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The aim of this in vitro study was to evaluate the surface roughness, translucency, fatigue failure load (FFL), and number of cycles for fatigue failure (CFF) of a recently released lithia-based material called advanced lithium disilicate and three other ceramics indicated for monolithic restorations. First, ALD (advanced lithium disilicate, CEREC Tessera, Dentsply Sirona), LD (lithium disilicate, IPS e. max CAD, Ivoclar), LS (lithium silicate-disilicate, Suprinity, Vita Zahnfabrik), and 4Y-PSZ (Yttria-stabilized zirconia, IPS e.max ZirCAD MT, Ivoclar) discs (n = 15, Ø = 10 mm and thickness = 1.0 mm) were fabricated from CAD/CAM blocks/discs, A2 shade. The discs were sintered/crystallized and subsequently analyzed by a rugosimeter (Mitutoyo SJ-410) to determine Ra and Rz surface roughness parameters. Next, they were evaluated to determine the translucency parameter (TP) using a bench-top spectrophotometer (SP60, EX-Rite). The discs were subsequently cemented to glass fiber epoxy resin discs, and the specimens were tested under cyclic loading (Step-test), immersed in distilled water at a frequency of 20 Hz, with an initial cyclic load of 200 N for 5,000 cycles and increments of 50 N every 10,000 cycles until failure. Fatigue failure load (FFL) and number of cycles for fatigue failure (CFF) were recorded for subsequent Kaplan Meier analysis, with post-hoc Mantel-Cox and Weibull analysis (α = 0.05). Complementary fractographic, topographic and energy dispersive spectroscopy analyses (EDS) were performed. 4Y-PSZ showed higher survival (p < 0.05), with higher FFL and CFF (1077 N; 180,333 cycles), followed by LD (980 N; 161,000 cycles), LS (937 N; 152,333 cycles) and ALD (910 N; 147,000 cycles). No differences were observed between the tested groups regarding Weibull modulus. ALD presented TP (28.14) equal to DL (28.27) and higher than LS (25.51). All lithia-based materials had higher translucency than 4Y-PSZ (TP = 8.62) (p < 0.05). ALD appears to have a similar elemental composition to LD and LSD for oxygen and silicon. ALD and LSD have a similar zirconium content. Fractures originated on the cemented surface of the ceramic discs. Lithia-based ceramics showed lower surface roughness, with ALD (Ra = 0.04 μm; Rz = 0.66 μm) showing the lowest values (p < 0.05). Despite showing lower FFL when compared to LD and 4Y-PSZ, ALD has compatible translucency and mechanical fatigue performance with its indication for fabricating monolithic, anterior and posterior adhesively cemented single-unit restorations. However, further studies are needed to substantiate its clinical performance., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

When partial and/or non-retentive preparation, such as those for occlusal veneers, is indicated, a proper and stable adhesion is essential. Therefore, the aim of this in vitro study was to evaluate the effect of loss of adhesion in different regions of the bonding interface on the fatigue behavior of simplified lithium disilicate restorations. For this, lithium disilicate (IPS e.max CAD) discs (1 mm thick and Ø = 10 mm) were fabricated, polished with #400-, #600-, #1200-grit silicon carbide (SiC) papers, and crystallized. As substrate, fiber-reinforced resin epoxy discs (2.5 mm thick and Ø = 10 mm) were fabricated and polished with #600-grit SiC paper. The ceramic bonding surface was treated with 5% hydrofluoric acid and a silane-containing primer (Monobond N), while the substrate was etched with 10% hydrofluoric acid followed by the application of the bonding system primers (Primer A + B). A lacquer (nail polish) was used to simulate the loss of adhesion in specific areas according to the study design to compose the testing groups: bonded (control; did not received nail polish application); - non-bonded (loss of adhesion in the whole specimen area); - margin (loss of adhesion in the ceramic margin); - center (loss of adhesion in the ceramic central area). The adhesive area of partially bonded groups was 50% of the adhesive surface. Then, the discs (n = 12) were bonded to the respective substrate using a resin cement (Multilink N), light-cured, water-stored for 90 days, and subjected to thermocycling (25,000 cycles, 5° to 55 °C) before testing. A cyclic fatigue test was run (20 Hz, initial load of 200 N for 5000 cycles, 50 N step size for 10,000 cycles each until specimen failure), and the fatigue failure