Ceramic Dental Restorations And Sleep Bruxism: Failure Rates And Clinical Implications: A Systematic Review And Meta-Analysis

Abstract

Background

Sleep bruxism is a common sleep-related movement disorder associated with excessive occlusal loading, which may adversely affect the longevity of ceramic dental restorations. Despite advances in ceramic materials, the influence of sleep bruxism on restoration failure remains uncertain, with conflicting evidence reported in the literature.

Objective

To systematically evaluate the failure rates of ceramic dental restorations in patients with sleep bruxism and to assess material-specific performance and clinical implications.

Methods

A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines, with protocol registration in PROSPERO (CRD42024562089). Electronic searches of PubMed, Cochrane Library, Embase, Scopus, and Web of Science were performed up to June 2024. Clinical and observational studies assessing ceramic restoration outcomes in sleep bruxism patients were included. Risk of bias was evaluated using ROBIS and Cochrane RoB 2 tools as appropriate. A random-effects meta-analysis was conducted to estimate pooled effect sizes.

Results

Eight studies met the inclusion criteria for qualitative synthesis, with five contributing to quantitative analysis. The pooled odds ratio demonstrated a modest but statistically significant association between sleep bruxism and ceramic restoration failure, with moderate heterogeneity (I² ≈ 50%). Zirconia-based restorations consistently showed superior survival compared with veneered ceramics and lithium disilicate, particularly under parafunctional loading. Evidence regarding the protective role of adjunctive measures such as occlusal splints was limited and inconsistent.

Conclusion

Sleep bruxism is associated with an increased risk of ceramic restoration failure, particularly for veneered and esthetically driven restorations. High-strength ceramics such as monolithic zirconia appear more suitable for bruxism patients. Standardized diagnostic criteria and long-term randomized trials are required to strengthen clinical guidelines.