Abstract
The purpose of this study was to systematically review the existing literature to assess the clinical survival and success of PICN and ZLS indirect restorations as the clinical evidence for them remains lacking. PubMed, SCOPUS, Embase, Cochrane Library, Web of Science, LILACs, and SciElo databases were searched from 1 January 2000 to 1 February 2021. Clinical trials and cohort studies published in English were included while case studies, case series, and in vitro studies were excluded. Results were analyzed qualitatively and a meta-analysis using a random effects model was performed. A strength of recommendation taxonomy (SORT) analysis was conducted and risk of bias (RoB) was assessed using the Newcastle–Ottawa scale and Cochrane RoB tools. An electronic search through the databases yielded 2454 articles, of which 825 remained after duplicate removal. Five studies investigating PICN and four investigating ZLS indirect restorations remained after assessing for eligibility. The overall survival rate of PICN over 1 year was 99.6% and 99.2% over 2 years. The overall survival rate of ZLS over 1 year was 99%. The main mode of failure for both materials was catastrophic fracture. One study had a high RoB, four had a moderate RoB, and four had a low RoB. Both materials demonstrated moderate strength of recommendation at a level 2 evidence for all studies based on SORT analysis. PICN and ZLS show promising short-term clinical performance as full and partial coverage indirect restorations, but longer follow-up studies are required to confirm their long-term performance.
Highlights
The exponential development of computer-aided design/computer-aided manufacturing (CAD/CAM) in dentistry has led to an increased conversion to a digital workflow and an uptake in the use of CAD/CAM materials [1]
Scanning electron microscope (SEM) imaging of zirconia-reinforced lithium silicate (ZLS) demonstrates a microstructure containing crystals that are much smaller than lithium disilicate (L.D.), which the manufacturer claims to ensure good milling and polishing characteristics of the material compared to L.D. [5,7]
Based on the current systematic review, Polymer-infiltrated ceramic networks (PICN) and ZLS demonstrated excellent clinical performance in the short term with a moderate strength of recommendation. These findings need to be interpreted with caution as longer follow-up studies are required to support the long-term performance of PICN and ZLS indirect restorations
Summary
The exponential development of computer-aided design/computer-aided manufacturing (CAD/CAM) in dentistry has led to an increased conversion to a digital workflow and an uptake in the use of CAD/CAM materials [1]. Polymer-infiltrated ceramic networks (PICN) and zirconia-reinforced lithium silicate (ZLS) are two CAD/CAM materials that have been recently introduced into the dental market [2]. PICN is a hybrid material comprised of a major ceramic phase infiltrated with a minor resin phase, formulating an interconnected ceramic and resin network that possesses properties of both ceramic and resin materials [3]. Scanning electron microscope (SEM) imaging and energy dispersive X-ray spectroscopy (EDS) analysis of PICN specimens revealed that the ceramic phase consists of leucite and a minor phase of zirconia [3]. SEM imaging of ZLS demonstrates a microstructure containing crystals that are much smaller than lithium disilicate (L.D.), which the manufacturer claims to ensure good milling and polishing characteristics of the material compared to L.D. PICN is indicated for posterior, aesthetic, and implant-supported crowns and veneers [8], while ZLS is indicated for anterior and posterior crowns, veneers, inlays, and onlays [5]
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