The aim of this systematic review was to evaluate the available scientific evidence on the survival and complication rates of veneered zirconia ceramic crowns when compared to metal ceramic implant supported crowns. The primary outcome of this review was the comparison of the survival rates of the veneered zirconia and metal ceramic crowns. Secondary outcomes reviewed were biological complication rates, technical complication rates and aesthetic failure rates.
- Zirconia ceramic and metal ceramic implants supported SCs exhibit similar 5-year survival rates. This applies to both anterior and posterior regions. This statement is based on 36 clinical trials (22 Prospective, 14 Retrospective), reporting on 4,363 implant supported metal ceramic SCs, and 912 veneered zirconia implant-supported SCs.
- The overall incidence of biological and technical complication is substantial (13%–16% or 1 SC out of 6) for implant supported SCs. This statement is based on 11 of the included trials (6 Prospective and 5 Retrospective).
- There is no statistically significant difference between the 5-year biological outcomes of zirconia ceramic and metal ceramic implant supported SCs, that is, peri-implant mucosal lesions and marginal bone loss >2 mm. This statement is based on 36 clinical trials (22 Prospective and 14 Retrospective).
- There is no statistically significant difference in veneering ceramic chipping between the two types of implant supported SCs at 5 years. There is also no difference in other technical complications such as the incidences of fracture of the abutment, abutment screw or occlusal screw and loss of retention (cemented SCs). However, catastrophic core fractures occur significantly more often with zirconia ceramic implant supported SCs. Furthermore, abutment screw or occlusal screw loosening occurs more frequently with metal ceramic implant supported SCs. This statement is based on 36 clinical trials (22 Prospective and 14 Retrospective).
- The risk of aesthetic failure is lower for zirconia ceramic SCs when compared to metal ceramic SCs. This statement is based on 12 clinical trials (8 Prospective and 4 Retrospective).
- For anterior and posterior implant supported SCs, both metal ceramic and zirconia ceramic can be recommended.
- The selection of the prosthetic material should be based on the aesthetic expectations and general demands of the patients.
- Patients should be informed about the likelihood and incidence of biological and technical complications for both types of crowns, as a substantial amount of time and effort may be needed for maintenance. Patient recall visits are highly recommended to reduce the risk of failure as a consequence of complications.