Fracture-surface analysis of dental ceramics

How and when does fabrication damage adversely affect the clinical performance of ceramic restorations?

OBJECTIVES

As compared to factory-processed ceramic parts, one unique trait of all-ceramic dental restorations is that they are custom-fabricated, which implies a greater susceptibility to fabrication defects. A variety of processing techniques is now available for the custom fabrication of all-ceramic single and multi-unit restorations, these include sintering, heat-pressing, slip-casting, hard machining and soft machining, all in combination with a final staining or veneering step. All these fabrication techniques, from shaping to firing, are associated with the production of flaws of various shapes and sizes, in conjunction with thermal residual stresses, all of which are capable of inducing failure.

METHODS

This review will examine the various types of fabrication damage inherent to each technique and attempt to establish a relationship between fabrication defects and clinical performance of all-ceramic dental restorations with particular attention to their longevity in vivo.

RESULTS

Failure mechanisms in dental ceramics can be very complex and often involve the combination of physical factors, to which are added patient and clinician-related variables such as restoration design and in vivo conditions.

SIGNIFICANCE

Tremendous progress has been made in understanding the failure mechanisms of all-ceramic dental restorations over the past thirty years. It remains that there is still a need for laboratory tests that usefully simulate clinical conditions.

Failure morphology of all-ceramic prostheses

The aim of this study is to investigate the internal morphology of all-ceramic prostheses before seating. Micro X-ray CT was used to inspect three dimensionally the locations and sizes of pores within experimentally fabricated all-ceramic crowns as well as measure the veneer and core thickness. Scanning electron microscopy (SEM) was used to examine the fracture sites of clinically failed prostheses. Micro X-ray CT analysis revealed the distribution patterns of pores within the all-ceramic prostheses, and SEM fractographic analysis indicated a strong relationship between the existence of pores and crack propagation. Therefore, micro X-ray CT is a useful tool for nondestructive inspection of the internal morphology of all-ceramic prostheses to identify the critical defects before seating.

Fracture strength of three all-ceramic systems: Top-Ceram compared with IPS-Empress and In-Ceram

PURPOSE

The purpose of this study was to investigate the fracture loads and mode of failure of all-ceramic crowns fabricated using Top-Ceram and compare it with all-ceramic crowns fabricated from well-established systems: IPS-Empress II, In-Ceram.

MATERIALS AND METHODS

Thirty all-ceramic crowns were fabricated; 10 IPS-Empress II, 10 In-Ceram alumina and 10 Top-Ceram. Instron testing machine was used to measure the loads required to introduce fracture of each crown.

RESULTS

Mean fracture load for In-Ceram alumina [941.8 (± 221.66) N] was significantly (p > 0.05) higher than those of Top-Ceram and IPS-Empress II. There was no statistically significant difference between Top-Ceram and IPS-Empress II mean fracture loads; 696.20 (+222.20) and 534 (+110.84) N respectively. Core fracture pattern was highest seen in Top- Ceram specimens.

The all-ceramic, inlay supported fixed partial denture. Part 3. Experimental approach for validating the finite element analysis

In a previous study, the authors used a finite element analysis (FEA) to evaluate the stresses developed during the loading of an all-ceramic, inlay supported fixed partial denture and compared it with the more traditional full crown supported prosthesis. To date there has been little research into correlating the responses of the numerical model against physical mechanical tests; such validation analysis is crucial if the results from the FEA are to be confidently relied upon. This study reports on the experimental methods used to compare with the FEA and thereby to validate the predictive fracture behaviour of the numerical model. This study also outlines the methods for manufacture and testing of the ceramic structure along with observations of the fracture tests. In addition the procedure used for developing the FEA model for the test system is outlined.

In vitro performance of full-contour zirconia single crowns

OBJECTIVES

Zirconia based restorations exhibited high failure rates due to veneering-porcelain fractures. Milling to full-contour might be an alternative approach for zirconia restorations. The aim of this study was to evaluate full-contour zirconia crowns in terms of light-transmission, contact wear (restoration and antagonist) and load-bearing capacity. Powder build-up veneered zirconia substructures and CAD/CAM-veneered zirconia substructures served as controls.

METHODS

Four different kinds of crowns were fabricated on 12 metal dies: zirconia substructure with powder build-up porcelain (veneering technique), zirconia substructure with CAD/CAM generated veneering (sintering technique), full-contour zirconia glazed (glazed full-contour) and full-contour zirconia polished (polished full-contour). All crowns had the same dimensions. After light-transmission was measured the crowns were cemented on the corresponding metal dies. The specimens were loaded according to a special wear method in the chewing simulator (120,000 mechanical cycles, 5 kg load, 0.7 mm sliding movement, 320 thermocycles). Wear of the restoration and the antagonist were measured. All specimens were loaded until failure. One-way ANOVA and a LSD post-hoc test were used to compare data at a level of 5%.

RESULTS

Polished full-contour showed significantly higher light transmission than the other groups (p=0.003; ANOVA). Polished full-contour exhibited significantly less contact wear at the restoration (p=0.01; ANOVA) and higher contact wear at the antagonist (p=0.016; ANOVA) compared to the other groups. Glazed full-contour zirconia showed similar contact wear at the antagonist compared to veneering technique (p=0.513, post-hoc LSD). Crowns with conventional veneering showed significantly lower load-bearing capacity (p<0.001; ANOVA).

