A Systematic Review and Meta-Analysis Evaluating the Survival, the Failure and the Complication Rates of Metal-Ceramic, Veneered and Monolithic All-Ceramic Tooth-Supported Multiple- Unit Fixed Dental Prostheses (Fdps)

OBJECTIVE: To evaluate the 5-year survival of metal-ceramic and all-ceramic tooth-supported fixed dental prostheses (FDPs) and assess biological and technical complication rates. METHODS: Randomized clinical trials and prospective studies on tooth-supported FDPs with a mean follow-up of ≥3 years were included. A systematic search of Medline (PubMed), Embase, and Cochrane CENTRAL (January 2014-December 2024) identified relevant studies. Seventeen additional studies from prior systematic reviews were included to cover earlier periods. Survival and complication rates were estimated using robust Poisson regression models to generate pooled 5-year survival estimates. RESULTS: Forty-one studies, including 600 metal-ceramic and 1532 all-ceramic FDPs, met inclusion criteria. The 5-year survival rates were 92.9% for veneered densely sintered zirconia, 91.3% for metal-ceramic, 88.4% for glass-infiltrated alumina, 87.9% for monolithic densely sintered zirconia, and 82.5% for lithium-disilicate reinforced glass-ceramic FDPs. Lithium-disilicate FDPs showed ignificantly lower survival than metal-ceramic restorations; other differences were not significant. 71.0% of restorations remained complication-free after five years. All-ceramic FDPs had higher rates of marginal caries and loss of retention than metal-ceramic FDPs. Framework fractures occurred more frequently in lithium-disilicate and glass-infiltrated alumina FDPs (>10% over five years). Ceramic surface chipping was common but least frequent in monolithic zirconia FDPs. CONCLUSIONS: Veneered and monolithic densely sintered zirconia and metal-ceramic FDPs demonstrate comparable 5-year survival. High fracture rates make weaker ceramics unsuitable for multi-unit restorations. Monolithic zirconia offers improved resistance to chipping and framework fractures.