RESEARCH ARTICLE

Short-Term Prospective Clinical Evaluation of Monolithic

and Partially Veneered Zirconia Single Crowns
€
WOLFGANG BOMICKE, MSC*, PETER RAMMELSBERG†, THOMAS STOBER‡, MARC SCHMITTER§

ABSTRACT
Objectives: The purpose of this study was to prospectively evaluate the short-term clinical performance and esthetics of
monolithic and partially (i.e., facially) veneered zirconia single crowns (MZC and PZC, respectively).
Methods: Between September 2011and June 2013, 68 participants received 90 MZCs and 72 PZCs.Clinical study
documentation was performed at crown cementation (baseline), atthe 6 -month follow-up, and then yearly
thereafter using standardized report forms.Eight participants with14 single crowns (eight MZCs and six PZCs)
dropped out during clinical follow-up.Thus, 60 participants (28 male, mean age 62.5 6 13.1years) f|tted with 82 MZCs
and 66 PZCs were analyzed in February 2016 (Kaplan^Meier survival; mean observation time for the restorations
35.1 6 6.3 months).Descriptive statistics were calculated for participants’and dentists’esthetic ratings on a numerical
rating scale from 0 to10 (0 5 unacceptable color and shape; 10 5 excellent color and shape).
Results: Complications were predominantly biologicalin nature.One PZCwas affected by minor chipping.Cumulative
3-year failure-free survival was 98.5% (standard error (SE),1.5%) for both MZCs and PZCs.Three-year cumulative
complication-free survival (success) was 93.6% (SE 2.8%) for MZCs and 95.5% (SE 2.6%) for PZCs.Three-year
cumulative fracture-free survival was100% for MZCs and 98.5% (SE1.5%) for PZCs.Crowns of both types were
awarded high esthetic scores by participants and dentists.
Conclusions: Monolithic and partially veneered zirconia crowns can be used clinically with excellent short-term survival
and success and without compromising esthetic appearance.Longer-term follow-up is, however, desirable.

CLINICAL SIGNIFICANCE
During the observation time, both monolithic and partially veneered zirconia crowns showed an outstanding
low technical complication rate: only one minor chipping and three losses of retention were observed.
Additionally, esthetics was excellent.Based on these results the clinical use of this kind of restoration is promising.
(J Esthet Restor Dent 29:22^30, 2017)

INTRODUCTION Unfortunately, technical complications with regard to

chipping of the veneer occurred more often for this
In the last decade, zirconia-based restorations have kind of restoration than for metal-based fixed dental
become increasingly common in dentistry. Because of prostheses2; with brand-specific differences.3–5 In
the esthetic limitations of first-generation zirconia recent years, every endeavor has been made to
materials, however,1 veneering used to be mandatory overcome this limitation, for example by optimization
to satisfy patients’ demand for esthetic restorations. of the design of the substructure,6 modification of

*Dr. med. Dent, Department of Prosthodontics, Heidelberg University Hospital, University of Heidelberg, Heidelberg, Germany
!
Prof. Dr. med. Dent, Department of Prosthodontics, Heidelberg University Hospital, University of Heidelberg, Heidelberg, Germany
`
Prof. Dr. med. Dent, Department of Prosthodontics, Heidelberg University Hospital, University of Heidelberg, Heidelberg, Germany
‰
Prof. Dr. med. Dent, Department of Prosthodontics,W€
urzburg University Hospital, University of W€
urzburg,W€
urzburg, Germany

