Reduction of load-bearing capacity of all-ceramic crowns due to cement aging

The purpose of this study was to investigate how water aging of the resin cement influences the stress distribution in all-ceramic crowns and if there is an increase in the propensity for crown failure. The failure of all-ceramic crowns attributed to cement degradation was explored using a combination of experimental and numerical methods. Sectioned all-ceramic crown specimens were fabricated of IPS e.max Ceram/e.max Press (CP) and Vita VM9/Cercon zirconia (VZ), and then stored in either air or distilled water for 30 days. Monotonic contact loads were applied to fracture near the buccal cusp ridge of each sample. Deformation within the crown layers during loading was analyzed by means of Digital Image Correlation (DIC). A 3D finite element model of the restoration including veneer, core, cement and tooth substrate was developed to evaluate the stress distribution in the crowns before and after cement degradation. There was a significant decrease (p<0.001) in the critical fracture load and a change in the fracture mode after cement water absorption in the CP crowns. In contrast, there was no significant influence of cement aging on fracture modes and fracture loads (p>0.05) in the VZ crowns. Finite element analysis showed that regardless of the crown types, the stress distribution is identical by degradation in Young's modulus of the cement. However, core/substrate debonding results in a change of the stress distribution and a significant increase in the magnitude. Water aging causes reduction of stiffness and bonding strength of cement agents. Degradation in bonding strength and stiffness could potentially lead to stress redistribution in the restored crown and reduce the load-bearing capacity of all-ceramic restorations after years of service.