Fatigue resistance of simplified CAD–CAM restorations: Foundation material and ceramic thickness effects on the fatigue behavior of partially- and fully-stabilized zirconia

The Effect of Die Material on the Crown Fracture Strength of Zirconia Crowns

BACKGROUND

Determination of the eligibility of several tooth analog materials for use in crown fracture testing.

METHODS

A standardized premolar crown preparation was replicated into three types of resin dies (C&B, low modulus 3D printed resin; OnX, high modulus 3D printed resin composite; and highest modulus milled resin composite). 0.8 mm zirconia crowns were bonded to the dies and the maximum fracture load of the crowns was tested. Twelve extracted human premolars were prepared to a standardized crown preparation, and duplicate dies of the prepared teeth were 3D printed out of C&B. Zirconia crowns were bonded to both the dies and natural teeth, and their fracture load was tested.

RESULTS

There was no statistical difference between the fracture load of zirconia crowns bonded to standardized dies of C&B (1084.5 ± 134.2 N), OnX (1112.7 ± 109.8 N) or Lava Ultimate (1137.5 ± 88.7 N) (p = 0.580). There was no statistical difference between the fracture load of crowns bonded to dentin dies (1313 ± 240 N) and a 3D-printed resin die (C&B, 1156 ± 163 N) (p = 0.618).

CONCLUSIONS

There was no difference in the static fracture load of zirconia crowns bonded to standardized resin dies with different moduli or between a low modulus resin die and natural dentin die.

Is dentin analogue material a viable substitute for human dentin in fatigue behavior studies?

This study aimed to compare the fatigue performance of a lithium disilicate ceramic cemented on different substrates (human dentin and glass fiber-reinforced epoxy resin - GFRER), treated with different types of conditioning (CTR - without surface conditioning; HF5 - 5% hydrofluoric acid; HF10 - 10% hydrofluoric acid; H3PO4 - phosphoric acid 37%; SAND - sandblasting with aluminum oxide). The occlusal surface of human molars (DENT group) (n = 15) was ground for dentin exposure and the root portion was cut, then the dentin slice (2.0 mm thick) was conditioned with 37% phosphoric acid and a dual-curing dental adhesive was applied. The GFRER in a round-rod format was cut into discs (Ø = 10 mm, 2.0 mm thick). Lithium disilicate glass ceramic blocks (IPS e.max CAD, Ivoclar, Schaan, Liechtenstein) were shaped into a cylinder format and cut, resulting in 90 discs (Ø = 10 mm, 1.5 mm thick). The substrate materials of each group were etched according to the groups and the ceramic was etched with 5% hydrofluoric acid for 30 s. A silane coupling agent was applied over the cementation surface in ceramic and GFRER surfaces and a dual cement was used for cementation (ceramic/GFRER or dentin). The disc/disc sets were submitted to thermocycling (25,000 cycles + storage for 6 months), and then tested in step-wise accelerated cyclic fatigue test. The failure pattern and topography were analyzed and the roughness and contact angle were measured before and after surface treatment. The DENT group presented the lowest load to failure values and number of cycles to failure in fatigue (637.33 N; 118.333), showing no statistical similarity with any of the other tested groups (p < 0.05). The topographic analysis showed that all proposed surface treatments modified the substrate surface when compared to the CTR group. All of the fractographical inspections demonstrated failure by radial crack. Considering the roughness analysis, the post-etched DENT group showed similar roughness to all groups of GFRER materials with their surface treated, except for SAND, which showed greater roughness and statistically different from the other groups. The DENT group (49.5) showed statistically different post-conditioning contact angle values from the HF10 group (96.5) and similar to the other groups. The glass fiber-reinforced epoxy resin was not able to simulate the results presented by the human dentin substrate when cemented to lithium disilicate regarding fatigue failure load and number of cycles for failure, regardless of the surface treatment. Lithium disilicate cemented on dentin analogue overestimates the load values for fatigue failure.

