How does the occlusal contact region influence the mechanical fatigue performance and fracture region of monolithic lithium disilicate ceramic crowns?

To characterize the effect of the occlusal contact region on the mechanical fatigue performance and on the fracture region of monolithic lithium disilicate ceramic crowns. Monolithic lithium disilicate ceramic crowns were machined in a CAD/CAM system and adhesively luted onto glass-fiber reinforced epoxy resin preparations with resin cement. The crowns were divided into three groups (n = 16) according to load application region (cusp tip: restricted to cusp tips; cusp plane: restricted to cuspal inclined plane; or mixed: associating tip cusp and cuspal inclined plane). The specimens were submitted to a cyclic fatigue test (initial load: 200 N; step-size: 100 N; cycles/step: 20,000; loading frequency: 20 Hz; load applicator: 6 mm or 40 mm diameter stainless steel) until observing cracks (1st outcome) and fracture (2nd outcome). The data were analyzed by the Kaplan-Meier + Mantel-Cox post-hoc tests for both outcomes (cracks and fracture). Finite element analysis (FEA), occlusal contact region, contact radii measurements, and fractographic analyzes were performed. The mixed group presented worse fatigue mechanical behavior (550 N / 85.000 cycles) compared to the cuspal inclined plane group (656 N / 111,250 cycles) (p < 0.05) for the first crack outcome, while the cusp tip group was similar to both groups (588 N / 97,500 cycles) (p > 0.05). The mixed group had the worst fatigue behavior (1413 N / 253,029 cycles) in relation to the other groups (Cusp tip: 1644 N / 293,312 cycles; Cuspal inclined plane: 1631 N / 295,174 cycles) considering the crown fracture outcome (p < 0.05). FEA showed higher tensile stress concentration areas just below the load application region. In addition, loading on the cuspal inclined plane induced a higher tensile stress concentration in the groove region. The most prevalent type of crown fracture was the wall fracture. Groove fracture was observed in 50% of the loading specimens exclusively on the cuspal inclined plane. Load application on distinct occlusal contact regions affects the stress distribution pattern and consequently the mechanical fatigue performance and fracture region of the monolithic lithium disilicate ceramic crowns. A combination of loading at distinct regions is recommended to promote better evaluation of the fatigue behavior of a restored set. • The loading pattern influences the fatigue performance of lithium disilicate crowns. • The fracture region of monolithic crowns changes according to the adopted loading pattern. • The combination of occlusal loading at distinct regions leads to better evaluation of the fatigue behavior of a restored set. [ABSTRACT FROM AUTHOR]