Survival and complications of tooth- and implant-supported ceramic restorations: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: During oral rehabilitation, clinicians manage various substrates including natural teeth and implants. Biomechanical differences might influence stress distribution within ceramic materials. PURPOSE: This systematic review compared the frequency of failures and fracture-related complications of tooth- and implant-supported ceramic restorations. MATERIAL AND METHODS: A search was conducted in MEDLINE/PubMed, Scopus, Web of Science, Embase, and LILACS databases to identify studies meeting the inclusion criteria. The PICOS question included: Population-multiple or single-unit, monolithic or bilayered, ceramic restorations; Intervention-implant-supported restorations; Comparison-tooth-supported restorations; Outcome-number of failures and number of complications; Study design-clinical trials or observational studies. Risk of bias was assessed with the Newcastle-Ottawa Scale and the confidence of the cumulative evidence was evaluated with GRADEpro. Meta-analyses were conducted separately for lithium disilicate, alumina, and zirconia ceramics comparing the outcomes of failures, technical failures, and complications associated with repairable fractures. RESULTS: The search yielded 2073 records. Of these, 38 studies were selected for full-text reading, and 25 were included in this review (17 quantitatively and 8 qualitatively analyzed). In all analyses, the heterogeneity among studies was low, and no significant differences were found between tooth- and implant-supported substrates. Risk of bias was mostly low, and confidence of evidence was considered low to moderate by GRADE assessment. CONCLUSIONS: No significant differences were found in the frequency of failures, technical failures, or repairable fracture-related complications between ceramic restorations supported by teeth or implants, regardless of the ceramic material evaluated.