Comparison of Failure and Complication Risks of Porcelain Laminate and Indirect Resin Veneer Restorations: A Meta-Analysis

Purpose: To evaluate and compare the failure and complication risks of porcelain laminate and indirect resin veneer restorations (VRs) by means of a meta-analysis. Methods: An electronic database search was performed in MEDLINE (PubMed), EMBASE (Ovid), and the Cochrane Central Register of Controlled Trials (CENTRAL) databases, and a gray literature search was performed on OpenGrey. All database searches were completed by March 2018. Two authors individually screened the literature according to the inclusion and exclusion criteria. The quality and risk of bias of the included studies were evaluated using the Newcastle- Ottawa scale (NOS) and the Cochrane Handbook for Systematic Reviews of Interventions (CHSRI). The Mantel-Haenszel method was used to synthesize the data of the included studies. All statistical analyses were performed using the software Stata 14.0, and the results were expressed as risk ratio (RR) with 95% confidence interval (CI). Results: Five studies-two randomized controlled trials (RCTs) and three clinical controlled trials (CCTs)-were included in this review. Of the three CCTs, two were assessed to be low quality, and the third was considered high quality. The two RCTs were rated as unclear risk of bias. The meta-analysis results showed the risk of failure for indirect resin VRs was higher than for porcelain laminate VRs (RR: 0.15, 95% CI: 0.06-0.40; P = .000). Fracture and debonding were the main complications leading to failure. For risk of fracture, an RR of 0.18 (95% CI: 0.04-0.71) and a statistically significant difference (P = .015) were found in favor of porcelain laminate VRs. For risk of debonding, there was no statistically significant difference (P = .108) found between the two types of VRs. The results of the sensitivity analysis (RR: 0.09, 95% CI: 0.02- 0.45; P = .004) suggested that this conclusion was reliable. Conclusion: The survival rate of porcelain laminate VRs was higher than indirect resin VRs, and the latter had a higher risk of fracture. However, there was no statistically significant difference in the risk of debonding between the two types of VRs. Porcelain laminate VRs have a better prognosis compared to indirect resin VRs, which provides an evidence-based reference for the selection of VRs in clinical practice.