Journal of the Mechanical Behavior of Biomedical Materials 74 (2017) 342348

Contents lists available at ScienceDirect

Journal of the Mechanical Behavior of

Biomedical Materials
journal homepage: www.elsevier.com/locate/jmbbm

Fracture strength of lithium disilicate crowns compared to polymer- MARK

inltrated ceramic-network and zirconia reinforced lithium silicate crowns

Kim Sieper , Sebastian Wille, Matthias Kern
Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University at Kiel, Germany

A R T I C L E I N F O A B S T R A C T

Keywords: Objectives: The aim of this study was to evaluate the fracture strength of crowns made from current CAD/CAM
Polymer inltrated ceramic network materials. In addition the inuence of crown thickness and chewing simulation on the fracture strength was
Zirconia reinforced lithium evaluated.
Monolithic crowns Methods: Crowns were fabricated from lithium disilicate, zirconia reinforced lithium silicate (ZLS-ceramic) and a
CAD/CAM
polymer-inltrated ceramic-network (PICN) with an occlusal thickness of 1.0 mm or 1.5 mm, respectively
Fracture strength
(n=16). Crowns were cemented on composite dies. Subgroups of eight specimens were loaded with 5 kg in a
chewing simulator for 1,200,000 cycles with thermal cycling. Finally, all specimens were loaded until fracture in
a universal testing machine. Three-way ANOVA was used to detect statistical interaction. Dierences regarding
the materials were tested with two-way ANOVA, following one-way ANOVA and a post-hoc Tukey's-Test.
Results: All crowns survived the chewing simulation. The material had a signicant inuence on the fracture
resistance (p0.05). Lithium disilicate achieved the highest values of fracture strength in almost all groups
followed by ZLS-ceramic. PICN achieved the lowest values of fracture strength. Chewing simulation increased
the fracture strength of thick lithium disilicate crown signicantly. Greater occlusal thickness of all crown
materials resulted in higher crown fracture strength before chewing simulation. After chewing simulation oc-
clusal thickness of lithium disilicate and PICN crowns had no signicant inuence on the fracture strength.
Conclusions: All crowns revealed fracture strength above the clinically expected loading forces. Therefore the
durability of the tested CAD/CAM materials seems promising also in an occlusal thickness of 1.0 mm.

1. Introduction
In times of digital dentistry the possibility of a quick chairside
production process with computer aided design and computer aided
manufacturing (CAD/CAM) leads to an increasing demand for mono-
lithic restoration materials (Mehl et al., 2013; Miyazaki et al., 2009;
Wittneben et al., 2009). Veneered zirconia has been successfully used
for all-ceramic restorations, but delamination of the veneering material
from the framework or minor chip-os often caused failures (Guess
et al., 2008; Guess et al., 2011; Kelly et al., 1995; Sailer et al., 2006;
Swain, 2009; Tinschert et al., 2005; Zhao et al., 2012). Another reason
for ceramic restoration failure are imperfections caused during the
manufacturing process. The CAD/CAM technology leads to a more
homogenous structure of the milled restorations, when they are cut
from standardized fabricated blocks. Using monolithic restorations
therefore seems promising to prevent these failures (Kern et al., 2017).
So far highly esthetic monolithic silicate ceramic has been successfully
used in inlays, onlays and veneers. However in larger restorations like
crowns there have been reports of complete fractures (Malament et al.,
2003; Skouridou et al., 2013). Silicate ceramic restorations in general
are brittle and fragile if manufactured too thinly. They are only reliable
for dental restorations when designed in adequate thickness (Guess
et al., 2013).
So far lithium disilicate ceramic appears to be an attractive mono-
lithic material. Its exural strength of 362 MPa and its fracture tough-
ness of 2.0 MPa m0.5 (Elsaka and Elnaghy, 2016) is higher than that of
conventional silicate ceramics with a exural strength of 134 MPa and a
fracture toughness of 1.74 MPa m0.5 (Wagner and Chu, 1996). When
lithium disilicate is used for crowns, there is no need for any metal or
zirconia framework, therefore chipping problems could be reduced.
Lithium disilicate ceramic (IPS e.max, Ivoclar Vivadent, Schaan Liech-
tenstein, Germany) can be monolithic pressed or be milled in CAD/CAM
systems and has been successfully tested in clinical trials (Fasbinder
et al., 2010; Gehrt et al., 2013; Kern et al., 2017). Kern et al. report that
the ten-year-survival rate of three-unit xed dental prosthesis from li-
thium disilicate was 87.9% (Kern et al., 2012). Gehrt et al. report an 8-