SIGNIFICANCE

Milling zirconia to full-contour with glazed surface might be an alternative to traditionally veneered restorations.

The all-ceramic, inlay supported fixed partial denture. Part 2. Fixed partial denture design: a finite element analysis

The clinical use of all-ceramic crowns and fixed partial dentures has seen widespread adoption over the past few years due to their increasing durability and longevity. However, the application of inlays as an abutment design has not been as readily embraced because of their relatively high failure rates. With the use of an idealized inlay preparation design and prosthesis form which better distributes the tensile stresses, it is possible to utilize the inlay as support for an all-ceramic fixed partial denture. Utilizing a three-dimensional finite element analysis, a direct comparison of the inlay supported all-ceramic bridge against the traditional full crown supported all-ceramic bridge is made. The results demonstrate that peak stresses in the inlay bridge are around 20% higher than in the full crown supported bridge with von Mises peaking at about 730 MPa when subjected to theoretical average maximum bite force in the molar region of 700 N, which is similar to the ultimate tensile strengths of current zirconia based ceramics.

Effect of thermocycling on the flexural strength of porcelain laminate veneers

Aim:

The aim of this study was to examine the impact of thermocycling on the flexural strength and development of surface flaws on the glazed surface of porcelain laminate veneer restorations with and without resin luting cement.

Materials and Methods:

80 Vitadur alpha dentin porcelain discs (10 mm diameter, 0.9 mm thickness) were glazed on one side and divided into two groups: A (porcelain laminate veneer only without resin luting cement) and B (porcelain laminate veneer luted with resin cement), each containing 40 discs. The discs in groups A and B were then thermocycled at different temperatures and were subjected to SEM analysis to evaluate the effect of thermocycling on crack propagation. Mean flexural strength was determined by using the ball-on-ring test. Student's t -test was used to find out the difference between strength values of the thermocycled porcelain discs and discs luted with resin cement.

Results:

SEM analysis revealed crack propagation in the subgroups subjected to extremes of temperature, i.e., 4 ± 1°C, 37 ± 1°C and 4 ± 1°C, 65 ± 1°C in the porcelain laminate veneers luted with resin cement. Flexural strength analysis revealed superior flexural strength for porcelain laminate veneers: 88.58 ± 6.94 MPa when compared to porcelain laminate veneers luted with resin cement: 8.42 ± 2.60 MPa. Results were tabulated and statistically analyzed using Student's t -test.

Conclusion:

Laminate veneer specimens exhibited greater flexural strength than those which were luted with resin cements. Laminate veneer specimens luted with resin cement and subjected to extremes of temperature, 4 ± 1°C and 37 ± 1°C and 4 ± 1°C and 65 ± 1°C, showed a marked decrease in flexural strength. After thermocycling at extremes of temperature, laminate veneer specimens luted with resin cement showed crack propagation. Fit of laminate veneers cannot / should not be compensated by the thickness of luting agent.

Transient and residual stresses in a pressable glass-ceramic before and after resin-cement coating determined using profilometry

OBJECTIVE

The effect of heat-pressing and subsequent pre-cementation (acid-etching) and resin-cementation operative techniques on the development of transient and residual stresses in different thicknesses of a lithium disilicate glass-ceramic were characterised using profilometry prior to biaxial flexure strength (BFS) determination.

METHODS

60 IPS e.max Press discs were pressed and divested under controlled conditions. The discs were polished on one surface to thicknesses of 0.61±0.05, 0.84±0.08, and 1.06±0.07 mm (Groups A-C, respectively). The mean of the maximum deflection (acid-etching and resin-coating was determined using high resolution profilometery prior to BFS testing. Paired sample t-tests were performed (p<0.05) on the 20 individual samples in each group (Groups A-C) for each comparison. Differences between the baseline quantification and resin-cement coating deflection values and BFS values for Groups A-C were determined using a one-way ANOVA with post hoc Tukey tests (p<0.05).

RESULTS

Baseline quantification for Groups A-C identified no significant differences between the group means of the maximum deflection values (p=0.341). Following HF acid-etching, a significant increase in deflection for all groups (p<0.001) was identified compared with the baseline quantification. Additionally, resin-cement coating significantly increased deflection for Group A (p<0.001), Group B (p<0.001) and Group C (p=0.001) specimens for the individual groups. The increased deflection from baseline quantification to resin-cement coating was significantly different (p<0.001) for the three specimen thicknesses, although the BFS values were not.

SIGNIFICANCE

The lower reported baseline quantification range of the mean of the maximum deflection for the IPS e.max(®) Press specimens was predominantly the result of specimen polishing regime inducing a tensile stress state across the surface defect integral which accounted for the observed surface convexity. Acid-etching and resin-cementation had a significant impact on the development and magnitude of the transient and residual stresses in the lithium disilicate glass-ceramic investigated.

