Survival Rates of Lithium Disilicate Single Restorations:

A Retrospective Study
Nicola Mobilio, DDS1/Alberto Fasiol, DDS2/Santo Catapano, MD, DDS3

Purpose: To assess the clinical performance of lithium disilicate single restorations on

natural teeth. Materials and Methods: All patients who received lithium disilicate single
restorations between 2009 and 2013 at the dental clinic of the University of Ferrara were
recalled for clinical evaluation. A total of 43 partial and total restorations in 17 patients were
evaluated from a minimum of 36 months follow-up to a maximum of 81 months follow-up,
with a mean follow-up of 51 months. Results: The cumulative survival rate was 97.7%, and
the cumulative success rate was 94.2%. Conclusion: Lithium disilicate can be successfully
used for single-tooth restorations. Int J Prosthodont 2018;31:283–286. doi: 10.11607/ijp.5601

L ithium disilicate is indicated for single-crown, three-

unit anterior partial dentures, veneers, and inlays.
It shows very good performance when compared to
Clinical Evaluation

Patients were clinically examined by a trained examin-

other glass-ceramics, and a number of studies pro-
pose the general use of lithium disilicate for fabricat-
ing both anterior and posterior single crowns.1,2 One
review concluded that lithium disilicate single crowns
showed excellent short-term survival rates, although
evidence for medium-term survival is limited.3 The aim
of this retrospective study was to assess the clinical
performance of lithium disilicate single restorations in
natural teeth over a minimum period of 3 years.
Materials and Methods
A total of 43 partial and total restorations were evalu-
ated in 17 patients who received lithium disilicate sin-
gle restorations at the dental clinic of the University of
Ferrara between July 2009 and July 2013 and who were
recalled for clinical evaluation. This report focuses on
single, total, and partial restorations (ie, crowns, inlays,
onlays, and veneers) on natural teeth (Table 1) with
a minimum follow-up period of 36 months. The study
protocol was approved by the University’s ethics com-
mittee, and all patients signed informed consent forms.
1Research Assistant, Dental School, Dental Clinic, University of Ferrara,
c.so Giovecca, Italy; Department of Medical Biotechnologies,
Division of Fixed Prosthodontics, University of Siena, Siena, Italy.
2Research Assistant, Dental School, Dental Clinic, University of Ferrara,
c.so Giovecca, Italy.
3Associate Professor, Dental School, Dental Clinic, University of Ferrara,
c.so Giovecca, Italy.
Correspondence to: Dr Nicola Mobilio, Dental School, Dental Clinic,
University of Ferrara, c.so Giovecca, 203, 44121 Italy.
Fax: +39 532 202329. Email: nicola.mobilio@unife.it
©2018 by Quintessence Publishing Co Inc.
er following a form designed specifically for the evalu-
ation of all-ceramic restorations (Fig 1).4 Mechanical
complications were reported in the form. Success was
defined as a restoration being free of all complica-
tions over the entire observation period, and survival
was defined as a restoration remaining in situ with
or without modification over the course of the entire
observation period.
Statistical Analyses
Data were statistically analyzed using the IBM SPSS
software v. 22 for Mac OSX. The minimum, mean, and
maximum follow-ups were calculated. Mechanical
complications were recorded as minor (loss of re-
tention, minor chipping: no replacement required) or
major (core fracture, support fracture, major chipping:
replacement required). Each complication was con-
sidered as a statistical event. The cumulative survival
and success rates were recorded using the Kaplan-
Meier analysis.
Results
The minimum follow-up interval for all 17 patients was
established as 36 months, while the maximum was
81 months for 2 restorations in 2 patients. The mean
follow-up was 51 months. Only two mechanical com-
plications were observed: one major (fracture of the
ceramic core) and one minor (chipping). The former
required the replacement of the restoration, while the
latter required just a superficial polishing. The cu-
mulative survival rate was 97.7%, and the cumulative
success rate 94.2%. Figure 2 shows the Kaplan-Meier

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Lithium Disilicate Single Restorations: A Retrospective Study

Fig 1   Form used for evaluation of ceramic restorations (adapted from Anusavice4).

Table 1 D
 istribution of Patients (n = 17) According
to Gender and Age and Restorations graph. Figure 3 shows the major complication that
(n = 43) According to Site and Type required intervention (replacement). Figures 4 and 5
Gender show some successful restorations.
 Male 7
 Female 10 Discussion
Age (y)
 20–29 2
 30–39 0 In the present study, the careful adhesive cementa-
 40–49 5 tion of the lithium disilicate restorations, following the
 50–59 4 routinely used protocol at the dental clinic,5 showed a
  ≥ 60 6
high success rate—94.2% at almost 7 years of obser-
Restoration site vation. All partial restorations (ie, inlays, onlays) were
 Anterior 17
 Posterior 26 luted after isolation using rubber dam, while crowns
were luted without using rubber dam. Apart from this,
Restoration type
  Full crowns 38 the luting protocol was the same for all restorations:
 Inlays/onlays 2 each tooth was polished to remove all remaining ce-
 Veneers 3 ments and/or temporary fillings, treated with adhesive

