Journal of Dental Research

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Reliability of Metalloceramic and Zirconia-based Ceramic Crowns

N.R.F.A. Silva, E.A. Bonfante, R.A. Zavanelli, V.P. Thompson, J.L. Ferencz and P.G. Coelho
J DENT RES 2010 89: 1051 originally published online 26 July 2010
DOI: 10.1177/0022034510375826

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 RESEARCH REPORTS
Biomaterials & Bioengineering

N.R.F.A. Silva1*, E.A. Bonfante2,

R.A. Zavanelli3, V.P. Thompson4,
Reliability of Metalloceramic
J.L. Ferencz1, and P.G. Coelho4 and Zirconia-based
1
Department of Prosthodontics, New York University College
of Dentistry, 345 East 24th Street, Room 804-S, New York,
Ceramic Crowns
NY 10010, USA; 2Department of Prosthodontics, Integrated
Center for Research, Bauru School of Dentistry, University of
São Paulo, Bauru, SP, Brazil; 3Prevention and Oral
Rehabilitation, Federal University of Goias School of Dentistry,
Goiania, GO, Brazil; and 4Department of Biomaterials and
Biomimetics, New York University College of Dentistry, New
York, NY, USA; *corresponding author, [email protected]

J Dent Res 89(10):1051-1056, 2010

Abstract Introduction
Despite the increasing utilization of all-ceramic
crown systems, their mechanical performance rel-
ative to that of metal ceramic restorations (MCR)
M etal ceramic restorations (MCR) are reputed to be the gold standard in
dentistry, offering reasonable esthetics (Donovan, 2009) and long-term
structural performance, with single-crown porcelain fracture documented
has yet to be determined. This investigation tested
clinically at ~ 3% over 20 yrs (Napankangas and Raustia, 2008). Primarily
the hypothesis that MCR present higher reliability
reported are biological complications in MCR, whereas technical complica-
over two Y-TZP all-ceramic crown systems under
tions such as porcelain failure are rarely described (Napankangas and Raustia,
mouth-motion fatigue conditions. A CAD-based
2008).
tooth preparation with the average dimensions of a
The patient demand for metal-free and tooth-colored restorations has
mandibular first molar was used as a master die to
driven substantial effort to increase the strength and reliability of dental
fabricate all restorations. One 0.5-mm Pd-Ag and
ceramic systems (Raigrodski, 2006). Given its strength and transformation
two Y-TZP system cores were veneered with 1.5
toughening, zirconia may be regarded as the most suitable substructure
mm porcelain. Crowns were cemented onto aged
ceramic for posterior restorations (Raigrodski, 2004). For dental applications,
(60 days in water) composite (Z100, 3M/ESPE)
yttrium oxide is usually added (2-3% mol of Y2O3) to the pure zirconia to
reproductions of the die. Mouth-motion fatigue
stabilize the tetragonal phase at room temperature, generating a multiphase
was performed, and use level probability Weibull
material, i.e., partially stabilized zirconia (Piconi and Maccauro, 1999). The
curves were determined. Failure modes of all sys-
utilization of yttria-tetragonal zirconia polycrystals (Y-TZP) in the areas of
tems included chipping or fracture of the porcelain
high tensile stresses of core and fixed partial denture (FPDs) connectors is
veneer initiating at the indentation site. Fatigue
indicated due to its inherent ability to suppress crack propagation (Studart
was an acceleration factor for all-ceramic systems,
et al., 2007a). Although Y-TZP substructures show high survival rates, techni-
but not for the MCR system. The latter presented
cal complications in FPDs, such as chipping of the veneering porcelain, have
significantly higher reliability under mouth-motion
resulted in high failure rates (Raigrodski et al., 2006; Sailer et al., 2007a).
cyclic mechanical testing.
Such complications have been suggested to arise due to possible variations in
materials processing (Coelho et al., 2009; Swain, 2009).
KEY WORDS: all-ceramic, dental ceramic, Simulation of occlusal function during laboratory material’s testing
metal ceramic retainers, fatigue, single-crown. becomes essential in predicting long-term performance before clinical usage.
Mouth-motion fatigue testing (Rekow and Thompson, 2007; Coelho et al.,
2009) has demonstrated success in duplicating and predicting clinical chip-
ping and fracture modes of ceramics (Rekow and Thompson, 2007; Bonfante
et al., 2009; Coelho et al., 2009; Silva et al., 2009). Whereas simulation of
Y-TZP crowns clinical failure has been shown to be possible in the laboratory,
DOI: 10.1177/0022034510375826 a parallel between laboratory and clinical failure modes in MCR restorations
has not been determined to date.
Received November 2, 2009; Last revision April 13, 2010;
This investigation tested the hypothesis that MCR (Pd-Ag) presents higher
Accepted April 15, 2010
reliability than two Y-TZP all-ceramic crown systems under mouth-motion
© International & American Associations for Dental Research fatigue conditions.

