Ceramic Fracture Research Articles

REVISION BEARING SELECTION FOLLOWING CERAMIC BEARING FRACTURE: A PATIENT SAFETY DECISION

Ceramic bearing fractures are rare events, but mandate revision and implantation of new bearings. Revisions using metal heads have been reported to lead to gross volumetric head wear (due to abrasive retained ceramic micro-debris), cobalt toxicity, multi-organ failure and death. Such complications are widely published (50+ reports), yet we know that patients continue to be put at risk. Using data from the NJR and AOANJRR, this study seeks to compare the risk of re-revision and death by revision bearing combination following a ceramic bearing fracture.Data were extracted from the NJR and AOANJRR, identifying revisions for ceramic bearing fracture. Subsequent outcomes of survival, re-revision and death were compared between revision bearing combinations (ceramic-on-ceramic, ceramic-on-polyethylene, and metal-on-polyethylene).366 cases were available for analysis from the NJR dataset (MoP=34, CoP=112, CoC=221) and 174 from the AOANJRR dataset (MoP=17, CoP=44, CoC=113). The overall incidence rate of adverse outcome (revision or death) was 0.65 for metal heads and 0.23 for ceramic head articulations (p=0.0012) across the whole time period (NJR). Kaplan-Meir survival estimates demonstrate an increased risk of both re-revision and death where a metal head has been used vs a ceramic head following revision for ceramic fracture.There are few decisions in arthroplasty surgery that can lead to serious harm or death for our patients, but revision using a metal head following ceramic bearing fracture is one of them. This study enhances the signal of what is already known but previously only reported as inherently low-level evidence (case reports and small series) due to event rarity. Use of a metal head in revision for ceramic fracture represents an avoidable patient safety issue, which revision guidelines should seek to address.

Effect of the CAD-CAM and lost-wax framework fabrication techniques on the fracture strength of porcelain in metal-ceramic restorations.

Ceramic fracture is a common problem in metal-ceramic restorations (MCRs). The advent of computer-aided design and computer-aided manufacturing (CAD-CAM) technology eliminated the lost-wax technique, which was responsible for many of the problems associated with framework fabrication. However, the role of the CAD-CAM technology in decreasing porcelain fracture is not yet known. The aim of the present in vitro study was to compare the fracture strength of porcelain in MCRs with metal frameworks fabricated with the use of the lost-wax and CAD-CAM techniques. Twenty metal dies were prepared with a deep chamfer finish line, with a depth of 1.2 mm and the occlusal taper of the walls of 8°, a 2-millimeter occlusal reduction of the functional cusp, a 1.5-millimeter occlusal reduction of the nonfunctional cusp, and the functional cusp bevel. Ten frameworks were fabricated using the CAD-CAM system and 10 with the lost-wax technique. After porcelain veneering, the specimens underwent thermocycling and cyclic loading to simulate the aging process. The load test was then performed. The fracture strength of porcelain was compared between the 2 groups, and the mode of failure was also determined using a stereomicroscope. Two specimens were excluded from the CAD-CAM group. Thus, 18 specimens were statistically analyzed. The results revealed no significant difference in fracture strength between the 2 groups (p > 0.05). The mode of failure was mixed in all specimens from both groups. Our results indicated that the fracture strength of porcelain and the mode of failure did not depend on the metal framework fabrication technique (lost-wax or CAD-CAM).

A peridynamic model for electromechanical fracture and crack propagation in piezoelectric solids