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firing procedures,7 and use of computer-aided design/ Treatment of the participants with monolithic (full-
computer-aided manufacturing (CAD/CAM)-produced contour, anatomically accurate) zirconia single crowns
veneer, which is attached to the zirconia framework by (MZC group, Figure 1) and/or partially veneered
use of a variety of techniques.8 Although these efforts zirconia single crowns (PZC group, Figure 2) was
have somewhat reduced the incidence of failure of performed by fully trained dentists between September
veneered zirconia restorations, unsolved problems, for 2011 and June 2013. The treatment decision whether
example, the sophisticated production process (e.g., use to use PZCs or MZCs was up to the treating dentist
of CAD/CAM-produced veneer), greater incidence of considering restoration esthetics, that is, in the maxilla,
fractures of the veneer in the posterior molar region,9 use of PZCs was preferable from second right to
and lack of standardization of manually produced second left premolar, and in the mandible from first
veneer,10 have impeded widespread application of these right to first left premolar. After complete removal of
techniques. In recent years, however, esthetic aspects carious dentine, abutment teeth were built up by use
of zirconia materials have been improved by of core build-up resin if necessary. Conical glass-fiber-
introducing more transparent blanks in numerous reinforced composite or cylindrical, screw-type
shades,11 and even multilayer zirconia blanks.12 Further titanium posts were used when additional retention of
individualization is possible by coloring the material in the core build up was required. Excessively damaged
the pre-sintered state and staining the fully sintered teeth were built up with cast post and cores.
material.11 These developments have led to the Abutment teeth were prepared with minimum occlusal
possibility of avoiding use of veneer and of producing reduction of 0.5 mm, minimum circular reduction of
monolithic zirconia restorations with adequate esthetic either 0.4 mm for monolithic or 1.2 mm for veneered
properties. Veneering of the labial surface might, crown surfaces, and a chamfer finish line. Polyether
nevertheless, further improve the esthetic outcome of impressions were taken from the prepared teeth. The
such restorations. Regrettably, few clinical data are situation was digitized by use of a laboratory scanner
available on the clinical performance of monolithic or (D700/D800; 3Shape A/S, Copenhagen, Denmark) and
partially veneered zirconia restorations.13 The purpose crowns were designed (3Shape DentalDesigner; 3Shape
of this study was to evaluate clinical outcome for A/S) as monolithic restorations or, in case of partially
monolithic and partially veneered zirconia crowns on veneered crowns, anatomically reduced to provide
the basis of crown survival and the incidence of space for a labial veneer. Anatomic reduction was
complications. Esthetics rated by dentists and study limited to areas without occlusal contact, that is,
participants were also assessed. occluding cusps were designed with complete
anatomical accuracy. Crown frameworks were
subsequently milled (Cercon Brain Expert; DeguDent
GmbH, Hanau, Germany) from pre-sintered blanks of
MATERIALS AND METHODS pre-colored (medium/light/white), translucent zirconia
(Cercon ht; DeguDent GmbH) and, after being colored
Participants in this study were recruited consecutively individually by use of acid-based coloring liquids
from patients scheduled for single-crown treatment at (Colour Liquid Prettau; Zirkonzahn GmbH, Gais,
the Department of Prosthodontics of the Heidelberg Italy), sintered at 1,5008C (Cercon Heat Plus;
University Hospital. Patients were enrolled in the study DeguDent GmbH). For partially veneered crowns the
if they presented with vital or sufficiently veneer (Cercon Ceram Kiss; DeguDent GmbH) was
endodontically treated and periodontally stable then built up manually, before all crowns were stained
abutment teeth and had signed an informed consent (Cercon stains; DeguDent GmbH) and glaze fired
form. The study protocol was approved by the ethics (Cercon glaze; DeguDent GmbH) according to the
committee of the medical faculty of the University of manufacturer’s instructions. Crowns were tried in
Heidelberg (no. 033/2004) and the study conducted in clinically and, if required, adjusted to fit by use of fine-
conformity with the Declaration of Helsinki. grain (15-mm) diamonds under irrigation. External

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FIGURE 1. Treatment of study participant with posterior monolithic zirconia single crowns. A, Initial situation with insufficient
cast-metal and metal–ceramic restorations. B, Definitive maxillary cast with new monolithic zirconia crowns. C, Definitive
mandibular cast with new monolithic zirconia crowns. D, Situation 6 months after crown cementation.

crown surfaces after adjustment were subsequently re- bulk fracture of the crown), or other complications
polished to high gloss by use of diamond powder- (with a request for further specification). Chipping
interspersed ceramic-specific polishers (set no. fractures were also graded as major, if the extent
4637.000; Gebr. Brasseler GmbH & Co. KG, Lemgo, necessitated renewal of the restoration, or minor, if it
Germany) or, after major adjustments, re-glazed. Glass could be resolved by polishing or intraoral repair with
ionomer (Ketac Cem; 3M ESPE, Seefeld, Germany), composite. Additionally, at baseline and repeated at
self-etch (Panavia 21; Kuraray Europe GmbH, each follow-up visit, the esthetic rating by both the
Hattersheim, Germany), or self-adhesive resin (RelyX dentist and the participant on a numerical scale from 0
Unicem; 3M ESPE or Panavia SA; Kuraray Europe to 10 (0 5 unacceptable color and shape, 10 5 excellent
GmbH) cement was used for definitive luting. color and shape) was noted.