Transient and residual stresses induced during the sintering of two dentin ceramics

OBJECTIVES

To characterize the stress induced deformation of bi-axial flexure strength (BFS) test specimens during processing to provide an insight into sintering effects and associated BFS determination.

METHODS

40 Vitadur-Alpha and 80 IPS e.max Ceram disc-shaped specimens were condensed and a sintered on a silicon nitride refractory tray under controlled firing and cooling parameters. The mean of the maximum deflection (μm) and Ra values (μm) were determined using a high resolution profilometer and were related to the orientation of the measured surface within the furnace. BFS testing of the subsequent groups (n = 20) was performed and the data related to the measured deformation of the sintered specimens. A two-way analysis of variance (ANOVA) where factors were identified as surface state and firing orientation with post hoc Tukey's tests was complemented by pair-wise comparisons with a Student's t-test for each measurement (P < 0.05).

RESULTS

The mean of the maximum deflection values and the mean BFS for Vitadur Alpha discs were not significantly influenced by firing orientation (P = 0.248 and P = 0.284, respectively). However, the Ra values were significantly different (P < 0.001). The two-way ANOVA revealed a significant impact on the mean of the maximum deflection measurements for surface state (P < 0.001) and firing orientation (P < 0.001) during sintering (P < 0.001). The mean Ra values were not significantly influenced. The BFS of sintered IPS e.max Ceram discs was sensitive to firing orientation (P < 0.001).

SIGNIFICANCE

Conventional glass theory explains that residual thermal stress gradients induced during sintering can cause test specimen deformation which can alter the expected BFS data. The study demonstrates that variability such as firing orientation during sintering which is very rarely reported in the literature can have a significant impact on the reported BFS data and can confound its interpretation.

Zirconia–parylene multilayer thin films for enhanced fracture resistance of dental ceramics

Recent research has shown that the application of specific thin films can enhance the material properties of a laminate construct. In this study, the effect of different mono/multilayered films on the strength of a ceramic specimen is demonstrated. It is well established that cracks can initiate and/or propagate from the internal surfaces of all-ceramic dental restorations. Modifying that surface by thin-film deposition might help increase clinical longevity and applicability. Specimens were divided into the following groups according to different surface treatments received: uncoated (control group), 10 μm yttria-stabilized zirconia (YSZ) thin film, 10 μm parylene thin film, 9.75 μm YSZ + 0.25 μm parylene film, and a multilayered film (five layers of 1.25 μm YSZ + 0.75 μm parylene). Depositions were performed using a radio-frequency magnetron sputter system (working pressure 15 mT, 150 °C, 30:1 Ar/O2 gas ratio) to produce the YSZ layers, and a vapour deposition process was used to produce the parylene layers. Flexural strength measurements were carried out by three-point bending (span = 10 mm) in a servo-electric material testing system in deioinized (DI) water (37 °C). The results showed that the strength of the specimen significantly increased with the deposition of all types of coating, showing the greatest increase with the multilayered film (∼32 per cent). It is hypothesized that a multilayer thin film (brittle/ductile) can promote crack deflection, causing strength enhancement of the brittle construct.

Fractography of Dental Restorations

The dental community is using a variety of ceramic restorative materials such as porcelains (leucite or alumina based), glass-ceramics (leucite, mica, lithium disilicates), alumina-glass infiltrated, and CAD-CAM ceramics including pure alumina and zirconia (3Y-TZP) core materials. Polycrystalline ceramics such as alumina and zirconia serve as substructure materials (i.e., framework or core) upon which glassy ceramics are veneered for an improved appearance. Under masticatory loads, sudden fracture of the full-thickness restoration or of the veneering ceramic (chips) may occur. Stereomicroscope and scanning electron microscope analyses were used to perform qualitative (descriptive) fractography on clinically failed dental ceramic restorations. The most common features visible on the fracture surfaces of the glassy veneering ceramic of recovered broken parts were hackle, wake hackle, twist hackle, arrest lines, and compression curls. The observed features are indicators of the local direction of crack propagation and were used to trace the crack’s progression back to its initial starting zone (the origin). This paper presents the applicability of fractographic failure analyses for understanding fracture processes in brittle dental restorative materials and it draws conclusions as to possible design or processing inadequacies in failed restorations.

Effect of microthreads and platform switching on crestal bone stress levels: a finite element analysis

BACKGROUND

The aims of this study were to investigate the effects of implant microthreads on crestal bone stress compared to a standard smooth implant collar and to analyze how different abutment diameters influenced the crestal bone stress level.

METHODS

Two-dimensional finite element imaging was used to create a cross-sectional model of an implant (5-mm platform and 13 mm in length) placed in the premolar region of the mandible. The two tapered implant models consisted of one with microthreads at the crestal portion and the other with a smooth neck. The implant model was reverse-engineered to resemble a commercially available microthread implant. Abutments of different diameters (4.0 mm: 20% platform switching; 4.5 mm: 10% platform switching; and 5.0 mm: standard) were loaded with a force of 100 N at 90 degrees vertical and 15 degrees oblique angles. Finite element analysis was used to analyze the stress patterns in bone, especially in the crestal region.