This paper presents for the first time an approach to the problem of electromechanical fracture and crack propagation in piezoelectric solids with peridynamics. Fracture in piezoelectric ceramics is an important problem in engineering due to its complexity. The majority of the computational models available on the literature rely on sharp crack representations, which have difficulties dealing with complex crack patterns, or rely on diffusive crack models, such as the phase-field fracture model, that can predict complex patterns but does not represent cracks in a discrete way. On the other hand, peridynamics has been designed to solve this problems and is able to simulate discrete cracks as well as complex crack phenomena like fragmentation and branching. We present a novel approach to the implementation of different electric crack face boundary conditions in a peridynamic way, by a field selective bond breaking approach. Moreover, it is also presented the first electromechanical failure criterion for fracture in piezoelectric ceramics. We develop an energy based failure criterion due to its generality and wide range of applications. These approaches are presented in a way such that they are valid for any type of peridynamic formulation. The used numerical model is implemented using correspondence-based peridynamics with the linear piezoelectricity constitutive setting, using a meshfree discretization and solved quasi-statically with an implicit incremental-iterative scheme. Numerical examples are presented to demonstrate the capabilities of these new approaches and assess the performance of the model against experimental results. The model is capable of numerically predicting complicated fracture behaviour and crack propagation in an intrinsic/autonomous way, as demonstrated by the results.

Diffusion Barriers Minimizing the Strength Degradation of Reactive Air Brazed Ba0.5Sr0.5Co0.8Fe0.2O3-δ Membranes during Aging.

The separation of oxygen from air by means of inorganic ceramic membranes requires gas-tight ceramic-metal joints that enable reliable permeation operation in the oxygen partial pressure gradient at 850 °C. Reactive air brazing is a promising method to solve this challenge. However, reactive air brazed BSCF membranes suffer from a significant strength degradation that is caused by unhindered diffusion from the metal component during aging. In this study, we investigated how diffusion layers applied on the austenitic steel AISI 314 influence the bending strength of BSCF-Ag3CuO-AISI314 joints after aging. Three different approaches were compared as diffusion barriers: (1) aluminizing via pack cementation, (2) spray coating with NiCoCrAlReY, and (3) spray coating with NiCoCrAlReY and an additional 7YSZ top layer. Coated steel components were brazed to bending bars and aged for 1000 h at 850 °C in air prior to four-point bending and subsequent macroscopic as well microscopic analyses. In particular, coating with NiCoCrAlReY showed low-defect microstructures. The characteristic joint strength was raised from 17 MPa to 35 MPa after 1000 h aging at 850 °C. In addition, the dominant delamination fracture between the steel and the mixed oxide layer, observed in the reference series with uncoated steel, could be replaced by mixed and ceramic fractures of higher strength. The effect of residual joint stresses on the crack formation and path is analyzed and discussed. Chromium poisoning could no longer be detected in the BSCF, and interdiffusion through the braze was effectively reduced. Since the strength degradation of reactive air brazed joints is mainly caused by the metallic joining partner, the findings on the effect of the diffusion barriers in BSCF joints might be transferred to numerous other joining systems.

Molecular Dynamics Simulations Correlating Mechanical Property Changes of Alumina with Atomic Voids under Triaxial Tension Loading

The functionalization of nanoporous ceramics for applications in healthcare and defence necessitates the study of the effects of geometric structures on their fundamental mechanical properties. However, there is a lack of research on their stiffness and fracture strength along diverse directions under multi-axial loading conditions, particularly with the existence of typical voids in the models. In this study, accurate atomic models and corresponding properties were meticulously selected and validated for further investigation. Comparisons were made between typical material geometric and elastic properties with measured results to ensure the reliability of the selected models. The mechanical behavior of nanoporous alumina under multiaxial stretching was explored through molecular dynamics simulations. The results indicated that the stiffness of nanoporous alumina ceramics under uniaxial tension was greater, while the fracture strength was lower compared to that under multiaxial loading. The fracture of nanoporous ceramics under multi-axial stretching, was mainly dominated by void and crack extension, atomic bond fracture, and cracking with different orientations. Furthermore, the effects of increasing strain rates on the void volume fraction were found to be similar across different initial radii. It was also found that the increasing tension loading rates had greater effects on decreasing the fracture strain. These findings provide additional insight into the fracture mechanisms of nanoporous ceramics under complex loading states, which can also contribute to the development of higher-scale models in the future.

