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Presented as a poster at the 91st General Session of the International Association for Dental Research, Seattle, Wash, March 2013.
a
Assistant Professor, Division of Prosthodontics and Restorative Dentistry, Faculty of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
b
Professor, Division of Biomaterials, Faculty of Dentistry, The University of British Columbia, British Columbia, Vancouver, Canada.
12 mm
Clinical Implications
Short- and long-term in vivo performance of
ceramics may be governed by, among other factors,
their resistance to crack propagation as determined 6 mm 6 mm
by their KIC values. Based solely on the KIC, the
clinical performance of IPS e.max Press may be
better than that of IPS e.max CAD.
6 mm
Figure 1. Notchless triangular prism specimen.
lithium disilicate glass ceramics designed to have 2
different processing pathways for the fabrication of
ceramic restorations. Both of the materials can be used to product is processed with the lost wax technique, which
produce cores that can be veneered with feldspathic involves waxing the restorations to the desired contours,
ceramic (IPS e.max Ceram). They can also be used as sprueing, and investing the wax patterns, melting the
monolithic materials in the fabrication of anatomic con- wax to create a mold within the investment, and then
tour restorations (Ivoclar Vivadent AG; http://www. heat pressing the molten ingot into the mold in a furnace
ivoclarvivadent.com/en/p/all/products/all-ceramics/ips-emax- developed specically for this product. Restorations are
technicians/download-center-ips-emax; 2016). In addition then divested, polished, characterized, and glazed before
to the monolithic block category, the IPS e.max CAD delivery.
system was recently expanded to include a second Clinical evidence shows that IPS e.max Press has a
category of blocks intended for veneering zirconia survival rate of 96.6% over 3 years for single crown res-
substructures and a third category used to fabricate torations.12 A study that evaluated xed partial dentures
implant-supported abutments for single teeth, where the fabricated from monolithic IPS e.max Press and observed
lithium disilicate milled components are bonded to a them for a mean period of 121 months found the survival
titanium base. All are available in a wide variety of shades rate to be 100% after 5 years and 87.9% after 10 years.
and opacities. The success rate was 91.1% after 5 years and 69.8% after
IPS e.max CAD is a lithium disilicate glass ceramic 10 years.13 A clinical evaluation of single IPS e.max CAD
designed to be used with CAD/CAM technology. A crowns showed 100% success after 2 years.14 However,
process called pressure casting leads to the production long- or short-term controlled clinical trials comparing
of partially crystallized IPS e.max CAD blue blocks. both materials are lacking.
These blocks are composed of 40% lithium metasilicate Fracture toughness (KIC) is an intrinsic material
crystals ranging in size from 0.2 to 1.0 mm, embedded in property, which describes the materials ability to with-
a glassy matrix. The partially crystallized state facilitates stand unstable crack propagation and which correlates
a faster milling process. After restorations are milled to with clinical performance (fracture and wear).3,15 As
the desired shape and contour, they are tempered at mechanical failure is always associated with a crack-
850 C in furnaces developed by the manufacturer for initiation/crack-propagation process, KIC values are use-
this material (Programat P300/P500; Ivoclar Vivadent ful in comparing different ceramics and, possibly, in
AG). In this process, lithium metasilicate crystals are predicting clinical performance. Many methods are
transformed into lithium disilicate crystals (70% volume available for assessing KIC, among which the most
fraction), which are responsible for the high strength of commonly used are the single-edge notched beam
the material.11 The coloring ions responsible for the blue (SENB), the chevron notched short rod (CNSR), and the
color in the partially crystallized stage change the indentation fracture (IF) methods.16 To ensure repro-
oxidation state when tempered, leading to the desired ducibility, the international standardization of testing
tooth color. procedures has been accomplished through detailed de-
IPS e.max Press is supplied as ingots of lithium dis- scriptions of specimen congurations and dimensions, as
ilicate glass-ceramic in several monochromatic shades, 4 well as test protocols and is summarized in the American
translucencies, and 2 sizes. Currently, new polychromatic Society for Testing and Materials (ASTM) standard
ingots (IPS e.max Press Multi; Ivoclar Vivadent AG) E1820-15.17 Most specimen congurations require pre-
provide a gradient of shades and translucencies crack initiation, which can lead to unstable crack growth.
mimicking those of a natural tooth. These are supplied in The SENB method, although it does yield a stable crack,
10 shades and a single size. The microstructure of IPS is technique-sensitive.18 The CNSR specimen KIC test
e.max Press consists of approximately 70% lithium dis- developed by Barker19 is accepted by the ASTM.20
ilicate crystals measuring 3 to 6 mm in length. This However, the specimen preparation involves cutting a
Figure 2. NTP specimen in holder, in mounting block, with spacer in Figure 3. Custom-built grinder.
place. NTP, notchless triangular prism.
1.000
In(In[1/(1-Pf)])
Figure 4. Custom grips attaching NTP specimen holder to testing
machine. NTP, notchless triangular prism. 0.000
0.200 0.400 0.600 0.800 1.000 1.200 1.400
1.000
Figure 6. Scanning electron micrographs of fractured surfaces of IPS e.max CAD (A1) and IPS e.max Press (B1) specimens at 50 (A1, B1), 5000 (A2, B2)
and 10 000 (A3, B3) magnication.
one half of the fractured prism is shown, with the defect- propagation through the glassy matrix, whereas the IPS
induced zone at the tip of each prism. At higher mag- e.max Press surface looks rough and irregular, with
nications of 5000 and 10 000, the IPS e.max CAD minimal glassy matrix visible and an almost entirely
surface looks smooth (Fig. 6A2, A3), indicating a crack crystallized surface (Fig. 6B2, B3).
28. Albakry M, Guazzato M, Swain MV. Fracture toughness and hardness Corresponding author:
evaluation of three pressable all-ceramic dental materials. J Dent 2003;31: Dr Lubna Alkadi
181-8. Division of Prosthodontics and Restorative Dentistry
29. van Belle G. Statistical rules of thumb. 2nd ed. Hoboken, NJ: Wiley; 2008. p. Faculty of Dentistry
27-51. King Saud bin Abdulaziz University for Health Sciences, Riyadh
30. Quinn JB, Quinn GD. A practical and systematic review of Weibull PO Box 57374, Riyadh, 11574
statistics for reporting strengths of dental materials. Dent Mater 2010;26: SAUDI ARABIA
135-47. Email: lubna.alkadi@gmail.com
31. Nohut S, Lu CS. Fracture statistics of dental ceramics: discrimination of
strength distributions. Ceram Int 2012;38:4979-90. Acknowledgments
32. Bubsey RT, Munz D, Pierce WS, Shannon JL Jr. Compliance calibration of the We thank Ivoclar Vivadent USA for donating the materials used in this study.
short rod chevron-notch specimen for fracture toughness testing of brittle
materials. Int J Fracture 1982;18:125-33. Copyright 2016 by the Editorial Council for The Journal of Prosthetic Dentistry.