RESULTS

Upon loading, the microthread implant model had 29% greater stress (31.61 MPa in oblique and 9.31 MPa in vertical) at the crestal bone adjacent to the implant than the smooth-neck implant (24.51 and 7.20 MPa, respectively). When the abutment diameter decreased from 5.0 to 4.5 mm and then to 4.0 mm, the microthread model showed a reduction of stress at the crestal bone level from 6.3% to 5.4% after vertical loading and from 4.2% to 3.3% after oblique loading. The smooth-neck model showed a reduction of stress from 5.6% to 4.9% after vertical loading and from 3.7% to 2.9% after oblique loading.

CONCLUSIONS

Microthreads increased crestal stress upon loading. Reduced abutment diameter (i.e., platform switching) resulted in less stress translated to the crestal bone in the microthread and smooth-neck groups.

Quantifying the Strength of a Resin-coated Dental Ceramic

Resin luting all-ceramic restorations increases clinical performance; however, the strengthening mechanisms are not fully understood. The authors have previously proposed the existence of a resin-ceramic hybrid layer, and the hypothesis tested was that ceramic strength enhancement was conferred by the characteristics of the resin-ceramic hybrid layer. Dentin porcelain discs were polished with a P4000-grade abrasive paper, and half were centrally indented at 9.8 N. Further discs were alumina-air-abraded. Groups of 30 specimens were coated with resin cement thicknesses varying from 0 to 250 ± 20 μm before bi-axial flexure testing. Following investigation of residual stresses by annealing, regression analysis enabled us to calculate the magnitude of ’actual’ strengthening for a theoretical ’zero’ thickness of resin cement on each surface texture. Accounting for resin bulk strengthening, resin cement coating significantly increased the mean strength that was attributed to a resin-ceramic hybrid layer sensitive to surface texture.

The firing procedure influences properties of a zirconia core ceramic

OBJECTIVES

High-strength ceramics for dental restoration are used as an understructure (core) that subsequently is covered by veneering ceramic. The veneering process involves a firing procedure at high temperatures at least once, usually two to five times. The aim of this study was to investigate whether these firing procedures affect the mechanical properties of a zirconia ceramic.

METHODS

Thirty-three specimens of an industrially sintered yttria-stabilized zirconia ceramic (DC Zircon, DCS Dental AG, Allschwil, Switzerland) were cut into bars (1.2mmx4mmx20mm). One set of specimens (n=13) remained untreated (controls). Another set of specimens (n=10) was heat-treated once, corresponding to the first step of the veneering process. The third set of specimens (n=10) was heat-treated five times to mimic the full veneering process. Flexural strength, microhardness, dimensions and surface roughness were measured. The fracture patterns were assessed by light microscopy.

RESULTS

The untreated specimens showed a statistically significant higher flexural strength (20%) and microhardness (9%) than both of the test groups (p< or =0.001). No significant differences were found for fracture patterns, dimensions or surface roughness.

SIGNIFICANCE

The heat treatment associated with the veneering procedure on a zirconia core material reduced the flexural strength of the core after the first firing. Subsequent firings were not detrimental to the properties measured.

Fractographic analyses of zirconia-based fixed partial dentures

OBJECTIVES

Advances in ceramic processing techniques enable clinicians and ceramists to fabricate all-ceramic fixed partial dentures (FPDs) for posterior regions using high-strength yttria-stabilized tetragonal zirconia polycrystals (Y-TZP). However, failures occur in ceramic FPDs due to their design. The objectives of this study were to determine the site of crack initiation and the causes of fracture in clinically failed zirconia-based ceramic FPDs.

METHODS

Five clinically failed four-unit Y-TZP-based FPDs (Cercon ceramics, DeguDent GmbH, Hanau, Germany) were retrieved and analyzed. The fragments containing the fracture origins in the veneers (Cercon Ceram S Veneering Ceramic, DeguDent GmbH, Hanau, Germany) of two samples were missing but the rest of veneer structures were present. The other three samples had their veneers intact. Fracture surfaces were examined using fractographic techniques, utilizing both optical and scanning electron microscopes (SEM). Quantitative fractography and fracture mechanics principles were used to estimate the stresses at failure.

RESULTS

Primary fractures initiated from the gingival surfaces of connectors at veneer surfaces in four out of the five samples. However, critical flaw sizes could be measured in three of the five cases since fracture origins were lost in the remaining two due to local fragmentation at the crack initiation site. Delaminations between glass veneer and zirconia core were observed in Y-TZP-based FPDs and a secondary fracture initiated from the zirconia core. Secondary fracture controlled the ultimate failure. Failure stresses of the fixed partial dentures that failed due to zirconia fracture ranged from 379 to 501 MPa. Fractures that had origins on the glass veneer surface had failure stresses between 31 and 38 MPa.

SIGNIFICANCE

Primary fractures in clinically failed Y-TZP-based FPDs initiated from the veneer surfaces. Interfacial delamination in glass veneer/zirconia core bilayer dental ceramic structures controlled the secondary fracture initiation sites and failure stresses in Y-TZP-based fixed partial dentures.

