardized assessment methods across clinical outcomes can facilitate a better comparison across primary studies and the conduct of more robust meta‐analyses. This systematic review provides valuable insights for clinicians to enhance the efficacy and predictability of PCR treatments. For appropriate decision‐making, dental professionals should inform their patients about the properties as well as desirable and undesirable outcomes of individual materials. While RMC may be more susceptible to cementation failure and deterioration in wear and surface luster over time, LDS obtained more favorable results in all investigated outcomes, with the exception of bulk fracture. Further studies are needed to assess the long‐term performance of PCRs on posterior teeth.

5. Conclusion

The survival of LDS restorations may slightly outperform RMC restorations after 3 years of follow‐up across outcomes, except for bulk fracture. No statistically significant differences were detected between different ceramic and ceramic‐based materials in the short‐term (1–3 years of follow‐up). The long‐term performance remains uncertain. Ceramic and ceramic‐based PCRs are a reliable treatment option to restore extended posterior defects.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Figure S1. Forest plot of the subgroup comparison of onlay restorations placed on vital versus non‐vital teeth for the outcome of restoration failure.

Figure S2. Forest plot of the subgroup comparison of onlay restorations placed on vital versus non‐vital teeth for the outcome of bulk fracture.

Figure S3. Forest plot of the subgroup comparison of onlay restorations placed on vital versus non‐vital teeth for the outcome of chipping.

Figure S4. Forest plot of the subgroup comparison of onlay restorations placed on vital versus non‐vital teeth for the outcome of loss of retention.

Figure S5. Forest plot of the subgroup comparison of onlay restorations placed on vital versus non‐vital teeth for the outcome of endodontic complication.

JERD-37-620-s001.docx^{(8.4MB, docx)}

Acknowledgments

The authors like to thank Hiltrud Niggemann for performing the statistical analysis.

Funding: The authors received no specific funding for this work.

L.S. Prott and S. Pieralli contributed equally to this manuscript.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