Standardized report forms were used for baseline and Statistical analysis was performed by use of statistical
follow-up data collection. Baseline data (Table 1) were software (IBM SPSS Statistics Version 22.0; IBM
gathered at crown cementation. Follow-up visits were Corporation, New York). The study groups were
scheduled at 6 months and then yearly thereafter. analyzed by use of descriptive statistics (means,
Abutments and crowns were checked for biological standard deviations, ranges, frequencies). Separate
(endodontic treatment, secondary caries, tooth 3-year survival for each of “crown failure” (failure-free
fracture, progression of periodontal disease), technical survival, crown, and/or abutment tooth in situ, no
(loss of retention, visible cracks located within the need for renewal or tooth extraction), “first
veneer and/or the zirconia material, adhesive veneer complication” (success, complication-free survival), and
chipping fracture, cohesive veneer chipping fracture, “ceramic fracture” (fracture-free survival, survival

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FIGURE 2. Treatment of study participant with anterior partially veneered zirconia single crowns. A, Initial situation with
insufficient metal–ceramic restorations. B, Situation with built up and prepared abutment teeth with cylindrical, screw-type titanium
post inserted in left lateral incisor for additional retention of resin core build-up. C, Definitive maxillary cast with labial veneered
and palatal stained zirconia crowns. D, Situation with partially veneered zirconia crowns 2 years after insertion.

without fracture of the ceramic veneer or core) were with 148 single crowns (82 [55.4%] MZCs and 66
calculated by use of the Kaplan–Meier method. [44.6%] PZCs) were part of the analysis performed in
February 2016. Participants had between one and 11
single crowns; the average number of restorations per
RESULTS participant was 2.5 6 2.4. For 33 (55%) participants
more than one tooth was restored, and six (10%)
Between September 2011 and June 2013, 68 participants received both MZCs and PZCs. The mean
participants (33 [48.5%] male) received a total of 162 observation time for the restorations was 35.1 6 6.3
zirconia single crowns (90 [55.6%] monolithic and 72 months. Baseline findings for the crowns in the study
[44.4%] partially veneered). Eight (11.8%) participants groups are listed in Table 1.
(five male and three female) fitted with 14 (8.6%)
single crowns (eight MZCs and six PZCs) dropped out In the MZC group, in a mean time in situ of
during follow-up (three completely, four after follow- 36.9 6 6.1 months (range 25.1–53.1 months), six
up <24 months, and one after follow-up >24 months, crowns (7.3%) were affected by complications.
all without known complications) for different reasons Technical complications were limited to loss of
(one did not recover after a stroke, four declared retention for two crowns (2.4%). With regard to
unwillingness to return for reasons of convenience, biological complications, endodontic problems were
two wished to miss follow-up and return at a later observed for four abutment teeth (4.9%); one abutment
time, one provided no reasons) and were therefore tooth (1.2%) was diagnosed with secondary caries, and
excluded from statistical analysis. Thus, 60 participants vertical root fracture was observed for one abutment
(28 [46.7%] male, mean age 62.5 6 13.1 years) treated tooth (1.2%). Two crowns (2.4%) were regarded as

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TABLE 1. Study groups compared for mean participant age and (relative) frequencies of baseline characteristics of crowns
Characteristic Details MZC PZC

Mean age (at crown placement) in years* 60.5 6 13.4 63.4 6 9.2

Sex* Male 49 (59.8%) 28 (42.4%)

Female 33 (40.2%) 38 (57.6%)

Restored arch Maxilla 38 (46.3%) 42 (63.6%)

Mandible 44 (53.7%) 24 (36.4%)

Position of restoration Anterior 3 (3.7%) 40 (60.6%)

