Influence of Mouth Motion Fatigue and Thermal Cycling on the Marginal Accuracy and Fracture Resistance of Lithium Disilicate and Zirconia Partial Crowns: A Systematic Review and Meta-Analysis
Keywords:
Lithium disilicate, Zirconia, Thermal cycling, Marginal accuracy, Fracture resistanceAbstract
The present systematic review and meta-analysis aimed to evaluate the effect of mouth motion fatigue and thermal cycling on the marginal accuracy and fracture resistance of lithium disilicate and zirconia partial crowns. A comprehensive search was conducted across PubMed, Cochrane Library, and Google Scholar, and 12 studies were included for qualitative synthesis and meta-analysis. The meta-analysis revealed a pooled effect size of 0.222 with a standard error of 0.015 and a 95% confidence interval of 0.193–0.251, indicating a consistent and moderate effect of thermo-mechanical aging on crown performance. Heterogeneity among the studies was negligible (I² = 0%), justifying the use of a fixed-effects model. Lithium disilicate demonstrated favorable marginal adaptation and esthetic properties, while zirconia exhibited superior fracture resistance and mechanical strength under fatigue and thermal stress. Although both materials showed clinical promise, zirconia held a slight mechanical advantage. However, the high risk of bias across studies and the predominance of in vitro designs underscore the need for standardized protocols and long-term clinical research. These findings support material-specific clinical decision-making and reinforce the relevance of fatigue and thermal testing in restorative material evaluation
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1. Sadeqi HA, Baig MR, Al-Shammari M. Evaluation of marginal/internal fit and fracture load of monolithic zirconia and zirconia lithium silicate (ZLS) CAD/CAM crown systems. Materials. 2021;14(21):6346.
2. Banh W, Hughes J, Sia A, Chien DC, Tadakamadla SK, Figueredo CM, Ahmed KE. Longevity of polymer-infiltrated ceramic network and zirconia-reinforced lithium silicate restorations: a systematic review and meta-analysis. Materials. 2021;14(17):5058.
3. Özcan M, Höhn J, de Araújo GM, Moura DD, Souza R. Influence of testing parameters on the load-bearing capacity of prosthetic materials used for fixed dental prosthesis: A systematic review and meta-analysis. Braz Dent Sci. 2018;21(4):470–90.
4. Aldhuwayhi S, Alauddin MS, Martin N. The structural integrity and fracture behaviour of teeth restored with PEEK and lithium-disilicate glass ceramic crowns. Polymers. 2022;14(5):1001.
5. Sirous S, Navadeh A, Ebrahimgol S, Atri F. Effect of preparation design on marginal adaptation and fracture strength of ceramic occlusal veneers: A systematic review. Clin Exp Dent Res. 2022;8(6):1391–403.
6. Bondzinskaitė R, Venskutė G, Kriaučiūnas A. Fracture resistance of various laminate veneer materials: systematic literature review. Prosthodontics. 2021;71(4):307–22.
7. Kui A, Manziuc M, Petruțiu A, Buduru S, Labuneț A, Negucioiu M, Chisnoiu A. Translucent zirconia in fixed prosthodontics—An integrative overview. Biomedicines. 2023;11(12):3116.
8. Ma L, Guess PC, Zhang Y. Load-bearing properties of minimal-invasive monolithic lithium disilicate and zirconia occlusal onlays: finite element and theoretical analyses. Dent Mater. 2013;29(7):742–51.
9. Goujat A, Abouelleil H, Colon P, Jeannin C, Pradelle N, Seux D, Grosgogeat B. Marginal and internal fit of CAD-CAM inlay/onlay restorations: A systematic review of in vitro studies. J Prosthet Dent. 2019;121(4):590–7.
10. Wahied DM. Effect of Thickness and CAD/CAM Materials on the Fracture Resistance of Biomimetic Occlusal Veneers. MSA Dent J. 2024;3(2):11–20.
11. Yıldız P, Güneş Ünlü D, Aydoğdu HM. Evaluation of vertical marginal discrepancy and load-to-failure of monolithic zirconia and lithium disilicate laminate veneers manufactured in different thicknesses. BMC Oral Health. 2024;24(1):913.
12. Chaturvedi S, Alqahtani T, Alsolami S, Alqahtani A, Das G, Alsubaiy E. Fracture resistance of CAD-CAM all-ceramic surveyed crowns with different occlusal rest seat designs. J Adv Prosthodont. 2021;13(1):36.