Effect of abutment screw-access hole on the fatigue performance of implant-supported lithium-disilicate luted simplified restorations

The present study aimed to evaluate the impact of the existence of an abutment screw-access hole and the filling effects on the fatigue mechanical behavior of a luted lithium-disilicate glass-ceramic. Seventy-two discs (Ø = 10 mm, 1.0 mm in thickness) of lithium disilicate (IPS e.max CAD, Ivoclar AG) were obtained from prefabricated blocks. Thirty-six abutment specimens of an opaque zirconia (Yz - IPS e.max ZirCAD, Ivoclar AG) and titanium (Ti - Luminesse Ti-Cam discs, Talladium Inc.) were confectioned, and allocated according to 6 groups: Yz and Ti rigid (without screw access hole); Yz unfilled, Yz filled, Ti unfilled and Ti filled (with the screw access (Ø = 2.5 mm) in the center). For the unfilled groups, only a polytetrafluoroethylene tape was used. Resin composite (Tetric N-Ceram, Ivoclar AG) was applied to the screw access hole for the filled groups (Yz and Ti). A cyclic fatigue test was carried out (load of 200 N, 10,000 cycles each; 20 Hz of frequency, step size of 100 N until failure detection (radial/cone crack). The fatigue failure load (FFL) and number of cycles until failure (CFF) were recorded for statistical purposes. The stress distribution (MPa) was evaluated by finite element analysis. A statistically positive effect of the abutment material and the presence of the screw access hole was observed (p ≤ 0.05). The rigid groups (without screw access holes) depicted almost 100% of survival after the fatigue tests. Among the other groups, the Yz-filled group showed the best performance (p ≤ 0.05), followed by the Yz unfilled group. The Ti groups depicted lower values of FFL and CFF, with the Ti unfilled group showing the most unfavorable fatigue behavior (p ≤ 0.05). The lowest tensile stress concentration in the restorative material was observed with the use of rigid abutments, the filled groups depicted intermediate values, while unfilled groups showed the highest stress concentration (Yz rigid = 306.3 MPa; Ti rigid = 310.4 MPa < Yz filled = 490.7 MPa; Ti filled = 498.9 MPa < Yz unfilled = 707.6 MPa; Ti unfilled = 719.7 MPa). Therefore, the presence of a screw-access hole decreases the mechanical performance of a lithium disilicate ceramic regardless of the abutment material. In the presence of a screw-access hole, zirconia abutments depicted a higher fatigue failure load when compared with titanium. The filling of the abutment screw-access hole with resin composite increased the mechanical performance of the simulated restoration.

The Effect of Restoration Thickness on the Fracture Resistance of 5 mol% Yttria-Containing Zirconia Crowns

BACKGROUND

To determine what thickness of 5 mol% yttria zirconia (5Y-Z) translucent crowns cemented with different cements and surface treatments would have equivalent fracture resistance as 3 mol% yttria (3Y-Z) crowns.

METHODS

The study included 0.8 mm, 1.0 mm, and 1.2 mm thickness 5Y-Z (Katana UTML) crowns and 0.5 and 1.0 mm thickness 3Y-Z (Katana HT) crowns as controls. The 5Y-Z crowns were divided among three treatment subgroups (n = 10/subgroup): (1) cemented using RMGIC (Rely X Luting Cement), (2) alumina particle-abraded then luted with the same cement, (3) alumina particle-abraded and cemented using a resin cement (Panavia SA Cement Universal). The 3Y-Z controls were alumina particle-abraded then cemented with RMGIC. The specimens were then loaded in compression at 30° until failure.

RESULTS

All 5Y-Z crowns (regardless of thickness or surface treatment) had a similar to or higher fracture force than the 0.5 mm 3Y-Z crowns. Only the 1.2 mm 5Y-Z crowns with resin cement showed significantly similar fracture force to the 1 mm 3Y-Z crowns.

CONCLUSION

In order to achieve a similar fracture resistance to 0.5 mm 3Y-Z crowns cemented with RMGIC, 5Y-Z crowns may be as thin as 0.8 mm. To achieve a similar fracture resistance to 1.0 mm 3Y-Z crowns cemented with RMGIC, 5Y-Z crowns must be 1.2 mm and bonded with resin cement.