Correspondence to: Dept. of Prosthodontics, Propaedeutics and Dental Materials, Christian-Albrechts University at Kiel, Friesische Strae 24a, 25980 Westerland, Germany.
E-mail address: kimsieper@gmx.de (K. Sieper).

http://dx.doi.org/10.1016/j.jmbbm.2017.06.025
Received 3 May 2017; Received in revised form 19 June 2017; Accepted 20 June 2017
Available online 21 June 2017
1751-6161/ 2017 Elsevier Ltd. All rights reserved.
K. Sieper et al. Journal of the Mechanical Behavior of Biomedical Materials 74 (2017) 342348

year survival rate for lithium disilicate crowns of 98.4% (Gehrt et al., Table 1
2013). Still there is a demand for optimized CAD/CAM materials that Tested materials used in the study and their LOT-Numbers.
are reliable even when used in reduced thicknesses.
Material Composition Manufacturer LOT-Nr.
An approach for an optimized CAD/CAM material is a polymer-in-
ltrated ceramic-network (PICN). By the combination of the benets IPS e.max CAD Lithium disilicate ceramic Ivoclar Vivadent, T08295
from ceramics and polymers the mechanical properties of a natural (SiO2 5780%, Li2O Schaan,
1119%, ZrO2 08%) Liechtenstein
tooth are supposed to be imitated. A CAD/CAM fabricated PICN-ma-
VITA Enamic Polymer-inltrated ceramic- VITA Zahnfabrik, 44640
terial is VITA Enamic (VITA Zahnfabrik, Bad Sckingen, Germany), network Bad Sckingen,
which consists of 86 wt% ceramic and 14 wt% polymer (75 vol% an- (Inorganic ceramic part 86% Germany 100013
organic and 25 vol% organic material). This composition is similar to with 2023% Al2O3, organic
modern dental composite resins, where an organic matrix is densely polymer part 14%)
VITA Suprinity Lithium silicate 90%, VITA Zahnfabrik, 36852
lled with anorganic particles. However, in this new PICN-material
Zirconia 10% Bad Sckingen, 35540
there is a ceramic network, which corresponds to that of a ne-structure Germany
feldspar ceramic enriched with aluminum oxide (5863% SiO2 and
2023% Al2O3). This has been fully inltrated by a polymer of UDMA
(urethane dimethacrylate) and TEGDMA (triethylene glycol dimetha- of the study was to test the crowns in an experimental low thickness of
crylate). 1.0 mm occlusally and 0.8 axially. Additionally the inuence of long-
A comprehensive review of this class of material has been recently term fatigue was evaluated with a chewing simulator. The rst null-
published by Swain et al. (2016). Mechanical properties in bulk are hypothesis was, that there is no inuence of masticatory fatigue re-
reported with a exural strength of 130 MPa and a fracture toughness garding the fracture strength of molar crowns made from monolithic
with 1.4 MPa m0.5, accordingly similar to conventional silicate CAD/CAM materials. The second null-hypothesis was, that there is no
ceramic (Swain et al., 2016; VITA-Zahnfabrik, 2016). The elastic inuence of crown thickness. The third null hypothesis was, that there
modulus and the Vickers hardness of the PICN material is similar to is no dierence between the dierent materials.
human enamel and dentin so it is more exible and softer than common
ceramic materials (Della Bona et al., 2014; Swain et al., 2016). Ac-
cording to manufacturer's information the load until failure of 2576 N 2. Materials and methods
(VITA-Zahnfabrik, 2016) in a static crown fracture test is declared su-
perior to that of conventional ceramics. PICN has a lower fatigue re- 2.1. Specimen preparation
sistance than LDS but still PICN restorations can withstand normal
masticatory forces (Homaei et al., 2016). In another laboratory study The tested materials and their corresponding LOT-numbers are
failures of PICN crowns occurred only at very high loads above 1000 N given in Table 1. The study design and group codes are shown in
(El Zhawi et al., 2016). So the combination of the PICN material's edge Table 2.
sharpness, high fracture strength and exibility makes it possible to A total of 96 crown specimen were manufactured. They were di-
produce thinner crowns or even veneers with a thickness of only vided into three material groups (n=32). Each material group was