1. Abduo J. and Sambrook R. J., “Longevity of Ceramic Onlays: A Systematic Review,” Journal of Esthetic and Restorative Dentistry 30, no. 3 (2018): 193–215. [DOI] [PubMed] [Google Scholar]
2. Edelhoff D., Erdelt K. J., Stawarczyk B., and Liebermann A., “Pressable Lithium Disilicate Ceramic Versus CAD/CAM Resin Composite Restorations in Patients With Moderate to Severe Tooth Wear: Clinical Observations up to 13 Years,” Journal of Esthetic and Restorative Dentistry 35, no. 1 (2023): 116–128. [DOI] [PubMed] [Google Scholar]
3. Clausen J. O., Abou Tara M., and Kern M., “Dynamic Fatigue and Fracture Resistance of Non‐retentive All‐Ceramic Full‐Coverage Molar Restorations. Influence of Ceramic Material and Preparation Design,” Dental Materials 26, no. 6 (2010): 533–538. [DOI] [PubMed] [Google Scholar]
4. Piemjai M. and Arksornnukit M., “Compressive Fracture Resistance of Porcelain Laminates Bonded to Enamel or Dentin With Four Adhesive Systems,” Journal of Prosthodontics 16, no. 6 (2007): 457–464. [DOI] [PubMed] [Google Scholar]
5. Edelhoff D. and Sorensen J. A., “Tooth Structure Removal Associated With Various Preparation Designs for Posterior Teeth,” International Journal of Periodontics and Restorative Dentistry 22, no. 3 (2002): 241–249. [PubMed] [Google Scholar]
6.“The Glossary of Prosthodontic Terms 2023,” Journal of Prosthetic Dentistry 130, no. 4 Suppl 1 (2023): e1–e3. [DOI] [PubMed] [Google Scholar]
7. H. T. Shillingburg, Jr. , Sather D. A., Wilson E. L., et al., Fundamentals of Fixed Prosthodontics, 4th ed. Chicago: Quintessence Publishing Co. Inc. (2012). [Google Scholar]
8. Naik V. B., Jain A. K., Rao R. D., and Naik B. D., “Comparative Evaluation of Clinical Performance of Ceramic and Resin Inlays, Onlays, and Overlays: A Systematic Review and Meta Analysis,” Journal of Conservative Dentistry 25, no. 4 (2022): 347–355. [DOI] [PMC free article] [PubMed] [Google Scholar]
9. Shi H. Y., Pang R., Yang J., et al., “Overview of Several Typical Ceramic Materials for Restorative Dentistry,” BioMed Research International 2022 (2022): 8451445. [DOI] [PMC free article] [PubMed] [Google Scholar]
10. Gracis S., Thompson V. P., Ferencz J. L., Silva N. R., and Bonfante E. A., “A New Classification System for All‐Ceramic and Ceramic‐Like Restorative Materials,” International Journal of Prosthodontics 28, no. 3 (2015): 227–235. [DOI] [PubMed] [Google Scholar]
11. McLaren E. A. and Whiteman Y. Y., “Ceramics: Rationale for Material Selection,” Compendium of Continuing Education in Dentistry 31, no. 9 (2010): 666–668. [PubMed] [Google Scholar]
12. Shenoy A. and Shenoy N., “Dental Ceramics: An Update,” Journal of Conservative Dentistry 13, no. 4 (2010): 195–203. [DOI] [PMC free article] [PubMed] [Google Scholar]
13. Spitznagel F. A., Boldt J., and Gierthmuehlen P. C., “CAD/CAM Ceramic Restorative Materials for Natural Teeth,” Journal of Dental Research 97, no. 10 (2018): 1082–1091. [DOI] [PubMed] [Google Scholar]
14. Wendler M., Belli R., Petschelt A., et al., “Chairside CAD/CAM Materials. Part 2: Flexural Strength Testing,” Dental Materials 33, no. 1 (2017): 99–109. [DOI] [PubMed] [Google Scholar]
15. Höland W., Schweiger M., Watzke R., Peschke A., and Kappert H., “Ceramics as Biomaterials for Dental Restoration,” Expert Review of Medical Devices 5, no. 6 (2008): 729–745. [DOI] [PubMed] [Google Scholar]
16. Lohbauer U., Fabris D. C. N., Lubauer J., et al., “Glass Science Behind Lithium Silicate Glass‐Ceramics,” Dental Materials 40, no. 5 (2024): 842–857. [DOI] [PubMed] [Google Scholar]
17. Fathy H., Hamama H. H., El‐Wassefy N., and Mahmoud S. H., “Clinical Performance of Resin‐Matrix Ceramic Partial Coverage Restorations: A Systematic Review,” Clinical Oral Investigations 26, no. 5 (2022): 3807–3822. [DOI] [PMC free article] [PubMed] [Google Scholar]
18. Coldea A., Swain M. V., and Thiel N., “Mechanical Properties of Polymer‐Infiltrated‐Ceramic‐Network Materials,” Dental Materials 29, no. 4 (2013): 419–426. [DOI] [PubMed] [Google Scholar]
19. Yu H., Özcan M., Yoshida K., Cheng H., and Sawase T., “Bonding to Industrial Indirect Composite Blocks: A Systematic Review and Meta‐Analysis,” Dental Materials 36, no. 1 (2020): 119–134. [DOI] [PubMed] [Google Scholar]
20. Ayres G., Parize H., Mendonça L. M., Kubata B. R., and Tirapelli C. “Is the digital workflow more efficient for manufacturing partial‐coverage restorations? A systematic review.” J Prosthet Dent 14 (2023): S0022‐3913(23)00506‐1. [DOI] [PubMed] [Google Scholar]
