Metal-free materials for fixed prosthodontic restorations.

Area of Science:

• Dental materials science
• Prosthodontics
• Clinical trial methodology

Background:

• Fixed prosthodontic treatments utilize various materials to replace missing teeth.
• Traditional metal-ceramic (MC) restorations are common, but metal-free alternatives offer potential aesthetic advantages.
• Comparative clinical performance data for different fixed prosthodontic materials remain unclear.

Purpose of the Study:

• To evaluate the clinical effectiveness of metal-free prosthodontic restorations compared to metal-ceramic or conventional all-metal materials.
• To assess the comparative outcomes of different metal-free dental restorative systems.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Searched multiple databases including Cochrane Library, MEDLINE, and Embase up to May 2017.
• Included RCTs comparing metal-free restorations with MC or all-metal restorations, or comparing different metal-free systems.

Main Results:

• Nine RCTs with 448 participants were included, with most trials assessed as having a high risk of bias.
• All evidence was rated as very low quality due to bias and imprecision, leading to high uncertainty in results.
• Specific comparisons showed insufficient evidence of difference in failure rates or complications for various metal-free crowns and fixed dental prostheses (FDPs) versus conventional materials.

Conclusions:

• Insufficient evidence exists to support or refute the effectiveness of metal-free materials over conventional restorations.
• The very low quality of current evidence necessitates caution when interpreting results.
• Further well-designed RCTs are urgently needed to guide clinical decisions on material selection for fixed prosthodontic treatments.