Ceramic versus metal-ceramic implant-supported prostheses: A systematic review and meta-analysis
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Statement of problem: There is insufficient evidence to recommend the restorative material for implant-supported prostheses. Purpose: The purpose of this systematic review and meta-analysis was to evaluate studies that compared ceramic and metal-ceramic restorations for implant-supported prostheses (within the same study to avoid indirect comparison)in terms of the mechanical and biological complication rates, prosthesis survival rate, and marginal bone loss. Material and methods: Two independent reviewers performed a comprehensive search in databases (PubMed/MEDLINE, Web of Science, and Cochrane Library)for articles indexed until March 31, 2018. The search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)statement and methods were registered in the International Prospective Register of Systematic Reviews (PROSPERO). The focused question was “Do ceramic restorations have mechanical/biological complication rates, prosthesis survival rates, and marginal bone loss similar to those of metal-ceramic restorations?” Results: The search identified 949 references. The interinvestigator agreement using kappa values was 0.87 for PubMed/MEDLINE, 0.93 for Scopus, and 1.0 for the Cochrane Library. After analysis, 12 studies were selected for qualitative and quantitative analysis. The mechanical complication rate did not differ between ceramic and metal-ceramic restorations (P=.89), independent of the type of prostheses (single crown: P=.63; fixed partial denture: P=.65). The biological complication rate was also not significantly different between ceramic and metal-ceramic restorations (P=.21). The prosthesis survival rate showed no significant differences between the 2 types of restorations (P=.56). Marginal bone loss was also similar for both types of restorations (P=.12). Conclusions: This systematic review indicated that ceramic and metal-ceramic implant-supported prostheses have similar mechanical and biological complication rates, prosthesis survival rates, and marginal bone loss. Thus, both treatments are appropriate options for long-term rehabilitation treatment.
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