21. Rodrigues S. B., Franken P., Celeste R. K., Leitune V. C. B., and Collares F. M., “CAD/CAM or Conventional Ceramic Materials Restorations Longevity: A Systematic Review and Meta‐Analysis,” Journal of Prosthodontic Research 63, no. 4 (2019): 389–395. [DOI] [PubMed] [Google Scholar]
22. Goujat A., Abouelleil H., Colon P., et al., “Marginal and Internal Fit of CAD‐CAM Inlay/Onlay Restorations: A Systematic Review of In Vitro Studies,” Journal of Prosthetic Dentistry 121, no. 4 (2019): 590–597. [DOI] [PubMed] [Google Scholar]
23. No‐Cortes J., Ayres A. P., Lima J. F., Markarian R. A., Attard N. J., and Cortes A. R. G., “Trueness, 3D Deviation, Time and Cost Comparisons Between Milled and 3D‐Printed Resin Single Crowns,” European Journal of Prosthodontics and Restorative Dentistry 30, no. 2 (2022): 107–112. [DOI] [PubMed] [Google Scholar]
24. Ladino L., Sanjuan M. E., Valdez D. J., and Eslava R. A., “Clinical and Biomechanical Performance of Occlusal Veneers: A Scoping Review,” Journal of Contemporary Dental Practice 22, no. 11 (2021): 1327–1337. [PubMed] [Google Scholar]
25. Wang B., Fan J., Wang L., Xu B., Wang L., and Chai L., “Onlays/Partial Crowns Versus Full Crowns in Restoring Posterior Teeth: A Systematic Review and Meta‐Analysis,” Head & Face Medicine 18, no. 1 (2022): 36. [DOI] [PMC free article] [PubMed] [Google Scholar]
26. Al‐Haj Husain N., Özcan M., Molinero‐Mourelle P., and Joda T., “Clinical Performance of Partial and Full‐Coverage Fixed Dental Restorations Fabricated From Hybrid Polymer and Ceramic CAD/CAM Materials: A Systematic Review and Meta‐Analysis,” Journal of Clinical Medicine 9, no. 7 (2020): 2107. [DOI] [PMC free article] [PubMed] [Google Scholar]
27. Vagropoulou G. I., Klifopoulou G. L., Vlahou S. G., Hirayama H., and Michalakis K., “Complications and Survival Rates of Inlays and Onlays vs Complete Coverage Restorations: A Systematic Review and Analysis of Studies,” Journal of Oral Rehabilitation 45, no. 11 (2018): 903–920. [DOI] [PubMed] [Google Scholar]
28. Fron Chabouis H., Smail Faugeron V., and Attal J. P., “Clinical Efficacy of Composite Versus Ceramic Inlays and Onlays: A Systematic Review,” Dental Materials 29, no. 12 (2013): 1209–1218. [DOI] [PubMed] [Google Scholar]
29. Bustamante‐Hernández N., Montiel‐Company J. M., Bellot‐Arcís C., et al., “Clinical Behavior of Ceramic, Hybrid and Composite Onlays. A Systematic Review and Meta‐Analysis,” International Journal of Environmental Research and Public Health 17, no. 20 (2020): 7582. [DOI] [PMC free article] [PubMed] [Google Scholar]
30. Morimoto S., Rebello de Sampaio F. B., Braga M. M., Sesma N., and Özcan M., “Survival Rate of Resin and Ceramic Inlays, Onlays, and Overlays: A Systematic Review and Meta‐Analysis,” Journal of Dental Research 95, no. 9 (2016): 985–994. [DOI] [PubMed] [Google Scholar]
31. Page M. J., McKenzie J. E., Bossuyt P. M., et al., “The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews,” BMJ 372 (2021): n71. [DOI] [PMC free article] [PubMed] [Google Scholar]
32. Prott L. S., Klein P., Spitznagel F. A., Blatz M. B., Pieralli S., and Gierthmuehlen P. C., Survival of partial coverage restorations on posterior teeth – A scoping review. Submitted to J Esthet Restor Dent (2024). [DOI] [PMC free article] [PubMed]
33. Santesso N., Glenton C., Dahm P., et al., “GRADE Guidelines 26: Informative Statements to Communicate the Findings of Systematic Reviews of Interventions,” Journal of Clinical Epidemiology 119 (2020): 126–135. [DOI] [PubMed] [Google Scholar]
34. Guyatt G. H., Oxman A. D., Schünemann H. J., Tugwell P., and Knottnerus A., “GRADE Guidelines: A New Series of Articles in the Journal of Clinical Epidemiology,” Journal of Clinical Epidemiology 64, no. 4 (2011): 380–382. [DOI] [PubMed] [Google Scholar]
35. Sterne J. A. C., Savović J., Page M. J., et al., “RoB 2: A Revised Tool for Assessing Risk of Bias in Randomised Trials,” BMJ 366 (2019): l4898. [DOI] [PubMed] [Google Scholar]
36. Borissov N., Haas Q., Minder B., et al., “Reducing Systematic Review Burden Using Deduklick: A Novel, Automated, Reliable, and Explainable Deduplication Algorithm to Foster Medical Research,” Systematic Reviews 11, no. 1 (2022): 172. [DOI] [PMC free article] [PubMed] [Google Scholar]
