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Monolithic and bi-layer CAD/CAM lithium–disilicate versus metal–ceramic fixed dental prostheses: Comparison of fracture loads and failure modes after fatigue

Clinical Oral Investigations volume 17, pages 1407–1413 (2013)Cite this article

Abstract

Objectives

The authors analyzed the effect of fatigue on the survival rate and fracture load of monolithic and bi-layer CAD/CAM lithium–disilicate posterior three-unit fixed dental prostheses (FDPs) in comparison to the metal–ceramic gold standard.

Materials and methods

The authors divided 96 human premolars and molars into three equal groups. Lithium–disilicate ceramic (IPS-e.max-CAD) was milled with the CEREC-3-system in full-anatomic FDP dimensions (monolithic: M-LiCAD) or as framework (Bi-layer: BL-LiCAD) with subsequent hand-layer veneering. Metal–ceramic FDPs (MC) served as control. Single-load-to-failure tests were performed before and after mouth-motion fatigue.

Results

No fracture failures occurred during fatigue. Median fracture loads in [N], before and after fatigue were, respectively, as follows: M-LiCAD, 1,298/1,900; BL-LiCAD, 817/699; MC, 1,966/1,818. M-LiCAD and MC FPDs revealed comparable fracture loads and were both significantly higher than BL-LiCAD. M-LiCAD and BL-LiCAD both failed from core/veneer bulk fracture within the connector area. MC failures were limited to ceramic veneer fractures exposing the metal core. Fatigue had no significant effect on any group.

Conclusions

Posterior monolithic CAD/CAM fabricated lithium–disilicate FPDs were shown to be fracture resistant with failure load results comparable to the metal–ceramic gold standard. Clinical investigations are needed to confirm these promising laboratory results.

Clinical relevance

Monolithic CAD/CAM fabricated lithium–disilicate FDPs appeared to be a reliable treatment alternative for the posterior load-bearing area, whereas FDPs in bi-layer configuration were susceptible to low load fracture failure.

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Acknowledgments

This study was supported by Ivoclar Vivadent, Schaan, Liechtenstein.

The authors would like to thank Ralf Storz, who accomplished all the laboratory work.

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Prosthodontics, School of Dentistry, Albert-Ludwigs-University Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany

    Stefan Schultheis, Joerg R. Strub & Petra C. Guess

  2. Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark

    Thomas A. Gerds

Authors
  1. Stefan Schultheis
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  2. Joerg R. Strub
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  3. Thomas A. Gerds
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  4. Petra C. Guess
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Correspondence to Petra C. Guess.

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Schultheis, S., Strub, J.R., Gerds, T.A. et al. Monolithic and bi-layer CAD/CAM lithium–disilicate versus metal–ceramic fixed dental prostheses: Comparison of fracture loads and failure modes after fatigue. Clin Oral Invest 17, 1407–1413 (2013). https://doi.org/10.1007/s00784-012-0830-1

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  • DOI: https://doi.org/10.1007/s00784-012-0830-1

Keywords

  • FDP
  • CAD/CAM
  • Lithium–disilicate
  • Metal–ceramic
  • Fatigue
  • Fracture load