0.2 mm (Egbert et al., 2015). Manufacturers also claim reduced wear of separated into two dierent thickness design groups (n=16). One half
burs in the CAD/CAM milling machine (VITA-Zahnfabrik, 2016). La- of them was tested directly in a static load to failure test (n=8) and the
boratory studies evaluated standard parameters such as modulus of other half experienced fatigue by chewing simulation before static load
elasticity, Weibull-modulus, density and exural strength (Denry and to failure test (n=8). Therefore two rst mandibular molars as typo-
Kelly, 2014; He and Swain, 2011; Homaei et al., 2016; Stawarczyk dont models (KaVo Dental, Bieberach/ Ri, Germany) were prepared in
et al., 2016; Swain et al., 2016) and reported high exibility and pro- two dierent designs. One specimen represented a full-cast preparation
mising stability. by preparing the axial walls only 0.8 mm and the occlusal surface only
A second approach of an optimized CAD/CAM material is a lithium 1.0 mm (group 1). This design is usually used for adapting the teeth to
silicate ceramic reinforced with 10% zirconia (ZLS-ceramic). Zirconia is metal crowns. The other specimen represented the preparation for a
known for phase transformation of the tetragonal phase to the mono- ceramic crown, so the dies were cut 1.0 mm axial and 1.5 mm occlusal
clinic phase with a volume increase that prevents crack propagation
and leads to a high fracture strength (Manicone et al., 2007). Optimized Table 2
Study design. Three dierent materials were tested. Before testing the maximum fracture
translucency and high durability are combined in ZLS-ceramic (VITA- strength, one subgroup was loaded in a chewing simulator and the other subgroup was
Zahnfabrik, 2013). Elsaka et al. reported a high exural strength of tested without previous chewing simulation. In both subgroups two dierent crown
445 MPa for ZLS, and a fracture toughness of 2.31 MPa m0.5 which thicknesses were represented.
was higher than that of lithium disilicate (Elsaka and Elnaghy, 2016).
Group code Material Loading type (Chewing Thickness (Axial/
Preis et al. investigated that adhesive cementation of ZLS results in the
simulation) Occlusal)
best fracture strength values for molar crowns (Preis et al., 2015).
However, there are only a few laboratory studies available that Li-U1 Lithium U = Unloaded 1 = 0.8 mm / 1.0 mm
evaluated the basic physical properties of the newly developed PICN disilicate
Li-U2 Lithium U = Unloaded 2 = 1.0 mm / 1.5 mm
material and there are even less investigations according to ZLS
disilicate
ceramic. Laboratory investigations simulating the clinical situation like Li-L1 Lithium L = Loaded 1 = 0.8 mm / 1.0 mm
the present study are important to test dental materials preclinically disilicate
before applying them in patients (Kelly, 1999). To the best knowledge Li- L2 Lithium L = Loaded 2 = 1.0 mm / 1.5 mm
of the authors there have been no clinical studies published yet. disilicate
En-U1 PICN-material U = Unloaded 1 = 0.8 mm / 1.0 mm
Therefore, the aim of this study was to evaluate the fracture strength En-U2 PICN-material U = Unloaded 2 = 1.0 mm / 1.5 mm
of a PICN material and a ZLS ceramic compared to the well-known li- En-L1 PICN-material L = Loaded 1 = 0.8 mm / 1.0 mm
thium disilicate ceramic in a crown design. According to the current En-L2 PICN-material L = Loaded 2 = 1.0 mm / 1.5 mm
guidelines for all-ceramic preparation an occlusal thickness of at least Su-U1 ZLS-ceramic U = Unloaded 1 = 0.8 mm / 1.0 mm
Su-U2 ZLS-ceramic U = Unloaded 2 = 1.0 mm / 1.5 mm
1.5 mm is required (Kern et al., 2017). However, Burke et al. report that
Su-L1 ZLS-ceramic L = Loaded 1 = 0.8 mm / 1.0 mm
adhesive cementation supports the ceramic crown materials leading to Su-L2 ZLS-ceramic L = Loaded 2 = 1.0 mm / 1.5 mm
a minor inuence of the thickness (Burke et al., 1998). So another aim

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K. Sieper et al. Journal of the Mechanical Behavior of Biomedical Materials 74 (2017) 342348

according the regular dimensions for ceramic restorations (group 2).