37. Zhang L., Hou X. X., Aishan M., Tian M. T., and He H. Y., “A 3‐Year Clinical Evaluation of Endodontically Treated Posterior Teeth Restored With Resin Nanoceramic Computer‐Aided Design/Computer‐Aided Manufacture (CAD/CAM)‐fabricated Partial Crowns,” Medical Science Monitor 28 (2022): e937331. [DOI] [PMC free article] [PubMed] [Google Scholar]
38. Guess P. C., Selz C. F., Steinhart Y. N., Stampf S., and Strub J. R., “Prospective Clinical Split‐Mouth Study of Pressed and CAD/CAM All‐Ceramic Partial‐Coverage Restorations: 7‐Year Results,” International Journal of Prosthodontics 26, no. 1 (2013): 21–25. [DOI] [PubMed] [Google Scholar]
39. Souza J., Fuentes M. V., Baena E., and Ceballos L., “One‐Year Clinical Performance of Lithium Disilicate Versus Resin Composite CAD/CAM Onlays,” Odontology 109, no. 1 (2021): 259–270. [DOI] [PMC free article] [PubMed] [Google Scholar]
40. Hassan A., Hamdi K., Ali A. I., Al‐Zordk W., and Mahmoud S. H., “Clinical Performance Comparison Between Lithium Disilicate and Hybrid Resin Nano‐Ceramic CAD/CAM Onlay Restorations: A Two‐Year Randomized Clinical Split‐Mouth Study,” Odontology 112, no. 2 (2024): 601–615. [DOI] [PMC free article] [PubMed] [Google Scholar]
41. Fasbinder D. J., Neiva G. F., Heys D., and Heys R., “Clinical Evaluation of Chairside Computer Assisted Design/Computer Assisted Machining Nano‐Ceramic Restorations: Five‐Year Status,” Journal of Esthetic and Restorative Dentistry 32, no. 2 (2020): 193–203. [DOI] [PubMed] [Google Scholar]
42. Schlichting L. H., Resende T. H., Reis K. R., Raybolt Dos Santos A., Correa I. C., and Magne P., “Ultrathin CAD‐CAM Glass Ceramic and Composite Resin Occlusal Veneers for the Treatment of Severe Dental Erosion: An up to 3‐Year Randomized Clinical Trial,” Journal of Prosthetic Dentistry 128, no. 2 (2022): 158.e1–158.e12. [DOI] [PubMed] [Google Scholar]
43. Fan J., Xu Y., Si L., Li X., Fu B., and Hannig M., “Long‐Term Clinical Performance of Composite Resin or Ceramic Inlays, Onlays, and Overlays: A Systematic Review and Meta‐Analysis,” Operative Dentistry 46, no. 1 (2021): 25–44. [DOI] [PubMed] [Google Scholar]
44. Kömürcüoğlu M. B., Sağırkaya E., and Tulga A., “Influence of Different Surface Treatments on Bond Strength of Novel CAD/CAM Restorative Materials to Resin Cement,” Journal of Advanced Prosthodontics 9, no. 6 (2017): 439–446. [DOI] [PMC free article] [PubMed] [Google Scholar]
45. Gierthmuehlen P., Spitznagel F., Koschate M., Bonfante E. A., and Prott L. S., “Influence of Ceramic Thickness and Dental Substrate on the Survival Rate and Failure Load of Non‐retentive Occlusal Veneers After Fatigue,” Journal of Esthetic and Restorative Dentistry 1‐8 (2023): 373–380. [DOI] [PubMed] [Google Scholar]
46. Valenzuela E. B. S., Andrade J. P., da Cunha P., Bittencourt H. R., and Spohr A. M., “Fracture Load of CAD/CAM Ultrathin Occlusal Veneers Luted to Enamel or Dentin,” Journal of Esthetic and Restorative Dentistry 33, no. 3 (2021): 516–521. [DOI] [PubMed] [Google Scholar]
47. Ioannidis A., Muhlemann S., Ozcan M., Husler J., Hammerle C. H. F., and Benic G. I., “Ultra‐Thin Occlusal Veneers Bonded to Enamel and Made of Ceramic or Hybrid Materials Exhibit Load‐Bearing Capacities Not Different From Conventional Restorations,” Journal of the Mechanical Behavior of Biomedical Materials 90 (2019): 433–440. [DOI] [PubMed] [Google Scholar]
48. Rinke S., Zuck T., Hausdörfer T., Leha A., Wassmann T., and Ziebolz D., “Prospective Clinical Evaluation of Chairside‐Fabricated Zirconia‐Reinforced Lithium Silicate Ceramic Partial Crowns‐5‐Year Results,” Clinical Oral Investigations 26, no. 2 (2022): 1593–1603. [DOI] [PMC free article] [PubMed] [Google Scholar]
49. Murgueitio R. and Bernal G., “Three‐Year Clinical Follow‐Up of Posterior Teeth Restored With Leucite‐Reinforced Ips Empress Onlays and Partial Veneer Crowns,” Journal of Prosthodontics 21, no. 5 (2012): 340–345. [DOI] [PubMed] [Google Scholar]
50. Schestatsky R., Zucuni C. P., Dapieve K. S., et al., “Microstructure, Topography, Surface Roughness, Fractal Dimension, Internal and Marginal Adaptation of Pressed and Milled Lithium‐Disilicate Monolithic Restorations,” Journal of Prosthodontic Research 64, no. 1 (2020): 12–19. [DOI] [PubMed] [Google Scholar]
51. McFadden E., Bashir S., Canham S., et al., “The Impact of Registration of Clinical Trials Units: The UK Experience,” Clinical Trials 12, no. 2 (2015): 166–173. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Figure S1. Forest plot of the subgroup comparison of onlay restorations placed on vital versus non‐vital teeth for the outcome of restoration failure.

