Journal of Prosthetic Dentistry
Clinical Research|Articles in Press

Up to 10 years clinical performance of zirconia ceramic and metal-ceramic fixed partial dentures: A retrospective study

Published:December 01, 2022DOI:


      Statement of problem

      Completely veneered zirconia ceramic (ZC) fixed partial dentures (FPDs) have been reported to have a higher incidence of ceramic chipping than the standard metal-ceramic FPDs. However, data from comparative long-term studies are sparse.


      The purpose of this retrospective study was to compare the long-term survival, chipping-free survival, and success of ceramic-veneered high noble metal alloy (HN), base metal alloy (cobalt-chromium alloy) (CC), and ZC FPDs and to isolate risk factors for the incidence of failure, veneer chipping, and overall complications.

      Material and methods

      Data from 289 study participants (58.7% women; mean age, 57.97 ±11.51 years) provided with a total of 400 FPDs comprising 197 (49.3%) HN FPDs, 121 (30.3%) CC FPDs, and 82 (20.5%) ZC FPDs fabricated from presintered 3 mol% yttria-stabilized zirconia (mean time of service, 6.85 ±3.25 years) were evaluated. Of these, 278 (69.5%) FPDs were provided by dentists and 122 (30.5%) by dental students. Five- and 10-year survival, chipping-free survival, and success rates were calculated using the Kaplan–Meier method and compared with the log-rank test. Risk factors were assessed using Cox regression analysis. The study was exploratory, so all P values were considered exploratory and descriptive.


      The 5- and 10-year survival rates were 94.7% and 77.8% for HN, 93.7% and 81.2% for CC, and 92.9% and 53.3% for ZC FPDs, respectively, indicating no clear difference in survival among the framework materials. The 5- and 10-year chipping-free rates were 94.1% and 82.8% for HN, 96.1% and 78.9% for CC, and 82.6% and 62.2% for ZC FPDs, respectively, indicating a difference between HN and ZC, and CC and ZC restorations. The 5- and 10-year success rates were 83.7% and 55.3% for HN, 86.5% and 51.4% for CC, and 68.9% and 30.2% for ZC FPDs, respectively, indicating a difference between HN and ZC, and CC and ZC restorations. The Cox regression model indicated framework material as an influencing risk factor for success, and this influence persisted when chipping was investigated. Compared with zirconia, the use of a metal alloy reduced the risk of chipping or the occurrence of complications by up to one-third.


