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Effect of Various Veneering Techniques on Mechanical

Strength of Computer-Controlled Zirconia Framework


Designs
Burcu Kanat, DDS, PhD,1 Erhan M. Çömlekoğlu, DDS, PhD,1 Mine Dündar-Çömlekoğlu, DDS, PhD,1
Bilge Hakan Sen, DDS, PhD,2 Mutlu Özcan, DDS, DMD, PhD,3 & Mehmet Ali Güngör, DDS, PhD1
1
Department of Prosthodontics, Ege University, School of Dentistry, Izmir, Turkey
2
Department of Endodontics, Izmir Katip Çelebi University, School of Dentistry, Izmir, Turkey
3
University of Zurich, Dental Materials Unit, Center for Dental and Oral Medicine, Clinic for Fixed and Removable Prosthodontics and Dental
Materials Science, Zurich, Switzerland

Keywords Abstract
CAD/CAM; file splitting; fracture resistance;
flexural strength; shear bond strength; finite Purpose: The objectives of this study were to evaluate the fracture resistance (FR),
element analysis. flexural strength (FS), and shear bond strength (SBS) of zirconia framework material
veneered with different methods and to assess the stress distributions using finite
Correspondence element analysis (FEA).
Burcu Kanat, Ege University School of Materials and Methods: Zirconia frameworks fabricated in the forms of crowns for
Dentistry, Department of Prosthodontics, FR, bars for FS, and disks for SBS (N = 90, n = 10) were veneered with either (a)
Bornova, Izmir, Turkey. file splitting (CAD-on) (CD), (b) layering (L), or (c) overpressing (P) methods. For
E-mail: burcukanat@hotmail.com crown specimens, stainless steel dies (N = 30; 1 mm chamfer) were scanned using the
labside contrast spray. A bilayered design was produced for CD, whereas a reduced
This research was supported in part by the design (1 mm) was used for L and P to support the veneer by computer-aided design
Ege University, Scientific Research Project and manufacturing. For bar (1.5 × 5 × 25 mm3 ) and disk (2.5 mm diameter, 2.5 mm
Department (Project no. 2011-DİŞ-006). height) specimens, zirconia blocks were sectioned under water cooling with a low-
The authors deny any conflicts of interest. speed diamond saw and sintered. To prepare the suprastructures in the appropriate
shapes for the three mechanical tests, nano-fluorapatite ceramic was layered and fired
Accepted September 3, 2013 for L, fluorapatite-ceramic was pressed for P, and the milled lithium-disilicate ceramics
were fused with zirconia by a thixotropic glass ceramic for CD and then sintered for
doi: 10.1111/jopr.12130 crystallization of veneering ceramic. Crowns were then cemented to the metal dies.
All specimens were stored at 37◦ C, 100% humidity for 48 hours. Mechanical tests
were performed, and data were statistically analyzed (ANOVA, Tukey’s, α = 0.05).
Stereomicroscopy and scanning electron microscopy (SEM) were used to evaluate the
failure modes and surface structure. FEA modeling of the crowns was obtained.
Results: Mean FR values (N ± SD) of CD (4408 ± 608) and L (4323 ± 462) were
higher than P (2507 ± 594) (p < 0.05). Mean FS values (MPa ± SD) of CD (583 ±
63) and P (566 ± 54) were higher than L (428 ± 41) (p < 0.05). Mean SBS values
(MPa ± SD) of CD (49 ± 6) (p < 0.05) were higher than L (28 ± 5) and P (30 ±
8). For crown restorations, while cohesive failures within ceramic and zirconia were
seen in CD, cohesive failures within ceramic were found in both L and P. Results were
verified by FEA.
Conclusion: The file splitting technique showed higher bonding values in all me-
chanical tests, whereas a layering technique increased the FR when an anatomical
core design was employed. Clinical significance: File splitting (CAD-on) or layering
veneering ceramic on zirconia with a reduced framework design may reduce ceramic
chipping.

Presintered yttrium-stabilized zirconium oxide blocks fabri- technology has been reported to provide homogenous zir-
cated to be milled with computer-aided design/computer- conia frameworks with no imperfections and/or porosities
aided manufacturing (CAD/CAM) systems as a framework, that may lead to veneering ceramic delamination and clinical
have been increasingly used in esthetic dentistry.1 CAD/CAM failures.2,3

Journal of Prosthodontics 00 (2014) 1–11 


C 2014 by the American College of Prosthodontists 1
Mechanical Performance of Veneering on Zirconia Kanat et al