Outcomes of Ceramic-On-Ceramic Bearing Total Hip Arthroplasty: A Minimum 10-Year Follow-Up Study

BackgroundAlthough the fourth generation of ceramics has demonstrated excellent clinical results 5 to 6 years postoperatively, concerns over ceramic fracture and squeaking persist and longer-term follow-up (minimum 10 years) studies are warranted. Our study aimed to evaluate the minimum 10-year clinical outcomes and bearing-specific complications of ceramic-on-ceramic (CoC) total hip arthroplasties. MethodsWe retrospectively evaluated all patients who underwent primary delta CoC total hip arthroplasty in our institution between January 2004 and February 2013. Demographics, surgical techniques, complications, patient-reported outcomes, and radiographic outcomes were collected and analyzed. For continuous variables, the comparison between groups was conducted using a one-way analysis of variance. Of all 235 patients included in the study, 70.5% were women (190 hips). The mean follow-up period was 12 years (range, 10 to 18). The femoral head sizes of 28- mm, 32 mm, and 36 mm were used in 50, 26, and 197 cases, respectively. Mean acetabular inclination and anteversion angles were 39.2 ± 7.1° and 14.9 ± 3.5°. ResultsThere were 5 hips revised at a mean 4.6 years (range, 0.1 to 7.1). One revision was squeaking-related. Squeaking was also reported by 8 other patients, but did not require revision. Other reasons for revision were early infection in 2 cases, stem loosening in 1 case, and stem fracture in 2 cases. The survival analysis for any causes for revision as an endpoint was 96.7% (95% confidence interval 0.313%-2.57%). ConclusionWe report excellent mean 12-year follow-up results regarding the complications and survivorship of the fourth generation CoC bearings.

Taper connection strength of revision heads with adapter sleeves compared to standard heads made of ceramics

Abstract Revision ceramic heads with titanium adapter sleeves are used in case of a femoral head revision in total hip arthroplasty to avoid ceramic fracture due to damaged tapers. Objective of the present study was to evaluate the taper connection strength of revision ceramic heads. Therefore, revision ceramic heads (Ø36 mm; adapter sleeve S) and standard ceramic heads (Ø36 mm; neck length S) were assembled with an axial load (2 kN) to titanium tapers with various damage modes (undamaged, truncated, and elevated). Subsequently, the heads were either pulled-off directly after assembly or after dynamic loading over 2.5 million cycles (sinusoidal 0.3 kN–3.0 kN). Pull-off forces of the revision heads (1.24 kN–1.66 kN) were up to 43.7% higher compared to standard heads (1.02 kN–1.48 kN) in dependency of the taper damage. After dynamic loading, the pull-off forces did not change in case of standard heads. The pull-off forces of the revision heads decreased in combination with the undamaged and truncated tapers but increased in combination with the elevated tapers. In conclusion, revision heads with adapter sleeves (size S) showed higher taper connection strength than standard heads both on undamaged and damaged tapers.

Forte ceramic-on-delta ceramic cementless total hip arthroplasty: an 8- to 15-year follow-up study.

Forte ceramic head on delta ceramic liner articulation showed satisfactory midterm results without ceramic-related complication. We aimed to investigate the clinical and radiological outcomes of cementless total hip arthroplasty (THA) with forte ceramic head on delta ceramic liner articulation. Overall, 107 patients (57 men, 50 women; 138 hips) who underwent cementless THA with forte ceramic head on delta ceramic liner articulation were enrolled. The mean follow-up duration was 11.6years. For the clinical assessments, Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), presence of thigh pain, and presence of squeaking were evaluated. Radiographs were assessed to search for osteolysis, stem subsidence, loosening of implants. Kaplan-Meier survival curves were evaluated. The mean HHS and WOMAC improved from 57.1 and 28.1 preoperatively to 81.4 and 13.1 at the final follow-up, respectively. Nine revisions (6.5%) were performed; 5 hips for stem loosening, 1 hip for ceramic liner fracture, 2 hips for periprosthetic fracture, and 1 hip for progressive osteolysis around cup and stem. Thirty-two patients (37 hips) complained squeaking, in which 4 cases (2.9%) were identified as ceramic-related noises. After a mean follow-up period of 11.6years, 91% (95% CI 87.8-94.2) were free from revision of both femoral and acetabular components due to any reason. Cementless THA with forte ceramic-on-delta ceramic articulation showed acceptable clinical and radiological results. Serial surveillance of these patients should be performed due to the possibility of cerami- related complications such as squeaking, osteolysis, and ceramic liner fracture.

