Zirconia, e.max or PFM for a single implant crown?

Which material lasts longest as a single implant crown?

None of the three stands out on survival as a single implant crown. The systematic review by Pjetursson and colleagues behind the 2018 ITI consensus estimated five-year survival at 98.3% for metal-ceramic crowns (4,363 crowns). Veneered zirconia crowns came in at 97.6% (912 crowns).

For monolithic ceramics, the same group’s 2021 update estimated three-year survival at 97.0% for monolithic reinforced glass-ceramics, the group that includes lithium disilicate, and 96.1% for monolithic zirconia. Apart from resin-matrix ceramics, none of the differences between materials reached statistical significance.

These figures come from reviews with different follow-up, from one to five years, and no study has followed all three materials in the same patients for long. The choice is yours, case by case.

Which chips less on an implant: zirconia or metal-ceramic?

Monolithic zirconia chips less than metal-ceramic on posterior implant crowns. In the meta-analysis of randomized controlled trials by Tajti and colleagues (The Journal of Prosthetic Dentistry, 2024), one-year chipping was 0% for monolithic zirconia and 7.61% for metal-ceramic. Marginal bone loss, bleeding on probing and implant failure did not differ.

Add veneering porcelain and the advantage disappears. In the 2018 review, veneered zirconia and metal-ceramic chipped at the same rate, and zirconia had more core fractures. The 2018 ITI consensus put it this way: similar clinical performance, different complications.

The evidence for monolithic zirconia is still short. The trials in the 2024 meta-analysis ran for one year, and the 2018 review found no monolithic implant crown study with three years of follow-up. Our article on monolithic vs layered vs multilayer zirconia vs e.max has the annual chipping rates.

Can you put an e.max crown on an implant?

An e.max implant crown is possible within the manufacturer’s indications. For IPS e.max CAD, Ivoclar lists implant-supported single-tooth restorations as hybrid abutments and screw-retained hybrid abutment crowns, anterior and posterior, covered by a separate instructions for use. A 1 mm minimally invasive crown on an implant is outside the indications.

The same instructions list bruxism as a contraindication for the material. In the clinical studies pooled in 2021, monolithic reinforced glass-ceramics reached three-year survival close to monolithic zirconia, with no statistical difference. Strength, minimum thickness and cementation are compared in our zirconia vs e.max article.

Screw-retained on a Ti-base: what changes?

On a screw-retained crown over a Ti-base, the ceramic, zirconia or lithium disilicate, becomes one piece with the titanium base and is screwed into the implant. In the review by Chantler and colleagues (Clinical Oral Implants Research, 2023), 857 single implant restorations on Ti-bases had 98.6% survival at one year, with a mean follow-up of 31 months.

Zhang and colleagues (Journal of Prosthodontic Research, 2024) pooled 20 studies of hybrid abutment crowns: 100% one-year survival and complications below 1%, with no difference against cemented crowns in direct comparisons. The authors call for studies of five years or more.

Retention is a separate decision from material. Our article on screw- vs cement-retained implant crowns covers access position and margin depth.

In the anterior, what should drive the material choice?

For an anterior implant crown, esthetics drives the choice, because survival didn’t change with position in the arch. In the 2021 review, anterior or posterior position made no difference to survival or chipping of ceramic implant crowns. In the 2018 review, zirconia had fewer esthetic complications than metal-ceramic.

For the lab, the anterior comes down to shade information: the Vita shade, a photo with the tab held against the adjacent tooth, and the substrate color. Our guide on how to communicate shade shows how to send each one.

What if the patient is a bruxer?

Bruxism weighs on implant prosthesis failure whatever the material. Barboza and colleagues (The Journal of Prosthetic Dentistry, 2026) pooled eight systematic reviews in an umbrella review. The more recent ones flag bruxism as a major risk factor; in one, failure was 4.68 times more likely in bruxers.

Ivoclar lists bruxism as a contraindication for IPS e.max CAD. If the patient grinds or clenches, put it on the Rx: it changes the conversation about material, thickness and design before milling.

What should go on the lab Rx?

For a single implant crown, the Rx needs the material, the retention, the implant system, the shade and any sign of bruxism. Without them, the lab can’t pick the disc or the component, and the case is held at check-in. Include:

• the material (monolithic zirconia, e.max or metal-ceramic) and whether you accept another if space is short;
• screw-retained on a Ti-base or cemented on an abutment;
• implant brand, model and platform;
• the Vita shade and, for anterior sites, a photo with the shade tab;
• bruxism or a previous porcelain fracture in the same patient.

Smile Digital Lab, a digital dental lab in São Paulo, Brazil, makes the zirconia implant crown in Aidite zirconia and the metal-ceramic implant coping. Our e.max is IPS e.max CAD, made in-house; an e.max crown on an implant is agreed when the case is opened. We use Neodent and Titaniumfix components, both made in Brazil.

We check every case when it arrives and on eight points before it ships, and every stage is logged. Our other implant restorations are on the implant restorations page.