Comparative Evaluation of the Fracture Strength of Monolithic Crowns Fabricated from Different all-ceramic CAD/CAM Materials (an in vitro study)

Abstract

The objective of this in vitro study was to evaluate and compare the fracture strength of monolithic crowns fabricated from five different all-ceramic CAD/CAM materials (lithium disilicate, zirconia, reinforced composite, hybrid dental ceramic, and zirconia-reinforced lithium silicate) using single load to failure test. Forty sound human maxillary first premolar teeth extracted for orthodontic purposes were selected for use in this study. Teeth were prepared according to a standard protocol with 1 mm deep chamfer finishing line, 4 mm axial height with planer occlusal reduction and 6º total convergence angle. Teeth were then divided into five groups of eight teeth each according to the material used for the fabrication of the monolithic crowns as follow: Group A: Crowns fabricated from lithium disilicate (IPS e.max CAD, Ivoclar Vivadent), Group B: Crowns fabricated from zirconia (CEREC Zirconia, Dentsply Sirona), Group C: Crowns fabricated from reinforced composite (BRILLIANT Crios, COLTENE), Group D: Crowns fabricated from hybrid dental ceramic (VITA ENAMIC, VITA Zahnfabric), Group E: Crowns fabricated from zirconia-reinforced lithium silicate (CELTRA DUO, Dentsply Sirona). Teeth of all groups were then scanned with CEREC Omnicam digital intraoral scanner and the crowns were then designed using CEREC Premium software (version 4.4.4) and milled using CEREC MC XL milling unit. Post-milling, crowns of each group were subjected to either a firing procedure or to a polishing only according to the manufacturer's instructions of each material. The internal surfaces of the crowns of each group were then subjected to surface treatment according to the manufacturer's instructions of each material and the crowns were then cemented on their respective teeth using a universal dual-cured adhesive resin cement (Duo-Link Universal, Bisco Inc.). All teeth with the cemented crowns were then stored in deionized distilled water at room temperature for 24 hours before testing. All samples were then subjected to compressive axial loading until fracture in computer-controlled universal testing machine (Zwick Z010, Ulm, Germany) at a crosshead speed of 0.5 mm/min. The data were statistically analyzed using one-way ANOVA test and LSD test at a level of significance of 0.05. The results of this study showed that the highest mean value of fracture strength was recorded by Group B (2337.37), followed by Group C (1880.59), Group E (1404.49), Group A (1085.39) and Group D (767.06), respectively with statistically highly significant differences among the different groups (p<0.01). From the results of this study, it seems that the differences in the chemical composition and microstructure of the tested all-ceramic CAD/CAM materials may be responsible for the differences in the fracture strength of the fabricated crowns.