Survival and complications of zirconia-

based fixed dental prostheses: A

systematic review
Ariel J. Raigrodski, DMD, MS,a Matthew B. Hillstead, DDS,b
Graham K. Meng, DDS,c and Kwok-Hung Chung, DDS, MS, PhDd
School of Dentistry, University of Washington, Seattle, Wash;
A.T. Still University, Mesa, Ariz; University of Illinois at Chicago,
Chicago, Ill.
Statement of problem. Evidence is limited on the efficacy of zirconia-based fixed dental prostheses.

Purpose. The purpose of this systemic review was to assess zirconia-based FDPs in terms of survival and complications.

Material and methods. Searches performed in PubMed databases were enriched by hand searches to identify suitable
publications. The keywords used were: “zirconia” and “fixed dental prosthesis,” “zirconia” and “crown,” “zirconia” and
“fixed partial denture” and “humans,” “zirconia” and “crown” and “humans,” “crown” and “all-ceramics,” and “fixed
partial denture” and “all-ceramics”. Titles and abstracts were read to identify literature that fulfilled the inclusion cri-
teria. Only peer reviewed clinical studies published in the English language from January 1999 through June 2011 were
included.

Results. Twelve clinical studies based on zirconia, framework design, and porcelain veneering technique met the
inclusion criteria. Of the studies identified, 1 was a randomized clinical study with 3-year follow-up results; the others
were cohort prospective studies. Clinical complications included chipping of veneering porcelain, abutment failure,
and framework fracture. One study investigated pressed ceramics as the veneering material and found no chipping of
veneering porcelain after 3 years.

Conclusions. Short term clinical data suggest that zirconia-based fixed dental prostheses may serve as an alternative
to metal ceramic fixed dental prostheses in the anterior and posterior dentition. (J Prosthet Dent 2012;107:170-177)

Clinical Implications
Zirconia-based fixed dental prostheses may be considered as an
acceptable restoration in both the anterior and posterior segments.

Meta-analyses have demonstrated
good long term clinical results for
conventional fixed dental prosthesis
(FDP) with a metal framework.1-3 As
dentistry has evolved, the demand for
metal free materials with increased
translucency that mimic the natural
dentition has arisen.4 This has led to
the development of several different
ceramics that are esthetically pleasing
and biocompatible.5-7 What is still be-
ing established is which materials are
acceptable not only for their favorable
optical properties, but also for their
favorable mechanical properties, ade-
quate clinical function, and longevity.
Currently, there are several ceramic
materials, including glass-based ce-
ramics, crystalline-dominated ceram-
ics, and polycrystalline ceramics, that
meet these requirements.8-12 Each
type has different physical and opti-
cal properties. However, the selection
of these ceramics must be made with
respect to the mechanical properties
of the materials, tooth preparation
design, and the ability to provide ad-
equate insertion procedures such as
traditional or adhesive luting.12-16
Zirconia is a polycrystalline ceram-

This review is partially supported by NIDCR R25 DE018436.

a
Professor and Director, Graduate Prosthodontics, Department of Restorative Dentistry, University of Washington.
b
Orthodontic Resident, Postgraduate Orthodontic Program, A.T. Still University.
c
Prosthodontic Resident, Prosthodontic and Implant Clinic, Department of Restorative Dentistry, University of Illinois at Chicago.
d
Professor, Department of Restorative Dentistry, University of Washington.

