Zirconia showdown: Are tooth-supported crowns cracking or slipping away?

Zirconia is commonly used for fixed partial dentures and single crowns owing to its attractive appearance, robust mechanical strength, and exceptional biocompatibility. Nonetheless, its long-term clinical performance can be challenged by technical issues. This review consolidates evidence from systematic reviews, meta-analyses, and clinical studies published in PubMed between 2014 and 2024 to determine whether zirconia crown restorations are more likely to fail due to fracture, chipping or loss of retention. A narrative evaluation of systematic reviews, meta-analyses, and retrospective investigations was conducted. Nine PubMed-indexed studies were analyzed, including those focusing on veneered zirconia, monolithic zirconia (MZ), and comparisons with metal-ceramic prostheses. Veneered zirconia consistently showed a greater frequency of veneer fractures compared with metal-ceramic prostheses, ranging between 6% and 24% over 3–5 years. Catastrophic framework fractures were rare (<1%). MZ restorations demonstrated superior outcomes, with survival exceeding 90% after 5 years and minimal chipping events. Loss of retention occurred less often than fractures but was influenced by preparation form and cement type. Retrospective studies with up to 9 years of follow-up confirmed survival rates above 90%, though long-term success diminished due to cumulative complications. Zirconia crown restorations over teeth are more prone to fracture or veneer chipping than debonding, particularly in veneered fixed dental prostheses. MZ substantially reduces these complications and demonstrates promising medium-term outcomes. Although less common, loss of retention remains clinically significant. Evidence beyond 10 years is limited and needed for validation.