Survival of Complete Coverage Tooth-Retained Fixed Lithium Disilicate Prostheses: A Systematic Review

Background and objectives: Porcelain-fused-to-metal (PFM) prostheses are considered the gold standard for the replacement of missing teeth, however, these have several drawbacks. Therefore, lithium disilicate (LDS) prostheses have been introduced for the construction of fixed crowns and bridges. The aim of this systematic review was to ascertain the long-term survival of LDS fixed prostheses in comparison to other materials. Materials and methods: The focused question was 'In patients who have undergone prosthodontic treatment (participants), what are the overall survival rate of lithium disilicate (LDS) crowns and fixed bridges; and how do they relate to survival rates of non-LDS similar restoration are the survival and com-plication rates (outcomes) of LDS-based fixed prostheses with complete coverage (intervention) higher or lower when compared to non-LDS materials (controls)?'. An electronic search was conducted in PubMED/Medline, EMBASE, Google Scholar, and ClinicalTrials.gov for articles published between January 2006 and August 2022 using appropriate MeSH terms and keywords. The following types of studies were included: (1) All types of prospective clinical studies; (2) Clinical studies focusing on the survival of fixed LDS bridges and crowns; (3) Studies using natural teeth with complete coverage as abutment for fixed LDS bridges and crowns; and (4) Studies in English. The following studies were excluded: (1) Laboratory/in vitro studies and studies on LDS prostheses with no description of outcomes or survival rates; (2) Commentaries; (3) Letters to the editor; (4) Reviews; and (5) Internal data from manufacturers. The data from included studies were extracted and the risk of bias was assessed within the studies using ROBINS-I. Results: A total of 25 studies were included in this systematic review. The overall 5-year and 10-year survival rates were of 95-100% and 71.4-100%, respectively. Generally, three-unit bridges had a significantly lower survival rate over 5 and 10 years compared to single-unit crowns. Overall, the risk of bias in the included studies was moderate. Conclusions: The LDS-based complete coverage prostheses have a survival rate ranging between 48.6% and 100%. Furthermore, due to the lack of comparative studies, the long-term function and survival of LDS prostheses compared to other material prosthesis (PFM and ZrO) is debatable.