      All FPDs showed high 5-year survival rates and acceptable 10-year survival rates with no strong differences among the materials. Higher success and chipping-free rates were observed for both HN and CC restorations compared with ZC restorations. Metal frameworks had a lower risk for complications or veneer chipping than zirconia frameworks.
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        • Tan K.
        • Pjetursson B.E.
        • Lang N.P.
        • Chan E.S.
        A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years.
        Clin Oral Implants Res. 2004; 15: 654-666
        • Pjetursson B.E.
        • Sailer I.
        • Makarov N.A.
        • Zwahlen M.
        • Thoma D.S.
        All-ceramic or metal-ceramic tooth-supported fixed dental prostheses (FDPs)? A systematic review of the survival and complication rates. Part II: multiple-unit FDPs.
        Dent Mater. 2015; 31: 624-639
        • Valderhaug J.
        A 15-year clinical evaluation of fixed prosthodontics.
        Acta Odontol Scand. 1991; 49: 35-40
        • Napankangas R.
        • Salonen-Kemppi M.A.
        • Raustia A.M.
        Longevity of fixed metal ceramic bridge prostheses: a clinical follow-up study.
        J Oral Rehabil. 2002; 29: 140-145
        • Walton T.R.
        An up to 15-year longitudinal study of 515 metal-ceramic FPDs: part 2. Modes of failure and influence of various clinical characteristics.
        Int J Prosthodont. 2003; 16: 177-182
        • De Backer H.
        • Van Maele G.
        • De Moor N.
        • Van den Berghe L.
        Long-term results of short-span versus long-span fixed dental prostheses: an up to 20-year retrospective study.
        Int J Prosthodont. 2008; 21: 75-85
        • Pjetursson B.E.
        • Sailer I.
        • Makarov N.A.
        • Zwahlen M.
        • Thoma D.S.
        Corrigendum to "All-ceramic or metal-ceramic tooth-supported fixed dental prostheses (FDPs)? A systematic review of the survival and complication rates. Part II: multiple-unit FDPs" [Dental Materials 31 (6) (2015) 624–639].
        Dent Mater. 2017; 33: e48-e51
        • Alsterstal-Englund H.
        • Moberg L.E.
        • Petersson J.
        • Smedberg J.I.
        A retrospective clinical evaluation of extensive tooth-supported fixed dental prostheses after 10 years.
        J Prosthet Dent. 2021; 125: 65-72
        • Behr M.
        • Winklhofer C.
        • Schreier M.
        • et al.
        Risk of chipping or facings failure of metal ceramic fixed partial prostheses--a retrospective data record analysis.
        Clin Oral Investig. 2012; 16: 401-405
        • Anderson R.J.
        • Janes G.R.
        • Sabella L.R.
        • Morris H.F.
        Comparison of the performance on prosthodontic criteria of several alternative alloys used for fixed crown and partial denture restorations: department of veterans affairs cooperative studies project 147.
        J Prosthet Dent. 1993; 69: 1-8
        • Eliasson A.
        • Arnelund C.F.
        • Johansson A.
        A clinical evaluation of cobalt-chromium metal-ceramic fixed partial dentures and crowns: a three- to seven-year retrospective study.
        J Prosthet Dent. 2007; 98: 6-16
        • Svanborg P.
        • Langstrom L.
        • Lundh R.M.
        • Bjerkstig G.
        • Ortorp A.
        A 5-year retrospective study of cobalt-chromium-based fixed dental prostheses.
        Int J Prosthodont. 2013; 26: 343-349
        • Sailer I.
        • Balmer M.
        • Husler J.
        • Hämmerle C.H.F.
        • Kanel S.
        • Thoma D.S.
        Comparison of fixed dental prostheses with zirconia and metal frameworks: five-year results of a randomized controlled clinical trial.
        Int J Prosthodont. 2017; 30: 426-428
        • Sailer I.
        • Balmer M.
        • Husler J.
        • Hämmerle C.H.F.
        • Kanel S.
        • Thoma D.S.
        10-year randomized trial (RCT) of zirconia-ceramic and metal-ceramic fixed dental prostheses.
        J Dent. 2018; 76: 32-39
        • Suarez M.J.
        • Perez C.
        • Pelaez J.
        • Lopez-Suarez C.
        • Gonzalo E.
        A randomized clinical trial comparing zirconia and metal-ceramic three-unit posterior fixed partial dentures: a 5-year follow-up.
        J Prosthodont. 2019; 28: 750-756
        • Ioannidis A.
        • Bindl A.
