Clinical Behavior of Ceramic, Hybrid and Composite Onlays. A Systematic Review and Meta-Analysis

Abstract

A systematic review and meta-analysis was performed to analyze the survival of onlay restorations in the posterior region, their clinical behavior according to the material used (ceramic reinforced with lithium disilicate, conventional feldspathic ceramic or reinforced with leucite; hybrid materials and composite), possible complications, and the factors influencing restoration success. The systematic review was based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, without publication date or language restrictions. An electronic search was made in the PubMed, Scopus, Embase, and Cochrane databases. After discarding duplicate publications and studies that failed to meet the inclusion criteria, the articles were selected based on the population, intervention, comparison, outcome (PICO) question. The following variables were considered in the qualitative and quantitative analyses: restoration survival rate (determined by several clinical parameters), the influence of the material used upon the clinical behavior of the restorations, and the complications recorded over follow-up. A total of 29 articles were selected for the qualitative analysis and 27 for the quantitative analysis. The estimated restoration survival rate was 94.2%. The predictors of survival were the duration of follow-up (beta = -0.001; p = 0.001) and the onlay material used (beta = -0.064; p = 0.028). Composite onlays were associated with a lower survival rate over time. Onlays are a good, conservative, and predictable option for restoring dental defects in the posterior region, with a survival rate of over 90%. The survival rate decreases over time and with the use of composite as onlay material.

Keywords: ceramics; clinical evaluation; complications; composite; hybrid dental material; onlays; posterior partial restorations; survival rate.

Figure 1

Partial restoration (onlay).

Figure 2

Indirect partial restorations made with different materials. (A). Composite. (B). Hybrid material. (C). Ceramics.

Figure 3

Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flowchart.

Figure 4

Forest plot indicating estimated percentage survival of the restorations.

Figure 5

Scatter plot of the percentage survival regression analysis considering the covariates follow-up time and material. Categories: 1 = Disilicate; 2 = Feldspathic ceramic; 3 = Composites; 4 = Hybrids.

Figure 6

Restoration survival over time. The black line corresponds to survival over time of the restoration using ceramic or hybrid material, while the grey line corresponds to the significantly lesser survival of the composite restorations. It can be estimated that at 150 months of follow-up, percentage survival would be 88% for ceramic or hybrid materials versus 80% in the case of composite.

Figure 7

Forest plot according to clinical parameters for modified USPHS criteria category. Alpha, Bravo, Charlie and Delta.

Figure 8

Forest plot according to parameters used to assess success.

Figure 9

Forest plot according to parameters used to assess survival.

Figure 10

Forest plot according to parameters used to assess failure.

Figure 11

Funnel plot adjusted and unadjusted according to the Trim and Fill method for percentage survival.