load and number of cycles for failure were recorded. As complementary analysis, finite element analysis (FEA) and scanning electron microscopy analysis were performed. Kaplan-Meier log-rank (Mantel-Cox) was conducted for survival analysis. The results showed that as the loss of adhesion reaches the central area, the worse is the fatigue behavior and the higher is the stress peak concentration in the ceramic bonding surface. The bonded specimens presented better fatigue behavior and stress distribution compared to the others. In conclusion in a non-retentive preparation situation, proper adhesion is a must for the restoration fatigue behavior even after aging; while the loss of adhesion reaches central areas the mechanical functioning is compromised., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The aim of this study was to evaluate the surface properties and fatigue mechanical behavior of an advanced lithium disilicate ceramic in comparison to lithium disilicate and zirconia. First, discs (n = 15, diameter = 13.5 mm and thickness = 1.2 mm) were made from the following materials: 4Y-PSZ - 4% mol yttria-stabilized zirconia (IPS e.max ZirCAD A2); LD - lithium disilicate (IPS e.max CAD); ALD - advanced lithium disilicate (CEREC Tessera). The specimens were crystalized/sintered and subsequently analyzed by a rugosimeter (Mitutoyo SJ-410) to determine surface roughness (parameters Ra and Rz). Specimens were subjected to biaxial flexural fatigue testing using the step-test method (20 Hz; 10,000 cycles per step; initial stress of 200 MPa; and step size of 25 MPa) until specimen fracture. Statistical analyses included Shapiro-Wilk, Kruskal-Wallis, and post-hoc tests for roughness data, while survival analysis (Kaplan-Meier and Mantel-Cox) and reliability analysis (Weibull modulus) were applied to flexural fatigue strength data. Hardness (Vickers) results were submitted to analysis of variance (1-way ANOVA) and Tukey's test. Zirconia (4Y-PSZ) showed higher FFS, CFF (467 MPa and 115216 cycles) and survival compared to the other materials. ALD had the lowest FFS, CFF (215 MPa and 11,908 cycles) and survival. ALD showed lower Weibull modulus (m = 6.63 for FFS; m = 1.27 for CFF) than LD for FFS (m = 17.33), and lower than LD (m = 4.64) and 4Y-PSZ (m = 6.69) for CFF. ALD showed the lowest Ra (0.07 μm) and Rz (1.05 μm) values, while 4Y-PSZ (Ra = 0.22 μm; Rz = 1.91 μm) and LD (Ra = 0.21 μm; Rz = 2.17 μm) showed higher and similar values. Zirconia (4-YPSZ) was the hardest material, while lithia-based ceramics (LD and ALD) presented the lowest and similar hardness values. Fractures originated in surface defects in the tensile stress concentration region. ALD has lower flexural fatigue strength compared to the other tested materials, along with higher variability (lower structural reliability)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: To evaluate whether an adhesive application after surface treatment on a lithium disilicate ceramic (LD) has an influence on its load-bearing capacity under fatigue., Methods: LD discs (Ø= 10 mm; thickness= 1 mm) were allocated into 8 groups (n= 15), considering 3 factors: "ceramic surface treatment" - HF: hydrofluoric acid + universal primer application; or MEP: single-component ceramic primer; "adhesive application" - with or without; and "aging protocol" - baseline: 24 h to 7 days; or aging: 180 days of storage + 25,000 thermal cycles. The LD discs were adhesively bonded to glass fiber-reinforced epoxy resin discs (Ø= 10 mm; thickness= 2 mm) and stored according to the condition and each group. Cyclic fatigue testing (initial load= 100 N; step size= 100 N until600 N and after step size= 25 N to failure; 10,000 cycles/step; 20 Hz frequency) was performed. Fractographic and adhesive interface analyzes were also performed. The collected data were then analyzed by Kaplan Meier and Mantel-Cox tests and One-way ANOVA., Results: The adhesive application in the baseline condition had no influence on the load-bearing capacity under fatigue when the HF surface treatment was performed, however, adhesive application for the MEP treatment led to worse results than without it. The adhesive application in the aged condition showed worse fatigue outcomes for both treatments. All specimens presented radial cracks. MEP treatment followed by adhesive application presented the thickest luting layer., Conclusion: The adhesive application after surface treatments