dental materi als 2 9 ( 2 0 1 3 ) e113e121

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Inuence of substructure design, veneer application
technique, and ring regime on the in vitro performance
of molar zirconia crowns
Verena Preis

, Christoph Letsch, Gerhard Handel, Michael Behr, Sibylle Schneider-Feyrer,

Martin Rosentritt
Department of Prosthetic Dentistry, University Medical Center Regensburg, 93042 Regensburg, Germany
a r t i c l e i n f o
Article history:
Received 20 September 2012
Received in revised form
23 April 2013
Accepted 25 April 2013
Keywords:
Zirconia
Ceramics
Veneering
Substructure design
Chipping
Fracture resistance
a b s t r a c t
Objectives. The aimof this in vitro study was to evaluate the inuence of substructure design,
veneer application technique, and ring regime on the failure and fracture resistance of
molar zirconia crowns.
Methods. Six groups (n=8/group) of zirconia crowns were fabricated in simple core (SC) or
anatomically reduced (AR) design, veneered with different feldspathic or glass ceramic
materials, and dened according to the application technique and ring regime (LT: lay-
ering technique; LT L: LT with long-termcooling; PT: press technique; DV: digital veneering
technique). The following groups were investigated: SCLT, ARLT, SCLT L, SCPT, ARPT, ARDV.
Crowns were adhesively bonded to polymethylmethacrylate abutment teeth and subjected
to thermal cycling (TC: 230005

/55

) and mechanical loading (ML: 1.210

6
; 50N; 1.6Hz)
in a chewing simulator with metal-ceramic molar crowns as antagonists. Failures were
monitored and fracture resistance determined after aging. Data were statistically analyzed
(one-way analysis of variance, ANOVA; post hoc Bonferroni, =0.05). Crowns were subjected
to scanning electron microscopy for fractographic failure analysis.
Results. Failures (chipping, cracks) during TCML were observed in groups SCLT (2), ARDV
(2) andSCLT L (1). Defect sizes variedbetween3.5mm(SCLT: crack) and30.0mm
2
(SCLT L:
chipping). Mean (SD) fracture forces ranged between 1529.0 (405.2) N for SCPT and 2372.3
(351.8) N for ARDV.
Signicance. The failure frequency of veneered zirconia crowns could be reduced by using
anatomically reduced substructures, the press veneering technique, and an adapted cooling
protocol. Fracture resistance increased with use of anatomically reduced substructures and
the digital veneering technique.
2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
1. Introduction
For restoring molar teeth with single crowns, yttria-stabilized
zirconia cores veneered with dental porcelains are highly

Corresponding author. Tel.: +49 941 944 6055; fax: +49 941 944 6171.
E-mail address: verena.preis@ukr.de (V. Preis).
esthetic alternatives to conventional metal-ceramics. Zirconia
ceramics can be processed with CAD/CAM (computer aided
design/computer aided manufacturing) or CAM technologies,
and their suitability as high-strength substructure materials
has been proven under in vitro and in vivo conditions over
0109-5641/$ see front matter 2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.dental.2013.04.011
e114 dental materi als 2 9 ( 2 0 1 3 ) e113e121
the past years [15]. Furthermore, zirconia ceramics provide
higher fracture toughness, a smaller range of strength varia-
tion, and higher structural reliability than glass ceramics [6].
The number and sequence of fabrication steps (for example,
wax modeling versus CAD) depend on the chosen systemand
material, but all zirconia substructures nally undergo par-
ticular CAMprocessing. After milling, these frameworks have
to be veneered with feldspathic or glass ceramics by means
of the layering, the press, or the digital veneering technique.
Although the application of full-contour zirconia restorations
is currently discussed as analternative to commonly veneered
restorations [5,7,8], esthetically superior results can only be
achieved by applying veneering materials with mechanical
properties inferior to those of the frameworks. Because the
veneering glass ceramic is the weakest part in this system,
clinically observed failures are mainly restricted to the veneer
layer [1,2]. As the veneering porcelain is directly exposed to
chewing, clenching, and moisture, fatigue mechanisms and
stress corrosion further weaken the veneer and nally result
in cracks or chippings [9,10].