Revision total hip arthroplasty by a ceramic bearing surface after a third- and fourth-generation ceramic head or liner fracture.

Although rare, fractures of ceramic components are difficult to revise, mainly due to the presence of residual ceramic debris that can cause catastrophic wear of the replacement components. Modern ceramic-on-ceramic bearings are suggested to improve outcomes of revision total hip arthroplasty (THA) for ceramic fractures. However, there are few published reports of mid-term outcomes of revision THA using ceramic-on-ceramic bearings. We evaluated clinical and radiographic outcomes of 10 patients who received ceramic-on-ceramic bearings during revision THA for ceramic fractures. All patients but one received fourth-generation Biolox Delta bearings. Clinical evaluation was performed using the Harris hip score at latest follow-up, and all patients received a radiographic evaluation to analyze the fixation of the acetabular cup and of the femoral stem. Osteolytic lesions and the presence of ceramic debris were noted. After a mean follow-up of 8.0 years, there were no complications or implant failures, and all patients reported satisfaction with their implant. The average Harris hip score was 90.6. There was neither osteolysis nor loosening, but despite our extensive synovial debridement, ceramic debris was noted in the radiographs of five patients (50%). We report excellent mid-term outcomes, with no implant failures after eight years despite ceramic debris being found in a significant proportion of patients. We conclude that modern ceramic-on-ceramic bearings are an advantageous option for the revision of THA due to the fracture of initial ceramic components.

Phase-Field Simulation of Temperature-Dependent Thermal Shock Fracture of Al2O3/ZrO2 Multilayer Ceramics with Phase Transition Residual Stress.

Compared with single-phase ceramics, the thermal shock crack propagation mechanism of multiphase layered ceramics is more complex. There is no experimental method and theoretical framework that can fully reveal the thermal shock damage mechanism of ceramic materials. Therefore, a multiphase phase-field fracture model including the temperature dependence of material for thermal shock-induced fracture of multilayer ceramics is established. In this study, the effects of residual stress on the crack propagation of ATZ (Al2O3-5%tZrO2)/AMZ (Al2O3-30%mZrO2) layered ceramics with different layer thickness ratios, layers, and initial temperatures under bending and thermal shock were investigated. Simulation results of the fracture phase field under four-point bending are in good agreement with the experimental results, and the crack propagation shows a step shape, which verifies the effectiveness of the proposed method. With constant thickness, high-strength compressive stress positively changes with the layer thickness ratio, which contributes to crack deflection. The cracks of the ceramic material under thermal shock have hierarchy and regularity. When the layer thickness ratio is constant, the compressive residual stress decreases with the increase in the layer number, and the degree of thermal shock crack deflection decreases.

A 10- to 12-year follow-up study of delta ceramic-on-ceramic total hip arthroplasty.

We previously reported five-to-seven-year results of total hip arthroplasty (THA) with the use of delta ceramic-on-ceramic (CoC) bearing. We conducted an extension study with a CT scan at a minimum of 10years after surgery. From March 2009 to March 2011, 273 patients (310 hips) received cementless THA with delta CoC bearing, porous-coated cup and hydroxyapatite-coated stem. In this extended study, 252 patients (144 men and 108 women) (288 hips) with a mean age of 49.7years (16-83) at surgery were followed for a mean of 10.4years (10-12) with CT scans in 133 hips (46.2%, 133/288). Clinical and radiographic evaluations were made at each follow-up and Kaplan-Meier survival analysis was performed with revision and reoperation as endpoints. There were no more ceramic fractures. Compared to mid-term results, the incidence of squeaking and RLLs increased to 3.1% (9/288) and 19.4% (56/288), respectively. The RLL progressed to focal osteolysis in 3 hips (5.4%, 3/56). No hip had detectable wear or prosthetic loosening. Two hips were reoperated due to periprosthetic joint infection and periprosthetic femoral fracture in each. The survivorship decreased to 98.3% (96.7-99.9%) at 12years. During the extended follow-up, no additional ceramic fracture occurred, and the incidence of squeak increased by 0.7%. The long-term survivorship of Delta CoC THA was encouraging. However, focal osteolysis occurred around the hydroxyapatite-coated stem in 1% (3/288). II (Prospective cohort study).

