ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Longevity of 3-Unit Bridge Restorations Utilizing CAD/CAM Technology Is Comparable to That of Metal-Ceramic Castings
Clinical Question In a patient needing a 3-unit bridge, does CAD/CAM technology lead to increased longevity as compared to a conventional metal-ceramic casting?
Clinical Bottom Line The survival rate of 3-unit CAD/CAM fabricated bridges is similar to conventional metal-ceramic castings.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22930766Palaez/201237 patients/40 posterior 3-unit FPDs to replace missing teethRandomized Controlled Trial
Key resultsCompared across 37 patients, the 4-year survival rate for CAD/CAM-fabricated zirconia restorations was 95% as compared to 100% for traditional metal-ceramic fabrications. There were no clinically significant differences between patient populations. The mean observation period was 50 +/- 2.4 months. Data was analyzed using the Wilcoxon rank sum and signed rank tests.
#2) 15819826Reich/200519 patients/24 3-unit FPDsRandomized Controlled Trial
Key resultsNo clinically significant differences existed between median marginal fit in CAD/CAM fabricated FPDs compared to traditional metal ceramic castings. However, the marginal gap seen in the CAD/CAM FPDs fabricated using the Digident system did exhibit significant differences from metal ceramics (p < 0.05).
Evidence Search "Denture, Partial, Fixed"[Mesh] AND "Computer-Aided Design"[Mesh] Filter: Clinical Trial
Comments on
The Evidence
Validity: Palaez/2012 had a 4-year follow-up with interval checks each year. All restorations were assessed objectively utilizing the California Dental Association (CDA) Assessment standards. The survival rates of both CAD-CAM and metal-ceramic FPDs would have both been 100% had it not been for a “longitudinal root fracture seen in an endodontically treated abutment tooth.” Reich/2005 did not measure survival rates. It is commonly understood, however, that a more intimate marginal fit a between 3-unit prostheses and their respective abutment teeth will lead to increased clinical longevity due to an improved retention and resistance form. This is supported by fixed prosthodontics literature. Perspective: These two studies, while not systematic reviews, show that conventional lab casting and CAD/CAM technology lead to similar survival rates. As a clinician, this is of great importance because this will effectively save time, leading to higher levels of patient satisfaction.
Applicability These studies show that for the average patient CAD/CAM-fabricated 3-unit prostheses are an acceptable alternative to conventional metal-ceramic casted FPDs. This technology would be recommended to improve clinical efficiency and reduce the number of patient visits. These recommendations are due to the similar longevity seen in both processes.
Specialty/Discipline (Prosthodontics)
Keywords CAD-CAM, survival, fixed partial denture
ID# 3157
Date of submission: 04/19/2017spacer
E-mail Pirzadeh@livemail.uthscsa.edu
Author Amir Pirzadeh
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Jeffrey Hicks, DDS
Faculty mentor/Co-author e-mail hicksj@uthscsa.edu
Basic Science Rationale
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