13. Liu C, Eser A, Heintze S, Rothbrust F, Broeckmann C. Computation of the fracture probability and lifetime of all ceramic anterior crowns under cyclic loading–An FEA study. Dent Mater. 2023;39(11):965–76.
14. Arellano Moncayo AM, Peñate L, Arregui M, Giner-Tarrida L, Cedeño R. State of the art of different zirconia materials and their indications according to evidence-based clinical performance: A narrative review. Dent J. 2023;11(1):18.
15. Miyazaki T, Nakamura T, Matsumura H, Ban S, Kobayashi T. Current status of zirconia restoration. J Prosthodont Res. 2013;57(4):236–61.
16. Neto CF, Santos GC, Santos MJMC. Influence of the fabrication technique on the marginal and internal adaptation of ceramic onlays. Oper Dent. 2020;45(2):163–72.
17. Qian K, Yang X, Feng H, Liu Y. Marginal adaptation of different hybrid ceramic inlays after thermal cycling. Adv Appl Ceram. 2020;119(5–6):284–90.
18. Almohammed SN, Alshorman B, Abu-Naba’a LA. Mechanical properties of five esthetic ceramic materials used for monolithic restorations: A comparative in vitro study. Ceramics. 2023;6(2):1031–49.
19. Sivaraman K, Chopra A, Narayan AI, Balakrishnan D. Is zirconia a viable alternative to titanium for oral implant? A critical review. J Prosthodont Res. 2018;62(2):121–33.
20. Heydecke G, Butz F, Binder JR, Strub JR. Material characteristics of a novel shrinkage-free ZrSiO4 ceramic for the fabrication of posterior crowns. Dent Mater. 2007;23(7):785–91.
21. Almohammed SN, Dourado AM, Quran FAA. Fracture resistance and failure mode of monolithic zirconia, veneered zirconia, and metal-ceramic full-coverage restorations: A comparative in vitro study. Int J Prosthodont. 2024;37(1).
22. Tugwell P, Tovey D. PRISMA 2020. Journal of Clinical Epidemiology. 2021 Jun 1;134:A5-6.
23. Flemyng E, Moore TH, Boutron I, Higgins JP, Hróbjartsson A, Nejstgaard CH, Dwan K. Using Risk of Bias 2 to assess results from randomised controlled trials: guidance from Cochrane. BMJ Evidence-Based Medicine. 2023 Aug 1;28(4):260-6.
24. Whiting P, Savović J, Higgins JP, Caldwell DM, Reeves BC, Shea B, Davies P, Kleijnen J, Churchill R. ROBIS: a new tool to assess risk of bias in systematic reviews was developed. Journal of clinical epidemiology. 2016 Jan 1;69:225-34.
25. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, Moher D, Tugwell P, Welch V, Kristjansson E, Henry DA. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. bmj. 2017 Sep 21;358.
26. Stappert CF, Chitmongkolsuk S, Silva NR, Att W, Strub JR. Effect of mouth-motion fatigue and thermal cycling on the marginal accuracy of partial coverage restorations made of various dental materials. Dent Mater. 2008;24(9):1248–57.
27. Federlin M, Sipos C, Hiller KA, Thonemann B, Schmalz G. Partial ceramic crowns. Influence of preparation design and luting material on margin integrity—a scanning electron microscopic study. Clin Oral Investig. 2004;9(1):8–17.
28. Nassar H, Halim CH, Katamish HA. Clinical outcomes of zirconia-reinforced lithium silicate partial coverage crowns compared to lithium disilicate partial coverage crowns: A randomized controlled split-mouth clinical study. F1000Res. 2019;8:305.
29. Nawafleh N, Elshiyab S, Öchsner A, George R. In vitro fatigue and fracture load of monolithic ceramic crowns supported by hybrid abutment. Open Dent J. 2021;15(1).
30. Elmokadem MI, Haggag KM, Mohamed HR. Effect of thermo-mechanical cycling on fracture resistance of different CAD/CAM crowns: An in vitro study. J Contemp Dent Pract. 2024;25(1):29–34.
31. Foong JK, Judge RB, Palamara JE, Swain MV. Fracture resistance of titanium and zirconia abutments: An in vitro study. J Prosthet Dent. 2013;109(5):304–12
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