Adhesively Luted, Metall-free Composite Crowns After Five Years

Purpose: The effect of location and preparation design of abutment teeth and of preparation design on the survival and complication rate of metal-free, adhesively luted composite crowns (Artglass, Heraeus Kulzer) and their clinical performance was investigated in this controlled, randomized, prospective clinical study. Materials and Methods: After randomization, 114 single crowns (68 posterior, 46 anterior) were prepared either with a 0.5 mm chamfer finishing line or with a 0.5 mm shoulder combined with occlusal reduction of at least 1.5 mm. Buildups were made with a composite material, using the corresponding dentin adhesive. Crowns were manufactured on stone dies and intraorally adhesively luted with resin cement. Follow-up examinations were conducted after 1 month and 1, 2, 3, and 5 years. Documentation included failures and complications, occlusal contacts, plaque accumulation and patients' rating of esthetics and functionality. After 5 years, data for 83 single crowns had been obtained. Results: Within an observation period of 5 years, 18 complications occurred, including 13 major failures which resulted in replacement of the crowns, and 5 minor complications which could be repaired. All loosened crowns (n = 2) were successfully re-cemented. The Cox Regression did not reveal any effect of location or preparation design on complication rate. Calculation of the Kaplan-Meier survival curve on the basis of major failures indicated a probability of survival of 96% after 3 years and 88.5% after 5 years. Four Artglass crowns had no contact in static occlusion after 5 years and plaque accumulation was significantly higher than for control teeth. Esthetic and functional evaluation by patients revealed that acceptance was high. Conclusion: Metal-free composite crowns may be recommended for long-term temporary use. However, the complication rate and the increased plaque accumulation restrict the indication for permanent restorations. Keywords: clinical survival, complication rate, composite, single crown, adhesive cementation