These brittle breakdowns are typical failures of ceramic
materials. Although chippings may also present a problem
with porcelain-fused-to-metal (PFM) restorations, particularly
the chipping failures with all-ceramic zirconia restorations
are discussed [2,3,11]. Various inuencing factors have been
reported, such as the support and thickness of the veneer
[12,13], the morphology of the circular nishing line [14], the
adhesive forces between substructure and veneering [15], the
mismatch of coefcients of thermal expansion (CTE) [16], or
the ring protocol during the veneering process [17]. Opti-
mization of the zirconia substructure design has been proven
as a considerable factor in reducing chipping failures [13],
and coping modications are still a topic of current investi-
gations [18,19]. The main issues of Y-TZP-based restorations
seemto be the structural integrity of the veneering porcelain
on the one hand and its support by the zirconia substructure
on the other hand; therefore, the inuence of the applica-
tion technique and ring regime of the veneering material in
combination with the zirconia substructure design should be
further investigated to decrease failure rates.
Laboratory tests, such as the nite element analysis, may
help to predict the fracture behavior of specic material com-
binations [18,20]. But failure types and patterns are notably
inuenced by clinical variables, such as an individual crown
design with its occlusal variations, a patients chewing behav-
ior, and functioning in an oral environment. These variables
may have different effects on loading, force distribution, and
aging. Chewing simulations that imitate the clinical situa-
tion with dynamic loading and thermal cycling may help
examine specimen behavior under clinically approximated
conditions [4,21,22]. Material breakdowns during simulation
can be compared with clinically observed failures, and frac-
tographic methods can be applied for further investigations
of failed ceramic restorations [2325]. Chippings and frac-
tures are mostly initiated by aws inside the material or
defects in the marginal areas or on the occlusal surface
[23,24]. Even in cases without any catastrophic failures (frac-
ture) during oral application, aging and deterioration effects
might occur, which weaken the ceramic structure, thus
reducing strength and fracture resistance. In these cases a
subsequent static fracture test may help locate initiated weak
points.
The hypothesis tested in this study was that different
substructure designs (simple core or anatomically reduced
design), veneer application techniques (layering, press, or
digital veneering technique), and ring regimes (normal or
slowcooling) inuence the number and dimension of failures
in zirconia-based all-ceramic crowns during simulated oral
service and affect the fracture resistance after fatigue testing.
2. Materials and methods
The tooth 46 (Morita, Dietzenbach, Germany) was prepared
for a single crown according to the directives for zirconia
all-ceramic restorations. A circular and occlusal anatomical
reduction of 1.52.0mm was carried out with a preparation
angle of 4

. The nishing line resulted in a 1mmdeep circular

shoulder with rounded inner angles at an isogingival height
of the tooth cervix. Sharp inner edges and undercuts were
eliminated. This prepared tooth was then multiplied result-
ing in 48 identical polymethylmethacrylate (Palapress Vario,
Heraeus-Kulzer, Hanau, Germany) teeth. Their roots were cov-
ered with a 1mmthick layer of polyether material (Impregum,
3M Espe, Seefeld, Germany) to simulate periodontal tooth
mobility [22]. For achieving a constant layer, the roots were
dipped in a wax bath, which was replaced by polyether in
a second fabrication process, as described in previous stud-
ies [22,26]. We positioned the teeth in resin blocks (Palapress
Vario, Heraeus-Kulzer) and made polyether impressions (Per-
madyne, 3M Espe) and working dyes of class IV dental stone
(Fuji Rock, GC-Corporation, Tokyo, Japan). 48 substructures for
the molar crowns were fabricated with yttria-stabilized zirco-
nia (Lava, 3M Espe) using the CAD/CAM technique according
to the manufacturers instructions. Six groups were dened
(n=8/group) that nally showed the same crown shape but
differed in substructure design, veneer application technique,
and ring regime:
SCLT, simple core; veneered in layering technique (reference
group)
ARLT, anatomically reduced core; veneered in layering tech-
nique
SCLT L, simple core; veneered in layering technique (long-
termcooling)
SCPT, simple core; veneered in press technique
ARPT, anatomically reduced core; veneered in press tech-
nique
ARDV, anatomically reduced core; veneered with digital
veneering technique.
