{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T14:11:48Z","timestamp":1792419108658,"version":"4.5.0"},"reference-count":49,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,8,27]],"date-time":"2023-08-27T00:00:00Z","timestamp":1693094400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biomimetics"],"abstract":"<jats:p>Background: Additive manufacturing (three-dimensional (3D) printing) has become a leading manufacturing technique in dentistry due to its various advantages. However, its potential applications for dental ceramics are still being explored. Zirconia, among ceramics, has increasing popularity and applications in dentistry mostly due to its excellent properties. Although subtractive manufacturing (3D milling) is considered the most advanced technology for the fabrication of zirconia restorations, certain disadvantages are associated with it. Methods: A systematic review was piloted to compare the clinical performance of zirconium crowns that were fabricated using three-dimensional (3D) milling and 3D printing. A meta-analysis was performed, and studies published up to November 2022 were identified. The terms searched were \u201cZirconium crowns\u201d, \u201c3D printing\u201d, \u201cCAD\/CAM\u201d (Computer-Aided Design and Computer-Aided Manufacturing), \u201cMilling\u201d, \u201cdental crowns\u201d, and \u201c3D milling\u201d. The characteristics that were compared were the year in which the study was published, study design, age of the patient, country, the number of crowns, the type of crown fabrication, marginal integrity, caries status, and outcomes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to structure this systematic review. Out of eleven hundred and fifty titles identified after a primary search, nine articles were included in the quantitative analysis. The research question based on PICO\/PECO (Participant, Intervention\/exposure, Comparison, and Outcome) was \u201cDo 3D-printed and milled (P) zirconia crowns and FDPs (I) have a better survival rate (O) when conventional prosthesis is also an option (C)\u201d? The data collected were tabulated and compared, and the risk of bias and meta-analysis were later performed. Only nine articles (clinical research) were selected for the study. Since there were no clinical studies on the 3D printing of zirconium crowns, six in vitro studies were considered for the comparison. Zirconium crowns in the milling group had an average minimum follow-up of 6 months. Results: A moderate risk of bias was found, and survival was significant. A high heterogeneity level was noted among the studies. Marginal integrity, periodontal status, and survival rate were high. Linear regression depicted no statistical correlation between the type of cement used and the survival rate. Conclusions: It can be concluded that the milled crowns had a higher performance and satisfactory clinical survival.<\/jats:p>","DOI":"10.3390\/biomimetics8050394","type":"journal-article","created":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T05:46:47Z","timestamp":1693201607000},"page":"394","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Clinical Effectiveness of 3D-Milled and 3D-Printed Zirconia Prosthesis\u2014A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2294-4710","authenticated-orcid":false,"given":"Harisha","family":"Dewan","sequence":"first","affiliation":[{"name":"Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Schweiger, J., Edelhoff, D., and G\u00fcth, J.-F. (2021). 3D Printing in Digital Prosthetic Dentistry: An Overview of Recent Developments in Additive Manufacturing. J. Clin. Med., 10.","DOI":"10.3390\/jcm10092010"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s40496-019-00243-4","article-title":"3D Printing of Zirconia\u2013What is the Future?","volume":"6","author":"Schweiger","year":"2019","journal-title":"Curr. Oral Health Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.dental.2007.05.007","article-title":"State of the art of zirconia for dental applications","volume":"24","author":"Denry","year":"2008","journal-title":"Dent. Mater."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Khanlar, L.N., Salazar Rios, A., Tahmaseb, A., and Zandinejad, A. (2021). Additive Manufacturing of Zirconia Ceramic and Its Application in Clinical Dentistry: A Review. Dent. J., 9.","DOI":"10.3390\/dj9090104"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"103792","DOI":"10.1016\/j.jdent.2021.103792","article-title":"Trueness and precision of 3D-printed versus milled monolithic zirconia crowns: An in vitro study","volume":"113","author":"Lerner","year":"2021","journal-title":"J. Dent."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/j.prosdent.2020.02.032","article-title":"Dimensional accuracy and clinical adaptation of ceramic crowns fabricated with the stereolithography technique","volume":"125","author":"Wang","year":"2021","journal-title":"J. Prosthet. Dent."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.prosdent.2018.04.012","article-title":"Trueness analysis of zirconia crowns fabricated with 3-dimensional printing","volume":"121","author":"Wang","year":"2019","journal-title":"J. Prosthet. Dent."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Kim, M.-S., Hong, M.-H., Min, B.-K., Kim, Y.-K., Shin, H.-J., and Kwon, T.-Y. (2022). Microstructure, Flexural Strength, and Fracture Toughness Comparison between CAD\/CAM Milled and 3D-Printed Zirconia Ceramics. Appl. Sci., 12.","DOI":"10.3390\/app12189088"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Abualsaud, R., and Alalawi, H. (2022). Fit, Precision, and Trueness of 3D-Printed Zirconia Crowns Compared to Milled Counterparts. Dent. J., 10.","DOI":"10.3390\/dj10110215"},{"key":"ref_10","first-page":"369","article-title":"Three generations of zirconia: From veneered to monolithic. Part I","volume":"48","author":"Stawarczyk","year":"2017","journal-title":"Quintessence Int."