Advanced lithium disilicate: A comparative evaluation of translucency and fatigue failure load to other ceramics for monolithic restorations

The aim of this in vitro study was to evaluate the surface roughness, translucency, fatigue failure load (FFL), and number of cycles for fatigue failure (CFF) of a recently released lithia-based material called advanced lithium disilicate and three other ceramics indicated for monolithic restorations. First, ALD (advanced lithium disilicate, CEREC Tessera, Dentsply Sirona), LD (lithium disilicate, IPS e. max CAD, Ivoclar), LS (lithium silicate-disilicate, Suprinity, Vita Zahnfabrik), and 4Y-PSZ (Yttria-stabilized zirconia, IPS e.max ZirCAD MT, Ivoclar) discs (n = 15, Ø = 10 mm and thickness = 1.0 mm) were fabricated from CAD/CAM blocks/discs, A2 shade. The discs were sintered/crystallized and subsequently analyzed by a rugosimeter (Mitutoyo SJ-410) to determine Ra and Rz surface roughness parameters. Next, they were evaluated to determine the translucency parameter (TP) using a bench-top spectrophotometer (SP60, EX-Rite). The discs were subsequently cemented to glass fiber epoxy resin discs, and the specimens were tested under cyclic loading (Step-test), immersed in distilled water at a frequency of 20 Hz, with an initial cyclic load of 200 N for 5,000 cycles and increments of 50 N every 10,000 cycles until failure. Fatigue failure load (FFL) and number of cycles for fatigue failure (CFF) were recorded for subsequent Kaplan Meier analysis, with post-hoc Mantel-Cox and Weibull analysis (α = 0.05). Complementary fractographic, topographic and energy dispersive spectroscopy analyses (EDS) were performed. 4Y-PSZ showed higher survival (p < 0.05), with higher FFL and CFF (1077 N; 180,333 cycles), followed by LD (980 N; 161,000 cycles), LS (937 N; 152,333 cycles) and ALD (910 N; 147,000 cycles). No differences were observed between the tested groups regarding Weibull modulus. ALD presented TP (28.14) equal to DL (28.27) and higher than LS (25.51). All lithia-based materials had higher translucency than 4Y-PSZ (TP = 8.62) (p < 0.05). ALD appears to have a similar elemental composition to LD and LSD for oxygen and silicon. ALD and LSD have a similar zirconium content. Fractures originated on the cemented surface of the ceramic discs. Lithia-based ceramics showed lower surface roughness, with ALD (Ra = 0.04 μm; Rz = 0.66 μm) showing the lowest values (p < 0.05). Despite showing lower FFL when compared to LD and 4Y-PSZ, ALD has compatible translucency and mechanical fatigue performance with its indication for fabricating monolithic, anterior and posterior adhesively cemented single-unit restorations. However, further studies are needed to substantiate its clinical performance.

Thickness and Substrate Effect on the Mechanical Behaviour of Direct Occlusal Veneers

PURPOSE

This study aimed to evaluate the fracture resistance and stress magnitude of occlusal veneers made of conventional or flowable resin composites at different minimal thicknesses bonded on enamel or dentin.

MATERIAL AND METHODS

A total of 120 sound bovine incisors were flattened and used as substrates (enamel or dentin) for the restorations. The teeth were embedded into polymethyl methacrylate and allocated into 4 groups according to the resin composite (Clearfil AP-X PLT and Clearfil Majesty Flow, Kuraray Dental) and substrate. Further, the substrates were randomly subdivided in 12 groups (N = 120, n = 10) according to the occlusal veneer minimal thickness: 0.5, 1.0, or 2.0 mm. The teeth were directly restored with a standardised procedure. Then, the specimens were loaded until fracture in a universal testing machine (Instron 6022, Instron Corp.). A 3-way and a 1-way analysis of variance were used to determine significant differences for each factor. Three-dimensional finite element analysis was carried out following the in vitro boundary conditions to assess the stress magnitude in the restoration during compressive loading.

RESULTS

The fracture loads were recorded into initial load to failure (ILF) and fatal load to failure (FLF). Differences were found in material for ILF and FLF, leading to an overall equal good performance in fracture load and stress distribution for both materials, regardless of the substrate. Differences in thickness were apparent in both ILF and FLF.

