A new method to test the fracture probability of all-ceramic crowns with a dual-axis chewing simulator

Abstract

Objectives The purpose of this study was to validate a new laboratory method to test all-ceramic systems with regard to the proportion of failures. Methods Sixteen standardized mandibular molar crowns consisting of two different materials (IPS Empress, IPS e.max Press) were adhesively luted on CAD/CAM milled PMMA abutments (first lower molar, circular chamfer). All crowns were loaded applying an eccentric force in a Willytec chewing simulator (steel stylus, Ø 2.4 mm, 2 mm lateral movement from fossa to cuspal tip) with stepwise increase of the load (3, 5, 9 kg, 100,000 cycles each, 0.8 Hz) and simultaneous thermocycling (5 °C/55 °C × 417 per phase). Another four crowns of each material were subjected to force measurements with a 3D force sensor during dynamic loading of each loading phase using two different lateral movements (from fossa to cusp and vice versa). Results The cumulative forces for the three directions in space were much higher compared to the static load of the chewing simulator (maximal force at 3 kg 60 N, 5 kg 160 N, 9 kg 240 N). There was no statistically significant difference in the mean or maximal force between the two materials or two different lateral movements. During dynamic loading, no fractures occurred in the molar crowns made of IPS e.max Press, whereas 50% of the IPS Empress crowns showed failures (75% fractures and 25% chippings) (log-rank test p = 0.002). Most of the Empress crowns fractured during the third loading phase (9 kg). Conclusions The forces that the dead weights exerted during dynamic loading were 2–3 times higher than those during static loading. None of the lithium disilicate ceramic molar crowns fractured, whereas half of the leucite reinforced molar crowns failed during dynamic loading.