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PubMed · 42457117

Marginal fit and five-year outcomes of posterior monolithic zirconia restorations: A randomized paired and observational clinical study.

Jaana-Sophia Kern·Oliver Hartkamp·Christina Kühne·Berfin Yatmaz·Karin Groß·Stefan Wolfart·Sven Reich
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Abstract

OBJECTIVES: The aim of this study was to evaluate the marginal fit and five-year clinical performance of posterior 5 mol% yttria-partially stabilized zirconia restorations. A randomized paired comparison with lithium disilicate crowns was performed for marginal fit. METHODS: A total of 65 posterior restorations were placed in 38 patients, including 32 zirconia crowns, 17 lithium disilicate crowns, and 16 zirconia partial coverage restorations. In the randomized paired comparison, 17 patients received one lithium disilicate crown and one zirconia crown. Additional zirconia crowns (n=15) and zirconia partial coverage restorations (n=16) were included in a prospective observational cohort. The primary outcome was marginal fit within the randomized cohort. Marginal and internal fit were assessed using the replica technique. Marginal and internal gap values were compared using the Wilcoxon signed-rank test; clinical outcomes were analyzed descriptively, and Kaplan-Meier estimates were calculated for survival and complication-free survival. Clinical performance was assessed using CDA criteria, periodontal parameters, complication recording, and patient-reported outcomes. Clinical examinations were performed at baseline and at 12, 24, 36, 48, and 60 months. RESULTS: Mean marginal gap values at the crown margin were 46 ±33 µm for lithium disilicate crowns and 50 ±32 µm for zirconia crowns (p>0.05). No restoration required replacement, resulting in 100% restoration survival after a median follow-up of 60 months (range: 57-64 months). Most complications were biological or functional, including endodontic, periodontal, occlusal, and proximal-contact-related events. One zirconia partial coverage restoration exhibited a small ceramic fracture managed by polishing. The Kaplan-Meier probability of complication-free survival was 76.4% for zirconia crowns, 66.7% for lithium disilicate crowns, and 87.5% for zirconia partial coverage restorations. CONCLUSIONS: In the randomized paired comparison, 5 mol% yttria-partially stabilized zirconia crowns showed marginal gap values similar to lithium disilicate crowns. All restorations remained in situ during the observation period. Lower complication-free survival was mainly related to biological and functional events and should be interpreted separately from restoration survival. CLINICAL SIGNIFICANCE: Clinical evidence for posterior 5 mol% yttria-partially stabilized zirconia restorations remains limited. This study provides mid-term clinical data on crowns and partial coverage restorations. In the randomized full-crown comparison, marginal fit was similar to that of lithium disilicate crowns, supporting the clinical consideration of monolithic zirconia restorations for posterior teeth.

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HumansZirconiumCrownsDental PorcelainFemaleProspective StudiesDental Marginal AdaptationDental Restoration FailureMaleMiddle AgedAdultDental Restoration, PermanentTreatment OutcomeDental MaterialsDental Prosthesis DesignYttriumFollow-Up StudiesSurface PropertiesReplica Techniques5Y-PSZClinical performanceLithium disilicateMarginal fitPartial coverage restorationsPosterior crownsProspective studyZirconiaJournal ArticleRandomized Controlled TrialObservational StudyComparative Study

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Jaana-Sophia Kern, Oliver Hartkamp, Christina Kühne, Berfin Yatmaz, Karin Groß, Stefan Wolfart, Sven Reich. 2026-07-15. Marginal fit and five-year outcomes of posterior monolithic zirconia restorations: A randomized paired and observational clinical study.. https://doi.org/10.1016/j.jdent.2026.106912

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Adult subjectComparative Study subjectCrowns subjectDental Materials subjectDental Porcelain subjectDental Restoration Failure subjectDental Restoration, Permanent subjectFemale subjectFollow-Up Studies subjectHumans subjectJournal Article subjectLithium disilicate subjectMale subjectMiddle Aged subjectObservational Study subjectRandomized controlled trials study

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