Fatigue failure and success rate of lithium disilicate table-tops as a function of cement thickness

J Prosthodont Res. 2021 Jun 10. doi: 10.2186/jpr.JPR_D_20_00220. Online ahead of print.


Purpose: Under thin, partial coverage restoration the proper cement thickness to be clinically employed still remains an issue. The aim of this study was to determine the failure and success rates of simplified lithium disilicate occlusal veneers as a function of cement thickness. The null hypothesis was that cement thickness has no effect on the fatigue resistance.

Methods: Sound human molars were severed in a plane parallel to the occlusal surface to create a flat dentin surface surrounded by enamel edges. Forty-five occlusal veneers 1.0 mm thick (IPS e.max CAD LT) were luted to the teeth with Multilink Automix resin cement, creating 3 experimental groups (n=15) with cement thicknesses of 50, 100, and 200 µm. The restorations were fatigue-cycled using a ball mill machine containing zirconia and stainless steel spheres. Twelve 60 min cycles were performed. Survival statistics were applied to "failure" and "success" events, comparing the three groups using a log-rank Mantel-Cox test and a log-rank test for trends (alpha = 0.05).

Results: The failure and success rates were not significantly influenced by cement thickness (P = 0.137 and P = 0.872, respectively); thus, the null hypothesis was accepted. However, when log-rank test for trends was applied to failure events, the tendency to have less failures with increasing thicknesses was found statistically significant (P = 0.047).

Conclusions: The cement thickness within the range adopted here did not have a significant effect on the failure or success rate of lithium disilicate occlusal veneers when exposed to randomized impact stresses generating fatigue phenomena.

Keywords: All-ceramic restorations; Fatigue resistance; Lithium disilicate; Luting cements; Occlusal veneers.