The Journal of Prosthetic Dentistry Raigrodski et al

March 2012
ic without a glassy phase and exists in
several forms. It exists in a monoclinic
crystalline state at room tempera-
ture, then through sintering changes
to tetragonal and cubic crystalline
states.12 The cooling of either state
will normally result in reversion to a
monoclinic state. The most common
method of stabilizing the tetragonal
phase and maintaining zirconia in a
metastable condition at room tem-
perature is by adding a small amount
of yttria to the zirconia.11-13 Such
treatment produces a material that is
stronger and tougher than other avail-
able ceramics. Factors that facilitate
tetragonal to monoclinic conversion
include water/moisture and mechani-
cal work such as polishing, which may
eventually weaken the matreial.13
Recently, zirconia has been used
to fabricate ceramic FDPs with rela-
tively high strength and good es-
thetics. In vitro studies have been
conducted to evaluate zirconia’s me-
chanical strength, biocompatibility,
and the marginal integrity of different
computer-assisted design computer-
assisted manufacturing (CAD/CAM)
systems using zirconia.17-21 Compared
with alumina, zirconia has supe-
rior fracture toughness and flexural
strength and lower modulus of elas-
ticity and hardness. Some zirconia-
based restorative CAD/CAM systems
present with acceptable marginal in-
tegrity even after processing.20,21
Two limitations have been ob-
171
served clinically as related to the
bond strength of the veneering porce-
lain to the zirconia framework. These
are veneering porcelain chipping and
the possible degradation of zirco-
nia when exposed to moisture in the
oral environment, which may lead to
a long term decrease in strength and
the possibility of catastrophic fail-
ure.18,22-24 However, in vitro studies
have demonstrated that bonding is
not always the issue, it is the quality of
the veneering porcelain that is impor-
tant.25,26 Current research is focused
on framework design and methods of
veneering porcelain to zirconia frame-
works.27 It has been shown that de-
signing frameworks with an anatomic
design rather than an arbitrary resto-

Table I. Summary of systems, connector dimensions, and veneering technique for zirconia-based restorations
Authors
(Year) Zirconia-ceramic Systems Connector Dimensions Veneering Technique

Raigrodski et al30 F: Lava Connector: ≥ 9 mm2 Layering

(2006) V: Lava Ceram
Sailer et al 31
F: Cercon No information Layering
(2007) V: a newly developed
prototype veneering ceramic
Edelhoff et al32 F: DigiZon Connector: 6 - 9 mm2 Layering
(2008) V: Initial Zr-Keramik
Molin & Karlsson 33
F: Denzir Connector: 9 mm2 Layering or Pressing
(2008) V: Vita D or IPS Empress
Tinschert et al34 F: DC-Zircon Connector: 15 - 16 mm2 Layering
(2008) V: Vita D
Beuer et al 35
F: Cercon Cross sections of connector: Pressing
(2009) V: Cercon Ceram Express 12.2 to 13.3 mm in vertical thickness
Sailer et al36 F: Cercon No information Layering
(2009) V: Cercon CeramS
Schmitt et al 37
F: Lava Connector: ≥ 9 mm2 Layering
(2009) V: Lava Ceram
Schmitter et al38 F: Cercon Connector: 9 mm2 Layering
(2009) V: Cercon CeramS
Wolfart et al 39
F: Cercon Connector: 9 mm2 Pressing
(2009) V: Cercon Ceram Express
Beuer et al40 F: IPS e.max ZirCAD No information Layering
(2010) V: IPS e.max Ceram
Roediger et al 41
F: Cercon Connector: ≥ 9 mm2 Layering
(2010) V: Cercon CeramS

F: framework; V: veneering

Raigrodski et al
172
ration thickness increases restoration
strength.28
The increased use of zirconia in
the oral environment renders it nec-
essary to examine its use as a clini-
cally successful restorative material.
The purpose of this systematic review
was to assess zirconia-based FDPs in
terms of survival and complications.
Veneering techniques for porcelain
application to zirconia frameworks,
either pressing or conventional layer-
ing, were also examined.
MATERIAL AND METHODS
A PubMed electronic search was
done of both MeSH terms and key
words. Articles published and record-
ed on PubMed from January 1999
through June 2011 were searched by
using the following key terms: “zir-
conia” and “fixed dental prosthesis,”
“zirconia” and “crown,” “zirconia” and
“fixed partial denture” and “humans,”
“zirconia” and “crown” and “hu-
mans,” “crown” and “all-ceramics,”
and “fixed partial denture” and “all-
ceramics”. All titles revealed by this
research strategy were screened, and
an abstract search to conduct articles
that could be of possible relevance
was done. Additional hand searching
was done to identify any other clinical
studies on zirconia-based FDPs. Only
English, peer-reviewed articles of clin-
ical studies included.
The articles were identified based
on the following inclusion and exclu-
sion criteria. Studies were included if
subjects had been examined clinically
at regular intervals. Studies on mul-
Volume 107 Issue 3
tiple complete coverage units, fixed
prostheses fabricated entirely from
zirconia, or zirconia frameworks were
considered. Data on the survival and
failure of the FDPs and descriptions
of the biological and technical com-
plications, with their time of occur-
rence, were reported. Retrospective
and in vitro studies were excluded.
Studies on partial coverage prosthe-
ses or implant-supported restorations
were also excluded.
The search yielded 12 articles in-
volving clinical studies on zirconia-
based FDPs that satisfied the inclu-
sion criteria. Subsequently, a final
search was done on the references of
the found articles, but no additional
articles were located. No statistical
analysis or meta-analysis was per-
formed because too few related stud-

