A multi-center retrospective assessment of monolithic zirconia restorations on posterior teeth and implants.

  • Sandra AlTarawneh Head of Department of Prosthodontics, School of Dentistry, the University of Jordan, Amman, Jordan.
  • Motasum Abu-Awwad Department of Prosthodontics, School of Dentistry, the University of Jordan, Amman, Jordan.
  • Salah Riyal Riyal dental clinics, Amman, Jordan.
  • Rania Samara Private practice, Amman, Jordan
  • Susan Hattar Department of Conservative Dentistry, School of Dentistry, the University of Jordan, Amman, Jordan


Objective: the purpose of this multicenter retrospective study was to report on survival, success, and complication rates in monolithic zirconia restorations on teeth and implants. Materials and Methods: data on 671 monolithic zirconia restorations was collected by five prosthodontists from three different specialty practice centers, including a dental school and two private practice centers. Restorations included single crowns and multiple-unit fixed dental prostheses on teeth and implants in the posterior area (premolar and molars). Follow-up time was up to 62 months. Results: mean follow-up time was 28.1±12.9 months. A total of 671 units, 534 single crowns, and 137 multi-unit restorations. Cumulative survival and success rates at 5 years were 97.4%, and 93.8% respectively. Complications presented in 11 restorations out of 671 and included: decementation, abutment screw loosening, restoration crack, restoration fracture, and tooth fracture. No significant differences were observed between tooth-supported and implant-supported restoration (p=0.42), single crowns and multiple-unit restorations (p=0.07), bruxers and non-bruxers (p=0.57). Patients with group function occlusal scheme had significantly less survival rates (p=0.001). Conclusion: the use of monolithic zirconia for restorations on the posterior teeth and implants seems to be promising as it provides a durable solution with a low rate of complications.