1051
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© 2010 International & American Associations for Dental Research

1052 Silva et al. J Dent Res 89(10) 2010

Materials & Methods WC indenter under load moved lingually 0.7 mm downward on
the incline of the disto-buccal cusp of the mandibular first
We modeled an anatomically correct 3-D prototype of a man- molar, beginning 0.5 mm lingual to the cusp tip.
dibular first molar full-crown preparation by reducing proximal Use level probability Weibull curves with a cumulative dam-
walls by 1.5 mm and the occlusal surface by 2.0 mm using CAD age and power law relationship were calculated (Zhao and
software (Pro/Engineer Wildfire, PTC, Needham, MA, USA). Elsayed, 2005) (Alta Pro 7, Reliasoft, Tucson, AZ, USA).
The CAD file of the prepared tooth was imported to a milling Reliability (90% two-sided confidence bounds) for completion
machine to generate plastic models with the dimensions described of a mission of 50,000 cycles at a 200-N load was determined
above. These models were replicated and placed on a dental for group comparisons. If the Weibull use level probability cal-
articulator with a cast of the opposing dentition. Impressions of culated β was < 1 for any group, then a Weibull two-parameter
the prepared, adjacent, and opposing teeth were taken (Aquasil, probability multi-plot (Unreliability vs. load) and Contour plot
Dentsply, York, PA, USA) for sample preparation. Alloy (Pd-Ag (β vs. η) were calculated using final load at failure or survival of
White Porcelain Alloy, Jensen Industries, North Haven, CT, specimens.
USA) copings (0.5 mm thick) were fabricated and designated as All specimens were evaluated under polarized light (MZ-APO
group MCR (n = 21). Y-TZP core systems were milled in pre- stereomicroscope, Carl Zeiss MicroImaging, Thornwood, NY,
sintered stage, and then fully sintered to achieve 0.5 mm in thick- USA) at the completion of each fatigue step for crack initiation/
ness following manufacturers’ guidelines. The two all-ceramic evolution. Criteria for failure involved porcelain veneer fracture
groups were designated as follows: LAV (n = 21) for LAVA with or without core exposure, and bulk fracture (Rekow et al.,
(LAVA, 3M/ESPE, St. Paul, MN, USA) and CER (n = 21) for 2007). Selected samples were gold-sputtered (Emitech K650,
CERCON (CERCON, Dentsply, York, PA, USA). All groups Emitech Products Inc., Houston, TX, USA), and fractographic
were hand-layered-veneered with corresponding porcelain for analysis was performed by scanning electron microscopy (SEM)
each system (Creation Porcelain, Jensen Industries, North Haven, (Hitachi, Model 3500S, Osaka, Japan).
CT, USA; LAVA Veneer, 3M/ESPE, St. Paul, MN, USA; and Images of clinical failure and impression replicas of MCR
Vita Veneer, Dentsply, York, PA, USA, respectively) following and Y-TZP-supported ceramic systems were utilized for com-
the manufacturers’ directions. The standardization of the thick- parison with laboratory failure modes.
ness of the veneering ceramic was accomplished with a silicone
index made from an impression of the waxed desired anatomy,
which was used to guide porcelain contour and anatomy in all
Results
crowns. Final crowns presented appropriate marginal fit (checked
by probing and visual inspection) and occlusal morphology. The single-load-to-failure SLF mean value (n = 3) for group