Table II. Summary of number of FDPs and mean observation period for zirconia-based restorations
Authors Number of Number of FDPs Number of FDPs Mean
(Year) Subjects at Baseline at Observation Observation Period

Raigrodski et al30 16 20 20 31.2 months

(2006)
Sailer et al31 45 57 33 53.4 ±13 months
(2007)
Edelhoff et al32 18 22 21 39.1 months
(2008)
Molin & Karlsson33 18 19 19 60 months
(2008)
Tinschert et al34 46 65 58 37.5 months
(2008)
Beuer et al35 19 21 21 40 months
(2009)
Sailer et al36 59 36 34 40.3 ±2.8 months
(2009)
Schmitt et al37 30 30 27 34.2 months
(2009)
Schmitter et al38 27 30 28 25 months
(2009)
Wolfart et al39 21 24 17 48 ±7 months
(2009)
Beuer et al40 38 18 18 35 ±14 months
(2010)
Roediger et al41 75 99 91 50 months
(2010)

The Journal of Prosthetic Dentistry Raigrodski et al

March 2012
ies were identified. Statistics are pre-
sented from the articles reviewed.
RESULTS
Of the clinical studies identi-
fied, there was only 1 randomized
controlled trial. The other 11 were
prospective cohort studies evaluat-
ing 2- to 5-year follow-up of restora-
tions with zirconia frameworks. The
crossover among studies was limited,
with few similarities between them. A
direct comparison of selected stud-
ies was not possible. Those clinical
studies were grouped by connector
dimension (> 9mm2 or ≤ 9mm2) and
method of applying the veneering
porcelain (layering or pressing).
The articles included in this study
are listed in Table I by author, brand
of restoration, connector dimen-
sions, and veneering technique. Table
II shows the number of subjects as-
signed to each study, the number and
type of FDPs used in the study, the
number of FDPs at observation, and
the mean observation period. The 12
clinical studies included one 5-year fol-
low-up, three 4-year follow-ups, seven
3-year follow-ups, and one 2-year
follow-up. Table III summarizes the re-
sults of the studies, with emphasis on
complications and survival rates.
Technical and biological compli-
cations were used to determine the
failures of the restorations. The most
prevalent technical complication was
chipping of the veneering porcelain,
followed by framework fracture, loss of
retention, and marginal discrepancies.
The biological complications reported
were secondary caries, endodontic
complications, fracture of abutment
teeth, and periodontal disease.29
Survival rates ranged from 73.9%
to 100% within the 12 studies. Five
studies reported 100% survival rates
during the observations period. One
study reported 73.9% survival of
frameworks and the rest (6 studies)
had survival rates ranging between
88.2% and 96.6%.
Raigrodski et al30 inserted twenty
3-unit posterior zirconia-based FDPs
Raigrodski et al
fabricated with Lava system (3M
ESPE, St Paul, Minn) in 16 subjects.
All the restorations were designed in
a similar fashion with uniform thick-
ness of the framework and connector
size larger than 9 mm2. Follow-up was
performed every 6 months for the first
2 years and then a 3-year follow-up
was done. Minor chipping occurred
in 5 FDPs and 1 FDP presented with
a molar abutment with irreversible
pulpitis after definitive cementation.
The restoration, however, remained in
situ. The results of the 3-year follow-
up showed a 100% survival rate.
Sailer et al31 conducted a 5-year
follow-up on 3-unit to 5-unit zirco-
nia-based FDPs with frameworks pro-
duced by the direct ceramic machin-
ing system. Fifty-seven were initially