of a lithium disilicate glass-ceramic is detrimental to its load-bearing capacity under fatigue when adhesively luted onto a supporting substrate., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The aim of the study was to compare the outcomes for the fatigue mechanical behavior of bonded simplified lithium disilicate restorations, with and without an internal adjustment by grinding with diamond bur in running two fatigue tests: Staircase and Step-stress testing approaches. Ceramic discs (IPS e.max CAD) were prepared (Ø = 10 mm; thickness = 1.0 mm), submitted to an in-lab simulation of CAD/CAM milling (#60 SiC paper) and allocated into 2 groups according to the internal adjustment by grinding of the cementation surface: no adjustment (CTRL); or grinding with a coarse diamond bur (GR). Adhesive cementation (Multilink N) was performed onto epoxy resin discs (Ø = 10 mm; thickness = 2 mm) after ceramic/epoxy surface treatments. The cemented assemblies of each group were randomly assigned into 2 subgroups considering two fatigue tests (n = 15): Staircase - SC (250,000 cycles; 20 Hz), or Step-stress - SS (10,000 cycles per step; 20 Hz). Roughness, topographic and fractographic analyses were additionally performed. Statistical analyses were carried out using the Dixon and Mood method for Staircase data, and Kaplan-Meier and Mantel-Cox (log-rank) tests for Step-stress data. Ceramic restorations having its intaglio surface ground (GR group: SC test = 306.67 N; SS test = 646.67 N) presented lower fatigue failure load (FFL) values than the CTRL group (SC test = 879.28 N; SS test = 1090.00 N), regardless of the fatigue testing approach. The percentage of mean FFL decrease comparing the CTRL to GR group was higher for SC (65.1%) than the SS (40.7%) approach. However, a different total number of cycles was applied for each method. Both fatigue tests were able to detect the negative effect of internal adjustments of lithium disilicate glass-ceramic simplified restorations on their mechanical behavior. Therefore, both methods can be applied for similar evaluations (fatigue testing for ceramic restorations)., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

This study evaluated the influence of occlusal resin cement space on the fatigue performance of bonded-leucite crowns to a dentin-analogue material. Leucite anatomical crowns were adhesively cemented to dentin-like preparations having distinct occlusal cement space (50, 100 and 300 μm) (n = 18), and subjected to step-stress fatigue testing (150 N - 350 N; step-size: 25 N; 20,000 cycles/step; 20 Hz). Fatigue data (load and number of cycles for failure) were analyzed using Kaplan-Meier and Mantel-Cox (log-rank) tests (p <0.05). Fractographic analysis and occlusal internal space measurements were also performed. There was no significant difference for the distinct occlusal cement layer (50 μm: 289 N, 136,111 cycles; 100 μm: 285 N, 132,778 cycles; 300 μm: 246 N, 101,667 cycles). Occlusal internal space analysis showed a mean thickness of 120.4 (50 μm), 174.9 (100 μm) and 337.2 (300 μm). All failures were radial cracks originating at the ceramic-cement interface. Distinct occlusal cement spaces had no effect on the fatigue behavior of anatomical leucite crowns., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

This study evaluated the effects of diamond bur grinding the intaglio surface of second (yttria partially-stabilized zirconia polycrystals, PSZ) and third-generation zirconia (fully-stabilized zirconia polycrystals, FSZ) adhesively cemented to dentin analogue substrate on the fatigue failure load, cycle number until failure, surface micromorphology and phase transformation. Disc-shaped specimens were produced from second (Katana ML-HT, Kuraray) and third-generation zirconia (Katana STML, Kuraray) and randomly allocated (n = 15) into two groups according to the intaglio surface treatment: Control - Ctrl (without grinding); Grinding - Gr (grinding at the center of the intaglio surface). The ceramic discs were adhesively cemented (Multilink Automix System) onto dentin analogue discs. Fatigue tests were executed by the step-stress method. The obtained data were analyzed by Kaplan Meier and Mantel-Cox tests. In addition, surface topography, roughness, phase transformation and fractography analyses were performed. SEM analysis showed that grinding increased the surface roughness and introduced defects in zirconia from both