284 The International Journal of Prosthodontics

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0.98
1.0 0.94
0.8
Cumulative survival (%)
0.6
0.4
0.2
0 20 40 60 80
Months
Fig 4 (above)  Successful veneer on maxillary left central incisor and
successful crown on maxillary left lateral incisor.
Fig 5 (right)  Successful crown on maxillary right first premolar.
(Multilink Primer, Ivoclar Vivadent AG), and dried.
The intaglio surfaces of the restorations were etched
with 5% hydrofluoric acid (IPS Ceramic gel, Ivoclar
Vivadent AG) for 20 seconds, rinsed, and cleaned
in pure alcohol in an ultrasonic bath for 10 minutes,
treated with a universal primer (Monobond Plus,
Ivoclar Vivadent AG) for 60 seconds, and then dried
with hot air. The cement (Multilink Automix, Ivoclar
Vivadent AG) was applied onto the intaglio surface
and the restoration was seated onto the tooth, light
cured for 2 seconds to easily remove the excess, and
then polymerization was completed. Veneers were
cemented in the same way with a different cement
(Variolink, Ivoclar Vivadent AG).
The adhesion of lithium disilicate to natural teeth
is reported5 and has shown a failure load three times
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Mobilio et al
Fig 2 (left)  Kaplan-Meier graph of complication onset in relation to
time for lithium disilicate single restorations.
Fig 3 (below)  Major complication (fracture) of a lithium disilicate
single crown.
100
higher than those that were conventionally cement-
ed. Furthermore, the majority of adhesive groups
failed by fracture of the tooth rather than from crown
decementation.
The cumulative survival rate is similar to that re-
ported in both prospective1 and retrospective stud-
ies,2 confirming the optimal clinical performance of
these restorations in the medium term. The presented
results are consistent with data from the literature,
wherein it is reported that the survival rate for lithium
disilicate single crowns ranges from 100% at 2 years
to 97.8% at 5 years to 96.7% at 10 years.3
The present study is limited by the number of ob-
served restorations. Nonetheless, the homogeneity of
the observational time frame suggests optimism for
larger studies of longer duration.
Volume 31, Number 3, 2018 285
Lithium Disilicate Single Restorations: A Retrospective Study

Conclusions References

It appears that lithium disilicate can be successfully   1. Gehrt M, Wolfart S, Rafai N, Reich S, Edelhoff D. Clinical results
used for single, total, and partial restorations on natu- of lithium-disilicate crowns after up to 9 years of service. Clin
Oral Investig 2013;17:275–284.
ral teeth, provided that an adhesive cementation pro-
 2. Fabbri G, Zarone F, Dellificorelli G, et al. Clinical evaluation
tocol is used. Further in vivo investigations are clearly of 860 anterior and posterior lithium disilicate restorations:
required to confirm the clinical reliability of lithium di- Retrospective study with a mean follow-up of 3 years and a
silicate restorations in the long term and for extensive maximum observational period of 6 years. Int J Periodontics
restorations (eg, partial dentures). Restorative Dent 2014;34:165–177.
 3. Pieger S, Salman A, Bidra AS. Clinical outcomes of lithium
disilicate single crowns and partial fixed dental prostheses:
Acknowledgments A systematic review. J Prosthet Dent 2014;112:22–30.
  4. Anusavice KJ. Standardizing failure, success, and survival de-
The authors received no funds for the study and declare no con- cisions in clinical studies of ceramic and metal-ceramic fixed
flicts of interest. dental prostheses. Dent Mater 2012;28:102–111.
  5. Mobilio N, Fasiol A, Mollica F, Catapano S. Effect of different
luting agents on the retention of lithium disilicate ceramic
crowns. Materials (Basel) 2015;8:1604–1611.

Literature Abstract

Three-Year Analysis of Zirconia Implants Used for Single-Tooth Replacement and Three-Unit Fixed Dental Prostheses:
A Prospective Multicenter Study

The aim of the present investigation was to evaluate clinically and radiographically the outcome of zirconia oral implants after 3 years
in function. In 60 patients in need of either a single-tooth replacement or a three-unit fixed dental prosthesis (FDP), a total of 71 one-
piece zirconia implants were placed and immediately restored with temporary fixed prostheses. After a period of at least 2 months in
the mandible and at least 4 months in the maxilla, zirconia-based reconstructions were cemented. The implants were clinically and
radiologically examined at implant insertion, prosthesis delivery, at 6 months, and then annually up to 3 years. A linear mixed model was
used to analyze the influence of prognostic factors on changes in marginal bone level. A total of 71 implants (48 in the mandible, 23 in the
maxilla) inserted in 60 patients were restored with 49 crowns and 11 FDPs. One patient lost an implant after 5 weeks, and five patients with
one implant each could not be evaluated after 3 years. Based on 55 patients with a total of 66 implants, the mean survival rate was 98.5%
after 3 years in function. A statistically significant mean marginal bone loss (0.70 mm ± 0.72 mm) has been detected from implant insertion
to the 3-year follow-up. The largest marginal bone loss occurred between implantation and prosthetic delivery (0.67 mm ± 0.56 mm). After
delivery, no statistically significant bone level change was observed (0.02 mm ± 0.59 mm). None of the investigated prognostic factors had
a significant influence on changes in the marginal bone level. After 3 years in function, the investigated one-piece zirconia implant showed
a high survival rate and a low marginal bone loss. The implant system was successful for single-tooth replacement and three-unit FDPs.
Further investigations with long-term data are needed to confirm these findings.

Balmer M, Spies BC, Vach K, Kohal RJ, Hämmerle CHF, Jung RE. Clin Oral Implants Res 2018;29:290–299. References: 31. Reprints: Marc Balmer,
marc.balmer@zzm.uzh.ch —Steven Sadowsky, USA

286 The International Journal of Prosthodontics

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