The substructures were divided into two groups:
- simple core (SC) with an overall thickness of 0.5mm, result-
ing in a varying veneer thickness
- anatomically reduced (AR) core, in which the crown dimen-
sion was reduced all around by 1mm, resulting in a
substructure thickness between 0.5 and 1mm to ensure
optimal support and constant thickness of the veneer layer.
dental materi als 2 9 ( 2 0 1 3 ) e113e121 e115
Table 1 Materials (data provided by manufacturer).
Material Manufacturer Type Application Fracture
strength
(MPa)
Lava Ceram 3M Espe, Germany Feldspathic porcelain Veneer, layering technique 100
IPS e.max ZirPress Ivoclar Vivadent, Liechtenstein Fluorapatite glass ceramic Veneer, press technique 110
Experimental material 3M Espe, Germany Glass ceramic Veneer, digital veneering technique 100
Lava 3M Espe, Germany Y-TZP Substructure, CAD/CAM >1100
The maximal thickness of the entire restoration was 2mm.
Thus, the veneering thickness depended on the substruc-
ture design. Veneering was done using the layering technique
(Lava Ceram, 3M Espe), the press technique (IPS e.max Zir-
Press, Ivoclar Vivadent, Schaan, Liechtenstein), or the digital
veneering technique (exp. material, 3MEspe) according to the
manufacturers instructions. Details on the materials used
are provided in Table 1. For the digital veneering technique,
the CAD/CAM-manufactured veneer and the Y-TZP core were
connected with fusion porcelain. Long-term cooling (SCLT L)
was performed according to standard regimes, only the cool-
ing phase was prolonged to 6min. All crowns were cemented
using a self-adhesive resin-based cement (RelyX UnicemApl-
icap, 3M Espe; 420s, Bluephase C8, 800mW/cm
2
, Ivoclar
Vivadent).
48 identical crowns were fabricated based on tooth 16
(Morita) of CoCr-alloy (Wirobond LFC, Bego, Bremen, Germany)
and a veneering porcelain (VM 15, Vita, Bad Sckingen,
Germany), which ought to serve as antagonists during the
entire chewing simulation. The all-ceramic crowns and their
antagonists were adjusted in a three point contact in a dental
articulator (Artex CN, Amann Girrbach, Pforzheim, Germany)
and transferred to the chewing simulator (EGO, Regensburg,
Germany) using a bite registration. According to an ideal-
ized occlusion concept, the distobuccal and the two lingual
cusps were loaded by the opposing mesiopalatinal cusp of
the antagonistic crown via tripodized contacts in the central
fossa. Further antagonistic contact areas were located at the
mesiobuccal and distobuccal cusp tips.
Fig. 1 Scanning electron micrograph (90) of a wear facet
of series SCLT.
Thermal cycling (TC: 230005

/55

; 2min each cycle)

and mechanical loading (ML: 1.210
6
; 50N; 1.6Hz) was per-
formed. Parameters are based on literature data on zirconia
and ceramic restorations expressing that chewing simulation
using these parameters might simulate a maximum of ve
years of oral service [4,21]. During the simulation time, all
crowns and their antagonists were monitored, appearing fail-
ures of the specimens were documented (type, number of
mechanical cycles) and failed crowns were excluded fromthe
further simulation process. Location (mesial, distal, buccal or
lingual direction) andextensionarea or lengthof the occurring
failure mode were determined by means of a light micro-
scope (M420, Wild, Heerbrugg, Switzerland). Scanning electron
microscopy (SEM; magnication: 20600; working distance:
20.4mm; voltage: 510keV; low vacuum; Quanta FEG 400, FEI
Company, Hillsboro, USA) was used for fractographic failure
analyzing. This way, overview and detailed micrographs were
produced.
Molar crowns without any failure during TCML were sub-
sequently loaded with a testing machine (Zwick 1446, Ulm,
Germany; v=1mm/min) until failure. The force was applied
using a steel ball (d=12mm) and a folded tin foil (40.25mm,
Dentaurum, Ispringen, Germany), between crown and antag-
onist prevented force peaks. Crowns were optically examined
after fracture testing, and failure modes were divided into
chipping of the veneer or combined fracture of the veneer and
core.
