FRACTURE RESISTANCE AND FAILURE MODE OF TWO RESTORATION DESIGNS MADE OF MONOLITHIC HYBRID AND GLASS MACHINABLE CERAMICS ; IN VITRO STUDY

Statement of the problem: Monolithic hybrid and glass ceramics are indicated for intracoronal and extracoronal ceramic restorations. Available data regarding selection of the appropriate ceramic type for each preparation design and its influence on fracture resistance of tooth restoration complex is still scarce.
Purpose: The purpose of this study was to evaluate in vitro the fracture resistance and investigate failure mode of two restoration designs (crowns and inlays) made from lithium disilicate glass ceramic and hybrid ceramic constructed by the CAD /CAM technique.
Materials and Methods: A total of twenty ceramic restorations restoring lower molars were designed and fabricated in this study. The restorations were divided into two groups; Group 1: Ten full coverage crowns and Group 2: Ten inlays. Each of the previous groups was further subdivided into two equal subgroups; Subgroup 1: Five restorations constructed from lithium disilicate glass ceramics (e.max CAD) and Subgroup 2: Five restorations constructed from hybrid ceramic (VITA ENAMIC) by the CAD/CAM technology. Two ivorine teeth were prepared following the guidelines for full coverage and inlay ceramic restorations, they were duplicated into stone dies followed by scanning, designing and milling of restorations. The stone dies were duplicated into epoxy dies where the restorations were adhesively cemented on them. All cemented samples were exposed to 2000 thermal cycles (5°C and 55°C in water) with a dwell time of 25 seconds in a computer controlled thermocycler. All specimens were loaded in a universal testing machine where fracture test was done by compressive mode of load applied occlusally using a metallic rod with round tip at cross-head speed of 1mm/min until fracture occurred. Fracture resistance values were recorded in Newtons then they were statistically evaluated and failure modes were analyzed.
Results: For group 1 representing crown restorations, a statistically significant difference was found between (e.max CAD) and (VITA ENAMIC) subgroups at (p=0.05) where the highest mean value of maximum load was found in (VITA ENAMIC) (951.77 N ± 81.05) and the lowest mean value of maximum load was found in (e.max CAD) (709.35 N± 49.51). While for the second group representing inlay restorations, no statistically significant difference was found between (e.max CAD) and (VITA ENAMIC) subgroups at (p=0.307) where the highest mean value of maximum load was found in (e.max CAD) (627.71 N ± 80.01) and the lowest mean value of maximum load was found in (VITA ENAMIC) (581.26 N± 51.74). For the e.max CAD subgroup, a statistically significant difference was found between (Crown) and (Inlay) groups at (p=0.005) where the highest mean value of maximum load was found in the crown group (790.35 N± 49.51) and the lowest mean value of maximum load was found in the inlay group (627.71N ± 80.01).Regarding the VITA ENAMIC subgroup, a statistically significant difference was found between (Crown) and (Inlay) groups at (p<0.001) where the highest mean value of maximum load was found in the crown group (951.77 N ± 81.05) and the lowest mean value of maximum load was found in the inlay group (581.26N±51.74).
Conclusions: 1. All inlays and crowns constructed from hybrid and glass ceramics in this study revealed fracture load values falling in the range of physiologic masticatory forces 2. When considering restoration of molars with full coverage crowns, VITA ENAMIC is more preferred than e.max CAD ceramic in terms of fracture resistance as it showed a higher statistical significant mean values.3. When planning to restore molars with minimally invasive intracoronal restorations, both ceramics can be used as there was insignificant statistical difference between them , however e.max CAD can be recommended due to its more favorable mode of fracture compared to VITA ENAMIC.4. Irrespective of preparation designs, both ceramics showed insignificant difference regarding fracture resistance mean values.