Different methods can be applied for veneering ceramic on The aim of this study was to investigate the effect of differ-
zirconia frameworks. In the traditional layering technique, the ent veneering procedures (layering, overpressing, and CAD-on)
mixed ceramic powder and its liquid are built on the sintered on the fracture resistance (FR) of single molar crown restora-
zirconia core being larger than the final dimension to compen- tions with zirconia framework. Three complementary tests were
sate for the shrinkage of ceramic,4,5 whereas the overpressing performed to interpret the findings: (a) the effect of flexural
technique requires a final contour wax-up model on the sintered strength (FS) of the veneering ceramic on the FR of the restora-
zirconia framework to be invested under heat-pressed vacuum tion by performing a three-point bending test on the bar-shaped
with pressable ceramics.4 The subtractive type of file-splitting specimens; (b) the effect of interfacial bonding on the FR of
method involves the fabrication of metal-ceramic restorations the restoration by a shear bond strength (SBS) test using disk-
through scanning by a digital probe for data aquisition.6 In shaped specimens; and (c) finite element modeling of the crown
addition to these commonly used veneering techniques for zir- system to observe the location of the accumulated stresses by
conia, a new technique with the generic term “CAD-on” has simulating loading conditions. The null hypothesis of this study
been introduced.3,7 In this technique, a presintered zirconia was that the veneering technique would not affect the FR of the
framework and a high-strength ceramic veneering material are bilayered zirconia crowns.
designed and milled through CAD/CAM, and then sintered
zirconia and ceramic suprastructure are combined by a fusion
glass ceramic.3,7 Because of the thixotropic feature of the fu-
Materials and methods
sion glass ceramic, mixing it with a special vibration device is Crown, bar, and disk-shaped specimens for FR, three-point
recommended by the manufacturer in the CAD-on technique.7 bending (FS), and SBS tests, respectively, were prepared with
The capsule fabricated for single use is put onto a flat surface of CAD/CAM-fabricated (InLab; Sirona Dental Systems GmbH,
a special vibrator for 10 seconds to liquefy and be inserted into Bensheim, Germany) zirconia frameworks and veneered with
superstructures for fusing procedures. The mixer allows the three techniques on the substructures as: layering (L), over-
material to be more homogenous by getting the components pressing (P), and CAD-on (CD) (N = 90) (n = 10/subgroup).
together between the cores and suprastructures.8 The brands, manufacturers, chemical compositions, some me-
Anatomical cusp support design of the CAD/CAM- chanical properties, and batch numbers of the materials used in
fabricated zirconia core with layering ceramic under mechan- this study are listed in Table 1.
ical loading was reported to significantly reduce the chipping
failures of zirconia-supported crowns,9 which has been at-
Preparation of zirconia frameworks
tributed to optimal preservation of the uniform thickness of the
veneering ceramic through controlled CAD.9,10 By decreasing For crown-shaped specimens, thirty stainless steel dies (n =
the chipping of the veneering ceramic, removal and renewal 30) with a 1 mm standard circumferential chamfer, which had
of the restorations can be prevented clinically. Also, by this a groove on the axial surface to prevent the rotation of the
route, time and cost for both the patient and the dentist, as well restorations during the mechanical test, were scanned (InEos
as excessive material consumption in the laboratory, can be Blue; Sirona Dental Systems) using a labside contrast spray
eliminated.7,11 (IPS Contrast Spray Labside; Ivoclar Vivadent). Digital impres-
Studies have emphasized the significance of form and thick- sions were obtained. The restoration form was chosen for the
nesses of the frameworks, veneering techniques, quality, and mandibular left first molar in the CAD/CAM software (CEREC
homogeneity of the veneering ceramic as well as the phys- 3D, Sirona InLab V3.88; Sirona Dental Systems). Multilayered
ical properties such as the coefficient of thermal expansion design was performed for CD, whereas the reduced form with 1
and elastic modulus of veneering ceramic and zirconia for mm was preferred for both L and P, producing a uniform veneer-
durable bond strengths between the two materials.10,11 Chip- ing ceramic thickness and support for the cusps.16 The thickness
ping of the veneering ceramic in zirconia-supported restora- of the die spacer was selected as 10 μm, since the die material
tions has been reported to be one of the most common clinical was not a tooth substance, but made of metal. The adaptation of
failure types12 with a 25% failure rate in a 3-year follow-up the framework to the metal die was aimed to decrease the rota-
randomized controlled clinical trial.13 Since the nature of the tion of the substructure during fracture tests.3 Circumferential
clinical problem determines the systematic approach for me- margin and insertion path of the metal dies were determined as
chanical/physical and/or clinical testing, the main question to the groove was positioned buccally. The zirconia frameworks
be answered when incorporating a novel veneering method on were milled (InLab MC XL; Sirona Dental Systems) out of
a zirconia framework depends on the above-mentioned major presintered zirconia blocks (IPS e.max ZirCAD) with 20% to
failure type: ceramic chipping. Such a failure can be identi- 25% enlarged volume to compensate for shrinkage after the
fied by analytical and experimental procedures validated by sintering process. Then, the frameworks were sintered (InFire
clinical studies. Recommended mechanical tests for mono- HTC speed; Sirona Dental Systems), and their fit to the dies
lithic and/or bilayered specimens might be three- or four-point was controlled.
flexure tests, biaxial flexure tests, or shear bond tests cou- Bar- (length: 25 mm, width: 5 mm, height: 1.5 mm) and
pled with finite element analysis (FEA) and/or fractographic square- (4 × 4 mm2 ) shaped specimens (n = 30/per group),
analyses.14 Thus, mechanical tests may allow for identification which would be used in three-point bending and SBS tests,
of the failure initiation site of zirconia framework and veneer- respectively, were sectioned in three axes under water cool-
ing ceramic combinations fabricated with different layering ing using a low-speed diamond saw (Isomet 1000; Buehler
techniques.14,15 Ltd., Lake Bluff, IL) from presintered yttrium-stabilized

