Survival and Complication Rates of Zirconia-Ceramic and Metal-Ceramic Multiple-Unit FDPs

Amsterdam 2018


The aim of this systematic review was evaluation of available scientific evidence on the survival and complication rates of veneered zirconia ceramic FDPs when compared to metal ceramic implant supported FDPs. The primary outcome evaluated was comparison of the survival rates of the veneered zirconia and metal ceramic FDPs. Secondary outcomes reviewed were biological complication rates, technical complication rates and aesthetic failure rates.

Consensus Statements

  • Zirconia ceramic (veneered) implant supported FDPs exhibit significantly lower 5-year survival rates than metal ceramic implant supported FDPs. This statement is based on 14 studies reporting on 932 implant-supported metal ceramic FDPs (9 Prospective, 5 Retrospective) and three studies (2 Prospective and 1 Retrospective) reporting on 175 veneered zirconia implant-supported FDPs.
  • There is a lack of detailed information in the current literature to provide a statement on the biological and technical outcomes of the zirconia ceramic and metal ceramic implant supported FDPs. This statement is based on the systematic review scrutinizing the available literature on implant supported multiple unit FDPs.
  • Significantly more zirconia ceramic implant supported FDPs fail due to material fracture than metal ceramic implant supported FDPs. This statement is based on 18 clinical trials (11 Prospective and 7 Retrospective).
  • Chipping of the veneering ceramic is a common technical complication for both types of FDPs and may lead to a need for repair or replacement of the FDP. This statement is based on 14 clinical trials (8 Prospective and 6 Retrospective).

Clinical Recommendations

  • Zirconia ceramic (i.e., veneered) implant supported FDPs cannot be recommended as a first treatment option. If utilized, the patients need to be informed about the risks for fractures of the framework and chipping of the veneering ceramic.
  • Metal ceramic, using high noble (noble metal content > or =60% and gold > or =40%) or noble (noble metal content > or =25%) alloys, should still be considered as the first option for implant supported FDPs.
  • Due to the high costs of conventional metal ceramic FDPs and frequent technical problems associated with the veneered FDPs, monolithic zirconia may be an interesting alternative. However, clinical medium- to long-term outcomes have yet to be sufficiently analysed.


Publication date: Nov 16, 2018 Last review date: Nov 9, 2018 Next review date: Nov 9, 2021
  • 6th ITI Consensus Conference
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