CONCLUSIONS

Direct conventional and flow resin composite occlusal veneers present a promising mechanical behaviour when bonded on enamel or dentin. However, caution is advised when preparing 0.5-mm minimal thickness restorations.

Reliability and lifetime of lithium disilicate, 3Y-TZP, and 5Y-TZP zirconia crowns with different occlusal thicknesses

OBJECTIVES

To assess the probability of survival of crowns made with a 3Y-TZP, a 5Y-TZP, and a lithium disilicate.

MATERIALS AND METHODS

CAD-CAM premolar crowns with occlusal thicknesses of 1.0 mm or 1.5 mm and cemented on a metal dye. Step-stress accelerated life testing (SSALT) was performed to access the use level probability Weibull curves and reliability were calculated for the completion of a mission of 100,000 cycles at 300 to 1200 N.

RESULTS

All ceramics showed a high probability of survival (87-99%) at 300 N, irrespective of thickness. 3Y-TZP shows no significant decrease in the probability of survival up to 1200 N (83-96%). Lithium disilicate presented lower reliability than zirconia under the 600 N mission. 5Y-TZP showed lower reliability than 3Y-TZP at 1200 N. There was no significant difference in the Weibull modulus (3.23-7.12). 3Y-TZP had the highest characteristic strength (2483-2972 N), followed by 5Y-TZP (1512-1547 N) and lithium disilicate (971-1154 N).

CONCLUSION

Zirconia ceramics have a high probability of survival (up to 900 N-load), while lithium disilicate survives up to 300 N load only, irrespective of the thickness (1.0 mm or 1.5 mm).

CLINICAL RELEVANCE

The probability of survival of posterior crowns made with zirconia ceramics resists extreme loads while glass ceramics resist normal chewing loads. In addition, crowns with thinner occlusal face showed sufficient mechanical behavior.

A brief review on fatigue test of ceramic and some related matters in Dentistry

The characteristics of dental ceramics have been extensively studied over the years to provide highly qualified materials for use in prosthetic restorations. The ability to adhere to dental substrates, outstanding aesthetics (translucency, color, and substrate masking ability) and improved mechanical properties provide these materials with optical features and high strength to withstand masticatory stimuli. Different classifications are adopted, and it is generally considered that glass-ceramics have better optical characteristics due to the high glass content, and polycrystalline ceramics have superior strength favored by their densified and organized crystals, hampering crack growth. This knowledge was largely built-up during years of scientific research through different testing methodologies, but mainly employing static loads. It is important to not only take into account the intensity of loads that these materials will be exposed to, but also the effect of the intermittence of cyclic load application leading to mechanical fatigue and the influence of factors related to the crack origin and their propagation under this condition. Furthermore, the bonding surface of ceramic restorations requires surface treatments that improve the bond strength to luting agents; however, these treatments require caution because of their potential to produce defects and affect the structural behavior. Moreover, ceramic restorations often require internal adjustments for proper seating or external adjustments for fitting the occlusal contact with the antagonist. In this sense, finishing/polishing protocols may alter the defect population, as luting agents may also interact by filling in the superficial defects on the restoration intaglio surface. Thus, the balance among all these factors will define the performance of a restorative setup, as well as the posterior exposure to the humid environment and the masticatory stimuli (cyclical loading), which may favor developing slow and subcritical growth of cracks in ceramic materials and the degradation of the bond interface. Therefore, it is essential that the concepts which explain the fatigue mechanism are understood, as well as the crack propagation and failure patterns of restorative ceramic materials.

Which dentine analogue material can replace human dentine for crown fatigue test?

OBJECTIVE

To seek dentine analogue materials in combined experimental, analytical, and numerical approaches on the mechanical properties and fatigue behaviours that could replace human dentine in a crown fatigue laboratory test.