        Clinical prospective evaluation of zirconia-based three-unit posterior fixed dental prostheses: Up-to ten-year results.
        J Dent. 2016; 47: 80-85
        • Forrer F.A.
        • Schnider N.
        • Brägger U.
        • Yilmaz B.
        • Hicklin S.P.
        Clinical performance and patient satisfaction obtained with tooth-supported ceramic crowns and fixed partial dentures.
        J Prosthet Dent. 2020; 124: 446-453
        • Sola-Ruiz M.F.
        • Leon-Martine R.
        • Labaig-Rueda C.
        • Selva-Otalaorrouchi E.
        • Agustin-Panadero R.
        Clinical outcomes of veneered zirconia anterior partial fixed dental prostheses: a 12-year prospective clinical trial.
        J Prosthet Dent. 2022; 127: 846-851
        • Sax C.
        • Hämmerle C.H.
        • Sailer I.
        10-year clinical outcomes of fixed dental prostheses with zirconia frameworks.
        Int J Comput Dent. 2011; 14: 183-202
        • Rinke S.
        • Gersdorff N.
        • Lange K.
        • Roediger M.
        Prospective evaluation of zirconia posterior fixed partial dentures: 7-year clinical results.
        Int J Prosthodont. 2013; 26: 164-171
        • Rinke S.
        • Wehle J.
        • Schulz X.
        • Burgers R.
        • Rödiger M.
        Prospective evaluation of posterior fixed zirconia dental prostheses: 10-year clinical results.
        Int J Prosthodont. 2018; 31: 35-42
        • Rathmann F.
        • Bömicke W.
        • Rammelsberg P.
        • Ohlmann B.
        Veneered zirconia inlay-retained fixed dental prostheses: 10-Year results from a prospective clinical study.
        J Dent. 2017; 64: 68-72
        • Teichmann M.
        • Wienert A.L.
        • Ruckbeil M.
        • Weber V.
        • Wolfart S.
        • Edelhoff D.
        Ten-year survival and chipping rates and clinical quality grading of zirconia-based fixed dental prostheses.
        Clin Oral Investig. 2018; 22: 2905-2915
        • Passia N.
        • Chaar M.S.
        • Kern M.
        Outcome of posterior fixed dental prostheses made from veneered zirconia over an observation period of up to 13 years.
        J Dent. 2019; 86: 126-129
        • Heintze S.D.
        • Rousson V.
        Survival of zirconia- and metal-supported fixed dental prostheses: a systematic review.
        Int J Prosthodont. 2010; 23: 493-502
        • Al-Amleh B.
        • Lyons K.
        • Swain M.
        Clinical trials in zirconia: a systematic review.
        J Oral Rehabil. 2010; 37: 641-652
        • Pelaez J.
        • Cogolludo P.G.
        • Serrano B.
        • Serrano J.F.
        • Suarez M.J.
        A four-year prospective clinical evaluation of zirconia and metal-ceramic posterior fixed dental prostheses.
        Int J Prosthodont. 2012; 25: 451-458
        • Vigolo P.
        • Mutinelli S.
        Evaluation of zirconium-oxide-based ceramic single-unit posterior fixed dental prostheses (FDPs) generated with two CAD/CAM systems compared to porcelain-fused-to-metal single-unit posterior FDPs: a 5-year clinical prospective study.
        J Prosthodont. 2012; 21: 265-269
        • Anusavice K.J.
        Standardizing failure, success, and survival decisions in clinical studies of ceramic and metal-ceramic fixed dental prostheses.
        Dent Mater. 2012; 28: 102-111
        • Raigrodski A.J.
        • Yu A.
        • Chiche G.J.
        • Hochstedler J.L.
        • Mancl L.A.
        • Mohamed S.E.
        Clinical efficacy of veneered zirconium dioxide-based posterior partial fixed dental prostheses: five-year results.
        J Prosthet Dent. 2012; 108: 214-222
        • Pihlaja J.
        • Napankangas R.
        • Raustia A.
        Outcome of zirconia partial fixed dental prostheses made by predoctoral dental students: a clinical retrospective study after 3 to 7 years of clinical service.
        J Prosthet Dent. 2016; 116: 40-46
        • Koenig V.
        • Vanheusden A.J.
        • Le Goff S.O.
        • Mainjot A.K.
        Clinical risk factors related to failures with zirconia-based restorations: an up to 9-year retrospective study.
        J Dent. 2013; 41: 1164-1174
        • Chaar M.S.
        • Passia N.
        • Kern M.
        Ten-year clinical outcome of three-unit posterior FDPs made from a glass-infiltrated zirconia reinforced alumina ceramic (In-Ceram Zirconia).
        J Dent. 2015; 43: 512-517
        • Limones A.
        • Molinero-Mourelle P.
        • Azevedo L.