Tensile fracture test of nanocomposite ceramics under ultrasonic vibration based on nonlocal theory

Based on non-local theory, the dispersion characteristics of ultrasonic vibration in Specimen tension are analyzed, and the effects of ultrasonic frequency and amplitude on the wave dispersion are obtained through theoretical analysis. Tensile tests were carried out using an ultrasonic vibration system and specimens, and the test process as well as test parts were observed and analyzed. The influence of the ultrasonic vibration on fracture properties and the change of grain micro-organization under different loading conditions were verified by experiments. The introduction of ultrasonic vibration changes the internal stress of the ceramic fracture, affects the hardness of the workpiece, and also leads to the scattering of particles, which leads to the aggravation of ultrasonic attenuation and phase velocity dispersion. SEM and XRD analyses showed that with the increase in ultrasonic frequency and amplitude，the trans -granular fracture was more obvious, the micro-cracks and dimples increased, and micro-pores increased in size and number. The tensile stress produced by ultrasonic vibration will induce the transformation from T-phase ZrO2 particles to M-phase ZrO2 particles and absorb strain, which greatly improves the plastic mechanical properties of nanocomposite ceramics. Due to the inherent phase transformation toughening mechanism, the material improves the plastic mechanical properties under the ultrasound excitation, and it is easier to achieve ductile domain processing.

The study of diffuse interface propagation of dynamic failure in advanced ceramics using the phase-field approach

Dynamic failure in advanced ceramic materials is a complex mechanical phenomenon, which is challenging to study in experimental and computational works. This work models and investigates the crack initiation, growth, propagation, and branching in two-dimensional single crystalline boron carbide at the nanometer length-scale and picosecond time-scale. A phase-field approach is used by carefully selecting the interfacial energy allowing a monolithic numerical solution method capturing strong coupling between mechanics and damage. Specifically, the transient Ginzburg–Landau equation is coupled with the balance of momentum including geometric nonlinearities and solved by using the open-source computing platform FEniCS. The monolithic computation ensures necessary accuracy for dynamic fracture under pure mode I loading, and also demonstrates the capability of crack branching depending on the loading rate. The effect of crack regularization length and kinetic coefficient on the crack interface profile and crack tip velocity is also studied. Altogether, the results are important for modeling anisotropic fracture in advanced ceramics and designing materials with desired dynamic failure characteristics.

Impact of different axial wall designs on the fracture strength and stress distribution of ceramic restorations in mandibular first molar

BackgroundThe purpose of this study was to investigate the fracture strength and stress distribution of four ceramic restorations.MethodsForty human mandibular first molars were collected and randomized into four groups after establishing the distal defect: full crown group with 4 mm axial wall height (AWH) (FC4); short AWH crown group with 2 mm AWH (SC2); occlusal veneer group with 0 mm AWH (OV0); occlusal distal veneer group with only the distal surface prepared, and 4 mm AWH (OD4). The teeth were prepared according to the groups and the ceramic restorations were completed using celtra duo ceramic blocks. The ceramic thickness of the occlusal surface is about 1.5 mm and the edge is about 1 mm. The failure load values and fracture modes of each group were detected by mechanical test in vitro. According to the groups to establish three-dimensional finite element analysis (FEA) models, a 600 N loading force was applied vertically using a hemispherical indenter with a diameter of 6 mm. and compare the stress distribution under the condition of different restorations.ResultsIn vitro mechanical tests showed that the failure load values were SC2 (3232.80 ± 708.12 N) > OD4 (2886.90 ± 338.72 N) > VO0 (2133.20 ± 376.15 N) > FC4(1635.40 ± 413.05 N). The failure load values of the short AWH crown and occlusal distal veneer were significantly higher than that of occlusal veneer and full crown (P<0.05). The fracture modes of the full crown and occlusal veneer groups were mainly ceramic fractures and some were restorable tooth fractures. The short AWH crown and occlusal distal veneer groups presented with three fracture modes, the proportion of non-restorable tooth fracture was higher. The results of FEA show that under the spherical loading condition, the stress of ceramic was concentrated in the contact area of the loading head, the maximum von Mises stress values were FC4 (356.2 MPa) > VO0 (214.3 MPa) > OD4 (197.9 MPa) > SC2 (163.1 MPa). The stress of enamel was concentrated in the area where the remaining enamel was thinner, the maximum von Mises stress values was OD4 (246.2 MPa) ≈ FC4 (212.4 MPa) > VO0 (61.8 MPa) ≈ SC2 (45.81 MPa). The stress of dentin is concentrated in the root furcation and the upper third region of the root. However, stress concentration was observed at the tooth cervix in the full crown.ConclusionUnder certain conditions, the occlusal distal veneer shows better performance than the full crown.

