CAD/CAM or conventional ceramic materials restorations longevity: a systematic review and meta-analysis

Purpose: This systematic review and meta-analysis aimed to evaluate the difference in longevity of tooth-supported ceramic prostheses designed by conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) techniques. Study selection: Two reviewers searched the Web of Science, PubMed, SCOPUS and LILACS databases between 1966 and October 2017. Clinical studies that compared the survival rate of CAD/CAM against conventional restorations were included. Results: Eleven randomized controlled trials and three prospective studies were included, n = 14. Three types of tooth-supported restorations were searched in the included studies: single crown, multiple-unit and partial ceramic crown. The follow-up of patients in the studies ranged from 24 to 84 months. A total of 1209 restorations had been placed in 957 patients in the included trials, and failures were analyzed by type and material restoration. From a total of 72 restoration failures, the CAD/CAM system resulted in a 1.84 (IC95%: 1.28-2.63) higher risk than conventional manufacturing of ceramic restoration. Nevertheless, when drop-outs were included as a failure risk, the CAD/CAM system resulted in a risk of 1.32 (IC95%: 1.10-1.58). Multilevel analysis of tooth-supported ceramic restorations, considering drop-outs as successes, resulted in rates of 1.48 and 2.62 failures per 100 restoration-years for the controls and CAD/CAM groups, respectively. Considering drop-outs as failures, we found rates of 4.23 and 5.88 failures per 100 restoration-years for the controls and CAD/CAM groups, respectively. Conclusions: The meta-analysis results suggest that the longevity of a tooth-supported ceramic prostheses made by CAD/CAM manufacturing is lower than that of crowns mad by the conventional technique. (C) 2018 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.