Sixty-three tooth composite (Z100, 3M/ESPE, St. Paul, MN) MCR was 2002 N ± 597 N, for LAV 1220 ± 220 N, and for CER
dies were fabricated from silicon rubber impressions (Aquasil, 1140 ± 280 N.
Dentsply, York, PA, USA) of the machined plastic model. The The β values were derived from use level probability Weibull
dies were stored in distilled water at 37oC for 30 days to elimi- calculation (reliability vs. number of cycles). Considering a use
nate any effect of water-uptake dimensional expansion (Huang stress of 200 N (Table), group MCR exhibited higher reliability
et al., 2008). than both CER and LAV for a mission of 50,000 cycles at 200
All crowns were cemented (RelyX Unicem, 3M/ESPE, St. N. β values (two-sided 90% confidence bounds) of 1.43 (0.76 -
Paul, MN, USA) under a 10-N load following manufacturer’s 2.69) and 1.72 (0.83 - 3.56) for CER and LAV, respectively,
instructions. The cemented crowns were vertically embedded in indicated that fatigue was an acceleration factor for both groups.
acrylic resin (Orthoresin, Degudent, Mainz, Germany) poured in The resulting β of 0.05 (0.03 - 0.08) for MCR indicated that load
a 25-mm-diameter plastic tube, leaving buccal, lingual, and alone dictated the failure mechanism for this group, and that
interproximal cervical margins evenly exposed 2 mm above the fatigue damage did not appear to accumulate. Load-at-failure
potting surface (acrylic resin surface). data of all 3 groups were then calculated by a probability
After cementation, the specimens were equilibrated in dis- Weibull distribution (Weibull 7++, Reliasoft). One instructive
tilled water for at least 7 days before mechanical testing. Three graphical method for making this determination involves plot-
crowns of each group underwent single-load-to-fracture (SLF) ting the data with confidence bounds and seeing whether the
testing at a cross-head speed of 1 mm/min in a universal testing bounds overlap or separate at the point of interest. Probability
machine (INSTRON 5666, Canton, MA, USA) with a 6.25-mm- Weibull two-parameter multi-plot (Unreliability vs. load)
diameter tungsten carbide (WC) ball. Based upon the mean load showed the Weibull modulus for MCR (β = 4.9). CER and LAV
to failure from SLF, 3 sliding-contact step-stress accelerated presented Weibull moduli β = 2.5 and β = 3.3, respectively (Fig.
life-testing (SSALT) profiles were determined with specimens 1a). MCR presented significantly higher characteristic strength
assigned to each group in the ratio 3:2:1 (mild, moderate, and (two-sided 90% confidence bounds), η = 1304.78 (1215.56–
aggressive, respectively) (Nelson, 1990). Fatigue testing was 1400.55), than CER η = 365.73 (316.94–422.04) and LAV
performed at 2 Hz with an electrodynamic fatigue testing 370.60 (327.36–419.68) (the confidence bounds overlapped for
machine (ELF 3300, EnduraTec Division, Bose Corporation, CER and LAV) (Fig. 1a). Another way to determine whether
Minnetonka, MN, USA). All specimens were subjected to these datasets are significantly different (based upon non-over-
mouth-motion step-stress sliding contact fatigue until failure or lap of confidence bounds) is the utilization of a Weibull param-
survival (Nelson, 1990). During fatigue, a 6.25-mm-diameter eter contour plot (Fig. 1b).

