ABSTRACT
OBJECTIVES: This study aimed to investigate the clinical performance of zirconia-based fixed dental prostheses (FDPs) in comparison to metal-ceramic (MC) FDPs. METHODS: A comprehensive search on MEDLINE (PubMed), Web of Science (Core Collection), Scopus up to June 2024 was conducted. Studies that compared the success, survival and complication rates between zirconia based FDPs and MC FDPs were eligible for inclusion. RESULTS: Thirty-one articles were identified, of which 22 were included for systematic review and 7 RCTs were included for meta-analysis. 10, 9 and 3 studies were classified to mean follow-up ≤ 5 years, 5 years < mean Follow-up ≤ 10 years, mean Follow-up >10 years, respectively. In the pooled analysis, 180 bilaminar zirconia (ZC) FDPs and 206 MC FDPs were included. ZC FDPs were significantly associated with more failures (RR=3.64, p=0.009) and more Ceramic Chipping (RR=2.92, p<0.0001) when compared to MC FDPs. Higher risks of Framework Fracture (RR=4.57, p=0.18), Loss of Retention (RR=4.79, p=0.17), Secondary Caries (RR=1.25, p=0.68), Endodontic complications (RR=1.30, p=0.74) and Marginal Integrity (RR=1.07, p=0.88) were also found in ZC FDPs when compared to those of MC FDPs, but with no statistical difference. CONCLUSION: The current evidence continues to support the preference for traditional MC FDPs over ZC FDPs. Studies indicate that ZC FDPs have higher failure rates and more complications compared to MC FDPs, with ceramic chipping being a significant concern. There is lack of long term (>10 years follow-up) evidence of the clinical performance of ZC FDPs and monolithic zirconia FDPs. CLINICAL SIGNIFICANCE: The study suggests that despite the growing popularity of zirconia, evidence shows MC FDPs may still be considered preferable to ZC FDPs.
ABSTRACT
OBJECTIVE: To explore and analyse the perspective of patients undergoing and recovering from nasopharyngeal carcinoma (NPC) therapy. METHODS: Thirty-three NPC patients at different stages of treatment were enroled. Seven were actively undergoing treatment, 13 were immediately post-treatment, and 13 were long-term. Patients were interviewed using a structured questionnaire based on a review of the literature that covered different phases of their treatment journey. The interview was recorded and transcribed for qualitative data analysis using a thematic inductive-deductive approach. RESULTS: Three main domains embracing aspects of NPC patients' experiences were identified; side effects, psychosocial well-being, and the role and support of healthcare workers. Side effects were experienced orally, locally, and systemically. Oral side effects (oral mucositis, xerostomia, altered taste, dysphagia) were the most significant challenge experienced by NPC patients. Locally, skin injury (desquamation, fibrosis, darkening of the skin, erythema, pruritus, and swelling around the neck region) and hair loss, resolved after cessation of therapy. Systemic side effects from the treatment were related to general weakness, weight loss and nausea. The psychosocial well-being of NPC patients was influenced by a range of issues including support (healthcare workers and family), pain management, functional limitations, nutritional needs, perceived level of information, emotion, and finances. CONCLUSION: NPC patients were significantly impacted based on the diagnosis, treatment and recovery phase affecting them locally, systemically, and psychologically. The role of family and healthcare staff was also influential in the overall treatment experience, and they have key roles to play in facilitating patients along their treatment journey. CLINICAL SIGNIFICANCE: Oral and general side effects from NPC treatment have significant impact on patients physical and emotional well-being. It is important for healthcare providers to have insights of these so as to understand and support patients during their treatment journey and recovery and be able to empathetically facilitate their clinical management.