title: Monolithic CAD/CAM lithium disilicate versus veneered Y-TZP crowns: comparison of failure modes and reliability after fatigue.
abstract: OBJECTIVE
  The aim of this research was to evaluate the fatigue behavior and reliability of monolithic computer-aided design/computer-assisted manufacture (CAD/CAM) lithium disilicate and hand-layer-veneered zirconia all-ceramic crowns.
  
  
  METHODS
  A CAD-based mandibular molar crown preparation, fabricated using rapid prototyping, served as the master die. Fully anatomically shaped monolithic lithium disilicate crowns (IPS e.max CAD, n = 19) and hand-layer-veneered zirconia-based crowns (IPS e.max ZirCAD/Ceram, n = 21) were designed and milled using a CAD/CAM system. Crowns were cemented on aged dentinlike composite dies with resin cement. Crowns were exposed to mouth-motion fatigue by sliding a WC-indenter (r = 3.18 mm) 0.7 mm lingually down the distobuccal cusp using three different step-stress profiles until failure occurred. Failure was designated as a large chip or fracture through the crown. If no failures occurred at high loads (> 900 N), the test method was changed to staircase r ratio fatigue. Stress level probability curves and reliability were calculated.
  
  
  RESULTS
  Hand-layer-veneered zirconia crowns revealed veneer chipping and had a reliability of < 0.01 (0.03 to 0.00, two-sided 90% confidence bounds) for a mission of 100,000 cycles and a 200-N load. None of the fully anatomically shaped CAD/CAM-fabricated monolithic lithium disilicate crowns failed during step-stress mouth-motion fatigue (180,000 cycles, 900 N). CAD/CAM lithium disilicate crowns also survived r ratio fatigue (1,000,000 cycles, 100 to 1,000 N). There appears to be a threshold for damage/bulk fracture for the lithium disilicate ceramic in the range of 1,100 to 1,200 N.
  
  
  CONCLUSIONS
  Based on present fatigue findings, the application of CAD/CAM lithium disilicate ceramic in a monolithic/fully anatomical configuration resulted in fatigue-resistant crowns, whereas hand-layer-veneered zirconia crowns revealed a high susceptibility to mouth-motion cyclic loading with early veneer failures.
authors.affiliation: Department of Bionmaterials and Biomimetics, New York University, New York, NY, USA. petra.guess@uniklinik-freiburg.de
authors.forename: Petra C
authors.initials: PC
authors.lastname: Guess
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Zavanelli
authors.forename: Nelson R F A
authors.initials: NR
authors.lastname: Silva
authors.forename: Estevam A
authors.initials: EA
authors.lastname: Bonfante
authors.forename: Paulo G
authors.initials: PG
authors.lastname: Coelho
authors.forename: Van P
authors.initials: VP
authors.lastname: Thompson
mesh_terms: D017076:Computer-Aided Design; D003442:Crowns; D003776:Dental Porcelain; D017267:Dental Prosthesis Design; D019232:Dental Restoration Failure; D003799:Dental Stress Analysis; D003801:Dental Veneers; D018020:Lithium Compounds; D008422:Materials Testing; D003765:Models, Dental; D017640:Silicates; D013314:Stress, Mechanical; D015019:Yttrium; D015040:Zirconium
chemical_list: D018020:Lithium Compounds; D017640:Silicates; C499362:yttria stabilized tetragonal zirconia; D003776:Dental Porcelain; D015019:Yttrium; D015040:Zirconium