Calculations and statistical analysis were carried out using
SPSS 19.0 for Windows (SPSS Inc., Chicago, IL, USA). Mean
values and standard deviations (SD) were calculated and ana-
lyzed by means of one-way analysis of variance (ANOVA) and
the Bonferroni multiple comparison test for post hoc analysis.
The level of signicance was set to =0.05.
3. Results
During the simulation process, failures occurred in the exam-
ination groups SCLT, ARDV (2 each) and SCLT L (1), whereas
the two groups with the press technique as well as the ARLT
group remained undamaged. Failures mostly consisted of
chipping of the veneering ceramic, and only in one case did
a crack occur (SCLT). Failure descriptions are summarized in
Table 2. Defect sizes varied between 3.5mm(SCLT: crack) and
30.0mm
2
(SCLT L: chipping), but neither the area (p=0.578)
nor the number (p=0.359) of failures showed any signicant
differences. Antagonistic metal-ceramic crowns did not reveal
any chipping failures but only wear facets.
The SEM evaluation illustrated that the occlusal contact
areas of all molar zirconia crowns were roughened by their
antagonist. The microcracked and ploughed surface of these
e116 dental materi als 2 9 ( 2 0 1 3 ) e113e121
Fig. 2 (a) Overview(27) and (b) detail scanning electron micrographs (80200) of a small-area chipping of series ARDV: O,
point of origin at wear facet (W); C, crack propagation; H, hackles and wake hackles; A, arrest lines.
wear facets (Fig. 1) measuring between 2 and 4mm
2
on
average was similar in all examination groups. As the fracto-
graphic analysis showed, these load-bearing areas were the
origin of cracks running through the veneering porcelain,
which resulted in the described chipping failures. Exemplary
SEM pictures are provided as overview and detailed gures
(Figs. 24). Fractographic features were identied for interpre-
ting failure patterns, showing their occlusal origin, fracture
mirrors, hackles, wake hackles, and arrest lines as indicators
of the direction of the crack propagation. Whereas both defect
modes of SCLT were located at the mesiobuccal cusp, all other
chippings in ARDV and SCLT L started at the disto- or mesi-
olingual cusps and were directed toward the crown equator or
margin. Inadditionto the major chipping indistolingual direc-
tion, one failed crown of ARDV (Fig. 3) showed a secondary
smaller chipping, which also started at the distolingual cusp
but proceeded in mesial direction. The large-area chipping in
SCLT L (Fig. 4) reached the nishing line but without exposing
the zirconia substructure. A thin layer of veneering porcelain
remained in the marginal area of the zirconia core. In each
investigated crown, the failure occurred inside the veneer, and
we did not nd any interfacial fractures between the zirconia
substructure and the veneering porcelain.
Mean (SD) fracture forces (Table 2) varied between 1529.0
(405.2) N for SCPT and 2372.3 (351.8) N for ARDV. The results
for SCPT were signicantly lower than for ARLT (p=0.036) and
ARDV (p=0.012). The most frequent fracture pattern was a
fracture of both veneer and core. Only ARDV showed a con-
gruent number of sole veneer chipping and combined veneer
and core fractures (3 each).
Fig. 3 (a) Overview (31) and (b) detail scanning electron micrographs (80300) of a small-area chipping (twin) of series
ARDV: O, point of origin with wear facet (W); C, crack propagation; H+A, wake hackles and arrest lines.
dental materi als 2 9 ( 2 0 1 3 ) e113e121 e117
Fig. 4 (a) Overview (23) and (b) detail scanning electron micrographs (37150) of a large-area chipping of series SCLT L:
O, point of origin; C, crack propagation; H+A, wake hackles and arrest lines.
4. Discussion
Both parts of the hypothesis of this study that different
substructure designs, veneer application techniques, and
ring regimes inuence the number and dimension of fail-
ures in zirconia-based all-ceramic crowns during simulated
oral service and affect the fracture resistance after fatigue
testing, were conrmed. The failure frequency during the
endurance test could be decreased with an anatomically
reduced substructure design and the press veneering tech-
nique. The adapted cooling protocol of the layering technique
showed a lower number of failures for the simple substructure
design, but also an increased chipping area, however without
any statistically signicant difference. The highest fracture
forces during subsequent single load fracture testing were
observed for the digital veneering technique and for the layer-
ing technique in combination with the anatomically reduced
design.
