Five-year follow-up of implant-supported all-ceramic FDPs. A randomized clinical trial.

Objectives: The purpose of this study was to evaluate the clinical performance of two- to five-unit implant-supported all-ceramic restorations and to compare the results of two different all-ceramic systems, Denzir® (DZ) and In-Ceram Zirconia® (InZ). Methods: Eighteen patients were treated with a total of 25 two- to five-unit implant-supported fixed dental prostheses. Nine patients were given restorations of the DZ system and the other nine were given restorations of the InZ system. The restorations were cemented with zinc phosphate cement onto customized titanium abutments and were evaluated after one, three and five years. Results: At the five-year follow-up, all restorations were in function; none had fractured. Superficial cohesive (chip-off) fractures were, however, observed in 9 of the 18 patients (11 of 25 restorations). Sixteen units in the DZ group (9 of 13 restorations) and 3 in the InZ group (2 of 12 restorations) had chip-off fractures. The difference between the two groups regarding frequency of chip-off fractures was statistically significant (P<0.05 at FDP level and P<0.001 at unit level). Conclusion: The results suggest that all-ceramic implant-supported fixed dental prostheses of two- to five-units may be considered a treatment alternative. The DZ system as used in this study, however, exhibits an unacceptable amount of veneering porcelain fractures and thus cannot be recommended for the type of treatment evaluated in this trial. Poor compatibility or problems with the bond mechanisms between veneer and framework could not explain the chip-off fractures. Factors concerning veneering porcelain need to be further evaluated.