inserted in 45 subjects. These frame-
works (Cercon; DeguDent, Hanau,
Germany) were nonanatomically de-
signed and veneered with convention-
al layering techniques but with a newly
developed veneering ceramic. At the
3-year recall, 7 FDPs were replaced
because they were no longer clini-
cally acceptable due to open margins
resulting in secondary caries. At the
5-year follow-up, 11 subjects with 17
FDPs left the study and did not partic-
ipate in the recall. A total of 33 FDPs
were still in service. Twelve of the
FDPs had to be replaced after 5 years,
one because of fracture through a
connector when a patient masticated
on a hard particle in a piece of bread
and the rest were replaced because of
biologic complications. A major issue
with the FDPs in this study was the
presence of clinically detectable mar-
ginal gaps (58%) that resulted in 10
(21%) of the restorations having clini-
cally detectable secondary caries at
the 5-year recall. The survival rate was
only 73.9% after the 5-year follow-up.
Edelhoff et al32 inserted 22 zirco-
nia-based FDPs in 18 subjects and re-
called them every 12 months for more
than 36 months. The zirconia frame-
works (DigiZon; Amann Girrbach
GmbH, Pforzheim, Germany) were
milled from fully sintered zirconia.
Three FDPs exhibited complications:
173
1 crack and 2 chipped veneering ce-
ramic (Initial Zr-keramik; GC Europe
NV, Leuven, Germany). Defects in the
veneering material were found in 9.5%
of evaluated FDPs.
Molin and Karlsson33 placed 19
zirconia-based 3-unit FDPs in 18 sub-
jects and followed up for 5 years. CAD/
CAM zirconia frameworks (DenZir;
Cad.esthetics AB, Skelleftea, Sweden)
were manufactured with an anatomic
form and then sintered. The frame-
works were then veneered with either
a feldspathic porcelain (Vita Veneer-
ing Ceramic D; Vita Zahnfabrik, Bad
Säckingen, Germany) or a glass-ce-
ramic (IPS Empress; Ivoclar Vivadent,
Schaan, Liechtenstein). All restora-
tions were still in service at the 5-year
recall. One had lost retention after 12
months and had to be recemented.
Approximately 30% displayed an in-
crease in pitting or roughened occlu-
sal surfaces at the 5-year recall. How-
ever, no differences of mean surface
roughness were found between FPDs
veneered with IPS Empress or Vita D
veneered surfaces.
Tinschert et al34 placed 65 zirco-
nia-based FDPs in 46 subjects. Fif-
teen were placed in the anterior and
50 in the posterior dentition. A con-
nector size of 16 mm2 was intended
but, because of clinical conditions,
was only achieved in 39% of ante-
rior and 57% of posterior prostheses.
The prostheses were DC-Zirkon (DCS
Dentalsysteme GmgH, Kelkheim, Ger-
many) substructures with Vita D (Vita
Zahnfabrik) veneered porcelain. All
FDPs were in service and no remakes
were necessary at the 3-year follow-
up. However, 4 (6.1%) of the poste-
rior restorations displayed chipping
in the veneering porcelain. Two FDPs
required recementation, and 3 teeth
needed endodontic treatment. No
pathology at the gingival margin was
observed.
Beuer et al35 inserted 21 zirconia-
based FDPs in 19 subjects and re-
called them every 12 months for 3
years. The teeth were prepared in a
similar manner, and the prosthesis
was waxed to anatomic contour and
174 Volume 107 Issue 3

Table III. Summary of complications and survival rate for zirconia-based restorations
Authors Number of Survival
(Year) Complications Number and Type of Complications Rate