Effect of loading method on the fracture mechanics of two layered all-ceramic restorative systems

OBJECTIVE

The aim of this research was to evaluate both the fracture and impact strength of two core veneered all-ceramic systems and to reveal whether the speed of loading affects fracture mechanism.

METHODS

The absorbed energy by (IPS)Empress-Eris crowns and Cercon-Ceram S crowns in a fracture strength test was compared by the energy absorbed in an impact strength test. The principles of fractography were used to identify fracture origin and dimensions and to calculate the stress at failure. Finite element analysis (FEA) was used to rationalize the results.

RESULTS

For the (IPS)Empress 2-Eris crowns, there was a significant difference in the energy absorbed for the fracture test and the impact test, where for the Cercon-Ceram S, there was no significant difference. Despite the high strength of the zirconia cores there was no significant difference in the energy absorbed between the two systems in the impact strength test. The dominant mode of failure of layered all-ceramic restorations under occlusal loading is cone cracking in the veneering ceramic.

SIGNIFICANCE

It was concluded that to exploit the high strength of the zirconia cores the strength of the veneering ceramic has to improve as delamination and cone cracking of the veneer are the most expected failure modes.

Statistical failure analysis of adhesive resin cement bonded dental ceramics

The goal of this work is to quantitatively examine the effect of adhesive resin cement on the probability of crack initiation from the internal surface of ceramic dental restorations. The possible crack bridging mechanism and residual stress effect of the resin cement on the ceramic surface are examined. Based on the fracture-mechanics-based failure probability model, we predict the failure probability of glass-ceramic disks bonded to simulated dentin subjected to indentation loads. The theoretical predictions match experimental data suggesting that both resin bridging and shrinkage plays an important role and need to be considered for accurate prognostics to occur.

Recent advances in materials for all-ceramic restorations

The past 3 years of research on materials for all-ceramic veneers, inlays, onlays, single-unit crowns, and multi-unit restorations are reviewed in this article. The primary changes in the field were the proliferation of zirconia-based frameworks and computer-aided fabrication of prostheses, and a trend toward more clinically relevant in vitro test methods. This article includes an overview of ceramic fabrication methods, suggestions for critical assessment of material property data, and a summary of clinical longevity for prostheses constructed of various materials.

Fracture toughness determination of two dental porcelains with the indentation strength in bending method

OBJECTIVE

This study was to investigate the influence of the bending test configurations and the crosshead displacement speeds on the fracture toughness (K(Ic)) of dental porcelains obtained with the indentation strength in bending (ISB) method.

METHODS

The strength of the dental veneering porcelains Duceram and Sintagon Zx, Vickers' indented at a load of 2 kg was measured at a crosshead speed of 0.5mm/min with three test configurations, which were 3-point, 4-point, and biaxial bending. Two more groups of Sintagon Zx were tested the same way, but at speeds of 0.1, and 0.05 mm/min, respectively. Both porcelains, the three crosshead speeds, and the three test configurations were compared statistically.

RESULTS

Duceram had a higher toughness than Sintagon Zx with all three test configurations and there was no significant difference between three test configurations with either porcelain. Within the crosshead speed groups of Sintagon Zx, a significant difference was found only in the 0.5mm/min group between the 3-point, and 4-point configurations. Within the configuration groups, significant differences were found between all speeds with the 3-point configuration and only between the highest and lowest speed with the 4-point and the biaxial tests.

CONCLUSION

The crosshead displacement speed can cause statistically different results of fracture toughness obtained with the ISB method.

Which mechanical and physical testing methods are relevant for predicting the clinical performance of ceramic-based dental prostheses?

PURPOSE

The survival and performance of clinical prostheses with a ceramic component are probabilistic in nature. Only under very rare circumstances will all of the prostheses in a group exhibit either 100% successes or 100% failures over a period of 5 years or more. Prosthesis failure may be defined as any condition that leads to replacement. These conditions include secondary caries, irreversible pulpitis, excessive wear of opposing tooth surfaces, excessive erosion and roughening of the ceramic surface, ditching of the cement margin, unacceptable esthetics, cracking, chipping and fracture. A systematic review of the dental literature was performed to determine the extent to which the mechanical and physical properties of dental alloys and ceramics can predict the 5-year clinical performance of metal-ceramic and all-ceramic fixed dental prostheses (FDP) and to determine the associated quality of reported outcomes associated with these clinical studies.

MATERIALS AND METHODS

The review was based on clinical research studies of 5 years or greater duration that were published in English dental journals between 1980 and 2006 using the following key words and MeSH terms. Our search strategy was as follows: Search 1: Partial fixed denture OR denture, partial, fixed OR denture, partial fixed OR dental porcelain OR metal ceramic alloys OR dental ceramic Search 2: Prosthesis failure OR dental restoration failure OR time factors OR survival analysis Search 3: Meta-analysis OR evaluation studies OR review OR clinical trial OR comparative study OR follow-up studies OR prospective studies OR clinical follow-up study OR clinical trial OR longitudinal studies Inclusion of searches 1, 2 and 3 and limits placed on the publication date starting on January 1, 1980, English language, and clinical studies involving humans resulted in a total of 684 articles. By restricting the clinical studies to 5 years or more in duration, the number was reduced to 193. By eliminating resin-bonded FDPs, cantilever designs, implant-supported prostheses, crowns, inlay- or onlay-supported prostheses, a total of 37 articles remained for detailed review. After excluding review articles and articles involving resin-bonded bridges, single-author clinical research articles, cantilever designs and implant-supported FDPs, 11 clinical research articles remained. For these articles, it was not possible to determine conclusively the probability of failure for three-unit FDPs compared with four-unit and larger prostheses or the location of the crowns and pontics.