2 Journal of Prosthodontics 00 (2014) 1–11 


C 2014 by the American College of Prosthodontists
Kanat et al Mechanical Performance of Veneering on Zirconia

Table 1 Materials used

Elastic Coefficient of Flexural


Chemical modulus thermal expansion strength Batch
Brand Manufacturer composition (%) [GPa] (CTE)[10−6 /K] [MPa] number

IPS e.max ZirCAD Ivoclar Vivadent, Schaan, ZrO2 (87–95) Y2 O3 (4–6) HfO2 (1–5) 210 10.8 900–1200 N75038
Liechtenstein Al2 O3 (0–1)
IPS e.max Ceram Ivoclar Vivadent, Schaan, SiO2 (60–65), Al2 O3 (9–11), K2 O 65 9.5 90 R23691
Liechtenstein (7–8), Na2 O (7–8), ZnO2 (2–3),
CaO, P2 O5 , and F (2,5–7,5)
IPS e.max ZirPress Ivoclar Vivadent, Schaan, SiO2 (57–62), Na2 O (6–8), K2 O 65 9.9 110 N54798
Liechtenstein (2–4), CaO (2–4), Al2 O3 (12–16),
ZrO2 (1,5–2,5), P2 O5 (1–2), and F
(0,5–1)
IPS e.max CAD Ivoclar Vivadent, Schaan, SiO2 (57–80), Li2 O (11–19), K2 O 95 10.2 360 P11325
Liechtenstein (0–13), P2 O5 (0–11), ZrO2 (0–8),
ZnO (0–8), Other and coloring
oxides (0–12)
IPS e.max CAD Ivoclar Vivadent, Schaan, Oxides, water, butandiol, and 65 9.2–9.5 160 P77677
Crystall/Connect Liechtenstein chloride
RelyX luting 3M ESPE, Seefeld, Germany Sılane-treated glass (> 98), 9XC-9WU
cement potassıum persulfate (<0.2)
IPS e.max Ceram Ivoclar Vivadent, Schaan, Ceramic powder and pigments R36248
Glaze Liechtenstein (60–70), glycole and glycerin
(30–40)

zirconia blocks (IPS e.max ZirCAD) considering the 20% to This mold behaved as patrix and matrix components consisting
25% sintering shrinkage of the zirconia and thickness of the of the pressable wax filling the socket and the hole for insertion
saw. Sinterization process was conducted in a special oven (In- of the framework to join the two parts together. In the L group
Fire HTC speed). the layered veneering ceramic was fired according to the manu-
facturer’s instructions (Programat P300) (Table 2), and optimal
and similar crown dimensions were obtained after grinding or
Preparation of suprastructures corrective firing where necessary (n = 10). In the P group, the
For crown-shaped specimens in the CD group, the veneering zirconia frameworks with the wax superstructure were invested
restorations previously designed by the software according to in a special investing material (IPS PressVEST; Ivoclar Vi-
the geometry of the framework were processed in the milling vadent). After the wax (FC Modelling Wax) was burnt out, the
unit (InLab MC XL) from lithium disilicate glass-ceramic pressing process was carried out (Programat EP 3000) (Table 2)
blocks (IPS e.max CAD C14, Ivoclar Vivadent). After the according to the manufacturer’s instructions using a pressable
adaptation of the sintered zirconia frameworks and veneering ceramic (IPS e.max ZirPress) (n = 10). After divesting,
ceramics were controlled, they were fused to each other by the sprues were cut using a diamond disk and burs (Acurata,
a specially developed thixotropic glass-ceramic (IPS e.max Thurmansbang, Germany), and the remnants of the investment
CAD Crystall/Connect; Ivoclar Vivadent) that turns into material were cleaned using an airborne-particle-abrasion
liquid when vibrated (Ivomix; Ivoclar Vivadent). Fused mate- device (Renfert, Hilzingen, Germany) with 50 μm Al2 O3
rials were then sintered in the furnace (Programat P300; Ivoclar under 2 bar pressure.
Vivadent), and the crystalline intermediate (metasilicate) stage For bar- and disk-shaped specimens in the CD group, lithium
of the ceramic was converted into disilicate phase after crystal- disilicate glass-ceramic (IPS e.max CAD B40; Ivoclar Vi-
lization firing (Table 2). For L and P veneering techniques, an in- vadent) blocks were sectioned using a slow-speed diamond saw
termediate liner layer (ZirLiner; Ivoclar Vivadent) was applied (Isomet 1000) under water cooling in 25 × 5 × 1.5 mm3 and
on the anatomical zirconia frameworks and fired (Programat 2.5 mm diameter × 2.5 mm height dimensions, respectively.
P300) (n = 10) (Table 2). In the L group, veneering ceramic (IPS Then, the sintered zirconia frameworks and glass-ceramic
e.max Ceram, Ivoclar Vivadent) was layered, whereas in the suprastructures were fused to each other by a thixotropic glass-
P group, modeling wax for pressable ceramics (FC Modelling ceramic (IPS e.max CAD Crystall/Connect) and sintered (Ta-
Wax; Bego, Bremen, Germany), which burns without residue, ble 2) (n = 20). In L and P techniques, the liner (ZirLiner) was
was combined with the framework using a poly(vinyl siloxane) applied on the sintered zirconia using a metal mold and fired
impression mold (Affinis; Coltene Whaledent, Altstätten, (Table 2). In the L group, the veneering ceramic was layered
Switzerland). This was recorded from the milled veneering (IPS e.max Ceram) as a bar (25 × 5 × 1.5 mm3 ) and disk
ceramic prototype standardized by the CAD-on technique. shape (2.5 mm diameter, 2.5 mm height) by an experienced