Standardization of the examined restorations and the test-
ing conditions was required in this in vitro study because
the evaluation of crown performance and underlying rea-
sons for clinically observed chipping failures is complicated
by individual variables, such as tooth structure, periodontal
mobility, occlusal loads, chewing behavior, the oral environ-
ment, as well as differences in the preparation design of the
abutment teeth and the material selection of both crown and
luting materials [23,27]. Furthermore, the fabrication of dental
restorations in the laboratory is a process that highly depends
on the skills and preferences of the individual dental tech-
nician [28]. Therefore, in this in vitro study, the multiplying
of one prepared tooth as well as the application of CAD/CAM
technologies allowed the fabrication of molar crowns iden-
tical in shape and size. Such uniformity is important for a
reliable comparison of different groups and may allow for
identifying single risk factors. In return, the comparability
of in vitro and in vivo loading situations is limited because
articial abutment teeth differ from human teeth in terms
of modulus of elasticity and bonding capacity to the cement
[29]. The inuence of resilient support of the abutment teeth
on the aging process and fracture strength of molar crowns
should be considered by a polyether interface, which natu-
rally does not stay abreast of the complex human periodontal
ligament, but might avoid an overestimation of the strength
of ceramic restorations [26]. TCML parameters have been cho-
sen congruent to numerous other in vitro studies [13,28,30].
They are supposed to simulate restoration stress according to
a maximumof ve years of intraoral use [4,21]. Different stress
simulation parameters might have affected the appearance of
failures and the fracture load. Especially an additional lateral
movement is considered to be essential for simulating fatigue
wear of ceramics [22], results in shear loading produced by
side shift chewing forces and may have fostered cracks and
the chance of chipping. Although no lateral movements dur-
ing the chewing simulationwere includedinthe present study,
minor sliding contacts occurred as a result of deection by
the polyether layer ligament. Metal-ceramic antagonists were
used, because they reect a high percentage of clinical situa-
tions and allowthe standardization of antagonistic situations.
Though, the tribological and mechanical properties of human
enamel, the natural antagonist in the oral cavity, differ from
glass ceramics [31], which might have caused different wear
[7,32], damage, and nally chipping behavior.
Supposed crucial factors for chipping failure during chew-
ing simulations are occlusal overloading [23], stress corrosion,
and fatigue [1012], particularly in the case of improper
substructure design [13], which does not provide sufcient
occlusal support for the veneering porcelain. Occlusal over-
loading may be restricted to individual cases of bruxism or
force peaks when people bite on a hard object [23,33,34] but
can be excluded for average chewing forces as applied during
the chewing simulation. A more common reason for chipping
is fatigue as a result of antagonist wear and selective load-
ing via chewing impact and clenching [4,28]. Wear results in
e118 dental materi als 2 9 ( 2 0 1 3 ) e113e121
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roughening of the ceramic surface by microploughing, micro-
cracking, and microcutting and causes the formation and
propagationof subsurface cracks [35]. Insimple substructures,
suchaws canpropagate throughthe veneering ceramic with-
out being stopped or deected. This theory is supported by the
present observations of failures (chipping, cracks) that origi-
nated from occlusal wear facets and were primarily detected
in crowns with a simple core design; such failures are mainly
due to insufcient support and the varying thickness of the
veneer layer.
According tothe present invitroresults that didnot include
any interfacial cracks between substructure and veneer, chip-
ping failures withinthe veneering material represent the most
common type of failure observed in clinical studies [1,2,23].
These cohesive failures indicate a reliable bond between the
veneering ceramics and the high-strength zirconia frame-
works but also reveal the weakness of the veneering porcelain.
By cyclic loading, a hydraulically assisted steady propagation
of inner and partial cone cracks occurs in the mid-layer of the
veneering ceramic that may nally lead to failure by chipping
[9,10,20]. The occlusal load is divided into two components
that are either directed at the fossa or at the equator [13];
therefore a supporting substructure is necessary that allows
an efcient shift of the stress distribution from the veneer to
the core layer. In this case, a thinner layer of the weak veneer-
ing porcelain is supported by the underlying zirconia cusps,
whichmay serve as anexplanationfor the reductionof failures
for molar crowns with anatomically reduced core design.