RESULTS

This systematic review of studies on ceramic-based FDPs confirms the results of previous studies that, in most cases, less than 15% of these prostheses were removed or were in need of replacement at 10 years. However, there was considerable variability in the number of parameters that were reported as well as the range of details on failures that occurred. In some studies, a standardized evaluation system was used in which USPHS or Ryge criteria were applied. However, there was also great uncertainty in the definition of failure with respect to repairable fractures and whether the identified causative factors were directly or indirectly associated with the replacement of the prostheses.

CONCLUSIONS

This review indicates that there is no single in vitro test variable that can predict clinical performance in these prostheses. Based on these reviews, there is an urgent need to develop a comprehensive classification system for identifying clinical prosthesis failures, technical complications and biologic complications. Guidelines on the retrieval of fractured prostheses and/or impressions that capture the fracture surface details should also be developed. The predictive power of in vitro data can be increased by finite element stress analysis and computer programs such as the CARES/Life software (NASA Lewis Research Center, Cleveland, OH) that estimates the time-dependent nature of ceramic structure survival.

Dynamic fatigue and strength characterization of three ceramic materials

Fracture strength and fatigue parameters of three ceramic materials submitted to dynamic fatigue were evaluated. A machinable leucite-reinforced dental ceramic, aluminum oxide, and yttria-stabilized zirconia (YSZ) were tested. The inert strength of the materials was determined in air (25 degrees C) at stressing rates of 70, 250, 400 MPa/s for Porcelain, Alumina and YSZ respectively. The data was analyzed using a two-parameter Weibull distribution. The Weibull modulus (m) and the characteristic of fracture (sigma0) parameters were determined for each material. Specimens were also tested in 3-point bending at different stressing rates in distilled/deionized water at 37 degrees C (dynamic fatigue) in order to calculate the fatigue parameters n and ln B. The strength for each material was characterized using Strength-Probability-Time (SPT) diagrams for 1 day, 1 year and 10 years. YSZ showed a high-fracture strength sigma0 (1,459 MPa) at a failure probability of 63.2% and high resistance to subcritical crack growth. YSZ and alumina showed better resistance to slow crack growth than porcelain, indicating less susceptibility to strength degradation by stress corrosion. Lifetime predictions after 10 years indicate a reduction of 50%, 36% and 29% in strength for porcelain, alumina and YSZ respectively. YSZ seems to be a very promising material for long-term dental and biomedical applications.

Partial Ceramic Crowns: Influence of Ceramic Thickness, Preparation Design and Luting Material on Fracture Resistance and Marginal Integrity In Vitro

For fracture resistance and the marginal integrity of adhesively bonded partial ceramic crowns (PCC), the choice of ceramic thickness and luting material are more important than preparation design. PCC fabricated from industrially sintered feldspathic ceramic should have at least a thickness of 1.5–2.0 mm in stress bearing areas.

Fractographic ceramic failure analysis using the replica technique

OBJECTIVES

To demonstrate the effectiveness of in vivo replicas of fractured ceramic surfaces for descriptive fractography as applied to the analysis of clinical failures.

METHODS

The fracture surface topography of partially failed veneering ceramic of a Procera Alumina molar and an In-Ceram Zirconia premolar were examined utilizing gold-coated epoxy poured replicas viewed using scanning electron microscopy. The replicas were inspected for fractographic features such as hackle, wake hackle, twist hackle, compression curl and arrest lines for determination of the direction of crack propagation and location of the origin.

RESULTS

For both veneering ceramics, replicas provided an excellent reproduction of the fractured surfaces. Fine details including all characteristic fracture features produced by the interaction of the advancing crack with the material's microstructure could be recognized. The observed features are indicators of the local direction of crack propagation and were used to trace the crack's progression back to its initial starting zone (the origin). Drawbacks of replicas such as artifacts (air bubbles) or imperfections resulting from inadequate epoxy pouring were noted but not critical for the overall analysis of the fractured surfaces.

SIGNIFICANCE

The replica technique proved to be easy to use and allowed an excellent reproduction of failed ceramic surfaces. It should be applied before attempting to remove any failed part remaining in situ as the fracture surface may be damaged during this procedure. These two case studies are intended as an introduction for the clinical researcher in using qualitative (descriptive) fractography as a tool for understanding fracture processes in brittle restorative materials and, secondarily, to draw conclusions as to possible design inadequacies in failed restorations.

Influence of bond quality on failure load of leucite- and lithia disilicate–based ceramics

STATEMENT OF PROBLEM

The long-term survival of bonded ceramic restorations for posterior teeth is a clinical concern. The durability of the bond between the ceramic and dentin during clinical service is a factor in the load-bearing capacity of the restoration.