Figure S2. Forest plot of the subgroup comparison of onlay restorations placed on vital versus non‐vital teeth for the outcome of bulk fracture.

Figure S3. Forest plot of the subgroup comparison of onlay restorations placed on vital versus non‐vital teeth for the outcome of chipping.

Figure S4. Forest plot of the subgroup comparison of onlay restorations placed on vital versus non‐vital teeth for the outcome of loss of retention.

Figure S5. Forest plot of the subgroup comparison of onlay restorations placed on vital versus non‐vital teeth for the outcome of endodontic complication.

JERD-37-620-s001.docx^{(8.4MB, docx)}

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

[jerd13353-bib-0001] 1. Abduo J. and Sambrook R. J., “Longevity of Ceramic Onlays: A Systematic Review,” Journal of Esthetic and Restorative Dentistry 30, no. 3 (2018): 193–215. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0002] 2. Edelhoff D., Erdelt K. J., Stawarczyk B., and Liebermann A., “Pressable Lithium Disilicate Ceramic Versus CAD/CAM Resin Composite Restorations in Patients With Moderate to Severe Tooth Wear: Clinical Observations up to 13 Years,” Journal of Esthetic and Restorative Dentistry 35, no. 1 (2023): 116–128. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0003] 3. Clausen J. O., Abou Tara M., and Kern M., “Dynamic Fatigue and Fracture Resistance of Non‐retentive All‐Ceramic Full‐Coverage Molar Restorations. Influence of Ceramic Material and Preparation Design,” Dental Materials 26, no. 6 (2010): 533–538. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0004] 4. Piemjai M. and Arksornnukit M., “Compressive Fracture Resistance of Porcelain Laminates Bonded to Enamel or Dentin With Four Adhesive Systems,” Journal of Prosthodontics 16, no. 6 (2007): 457–464. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0005] 5. Edelhoff D. and Sorensen J. A., “Tooth Structure Removal Associated With Various Preparation Designs for Posterior Teeth,” International Journal of Periodontics and Restorative Dentistry 22, no. 3 (2002): 241–249. [PubMed] [Google Scholar]

[jerd13353-bib-0006] 6.“The Glossary of Prosthodontic Terms 2023,” Journal of Prosthetic Dentistry 130, no. 4 Suppl 1 (2023): e1–e3. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0007] 7. H. T. Shillingburg, Jr. , Sather D. A., Wilson E. L., et al., Fundamentals of Fixed Prosthodontics, 4th ed. Chicago: Quintessence Publishing Co. Inc. (2012). [Google Scholar]

[jerd13353-bib-0008] 8. Naik V. B., Jain A. K., Rao R. D., and Naik B. D., “Comparative Evaluation of Clinical Performance of Ceramic and Resin Inlays, Onlays, and Overlays: A Systematic Review and Meta Analysis,” Journal of Conservative Dentistry 25, no. 4 (2022): 347–355. [DOI] [PMC free article] [PubMed] [Google Scholar]

[jerd13353-bib-0009] 9. Shi H. Y., Pang R., Yang J., et al., “Overview of Several Typical Ceramic Materials for Restorative Dentistry,” BioMed Research International 2022 (2022): 8451445. [DOI] [PMC free article] [PubMed] [Google Scholar]

[jerd13353-bib-0010] 10. Gracis S., Thompson V. P., Ferencz J. L., Silva N. R., and Bonfante E. A., “A New Classification System for All‐Ceramic and Ceramic‐Like Restorative Materials,” International Journal of Prosthodontics 28, no. 3 (2015): 227–235. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0011] 11. McLaren E. A. and Whiteman Y. Y., “Ceramics: Rationale for Material Selection,” Compendium of Continuing Education in Dentistry 31, no. 9 (2010): 666–668. [PubMed] [Google Scholar]

[jerd13353-bib-0012] 12. Shenoy A. and Shenoy N., “Dental Ceramics: An Update,” Journal of Conservative Dentistry 13, no. 4 (2010): 195–203. [DOI] [PMC free article] [PubMed] [Google Scholar]

