Clinical and patient-reported outcomes of zirconia-based implant fixed dental prostheses: Results of a prospective case series 5 years after implant placement

Abstract

Objective

To evaluate the clinical and patient-reported outcome of all-ceramic zirconia implant supported fixed dental prostheses (FDPs) 5 years after implant installation.

Materials and methods

Thirteen patients were treated with two terminally placed one-piece zirconia implants for a three-unit FDP each. The FDPs consisted of a CAD/CAM-fabricated zirconia framework over-pressed with a fluor-apatite veneering ceramic and were adhesively cemented. Survival and success were assessed by applying modified US Public Health Service (USPHS) criteria and preparation of Kaplan–Meier (KM) plots. Alpha and Bravo ratings were accepted for success (among others including small area veneer chippings and occlusal roughness), whereas Charlie ratings allowing for intra-oral correction (e.g., polishing) were accepted for survival. Furthermore, patient-reported outcome measures (PROMs) were analyzed with the help of visual analogue scales (VAS). Wilcoxon matched-pairs signed-rank test (USPHS criteria) and linear mixed models (PROMs) were used to evaluate time effects on response variables.

Results

All patients were available 61.8 ± 1.1 months after implant installation (53.6 ± 3.1 months after final prosthesis insertion). FDP survival was 100%. Significant incidence of veneer chipping (p = .0096) and occlusal roughness (p = .0019) was observed. Charlie rated extent of both phenomena resulted in a KM success estimate of 38.5% (95% CI: 14.1%–62.8%; seven FDPs with obvious roughness, three of them with extended veneer chipping). Compared with the pre-treatment assessments (30%–81% of satisfaction), all surveys at prosthetic delivery showed significantly improved VAS scores (66%–93%; p ≤ .038), except for speech (p = .341). Concerning function, esthetics and self-esteem, no decrease in satisfaction could be observed until the end of follow-up (90%–96%; p ≥ .057), whereas perception of sense (92%) and speech (95%) increased over time (p ≤ .030). Occurrence of technical complications did not correlate with patient satisfaction.

Conclusions

Bi-layered FDPs made from zirconia/fluor-apatite highly satisfied patients but showed significant incidence of technical complications.

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