PURPOSE

This study aimed to evaluate the effect of interfacial bonding quality on the interface failure initiation loads of 2 all-ceramic systems.

MATERIAL AND METHODS

One leucite-reinforced ceramic, IPS Empress (E1), and 1 lithia disilicate glass-ceramic, IPS Empress 2 (E2), were used to form disks 8.5 mm in diameter, with an approximate 1.35-mm total thickness (n=45). The ceramic specimens were fabricated in a manner that simulated their clinical application. The E1 specimens were fabricated using the staining technique, and the E2 specimens were made using a layering technique. Completed disks of each ceramic system were divided into 3 subgroups (n=15) that were subsequently cemented using 1 of 3 bonding conditions (Control, Cer, Sub). The control group followed ideal bonding protocol, whereas groups Cer and Sub had bonds that were compromised between the cement and the ceramic (Cer) or the substrate and the cement (Sub). All luted specimens were loaded at the center with a 10-mm-diameter ball indenter at a crosshead speed of 0.01 mm/min in a universal testing machine. Intermittent loads were applied in increasing increments of 50 N until a fracture could be observed in the ceramic substrate by transillumination with x2.6 optical magnification. The maximum load applied prior to crack observation was recorded as the failure initiation load. Survival analytical methods were used to determine differences between groups.

RESULTS

The characteristic fracture initiation loads ranged from 223.5 to 760.6 N. Group E2 had the greatest mean observed load to failure (715.6 N), which was significantly greater than group E1 (P<.001). For both the E1 and E2 ceramic systems, the control groups had significantly greater mean fracture initiation loads than either of the interface-inhibited Cer and Sub groups.

CONCLUSIONS

Poor bond quality at either the ceramic-cement or dentin-cement interface can significantly reduce the fracture initiation load-bearing capacity of ceramic disks bonded to compliant dentin-like substrates. For the E2 ceramic material, disruption of the ceramic-cement interface had a more detrimental effect on the load-bearing capacity of the simulated restoration than the disruption of the cement-dentin interface.

Effect of YSZ thin film coating thickness on the strength of a ceramic substrate

Although ceramics are used for many different biomedical applications they are brittle materials that can be compromised by surface defects when under stress. The objective of this study was to evaluate the effect of surface modification with an yttria-stabilized zirconia (YSZ) thin film coating on the strength of a machinable dental ceramic. Fifty bars (2 mm x 2 mm x 15 mm) were cut from ProCAD (Ivoclar-Vivadent) blocks. Specimens were wet-polished through 1200-grit SiC abrasive. One surface of each bar was sandblasted with 50 microm Al(2)O(3) abrasive (0.34 MPa). Specimens were further modified through the deposition of a sputtered YSZ thin film on the sandblasted surface. Different thin film thicknesses were evaluated: 1, 3, 5, and 7 microm. Depositions were performed using a radio frequency magnetron sputter system (working pressure of 15 mT, 150 degrees C, 30:1 Ar/O(2) gas ratio). Flexural strength measurements were carried out by three-point bending (span = 10 mm) in a servo-electric material testing system in DI water (37 degrees C). The results showed that the strength of porcelain significantly increased with the deposition of a 3-microm YSZ thick coating. A nonlinear relationship was observed between film thickness and strength. Strengthening of porcelain is shown through the application of a sputtered YSZ thin film. It is presumed that the strengthening mechanism is due to modification of surface flaws and/or surface residual stress by the applied thin film.

Finite Element Stress Analysis of Indirect Restorations Prepared in Cavity Bases

The objective of this study was to analyze the distribution of tensile stresses in indirect restorations prepared in several composite cavity bases. Elastic moduli of 20 materials were measured by nanoindentation technique for finite element analysis. Axisymmetric models of posterior onlays were constructed using combinations of two onlay materials and three cavity base materials. Thickness of resin cement was 50 um. A vertical load of 95.5 N was applied on the cusp tip. Maximum stress of 18.1 MPa was found in the model consisting of a ceramic onlay and a flowable resin composite base. It was also found that tensile stress increased as the area of the base having a lower elastic modulus became wider. Base materials having higher elastic moduli were determined to be suitable as cavity base materials for posterior restorations.

Influence of surface roughness on crack formation in a glass-ceramic bonded to a resin composite base

The objective of the present study was to assess the influence of the roughness of a loaded surface on crack formation in a mica-based glass-ceramic bonded to a resin composite base. Five different surface roughnesses were created on glass-ceramic discs by serial wet-grinding with silicone carbide abrasives. The thicknesses of the ceramic discs were 1.50 +/- 0.01 mm. Resin composite discs were bonded to the ceramic surfaces opposite to the ground surfaces using an adhesive resin composite cement and a silane coupling agent. A compressive load was then applied at the center of the ground ceramic surface. The loads at initial radial and cone crack formations in the ceramic were measured macroscopically. In three of the five groups, the initial radial crack formations could not be observed due to the high roughness of these surfaces. Statistical analysis was performed using Student's t test for initial radial cracks and one-way ANOVA for the cone cracks. There were no significant differences between the two groups for the initial radial cracks or among the five groups for the cone cracks (P < 0.05). The roughness of the loaded surface had no influence on crack formation in the bonded mica-based glass-ceramic.

