title: Survival of resin infiltrated ceramics under influence of fatigue.
abstract: OBJECTIVE
  to evaluate influence of cyclic fatigue on two resin infiltrated ceramics and three all-ceramic crowns manufactured using CAD/CAM technology.
  
  
  METHODS
  CAD/CAM anatomically shaped crowns were manufactured using two resin infiltrated ceramics (Lava Ultimate and Vita Enamic), two reinforced glass ceramic milling blocks ((IPS)Empress CAD and (IPS)e.max CAD) and a veneered zirconia core ((IPS)Zir CAD). (IPS)e.max CAD and (IPS)Zir CAD were milled into 0.5mm thick anatomically shaped core structure which received standardized press-on veneer ceramic. The manufactured crowns were cemented on standardized resin dies using a resin adhesive (Panavia F2.0). Initial fracture strength of half of the specimens was calculated using one cycle load to failure in a universal testing machine. The remaining crowns were subjected to 3.7 million chewing cycles (load range 50-200N at 3s interval) in a custom made pneumatic fatigue tester. Survival statistics were calculated and Weibull modulus was measured from fitted load-cycle-failure diagrams. Scanning electron microscopy was performed to fractographically analyze fractured surfaces. Data were analyzed using two way analysis of variance and Bonferroni post hoc tests (α=0.05).
  
  
  RESULTS
  Dynamic fatigue resulted in significant reduction (F=7.54, P<0.005) of the initial fracture strength of the tested specimens. Zirconia showed the highest deterioration percent (34% reduction in strength) followed by (IPS)Empress (32.2%), (IPS)e.max (27.1%) while Lava Ultimate and Vita Enamic showed the lowest percent of reduction in strength. The two types of resin infiltrated ceramics and (IPS)Empress demonstrated the highest percent of fracture incidences under the influence of fatigue (35-45% splitting). None of the tested veneered zirconia restorations were fractured during testing, however, chipping of the veneer ceramics was observed in 6 crowns. The lowest percent of failure was observed for (IPS)e.max crowns manifested as 3 cases of minor chipping in addition to two complete fracture incidences. SEM images demonstrated the internal structure of the tested materials and detected location and size of the critical crack.
  
  
  CONCLUSIONS
  The internal structure of the tested materials significantly influenced their fatigue behavior. Resin infiltrated ceramics were least influenced by fatigue while the characteristic strength of zirconia prevented core fracture but failure still occurred from the weaker veneer ceramic.
authors.affiliation: Department of Dental Materials, Faculty of Dentistry, Alexandria University, Egypt. Electronic address: Bluemarline_1@yahoo.com.
authors.forename: Moustafa N
authors.initials: MN
authors.lastname: Aboushelib
authors.affiliation: Dental Material Research Unit, Faculty of Dentistry, Alexandria University, Egypt.
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Elsafi
mesh_terms: D000538:Aluminum Silicates / Q000737:chemistry; D002516:Ceramics / Q000737:chemistry*; D003188:Composite Resins / Q000737:chemistry*; D017076:Computer-Aided Design; D003442:Crowns; D003776:Dental Porcelain / Q000737:chemistry; D019232:Dental Restoration Failure; D003799:Dental Stress Analysis; D008422:Materials Testing; D008855:Microscopy, Electron, Scanning; D018583:Pliability; D019279:Resin Cements / Q000737:chemistry; D013499:Surface Properties; D015040:Zirconium / Q000737:chemistry
chemical_list: D000538:Aluminum Silicates; D003188:Composite Resins; C000621147:IPS e.max Ceram; C075815:IPS-Empress ceramic; C438843:Panavia-Fluoro; D019279:Resin Cements; C000621297:VITA Enamic; D003776:Dental Porcelain; C023506:Glass ceramics; D015040:Zirconium; C028541:zirconium oxide
keywords: Cyclic fatigue; Fracture strength; Survival analysis