Posterior 79 (96.3%) 26 (39.4%)

Restored tooth Central incisor ^ 12 (18.2%)

Lateral incisor 1 (1.2%) 13 (19.7%)

Canine 2 (2.4%) 15 (22.7%)

First premolar 17 (20.7%) 14 (21.2%)

Second premolar 18 (22.0%) 9 (13.6%)

First molar 28 (34.1%) 3 (4.5%)

Second molar 14 (17.1%) ^

Third molar 2 (2.4%) ^

Endodontic status of restored tooth Endodontically treated 21 (25.6%) 18 (27.3%)

Vital 61 (74.4%) 48 (72.7%)

Core build-up No 11 (13.4%) 7 (10.6%)

Glass f|ber reinforced composite post 1core build-up resin 2 (2.4%) ^

Cylindrical, screw-type titanium post 1core build-up resin 2 (2.4%) 4 (6.1%)

Cast post and core 1 (1.2%) ^

Exclusively core build-up resin 65 (79.3%) 51 (77.3%)

Glass ionomer cement 1 (1.2%) 4 (6.1%)

Support of antagonist Periodontal 67 (81.7%) 59 (89.4%)

Implant 8 (9.8%) 2 (3.0%)

Combined periodontal and mucosal 5 (6.1%) 2 (3.0%)

Combined implant and mucosal 2 (2.4%) 3 (4.5%)

Cement type Conventional 70 (85.4%) 60 (90.9%)

Adhesive resin 10 (12.2%) 6 (9.1%)

Temporary 2 (2.4%) ^

Chairside occlusal adjustment, No 28 (34.1%) 23 (34.8%)

subsequent treatment
Yes, polished 33 (40.2%) 36 (54.5%)

Yes, glazed 18 (22.0%) 7 (10.6%)

Missing data 3 (3.7%) ^

MZC, monolithic zirconia single crown; PZC, partially veneered zirconia single crown. *Participants received more than one restoration.

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FIGURE 3. Kaplan–Maier probability of survival for “crown FIGURE 4. Kaplan–Maier probability of survival for “first
failure” plotted for monolithic zirconia (MZC) and partially complication” plotted for monolithic zirconia (MZC) and
veneered zirconia (PZC) single crowns. Numbers (N) of partially veneered zirconia (PZC) single crowns. Numbers (N)
restorations under observation in the study groups are of restorations under observation in the study groups are
indicated below the plot. indicated below the plot.

failures (3%) were recorded, because the abutment

tooth with ongoing periodontal disease was extracted
and one crown was renewed after endodontic therapy.

After 3 years, identical probabilities of failure-free

survival of 98.5% (standard error (SE), 1.5%) were
calculated for both MZCs and PZCs (Figure 3). The
probabilities of 3-year complication-free survival
(success) were 93.6% (SE 2.8%) for MZCs and 95.5%
(SE 2.6%) for PZCs (Figure 4). Finally, the probabilities
of 3-year fracture-free survival were 100% for MZCs
and 98.5% (SE 1.5%) for PZCs (Figure 5).
FIGURE 5. Kaplan–Maier probability of survival for “ceramic
fracture” plotted for monolithic zirconia (MZC) and partially
veneered zirconia (PZC) single crowns. Numbers (N) of At baseline, dentists rated crown esthetics with mean
restorations under observation in the study groups are scores of 8.5 6 1.2 for MZCs and 8.3 6 1.4 for PZCs.
indicated below the plots. Participants awarded MZCs a mean score of 9.5 6 0.7
failed, because the abutment with the vertical root and PZCs a mean score of 9.7 6 0.6. At last follow-up,
fracture was extracted and the abutment tooth with dentists’ rated crown esthetics with a mean score of
secondary caries received a new crown after caries 8.5 6 1.2 for MZCs and a mean score of 9.1 6 1.0 for
therapy. PZCs. Participants rated follow-up esthetics with mean
scores of 9.5 6 0.8 for MZCs and 9.6 6 0.5 for PZCs.
In the PZC group, in a mean time in situ of 32.8 6 5.9
months (range 16.8–48.3 months), three crowns (4.5%)
were affected by complications. Technical DISCUSSION
complications included one loss of retention (1.5%)
and one minor chipping (1.5%). Biological Fracture of the veneer was recently identified as the
complications comprised progression of periodontal most common technical complication leading to
disease for one abutment tooth (1.5%) and endodontic clinical failure of zirconia-based single crowns.14 Thus,
problems for another abutment (1.5%). Two crown in the present study the low incidence of ceramic

