Surface characteristics of zirconia-based posterior restorations: clinical and scanning electron microscopic analysis

The aim of this prospective clinical trial was to evaluate the performance of zirconia-based all-ceramic posterior fixed partial dentures (FPDs) after 4 years of clinical use. Fifteen patients who needed 3- or 4-unit posterior FPDs were enrolled in the study. One manufacturer fabricated all restorations, following established clinical protocols and using computer-aided design/computer-aided manufacturing technology and one veneering material. Survival and success were evaluated clinically. Impressions were taken immediately after definitive cementation and after 48 months. Gold-coated epoxy replicas of the restorations were analyzed with scanning electron microscopy (SEM). Surface alterations were also evaluated clinically. After 48 months, the survival rate for the FPDs was 100%. Three restorations exhibited minor chipping, for a fracture rate of 20% after 4 years. Thirty (59%) of the 51 individual restoration units revealed clinically rough occlusal surfaces, a finding that was confirmed by SEM. The placement of 3- and 4-unit zirconia-based posterior FPDs can be considered a reliable treatment modality for medium-term clinical use. However, surface alterations of the veneering ceramics were observed after 4 years and are of notable clinical concern.