Effect of preparation designs and CAD-CAM materials on step-stress fatigue survival of premolar partial coverage restorations: An in-vitro study with fractographic analysis
Dina M. Nasr , Islam M Abdelraheem , David C. Watts , Nikolaos Silikas , Marcia Borba , Nada Alharbi , Khaled Abid Althaqafi , Alaaeldin Elraggal
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Abstract
Objectives
The growing trend of minimally invasive approaches has encouraged the application of partial coverage designs in restorative dentistry. This study aimed to evaluate the cyclic fatigue performance of different CAD-CAM materials used in various partial coverage designs for premolar restorations.
Methods
A freshly extracted upper premolar was prepared using a high-speed handpiece to create mesio-occluso-distal (MOD) cavities with standardized dimensions. Three preparation designs were investigated: onlay, overlay, and vonlay. CAD software was used to create digital models of the restorations, which were milled into one of four CAD-CAM materials: Zr - zirconia polycrystals (4Y-PSZ); EX - lithium disilicate glass-ceramic; VS - zirconia-reinforced lithium silicate glass-ceramic; GB - nanohybrid composite. Partial coverage restorations were bonded to tooth replicas and subjected to step-stress cyclic fatigue testing using a chewing simulator device (n = 10). The number of cycles-to-failure and fatigue fracture resistance (N) were recorded and analysed with Kaplan-Meier survival statistics and Weibull analysis, respectively. Fracture surfaces were analysed using fractography.
Results
Zr exhibited significantly higher number of cycles-to-failure and greater characteristic fracture load (L0) than the other materials, for onlay and overlay designs. For vonlay design, Zr, VS and EX had similar and greater number of cycles-to-failure than GB. When comparing different designs for the same material, Zr had lower number of cycles-to-failure for vonlay in comparison to onlay and overlay, while the other materials had similar values among the different designs. Weibull modulus was similar among experimental groups.
Significance
The findings of this study emphasize the critical role of material selection and preparation design in optimizing the mechanical performance and clinical success of partial coverage restorations. 4Y-PSZ is recommended for high-stress areas due to its superior fatigue and fracture resistance. Overlay designs provide better fatigue resistance, making them more suitable for clinical scenarios requiring higher durability. Understanding the fatigue performance of different materials and designs aids in making informed decisions to enhance the longevity and success of partial coverage restorations in premolars.
期刊介绍：
Dental Materials publishes original research, review articles, and short communications.
Academy of Dental Materials members click here to register for free access to Dental Materials online.
The principal aim of Dental Materials is to promote rapid communication of scientific information between academia, industry, and the dental practitioner. Original Manuscripts on clinical and laboratory research of basic and applied character which focus on the properties or performance of dental materials or the reaction of host tissues to materials are given priority publication. Other acceptable topics include application technology in clinical dentistry and dental laboratory technology.
Comprehensive reviews and editorial commentaries on pertinent subjects will be considered.
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