Fracture surface analysis of clinically failed fixed partial dentures

Ceramic systems have limited long-term fracture resistance, especially when they are used in posterior areas or for fixed partial dentures. The objective of this study was to determine the site of crack initiation and the causes of fracture of clinically failed ceramic fixed partial dentures. Six Empress 2 lithia-disilicate (Li(2)O x 2SiO(2))-based veneered bridges and 7 experimental lithia-disilicate-based non-veneered ceramic bridges were retrieved and analyzed. Fractography and fracture mechanics methods were used to estimate the stresses at failure in 6 bridges (50%) whose fracture initiated from the occlusal surface of the connectors. Fracture of 1 non-veneered bridge (8%) initiated within the gingival surface of the connector. Three veneered bridges fractured within the veneer layers. Failure stresses of the all-core fixed partial dentures ranged from 107 to 161 MPa. Failure stresses of the veneered fixed partial dentures ranged from 19 to 68 MPa. We conclude that fracture initiation sites are controlled primarily by contact damage.

Thin-wall ceramic CAD/CAM crown copings: strength and fracture pattern

The strength and fracture pattern of posterior CAD/CAM-generated crown copings with 0.4 mm wall thickness were evaluated in vitro hypothesizing that fracture resistance of YTZP-zirconia copings might be independent of mode of cementation whether resin-bonded or cemented because of the high strength of YTZP-zirconia. Two sets of copings (n = 15) each were fabricated using CEREC inLab CAD/CAM from (i) lithiumdisilicate glass-ceramic, (ii) infiltration ceramic as controls and (iii) YTZP-zirconia. Copings (n = 15) of ceramics (i), (ii) and (iii) each were (a) zinc-phosphate cemented, (b) adhesively seated on resin-based composite dies and loaded until fracture. Load (N) data was analysed using anova and Scheffé tests. Crack pattern was evaluated on additional three sample cross-sections for each group at fracture-start. Radial cracks originated early at the cementation interfaces and cone cracks were observed finally at the loading sites. Mean load (N) values (+/-s.d.) of A-copings at fracture-start/-end (i) 804 +/- 195/862 +/- 162, (ii) 923 +/- 180/975 +/- 147, (iii) 697 +/- 110/1607 +/- 145, were all significantly (P < 0.01) lower when compared with their B-crown coping analogs (i) 1183 +/- 318/1919 +/- 326, (ii) 1621 +/- 165/1820 +/- 211, (iii) 731 +/- 115/1973 +/- 287 except for A3 and B3 at fracture-start. This confirmed our hypothesis at fracture-start (P > 0.05) but rejected it at fracture-end (P < 0.01). The A3 fracture-end data, even if significantly (P < 0.01) lower, came close to the B3 values by 18%. A3 was significantly (P < 0.001) stronger by 86/74% than A1/A2 at fracture-end. The data indicates that YTZP-zirconia copings have the potential to provide support for all-ceramic core crowns, which may be adequate for non-adhesive cementation.

Evidence-based decision making: Guide to reading the dental materials literature

Although potential links between materials data and clinical behavior are often implied, the status of such linkage is often left obscure. This paper provides clinicians a context within which to view materials information as evidence for clinical indications and to broaden readers' appreciation for the subject. Hierarchies of both clinical and nonclinical data are presented and discussed from the point of view of their predictive potential regarding clinical performance. Excellent sources of information are identified for the clinician making treatment decisions, and perspectives are offered on the value of other published materials data.

Flexural strength of a layered zirconia and porcelain dental all-ceramic system

STATEMENT OF PROBLEM

New processing techniques have facilitated the use of zirconia core materials in all-ceramic dental prostheses. Zirconia has many potential advantages compared to existing core materials; however, its performance when layered with porcelain has not been evaluated.

PURPOSE

This study investigated the strength of a wide variety of layered zirconia and porcelain beams to determine whether the inclusion of zirconia cores results in improved strength.

MATERIAL AND METHODS

Eight types of layered or simple zirconia and porcelain beams (n = 10), approximately fixed partial denture-size, were made of a tetragonal polycrystalline zirconium dioxide partially stabilized with yttria core (Lava System Frame) and a feldspathic dental porcelain (Lava Ceram veneer ceramic). Elastic moduli of the materials were measured using an acoustic method. Maximum force and modulus of rupture were determined using 3-point flexural testing and a universal testing machine. Descriptive statistical methods were used.

RESULTS

Beams with porcelain tensile surfaces recorded mean tensile strengths or moduli of rupture from 77 to 85 MPa, whereas beams with zirconia tensile surfaces recorded moduli of rupture almost an order of magnitude higher, 636 to 786 MPa. The elastic moduli of the porcelain and zirconia materials were 71 and 224 GPa, respectively. Crack propagation following initial tensile cracking often involved the porcelain-zirconia interface, as well as bulk porcelain and zirconia.

CONCLUSION

The layered zirconia-porcelain system tested recorded substantially higher moduli of rupture than have been previously reported for other layered all-ceramic systems.