For both dies the preparation angle was determined at 4 by special
drills xed in a parallelometer. Afterwards tooth replicas were fabri-
cated using silicone impressions (Elastosil, Wacker Chemie, Munich,
Germany) taken from the plastic models. The impressions were lled
with layers of resin-based composite (Z100, 3M ESPE, Seefeld,
Germany). The composite dies were cured according to the manufac-
turer's instructions. The replicas were stored in distilled water at 37 C
for a minimum of 30 days to assure hydration and eliminate any eects
of dimensional expansion by water uptake after crown cementation
(Coelho et al., 2009; Wang et al., 2014).
A full crown wax-up was created on the dies with the dimensions
0.8 / 1.0 mm and 1.00 mm / 1.5 mm. The opening angle between the
cusps was 150 in both groups (Clausen et al., 2010). Both full wax-ups
were scanned and additionally designed with the Sirona 3shape scanner
(Sirona Dental GmbH, Salzburg, Austria). The resulting stl-les were
sent to the Cerec milling machine. PICN-material, ZLS-ceramic and li-
thium disilicate ceramic were used as crown materials. A total of 96
crowns were milled and afterwards polished as recommended by the
manufacturer. The polishing was done by a single operator with the aid
of a magnication loupe (4.5 magnication Zeiss, Jena, Germany) using
specic burs (Polishing Set clinical, VITA Zahnfabrik, Bad Sckingen
Germany). No glaze was added. All cementation procedures followed
the manufacturers instructions: Z100 dies were thoroughly cleaned
with ethanol in an ultrasonic bath and air-dried, followed by applica-
tion of the Multilink Automix Primer A and B 1:1 mixture (Ivoclar Vi-
vadent, Schaan, Liechtenstein), rubbing it for 30 s. The crowns were
cleaned with ethanol in an ultrasonic bath and air-dried. A 5% hydro-
uoric acid gel (Ivoclar, Vivadent, Schaan, Liechtenstein) was applied
to the inner surfaces of the PICN crowns for 60 s and of the LDS and ZLS
crowns for 20 s, rinsed in tap water, and air dried for 20 s. Silane Fig. 1. a) Schematic view of the crown design b) specimen in the chewing simulator.
coupling agent (Monobond Plus, Ivoclar Vivadent, Schaan, Liechten-
stein) was applied to the etched surface, followed by 60 s rest period, Germany) at a cross-head speed of 1 mm/min. The load of the testing
and air drying. The crowns were luted with Multilink Automix (Ivoclar machine was applied along the long axis of the restored dies using a
Vivadent, Schaan, Liechtenstein) onto the dies using a cementation stainless steel ball with 6 mm in diameter that was centered on the
device with a load of 10 N. Excess cement was chipped away after 23 s midline ssure of each specimen. The load was applied to the both
light curing. Photopolymerization of the luting agent was carried out by lingual and facial cusps. Between the ball and the crown surface there
exposing each surface of the crown to a dental curing light with an was a 0.6 mm thick tin foil to spread the load. The compressive load
irradiance of 850 mW/cm2 for 40 s (UniXS, Heraeus Kulzer, Hanau, required to cause fracture was recorded for each specimen by a soft-
Germany). All cementation procedures were carried out by a single ware (Mitsias et al., 2014).
operator. The crowns were stored for another 24 h in distilled water at
37 C (VITA-Zahnfabrik, 2016). Then the specimens were xed in
2.4. Fracture surface evaluation
15 mm-diameter metal rings, using fast-setting polyester resin (Tech-
novit 4000, Heraeus Kulzer, Wehrheim, Germany). To avoid any
Representative specimens were taken for microstructural analysis.
movement of the specimens in the metal rings, each root part was
The fracture surfaces were coated with platinum and palladium using
equipped with a 0.9 mm steel-wire before xing with the resin (Clausen
Magnetron Ion sputter (Leica EM QSG 100, Wetzler, Germany) before
et al., 2010).
scanning electron microscopy (SEM) analysis (XL30 CP, Philips, Kassel,
Germany)
2.2. Dynamic loading

