J Adv Prosthodont.  2016 Jun;8(3):194-200. 10.4047/jap.2016.8.3.194.

Early complications and performance of 327 heat-pressed lithium disilicate crowns up to five years

• Huettig F
• Gehrke UP

• KMID: 2376843
• DOI: http://doi.org/10.4047/jap.2016.8.3.194

Abstract

PURPOSE
The prospective follow-up aimed to assess the performance of lithium disilicate crowns and clinical reasons of adverse events compromising survival and quality.
MATERIALS AND METHODS
58 patients were treated with 375 heat-pressed monolithic crowns, which were bonded with resin cement. Annual recalls up to five years included a complete dental examination as well as quality assessment using CDA-criteria. Any need for clinical intervention led to higher complication rate and any failure compromised the survival rate. Kaplan-Meier-method was applied to all crowns and a dataset containing one randomly selected crown from each patient.
RESULTS
Due to drop-outs, 45 patients (31 females, 14 males) with the average age of 43 years (range = 17-73) who had 327 crowns (176 anterior, 151 posterior; 203 upper jaw, 124 lower jaw) were observed and evaluated for between 4 and 51 months (median = 28). Observation revealed 4 chippings, 3 losses of retention, 3 fractures, 3 secondary caries, 1 endodontic problem, and 1 tooth fracture. Four crowns had to be removed. Survival and complication rate was estimated 98.2% and 5.4% at 24 months, and 96.8% and 7.1% at 48 months. The complication rate was significantly higher for root canal treated teeth (12%, P<.01) at 24 months. At the last observation, over 90% of all crowns showed excellent ratings (CDA-rating Alfa) for color, marginal fit, and caries.
CONCLUSION
Heat pressed lithium disilicate crowns showed an excellent performance. Besides a careful luting, dentists should be aware of patients' biological prerequisites (grade of caries, oral hygiene) to reach full success with these crowns.

Keyword

Dental bonding; Dental restoration failure; Dental marginal adaptation; Dental porcelain; Follow-up studies; Survival analysis

MeSH Terms

Crowns*
Dataset
Dental Bonding
Dental Marginal Adaptation
Dental Porcelain
Dental Pulp Cavity
Dental Restoration Failure
Dentists
Female
Follow-Up Studies
Hot Temperature
Humans
Jaw
Lithium*
Prospective Studies
Resin Cements
Survival Analysis
Survival Rate
Tooth
Tooth Fractures
Dental Porcelain
Lithium
Resin Cements

Figure

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  Fig. 1 Modified CONSORT flow chart of treatment, exclusion and mode of statistical evaluation.

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  Fig. 2 Distribution of crowns towards jaw and region. The mosaic plot shows the distribution of crowns to the upper and lower jaw as well as to the anterior and posterior region. Crowns that experienced adverse events are shaded and their share is noted in brackets (%). 62% of all crowns are in the upper jaw and 53% of all crowns are in the anterior region.

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  Fig. 3 Estimations of an average survival rate. The Kaplan-Meier survivor shows two curves with 95% confidence intervals. A censoring event was an observation classified as "failure" (SAE or removal). The red line estimates the survival of all crowns in the observed cohort, and the blue line estimates it from a set of 45 randomly drawn (one out of each patient) crowns. The remaining "crowns at risk" are noted on top axis. The estimation at 24 months was favored as cut-off to average both estimations, because after 28 months less than half of the cohort was still at risk.

• 

  Fig. 4 Estimations of average complication rate. Estimations of average complication rate: the failing function shows two curves with 95% confidence intervals. A censoring event was the observation of "any need for intervention". The red line estimates the complication rate of all crowns within the cohort, and the blue line estimates from a set of 45 randomly drawn (one out of each patient) crowns. The remaining "crowns at risk"are noted on the top axis.

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  Fig. 5 Estimations for the complication rate with respect to anterior and posterior. Estimations for the complication rate with respect to anterior and posterior: the failing function shows two curves with 95% confidence intervals. A censoring event was the observation of "any need for intervention". The red line estimates the complication rate of all crowns within the cohort inserted to anterior, and the blue line estimates all crowns inserted to posterior. The remaining "crowns at risk" are noted on the top axis. At 24 months, the log rank test shows no statistical significant difference between both estimations.

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  Fig. 6 Estimations for the complication rate of all crowns with respect to root canal filled and vital teeth. The failing function shows two curves with 95% confidence intervals (CI). A censoring event was observation of "any need for intervention". The red line estimates the complication rate of all crowns on vital teeth, and the blue line estimates all crowns on root canal treated (RCT) teeth. The remaining "crowns at risk" are noted on the top axis.

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