Journal of Prosthodontics 00 (2014) 1–11 


C 2014 by the American College of Prosthodontists 3
Mechanical Performance of Veneering on Zirconia Kanat et al

Table 2 Firing procedures of the all-ceramic materials used

Predrying Predrying time Heating rate Firing temperature Vacuum start Vacuum finish
temperature ((C) (min.) ((C/min) ((C) temperature ((C) temperature ((C)

IPS e.max CAD Crystall/Connect 403 2 30 840 550 820


IPS e.max CAD Crystall/Glaze 403 6 60 840 550 820
IPS e.max ZirLiner 403 4 40 960 450 959
IPS e.max Ceram 403 4 40 750 450 749
IPS e.max ZirPress 700 – 60 900 500 900
IPS e.max Ceram Glaze 403 6 60 725 450 724

dental technician (n = 20). In the P group, pressable wax (FC Statistical analysis
Modelling Wax) was modeled as bars (25 × 5 × 1.5 mm3 ) on
Data were statistically analyzed by one-way ANOVA for all
the frameworks. The total dimensions of the framework-veneer
groups (α = 0.05, SPSS 11.0 for Windows; Chicago, IL). Ad-
combinations were measured with a digital caliper (Mitutoyo
ditional post hoc tests (Bonferroni) were performed to make
Corp, Kanagawa, Japan), and then the dimensions of the ve-
multiple comparisons between the groups. p-values less than
neering wax model were subtracted from the total thickness. To
0.05 were considered to be statistically significant in all tests.
prevent the deformation of the wax superstructures, measure-
Weibull statistical analysis (MINITAB Version 14; Minitab,
ment was performed by a precise digital caliper after the wax
Inc., State College, PA) was used to describe fracture load
model turned rigid. For disk-shaped (diameter: 2.5 mm, height:
analysis and evaluate the reliability of veneering methods. The
2.5 mm) specimens for SBS tests, a sprue wax with a 2.5 mm
adjusted Anderson-Darling (AD) goodness-of-fit with 95% CI
diameter was connected to each framework, and the combined
estimation method of maximum likelihood was performed for
specimens were invested and pressed using a pressable ceramic
mechanical test results data to determine the Weibull distribu-
(IPS e.max ZirPress) as described above (n = 20) followed
tion and survival plot.
by divesting and cutting the sprues from the specimens to the
required dimensions.
All specimens were glazed (IPS e.max Ceram Glaze & IPS Failure type analysis
e.max CAD Crystall/Glaze) according to the manufacturer’s All fractured surfaces were assessed using a stereomicro-
instructions (Table 2). The crowns were seated on the stainless scope (MP 320; Carl Zeiss, Jena, Germany) at 20× mag-
steel dies using a glass-ionomer cement3,5,17 (RelyX Luting nification for failure analysis. Failure types were defined as
Cement; 3M ESPE, Seefeld, Germany) under 300 g standard (a) adhesive failure between the zirconia framework and ve-
load for 3 minutes by the same experienced operator using a neering ceramic (Adhesive); (b) cohesive failure in the ve-
parallelometer pin.18 All specimens were stored at 37◦ C, 100% neering ceramic (Cohesive-cer); (c) cohesive failure in the
humidity for at least 48 hours until mechanical testing. zirconia framework (Cohesive-zir); (d) mixed failure when
a combination of cohesive and adhesive failures occurred
Mechanical tests (Mix). One representative specimen from each failure type
group was evaluated under a scanning electron microscope
The crown specimens were mounted in a universal testing ma- (SEM) (JSM 5200; JEOL, Kyoto, Japan) with magnification
chine (Autograph AG-500 kNG; Shimadzu, Kyoto, Japan), and of 100× to 750× for FS test and 35× to 250× for SBS test to
the load was applied at a 1 mm/min crosshead speed until analyze the pattern of debonding.
fracture using a custom-made 7.5 mm diameter stainless steel
ball3 with a three-point-contact between the piston and the
FEA
occlusal surface. A 1-mm thin piece of polyethylene vacuum-
forming foil (Copyplast 1.0; Scheu-Dental, Iserlohn, Germany) For crown modeling, the metal die, the anatomical framework
was used between the piston and the crown for distribution of on the die, the multilayered design framework on the die, and
applied forces and to prevent stress concentrations on the ve- the final restoration obtained from the CD group were scanned,
neering material.3 and the created point clouds were transferred to an FEA pro-
The bar specimens (25 × 5 × 3 mm3 ) were placed flat on gram (Simufact.forming v11.0; Simufact Engineering GmbH,
an apparatus that had supporting rods 20 mm apart, and three- Hamburg, Germany). All layers were built with the identical di-
point bending test was applied vertically at the center of the mensions and specific properties of each material, such as elas-
specimen at a 0.5 mm/min crosshead speed (Autograph AG- ticity modulus and Poisson’s ratio, using a reduction technique.
50 kNG). The disk specimens were inserted in a metal ring Finally, crown models including suprastructure, interfacial sur-
holder to apply the forces at the core/veneer interface with a face, framework, and metal die for CD; and suprastructure,
0.5 mm/min crosshead speed until fracture (Autograph AG-50 anatomical framework, and metal die for L and P, were built to
kNG), and SBS values were obtained by the software according present the location of the accumulated stresses obtained from
to the formula:19 the FR test. The stainless steel ball with a three-point contact
Shear bond strength (MPa) = Load (N)/Area (mm2 ) with the occlusal surface was also modeled. Crown analyses

