Zaid Badr1, Lee Culp2, Ibrahim Duqum3, Chek Hai Lim4, Yu Zhang4, Taiseer A Sulaiman3. 1. Department of Adult Restorative Dentistry, University of Nebraska Medical Center, College of Dentistry, Lincoln, Nebraska, USA. 2. Sculpture Studios, Cary, North Carolina, USA. 3. Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA. 4. Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Abstract
OBJECTIVE: To compare four different types of monolithic zirconia crowns in terms of survival rate and fracture resistance after thermocycling and/or thermo-mechanical loading in a chewing simulator. METHODS: Partially stabilized zirconia (PSZ) crowns with fiber-reinforced resin die assemblies (n = 80) were fabricated using: multi-yttria-layered 5Y-PSZ/3Y-PSZ, multi-yttria-layered 5Y-PSZ/4Y-PSZ, monolithic 4Y-PSZ, and monolithic 3Y-PSZ as control (n = 20). Half of the samples in each group were subjected to thermo-mechanical loading under 110 N, 1.4 Hz, 1.2 million cycles with simultaneous thermocycling (10,000 cycles, 5-55°C). The other half were subjected to thermocycling alone. The samples were loaded to failure to measure their fracture resistance. The data were analyzed using by two-way ANOVA and Tukey's HSD post-hoc test (α = 0.05). RESULTS: All specimens survived the aging protocols. The yttria content significantly affected the fracture resistance of the crowns (p < 0.0001). The mean fracture resistance, from highest to lowest: 3Y-PSZ, 4Y-PSZ, followed by the two multi-yttria-layered systems. The mean difference between the two multi-yttria-layered systems were not statistically significant (p = 0.98). The mechanical loading protocol did not affect the mean fracture resistance within each group (p = 0.18). CONCLUSIONS: Within each group, there was no difference in fracture resistance after thermocycling alone and thermo-mechanical loading. However, increasing the yttria concentration at the occlusal third of the crown decreased its fracture resistance. CLINICAL SIGNIFICANCE: The term "monolithic zirconia" alone without specifying the actual yttria content is misleading. This term represents different materials with different mechanical properties. The yttria content has an inverse relationship with the fracture resistance of zirconia crowns. The fracture resistance of multi-layer zirconia crowns is determined by the amount of the weaker zirconia phase at the occlusal part of the restoration rather than enforced by the stronger zirconia at the cervical part of the crown.
OBJECTIVE: To compare four different types of monolithic zirconia crowns in terms of survival rate and fracture resistance after thermocycling and/or thermo-mechanical loading in a chewing simulator. METHODS: Partially stabilized zirconia (PSZ) crowns with fiber-reinforced resin die assemblies (n = 80) were fabricated using: multi-yttria-layered 5Y-PSZ/3Y-PSZ, multi-yttria-layered 5Y-PSZ/4Y-PSZ, monolithic 4Y-PSZ, and monolithic 3Y-PSZ as control (n = 20). Half of the samples in each group were subjected to thermo-mechanical loading under 110 N, 1.4 Hz, 1.2 million cycles with simultaneous thermocycling (10,000 cycles, 5-55°C). The other half were subjected to thermocycling alone. The samples were loaded to failure to measure their fracture resistance. The data were analyzed using by two-way ANOVA and Tukey's HSD post-hoc test (α = 0.05). RESULTS: All specimens survived the aging protocols. The yttria content significantly affected the fracture resistance of the crowns (p < 0.0001). The mean fracture resistance, from highest to lowest: 3Y-PSZ, 4Y-PSZ, followed by the two multi-yttria-layered systems. The mean difference between the two multi-yttria-layered systems were not statistically significant (p = 0.98). The mechanical loading protocol did not affect the mean fracture resistance within each group (p = 0.18). CONCLUSIONS: Within each group, there was no difference in fracture resistance after thermocycling alone and thermo-mechanical loading. However, increasing the yttria concentration at the occlusal third of the crown decreased its fracture resistance. CLINICAL SIGNIFICANCE: The term "monolithic zirconia" alone without specifying the actual yttria content is misleading. This term represents different materials with different mechanical properties. The yttria content has an inverse relationship with the fracture resistance of zirconia crowns. The fracture resistance of multi-layer zirconia crowns is determined by the amount of the weaker zirconia phase at the occlusal part of the restoration rather than enforced by the stronger zirconia at the cervical part of the crown.