METHODS

A woven glass fibre-filled epoxy (NEMA grade G10; G10) and a glass fibre-reinforced polyamide-nylon (30% glass fibre reinforced polyamide-nylon 6,6; RPN) were investigated and compared with human dentine (HD). Flexural strength and elastic modulus (n = 10) were tested on beam-shaped specimens via three-point bending, while indentation hardness (n = 3) was tested after fracture. Abutment substrates of G10, RPN and HD were prepared and resin-bonded with monolithic lithium disilicate crowns (n = 10), then subjected to wet cyclic loading in a step-stress manner (500 N initial load, 100 N step size, 100,000 cycles per step, 20 Hz frequency). Data were statistically analysed using Kruskal-Wallis one-way ANOVA followed by post-hoc comparisons (α = 0.05). Survival probability estimation was performed by Mantel-Cox Log-Rank test with 95% confidence intervals. The fatigue failure load (FFL) and the number of cycles until failure (NCF) were evaluated with Weibull statistics. Finite Element Models of the fatigue test were established for stress distribution analysis and lifetime prediction. Fractographic observations were qualitatively analysed.

RESULTS

The flexural strength of HD (164.27 ± 14.24 MPa), G10 (116.48 ± 5.93 MPa), and RPN (86.73 ± 3.56 MPa) were significantly different (p < 0.001), while no significant difference was observed in their flexural moduli (p = 0.377) and the indentation hardness between HD and RPN (p = 0.749). The wet cyclic fatigue test revealed comparable mean FFL and NCF of G10 and RPN to HD (p = 0.237 and 0.294, respectively) and similar survival probabilities for the three groups (p = 0.055). However, RPN promotes higher stability and lower deviation of fatigue test results than G10 in Weibull analysis and FEA.

SIGNIFICANCE

Even though dentine analogue materials might exhibit similar elastic properties and fatigue performance to human dentine, different reliabilities of fatigue on crown-dentine analogues were shown. RPN seems to be a better substrate that could provide higher reliability and predictability of laboratory study results.

Mechanical characterization of a multi-layered zirconia: Flexural strength, hardness, and fracture toughness of the different layers

This study compared the flexural strength under monotonic (static - sσ) and cyclic load application (fatigue - fσ), hardness (H) and fracture toughness (K_IC) of different layers of a multi-layered zirconia (IPS e.max ZirCAD MT Multi, Ivoclar). Each layer was sectioned, classified into three groups according to yttria content (4-YSZ, 4/5-YSZ and 5-YSZ), and shaped on samples for flexural strength and fracture toughness tests (bars: 1.0 × 1.0 × 11 mm); and Vickers hardness test (plates: 1.5 × 4.0 × 5.0 mm). Flexural strength under monotonic load application (sσ; n = 10) was obtained through two different devices (three-point-bending and ball-in-hole device) and fatigue flexural strength (fσ; n = 15; initial load: 10 N; step-size: 5 N; 10,000 cycles/step) was assessed using a ball-in-hole device under cyclic load application. Vickers hardness test (n = 5), fracture toughness test (n = 10), and additional analyzes (Finite Element Analysis - FEA, Energy-dispersive X-ray spectroscopy - EDS and Scanning Electron Microscopy - SEM) were also performed. No differences were found between the different devices in the monotonic flexural strength test, and FEA showed similar tensile stress distribution for the two devices. 4-YSZ showed higher values of flexural strength under monotonic and cyclic load application modes (sσ = 1114.73 MPa; fσ = 798.84 MPa), and fracture toughness (K_IC = 3.90 MPa√m). 4/5-YSZ had an intermediate sσ; however, fσ was similar to 5-YSZ (404.00-429.36 MPa) and K_IC similar to 4-YSZ (K_IC = 3.66 MPa√m). No statistical differences were found for hardness and Weibull modulus for fatigue flexural strength data. The amount of yttria in the layer compositions increased from 4-YSZ to 5-YSZ, and larger zirconia crystals were observed in the topographic images of 5-YSZ. Failures in the flexural strength and toughness tests started from the face subjected to tensile stress. Different layers of the multi-layered zirconia blank presented distinct mechanical properties. 4-YSZ (cervical layer) presented the highest flexural strength under monotonic and cyclic loads (fatigue), and higher fracture toughness even similar to the transition layer (4/5-YSZ). Hardness was similar between the layers. The ball-in-hole device performed similarly to the three-point bending device and can be used as an alternative to the traditional method.