        • Romeo-Rubio M.
        • Correia A.
        • Gomez-Polo M.
        Zirconia-ceramic versus metal-ceramic posterior multiunit tooth-supported fixed dental prostheses: a systematic review and meta-analysis of randomized controlled trials.
        J Am Dent Assoc. 2020; 151: 230-238.e7
        • Beuer F.
        • Stimmelmayr M.
        • Gernet W.
        • Edelhoff D.
        • Guth J.F.
        • Naumann M.
        Prospective study of zirconia-based restorations: 3-year clinical results.
        Quintessence Int. 2010; 41: 631-637
        • Naenni N.
        • Bindl A.
        • Sax C.
        • Hämmerle C.
        • Sailer I.
        A randomized controlled clinical trial of 3-unit posterior zirconia-ceramic fixed dental prostheses (FDP) with layered or pressed veneering ceramics: 3-year results.
        J Dent. 2015; 43: 1365-1370
        • Rosentritt M.
        • Steiger D.
        • Behr M.
        • Handel G.
        • Kolbeck C.
        Influence of substructure design and spacer settings on the in vitro performance of molar zirconia crowns.
        J Dent. 2009; 37: 978-983
        • Guess P.C.
        • Bonfante E.A.
        • Silva N.R.
        • Coelho P.G.
        • Thompson V.P.
        Effect of core design and veneering technique on damage and reliability of Y-TZP-supported crowns.
        Dent Mater. 2013; 29: 307-316
        • Fischer J.
        • Stawarzcyk B.
        • Trottmann A.
        • Hammerle C.H.
        Impact of thermal misfit on shear strength of veneering ceramic/zirconia composites.
        Dent Mater. 2009; 25: 419-423
        • Rues S.
        • Kröger E.
        • Müller D.
        • Schmitter M.
        Effect of firing protocols on cohesive failure of all-ceramic crowns.
        J Dent. 2010; 38: 987-994
        • Tan J.P.
        • Sederstrom D.
        • Polansky J.R.
        • McLaren E.A.
        • White S.N.
        The use of slow heating and slow cooling regimens to strengthen porcelain fused to zirconia.
        J Prosthet Dent. 2012; 107: 163-169
        • Paula V.G.
        • Lorenzoni F.C.
        • Bonfante E.A.
        • Silva N.R.
        • Thompson V.P.
        • Bonfante G.
        Slow cooling protocol improves fatigue life of zirconia crowns.
        Dent Mater. 2015; 31: 77-87
        • Sailer I.
        • Gottnerb J.
        • Kanelb S.
        • Hämmerle C.H.
        Randomized controlled clinical trial of zirconia-ceramic and metal-ceramic posterior fixed dental prostheses: a 3-year follow-up.
        Int J Prosthodont. 2009; 22: 553-560
        • Matta R.E.
        • Motel C.
        • Kirchner E.
        • et al.
        Wear of feldspathic-ceramic-veneered zirconia posterior FPDs after 10 years.
        BMC Oral Health. 2020; 20: 345
        • Reitemeier B.
        • Hansel K.
        • Kastner C.
        • Weber A.
        • Walter M.H.
        A prospective 10-year study of metal ceramic single crowns and fixed dental prosthesis retainers in private practice settings.
        J Prosthet Dent. 2013; 109: 149-155
        • Habibi Y.
        • Dawid M.T.
        • Waldecker M.
        • Rammelsberg P.
        • Bömicke W.
        Three-year clinical performance of monolithic and partially veneered zirconia ceramic fixed partial dentures.
        J Esthet Restor Dent. 2020; 32: 395-402
        • Pontevedra P.
        • Lopez-Suarez C.
        • Pelaez J.
        • Garcia-Serdio S.
        • Suarez M.J.
        Prospective clinical evaluation of posterior monolithic zirconia fixed partial dentures using a complete digital workflow: two-year follow-up.
        J Prosthodont. 2021; 30: 298-304
        • Rauch A.
        • Schrock A.
        • Schierz O.
        • Hahnel S.
        Material preferences for tooth-supported 3-unit fixed dental prostheses: a survey of German dentists.
        J Prosthet Dent. 2021; 126: 91.e1-91.e6
        • Chuang S.K.
        • Cai T.
        • Douglass C.W.
        • Wei L.J.
        • Dodson T.B.
        Frailty approach for the analysis of clustered failure time observations in dental research.
        J Dent Res. 2005; 84: 54-58
        • Hannigan A.
        • Lynch C.D.
        Statistical methodology in oral and dental research: pitfalls and recommendations.
        J Dent. 2013; 41: 385-392
        • Wienke A.
        Frailty models in survival analysis.
        1st ed. Chapman and Hall/CRC, New York2010: 55-131