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J Dent Res 89(10) 2010 Reliability of Metalloceramic over Zirconia   1053

Table. Calculated Reliability for Full Crowns Given a Mission of 50,000 Cycles at 200 N Load with MCR Showing Significantly Higher Reliability
than Both All-ceramic Systems
Output (50 K cycles @ 200 N) Cercon LAVA MCR

Upper 0.80 0.79 1.00

Reliability 0.66 0.64 0.99*
Lower 0.44 0.43 0.99
β 1.43 (0.76-2.69) 1.72 (0.83-3.56) 0.05 (0.03-0.08)

β is the use level probability Weibull shape factor which, calculated, is < 1 for MCR and > 1 for LAV and CER, indicating that fatigue is an
accelerating factor for both of the Y-TZP-supported all-ceramic systems, but not for the MCR.
*represents significant higher reliability.

A Representative failed specimens of MCR (Figs. 2a-2d) and

Probability - Weibull(2P) CB@90% 2-Sided [T]
CER (Figs. 2e, 2f) show the different systems’ fracture modes.
99
CER F=18/S=0 All MCR specimens failed, exposing the Pd-Ag coping with
Data Points
90
Probability Line
different fracture sizes. Y-TZP failures were confined within the
β=2.5, η=365.7, ρ=0.98 porcelain veneer (Fig. 2). Magnified images of the cohesive
LAV F=14/S=0
failed porcelain showed typical markers of crack direction (cir-
50
Data Points cled area on Fig. 2f), represented by hackles and twist hackles,
Unreliability, F(t)

Probability Line
β=3.3, η=370.6, ρ=0.98
indicating crack propagation from the sliding contact area
toward the margins of cohesively failed porcelain veneer. To
MCR F=19/S=0
Data Points
compare failure modes found in the present study with those
10 Probability Line observed clinically, we selected and documented representative
β=4.9, η=1304.8, ρ=0.97
examples from clinical practice. Observations included inter-
5 Top CB-I proximal cohesive fracture of the veneer ceramic of MCR after
Bottom CB-I
4 mos of service (Fig. 3a), which may be the result of limited
core support. The most common failure mode observed clini-
1
cally for MCR (Figs. 3b, 3c) was veneer fracture, with exposure
10 100 1000 10000 of the coping, similar to what was observed in laboratory testing
Load (N)
failures (Figs. 2a-2d). A clinical cohesive failure of a veneered
Y-TZP after 2.5 yrs of service is also presented (Figs. 3d-3f). We
B Contour Plot Weibull-2P 90% CB have several clinical replicas where the veneered Y-TZP failure
7.00 mode corresponds to our laboratory findings.
CER F=18/S=0
β=2.5, η=365.7, ρ=0.98
5.60
LAV F=14/S=0
Discussion
β=3.3, η=370.6, ρ=0.98
The majority of in vivo (Larsson et al., 2006; Sailer et al.,
MCR F=19/S=0
β=4.9, η=1304.8, ρ=0.97 2007a,b; Molin and Karlsson, 2008; Tinschert et al., 2008) and
4.20
in vitro (Studart et al., 2007b; Kohorst et al., 2008) published
data on Y-TZP systems have focused on fixed partial dentures.
Beta

