Title Posterior All-Ceramic Crowns Have Higher Fracture Rate Than Anterior All-Ceramic Crowns
Clinical Question For all-ceramic crowns, do the anterior tooth-supported crowns have better outcomes than posterior tooth-supported crowns?
Clinical Bottom Line Posterior all-ceramic crowns have higher fracture rate than anterior all-ceramic crowns.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
22930765Wang/2012Included 5,600 titles and abstracts 37 publications with a follow-up period from 36 to 97 months for tooth supported all ceramic crownsSystematic review
Key resultsThe study showed the higher fracture rate for tooth-supported posterior crowns (5.4%) in comparison to anterior crowns (3.0%). There also was a significantly higher fracture rate in molar crowns (8.1%) than premolar crowns (3.0%).
20305850Heintze/20107 clinical studies involved 1,487 luted crowns (mean observation time: 4.5+/-1.7 years) and 81 crowns cemented with zinc-phostphate cement ( mean observation tme: 1.6+/-0.8 years)Systematic review
Key results38% of luted crowns fractured, and 62% of fractures occurred between the third and sixth year after placement. 5 in 1,000 crowns fractured for incisors, 7 in 1,000 crowns for premolars, 12 in 1,000 crowns for canines, and 16 n 1000 crowns for molars. IPS Empress crowns demonstrated a low fracture rate for incisors and premolars and a higher rate for molars and canine.
Evidence Search ("Ceramics"[Mesh]) AND "Crowns"[Mesh], fracture rate, anterior crowns, posterior crowns
Comments on
The Evidence
Although Systemic Reviews have collected data from different articles with the same topic related to ceramic crowns, more studies with the large sample sizes and longer observation period should be obtained for more definite results. Standard guidelines in analysis of chipping fracture should be clearly defined for success or failure.
Applicability In clinical practice, patients often present with fracture or caries teeth needing crowns. The decision-making on what materials should be used for tooth-supported crowns sometimes is difficult. The evidence shows that the posterior all ceramic crowns have a higher fracture rate than anterior crowns. Metal crowns or PMF crowns might be recommended for posterior crowns.
Specialty (General Dentistry) (Prosthodontics) (Restorative Dentistry)
Keywords All-ceramic crowns, anterior, posterior, fracture rate, tooth-supported crowns,
ID# 2925
Date of submission 10/28/2015
E-mail trangt@livemail.uthscsa.edu
Author Giang Tran, DDS
Co-author(s) e-mail
Faculty mentor John D. Jones, DDS
Faculty mentor e-mail JONESJD@UTHSCSA.EDU
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available