Clinical Performance of NobelProcera/Procera Zirconia Implant Bridges: A Systematic Review

Objectives: To evaluate the clinical performance of zirconia screw-retained NobelProcera/Procera implant bridges (ZrPIBs).
Methods: A literature search was conducted to identify clinical articles on ZrPIBs published between June 2004 and August 2015 in peer-reviewed journals indexed by PubMed. The following inclusion criteria were applied: (1) prospective or retrospective clinical studies or case series (2) reporting specifically on ZrPIB survival and (3) written in English. Single case reports and papers describing surgical methods were excluded.
Results: The initial search yielded 1406 publications. Four publications met the inclusion criteria. The included studies reported on 65 ZrPIBs placed in fully edentulous mandibles and maxillae of more than 50 patients. The ZrPIBs were directly connected to implants and the majority had a length of 12-14 units (n=44). All implants included in the studies were Nobel Biocare and had an internal-trilobe, an internal-conical, or an external type of implant/abutment-ZrPIB connection.
Of the 65 included ZrPIBs, none failed, rendering a ZrPIB survival rate of 100% after a mean follow-up period of 3.5 years (range 2.5-4.1 years). Nine minor technical complications (veneer chipping) were reported. All veneer chippings could be repaired either intra-orally or in-lab. According to one author, patient satisfaction was not affected by these complications. This statement is supported by the high patient satisfaction reported in the two studies that assessed the function and the esthetics on a visual analog scale (VAS) and showed a mean VAS of 95.5-99.2 and of 98.1, respectively.
Conclusions: Low complication rates and high patient satisfaction identified in this systematic review indicate that ZrPIBs are a safe and reliable treatment option of fully edentulous patients. However, longer follow-up studies on ZrPIBs, and studies on partial ZrPIBs, are still needed to assess long-term performance of these implant-retained restorations.