The results showed that not only the substructure design
but also the application technique and type of veneering
material inuenced the chipping behavior of zirconia molar
crowns. In contrast to the layering and digital veneering tech-
nique, no failures were observed for cores (SC, AR) veneered
by the press technique. It has been suggested earlier that
lower amounts of voids are introduced to the veneer layer
when applying a controlled process such as the press tech-
nique [3,36], which contributes to a more homogenous and
damage-resistant structure because any porosity may act as
a stress-raiser for crack initiation [37]. Accordingly, a prospec-
tive 3-year clinical trial on Y-TZP xed partial dentures has
shown promising results with the over-pressing technique,
i.e. no veneer chipping and a success rate of 95.2% with zir-
conia frameworks [3]. A further reason for the outstanding
resistance to fatigue of pressed material may be an improved
ceramic microstructure, because IPS e.max ZirPress is a uora-
patite glass ceramic that might exceedthe strength(100MPa)
and fracture toughness (1MPam
1/2
) values of commonfelds-
pathic layering porcelains such as Lava Ceram. Although a
digital veneering technique is supposed to achieve indus-
trial quality standards and therefore reduce failure rates [38],
chipping behavior of group ARDV was similar to the groups
with simple cores and layered veneers, indicating that even
almost awless materials are not able to withstand fatigue, if
mechanical properties (strength, fracture toughness) are infe-
rior. When comparing the present results with in vitro studies
reporting improved resistance to failure and higher fracture
loads for CAD/CAM-fabricated veneers compared to the layer-
ing technique [38,39], it has to be considered that substantially
stronger veneering materials of lithiumdisilicate may have
contributed to low failure rates.
dental materi als 2 9 ( 2 0 1 3 ) e113e121 e119
Because of the lowthermal conductivity of the Y-TZP core,
the development of thermal gradients during cooling could
lead to the entrapment of tempering stresses in the veneer
and therefore increase the risk of pre-damage during the man-
ufacturing process [17]. The assumed favorable effects of a
prolonged cooling rate reduced the failure rate of the layered
veneer for the simple core design. However, although only one
crownof SCLT L showed chipping, the damage was larger than
that observed in all other groups. Therefore, the combina-
tion of a prolonged cooling rate with an anatomically reduced
design should be most effective in reducing the number and
dimension of chipping failures.
However, because of the unexpectedly low differences in
the number and dimension of failures in the various groups,
it should be kept in mind that fatigue failures might be ran-
domevents associated with material or fabrication defects. A
higher sample size might have allowed a better differentiation
between the investigated groups.
The fact that the majority of chippings in this study
occurred in lingual direction can be explained by interocclusal
tooth references. The main chewing forces of the mandibular
molars tested occur in the central lingual areas. The non-load
bearing lingual cusps have to withstand the side shift chewing
forces. Thus, shearing forces produced by clenching mainly
occur in distal and lingual directions, causing chipping fail-
ures [13]. A nite element analysis of the force distribution
in molars during clenching and mastication was conducted
by Dejak [40], who showed that maximal stress occurs at the
occlusal surface and the cervical region of the lingual wall
of the rst mandibular molar. It has been further suggested
that the higher fracture potential of nonfunctional cusps in
mandibular teethis relatedto their anatomical shape, because
they are narrower, and the angular inclinations of these cusps
are smaller than the functional cusps [18]. Therefore, they
might be more susceptible to the horizontal loading compo-
nent. Further studies investigating the inuence of the crown
design (cusp inclination and curvature) on chipping behavior
seemto be necessary.
The present SEMobservations with chipping failures origi-
nating fromocclusal wear facets showthe necessity of looking
at the antagonist teeth and the condition of the crown sur-
face. On a smooth surface, the antagonist slides easily into
the nal situation with an optimal cuspfossa relation. With
increasing roughness (e.g. due to wear) and destruction of the
loading point, biting forces are distributed over a larger area
and the loading toward the equator of the crown is reduced
with the attening of the crown [13]. As the antagonistic
crowns were not changed during the entire fatigue testing,
it might be argued that different stress scenarios and con-
tact pressures that are associated with ongoing wear of the
surface limit the signicance of this study. However, this nat-
ural phenomenon also takes place in clinical service. The
friction between crown and antagonist gradually increases,
and progressively ploughed and awed surfaces [7] further the
development of cracks and the chance of chipping. Therefore,
polishing wear facets on ceramics every nowand then may be
recommendable.