4 Journal of Prosthodontics 00 (2014) 1–11 


C 2014 by the American College of Prosthodontists
Kanat et al Mechanical Performance of Veneering on Zirconia

Table 3 Fracture loads for all groups (different superscript letters rep- parametric survival plot graphics of FR, FS, and SBS tests can
resent significant differences among groups) be seen in Figure 1.
Failure assessment of the crown specimens revealed that
Groups N Mean Standard deviation Minimum Maximum
mostly cohesive-cer and cohesive-zir types of failures were
FR–P (N) 10 2507a 594 1178 3384 observed in CD (Fig 2a1), while only cohesive-cer failure type
FR–L (N) 10 4323b 462 3516 5119 was seen in L and P (Figs 2b1, 2c1). Also, lateral cracks were
FR–CD (N) 10 4408b 608 3622 5447 observed in the P group because of the failure pattern of ce-
FS–P (MPa) 10 566c 54 463 653 ramic with small pieces of chipping during the mechanical
FS–L (MPa) 10 428d 41 374 486 test (denoted by red dot in Fig 2c1). With FS tests, all the
FS–CD (MPa) 10 583c 63 487 702 bar-shaped specimens were broken into two pieces, including
SBS–P (MPa) 10 30e 8 19 44 zirconia framework. In the CD group, less delamination was
SBS–L (MPa) 10 28e 5 21 37 observed with respect to L and P. Mainly mixed and adhesive
SBS–CD (MPa) 10 49f 6 38 61 failures were observed in all groups after SBS tests, with the
exception of one cohesive-cer type in the P group (Table 5).
Table 4 Relation of the scale and shape parameters among groups
According to the FEA of crown restorations, the stresses ac-
(different superscript letters represent significant differences among
cumulated in the ceramic were propagated into the zirconia in
groups)
the CD group (Figs 2a2, 2a3). The stresses were largely accu-
mulated in the ceramic and in the zirconia along the interface
Scale (N) 95%CI (scale) (N) Shape 95%CI (shape) AD in the L group rather than the P group (Figs 2b2-2b3, 2c2–2c3).
a a
The SEM analysis of the failed surfaces of the bar speci-
FR CD 4663 (4316, 5039) 8.4 (5.2,13.6) 1.573
mens revealed no imperfections in ceramic for the CD group
P 2718b (2412, 3062) 5.4a (3.3, 8.9) 1.535
(Fig 3a1), whereas many lateral cracks and porosities were
L 4522c (4250, 4812) 10.5a (6.6, 16.8) 1.566
observed in L and P groups (Figs 3b1- 3c1). Although failures
Scale 95%CI (scale) 95%CI
(MPa) (MPa) Shape (shape) AD
occurred in fusing glass ceramic in the CD group, the interfacial
FS CD 610d (572, 650) 10.3b (6.5, 16.3) 1.641
bonding of the glass ceramic either to the zirconia or the veneer-
P 589e (558, 622) 12.0b (7.5, 19.1) 1.625 ing ceramic was not affected (Fig 3a2). In the L group, most
L 446f (423, 470) 12.3b (7.6, 20.1) 1.551 probably the porosities resulted in cracks and partial detach-
SBS CD 52g (48, 56) 8.5c (5.3, 13.5) 1.619 ments from the zirconia (Fig 3b2). The P group showed porosi-
P 32h (27, 37) 4.2c (2.6, 6.8) 1.570 ties and partial detachments from the framework material along
L 29i (26, 33) 6.0c (3.7, 9.6) 1.470 the interfacial area, similar to the L group (Fig 3c2). Figure 4
illustrates the distribution of failure modes of debonded repre-
sentative disk specimens. Zirconia surfaces were observed in
were performed by approximately 250,000 four-noded linear adhesive failures, whereas in mixed failures, both the adhesive
tetrahedral elements (element type 134). The forces obtained failures on the zirconia surfaces and cohesive failures within
from the FR test were applied to each veneering technique the ceramic were observed simultaneously.
group.
Discussion
Results
The exact reason for veneer chipping observed in zirconia core
The mean values of FR, FS, and SBS within groups are pre- restorations is unclear, but it is thought that generally three
sented in Table 3. For FR (N ± SD), significantly different factors play an important role in the chipping of the ceramic
values were obtained in group P (p < 0.05), while no signifi- for zirconia-supported restorations, namely interfacial bonding,
cant differences were observed between the L and CD groups match of the core-veneer materials, and strength of the veneer-
(p > 0.05) (Table 3). For FS (MPa ± SD), the L group exhibited ing ceramic.2,20,21 Veneering techniques also have a potential
the lowest values (p < 0.05), and there were no significant dif- effect on the chipping of ceramic due to the processing meth-
ferences between P and CD groups (p ≥ 0.05) (Table 3). SBS ods of ceramic.2,4 Accordingly, in the present study, the FR of
tests (MPa ± SD) resulted in significantly higher values in the single molar zirconia crowns with zirconia frameworks and ve-
CD group (p < 0.05), but there were no significant differences neering ceramics prepared with different techniques (CAD-on,
between P and L groups (p ≥ 0.05). layering, overpressing) and the effect on chipping were investi-
Estimates of the parameters of the Weibull distribution for gated. Three complementary tests were conducted, in addition
the FR, FS, and SBS mechanical tests are presented in Table 4. to the FR test, to interpret the findings, namely three-point
The test to estimate shape parameters (p ≥ 0.05) indicated no bending test to investigate the effect of FS of the veneering
statistical differences in Weibull shape parameters among the ceramic on the restoration; SBS testing of the veneering ce-
veneering groups for any of the mechanical tests (Table 4). ramic and zirconia framework bilayered system to find out
The test for equal scale parameters (p < 0.05), together with whether the bond strength affected the FR of the crowns; and
the Bonferroni post hoc confidence interval, indicated that all finite element modeling simulating the loading conditions of
of the veneering method groups had different scale parameters the crown system to evaluate the location of the accumulated
for FR, FS, and SBS mechanical tests (Table 4). According to stresses. Also, to eliminate the mismatch of the framework
the analysis with the Weibull distribution, probability plot and and suprastructures, the materials were chosen according to the

