In vitro fracture load of monolithic lithium disilicate ceramic molar crowns with different wall thicknesses.

Objectives: The objective of this in vitro study was to assess the effect of wall thickness on the fracture loads of monolithic lithium disilicate molar crowns.
Material and Methods: Forty-eight extracted molars were prepared by use of a standardized preparation design. Lithium disilicate crowns (e.max CAD, Ivoclar/Vivadent, Schaan, Liechtenstein) of different wall thicknesses (d = 0.5, 1.0, and 1.5 mm; n = 16 for each series) were then constructed and milled (Cerec MC-XL, Sirona, Bensheim, Germany). After placement of the teeth in acrylic blocks (Technovit, Heraeus Kulzer, Hanau, Germany), the crowns were adhesively luted (Multilink, Ivoclar Vivadent). In each series, eight crowns were loaded without artificial aging whereas another eight crowns underwent thermocycling (10,000 cycles, THE-1100, SD Mechatronik) and chewing simulation (1.2 million cycles, Willytec CS3, SD Mechatronik, F max = 108 N). All specimens were loaded until fracture on one cusp with a tilt of 30° to the tooth axis in a universal testing machine (Z005, Zwick/Roell). Statistical assessment was performed by use of SPSS 19.0.
Results: Crowns with d = 1.0 and 1.5 mm wall thickness did not crack during artificial aging whereas two of the crowns with d = 0.5 mm wall thickness did. The loads to failure (F u) of the crowns without aging (with aging) were 470.2 ± 80.3 N (369.2 ± 117.8 N) for d = 0.5 mm, 801.4 ± 123.1 N (889.1 ± 154.6 N) for d = 1.0 mm, and 1107.6 ± 131.3 N (980.8 ± 115.3 N) for d = 1.5 mm. For aged crowns with d = 0.5 mm wall thickness, load to failure was significantly lower than for the others. However, differences between crowns with d = 1.0 mm and d = 1.5 mm wall thickness were not significant.
Conclusions: Fracture loads for posterior lithium disilicate crowns with 0.5 mm wall thickness were too low (F u < 500 N) to guarantee a low complication rate in vivo, whereas all crowns with 1.0 and 1.5 mm wall thicknesses showed appropriate fracture resistances F u > 600 N.
Clinical Relevance: The wall thickness of posterior lithium disilicate crowns might be reduced to 1 mm, thus reducing the invasiveness of the preparation, which is essential for young patients.