Comparison of technical, biological, and esthetic parameters of ceramic and metal-ceramic implant-supported fixed dental prostheses: A systematic review and meta-analysis

Statement of problem. Differences between ceramic and metal-ceramic implant-supported fixed dental prostheses are unclear. Purpose. The purpose of this systematic review and meta-analysis was to compare the technical, biological, and esthetic complication rates of implant-supported ceramic and metal-ceramic restorations. Material and methods. Six databases were searched to identify randomized controlled clinical trials (RCTs) and prospective and retrospective cohort studies of implant-supported fixed dental prostheses. The survival rate, marginal adaptation, marginal bone loss, pocket probing depth, crown color match, and mucosal discoloration of ceramic and metal-ceramic single crowns were assessed. For implant-supported fixed partial dental prostheses (FPDPs), only the survival rate was assessed. The risk of bias was assessed for individual studies and across studies by using the Cochrane guidelines, Newcastle-Ottawa scale, and funnel plots. Results. Twenty studies were included in this meta-analysis. Ceramic and metal-ceramic implant-supported single crowns were compared in terms of the survival rate (OR=0.84 [0.32, 2.23], P=.730), marginal adaptation (mean difference [MD]=0.33 [0.19, 0.47], P<.001), marginal bone loss (MD=-0.03 [-0.07, 0.02], P=.260), pocket probing depth (MD=-0.07 [-0.14, 0.00], P=.060), crown color match (MD=-0.15 [-0.29, 0.00], P=.040), and mucosal discoloration (standardized mean difference [SMD]=-0.14 [-0.86, 0.58], P=.710). The survival rate of ceramic and metal-ceramic implant-supported FPDPs was also compared (odds ratio [OR]=1.92 [1.26, 2.94], P=.003). Conclusions. No significant difference was observed between ceramic and metal-ceramic implant-supported single crowns in terms of the survival rate, marginal bone loss, pocket probing depth, or mucosal discoloration. However, metal-ceramic single crowns had better marginal adaptation and poorer crown color match than did ceramic single crowns. In addition, current evidence indicates that metal-ceramic implant-supported FPDPs might have a higher survival rate than ceramic FPDPs.