Raigrodski et al30 6 1 abutment tooth required endodontic therapy 100%

(2006) 5 minor chipping of veneering ceramic
Sailer et al31 12 1 framework fracture due to trauma 73.9%
(2007) 1 loss of retention
2 abutment tooth fracture
6 secondary caries
1 major chipping of veneering ceramic
1 abutment tooth with endodontic problem
Edelhoff et al 32
3 1 cracking of veneering ceramic 90.5%
(2008) 2 chipping of veneering ceramic
1 abutment tooth required endodontic therapy
Molin & Karlsson 33
1 1 loosening and recementation 100%
(2008)
Tinschert et al34 9 4 minor chipping of veneering ceramic 100%
(2008) 3 abutment teeth required endodontic therapy
2 loosening and recementation,
Beuer et al 35
2 2 lost (1 zirconia framework fracture and 1 loss of retention) 90.5%
(2009)
Sailer et al36 13 1 abutment tooth required endodontic therapy 100%
(2009) 9 minor chipping of veneering ceramic
3 major chipping of veneering ceramic
Schmitt et al37 4 1 abutment tooth required endodontic therapy 100%
(2009) 2 minor chipping of veneering ceramic
1 major chipping of veneering ceramic
Schmitter et al 38
5 1 lost (framework fracture at connector) 96.6%
(2009) 2 loosening and recementation
1 chipping of veneering ceramic
1 abutment tooth required endodontic therapy
Wolfart et al 39
7 1 lost (secondary caries) 96%
(2009) 3 biological and 3 technical failures
2 abutment teeth required endodontic therapy,
2 loosening and recrementation
3 chipping of veneering ceramic
Beuer et al40 8 3 biological and 5 technical failures 88.2%
(2010) 1 FDP removed because of loss of vitality
Roediger et al 41
30 7 lost (1 marginal chipping, 3 loss of retention, 1 root fracture, 94%
(2010) 1 abutment loss because of periodontal lesion, and 1 marginal caries)
13 minor chipping of veneering ceramic
6 loosening and recementation
3 secondary caries
1 abutment tooth required endodontic therapy