In-lab simulation of CAD/CAM grinding and intaglio surface treatments of 4YSZ monolithic restorations: Effect on its load-bearing capacity under fatigue

OBJECTIVES

To evaluate the effect of in-lab simulation of CAD/CAM grinding and intaglio surface treatments on the surface characteristics (topography and roughness) and fatigue behavior of adhesively luted 4YSZ simplified restorations.

METHODS

Ceramic discs (Ø = 10 mm, thickness = 1 mm) were randomly allocated into 6 groups considering: "In-lab simulation of CAD/CAM grinding" (ground or polished) and "intaglio surface treatments": Ctrl (without surface treatment), AlOx (aluminum oxide air abrasion) or GLZ (glaze spray application). The surface roughness of all samples was measured, the treated discs received a ceramic primer, were luted with resin cement onto a dentin analogue material (woven glass-reinforced epoxy resin) and tested under a cyclic fatigue test (step-stress approach, n = 15; 1.4 Hz, 10,000 cycles/step, step-size of 100N starting at 200N until failure). A complementary analysis was performed to corroborate the findings in the fatigue test that the glaze fill defects increase the mechanical properties of the ceramic. To do so, bars (n= 10; 1.0 × 1.0 × 12 mm; considering the groups: N-ID: non-indented; ID: indented; ID-GLZ: indented plus glaze spray application) were indented in a vickers hardness tester to produce a crack pattern, treated with glaze or not, and then submitted to flexural strength tests (FS). Fractographic and topographic analysis were performed.

RESULTS

In-lab simulation of CAD/CAM grinding decreased the fatigue failure load of the 4YSZ ceramic when comparing polished and ground groups, regardless of surface treatment. GLZ induced better fatigue performance compared to the air abrasion, regardless of the grinding condition (ground or polished surface). The results of the flexural strength test corroborated the findings in the fatigue test, as the ID-GLZ group presented superior FS than the ID group, however both had inferior FS than N-ID. There is an inverse association between roughness and fatigue failure load, as the higher the surface roughness, the lower the fatigue failure load. Failures in the fatigue and flexural strength tests started from the face subjected to tensile stresses.

CONCLUSION

In-lab simulation of CAD/CAM grinding had a detrimental effect on the fatigue behavior of 4YSZ and glaze spray induced better 4YSZ performance compared to the air abrasion. The intaglio surface treatments differently influenced the 4YSZ fatigue performance, however, only glaze spray can reverse the damage caused by the grinding.

Grinding and polishing of the inner surface of monolithic simplified restorations made of zirconia polycrystals and lithium disilicate glass-ceramic: Effects on the load-bearing capacity under fatigue of the bonded restorations

This study evaluated the effect of grinding and polishing the inner surface of monolithic discs made of zirconia polycrystals (ZR) and lithium disilicate glass-ceramic (LD) on the load-bearing capacity under fatigue of the restorations bonded onto a dentin analogue material (epoxy resin). ZR and LD ceramic discs (10 mm in diameter, 1 mm in thickness) were produced and randomly allocated into 10 groups considering the internal adjustment approach: Ctrl - No adjustment; F - Grinding with fine diamond bur (46 μm); F + Pol - Grinding with fine diamond bur followed by polishing with 2 tips (finisher and polisher); FF - Grinding with extrafine diamond bur (30 μm); FF + Pol - Grinding with extrafine diamond bur followed by polishing. In addition, discs (10 mm in diameter, 2.5 mm in thickness) of fiber reinforced epoxy resin were produced. Afterwards, the intaglio surface of the ZR discs were air-abraded with 45 μm alumina particles for 10 s, the LD and resin epoxy discs were etched with hydrofluoric acid (5%/20 s and 10%/60 s, respectively), and the treated discs were primed as recommended. Each ceramic disc was luted onto the epoxy resin disc with resin cement. Then, the samples were tested under a step-stress fatigue test (20 Hz, 10,000 cycles/step, step-size of 100 N starting at 200 N, and proceeding until failure detection). Fractographic, topographic and surface roughness analysis were also performed. The adjustments (grinding with or without polishing) (ZR: 733-880 N; LD: 1040-1106 N) triggered a detrimental effect on the fatigue behavior in both ceramics compared with the absence of treatment (control group; ZR: 973 N; LD: 1406 N). The polishing step had no effect on fatigue findings. Thus, grinding the inner surface of the tested ceramics should be avoided wherever possible to prevent introducing damage and its detrimental effects on the fatigue behavior.

