Posterior ceramic versus metal restorations: A systematic review and meta-analysis

Objectives: The goal of this systemic review and meta-analysis was to evaluate the long-evity of indirect adhesively-luted ceramic compared to conventionally cemented metal single tooth restorations.Data: Randomized controlled trials (RCT) investigating indirect adhesively-luted ceramic re-storations compared to metal or metal-based cemented restorations in permanent posterior teeth.Sources: Three electronic databases (PubMed, CENTRAL (Cochrane) and Embase) were screened. No language or time restrictions were applied. Study selection, data extraction and quality assessment were done in duplicate. Risk of Bias and level of evidence was graded using Risk of Bias 2.0 tool and Grade Profiler 3.6.Results: A total of 3056 articles were found by electronic databases. Finally, four RCTs were selected. Overall, 443 restorations of which 212 were adhesively-luted ceramic restorations and 231 conventionally cemented metal restorations have been placed in 314 patients (age: 22-72 years). The highest annual failure rates were found for ceramic restorations ranging from 2.1% to 5.6%. Lower annual failure rates were found for metal (gold) restorations ranging from 0% to 2.1%. Meta-analysis could be performed for adhesively-luted ceramic vs. conventionally cemented metal restorations. Conventionally cemented metal restoration showed a significantly lower failure rate than adhesively-luted ceramic ones (visual-tactile assessment: Risk Ratio (RR)[95%CI]=0.31[0.16,0.57], low level of evidence). Furthermore, all studies showed a high risk of bias. Conclusion: Conventionally cemented metal restorations revealed significantly lower failure rates compared to adhesively-luted ceramic ones, although the selected sample was small and with medium follow-up periods with high risks of bias.(c) 2022 The Authors. Published by Elsevier Inc. on behalf of The Academy of Dental Materials. This is an open access article under the CC BY license (http://creative-commons.org/licenses/by/4.0/).