1. Heintze SD, Rousson V. Survival of zirconia- and metal-supported fixed dental prostheses: a systematic review. Int J Prosthodont. 2010;23(6):493-502.
2. Denry I, Kelly JR. State of the art of zirconia for dental applications. Dent Mater. 2008;24(3):299-307.
3. Esquivel-Upshaw JF, Kim MJ, Hsu SM, Abdulhameed N, Jenkins R, Neal D, Ren F, Clark AE. Randomized clinical study of wear of enamel antagonists against polished monolithic zirconia crowns. J Dent. 2018;68:19-27
4. Piconi C, Maccauro G. Zirconia as a ceramic biomaterial. Biomaterials. 1999;20(1):1-25.
5. Stawarczyk B, Keul C, Eichberger M, Figge D, Edelhoff D, Lumkemann N. Three generations of zirconia: 
 From veneered to monolithic. Part I. Quintessence Int. 2017;48(5):369-80
6. Larsson C, Vult von Steyern P. Five-year follow-up of implant-supported Y-TZP and ZTA fixed dental prostheses. A randomized, prospective clinical trial comparing two different material systems. Int J Prosthodont. 2010;23(6):555-61.
7. Cheng CW, Chien CH, Chen CJ, Papaspyridakos P. Clinical Results and Technical Complications of Posterior Implant-Supported Modified Monolithic Zirconia Single Crowns and Short-Span Fixed Dental Prostheses: A 2-Year Pilot Study. J Prosthodont. 2018;27(2):108-14
8. Bomicke W, Rammelsberg P, Stober T, Schmitter M. Short-Term Prospective Clinical Evaluation of Monolithic and Partially Veneered Zirconia Single Crowns. J Esthet Restor Dent. 2017;29(1):22-30.
9. Papaspyridakos P, Lal K. Computer-assisted design/computer-assisted manufacturing zirconia implant fixed complete prostheses: clinical results and technical complications up to 4 years of function. Clin Oral Implants Res. 2013;24(6):659-65.
10. Moscovitch M. Consecutive case series of monolithic and minimally veneered zirconia restorations on teeth and implants: up to 68 months. Int J Periodontics Restorative Dent. 2015;35(3):315-23.
11. Rojas Vizcaya F. Retrospective 2- to 7-Year Follow-Up Study of 20 Double Full-Arch Implant-Supported Monolithic Zirconia Fixed Prostheses: Measurements and Recommendations for Optimal Design. J Prosthodont. 2018;27(6):501-8
12. Abdulmajeed AA, Lim KG, Narhi TO, Cooper LF. Complete-arch implant-supported monolithic zirconia fixed dental prostheses: A systematic review. J Prosthet Dent. 2016;115(6):672-7.e1
13. Pjetursson BE, Bragger U, Lang NP, Zwahlen M. Comparison of survival and complication rates of tooth-supported fixed dental prostheses (FDPs) and implant-supported FDPs and single crowns (SCs).Clin Oral Implants Res. 2007;18 (Suppl 3):97-113.
14. Nothdurft FP, Pospiech PR. Zirconium dioxide implant abutments for posterior single-tooth replacement: first results. J Periodontol. 2009;80(12):2065-72
15. Spies BC, Kohal RJ, Balmer M, Vach K, Jung RE. Evaluation of zirconia-based posterior single crowns supported by zirconia implants: preliminary results of a prospective multicenter study. Clin Oral Implants Res. 2017;28(5):613-9
16. Spies BC, Witkowski S, Butz F, Vach K, Kohal RJ. Bi-layered zirconia/fluor-apatite bridges supported by ceramic dental implants: a prospective case series after thirty months of observation. Clin Oral Implants Res. 2016;27(10):1265-73
17. Schley JS, Heussen N, Reich S, Fischer J, Haselhuhn K, Wolfart S. Survival probability of zirconia-based fixed dental prostheses up to 5 yr: a systematic review of the literature. Eur J Oral Sci. 2010;118(5):443-50.
18. Sax C, Hammerle CH, Sailer I. 10-year clinical outcomes of fixed dental prostheses with zirconia frameworks. Int J Comput dent. 2011;14(3):183-202.
19. Cheng CW, Chien CH, Chen CJ, Papaspyridakos P. Complete-mouth implant rehabilitation with modified monolithic zirconia implant-supported fixed dental prostheses and an immediate-loading protocol: a clinical report. J Prosthet Dent. 2013;109(6):347-52.
20. Altarawneh S, Limmer B, Reside GJ, Cooper L. Dual jaw treatment of edentulism using implant-supported monolithic zirconia fixed prostheses. J Esthet Restor Dent. 2015;27(2):63-70
21. Limmer B, Sanders AE, Reside G, Cooper LF. Complications and patient-centered outcomes with an implant-supported monolithic zirconia fixed dental prosthesis: 1 year results. J Prosthodont. 2014;23(4):267-75.
22. Venezia P, Torsello F, Cavalcanti R, D'Amato S. Retrospective analysis of 26 complete-arch implant-supported monolithic zirconia prostheses with feldspathic porcelain veneering limited to the facial surface. J Prosthet Dent. 2015;114(4):506-12.
23. Spitznagel FA, Horvath SD, Gierthmuehlen PC. Prosthetic protocols in implant-based oral rehabilitations: A systematic review on the clinical outcome of monolithic all-ceramic single- and multi-unit prostheses. Eur J Oral Implantol. 2017;10 Suppl 1:89-99.
24. Tawil G, Aboujaoude N, Younan R. Influence of prosthetic parameters on the survival and complication rates of short implants. Int J Oral Maxillofac Implants. 2006;21(2):275-82.
25. Lo J, Abduo J, Palamara J. Effect of different lateral occlusion schemes on peri-implant strain: A laboratory study. J Adv Prosthodont. 2017;9(1):45-51.
26. Sripetchdanond J, Leevailoj C. Wear of human enamel opposing monolithic zirconia, glass ceramic, and composite resin: an in vitro study. J Prosthet Dent. 2014;112(5):1141-50
27. Stober T, Bermejo JL, Schwindling FS, Schmitter M. Clinical assessment of enamel wear caused by monolithic zirconia crowns. J Oral Rehabil. 2016;43(8):621-9.
28. Brignardello-Petersen R. There seem to be no differences in enamel wear among natural teeth opposing monolithic zirconia crowns, porcelain fused-to-metal crowns, and other natural teeth. J Am Dent Assoc. 2018;149(2):e45.
29. Esquivel-Upshaw JF, Rose WF Jr, Barrett AA, Oliveira ER, Yang MC, Clark AE, Anusavice KJ. Three years in vivo wear: core-ceramic, veneers, and enamel antagonists. Dent Mater. 2012;28(6):615-21.
30. Mundhe K, Jain V, Pruthi G, Shah N. Clinical study to evaluate the wear of natural enamel antagonist to zirconia and metal ceramic crowns. J Prosthet Dent. 2015;114(3):358-63.
How to Cite
ALTARAWNEH, Sandra et al. A multi-center retrospective assessment of monolithic zirconia restorations on posterior teeth and implants.. Journal of Oral Research, [S.l.], v. 8, n. 4, p. 298-304, oct. 2019. ISSN 0719-2479. Available at: <http://www.joralres.com/index.php/JOR/article/view/joralres.2019.044>. Date accessed: 13 aug. 2020. doi: https://doi.org/10.17126/joralres.2019.044.