Clinical behavior and survival of CAD-CAM resin nanoceramic and polymer interpenetrating ceramic network material restorations on endodontically treated teeth: A systematic review and meta-analysis.

Abstract

Statement of problem: Attempting to combine the mechanical and optical properties of ceramics and composite resins to mimic natural teeth has led to the emergence of resin nanoceramics and polymer interpenetrating ceramic network materials. Systematic reviews on the survival of these materials in endodontically treated teeth are lacking.

Purpose: This systematic review and meta-analysis assesses the survival of computer-aided design and computer-aided manufacturing (CAD-CAM) resin nanoceramics and polymer interpenetrating ceramic network material restorations on endodontically treated teeth and to describe the incidence of complications.

Material and methods: The study was registered in the international prospective register of systematic reviews (PROSPERO) database and adhered to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A comprehensive search across 6 online databases was performed. Clinical studies which involved CAD-CAM manufactured resin nanoceramics and polymer interpenetrating ceramic network material restorations on endodontically treated teeth were included. Several investigators independently conducted the study selection, data extraction, and quality assessment processes. Risk of bias was assessed by using the Cochrane Risk of Bias 2 tool and Newcastle-Ottawa Scale. Failure rates were analyzed using Poisson regression models to obtain summary estimates of 3- and 5-year survival proportions, which were pooled using a random-effects model. Subgroup analysis was performed for material type and restoration design (α=.05).

Results: The search resulted in 250 studies after duplicate removal, and 11 articles were included in the final analysis. The meta-analysis of 289 restorations revealed an overall estimated failure rate of 3.44 (95% confidence interval [95% CI]: 2.67-4.21) per 100 restoration years, equivalent to a survival rate of 90.2% (95% CI: 88.1-92.3%) after 3 years and 84.2% (95% CI: 81.0-87.5%) after 5 years. A significantly lower (P<.001) failure rate was reported for polymer interpenetrating ceramic network material restorations (1.61, CI: 0.87-2.36) compared with resin nanoceramic restorations (5.97, CI: 3.52-8.41). Partial-coverage restorations (3.45, 95% CI: 1.98-4.92) had a significantly lower (P<.001) failure rate compared with 1-piece endodontic crowns (5.19, 95% CI: 2.75-7.64). Restoration debonding was the main reason for failure.

Conclusions: Endodontically treated teeth restored with CAD-CAM manufactured resin nanoceramic and polymer interpenetrating ceramic network material restorations have an acceptable survival rate and can be recommended as an alternative to conventional indirect restorative materials. Polymer interpenetrating ceramic network material restorations have a higher survival rate than resin nanoceramic restorations.