Volume 6, Issue 4

Background. Monolithic zirconia and lithium disilicate are the materials most widely used for single crowns made with digital workflows, but their long-term clinical performance has rarely been compared. Objective. To compare the 5-year survival and complication rates of tooth-supported monolithic zirconia and lithium disilicate single crowns. Methods. MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and Web of Science were searched from January 2008 to December 2025 for randomized trials and prospective cohort studies with a mean follow-up of at least 4 years. Risk of bias was assessed with RoB 2 and the Newcastle–Ottawa Scale. Five-year survival and complication rates were estimated with random-effects Poisson regression, and trials comparing the two materials directly were pooled as risk ratios. Results. Eight studies (three randomized trials and five prospective cohort studies) reporting on 1,277 crowns in 926 patients were included. Estimated 5-year survival was 97.5% (95% CI 95.9–98.5) for monolithic zirconia and 96.6% (95% CI 95.0–97.6) for lithium disilicate (p = 0.31). In the randomized trials, the risk of failure did not differ between materials (risk ratio 1.44, 95% CI 0.47–4.42; I² = 0%). Ceramic fracture was more frequent with lithium disilicate (1.5% vs 0.3%; p = 0.044), whereas loss of retention was more frequent with monolithic zirconia (2.3% vs 0.8%; p = 0.024). Conclusions. Both materials show high and comparable 5-year survival as single crowns. Their different complication profiles, rather than survival, should guide material selection and cementation, although the certainty of the evidence is low.