***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study prospect ively evaluated the clinical performance of computer-assisted design and computer-assisted manufacturing (CAD/CAM)-generated In-Ceram Alumina core crowns in Japanese patients for up to 5 years . A total of 101 In-Ceram crowns with aluminium copings fabricated using the GN-I system were placed in Japanese patients . The crowns were evaluated using a California Dental Association ( CDA ) quality assessment system at baseline and at all follow-up examinations . Gingival condition was assessed using plaque and bleeding scores . The survival of anterior and posterior crowns was analysed according to the Kaplan-Meier method . The scores of gingival condition were compared between restored crowns and contralateral teeth using a t-test . During the observation period , six crowns were lost to follow-up . Five crowns were fractured from the copings and removed , and four crowns were removed for other reasons . Chipping within the porcelain was detected in three crowns , which were then polished . The cumulative survival rates after 60 months were 96·9 % for anterior crowns and 87·7 % for posterior ones , and there were no significant differences between anterior and posterior crowns . According to the CDA criteria , most of the crowns were rated as satisfactory during the observation period . There were significant differences in soft tissue conditions between In-Ceram crowns and control teeth at 2- and 5-year examinations . Despite the five fractures from copings , In-Ceram Alumina crowns with copings fabricated using the CAD/CAM ( GN-I system ) for replacing both anterior and posterior teeth showed predictable results during a 5-year observation period Objectives The purpose of this prospect i ve study was to evaluate the clinical outcome of  anterior and posterior crowns made of a lithium-disilicate glass – ceramic framework material ( IPS e.max Press , Ivoclar Vivadent ) . Material s and methods A total of 104 single crowns were placed in 41 patients ( mean age , 34 ± 9.6 years ; 15 male , 26 female ) . Eighty-two anterior and 22 posterior crowns were inserted . All teeth received a 1-mm-wide chamfer or rounded shoulder preparation with an occlusal/incisal reduction of 1.5–2.0 mm . The minimum framework thickness was 0.8 mm . Frameworks were laminated by a prototype of a veneering material combined with an experimental glaze . Considering the individual abutment preconditions , the examined crowns were either adhesively luted ( 69.2 % ) or inserted with glass – ionomer cement ( 30.8 % ) . Follow-up appointments were performed 6 months after insertion , then annually . Replacement of a restoration was defined as failure . Results Four patients ( 10 crowns ) were defined as dropouts . For the remaining 94 crowns , the mean observation time was 79.5 months ( range , 34–109.7 months ) . The cumulative survival rate according to Kaplan – Meier was 97.4 % after 5 years and 94.8 % after 8 years . Applying log rank test , it was shown that the location of the crown did not significantly have an impact on the survival rate ( p = 0.74 ) and that the cementation mode did not significantly influence the occurrence of complications ( p = 0.17 ) . Conclusions The application of lithium-disilicate framework material for single crowns seems to be a reliable treatment option . Clinical relevance Crowns made of a lithium-disilicate framework material can be used clinical ly in the anterior and posterior region irrespective of an adhesive or conventional cementation when considering abutment preconditions PURPOSE This study aim ed to prospect ively analyze the outcomes of 304 feldspathic porcelain veneers  prepared by the same operator , in 100 patients , that were in situ for up to 16 years . MATERIAL S AND METHODS A total of 304 porcelain veneers on incisors , canines , and premolars in 100 patients completed by one prosthodontist between 1988 and 2003 were sequentially included . Preparations were design ed with chamfer margins , incisal reduction , and palatal overlap . At least 80 % of each preparation was in enamel . Feldspathic porcelain veneers from refractory dies were etched ( hydrofluoric acid ) , silanated , and cemented ( Vision 2 , Mirage Dental Systems ) . Outcomes were expressed as percentages ( success , survival , unknown , dead , repair , failure ) . The results were statistically analyzed using the chi-square test and Kaplan-Meier survival estimation . Statistical significance was set at P < .05 . RESULTS The cumulative survival for veneers was 96 % + /- 1 % at 5 to 6 years , 93 % + /- 2 % at 10 to 11 years , 91 % + /- 3 % at 12 to 13 years , and 73 % + /- 16 % at 15 to 16 years . The