A group of 48 specimens (n=8) was loaded in a computerized 2.5. Statistics

masticatory simulator (Chewing Simulator CS-4, SD Mechatronic,
Feldkirchen-Westerham, Germany). They were cyclic loaded 1,200,000
times with 5 kg weight and a 30 mm/s descending speed. Specimen
were additionally thermal cycled between 5 and 55 C in tap water with
a 60 s dwell time at each temperature (Steiner et al., 2009). A loading
cycle frequency of 1.2 Hz with a lateral component of 0.3 mm was se-
lected to simulate usual physiological masticatory forces (Steiner et al.,
2009). The antagonistic steatite ball was positioned as shown in Fig. 1.
The steatite ball was trimmed in a way that no undened contact on the
opposite cusp during the lateral component was possible.
The statistical analyses were performed using the SPSS statistical
program (Version 20, IBM, Armonk, NY, USA). The ShapiroWilk-Test
was used to determine a normal distribution. Three-way analysis of
variance (ANOVA), due to signicant interaction followed by two-way
and if necessary serial one-way ANOVAs were used for statistical ana-
lysis of the data. Tukey's honest signicant dierence test (HSD) at a
signicance level of 0.5 was used to investigate signicant dierences.
3. Results

2.3. Static loading 3.1. Fracture strength

Both groups were tested for their maximum load until catastrophic Fracture strengths of all test groups and statistically signicant
failure in a universal testing machine (Zwick Z010/TN2A, Ulm, dierences are presented in Table 3. Three-way ANOVA revealed that

