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

doi:10.1016/j.dental.2024.11.003

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

Dent Mater. 2024 Nov 29:S0109-5641(24)00337-3. doi: 10.1016/j.dental.2024.11.003. Online ahead of print.

Authors

Dina M Nasr¹, Islam M Abdelraheem¹, David C Watts², Nikolaos Silikas², Marcia Borba², Nada Alharbi³, Khaled Abid Althaqafi⁴, Alaaeldin Elraggal⁵

Affiliations

¹ Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
² Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
³ Assistant professor of fixed prosthodontics, School of Dentistry, Taibah University, Madina, Saudi Arabia.
⁴ Restorative Dentistry Department, Faculty of Dentistry, College of Dental Medicine, University of Umm Al Qura, Makkah, Saudi Arabia.
⁵ Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt; Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK. Electronic address: Alaaeldin.elraggal@manchester.ac.uk.

PMID: 39616090
DOI: 10.1016/j.dental.2024.11.003

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.

Keywords: 4Y-PSZ; Cyclic fatigue; Lithium disilicate; Resin nanoceramic composite; Step-stress test; Zirconia-reinforced lithium disilicate.