Journal of Prosthodontics 00 (2014) 1–11 


C 2014 by the American College of Prosthodontists 5
Mechanical Performance of Veneering on Zirconia Kanat et al

Figure 1 Survival and probability plots of FR, FS, and SBS test groups.

manufacturers’ instructions. The results of this study demon- of the ceramic play an important role in the success of the
strated that the CAD-on technique resulted in significantly veneering technique.4,5,14,17 The veneering ceramic used in
higher FR values, although anatomical zirconia frameworks this technique has been reported to have an FS of approxi-
were used in the L and P groups. There were no signifi- mately 90 MPa. In the overpressing technique, the modeling
cant differences between CD and L groups with anatomical
cores according to ANOVA analysis, whereas the CD group Table 5 Failure-type distributions of mechanical test groups. A: Adhe-
had significantly higher values with respect to the L group sive, CC: Cohesive within veneering ceramic, CZ: Cohesive within zirco-
according to Weibull analysis. Thus, the null hypothesis was nia, M: Mixed
rejected. FR FS SBS
Currently used veneering techniques on zirconia frameworks
are layering, overpressing, or recently improved file-splitting A CC CZ M A CC CZ M A CC CZ M
(CAD-on). The layering technique is a very delicate method,
CD - 2 8 - - 10 - - 7 - - 3
as several factors such as the experience of the dental tech-
P - 10 - - - 8 - 2 5 1 - 4
nician, homogeneity of the mixed ceramic slurry, duration of
L - 10 - - - 9 - 1 7 - 3
the firing and cooling, the number of firings, and shrinkage

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C 2014 by the American College of Prosthodontists
Kanat et al Mechanical Performance of Veneering on Zirconia

Figure 2 Representative failure types and FEA models of the crown distributed over the entire surfaces can be observed in L. (c1) Cohesive
restorations. (a1) Cohesive failures within ceramic and zirconia in CD failure within ceramic and lateral cracks due to the stress peaks as indi-
group. (a2-a3) von Mises stress distributions of CD can be seen. (b1) cated with an arrow in the P group. (c2-c3) von Mises stress distribution
Cohesive failures within ceramic in L group. (b2-b3) von Mises stresses of P.

wax is placed on the sintered zirconia, and this combination is furnace, and controlled air-abrasion during separation of the
attached to a flask by a sprue. The flask is filled with a spe- restorations from the investment material might affect the suc-
cial investment material according to the manufacturer’s in- cess of this method. Particle size, morphology, and pressure
structions. After the wax is burnt out, the pressable ceramics, during air-abrasion may damage the ceramic surface. Since
which have about 110 MPa FS, are pressed into the spaces, and the surfaces of the zirconia in the present study were already
the final anatomic restorations are obtained.4 This technique veneered, they were not subjected to additional air-abrasion
allows the restoration to be produced faster and easier, com- during the airborne-particle abrasion procedure for divesting.
pared with the conventional layering technique. Moreover, the With the newly developed file-splitting (generic term: “CAD-
firing shrinkage observed in the layering technique can be min- on”) technique, time-consuming and operator-sensitive labo-
imized, and a good marginal adaptation of the restoration can ratory procedures such as impression making, model obtain-
be obtained.17 However, preliminary processes such as accu- ing, investing, and finishing can be eliminated with the aid
rate attachment to the flask, cleanness of the modeling wax, of computer-controlled design and fabrication.22 Furthermore,
quality of the pressing material, temperature of the preheating the file-splitting (CAD-on) technique is introduced as a more

