Effect of Incisal Porcelain Veneering Thickness on the Fracture Resistance of CAD/CAM Zirconia All-Ceramic Anterior Crowns

STATEMENT OF PROBLEM: In some clinical situations, the vertical length of either a prepared tooth or an implant abutment is short, while the occlusal clearance to be restored by a porcelain crown is large. Incisal thickness of the veneering porcelain should be considered to prevent mechanical failure of the crown. PURPOSE: The aim of this study is to evaluate the effect of two different incisal veneering porcelain thickness on the fracture resistance of the anterior all-ceramic CAD/CAM zirconia crown system as compared with the conventionally used metal ceramic crown system. METHOD: CAD/CAM zirconia all-ceramic and metal ceramic crowns were fabricated on the prepared dies with standardized dimensions and designs using standardized methods according to the manufacturer's instructions. All crowns were then adhesively luted with resin-based cement (Multilink cement system), subjected to thermal cycling and cyclic loading, and were loaded until fracture using the universal testing machine to indicate the fracture resistance for each crown material in each veneering thickness. RESULTS: Statistical analysis was carried out, and the results showed that the fracture resistance of the nickel-chromium metal ceramic group was significantly higher than that of the CAD/CAM zirconia all-ceramic group. Also, the fracture resistance of crowns with 1.5 mm incisal veneering thickness was significantly higher than those with 3 mm incisal veneering thickness in both groups. Furthermore, there was no significant difference in the fracture mode of the two groups where 50% of the total specimens demonstrated Mode II (veneer chipping), while 35% demonstrated Mode I (visible crack) and only 15% demonstrated Mode III (bulk fracture). CONCLUSION: High failure load values were demonstrated by the specimens in this study, which suggest sufficient strength of both incisal veneering thickness in both crown systems to withstand clinical applications; however, the fracture patterns still underline the requirement of a core design that support a consistent thickness of the veneering ceramic, and it is recommended to conduct long-term prospective clinical studies to confirm findings reported in the present study.