Spontaneous formation of uniform 1D/2D amorphous carbon nanostructures upon fracture of CNT-concentrated ceramics

Uniform 1D/2D amorphous carbon nanostructures were discovered to spontaneously form on the fracture surfaces of carbon nanotube-concentrated ceramic composites upon their static fracture. The factors potentially responsible for the formation, thickness and detectability of such nanosized amorphous carbon structures are discussed. Ultimately, a mechanism for their formation upon fracture is proposed. The present discovery could help to avoid misinterpretation of the carbon/matrix interfacial strength, reactions and the composites reinforcing mechanism especially in carbon-concentrated composite systems. Furthermore, this is the first report on the formation of amorphous carbon nanostructures upon fracture of a carbon-based composite material.

Modeling Deformation and Fracture of Boron-Based Ceramics with Nonuniform Grain and Phase Boundaries and Thermal-Residual Stress

A phase field framework of elasticity, inelasticity, and fracture mechanics is invoked to study the behavior of ceramic materials. Mechanisms addressed by phase field theory include deformation twinning, dislocation slip, amorphization, and anisotropic cleavage fracture. Failure along grain and phase boundaries is resolved explicitly, whereWeibull statistics are used to characterize the surface energies of such boundaries. Residual stress incurred by mismatching coefficients of thermal expansion among phases is included. Polycrystalline materials of interest are the ultra-hard ceramics boron carbide (B4C) and boron carbide-titanium diboride (B4C-TiB2), the latter a dual-phase composite. Recent advancements in processing technology enable the production of these materials via spark-plasma sintering (SPS) at nearly full theoretical density. Numerical simulations invoking biaxial loading (e.g., pure shear) demonstrate how properties and mechanisms at the scale of the microstructure influence overall strength and ductility. In agreement with experimental inferences, simulations show that plasticity is more prevalent in the TiB2 phase of the composite and reduces the tendency for transgranular fracture. The composite demonstrates greater overall strength and ductility than monolithic B4C in both simulations and experiments. Toughening of the more brittle B4C phase from residual stress, in addition to crack mitigation from the stronger and more ductile TiB2 phase are deemed advantageous attributes of the composite.

Intraoral repair of fractured ceramics: a literature review

Background: Fracture or chipping of veneering ceramic resulting in aesthetic and functional issues is a frequent technical complication encountered with fixed dental prostheses. Treatment options include extraoral or intraoral repair of the ceramic restoration; the latter being minimally invasive and cost-effective. We reviewed the various intraoral repair techniques for ceramic fractures and their efficiency in the last decade. Methods: A literature search was carried out between 2017 and 2022 using the PubMed database with keywords: intraoral, repair, ceramics, porcelain, and ‘porcelain fused to metal’. Screening of abstracts and full texts was carried out to determine the final list of eligible studies. Results: Twenty-one eligible studies were included in the review which consisted of 17 in vitro studies, three case reports, and one prospective clinical study. Researchers and dentists preferred repairing cracked veneered zirconia-based restorations intraorally if the restoration is in acceptable condition. However, successful intraoral repair of veneering fractures relies on the bond between the previous restoration and the new repair material, the right adhesive resin, and adequate surface conditioning. The review indicated that the best technique to fix chipping in a complex made of zirconia core and veneering ceramic is to treat the veneering ceramic with hydrofluoric acid before covering the core ceramic with silica. Conclusion: Intraoral repair is an efficient and economic procedure without the need for repeated sessions. However, the success and longevity of the restoration rely on the technical skills of the clinicians and adherence to prescribed protocols.