marked drop in survival between 13 and 16 years was the result of the death of 1 patient and the low number of veneers in that period . The cumulative survival was greater when different statistical methods were employed . Sixteen veneers in 14 patients failed . Failed veneers were associated with esthetics ( 31 % ) , mechanical complications ( 31 % ) , periodontal support ( 12.5 % ) , loss of retention > 2 ( 12.5 % ) , caries ( 6 % ) , and tooth fracture ( 6 % ) . Statistically significantly fewer veneers survived as the time in situ increased . CONCLUSIONS Feldspathic porcelain veneers , when bonded to enamel substrate , offer a predictable long-term restoration with a low failure rate . The statistical methods used to calculate the cumulative survival can markedly affect the apparent outcome and thus should be clearly defined in outcome studies The aim of this prospect i ve clinical study was to investigate the long-term survival of Procera AllCeram all-ceramic crowns in the anterior and posterior regions . Between 1997 and 2005 , 155 Procera crowns with aluminum oxide cores were placed in 50 patients . Patients were recalled in 2005 for a clinical assessment . Thirty-nine patients with 135 crowns attended the recall examination . Of the 135 total crowns , 103 were located in the posterior region and 32 were located in the anterior region . The cumulative survival rate was 100 % in the anterior region and 98.8 % in the posterior region ( 1 crown fracture ) after 5 and 7 years . Clinical success was achieved irrespective of the tooth position , cement used ( resin composite or glass-ionomer cement ) , or the core design with reduced or conventional margins . Procera AllCeram seems to be a predictable technique for esthetic all-ceramic single crown restorations in the anterior and posterior regions OBJECTIVE Ceramic inlays and onlays are a tooth colored alternative to metallic restorations . Clinical long-term data are scarce though , especially about inlays and onlays having proximal margins in dentin . The present prospect i ve controlled clinical study evaluated the clinical performance of IPS Empress inlays and onlays with cuspal replacements and proximal margins below the cementoenamel junction over eight years . METHODS Ninety six ceramic restorations were placed in 34 patients by six dentists . The restorations were bonded with an enamel/dentin bonding system ( Syntac Classic ) and four different resin composite systems . The restorations were assessed after placement by two calibrated investigators using modified USPHS codes and criteria at the following time periods : baseline , 1,2,4,6 and 8 years . RESULTS Eight of the 96 restorations investigated had to be replaced ( failure rate 8 % ; Kaplan-Meier ) : Six inlays suffered cohesive bulk fractures , two teeth required endodontic treatment . After eight years of clinical service , significant deterioration ( Friedman 2-way ANOVA ; P < 0.05 ) was found for marginal adaptation of the remaining restorations . 98 % of the surviving restorations exhibited marginal deficiencies , independent of the luting composite . CONCLUSIONS IPS Empress inlays and onlays demonstrated to be successful even in large defects . Neither the absence of enamel margins , nor cuspal replacement significantly affected the quality of the restorations Procera AllCeram crowns were prospect ively evaluated clinical ly in both anterior and posterior regions in Japanese . One-hundred and one crowns were fabricated for 57 patients at the Tsurumi University Dental Hospital from August 2001 to October 2002 and evaluated according to the California Dental Association ( CDA ) quality evaluation system at baseline and annually at all follow-up examinations for 5 years . The plaque index ( PI ) and gingival index ( GI ) were recorded , and chipping and fracture were checked at the same time as well . A total of 75 Procera AllCeram crowns were evaluated , and the cumulative survival rate was 90.2 % over the 5-year clinical trial . Six crowns experienced fractures within the veneering porcelain and from aluminium oxide coping , all of which occurred on the premolar and molar regions , and they had to be removed . Small chipping was observed on three crowns . According to the CDA criteria , 98 % of Procera AllCeram crowns were rated as satisfactory , and PI and GI were comparable to those of control teeth during the observation period PURPOSE The aim of this prospect i ve study was to evaluate the clinical efficacy and long-term survival rate of  three-unit fixed partial dentures ( FPDs ) made from lithium disilicate-based core ceramic . MATERIAL S AND METHODS Twenty-one three-unit FPDs were placed in 19 patients to replace single lost