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C 2014 by the American College of Prosthodontists 7
Mechanical Performance of Veneering on Zirconia Kanat et al

Figure 3 Representative SEM images of the fractured bar-shaped speci- propagation arose from lateral cracks and porosities due to layering tech-
mens. (C: ceramic, Z: zirconia, A: adhesive material). (a1-a2) (left column) nique observed in L. (c1-c2) (right column) Porosities along the interface
Homogeneous ceramic and crack origin in the adhesive material as indi- and lateral cracks in P.
cated with an arrow can be seen for CD. (b1-b2) (center column) Crack

Figure 4 Representative SEM images of the debonded surfaces of disk-shaped specimens. (C: ceramic, Z: zirconia). (a1-a2) (left column) Mixed
failures in the CD group. (b1-b2) (center column) Mixed failures in the L group. (c1-c2) (right column) Mixed failures in the P group.

reliable method because of the advantages of prefabricated structure, framework, and the interfacial material act mutually
blocks manufactured by industrial pressing without any porosi- under force.20 Using analysis methods such as SEM and/or FEA
ties, perfect adaptation of the restorations by CAD/CAM sys- of fractured surfaces for assessment of the failed surfaces to-
tem, and fast processing.3 gether with the mechanical tests, a connection between in vivo
For in vitro studies, preparation of bilayered specimens has and in vitro studies can be established.14 In the literature, the
been recommended since it has been reported that the super- chipping problem was investigated using only one mechanical

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Kanat et al Mechanical Performance of Veneering on Zirconia