To date, there is one private-practice retrospective short-term

2.80
evaluation of Y-TZP-supported single crowns (Ortorp et al.,
2009), and only one controlled clinical trial (Cehreli et al.,
2009), yet with limited numbers of crowns investigated.
1.40
Comparisons of Y-TZP with MCR tooth-supported crowns are
not available.
In a recent comparison regarding the chipping resistance
0.00
100 480 860 1240 1620 2000 between MCR and Y-TZP, bar-shaped specimens were tested
Eta (N)
with no difference between groups (Quinn et al., 2010). These
Figure 1. Probability Weibull (A) and Contour (B) plots for group authors concluded that clinical differences in chipping between
comparisons. Both plots represent the same Weibull calculation with MCR and Y-TZP should exist only if residual stresses or inter-
different data deliverables. Note that characteristic strength (63.2% of
face flaws may occur. In contrast, the mouth-motion fatigue
the specimens would fail by that load level) for group MCR is
significantly higher than for both Y-TZP-supported all-ceramic systems,
testing of anatomically correct molar crowns in the present
and the datapoint with probability line is positioned to the right (A) study revealed MCR failures occurring as a function of load and
with no overlap of confidence intervals (two-sided 90% confidence not fatigue. In contrast, both Y-TZP systems’ failures were
bounds). accelerated by fatigue. Values of β less than 1 indicate that the

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© 2010 International & American Associations for Dental Research

1054 Silva et al. J Dent Res 89(10) 2010

systems is a function of lower loads

initiating porcelain veneer damage
accumulation and failure when com-
pared with MCR crowns.
Differences in thermal conductivity
between Y-TZP and metals, the pres-
ence of thermal mismatches between
core materials and veneer, and cooling
rate protocols have been suggested as
potential sources of residual stresses
within the veneer (Coelho et al., 2009;
Swain, 2009). Whereas a layer of com-
pressive stresses has been described as
forming in the outer veneer aspect of
Y-TZP-based restorations upon cool-
ing, major tensile stresses may develop
and become entrapped in an inner layer
(Aboushelib et al., 2008; Taskonak
et al., 2008). Hence, the combination of
tensile stresses from sliding indenter
trailing edges and the sliding-contact-
fatigue-derived partial cone cracks
propagating into the tensile stress layer
is likely related to the cohesive failures
within the veneer in both Y-TZP crown
systems (Kim et al., 2008a,b). Although
assessment of residual stresses within
the porcelain veneer was not the aim of
the present study, our imaging results
revealed the consistent presence of
twist hackles, especially in the margins
of the cohesively failed veneers of
Y-TZP crowns. Twist hackles are not
only a strong telltale fractographic
mark indicating local crack direction,
Figure 2. A series of light-polarized (LP) and SEM images after sliding fatigue testing. Images (a) but are also associated with specimens
and (b) are LP and SEM of a sizable fracture of 1 MCR crown after 200,023 cycles at 1300 N presenting strong thermal or stress gra-
of load (mild profile). White (a) and black (b) crosses lie on the exposed PdAg core after the dients (Quinn, 2007). SEMs of chipped
fracture event. Oval segmented black line shows the damage created at the indentation contact
MCR samples did not disclose clear
area, and arrows delimit the fracture extension. (c) is a representative smaller chip fracture of an
MCR crown (dotted box), exposing the PdAg core (white cross). (d) shows the SEM image of the
fractographic marks, such as hackles,
dotted box presented in (c), showing the fracture extension after 95,034 cycles at 1220 N load. wake, and twist hackles, perhaps
Black cross in (d) lies on the core exposed after fracture. Images (e) and (f) are LP and SEM because the veneering porcelain has a
images of a representative fatigue-failed specimen of CER after 49,500 cycles at 300 N Load. more coarse inclusion structure or less
(f) shows an occlusal SEM view of the indentation area and the arrow indicating the sliding residual stress.
direction toward central fossa. Right and left bottom images in (f) are magnifications of marginal We compared two Y-TZP systems
areas (white circles) of porcelain cohesive fracture. Hackle lines (dotted arrows) and a series of
with MCR, utilizing a testing scenario
twist hackles (oval dotted lines) indicate fracture propagation from indentation contact toward
the margins. Note that the Y-TZP core was not exposed. with a standardized mandibular first
molar full-crown preparation. The
resemblance of clinical failure modes
failure rate is decreasing with time and are commonly associated with the laboratory-tested crowns strongly suggests that sliding
with failures that occur at a relatively early time due to egre- contact associated with fatigue in watery media is a powerful
gious flaws. Values of β approximately equal to 1 indicate a tool to predict a material’s reliability and ultimately to validate
failure rate that does not vary over time and are associated with its potential in a clinical scenario.
failures of a random nature. Values of β greater than 1 indicate The properties of the core, such as modulus of elasticity, hard-
that the failure rate is increasing with time and are associated ness, and toughness, are known to be important predictors of
with failures related to mechanical wear-out modes (Abernethy, reliability in crown-veneered systems (Rekow et al., 2007). Since
2004). The significantly lower reliability found for the Y-TZP core failure was not observed in either MCR or Y-TZP systems,