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chipping (only one minor chipping fracture in the PZC as possible options for crowns located on terminal
group) might have contributed to the high 3-year abutments.9 Nejatidanesh and colleagues re-examined
success calculated for the crowns. Instead, PZCs and 142 anterior and 182 posterior tooth-supported single
MZCs failed for biological reasons, in contrast with crowns after a mean of 60.7 months and calculated
fully veneered zirconia crowns, for which technical cumulative ceramic fracture-free survival of 91%.19 The
(veneer fracture, loss of retention) and biological incidence of chipping was significantly (p 5 0.004)
(endodontic and/or periodontic) reasons were found to higher for molar and anterior crowns than for
cause failure equally often.14 Cumulative survival of premolars.19 This was ascribed to larger occlusal forces
98.5% for both MZCs and PZCs after 3 years can be in the posterior region and an unfavorable load
regarded as superior to that of fully veneered zirconia direction for anterior teeth.19 In comparison with these
crowns, for which 5-year survival of 91.2% and annual studies, in the present study mechanical stability of the
failure of 1.84% were reported more recently in a restoration material was superior: fracture-free survival
review and meta-analysis of 1,049 restorations with a was 98.5% for PZCs (60.6% located in the anterior
mean follow-up time of 3.7 years.2 In another review, region) and 100% for MZCs (96.6% located in the
3-year cumulative survival of veneered zirconia crowns posterior region). Thus, omitting the ceramic veneer
was estimated as 95.9% (on the basis of 300 tooth- where it is subjected to occlusal loading effectively
supported single crowns observed for 24–39.2 reduced the incidence of chipping to a minimum. A
months)15; this, also, is less compared with the present similar observation was made by Moscowitch, who
analysis. evaluated the performance of single and multi-unit
zirconia fixed dental prostheses on teeth and implants,
Chipping is among the most common complications of with feldspathic ceramic limited to nonfunctional
veneered zirconia crowns.2,14 The annual incidence of surfaces; he observed no ceramic fractures of the core
complications for ceramic chipping has been estimated or veneer.13
to be 0.64%; loss of another 0.64% of the crowns per
year because of ceramic fractures was also estimated.2 Greater reliability of zirconia-based restorations with
Apart from inherent flaws as origins of ceramic failure, regard to ceramic defects has also been observed for
zones of occlusal contact wear have been identified as CAD/CAM-produced veneers.20 Use of monolithic
primary starting points of chipping fracture.16 Posterior zirconia has another advantage, however; it enables
crowns were, accordingly, found to be particularly manufacture of thinner, thus tissue-preserving,
vulnerable to chipping.17 Rinke and colleagues restorations. This advantage is particularly important
confirmed this; they evaluated 323 single crowns (96 when the occlusal substance removal necessary for
incisors, 89 premolars, and 138 molars) over a mean monolithic zirconia crowns, namely 0.5 mm,11 is
period of 79.7 6 14.2 months and found that placing a compared with the 1.8 mm occlusal substance removal
crown on a molar doubled the risk of chipping (hazard necessary for crowns with a CAD/CAM-produced
ratio 2.15, p 5 0.034).18 Further differentiation of the veneer.20 Another aspect, which merits attention when
risk of chipping of posterior restorations was derived using veneered zirconia crowns, is the selective chair-
from another study which compared veneered zirconia side occlusal adjustment before and/or after
and porcelain-fused-to-metal crowns exclusively placed cementation (which affected 66% of crowns in this
on molars.9 After 5 years, survival without fracture of study). Deterioration of the ceramic surface as a result
the ceramic veneer was 95.7% for crowns on tooth- of occlusal adjustment has been shown to affect both
neighboring abutments whereas that for crowns on flexural and fatigue flexural strength.21,22 It has,
terminal abutments was 85.2%. Subsequently, terminal furthermore, recently been shown that after occlusal
abutments were calculated to be at 5.5-fold higher risk adjustment of the ceramic veneer neither polishing nor
(p 5 0.035) of veneering ceramic fracture, irrespective glaze firing could restore the original fracture
of crown material.9 To cover this risk the authors resistance of zirconia-based crowns.23 Avoidance of
suggested full-cast metal or monolithic zirconia crowns veneer in the occlusal area is, thus, beneficial in this