[jerd13353-bib-0013] 13. Spitznagel F. A., Boldt J., and Gierthmuehlen P. C., “CAD/CAM Ceramic Restorative Materials for Natural Teeth,” Journal of Dental Research 97, no. 10 (2018): 1082–1091. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0014] 14. Wendler M., Belli R., Petschelt A., et al., “Chairside CAD/CAM Materials. Part 2: Flexural Strength Testing,” Dental Materials 33, no. 1 (2017): 99–109. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0015] 15. Höland W., Schweiger M., Watzke R., Peschke A., and Kappert H., “Ceramics as Biomaterials for Dental Restoration,” Expert Review of Medical Devices 5, no. 6 (2008): 729–745. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0016] 16. Lohbauer U., Fabris D. C. N., Lubauer J., et al., “Glass Science Behind Lithium Silicate Glass‐Ceramics,” Dental Materials 40, no. 5 (2024): 842–857. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0017] 17. Fathy H., Hamama H. H., El‐Wassefy N., and Mahmoud S. H., “Clinical Performance of Resin‐Matrix Ceramic Partial Coverage Restorations: A Systematic Review,” Clinical Oral Investigations 26, no. 5 (2022): 3807–3822. [DOI] [PMC free article] [PubMed] [Google Scholar]

[jerd13353-bib-0018] 18. Coldea A., Swain M. V., and Thiel N., “Mechanical Properties of Polymer‐Infiltrated‐Ceramic‐Network Materials,” Dental Materials 29, no. 4 (2013): 419–426. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0019] 19. Yu H., Özcan M., Yoshida K., Cheng H., and Sawase T., “Bonding to Industrial Indirect Composite Blocks: A Systematic Review and Meta‐Analysis,” Dental Materials 36, no. 1 (2020): 119–134. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0020] 20. Ayres G., Parize H., Mendonça L. M., Kubata B. R., and Tirapelli C. “Is the digital workflow more efficient for manufacturing partial‐coverage restorations? A systematic review.” J Prosthet Dent 14 (2023): S0022‐3913(23)00506‐1. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0021] 21. Rodrigues S. B., Franken P., Celeste R. K., Leitune V. C. B., and Collares F. M., “CAD/CAM or Conventional Ceramic Materials Restorations Longevity: A Systematic Review and Meta‐Analysis,” Journal of Prosthodontic Research 63, no. 4 (2019): 389–395. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0022] 22. Goujat A., Abouelleil H., Colon P., et al., “Marginal and Internal Fit of CAD‐CAM Inlay/Onlay Restorations: A Systematic Review of In Vitro Studies,” Journal of Prosthetic Dentistry 121, no. 4 (2019): 590–597. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0023] 23. No‐Cortes J., Ayres A. P., Lima J. F., Markarian R. A., Attard N. J., and Cortes A. R. G., “Trueness, 3D Deviation, Time and Cost Comparisons Between Milled and 3D‐Printed Resin Single Crowns,” European Journal of Prosthodontics and Restorative Dentistry 30, no. 2 (2022): 107–112. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0024] 24. Ladino L., Sanjuan M. E., Valdez D. J., and Eslava R. A., “Clinical and Biomechanical Performance of Occlusal Veneers: A Scoping Review,” Journal of Contemporary Dental Practice 22, no. 11 (2021): 1327–1337. [PubMed] [Google Scholar]

[jerd13353-bib-0025] 25. Wang B., Fan J., Wang L., Xu B., Wang L., and Chai L., “Onlays/Partial Crowns Versus Full Crowns in Restoring Posterior Teeth: A Systematic Review and Meta‐Analysis,” Head & Face Medicine 18, no. 1 (2022): 36. [DOI] [PMC free article] [PubMed] [Google Scholar]

[jerd13353-bib-0026] 26. Al‐Haj Husain N., Özcan M., Molinero‐Mourelle P., and Joda T., “Clinical Performance of Partial and Full‐Coverage Fixed Dental Restorations Fabricated From Hybrid Polymer and Ceramic CAD/CAM Materials: A Systematic Review and Meta‐Analysis,” Journal of Clinical Medicine 9, no. 7 (2020): 2107. [DOI] [PMC free article] [PubMed] [Google Scholar]

[jerd13353-bib-0027] 27. Vagropoulou G. I., Klifopoulou G. L., Vlahou S. G., Hirayama H., and Michalakis K., “Complications and Survival Rates of Inlays and Onlays vs Complete Coverage Restorations: A Systematic Review and Analysis of Studies,” Journal of Oral Rehabilitation 45, no. 11 (2018): 903–920. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0028] 28. Fron Chabouis H., Smail Faugeron V., and Attal J. P., “Clinical Efficacy of Composite Versus Ceramic Inlays and Onlays: A Systematic Review,” Dental Materials 29, no. 12 (2013): 1209–1218. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0029] 29. Bustamante‐Hernández N., Montiel‐Company J. M., Bellot‐Arcís C., et al., “Clinical Behavior of Ceramic, Hybrid and Composite Onlays. A Systematic Review and Meta‐Analysis,” International Journal of Environmental Research and Public Health 17, no. 20 (2020): 7582. [DOI] [PMC free article] [PubMed] [Google Scholar]

