A Systematic Review and Meta-Analysis Evaluating the Survival, the Failure and the Complication Rates of Metal-Ceramic, Veneered and Monolithic All-Ceramic Tooth-Supported Multiple- Unit Fixed Dental Prostheses (Fdps)

PURPOSE: To evaluate the 5-year survival of metal-ceramic and all-ceramic tooth-supported fixed dental prostheses (FDPs) and assess biologic and technical complication rates. MATERIALS AND METHODS: Randomized clinical trials and prospective studies on tooth-supported FDPs with a mean follow-up of ≥ 3 years were included. A systematic search of MEDLINE (PubMed), Embase, and Cochrane CENTRAL (January 2014 to December 2024) identified relevant studies. An additional 17 studies from prior systematic reviews were included to cover earlier periods. Survival and complication rates were estimated using robust Poisson regression models to generate pooled 5-year survival estimates. RESULTS: In total, 41 studies, including 600 metal-ceramic and 1,532 all-ceramic FDPs, met the inclusion criteria. The 5-year survival rates were 92.9% for veneered densely sintered zirconia, 91.3% for metal-ceramic, 88.4% for glass-infiltrated alumina, 87.9% for monolithic densely sintered zirconia, and 82.5% for lithium disilicate-reinforced glass-ceramic FDPs. Lithium disilicate FDPs showed significantly lower survival than metal-ceramic restorations, while differences among other materials were not statistically significant. Overall, 71.0% of restorations remained complicationfree after 5 years. All-ceramic FDPs had higher rates of marginal caries and loss of retention than metalceramic FDPs. Framework fractures were more prevalent in all-ceramic restorations, particularly in lithium disilicate-reinforced glass-ceramic and glass-infiltrated alumina FDPs (> 10% over 5 years). Ceramic chipping was common but least frequent in monolithic zirconia FDPs. CONCLUSIONS: Veneered and monolithic densely sintered zirconia and metal-ceramic FDPs demonstrate comparable 5-year survival rates. High fracture rates make weaker ceramics unsuitable for multiunit restorations. Monolithic zirconia offers improved resistance to chipping and framework fractures.