The Journal of Prosthetic Dentistry Raigrodski et al

March 2012
cut back, with 1 mm available for
an overpressed ceramic margin. All
frameworks were manufactured by a
CAM system (Cercon; DeguDent). Af-
ter clinical evaluation, occlusal ceram-
ic was added by using an overpressing
veneering ceramic (Cercon Ceram Ex-
press, DeguDent) with a coefficient
of thermal expansion similar to that
of zirconia. At the 3-year follow-up,
1 maxillary framework had fractured
and been removed, and 1 FDP had
been removed because of loss of re-
tention. The fractured framework had
little porcelain over it, and the zirconia
framework was 0.3-mm thick in this
area because of insufficient reduction
of the prepared tooth. No chipping of
veneering porcelain was observed on
the restorations, and the survival rate
was 90.5% after 40 months in service.
The success rate for the zirconia sub-
structure after 40 months was 95.2%
according to Kaplan-Meier analysis.
Sailer et al36 reported a 3-year fol-
low-up on a randomized controlled
trial of 59 subjects needing 76 zirco-
nia-based FDPs. Metal ceramic-based
(Metal-DeguDent U; DeguDent, Cer-
mic-Duceram Plus; DeguDent) and
zirconia ceramic-based (Zirconia-Cer-
con; DeguDent, Ceramic-Cercon Ce-
ramS; DeguDent) FDPs were placed.
Thirty-six zirconia ceramic-based FDPs
were evaluated at the 3-year follow-
up and 2 three-unit FDPs were lost to
follow-up. No fracture of a zirconia or
metal framework was observed. Both
types of FDPs showed a 100% survival
rate. Minor veneering porcelain chip-
ping occurred more frequently in the
zirconia ceramic-based FDPs than in
the metal ceramic-based FDPs.
Schmitt et al37 inserted 30 zirconia-
based FDPs constructed with Lava
system (3M ESPE) in 30 subjects. The
teeth were prepared with similar re-
duction, designed with similar speci-
fications, and then veneered with
porcelain. At the 3-year follow-up, 27
subjects returned. Three instances of
chipping of the ceramic veneer were
recorded and 1 abutment tooth be-
came nonvital. No significant differ-
ences between the periodontal pa-
Raigrodski et al
rameters of the test and control teeth
were observed. The survival rate was
100% after a mean of 34.2-months
follow-up.
Schmitter et al38 evaluated long
span (36 mm to 46 mm, 4 units to 7
units) zirconia ceramic-based (Zirco-
nia-Cercon; DeguDent, Ceramic-Cer-
con CeramS; DeguDent) FDPs. Thirty
zirconia-based FDPs were inserted (11
anterior teeth and 19 posterior) and
assessed at baseline and at 2 years in
27 subjects. There were 5 complica-
tions: 1 framework fractured and the
damage was likely caused by a tech-
nical failure; 2 had to be recemented;
1 abutment tooth had to be treated
endodontically; and 1 chipping of
veneering ceramic was observed. No
significant changes of probing depths
and hypersensitivity were determined,
and esthetics was highly rated by the
subjects. The overall survival at the
2-year follow-up was 96.6%.
Wolfart et al39 inserted 24 zirco-
nia-based (Cercon; DeguDent) FDPs
with a terminal abutment design in 21
subjects and 34 with a cantilever de-
sign in 27 subjects. Veneering ceramic
(Cercon Ceram Express; DeguDent)
was pressed on the frameworks, and
they were inserted and followed up
for 4 years. No framework fractures
occurred after 4-year follow-up. The
terminal abutment group had a sur-
vival rate of 96%, and the cantilever
design group 91%. No significant
differences between the groups were
detected in any of the Kaplan-Meier
analyses (P>.05).
Beuer et al40 fabricated 18 zirco-
nia-based FDPs and 50 single unit
restorations with partially sintered
zirconia (IPS e.max ZirCAD; Ivoclar
Vivadent) frameworks and veneered
with conventionally layered veneer-
ing porcelain (IPS e.max Ceram; Ivo-
clar Vivadent) for 38 subjects. At the
3-year follow-up, 88.2% had no com-
plications, and 98.5% were still in ser-
vice. Complications and failures were
seen only in the FDP groups. In this
study, the rate of technical complica-
tions, including veneer chipping rates,
was determined to be 7.4%.
175
Roediger et al41 observed 99 zir-
conia-based FDPs that were placed
in 75 subjects with a maximum of
2 adjacent missing teeth. The zirco-
nia frameworks (Cercon; DeguDent)
were veneered with ceramic (Cercon
CeramS; DeguDent) and restora-
tions were evaluated continuously in
6-month intervals. Overall survival of
the FDPs after 48 months was 94%
with 4 being lost to technical com-
plications and 3 to biologic compli-
cations. Thirteen displayed ceramic
chippings and needed to be polished
(13%), 6 showed loss of retention and
required recementation, 3 showed
carious lesions, and 1 showed loss
of vitality and required endodontic
treatment. No statistically significant
differences were determined in the
probability of success between the 2
groups of veneering material.
DISCUSSION
This systematic review focused on
the results of clinical studies on zirco-
nia-based FDPs. The number of pub-
lished studies was limited because of
the relatively short time zirconia has
been used in dentistry. The follow-
up times of published studies were
from 2 to 5 years, and the sample
sizes within most of the studies were
relatively low. Lack of similar outcome
criteria and time periods made it dif-
ficult to draw definitive conclusions.
Thus, conclusions are based on a
short time period with a small num-
ber of restorations. Only 1 study was
a randomized controlled clinical trial
