A prospective, multi-center, practice-based cohort study on all-ceramic crowns

Dental Materials, vol. 37, pp. 1273–1282

Abstract

OBJECTIVES: The aim of this prospective, multi-center, practice-based cohort study was to analyze factors associated with the success of all-ceramic crowns. METHODS: All-ceramic crowns placed in a practice-based research network ([Ceramic Success Analysis, AG Keramik) were analyzed. Data from 1254 patients with (mostly in-office CAD/CAM) all-ceramic crowns placed by 101 dentists being followed up for more than 5 years were evaluated. At the last follow-up visit crowns were considered as successful (not failed) if they were sufficient, whereas crowns were considered as survived (not lost) if they were still in function. Multi-level Cox proportional hazards models were used to evaluate the association between a range of predictors and time of success or survival. RESULTS: Within a mean follow-up period (SD) of 7.2(2)years [maximum:15years] 776 crowns were considered successful (annual failure rate[AFR]:8.4%) and 1041 crowns survived (AFR:4.9%). The presence of a post in endodontically treated teeth resulted in a risk for failure 2.7 times lower than that of restorations without a post (95%CI:1.4-5.0;p = 0.002). Regarding the restorative material and adhesive technique, hybrid composite ceramics and single-step adhesives showed a 3.4 and 2.2 times higher failure rate than feldspathic porcelain and multi-step adhesives, respectively (p < 0.001). Use of an oxygen-blocking gel as well as an EVA instrument resulted in a 1.5-1.8 times higher failure rate than their non-use (p ≤ 0.001). SIGNIFICANCE: After up to 15years AFR were rather high for all-ceramic crowns. Operative factors, but no patient- or tooth-level factors were significantly associated with failure. The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00020271).

Authors 7

1. Richard Johannes Wierichs corresponding Aachen Department of Biohybrid and Medical Textiles (BioTex) Institute of Applied Medical Engineering

   University of Bern · RWTH Aachen University

   Affiliation as printed

   Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland; Department of Biohybrid & Medical Textiles, Institute of Applied Medical Engineering, RWTH Aachen University, Aachen, Germany. Electronic address: richard.wierichs@zmk.unibe.ch

   Department of Biohybrid & Medical Textiles, Institute of Applied Medical Engineering, RWTH Aachen University, Aachen, Germany

   Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland

2. Enno J. Kramer
   Affiliation as printed

   Private Practice Norden, Germany

3. Bernd Reiss
   Affiliation as printed

   German Society of Computerized Dentistry, Berlin, Germany

4. Falk Schwendicke

   Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Oral Diagnosis, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Berlin, Germany

5. Joachim Krois

   Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Oral Diagnosis, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Berlin, Germany

6. Hendrik Meyer‐Lueckel

   University of Bern

   Affiliation as printed

   Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland

7. Thomas Gerhard Wolf

   University of Bern · Johannes Gutenberg University Mainz · University Medical Center of the Johannes Gutenberg University Mainz

   Affiliation as printed

   Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland; Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University Mainz, Germany

   Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University Mainz, Germany

   Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland