Porcelain fracture of metal-ceramic tooth-supported and implant-supported restorations: A review

Metal-ceramic restorations are widely used in dentistry with a high degree of general success. However, fracture of these restorations does occur and usually frustrates both the dentist and the patient. Objective: This literature review discusses the factors that may lead to the fracture of these restorations whether they are tooth-supported or implant-supported with the aim of making dentists and technicians aware of these factors to avoid them. Factors reviewed include: technical factors, dentist-related factors, inherent material properties, direction, magnitude and frequency of applied loads, environmental factors, screw-retained implant-supported restorations, and posterior cantilevered prostheses. Material and Methods: A netbased search in “Pubmed” was performed and combined with a manual search. The search was limited to articles written in English. Conclusions: the published literature revealed that the factors predisposing to fracture of metal-ceramic restorations may be related to the technician, dentist, patient, environment, design of the restoration, or to inherent structure of ceramics and others. However, if the dentist and technician understand these factors and respect the physical characteristics of the materials, most of those are avoidable.