[jerd13353-bib-0030] 30. Morimoto S., Rebello de Sampaio F. B., Braga M. M., Sesma N., and Özcan M., “Survival Rate of Resin and Ceramic Inlays, Onlays, and Overlays: A Systematic Review and Meta‐Analysis,” Journal of Dental Research 95, no. 9 (2016): 985–994. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0031] 31. Page M. J., McKenzie J. E., Bossuyt P. M., et al., “The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews,” BMJ 372 (2021): n71. [DOI] [PMC free article] [PubMed] [Google Scholar]

[jerd13353-bib-0051] 32. Prott L. S., Klein P., Spitznagel F. A., Blatz M. B., Pieralli S., and Gierthmuehlen P. C., Survival of partial coverage restorations on posterior teeth – A scoping review. Submitted to J Esthet Restor Dent (2024). [DOI] [PMC free article] [PubMed]

[jerd13353-bib-0032] 33. Santesso N., Glenton C., Dahm P., et al., “GRADE Guidelines 26: Informative Statements to Communicate the Findings of Systematic Reviews of Interventions,” Journal of Clinical Epidemiology 119 (2020): 126–135. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0033] 34. Guyatt G. H., Oxman A. D., Schünemann H. J., Tugwell P., and Knottnerus A., “GRADE Guidelines: A New Series of Articles in the Journal of Clinical Epidemiology,” Journal of Clinical Epidemiology 64, no. 4 (2011): 380–382. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0034] 35. Sterne J. A. C., Savović J., Page M. J., et al., “RoB 2: A Revised Tool for Assessing Risk of Bias in Randomised Trials,” BMJ 366 (2019): l4898. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0035] 36. Borissov N., Haas Q., Minder B., et al., “Reducing Systematic Review Burden Using Deduklick: A Novel, Automated, Reliable, and Explainable Deduplication Algorithm to Foster Medical Research,” Systematic Reviews 11, no. 1 (2022): 172. [DOI] [PMC free article] [PubMed] [Google Scholar]

[jerd13353-bib-0036] 37. Zhang L., Hou X. X., Aishan M., Tian M. T., and He H. Y., “A 3‐Year Clinical Evaluation of Endodontically Treated Posterior Teeth Restored With Resin Nanoceramic Computer‐Aided Design/Computer‐Aided Manufacture (CAD/CAM)‐fabricated Partial Crowns,” Medical Science Monitor 28 (2022): e937331. [DOI] [PMC free article] [PubMed] [Google Scholar]

[jerd13353-bib-0037] 38. Guess P. C., Selz C. F., Steinhart Y. N., Stampf S., and Strub J. R., “Prospective Clinical Split‐Mouth Study of Pressed and CAD/CAM All‐Ceramic Partial‐Coverage Restorations: 7‐Year Results,” International Journal of Prosthodontics 26, no. 1 (2013): 21–25. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0038] 39. Souza J., Fuentes M. V., Baena E., and Ceballos L., “One‐Year Clinical Performance of Lithium Disilicate Versus Resin Composite CAD/CAM Onlays,” Odontology 109, no. 1 (2021): 259–270. [DOI] [PMC free article] [PubMed] [Google Scholar]

[jerd13353-bib-0039] 40. Hassan A., Hamdi K., Ali A. I., Al‐Zordk W., and Mahmoud S. H., “Clinical Performance Comparison Between Lithium Disilicate and Hybrid Resin Nano‐Ceramic CAD/CAM Onlay Restorations: A Two‐Year Randomized Clinical Split‐Mouth Study,” Odontology 112, no. 2 (2024): 601–615. [DOI] [PMC free article] [PubMed] [Google Scholar]

[jerd13353-bib-0040] 41. Fasbinder D. J., Neiva G. F., Heys D., and Heys R., “Clinical Evaluation of Chairside Computer Assisted Design/Computer Assisted Machining Nano‐Ceramic Restorations: Five‐Year Status,” Journal of Esthetic and Restorative Dentistry 32, no. 2 (2020): 193–203. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0041] 42. Schlichting L. H., Resende T. H., Reis K. R., Raybolt Dos Santos A., Correa I. C., and Magne P., “Ultrathin CAD‐CAM Glass Ceramic and Composite Resin Occlusal Veneers for the Treatment of Severe Dental Erosion: An up to 3‐Year Randomized Clinical Trial,” Journal of Prosthetic Dentistry 128, no. 2 (2022): 158.e1–158.e12. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0042] 43. Fan J., Xu Y., Si L., Li X., Fu B., and Hannig M., “Long‐Term Clinical Performance of Composite Resin or Ceramic Inlays, Onlays, and Overlays: A Systematic Review and Meta‐Analysis,” Operative Dentistry 46, no. 1 (2021): 25–44. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0043] 44. Kömürcüoğlu M. B., Sağırkaya E., and Tulga A., “Influence of Different Surface Treatments on Bond Strength of Novel CAD/CAM Restorative Materials to Resin Cement,” Journal of Advanced Prosthodontics 9, no. 6 (2017): 439–446. [DOI] [PMC free article] [PubMed] [Google Scholar]