344
K. Sieper et al.
Table 3
Fracture strengths of test groups in Newton N. All data in this Table was normally distributed. Statistically dierent means (p0.05) are indicated by dierent superscript upper case
letters within a row for same thickness to compare the materials. To compare the dierent thicknesses, dierent lower case letters show signicant dierences. Dierent superscript lower
case Greek letters compare loading type within the same thickness group. Standard deviations are given in parentheses.
Material Li = E.max CAD
Occlusal thickness 1.0 mm 1.5 mm
Before chewing-simulation 2499 Ab 3365 Aa
(167) (262)
After chewing simulation 2535 Aa 2648 Ba
(175) (311)
there was a statistical signicant interaction (p=0.04) between the
material, stress and thickness type. Therefore the groups of thick
crowns and thin crowns were investigated separately with following
two-way ANOVAs. In the group of thick crowns an interaction of the
factors material and chewing-simulation was revealed (p=0.008).
One-way ANOVA and post-hoc Tukey's test were used to investigate the
inuence of chewing-simulation for each material of the group of thick
crown. Two-way ANOVA for the group of thin crowns did not show any
interactions, post-hoc Tukey's test showed the signicant dierences.
Mean values and standard deviations are shown in Table 1. The
mean fracture strength values ranged from 1988 N (PICN, 1.0 mm oc-
clusal, before chewing-simulation) to 3011 N (ZLS ceramic, 1.5 mm
occlusal, after chewing-simulation). None of the crowns experienced
any kind of failure during the chewing simulation.
In the groups of thick crowns a signicant dierence between all
materials was revealed before and after chewing-simulation. PICN
achieved signicantly lowest mean values (p0.05). In the group of
thin crowns lithium disilicate showed a signicantly higher fracture
strength compared to the other materials (p0.05) before and after
chewing-simulation.
All unloaded crowns achieved signicantly higher fracture strength
values with a high occlusal thickness of 1.5 mm (p0.05). After
chewing-simulation the occlusal thickness had no signicant inuence
on the fracture strength of PICN and lithium disilicate crowns. In con-
trast ZLS ceramic crowns showed a higher fracture strength in the thick
design also after chewing-simulation (p0.001).
The inuence of chewing-simulation increased the fracture strength
of lithium disilicate crowns only in the thick design (p0.001), while
all the other materials independent from their thickness were not sig-
nicantly inuenced by chewing-simulation (p > 0.05).
3.2. Image analysis
Photographic images (Fig. 2) of the crowns after load to failure
show that the fracture line was not found at areas were the intender
acted on but through the central fossa. Nearly all specimens failed
mesio-distally below the CEJ (cemento-enamel-junction). The failure
pattern was described as combined cohesive and adhesive fracture.
Only one LDS specimen showed tangential fracture though the cusp
without splitting the die.
SEM images (Fig. 3) show dierent fracture behavior of the three
dierent materials. LDS shows lines running parallel to the direction of
crack propagation known as hackles. ZLS shows clear arrest lines. These
are shaped semicircular with its concave side to the origin of failure
(Scherrer et al., 2006). The SEM images of PICN show very ne hackles
compared to LDS.
4. Discussion
In the present study crown fracture behavior of two recently de-
veloped CAD/CAM materials (polymer inltrated ceramic network and
zirconia reinforced lithium silicate) was compared to a well-proven
CAD/CAM material (lithium disilicate). The inuence of experimental
345
Journal of the Mechanical Behavior of Biomedical Materials 74 (2017) 342348
En = VITA Enamic Su = VITA Suprinity
1.0 mm 1.5 mm 1.0 mm 1.5 mm
1988 Bb 2381 Ca 2015 Bb 2923 Ba
(138) (219) (270) (458)
2128 Ba 2281 Ca 2115 Bb 3011 Aa
(262) (255) (180) (542)
low crown thickness and also dynamic fatigue was evaluated. Years of
repetitive occlusal contact under wet conditions and dierent tem-
peratures in the patient's mouth can cause failure to dental restorations.
This dynamic fatigue was simulated in a masticatory simulator.
Parameters used for masticatory simulation were adjusted to physio-
logical values reported in the literature. It is recommended that
1,200,000 chewing cycles should be performed to simulate ve years of
clinical service (Bates et al., 1975; DeLong and Douglas, 1991; Steiner
et al., 2009). The mean masticatory forces during mastication and
swallowing in humans are ranging from 3 to 72 N. Therefore a load of
49 N was applied during the simulation of ve years of fatigue in the
chewing simulator. Maximum masticatory forces in posterior molar
region can also be much higher ranging from 200 to 540 N (Yoshinari
and Drand, 1994). When patients suer from bruxism values in the
range of 800 N and more have been reported (Krber and Ludwig,
1983). The mean fracture loads to failure for the CAD/CAM crowns in
the present study were higher than reported mean maximum mastica-
tory forces.
Both crown designs were manufactured by hand as a full wax up,
they had the same opening angle between the cusps and at cusp slopes
with a consistent thickness. Of course the crown design is inuenced by
the thickness and therefore the two dierent crown types were not
identical. PICN cannot be placed in an oven for glazing treatments
therefor manufacturers recommend ne polishing. ZLS and LDS can
either be glazed or polished. In order to create comparable conditions
all crowns were polished for a nal surface treatment.
The results of the study partly conrm the rst null hypothesis.
There was no signicant inuence of dynamic loading on the fracture
strength for most of the test groups. None of the crowns experienced
any kind of failure during the chewing simulation. This seems to be a
promising fact considering the long-term durability of the crowns. The
only exception was the group of thick lithium disilicate crowns as their
fracture strength before chewing-simulation was signicantly higher
than afterwards. The thin lithium disilicate crowns might be able to
compensate the dynamic loading by exing. At the same time it might
be that thicker crowns of this material become more inuenced by
micro-cracks and achieved signicantly lower results in the following
fracture strength test. The SEM image of a LDS crown shows dominant
hackles from the origin of failure to the die. However due to the me-
chanical properties of its polymer component PICN is more exible and