Cyclic fatigue tests on non-anatomic specimens of dental ceramic materials: A scoping review

The aim of the present scoping review was to identify and discuss the methods, testing parameters, and characteristics used to induce cyclic fatigue on non-anatomic dental ceramic specimens. In vitro studies written in English which evaluated commercially-available non-anatomic dental ceramic specimens subjected to mechanical cyclic fatigue were selected. The search was performed in the PubMed, Scopus and Web of Science databases. The initial search yielded 1,636 articles, of which 81 were included. Based on the collected data, most of the included studies evaluated dental ceramic specimens cemented to supporting substrate (n= 42; 51.9%); used step-stress (n= 35; 42.2%) accelerated fatigue test, loading frequencies above 10 Hz (n= 31, 35.6%), stainless steel (n = 28, 32.6%) load applicator with spherical shaped tip 40 mm diameter (n= 25, 30.9%); applied only axial loads (n= 77, 95.1%); and considered a wet testing environment (n= 65, 78.3%). The definition of test geometry, method, and testing parameters must be cautiously considered according to the study objective and the scenario that is simulated. Accelerated fatigue tests, load frequencies up to 20 Hz, a 40 mm stainless steel spherical load applicator and a wet testing environment are the major common defined parameters presented in the existing literature. More studies exploring the influence of such factors on fatigue mechanism are necessary.

Influence of surface treatment of resin composite substrate on the load-bearing capacity under fatigue of lithium disilicate monolithic simplified restorations

This study evaluated the influence of surface treatments of resin composite substrate on the fatigue behavior of adhesively cemented lithium disilicate glass-ceramic simplified restorations. CAD/CAM lithium disilicate ceramic blocks were shaped into discs (N = 60, Ø = 10 mm; thickness = 1.0 mm). Resin composite discs (N = 60, Ø = 10 mm, thickness = 2 mm) were allocated into four groups considering the "surface treatment" factor: Ctrl - no surface treatment; Bur - grinding with coarse diamond bur (#3101G, KG Sorensen); PA - etching with 37% phosphoric acid (15 s); AA - air abrasion with alumina particles (45 μm, 10 mm distance, 2.8 bars, 10 s). The surface topography, the roughness, the fractal dimension (estimated by the box-counting method) and the contact angle analyses were performed after the surface treatments. The lithium disilicate discs were etched (5% hydrofluoric acid, 20 s), silanized and adhesively cemented (Multilink N, Ivoclar Vivadent) on the resin composite discs. The samples (bonded restoration set) were subjected to a step-stress fatigue test at 20 Hz, 10,000 cycles/step with a step-size of 100 N applied on the ceramic surface, having ceramic up and resin composite down. Fractographic analysis was performed. The fatigue data (Fatigue Failure Load - FFL; and Cycles for Failure - CFF) were analyzed by Kaplan Meier with Mantel-Cox log-rank post-hoc tests (α = 0.05). No statistical difference for fatigue performance could be found among the groups (FFL means: 820-867 N; CFF means: 53,195-61,090 cycles). The bur group showed higher surface roughness and contact angle values. The PA group has the highest average fractal dimension. Therefore, the resin composite surface treatment induces topographical changes, however, it has no effect on the fatigue behavior of lithium disilicate restorations.

