Effect of resin cement selection on fracture resistance of chairside CAD-CAM lithium disilicate crowns containing virgilite: A comparative in vitro study

Abstract

Statement of problem. Studies on the fracture performance of a recently introduced computer-aided design and computer-aided manufacturing (CAD-CAM) lithium disilicate ceramic containing virgilite with different cements are lacking. Purpose. The purpose of this in vitro study was to evaluate the fracture resistance of crowns made of a recently introduced chairside CAD-CAM lithium disilicate containing virgilite cemented with different types of adhesive luting cement. Material and methods. Sixty complete coverage crowns for a maxillary right central incisor were milled out of a lithium disilicate with virgilite (CEREC Tessera) (n=48) and a traditional lithium disilicate (e.max CAD) (n=12) using a chairside CAD-CAM system (Primescan). The central incisor tooth preparation included a 1.5-mm incisal reduction, a 1.0-mm axial reduction, and a 1.0-mm chamfer finish line. The restorations were bonded with different types of resin cement to 3D printed dies of the tooth preparation and were divided into 5 groups (n=12 per group): e.max CAD with Multilink Automix (E.Mu); Tessera with Multilink Automix (T.Mu); Tessera with Calibra (T.Ca); Tessera with Unicem (T.Un); and Tessera with Speedcem (T.Sp). The cemented restorations were stored in water for 30 days and then loaded until they were fractured in compression. The load at fracture was analyzed with a 1-way analysis of variance (ANOVA) and the honestly significant difference (HSD) Tukey test (alpha=.05). Results. The mean fracture resistance of traditional lithium disilicate and virgilite lithium disilicate anterior crowns significantly differed depending on the type of resin cement used (P<.05). Group E.Mu displayed the highest values (946.35 +/- 155 N), followed by group T.Un (819.59 +/- 232 N), group T.Sp (675.52 +/- 153 N), and group T.Mu (656.95 +/- 193 N). The lowest values were displayed by group T.Ca (567.94 +/- 184 N). Conclusions. The fracture resistance of lithium disilicate containing virgilite and traditional lithium disilicate crowns cemented with the same cement displayed statistically similar values. However, significant differences were observed when the virgilite lithium disilicate crowns were cemented with different types of adhesive luting cement. The crowns in the T.Ca group displayed the lowest fracture resistance.