The clinical success of all-ceramic restorations.

BACKGROUND The authors conducted a comprehensive literature review to compile and compare clinical evidence for the treatment of teeth using all-ceramic restorations. TYPES OF STUDIES REVIEWED The authors searched the English-language peer-reviewed literature using MEDLINE and PubMed with a focus on research published between 1993 and 2008. They also conducted a hand search of relevant dental journals. They reviewed randomized controlled trials, nonrandomized controlled studies, longitudinal experimental clinical studies, longitudinal prospective studies and longitudinal retrospective studies. RESULTS Evidence suggests that for veneers, intracoronal restorations and complete-coverage restorations for single-rooted anterior teeth, clinicians may choose from any all-ceramic system on the basis of esthetic needs (many systems have had greater than 90 percent success at six years). Well-studied molar restorations include those made of alumina and, increasingly, zirconia and bonded lithium disilicate. Reasonable evidence has shown the effectiveness of anterior three-unit fixed partial dentures made of lithium disilicate, alumina and zirconia. For three-unit restorations involving a molar, expert consensus suggests that only zirconia-based systems are indicated. CLINICAL IMPLICATIONS Available evidence indicates the effectiveness of many all-ceramic systems for numerous clinical applications. Bonding has been shown to increase clinical success. Studies of zirconia prostheses indicate problems with porcelain cracking.