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Practice-Based Study on CAD/CAM Inlays, Onlays, and Crowns: Longevity and Risks.

R J Wierichs1,2, E J Kramer3,4, B Reiss5

  • 1Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland.

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|May 16, 2025
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Summary
This summary is machine-generated.

This study analyzed factors affecting the success of all-ceramic restorations. Endodontic treatment and specific instruments increased failure rates, while zirconia use improved longevity for CAD/CAM restorations.

Keywords:
ceramicsdental restorationdental restoration failurepermanentprospective studiesrisk factorssurvival

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Area of Science:

  • Dental Materials Science
  • Clinical Dentistry
  • Biomaterials Engineering

Background:

  • All-ceramic restorations are widely used for dental rehabilitation.
  • Understanding factors influencing their long-term success is crucial for clinical practice.
  • Previous studies have focused on specific materials or failure modes, necessitating a comprehensive analysis.

Purpose of the Study:

  • To identify predictors of failure and success for all-ceramic inlays, onlays, and crowns.
  • To analyze tooth-, technique-, and material-level factors associated with restoration longevity.
  • To evaluate the long-term performance of computer-aided design/computer-aided manufacturing (CAD/CAM) all-ceramic restorations.

Main Methods:

  • Prospective, multicenter, practice-based cohort study including 17,725 restorations from 12,468 patients.
  • Data collected from 1994 to 2023 by 303 dentists.
  • Multilevel Cox proportional hazards models used to analyze time to failure or success, with follow-up up to 25 years.

Main Results:

  • The annual failure rate after 5 years was 2.7%, with main failure types being ceramic fracture, endodontic complications, and tooth fracture.
  • Endodontic treatment (HR 1.6), positive papilla bleeding index (HR 1.2), and EVA instrument use (HR 1.8) significantly increased failure rates.
  • Zirconia (ZrO2) use significantly increased time until failure (HR 0.6).

Conclusions:

  • High success rates for CAD/CAM all-ceramic restorations were observed up to 25 years.
  • Tooth, technique, and material factors significantly influenced failure rates after 8 years.
  • Endodontic health and material choice are critical for long-term all-ceramic restoration survival.