Load-bearing capacity under fatigue and FEA analysis of simplified ceramic restorations supported by Peek or zirconia polycrystals as foundation substrate for implant purposes

The fatigue behavior and FEA analysis of different ceramic materials cemented over distinct substrates for implant-supported crowns were evaluated in this study. Discs of 10 mm in diameter of both restorative and substrate materials were made and randomly allocated into pairs (n = 15) considering the two study factors: 'restorative ceramic material' (1 mm thickness) - polymer-infiltrated ceramic network (PICN), lithium disilicate (LD), zirconia-reinforced lithium silicate (ZLS), or translucent zirconia (TZ); and 'foundation substrate' (2 mm thickness) - polyetheretherketone (Peek) or yttrium-stabilized zirconia (YZ). Adhesive cementation was made with a dual cure resin cement. Fatigue testing was run using the step-stress methodology: initial load of 200 N for 5000 cycles, followed by steps of 10,000 cycles starting at 400 N up to 2800 N or until failure, step size of 200 N, frequency of 20 Hz. Data were analyzed by the Kaplan Meier and log-rank post-hoc tests. Fractography analysis (stereomicroscope and SEM) and FEA were also performed. Both factors under study and their interaction statistically influenced the fatigue failure load (FFL), cycles for failure (CFF) and survival rates (p < 0.001). The restorative materials bonded to YZ had higher FFL and CFF than when adhering to Peek, while restorative materials with more crystalline content (TZ and ZLS) showed higher FFL and CFF than LD and PICN. The fractography analysis showed that all materials bonded to YZ resulted in failures starting at the occlusal surface (Hertzian cone cracks), while materials bonded to Peek had radial cracks from the ceramic-cement intaglio surface. FEA analysis showed that tensile stress concentration decreased in the intaglio surface when testing the restorative material over a stiffer (YZ) foundation substrate. In addition, the higher the restorative material's crystalline content, the more the stress is concentrated within the material (TZ > ZLS ≥ LD > PICN) when bonded to the same foundation substrate. Thus, it concluded that a stiffer foundation substrate (YZ) enhances the load-bearing capacity under fatigue of the restorative set; that restorative materials with higher crystalline content results in higher fatigue performance of the set, regardless of the foundation used; and that the foundation material influences the failure pattern of the restorative set.

Influence of the foundation substrate on the fatigue behavior of bonded glass, zirconia polycrystals, and polymer infiltrated ceramic simplified CAD-CAM restorations

This study evaluated the influence of distinct substrates on the mechanical fatigue behavior of adhesively cemented simplified restorations made of glass, polycrystalline or polymer infiltrated-ceramics. CAD/CAM ceramic blocks (feldspathic - FEL; lithium disilicate - LD; yttria-stabilized zirconia - YZ; and polymer-infiltrated ceramic network - PICN) were shaped into discs (n = 15, Ø = 10 mm; thickness = 1.0 mm), mimicking a simplified monolithic restoration. After, they were adhesively cemented onto different foundation substrates (epoxy resin - ER; or Ni-Cr metal alloy - MA) of the same shape (Ø = 10 mm; thickness = 2.0 mm). The assemblies were subjected to fatigue testing using a step-stress approach (200N-2800 N; step-size of 200 N; 10,000 cycles per step; 20 Hz) upon the occurrence of a radial crack or fracture. The data was submitted to two-way ANOVA (α = 0.05) to analyze differences considering 'ceramic material' and 'type of substrate' as factors. In addition, a survival analysis (Kaplan Meier with Mantel-Cox log-rank post-hoc tests; α = 0.05) was conducted to obtain the survival probability during the steps in the fatigue test. Fractographic and finite element (FEA) analyzes were also conducted. The factors 'ceramic material', 'type of substrate' and the interaction between both were verified to be statistically significant (p < .001). All evaluated ceramics presented higher fatigue failure load (FFL), cycles for failure (CFF) and survival probabilities when cemented to the metallic alloy substrate. Among the restorative materials, YZ and LD restorations presented the best fatigue behavior when adhesively cemented onto the metallic alloy substrate, while FEL obtained the lowest FFL and CFF for both substrates. The LD, PICN and YZ restorations showed similar fatigue performance considering the epoxy resin substrate. A more rigid foundation substrate improves the fatigue performance of adhesively cemented glass, polycrystalline and polymer infiltrated-ceramic simplified restorations.