Comparative evaluation of clinical performance of ceramic and resin inlays, onlays, and overlays: A systematic review and meta analysis

Abstract

Background: Advances in adhesive technologies and escalation in esthetic demands have increased indications for tooth-colored, partial coverage restorations. Recently, material knowledge has evolved, new materials have been developed, and no systematic review has answered the question posed by practitioners: Is the clinical efficacy of resin or ceramic better, for inlay, onlay, and overlay in the long run?

Aim: The aim of this systematic review and meta-analysis was to evaluate the clinical performance of ceramic and resin inlays, onlays, and overlays and to identify the complication types associated with the main clinical outcomes.

Materials and methods: Two reviewers (VN and AJ) searched PubMed, Embase, and Cochrane Central registry of controlled trials for published articles between 1983 and 2020 conforming to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for systematic reviews. Only clinical studies which met the following criteria were included (1) studies regarding ceramic and resin inlays, onlays, and overlays were included; (2) randomized controlled trials, retrospective or prospective studies conducted in humans; (3) studies with a dropout rate <50% 4) studies with a follow-up higher than 5 years.

Results: Of 1718 articles, 21 articles were selected. At 5 years, the estimated survival rates for resin (n = 129) was 86%, feldspathic porcelain (n = 1048) was 90%, and glass ceramic (n = 2218) was 92%; at 10 years, the survival of resin was 75% (n = 115), feldspathic porcelain was 91% (n = 1829), and glass ceramic was 89% (n = 1075).

Conclusion: The meta-regression indicated that ceramic partial coverage restorations (feldspathic porcelain and glass-ceramic) outperformed resin partial coverage restorations both at 5-year and 10-year follow-up. When compared between ceramic types, glass ceramics outperformed feldspathic porcelain at 5 years' follow-up and feldspathic porcelain outperformed glass ceramics at 10 years' follow-up. The failures were mostly due to fractures (6.2%), endodontic problems (3%), secondary caries (1.7%), and debonding which was 0.9%.

Keywords: Ceramics; composite resin; dental porcelain; dental restoration failure; dental restoration failure glass ceramics; longevity.

Figure 1

(A) Forest plot of pooled studies for 5 years (B) forest plot of pooled studies for 10 years forest plot of pooled studies at 5 years for (A1) resins (B1) feldspathic porcelain (C1) glass ceramics forest plot of pooled studies at 10 years for (D1) resins (E1) feldspathic porcelain (F1) glass ceramics

Figure 2

Forest plot of subgroup for outcome on (A) fractures, (B) endodontic complications (C) caries and (D) debonding outcome of subgroups for (A1) vitality of tooth (vital vs. nonvital), (B1) type of tooth (premolar vs. molar), (C1) pooled survival rate of inlays, (D1) pooled survival rate of onlays (C and D) showing inlays versus onlays

Appendix Figure 1

Study Bias Assessment. Funnel plot and standardized residual graphs for 5.year survival allowed us to evaluate the homogeneous distribution in all 21 articles included