teeth in the esthetic area , following a study protocol that took clinical , esthetic , and radiologic aspects into consideration . Each case was review ed at 1 week following placement , at 6 months , and then annually for 10 years . Statistical analysis was performed using Kaplan-Meier survival analysis . RESULTS Out of the 19 patients , 14.3 % presented reversible postoperative sensitivity . Recession was observed in 24 % of dental posts , and 7.1 % presented marginal discoloration . Treatment did not increase either Bleeding or Plaque Index scores at prepared teeth ; secondary caries did not appear either . The restorations ' survival rate at the 10-year follow-up was 71.4 % ; six FPDs had fractured and one debonded . CONCLUSIONS Fracture failure rate was 28.6 % after 10 years ; a high percentage corresponded to connector fractures and occurred during the first 5 years . Lithium disilicate glass-ceramic FPDs present a higher risk of fracture than st and ard therapies ( metal-ceramic ) or other more recently developed ceramic material s. The prognosis for survival improves for Class I occlusion and nonparafunctional patients The purpose of this prospect i ve cohort study was to assess the performance of tooth-supported ,  long-span , zirconia fixed dental prostheses ( FDPs ) . Thirty FDPs with span lengths from 36 to 46 mm ( mean 40·33 mm ) , with 4 - 7 units and with connector dimensions ∼9 mm(2 ) were inserted ( 19 in the posterior region , 11 including anterior teeth ) using glass-ionomer cement .  The performance of the FDPs was assessed ( aesthetic evaluation , failures , hypersensitivity/tooth vitality , secondary caries , pocket depth , decementation , and chipping ) at baseline and after 5 years . Cox regression analysis was performed to identify risk factors . There were 16 failures after 5 years . Framework fracture occurred for two FDPs , four FDPs had to be re-cemented , one abutment tooth had to be treated endodontically , one abutment tooth fractured and cohesive failure of the veneer occurred for eight . Four FDPs had to be replaced , so survival was 82 % . The aesthetics were rated as excellent by the patients at baseline and good at the 5-year recall . Cox regression analysis showed that both length [ P = 0·05 , exp(B ) = 1·22 ] and location [ P = 0·019 , exp(B ) = 4·09 ] of the FDP were risk factors for failure . Compared with the previously published 2-year results , the incidence of complications increased dramatically . Additionally , it was shown that long-span FDPs in the molar region are at greater risk of failure than FDPs in the anterior region PURPOSE The aim of the present study was to clinical ly evaluate the effect of two different adhesive/resin composite combinations for luting IPS Empress inlays with a special focus on luting gap wear and marginal adaptation . MATERIAL S AND METHODS In the course of a controlled prospect i ve clinical split-mouth study , 94 IPS Empress restorations were placed in 31 patients . The inlays were luted with EBS Multi + Compolute ( EC ; 3 M ESPE ) or with Syntac + Variolink II low ( SV ; Ivoclar Vivadent ) . At baseline and after 0.5 , 1 , 2 , 4 , and 8 years , the ceramic restorations were examined according to modified USPHS codes and criteria . Thirty-five selected sample s were investigated under an SEM regarding morphological changes ; marginal quality analysis was carried out using a stereo light microscope , and luting composite wear was scanned with a profilometer . RESULTS Eight patients ( including 25 restorations ) missed the recalls ; the recall rate at the last investigation was 72 % . After 96 months of clinical service , seven restorations in five patients ( six 
    Output:
    
Overall , the 5-year complication rates were low .
The most frequent complications were secondary caries , endodontic problems , ceramic fractures , ceramic chipping , and loss of retention .
CONCLUSION This systematic review showed that  all-ceramic restorations  fabricated using the correct clinical protocol have an adequate clinical survival for at least 5 years of clinical service with very low complication rates .
Minor ceramic chipping and debonding did not affect the longevity of the restorations .
CLINICAL RELEVANCE Long-term clinical performance of all-ceramic restorations manufactured using various ceramic systems provides clinical evidence of complications and long-term management of these restorations .
Available evidence indicates the effectiveness of many ceramic systems for numerous clinical applications .
Correct planning and a rigorous technical execution protocol increase clinical success .
Studies of ceramic prostheses indicate more problems with ceramic failure and debonding