The number of mechanical cycles at failure may give
important clues about the underlying failure reason. Cracks
or chippings at the beginning of the endurance test might
indicate the presence of processing defects, for example,
during the layering process or residual stresses from r-
ing during the veneering process, as may be assumed for
the early crack in group SCLT (63,006 mechanical cycles). In
return, failures at higher mechanical cycles may be more typ-
ical for fatigue mechanisms of the porcelain. Zirconia-based
restorations have shown strong TCML-dependent aging [4].
Therefore, fatigue probably played a major role in chipping
at mechanical cycles higher than 300,000. However, prema-
ture cracks may accelerate further failures, such as chipping,
and reduce fracture resistance. This theory is supported by
a study on fatigue testing of zirconia-based crowns, which
mostly revealed crack initiation and propagation before chip-
off fractures [41]. Though, reliable conclusions on this topic
require further investigations.
In contrast to TCML, fracture testing, during which crowns
are loaded to failure in one single stroke, shows no clinical
relevance but may provide helpful data for comparing tested
specimens. During oral simulation, aws, supercial wear, or
aging effects contribute to the deterioration of the material
and reduce fracture strength [22,42], particularly in the case
of improper substructure design. Therefore, fracture testing
after simulation may allowthe identication of initiated weak
points and permit the differentiation of material and design
variations. The digital veneering technique was shown to be
efcient in increasing fracture resistance compared to the lay-
ering or press technique, which was also demonstrated in an
in vitro study by Beuer [38]. Provided that the same veneering
material was applied, crowns with anatomically reduced sub-
structure design showed higher fracture forces than crowns
with simple core design, yet without any signicant differ-
ences. Despite the absence of failures during TCML, the molar
crowns fabricated in press technique showed the lowest frac-
ture forces. However, it has to be kept in mind that fracture
resistance may have been overestimated in groups with fail-
ures during TCML, because the failed crowns were excluded
from subsequent single load fracture testing. Nevertheless,
as the observed fracture loads considerably exceeded maxi-
mum chewing forces, which are reported to be up to 900N
[43], all molar zirconia crowns have the potential to with-
stand occlusal forces applied in the posterior region. Failures
for fatigue testing were caused by chip and crack formation,
whereas the most frequent failure type for single load fracture
testing was combined veneer and core fracturing.
These catastrophic failures, which have also been
described in other studies [10,38], underline the inability of
severe fracture testing to replicate clinically observed fail-
ure modes. Thus, only limited insight into clinically relevant
mechanisms of damage initiationand propagationcanbe pro-
vided.
The present results indicate that chipping seems to be a
phenomenon, which is not limited to zirconia restorations but
is strongly inuenced by the design of the substructure and
the intactness of the veneer. Chipping denitely appears to
be a cohesive failure of the veneering porcelain and not of
the interface between substructure and veneering ceramic as
assumed earlier [15,23]. As different types of veneering mate-
rials for zirconia or alloy-supported substructures showsmall
differences incomposition, mechanical properties, andsinter-
ing temperatures, which are only adapted for the veneering
e120 dental materi als 2 9 ( 2 0 1 3 ) e113e121
of the respective core material, there should be no differ-
ence between the chipping rates of alloy- or zirconia-based
crowns. Unfortunately, the design of the substructure, partic-
ularly with the launch of zirconia restorations, has provided
absolutely no support of the veneer and may have caused the
reported high numbers of chippings [1,41]. Use of controlled
veneer applicationtechniques, suchas the press technique, as
well as minimizing stress during the ring regime may consti-
tute one possibility to reduce cracking and chipping failures.
However, only in combination with an anatomically reduced
substructure design and a constant layer of the veneering
porcelain, the number and dimension of failures (chippings,
cracks) is likely to be effectively reduced.
5. Conclusion
The failure (chipping, cracks) frequency of veneered zirconia
crowns could be reduced by using an anatomically designed
substructure, the press veneering technique, and an adapted
cooling protocol. Fracture resistance increased with use of
anatomically reduced substructures and the digital veneering
technique.
Acknowledgement
We would like to thank 3M Espe for providing the materials.
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