German S3 guideline on implant-supported all-ceramic restorations

With increasing demand for aesthetic, metal-free restorations, all-ceramic materials have gained popularity in implant prosthodontics. However, questions regarding their long-term performance, material selection, and design features remain unresolved. This guideline, developed by the German Association of Oral Implantology (DGI) in collaboration with the German Society of Dentistry and Oral Medicine (DGZMK), aims to enhance treatment safety, guide clinical decision-making, and improve patient education concerning all-ceramic implant-supported restorations.

A systematic literature review was conducted to evaluate the clinical performance of all-ceramic restorations in three main indications: implant-supported single crowns, short-span fixed dental prostheses, and full-arch restorations. Recommendations were developed based on the quality of evidence or expert consensus.

For single crowns, lithium disilicate, silicate ceramics, and all generations of zirconia demonstrated favorable 3-year survival rates (~ 96-97%). In contrast, polymer-infiltrated ceramics showed inferior performance and were not recommended. For short-span FDPs and full-arch reconstructions, only 3Y-TZP zirconia is supported by clinical evidence. Micro-veneering and monolithic designs reduce chipping risks. Patient education is emphasized due to limited evidence for newer materials and full-arch restorations.

All-ceramic implant restorations can be successfully implemented with careful material selection, adherence to bonding protocols, and appropriate prosthetic design. However, clinical limitations persist, especially in full-arch indications. Interdisciplinary collaboration is essential to optimize outcomes and minimize complications.