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respect also. It should, however, be stressed that the the present study and Ian Davies for English language
surface of monolithic zirconia restorations must be revision of the manuscript.
fastidiously polished after occlusal adjustment if very
low antagonistic wear is to be achieved.24 Formerly,
polishing of ceramic restorations was challenging25; REFERENCES
today it is easily and effectively achieved by use of
suitable polishing kits.26 1. Stawarczyk B, Frevert K, Ender A, et al. Comparison of four
monolithic zirconia materials with conventional ones: contrast
ratio, grain size, four-point flexural strength and two-body
Some years ago, the esthetic properties of monolithic
wear. J Mech Behav Biomed Mater 2015;59:128–38.
zirconia restorations were in need of improvement, 2. Sailer I, Makarov NA, Thoma DS, et al. All-ceramic or
because only white blanks were available. In this study, metal-ceramic tooth-supported fixed dental prostheses
sophisticated coloring and staining techniques allowed (FDPs)? A systematic review of the survival and
for a better color match of monolithic zirconia crowns. complication rates. Part I: single crowns (SCs). Dent Mater
2015;31(6):603–23.
Facial veneers also improved esthetics in the so-called
3. Christensen RP, Ploeger BJ. A clinical comparison of
“esthetic zone” (i.e., in the maxilla, use of PZCs was zirconia, metal and alumina fixed-prosthesis frameworks
preferable from second right to second left premolar, veneered with layered or pressed ceramic: a three-year
and in the mandible from first right to first left report. J Am Dent Assoc 2010;141(11):1317–29.
premolar). All this might explain the outstanding 4. Nathanson D, Chu S, Yamamoto H, Staooert CF.
rating of the esthetics of the crowns in this study, Performance of zirconia based crowns and FDPs in
prosthodontic practice. J Dent Res 2010;89(Spec Iss B):
which was similar to that of fully veneered crowns.19
Abstract #2115.
5. Ozer F, Mante FK, Chiche G, et al. A retrospective survey
Although in-vitro data suggest high fracture resistance on long-term survival of posterior zirconia and porcelain-
of anatomic zirconia crowns and the ability to fused-to-metal crowns in private practice. Quintessence Int
sufficiently withstand molar chewing forces in the 2014;45(1):31–8.
long-term, even in the presence of low-temperature 6. Rosentritt M, Steiger D, Behr M, et al. Influence of
substructure design and spacer settings on the in vitro
degradation,27 the good performance of the crowns in
performance of molar zirconia crowns. J Dent 2009;37(12):
the present study must be verified clinically for longer 978–83.
follow-up periods. 7. Rues S, Kroger E, Muller D, Schmitter M. Effect of firing
protocols on cohesive failure of all-ceramic crowns. J Dent
2010;38(12):987–94.
8. Schmitter M, Schweiger M, Mueller D, Rues S. Effect on in
CONCLUSIONS vitro fracture resistance of the technique used to attach
lithium disilicate ceramic veneer to zirconia frameworks.
Within the limitation of a short-follow up period of Dent Mater 2014;30(2):122–30.
approximately 3 years, monolithic and partially 9. Rinke S, Kramer K, Burgers R, Roediger M. A practice-
veneered zirconia crowns could be used clinically with based clinical evaluation of the survival and success of
good survival and success and without compromising metal-ceramic and zirconia molar crowns: 5-year results.
J Oral Rehabil 2016;43(2):136–44.
esthetic appearance.
10. Schmitter M, Mussotter K, Rammelsberg P, et al. Clinical
performance of extended zirconia frameworks for fixed
dental prostheses: two-year results. J Oral Rehabil 2009;
DISCLOSURE AND ACKNOLEDGEMENTS 36(8):610–5.
11. Rinke S, Fischer C. Range of indications for translucent
zirconia modifications: clinical and technical aspects.
The authors do not have any financial interest in the
Quintessence Int 2013;44(8):557–66.
companies whose materials are included in this article. 12. Ueda K, Guth JF, Erdelt K, et al. Light transmittance by a
The authors would very much like to thank DeguDent multi-coloured zirconia material. Dent Mater J 2015;34(3):
GmbH for the financial support of the data analysis of 310–4.