A Cracking Tale of Ceramic Component Fracture Revision: A Case Report and Literature Review

A Cracking Tale of Ceramic Component Fracture Revision: A Case Report and Literature Review

Chipping of ceramic‐based dental materials by micrometric particles

AbstractChipping caused by micrometric particles poses a threat to the structural integrity of modern dental prosthetic materials. It can degrade their fracture strength and cause wear of both artificial crowns and antagonist teeth. Here, surface chipping of the main types of commercial ceramic‐based dental materials at the microcontact/particle level is investigated by means of indentation tests. Conical tips of different sizes (radii 20 and 200 μm) under axial and sliding loading are employed to simulate individual microcontacts. Both decreasing particle size and adding a lateral contact force decrease the chipping load below typical bite forces. Specific damage mechanisms are identified as predominantly brittle fracture in ceramics with small, equiaxed crystals, with significant quasi‐plastic damage in ceramics containing large, elongated crystals and composites. Critical loads for the occurrence of chipping are quantified (lowest values in equiaxed glass–ceramics; greatest in zirconia) and analyzed within the framework of fracture mechanics. The brittleness index (BI) is proposed as a simple indicator of the resistance to chipping of dental materials—the lower the BI, the greater the resistance. Special attention is paid to the effect of the materials’ microstructure, which can result in transformation toughening (as in zirconia) or quasi‐plastic behavior (as in lithium disilicate), both highly beneficial to increasing the chipping resistance. Finally, practical implications for the selection of current dental materials as well as for the development of novel materials with improved durability are discussed.

A 5-year retrospective study of computer aided design and computer aided manufacturing ceramic endocrowns in endodontically treated posterior teeth

Objective: To evaluate the clinical outcomes of computer aided design and computer aided manufacturing (CAD/CAM) ceramic endocrowns in endodontically treated posterior teeth after five years by a retrospective study. Methods: Patients who received CAD/CAM ceramic endocrowns after endodontically treatment in Department of Endodontics, School of Stomatology, The Fourth Military Medical University between January 2016 and June 2017 were invited for this clinical study. Clinical performance was evaluated in the aspect of color match, anatomic form,marginal adaptation, restoration integrity and secondary caries. Survival rate of the restorations was calculated by the use of Kaplan-Meier method. Log-rank test was applied as well for the sake of analyzing the effect of tooth position, sex and materials to the survival rate of the restorations. Results: Seventy-four patients, 25 men and 49 women with age of (38.8±10.2) years, participated in this study for a total of 101 CAD/CAM ceramic endocrowns after observation period of (62.8±12.0) months. There were 8 failed cases among 101 restorations, 5 were loss of retention, 2 were ceramic fracture and 1 was secondary caries respectively. In particular, 93% (89/96) restorations got score A on anatomic form and 95% (91/96) restorations got score A on marginal adaptation, while 38% (36/96) restorations showed the good color match compared with the abutment teeth. The estimated cumulative survival rate of CAD/CAM ceramic endocrowns in endodontically treated posterior teeth after 5 years was 93.0% (95%CI: 87.9%-98.1%). The single-factor Log-rank analysis demonstrated that there was no statistically significant difference in the survival rate of CAD/CAM ceramic endocrowns among men and women, premolars and molars, position in the dental arch, or different materials (χ²<0.01, P=0.957; χ²=0.64, P=0.422; χ²=0.69, P=0.407; χ²=0.88, P=0.349). Conclusions: Based on this clinical study, the clinical performance of CAD/CAM ceramic endocrowns in endodontically treated posterior teeth after five years is reliable, which could be a general option to restore nonvital teeth.