Microstructural and Mechanical Characterization of CAD/CAM Materials for Monolithic Dental Restorations

To determine and compare the microstructure, flexural strength, flexural modulus, fracture strength, and microhardness of four types of computer-aided design/computer-aided manufacturing (CAD/CAM) materials for monolithic dental restorations.

A lithium disilicate (LD; IPS e.max CAD), a zirconia-reinforced lithium silicate (ZLS; VITA Suprinity), a hybrid high-performance polymer (HPP) composite resin (GC Cerasmart), and a hybrid polymer-infiltrated ceramic network (PICN) material (VITA Enamic) were used to manufacture monolithic ceramic posterior crowns (n = 10) that were adhesively cemented on resin-based composite dies and loaded until fracture. In addition, 40 rectangular bars (n = 10) were milled and polished for three-point flexural strength testing. Microhardness (Vickers indentation), as well as quantitative (energy dispersive spectroscopy) and qualitative (scanning electron microscopy) structural analysis were conducted on fracture surfaces. Data were analyzed by one-way ANOVA and Tukey HSD post-hoc test (p = 0.05).

Mechanical testing results showed that the material type has a significant effect on the fracture strength (p < 0.0001) of the monolithic crowns with ZLS and LD presenting significantly higher fracture strength than the PICN and HPP hybrid materials. LD showed the highest flexural strength (p < 0.0001) followed by ZLS, HPP, and PICN, respectively. The lowest flexural modulus and hardness were presented by HPP whereas ZLS had the highest flexural modulus and hardness. The LD presented the highest modulus of resilience and the PICN the lowest.

All CAD/CAM crown materials exhibited high values of fracture and flexural resistance, making them suitable materials for posterior full-crown restorations. Glass-ceramics suffered more from catastrophic and nonreparable fracture patterns, whereas minimal chipping and type II fracture patterns were more common in hybrid materials. The combination of more flexibility, less stiffness, and increased softness with satisfactory flexural and fracture strength values observed in PICN and HPP makes these two hybrid materials suitable choices for chairside monolithic crown fabrication.