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Abualsaud, R., Abussaud, M., Assudmi, Y., Aljoaib, G., Khaled, A., Alalawi, H., Akhtar, S., Matin, A., and Gad, M.M. (2022). Physiomechanical and Surface Characteristics of 3D-Printed Zirconia: An In Vitro Study. Materials, 15.","DOI":"10.3390\/ma15196988"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.jmbbm.2017.08.018","article-title":"3D-printing zirconia implants; a dream or a reality? An in-vitro study evaluating the dimensional accuracy, surface topography and mechanical properties of printed zirconia implant and discs","volume":"75","author":"Osman","year":"2017","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1111\/jerd.12535","article-title":"The potential of additive manufacturing technologies and their processing parameters for the fabrication of all-ceramic crowns: A review","volume":"32","author":"Methani","year":"2020","journal-title":"J. Esthet. Restor. Dent."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Nakai, H., Inokoshi, M., Nozaki, K., Komatsu, K., Kamijo, S., Liu, H., Shimizubata, M., Minakuchi, S., Van Meerbeek, B., and Vleugels, J. (2021). Additively manufactured zirconia for dental applications. Materials, 14.","DOI":"10.3390\/ma14133694"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"843","DOI":"10.11607\/prd.2448","article-title":"Failure Probability of Three Designs of Zirconia Crowns","volume":"35","author":"Ramos","year":"2015","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.bioactmat.2019.12.003","article-title":"Photo-curing 3D printing technique and its challenges","volume":"5","author":"Quan","year":"2020","journal-title":"Bioact. Mater."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1016\/j.prosdent.2019.09.018","article-title":"Internal and marginal discrepancies associated with stereolithography (SLA) additively manufactured zirconia crowns","volume":"124","author":"Methani","year":"2020","journal-title":"J. Prosthet. Dent."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.jmbbm.2016.04.014","article-title":"In vitro analysis of the fracture resistance of CAD\u2013CAM monolithic zirconia molar crowns with different occlusal thickness","volume":"61","author":"Sorrentino","year":"2016","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Kontonasaki, E., Rigos, A.E., Ilia, C., and Istantsos, T. (2019). Monolithic Zirconia: An Update to Current Knowledge. Optical Properties, Wear, and Clinical Performance. Dent. J., 7.","DOI":"10.3390\/dj7030090"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1016\/j.prosdent.2014.05.002","article-title":"Clinical outcomes of three different crown systems with CAD\/CAM technology","volume":"112","author":"Batson","year":"2014","journal-title":"J. Prosthet. Dent."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Konstantinidis, I., Trikka, D., Gasparatos, S., and Mitsias, M. (2018). Clinical Outcomes of Monolithic Zirconia Crowns with CAD\/CAM Technology. A 1-Year Follow-Up Prospective Clinical Study of 65 Patients. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15112523"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e17385","DOI":"10.1097\/MD.0000000000017385","article-title":"Clinical evaluation of monolithic zirconia crowns for posterior teeth restorations","volume":"98","author":"Tang","year":"2019","journal-title":"Medicine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"124","DOI":"10.11607\/ijp.5444","article-title":"Clinical Evaluation of Monolithic Zirconia Crowns: A Short-Term Pilot Report","volume":"31","author":"Kitaoka","year":"2018","journal-title":"Int. J. Prosthodont."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.jdent.2018.01.013","article-title":"Monolithic zirconia crowns in the aesthetic zone in heavy grinders with severe tooth wear\u2014An observational case-series","volume":"72","author":"Hansen","year":"2018","journal-title":"J. Dent."},{"key":"ref_25","first-page":"459","article-title":"Monolithic zirconia reconstructions supported by teeth and implants: 1- to 3-year results of a case series","volume":"48","author":"Worni","year":"2017","journal-title":"Quintessence Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"154","DOI":"10.2334\/josnusd.17-0176","article-title":"Retrospective clinical evaluation of posterior monolithic zirconia restorations after 1 to 3.5 years of clinical service","volume":"60","author":"Gunge","year":"2018","journal-title":"J. Oral Sci."},{"key":"ref_27","first-page":"225","article-title":"Clinical performance of CAD\/CAM-fabricated monolithic zirconia endocrowns on molars with extensive coronal loss of substance","volume":"21","author":"Zou","year":"2018","journal-title":"Int. J. Comput. Dent."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1177\/0022034515608187","article-title":"Fracture Rates and Lifetime Estimations of CAD\/CAM All-ceramic Restorations","volume":"95","author":"Belli","year":"2016","journal-title":"J. Dent. Res."},{"key":"ref_29","unstructured":"Shillingburg, H.T., Sather, D.A., Wilson, E.L., Cain, J.R., Mitchell, D.L., Blanco, L.J., and Kessler, J.C. (2012). Fundamentals of Fixed Prosthodontics, Quintessence Publishing Co., Ltd.. [4th ed.]."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1111\/j.1365-2842.2007.01824.x","article-title":"Prosthetic treatment planning on the basis of scientific evidence","volume":"35","author":"Pjetursson","year":"2008","journal-title":"J. Oral Rehabil."