generations. Grinding increased the fatigue failure load, number of cycles to failure and survival rates of the second-generation zirconia statistically (control: 1373.33 N < grinding: 1600 N), while these same outcomes were reduced by grinding for the third-generation zirconia significantly (control: 766.67 N > grinding: 620 N). Thus, clinical adjustments with diamond burs damage the fatigue behavior of adhesively cemented third-generation zirconia., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Considering the long time spent in low frequency cyclic fatigue tests, this study aimed to evaluate the influence of loading frequency (2 Hz and 20 Hz) on the flexural fatigue strength (FFS) and on the time and number of cycles to failure of a leucite-reinforced glass-ceramic. Disc-shaped specimens were produced using leucite-reinforced glass-ceramic CAD/CAM blocks (IPS Empress CAD), according to ISO 6872/2015. Two fatigue tests were performed. The FFS (n = 17) was determined by staircase approach at a lifetime of 500,000 cycles, for 2 Hz (control - chewing frequency estimative) and 20 Hz (accelerated approach). To determine the time and the number of cycles to failure in flexural fatigue, discs (n = 20) were submitted to a cyclic loading ranging from 10 MPa to 99 MPa (60% of the monotonic strength), until a maximum of 500,000 cycles. Means, standard deviation and confidence intervals (CI) at 95% for FFS were calculated, whereas statistical differences were detected based on maximum likelihood estimations and overlapping of 95% CIs. Kaplan Meier (α = 0.05) and log rank post-hoc tests were used to analyze the time (in minutes) and the number of cycles to failure in the lifetime test. FFS did not differ significantly between 2 Hz (mean: 78 MPa; 95% CI: 69-88 MPa) and 20 Hz (mean: 84 MPa; 95% CI: 78-90 MPa). Regarding the lifetime test, there was no difference (p = 0.3) in the time to failure for 2 Hz (mean: 13 min; 95% CI: 6-20 min) and 20 Hz (mean: 69 min; 95% CI: 9-128 min). However, the group tested with 20 Hz survived a significantly (p < 0.01) higher number of cycles (mean: 82,247 cycles; 95% CI: 11,450-153,044) than the group tested with 2 Hz (mean: 1588 cycles; 95% CI: 779-2397). Therefore, in leucite-reinforced glass-ceramic fatigue strength tests, limited to a lifetime of 500,000 cycles, the use of loading frequencies up to 20 Hz did not influence the FFS estimations when compared to 2 Hz (chewing frequency estimative), and may be an alternative to accelerate data collection in this type of mechanical test. However, in lifetime tests, the use of higher loading frequencies, as 20 Hz, did not save time, since a higher number of cycles was necessary to promote the failure, when compared to 2 Hz., Competing Interests: Declaration competing of interest No conflict of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Considering the interest of the research community in the fatigue behavior of all-ceramic restorations and the time consumed in low-frequency cyclic fatigue tests, this study aimed to investigate the influence of the loading frequency on the zirconia fatigue strength. The biaxial flexural fatigue strength of Y-TZP discs was determined by the staircase approach after 500,000 cycles. The investigated frequencies were 2Hz (control-simulation of the chewing activity; n=20), 10Hz (n=20), 20Hz (n=20), and 40Hz (n=21). The fatigue strength data were analyzed using one-way ANOVA and post-hoc Tukey׳s test (α=0.05). Pearson coefficient (r) was calculated to assess the existence of a correlation between fatigue strength and loading frequency. X-ray diffraction analysis was used to determine the relative amount of monoclinic phase under each fatigue test condition. The fatigue strength was significantly higher for 40Hz group (630.7±62.1MPa) and did not differ among the groups 2Hz (550.3±89.7MPa), 10Hz (574.0±47MPa) and 20Hz (605.1±30.7MPa). Pearson correlation coefficient indicated a significantly moderate correlation (r=0.57) between fatigue strength and loading frequency. The percentage of monoclinic phase was similar among the groups. Therefore, the use of loading frequencies up to 20Hz seems a good alternative to expedite the cycling strength fatigue tests in polycrystalline ceramics without significantly changing the fatigue behavior showed by zirconia in tests employing the frequency of the masticatory cycle., (Copyright © 2016 Elsevier Ltd. All rights reserved.)