test, and no studies about the recently introduced CAD-on tech- studies and in our study could be attributed to different frame-
nique could be derived with 3-point bending and SBS tests. In work and veneering ceramic combinations as well as differing
this study, the crown-shaped restorations were used to imitate mechanical testing modalities that may affect the bond strength.
the clinical situation for FR tests. To evaluate the effect of FS The anatomical framework design in the present study might
of the ceramic on the FR, bar-shaped specimens were prepared have added to the increased bond strength values.
for 3-point bending tests. Also, disk-shaped specimens were Liu et al24 reported that zirconia-supported specimens under
obtained for the SBS test to investigate the interfacial bonding 3-point bending test were broken into two pieces as in the
effect on the FR of crown restorations. In addition to mechani- present study. It has been indicated that the FS of the ceramic
cal tests, stereomicroscopy and SEM were used to evaluate the plays an important role on the fracture pattern. A ceramic with
failure modes and debonded surface structures. The results of 300 MPa FS can lead to less delamination.24 In the CD group
the present study may provide clinically relevant data for wider in the present study,3 a lower delamination rate was observed
application of these materials. in the lithium disilicate group, because the FS was 360 MPa.
It was previously stated that the rate and area of ceramic According to SEM analysis of fractured bar specimens in the
chipping in zirconia-supported crowns might be significantly present study, the ceramic structure without any imperfections
reduced when an anatomically reduced core design was used in CD can be due to the homogeneity of the ceramic block.
because of the cusp support and homogenous thickness of the Lateral cracks and porosities observed in both the L and P
ceramic.9,16 It has also been reported that support of the anatom- groups can be explained with the sensitivity of the veneering
ical zirconia framework prevented chipping compared to the re- techniques. When the effect of FS of the ceramic according to
sults of FS of the ceramic.9 Therefore, anatomical framework FS test on the FR values were examined in the present study,
design was used for the L and P groups in the present study. higher FS of the ceramic for the CD group played an impor-
Eisenburger et al17 found that layering of the veneering ce- tant role on the FR. For the L group, higher FR values could
ramic group (IPS e.max ZirCAD-IPS e.max Ceram) showed not be supported with FS values, which indicated the effect
better FR values (919 ± 265 N) than the overpressing group of the anatomical framework design on the FR rather than the
(IPS e.max ZirCAD-IPS e.max ZirPress) (798 ± 226 N). Al- FS of the layering ceramic. For the P group, the authors at-
though the results of the present study were compatible with tributed the differences found between lower FR and higher
these results, the reason for higher FR values (L: 4323 ± 462 FS values to contributing factors such as different fabrication
N; P: 2507 ± 594 N) obtained in the present study could be procedures, experience in handling of overpressing technology
attributed to the differences in geometry and the anatomically for the dental technician, and recently suggested slower cooling
shaped framework used in this study.15 In a previous study, parameters.16,25-27
fracture strengths of crown specimens made by CAD/CAM Ishibe et al4 investigated the SBS of zirconia cylinders (Lava;
fabricated nonanatomic formed zirconia framework (IPS e.max 3M ESPE, St. Paul, MN) (diameter: 5 mm) to layered or
ZirCAD) and veneering ceramics (IPS e.max CAD for S, IPS pressed ceramics (diameter: 3 mm). While the overpressing
e.max Ceram for L, IPS e.max ZirPress for P) were found to group (e.max ZirPress) showed 40.41 ± 10.28 MPa SBS, in
be 6265 ± 2257 N with sintering, 3700 ± 1239 N with lay- the layering group (e.max Ceram), 30.03 ± 9.49 MPa was ob-
ering, and 3524 ± 1181 N with overpressing methods.3 In the tained. The differences in the framework-superstructure com-
present study, the FR of CAD/CAM-fabricated zirconia frame- bination and thermocycling application could be reasons for
works veneered with different veneering techniques tested on the discrepancy between the results. López-Mollá et al28 also
crown specimens were 4408 ± 608 N for CD and 4323 ± 462 reported SBS of zirconia disks (IPS e.max ZirCAD) (length: 15
and 2507 ± 594 N for L and P, respectively. The results of mm; diameter: 8 mm) to layered (IPS e.max Ceram) and press-
the present study showed that higher FR values could be ob- able ceramics (IPS max ZirPress) (length: 2 mm; diameter: 8
tained in the layering technique when an anatomical zirconia mm) as 7.85 ± 2.50 MPa and 12.69 ± 2.14 MPa, respectively.
framework design is employed. In the P group, lower FR values Higher SBS results in the present study, which were similar
could be attributed to chipping of the veneering ceramic into to the veneering techniques can be explained by different ge-
smaller pieces, causing lateral cracks. Also, the fracture types ometries and loading conditions of the specimens. Although
observed in S and L in the literature3 were compatible with various opinions about the failure types after SBS test were
our study, since failure within both veneer and zirconia was found in the literature, no correlations between the SBS values
observed more frequently in CD. On the other hand, only ce- and types of failures were observed in the present study. Ereifej
ramic chipping was observed in L. The overpressing veneering et al29 reported that layering veneering ceramic (IPS e.max Ce-
technique (IPS e.max ZirPress) (1514 ± 332 N) was reported ram) on zirconia cores (IPS e.max ZirCAD) led to lower SBS
to show higher load-bearing capacity than the layering tech- values (28.8 ± 9.5 MPa), adhesive failures because of insuffi-
nique (IPS e.max Ceram) (894 ± 160 N) on the zirconia core cient wettability of the liner material applied on the zirconia,
(ZENO TEC; Wieland Dental, Pforzheim, Germany) according and imperfections that occurred at the interfacial surface. SBS
to the Voss test of canine-form restorations.5 Tsalouchou et al23 values (28 ± 5 MPa) and adhesive fracture types compatible
showed that the differences between the layering (IPS e.max with the literature were also observed in the present study.
Ceram) (2189.9 ± 317.6 N) and overpressing (IPS e.max Zir- Failure types after SBS test, observed in both stereomi-
Press) (2135.6 ± 330.1 N) veneering materials on nonanatom- croscopy and SEM, could be different.30 SEM analysis revealed
ically designed zirconia frameworks (Kavo Everest, Biberach, a thin ceramic layer on the zirconia framework. Hence, careful
Germany) following cyclic loading were insignificant. The dif- investigation was recommended when stereomicroscopy was
ferences between the results obtained in the above-mentioned used, since it provides less detailed topographic information.

Journal of Prosthodontics 00 (2014) 1–11 


C 2014 by the American College of Prosthodontists 9
Mechanical Performance of Veneering on Zirconia Kanat et al

In the present study, no correlations were found between the 1. The file-splitting (CAD-on) technique could decrease ce-
failure types following SBS tests and different veneering tech- ramic chipping due to higher strength of the ceramic and
niques, since stereomicroscopy was conducted for overall sur- the interfacial bonding.
face inspection, and only representative specimens were ob- 2. Anatomical framework design increased the FR when a
served under SEM. layering veneering technique was employed.
When the effect of interfacial bonding strength on the FR
values according to SBS tests were examined in the present
study, higher interfacial bonding in the CD group was noted. Acknowledgments
That eventually played an important role on the FR. This can
be attributed to the durable bonding provided by the glass in- The authors would like to thank Prof. Dr. Tijen Pamir at the
terfacial ceramic. For the L group, higher FR values were also Department of Restorative Dentistry, Ege University School of
not replicated with the SBS values, and an explanation for this Dentistry, Izmir, Turkey and Assist. Prof. Dr. Osman Çulha
result might be that the anatomical framework design plays an at the Department of Materials Engineering, Celal Bayar Uni-
important role on the higher FR rather than interfacial bonding. versity, Manisa, Turkey for the mechanical tests and Canderim
For the P group, lower FR and SBS values can be attributed to Önder at Netform, Izmir, Turkey for FEA analyses. The authors
low strength of the ceramic. extend their gratitude to Ivoclar Vivadent, Schaan, Liechten-
According to the overall results of the three mechanical tests, stein for providing the veneering ceramic and fusion glass-
FEA of the crowns and failure assessment, higher FR, bond ceramic materials.
strength, and FSs of the ceramic in the CD technique, as well
as cohesive failure observed within the ceramic and zirconia for
most specimens can be attributed to durable interfacial bonding. References
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