BACKGROUND: The authors conducted a comprehensive literature review to compile and compare clinical evidence for the treatment of teeth using all-ceramic restorations. TYPES OF STUDIES REVIEWED: The authors searched the English-language peer-reviewed literature using MEDLINE and PubMed with a focus on research published between 1993 and 2008. They also conducted a hand search of relevant dental journals. They reviewed randomized controlled trials, nonrandomized controlled studies, longitudinal experimental clinical studies, longitudinal prospective studies and longitudinal retrospective studies. RESULTS: Evidence suggests that for veneers, intracoronal restorations and complete-coverage restorations for single-rooted anterior teeth, clinicians may choose from any all-ceramic system on the basis of esthetic needs (many systems have had greater than 90 percent success at six years). Well-studied molar restorations include those made of alumina and, increasingly, zirconia and bonded lithium disilicate. Reasonable evidence has shown the effectiveness of anterior three-unit fixed partial dentures made of lithium disilicate, alumina and zirconia. For three-unit restorations involving a molar, expert consensus suggests that only zirconia-based systems are indicated. CLINICAL IMPLICATIONS: Available evidence indicates the effectiveness of many all-ceramic systems for numerous clinical applications. Bonding has been shown to increase clinical success. Studies of zirconia prostheses indicate problems with porcelain cracking.