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"102","DOI":"10.3109\/00016357.2011.654248","article-title":"Two-body wear of monolithic, veneered and glazed zirconia and their corresponding enamel antagonists","volume":"71","author":"Stawarczyk","year":"2013","journal-title":"Acta Odontol. Scand."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1007\/s00784-011-0589-9","article-title":"Two-body wear of dental porcelain and substructure oxide ceramics","volume":"16","author":"Rosentritt","year":"2012","journal-title":"Clin. Oral Investig."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1016\/j.dental.2011.04.003","article-title":"Effect of the microstructure on the lifetime of dental ceramics","volume":"27","author":"Borba","year":"2011","journal-title":"Dent. Mater."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.dental.2010.10.025","article-title":"Slow crack growth and reliability of dental ceramics","volume":"27","author":"Gonzaga","year":"2011","journal-title":"Dent. Mater."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1002\/jbm.10468","article-title":"Lifetime prediction of CAD\/CAM dental ceramics","volume":"63","author":"Lohbauer","year":"2002","journal-title":"J. Biomed. Mater. Res."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Sayed, M.E., Dewan, H., Kharaf, R., Athlawi, M., Alfaifi, M., Mugri, M.H., Bosly, R.A.-A., Fageehi, N.Y., Hadi, M., and Zurbtan, B.J. (2022). Efficacy of Three Commercially Available Desensitizers in Reducing Post-Operative Sensitivity Following Composite Restorations: A Randomized Controlled Clinical Trial. Polymers, 14.","DOI":"10.3390\/polym14071417"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1016\/j.dental.2007.08.001","article-title":"Analysis of subcritical crack growth in dental ceramics using fracture mechanics and fractography","volume":"24","author":"Taskonak","year":"2008","journal-title":"Dent. Mater."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1016\/j.actbio.2010.09.020","article-title":"Low temperature degradation of a Y-TZP dental ceramic","volume":"7","author":"Scherrer","year":"2011","journal-title":"Acta Biomater."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.jmbbm.2015.03.007","article-title":"The influence of low-temperature degradation and cyclic loading on the fracture resistance of monolithic zirconia molar crowns","volume":"47","author":"Nakamura","year":"2015","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1111\/joor.12205","article-title":"A systematic review of CAD\/CAM fit restoration evaluations","volume":"41","author":"Boitelle","year":"2014","journal-title":"J. Oral Rehabil."},{"key":"ref_41","first-page":"162","article-title":"A retrospective evaluation of zirconia-fixed partial dentures in general practices: An up to 13-year study","volume":"31","author":"Gunne","year":"2015","journal-title":"Dent. Mater. Off. Publ. Acad. Dent. Mat."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.jpor.2013.09.001","article-title":"Current status of zirconia restoration","volume":"57","author":"Miyazaki","year":"2013","journal-title":"J. Prosthodont. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"68","DOI":"10.11607\/prd.3519","article-title":"Clinical Performance of CAD\/CAM Tooth-Supported Ceramic Restorations: A Systematic Review","volume":"38","author":"Carvalho","year":"2018","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Nedelcu, R., Olsson, P., Nystr\u00f6m, I., and Thor, A. (2018). Finish line distinctness and accuracy in 7 intraoral scanners versus conventional impression: An in vitro descriptive comparison. BMC Oral Health, 18.","DOI":"10.1186\/s12903-018-0489-3"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"5325032","DOI":"10.1155\/2018\/5325032","article-title":"Digital versus Analog Procedures for the Prosthetic Restoration of Single Implants: A Randomized Controlled Trial with 1 Year of Follow-Up","volume":"2018","author":"Mangano","year":"2018","journal-title":"BioMed Res. Int."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.adaj.2019.12.013","article-title":"Zirconia-ceramic versus metal-ceramic posterior multiunit tooth-supported fixed dental prostheses: A systematic review and meta analysis of randomized controlled trials","volume":"151","author":"Limones","year":"2020","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/j.dental.2015.02.011","article-title":"All-ceramic or metal-ceramic tooth-supported fixed dental prostheses (FDPs)? A systematic review of the survival and complication rates. Part I: Single crowns (SCs)","volume":"3","author":"Sailer","year":"2015","journal-title":"Dent. Mater."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"482","DOI":"10.3109\/00016357.2012.696690","article-title":"Influence of surface treatment on the wear of solid zirconia","volume":"71","author":"Kontos","year":"2013","journal-title":"Acta Odontol. Scand."},{"key":"ref_49","first-page":"147","article-title":"Clinical performance of chairside CAD\/CAM feldspathic ceramic posterior shoulder crowns and endocrowns up to 12 years","volume":"18","author":"Otto","year":"2015","journal-title":"Int. J. Comput. Dent."}],"container-title":["Biomimetics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2313-7673\/8\/5\/394\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:40:13Z","timestamp":1760128813000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2313-7673\/8\/5\/394"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,27]]},"references-count":49,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["biomimetics8050394"],"URL":"https:\/\/doi.org\/10.3390\/biomimetics8050394","relation":{},"ISSN":["2313-7673"],"issn-type":[{"value":"2313-7673","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,27]]}}}