therefore there is no signicant decrease in fracture strength caused by
chewing-simulation independent of the tested crown thickness. Coldea
et al. also reported crack propagation in PICN is hindered by the
polymer deformation across the crack. This phenomenon is known as
the Dugdale eect where polymer chains in the polymer phase spread
plasticity under load (Coldea et al., 2014; Dugdale, 1960; El Zhawi
et al., 2016; Leung et al., 2015). The SEM image of PICN (Fig. 3) shows
only very thin and short hackles compared to LDS, which supports the
thesis that crack propagation is hindered by the polymer phase. Also
ZLS ceramic crowns with high thickness showed no signicant decrease
in fracture strength caused by chewing-simulation. In ZLS the zirconia
is solved in the glass matrix of the lithium. In this case the crack for-
mation and propagation might be hindered by the transformation of the
K. Sieper et al.
tetragonal zirconia phase (Manicone et al., 2007). The SEM images of
ZLS show very clear semicircular arrest lines close to the origin of
failure. This leads to the assumption that micro-cracks might have a
smaller inuence on the fracture strength of ZLS ceramic crowns than
on lithium disilicate ceramic crowns.
The fact that no crack propagation was seen from the area where the
antagonist acted on supports the hypothesis that dynamic loading has
no signicant inuence on the fracture strength for most of the test
groups. Static load to failure provoked splitting the crowns from the
central fossa through the composite dies mesio-distally below CEJ. This
is a typical failure mode for monolithic crowns split by a hard intender
wedged between the molar cusps (Zhang et al., 2016). As El Zhawi et al.
and Homaei et al. described for PICN crowns the splits often deviated
slightly from the symmetry plane between buccal and lingual cusp this
failure pattern was also seen in the present study for the other materials
ZLS and LDS (El Zhawi et al., 2016; Homaei et al., 2016). Only one
specimen LDS showed tangential fracture though the cusp without
splitting the die (Fig. 2). It cannot be excluded that imperfections of
adhesive bonding led to this varying failure pattern.
The second hypothesis has to be rejected, as there is a statistical
signicant inuence of the crown thickness. Before chewing-simulation
crowns with a higher occlusal thickness achieved signicantly higher
fracture strength results than crowns with a lower thickness. So the
strengthening eect of the adhesive cementations might result in a
reduced inuence of the thickness of the crown materials (Burke et al.,
1998). The inuence of the thickness seems not completely compen-
sated by adhesive cementation of the crown to die. However, the dif-
ference in fracture strength of the tested crowns with dierent thick-
nesses was small for PICN. The reason for this might be that the
mechanical properties such as the elastic modulus of the dental com-
posite resin dies are quite similar compared to PICN (Sorrentino et al.,
2016; Tay and Pashley, 2007). So the eect of the adhesive cementation
to the die seems to be stronger for PICN than for materials with dif-
ferent mechanical properties. However, after chewing-simulation the
thickness design had no signicant inuence on lithium disilicate and
PICN crowns. Thin crowns of the tested materials showed fracture
strengths of 2000 N or even higher still after cyclic loading. Forces of
this magnitude usually do not appear intraorally. According to the
limits of this laboratory study, the less invasive preparation design with
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Journal of the Mechanical Behavior of Biomedical Materials 74 (2017) 342348
Fig. 2. Load to failure caused the same failure mode
(cohesive and adhesive splitting mesiodistally below
CEJ) for PICN, ZLS and LDS (a) crowns. Only one
LDS specimen (b) showed tangential cohesive and
adhesive failure without splitting the die. The white
arrows indicate the area where the antagonist acted
on in chewing simulation. Crack propagation did not
spread from this point but started from the middle
ssure.
thinner crowns seems to be sucient for the tested monolithic mate-
rials.
The third null-hypothesis of this study has to be rejected, as there
was a signicant inuence of the three dierent materials on the
fracture strengths of the crowns. The static fracture load for PICN
crowns with an axial thickness of 1 mm is present with more than
2700 N in the scientic technical information of VITA Enamic. In the
present study crowns in this shape achieved slightly lower values of
2381 219 N. According to manufacturer information of VITA
Suprinity, crowns with an occlusal thickness of 1 mm achieve a fracture
strength of more than 2200 N. This value is similar to the fracture
strength of 2015 270 N that was evaluated in the present study.
Although the fracture strength revealed in the current study were
slightly lower than reported by the manufacturers they are still far
above the physiological masticatory forces. Therefore it can be assumed
that forces in this magnitude will not appear in the clinical context
rendering both materials to withstand intraoral loading conditions.
5. Conclusions
Taking the results and conditions of this study into account, the
following conclusions can be drawn:
1. Crowns of all tested materials showed high values of fracture re-
sistance. Using a monolithic thin crown design fracture resistance of
about 2000 N was obtained.
2. Masticatory fatigue mostly did not aect the fracture strength of
crowns regardless of their material and thickness.
3. Polymer-inltrated ceramic network material and zirconia re-
inforced lithium silicate ceramic seems to be an alternative to well-
known lithium disilicate ceramic regarding its fracture strength.
However, further investigations including clinical studies are ne-
cessary before their general clinical use can be recommended.
Acknowledgments
The authors wish to thank Frank Lehmann and Rdiger Mller from
the Department of Prosthodontics, Propaedeutics and Dental Materials
of the University of Kiel and the manufacturers for providing the
K. Sieper et al.
Fig. 3. SEM images from the fracture point after loading to failure. The direction of crack
propagation is indicated by arrows. Parallel running hackles (h) are clearly visible in LDS
and PICN. Semicircular arrest lines (al) are seen closer from the origin of failure (o) in LDS
than in ZLS.
materials (Vita Zahnfabrik, Bad Sckingen, Germany and Ivoclar,
Schaan, Liechtenstein and 3M ESPE, Seefeld, Germany).
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