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J Dent Res 89(10) 2010 Reliability of Metalloceramic over Zirconia   1055

we speculate that they were sufficient to

withstand fatigue. Hence, the lower reli-
ability observed for both Y-TZP systems
resulted almost exclusively from veneer-
ing porcelain failure, regardless of the two
different systems, each fabricated accord-
ing to manufacturer’s guidelines.
Studies exploring veneer-core ther-
mal analysis and cooling rate are strongly
recommended. Since the role of frame-
work design in offsetting cohesive veneer
failures in Y-TZP crowns has been
empirically suggested (Marchack et al.,
2008), but not systematically tested,
investigations on the reliability and fail-
ure modes between standard design and
different modified-core designs for
Y-TZP systems are also warranted.
The hypothesis that MCR presents
higher reliability under mouth-motion
cyclic loading over two all-ceramic sys-
tems was confirmed. Fatigue was an
acceleration factor for Y-TZP systems.
The reliability and fracture analyses
established for MCR and Y-TZP veneer-
core systems provide the basis for com-
parison of other materials combinations
prior to clinical evaluation. Although the
extrapolation of the present results to
clinical performance is limited, the test-
ing method used herein may be utilized Figure 3. Clinical observations. Image (a) represents a cohesive veneer fracture on the mesial
for direct comparison between different aspect of an MCR crown placed on a lower second molar (segmented white arrow) after 4 mos
core/crown configurations for the devel- of service. (b) shows typical fractures of MCR molar crowns with metal coping exposure after
approximately 13 yrs of function. Note that besides the lingual fracture (segmented white box),
opment of new crown systems.
a cohesive veneer fracture is also observed on the buccal aspect of the crown (segmented white
arrow). Lower second molar in (b) also presents a fracture, with metal coping apparent at the
Acknowledgments distal portion (white arrow). SEM image (c) of an epoxy resin replica of the fractured area
delimited by the white-segmented box in (b) shows: white circles as evidence of bubbles from
This project was supported by NIDCR impression/replica processing; white arrows delimit the occlusal boundaries of fracture; black
Grant P01 DE01976. The authors also cross lying on the metal exposed after fracture event; white cross positioned on the cohesively
acknowledge CAPES, Brazil (Scholarship fractured feldspathic ceramic; white open arrows delimiting the junction between the fractured
ceramic and the exposed alloy. Image (d) represents a typical cohesive veneer fracture (open
Process BEX 1359/08-8). The authors
white arrow) at the proximal aspect of a Y-TZP-supported all-ceramic upper molar crown after
are grateful to Carlos A.O. Fernandes, 2.5 yrs in function. The epoxy resin replica of (d) is shown as an SEM image in (e), showing
Associate Professor, Department of the roughness caused by occlusal adjustments associated with wear facets (black asterisks).
Operative Dentistry, Federal University of SEM proximal view of the fractured site (f) shows arrest lines (white triangles) and their concave
Ceara–UFC, Brazil. The samples utilized portion pointing toward the fracture origin on the occlusal surface (segmented white arrow).
in this study were made by Marotta Dental Note that the crack initiation is likely associated with the occlusal adjustment area on the mesial
Studio, NY, USA. aspect of the crown, as shown in the occlusal view in (e).

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