[jerd13353-bib-0044] 45. Gierthmuehlen P., Spitznagel F., Koschate M., Bonfante E. A., and Prott L. S., “Influence of Ceramic Thickness and Dental Substrate on the Survival Rate and Failure Load of Non‐retentive Occlusal Veneers After Fatigue,” Journal of Esthetic and Restorative Dentistry 1‐8 (2023): 373–380. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0045] 46. Valenzuela E. B. S., Andrade J. P., da Cunha P., Bittencourt H. R., and Spohr A. M., “Fracture Load of CAD/CAM Ultrathin Occlusal Veneers Luted to Enamel or Dentin,” Journal of Esthetic and Restorative Dentistry 33, no. 3 (2021): 516–521. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0046] 47. Ioannidis A., Muhlemann S., Ozcan M., Husler J., Hammerle C. H. F., and Benic G. I., “Ultra‐Thin Occlusal Veneers Bonded to Enamel and Made of Ceramic or Hybrid Materials Exhibit Load‐Bearing Capacities Not Different From Conventional Restorations,” Journal of the Mechanical Behavior of Biomedical Materials 90 (2019): 433–440. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0047] 48. Rinke S., Zuck T., Hausdörfer T., Leha A., Wassmann T., and Ziebolz D., “Prospective Clinical Evaluation of Chairside‐Fabricated Zirconia‐Reinforced Lithium Silicate Ceramic Partial Crowns‐5‐Year Results,” Clinical Oral Investigations 26, no. 2 (2022): 1593–1603. [DOI] [PMC free article] [PubMed] [Google Scholar]

[jerd13353-bib-0048] 49. Murgueitio R. and Bernal G., “Three‐Year Clinical Follow‐Up of Posterior Teeth Restored With Leucite‐Reinforced Ips Empress Onlays and Partial Veneer Crowns,” Journal of Prosthodontics 21, no. 5 (2012): 340–345. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0049] 50. Schestatsky R., Zucuni C. P., Dapieve K. S., et al., “Microstructure, Topography, Surface Roughness, Fractal Dimension, Internal and Marginal Adaptation of Pressed and Milled Lithium‐Disilicate Monolithic Restorations,” Journal of Prosthodontic Research 64, no. 1 (2020): 12–19. [DOI] [PubMed] [Google Scholar]

[jerd13353-bib-0050] 51. McFadden E., Bashir S., Canham S., et al., “The Impact of Registration of Clinical Trials Units: The UK Experience,” Clinical Trials 12, no. 2 (2015): 166–173. [DOI] [PubMed] [Google Scholar]

PERMALINK

Survival and Complications of Partial Coverage Restorations on Posterior Teeth—A Systematic Review and Meta‐Analysis

L S Prott

S Pieralli

P Klein

F A Spitznagel

F Ibrahim

M‐I Metzendorf

A Carrasco‐Labra

M B Blatz

P C Gierthmuehlen

ABSTRACT

Objective

Materials and Methods

Results

Conclusion

Clinical Significance

1. Introduction

2. Materials and Methods

2.1. Study Design

2.2. Information Sources and Search Strategy

TABLE 1.

2.3. Study Selection

TABLE 2.

2.4. Data Extraction

2.5. Outcome Measures

2.6. Certainty of the Evidence

2.7. Data Analysis

3. Results

3.1. Study Selection

FIGURE 1.

TABLE 3.

3.2. Study Characteristics and Risk of Bias Assessment

FIGURE 2.

3.3. Outcomes

3.3.1. Survival and Failure Rates

TABLE 4.

TABLE 5.

FIGURE 3.

TABLE 6.

3.3.2. Bulk Fracture

TABLE 7.

FIGURE 4.

3.3.3. Chipping

TABLE 8.

FIGURE 5.

3.3.4. Loss of Retention

TABLE 9.

FIGURE 6.

3.3.5. Endodontic Complications

TABLE 10.

FIGURE 7.

3.3.6. Tooth Fracture

TABLE 11.

3.3.7. Secondary Caries

3.3.8. Marginal Adaptation

3.3.9. Esthetic and Surface Properties

3.3.10. Preparation Design and Thickness

3.4. Subgroup Analysis

3.4.1. Tooth Vitality

4. Discussion

5. Conclusion

Conflicts of Interest

Supporting information

Acknowledgments

Data Availability Statement

References

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

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