Mechanical stability of dental CAD-CAM restoration materials made of monolithic zirconia, lithium disilicate, and lithium disilicate-strengthened aluminosilicate glass-ceramic with and without fatigue conditions

Abstract

Statement of problem: Studies investigating the mechanical stability of lithium disilicate-strengthened aluminosilicate glass-ceramic that do not require sintering after milling compared with other computer-aided design and computer-aided manufacturing (CAD-CAM) materials are lacking.

Purpose: The purpose of this in vitro study was to investigate the flexural strength of CAD-CAM zirconia, lithium disilicate, and lithium disilicate-strengthened aluminosilicate glass-ceramics with and without fatigue conditions.

Material and methods: Specimens (N=90, n=15) (12×4×3 mm) from the following CAD-CAM materials were prepared and polished: lithium disilicate glass-ceramic (IPS e.max CAD); lithium disilicate-strengthened aluminosilicate glass-ceramic (N!ce); and zirconium dioxide ceramic (IPS e.max ZirCAD). All specimens were divided into 2 subgroups: immediate testing without aging and simulation of aging by using a mastication simulator for 1 200 000 cycles (5 °C-55 °C). Thereafter, flexural strength testing was performed by using a universal testing machine (1 mm/min) on nonaged and aged specimens. The data were evaluated by using nonparametric 2-way ANOVA and Wilcoxon rank post hoc tests (α=.05).

Results: Both the material type and aging significantly affected the results (P<.001). The interaction was not significant (P>.05). Under nonaged conditions, zirconium dioxide ceramic (1136 ±162 MPa) showed significantly higher mean ±standard deviation flexural strength (P<.001) than lithium disilicate (304 ±34 MPa) and lithium disilicate-strengthened aluminosilicate glass-ceramic (202 ±17 MPa). The glass-ceramic groups were also significantly different from each other (P<.001). After aging, zirconium dioxide (1087.9 ±185.3 MPa) also presented significantly higher mean ±standard deviation flexural strength (P<.001) than lithium disilicate (259 ±62 MPa) and lithium disilicate-strengthened aluminosilicate glass-ceramic (172 ±11 MPa) (P<.001). Aging significantly decreased the flexural strength of lithium disilicate (14.6%) (P=.03) and lithium disilicate-strengthened aluminosilicate glass-ceramic (14.5%) (P=.01) but had minimal effect on the zirconium dioxide ceramic (4.3%) (P=.29).

Conclusions: Among the tested CAD-CAM materials, the mechanical performance of lithium disilicate-strengthened aluminosilicate glass-ceramic was comparable with that of lithium disilicate and considerably lower than that of zirconia. Aging decreased the flexural strength of both lithium disilicate and lithium disilicate-strengthened aluminosilicate glass-ceramic.