with clinical significance.36 There was
no consensual guideline for quantify-
ing chipping of the veneering porce-
lain, and the criteria from study to
study as to what constituted a failure
varied. Combining results for statis-
tics was not feasible.
The biological complications noted
in some studies were an abutment tooth
needing endodontic therapy,30,32,34,36-39,41
recementation,33,34,38,39,41 or repair of a
carious lesion.41 The percentage of com-
plete failures resulting from framework
fracture or loss of retention was less
176
than 10%. Complete failures could be
explained chiefly by under-reduced
tooth structure and insufficient con-
nector size. In the 5-year study by Sail-
er et al,31 there was a high incidence
of marginal discrepancy (58%) and re-
sulting secondary caries (21.7%). The
authors of this study attribute this to
the prototype direct ceramic machin-
ing (DCM) technique for framework
fabrication. This system is now known
as the Cercon system.
Chipping of the veneering porce-
lain was a common concern noted
in all of the previously mentioned
studies. Recent studies show that
this may be due to feldspathic por-
celains with a different coefficient of
thermal expansion (CTE) from zirco-
nia or too rapid cooling of the res-
toration when removing it from the
porcelain furnace.42-45 Beuer et al35
showed that with a pressed porcelain
such as Cercon Ceram Express, the
rate of veneering chipping was 0%.
As more techniques are developed
for veneering ceramics to zirconia,
the rate of chipping may decrease. In
a short term clinical study, the rate
of veneering ceramic chipping was
not significantly higher than that of
metal ceramic FPDs.36 Thus, zirconia-
based FDPs may become an accept-
able alternative treatment. Swain23
stated that the high rates of chipping
of veneering porcelain on all ceramic
restorations may be due to residual
stress from a CTE mismatch. More
research into and development of
veneering porcelain with a similar
CTE to zirconia, along with press-
ing rather than traditional layering
techniques and an understanding of
optimal cooling rates during fabrica-
tion, are needed. In addition, it has
been demonstrated that anatomically
designed frameworks may result in a
lower rate of porcelain fracture.28,46
Zirconia frameworks were designed
with a minimum thickness of 0.5 mm
to 0.7 mm, and the size of reported
framework connectors mostly ranged
between 9 mm2 and 16 mm2. The me-
chanical properties of zirconia, except
its modulus of elasticity, are superior
The Journal of Prosthetic Dentistry
to any other tooth-colored restorative
material. In these studies, the rate of
fracture of the zirconia itself was low
or nonexistent.30-41 Thus, although
veneering porcelain chipping was
quite a frequent complication, a cata-
strophic fracture of the zirconia core
was only noted in isolated instances.
In terms of periodontal health,
none of the studies reported any dif-
ference or noted any changes in the
biological health of the soft and hard
tissues around the zirconia-based
restorations. Although some data
quantified and explored differences
in the biocompatibility of zirconia, no
instances of gingival inflammation or
periodontitis could be shown. Most
clinical studies have shown chipping
of the veneering porcelain.30-34,36,37,40,41
In the study that compared zirconia
to metal ceramic restorations, chip-
ping was noted at a similar or higher
rate.36 Further research into the han-
dling of zirconia restorations during
fabrication and further development
of ceramics with similar CTE to zirco-
nia, pleasing esthetics, and adequate
strength for clinical application is
needed. The use of pressed ceramics
versus layered porcelain also requires
evaluation. Further research with stan-
dardized parameters of evaluation and
long term follow-up are required.
CONCLUSIONS
Within the limitations of this sys-
tematic review, the following conclu-
sions were drawn:
1. Short term clinical data suggest
that zirconia-based FDPs may be con-
sidered a viable restoration.
2. Limited data suggest that the
pressed to zirconia technique resulted
in better clinical outcomes than the
conventional layering technique.
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Corresponding author:
Dr Kwok-Hung Chung
Department of Restorative Dentistry,
University of Washington
1959 NE Pacific Street, D-770 HSC
Box 357456
Seattle, WA 98195-7456
Fax: 206-543-7783
E-mail: akchung@u.washington.edu
Copyright © 2012 by the Editorial Council for
The Journal of Prosthetic Dentistry.

Noteworthy Abstracts of the Current Literature

Prognosis of zirconia ceramic fixed partial dentures: a 7-year prospective study

Lops D, Mosca D, Casentini P, Ghisolfi M, Romeo E.

Int J Prosthodont 2012;25:21-3.

The aim of this study was to evaluate the time-dependent clinical efficacy of anterior and posterior zirconia fixed
partial dentures (FPDs). A convenience sample of 28 patients, each wearing 1 FPD, was recalled annually throughout
a 6-year follow-up period (mean: 6.5 years). Four patients did not participate in the study (dropouts), and 24 FPDs
were in use during the observation period. The cumulative survival and success rates were 88.9% and 81.8%, respec-
tively. Fixed prostheses with zirconia frameworks may be regarded as acceptable alternatives to metal-ceramic anterior
and posterior FPDs.

Reprinted with permission from Quintessence Publishing.

Raigrodski et al