C 2016 Wiley Periodicals, Inc.

V DOI 10.1111/jerd.12270 Journal of Esthetic and Restorative Dentistry Vol 29 ! No 1 ! 22^30 ! 2017 29
 SHORT-TERM PROSPECTIVE CLINICAL EVALUATION B€
omicke et al.

13. Moscovitch M. Consecutive case series of monolithic and 21. Nakazato T, Takahashi H, Yamamoto M, et al. Effect of
minimally veneered zirconia restorations on teeth and polishing on cyclic fatigue strength of CAD/CAM ceramics.
implants: up to 68 months. Int J Periodontics Restorative Dent Mater J 1999;18(4):395–402.
Dent 2015;35(3):315–23. 22. Wang F, Chen JH, Wang H. Surface roughness of a novel
14. Larsson C, Wennerberg A. The clinical success of zirconia- dental porcelain following different polishing procedures.
based crowns: a systematic review. Int J Prosthodont 2014; Int J Prosthodont 2009;22(2):178–80.
27(1):33–43. 23. Schmitter M, Lotze G, Bomicke W, Rues S. Influence of
15. Takeichi T, Katsoulis J, Blatz MB. Clinical outcome of single surface treatment on the in-vitro fracture resistance of
porcelain-fused-to-zirconium dioxide crowns: a systematic zirconia-based all-ceramic anterior crowns. Dent Mater
review. J Prosthet Dent 2013;110(6):455–61. 2015;31(12):1552–60.
16. Moraguez OD, Wiskott HW, Scherrer SS. Three- to nine- 24. Preis V, Grumser K, Schneider-Feyrer S, et al. Cycle-
year survival estimates and fracture mechanisms of dependent in vitro wear performance of dental ceramics
zirconia- and alumina-based restorations using after clinical surface treatments. J Mech Behav Biomed
standardized criteria to distinguish the severity of ceramic Mater 2016;53:49–58.
fractures. Clin Oral Investig 2015;19(9):2295–307. 25. Kou W, Molin M, Sjogren G. Surface roughness of five
17. Guncu MB, Cakan U, Muhtarogullari M, Canay S. different dental ceramic core materials after grinding and
Zirconia-based crowns up to 5 years in function: a polishing. J Oral Rehabil 2006;33(2):117–24.
retrospective clinical study and evaluation of prosthetic 26. Preis V, Grumser K, Schneider-Feyrer S, et al. The
restorations and failures. Int J Prosthodont 2015;28(2): effectiveness of polishing kits: influence on surface
152–7. roughness of zirconia. Int J Prosthodont 2015;28(2):149–51.
18. Rinke S, Lange K, Roediger M, Gersdorff N. Risk factors for 27. Nakamura K, Harada A, Kanno T, et al. The influence of
technical and biological complications with zirconia single low-temperature degradation and cyclic loading on the
crowns. Clin Oral Investig 2015;19(8):1999–2006. fracture resistance of monolithic zirconia molar crowns.
19. Nejatidanesh F, Moradpoor H, Savabi O. Clinical J Mech Behav Biomed Mater 2015;47:49–56.
outcomes of zirconia-based implant- and tooth-
supported single crowns. Clin Oral Investig 2016;20(1):
169–78. Reprint requests:Wolfgang B€
omicke,MSc,Department of Prosthetic
20. Seydler B, Schmitter M. Clinical performance of two Dentistry,MZK 8.2,Im Neuenheimer Feld 400, 69121Heidelberg,
different CAD/CAM-fabricated ceramic crowns: 2-year Germany;Tel. 1496221566052; email:[email protected]
results. J Prosthet Dent 2015;114(2):212–6. heidelberg.de

30 Vol 29 ! No 1 ! 22^30 ! 2017 Journal of Esthetic and Restorative Dentistry DOI 10.1111/jerd.12270 V
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