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Clinical Outcomes of Pressed Lithium Disilicate Glass–Ceramic Complete- and Partial-Coverage Restorations in Patients With Severe Wear
TAKE-HOME MESSAGE
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Pressed lithium disilicate has been used for fabricating esthetic restorations for several decades; however, the evidence regarding their use for tooth wear is lacking. This study evaluated the long-term survival of adhesively luted lithium disilicate glass-ceramic complete- and partial-coverage restorations in 53 patients aged 25 to 85 years with severe dental wear and assessed the impact of various clinical parameters on their longevity. Of the 662 lithium disilicate restorations, 551 were complete-coverage and 111 were posterior partial-coverage restorations and were monitored for more than 14 years. The restorations demonstrated an overall high survival rate of 98.6%. However, this study was a prospective analysis of one practice with only one type of pressed ceramic; this may not reflect the current practice of general clinicians, as they are now prescribing milled CAD/CAM restorations.
- Pressed lithium disilicate appears to be successful in the long-term restoration of tooth wear; however, clinicians should carefully select materials based on individual patients and recent clinical research evidence.
abstract
This abstract is available on the publisher's site.
Access this abstract nowSTATEMENT OF PROBLEM
Long-term clinical data are lacking on the comparative survival of adhesively luted lithium disilicate glass-ceramic complete and partial coverage restorations in patients with severe wear and the effect that different clinical variables have on their survival.
PURPOSE
The purpose of this study was to examine the 14-year survival of pressed e.max lithium disilicate glass-ceramic complete and partial coverage restorations in patients with severe wear and to evaluate associated clinical parameters.
MATERIAL AND METHODS
Patients demonstrating severe wear and requiring single unit defect-specific partial or complete coverage restorations were recruited in a clinical private practice and received lithium disilicate restorations. The effect of various clinical parameters was evaluated using Kaplan-Meier survival curves to account for attrition bias and other causes of failure. The statistical significance of differences between parameters was determined by using the log rank test (α=.05).
RESULTS
A total of 53 participants (24 men and 29 women) requiring 662 lithium disilicate restorations were evaluated. The mean age of the participants at the time of restoration placement was 60 (range 25 to 85 years). Of 662 units, 551 were anterior and posterior complete and 111 were posterior partial coverage restorations. Six failures (bulk fracture or large chip) requiring replacement occurred with the average time to failure of 4.5 (range 2 to 8) years, yielding a crude estimate of annual failure of 0.1% (cumulative monitoring period of 4650 years, overall survival rate of 98.6%). Of the 551 complete coverage restorations, 4 failed (0 anterior, 4 posterior), yielding a crude estimate of 0.1% annual failure with the survival function time at 14 years. Of the 111 partial coverage restorations, 2 failed, yielding a crude estimate of 0.4% annual failure with the survival function time at 12 years. The only statistically significant difference was seen between anterior crowns and posterior onlays, with no failures in anterior crowns (P<.001). Other clinical variables had no significant effect on survival (P>.05).
CONCLUSIONS
Pressed e.max lithium disilicate partial and complete coverage restorations both showed high survival rates in patients with severe wear over 14 years with an overall yearly failure rate of 0.1%. Risk of failure at any age was minimal for both men and women. All anterior crowns survived. The highest annual failure rate (0.4%) was for posterior onlay partial coverage restorations.
Additional Info
Disclosure statements are available on the authors' profiles:
Over 14-year survival of pressed e.max lithium disilicate glass-ceramic complete and partial coverage restorations in patients with severe wear: A prospective clinical study
J Prosthet Dent 2024 Jul 30;[EPub Ahead of Print], M Margvelashvili-Malament, V Thompson, V Polyakov, KA MalamentFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This clinical study assessed the comparative long-term survival of adhesively bonded e.max lithium disilicate complete- (crowns) and partial-coverage (inlays and onlays) restorations in patients with severe wear. This study included 662 restorations placed in 53 patients with severe wear who were followed up for 14.1 years. A total of six failures (bulk fracture or large chip) requiring replacement occurred within an average time to failure of 4.5 (range, 2–8) years. The overall survival rate was 98.6%. Of the 551 complete-coverage restorations, four failed (n = 0 anterior and n = 4 posterior), and, of the 111 partial-coverage restorations, two failed. The only statistically significant difference was observed between anterior crowns and posterior onlays, with no failures in anterior crowns (P < .001). Other clinical variables, such as the tooth position, arch, age and sex of the patients, and type of restoration, had no significant effect on the survival rate (P > .05).
The limitations of the study were that the data were collected in a private practice setting and that some participants dropped out. The Kaplan–Meier survival function was used to create censored data and account for these factors.
Relevant facts to aid in the interpretation of these findings are as follows:
From my perspective
Choosing a material for patients with severe wear has always been debatable. Metal ceramic restorations are more aggressive in their preparation and no longer meet modern esthetic demands. Gold has excellent survival rates with no risk of chipping; however, the number of patients wanting gold restorations is declining. Clinicians are left with the choice of e.max lithium disilicate or zirconia.
The survival rates of zirconia restorations have been reported to be 90.0% at 4.8 years.1 The current study recorded a 98.6% survival rate at 14.1 years for e.max lithium disilicate restorations. This suggests that adhesively bonded pressed e.max lithium disilicate complete- and partial-coverage restorations represent a treatment of choice, with excellent longevity even in patients with severe wear. Taking into consideration the sample size and the follow-up time, the study was designed to provide evidence-based outcomes that could guide clinicians in choosing the ceramic material and the type of restoration for patients with severe wear.
Reference