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Dental Materials Journal 2011; 30(4): 554–562

Fracture load and failure analysis of zirconia single crowns veneered with
pressed and layered ceramics after chewing simulation
Bogna STAWARCZYK1, Mutlu ÖZCAN1, Malgorzata ROOS2, Albert TROTTMANN1 and Christoph H. F. HÄMMERLE1
1
Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032
Zurich, Switzerland
2
Division of Biostatistics, Institute of Social and Preventive Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland
Corresponding author,  Bogna STAWARCZYK;  E-mail:  bogna.stawarczyk@zzm.uzh.ch


This study determined the fracture load of zirconia crowns veneered with four overpressed and four layered ceramics after chewing
simulation. The veneered zirconia crowns were cemented and subjected to chewing cycling. Subsequently, the specimens were loaded
at an angle of 45° in a Universal Testing Machine to determine the fracture load. One-way ANOVA, followed by a post-hoc Scheffé
test, t-test and Weibull statistic were performed. Overpressed crowns showed significantly lower fracture load (543–577 N) compared
to layered ones (805–1067 N). No statistical difference was found between the fracture loads within the overpressed group. Within
the layered groups, LV (1067 N) presented significantly higher results compared to LC (805 N). The mean values of all other groups
were not significantly different. Single zirconia crowns veneered with overpressed ceramics exhibited lower fracture load than those
of the layered ones after chewing simulation.

Keywords: Zirconia, Overpressed ceramic, Layered ceramic, Fracture load, Aging




the failure type was mainly cohesive within the veneering


INTRODUCTION
ceramic17-19). In fact, both overpressed and layered
Zirconia-based reconstructions have the potential to veneering ceramics demonstrate similar chemical
substitute the metal-ceramic fixed dental prosthesis compositions. Hence, the objectives of this study were to
(FDP) due to their high biocompatibility1) and similar test the fracture load and failure analysis of zirconia
mechanical properties2-6) with those of metal-ceramics. frameworks for single crowns veneered with overpressed
The superior mechanical properties are due to the finer or layering technique after chewing simulation. The
grain size and the tetragonal-monoclinic transformation tested null- hypothesis was whether the overpressed and
toughening mechanism of the zirconia which leads to layered ceramic present similar fracture load bearing
compressive stresses in the material and results in capacity after chewing simulation.
reduced crack propagation7). However, some studies
reported that the combination of aging and phase
MATERIALS AND METHODS
transformation has been detrimental for fatigue
properties of Y-TZP without veneering8,9). Therefore, The study included four overpressed ceramics: PressX Zr
Y-TZP frameworks should be veneered using either (PZ), GC Initial IQ LF (PG), VITA PM9 (PV) and IPS
layering technique or overpressed technique. e.max ZirPress (PC) and four layered ceramics: Zirox
With the layering technique, over dimensional (LZ), GC Initial ZR (LG), Vita VM9 (LV) and IPS e.max
powder-liquid veneering ceramic is layered on the Ceram (LC) (Table 1).
framework and sintered in a special ceramic oven to final
dimensions. This procedure takes at least three firing Flexural strength of veneering ceramics
procedures including dentin, enamel and glaze. With the The overpressed ceramic specimens (N=60, n=15 per
overpressed technique, the veneer is modeled out of wax group) were cut from wax CAD/CAM disc (ZENO TEC
on the framework, which is then embedded in a special Wax Disc, Wieland Dental, Pforzheim, Germany) with
investment material. After evaporating the wax, the the dimensions of 3×4×12 mm by a diamond saw (Well
generated space is pressed with glass ceramic in a special 3241 Precision Diamond Wire Saw, Well, Le Locle,
press oven under standardized conditions according to Switzerland) and polished with SIC P500 disc. The
the manufacturers’ instructions. After the muffle is specimens were invested with the recommended
cooled, the pressed FDP is retrieved and carefully investment materials according to the manufacturers’
sandblasted with alumina particles. instructions. After evaporating the wax in a standard
Many of clinical studies often reported chipping of oven (EWL Type 5636, KaVo, EWL, Leutkirch am
the veneering ceramic but less framework fractures10-16). Allgäu, Germany), the ceramic was pressed in a special
This indicates that the weak link in the zirconia FDPs is press oven (EP 600, Ivoclar Vivadent, Schaan,
the veneering ceramic-zirconia interface. Liechtenstein) by the corresponding overpressed
Studies on the bond strength between the zirconia ceramic. The investment material was removed after
framework and veneering ceramic have reported that cooling in a sandblasting unit (CEMAT NT4,

Received Feb 2, 2011: Accepted Apr 25, 2011


doi:10.4012/dmj.2011-028 JOI JST.JSTAGE/dmj/2011-028
Dent Mater J 2011; 30(4): 554–562 555

Table 1 Products used and the composition of the veneering ceramics


Veneering Short
Framework Veneering ceramics (composition) Manufacturers Lot Number
technique name
ZENO Zr Overpressed PressX Zr (SiO2: 55–65%, Al2O3: 17–24%, Wieland PZ 2/07
(Wieland K2O: 7–11%, Na2O: 5–9%, B2O3: 0–2%, Dental, P: 0.03 /
Dental) pigments: 0.1–0.9%) Pforzheim, L: 043702
Investment: PressX ZR Germany P: 1/07 /
Glaze: P: PressX ZR Glaze/ L: Stain Liquid Special L: 2/07
GC Initial IQ LF (SiO2: 63–68%, Al2O3: 14–17%, GC Europe, PG 200710101
K2O: 9–13%, Na2O: 5–7%, TiO2: <1%, CeO2: <1%, Leuven,
ZrO2: <1%, CaO: 0–1%, B2O3: 1–2%, BaO: 0–1%, Belgium P: 200806051A /
LiO2: <1%, MgO: <1%, pigments: 0.3–3) L: 0805151
Investment: GC Multi PressVest P: 200805201 /
Glaze: P: GC Initial IQ/POZr L-N / L: GC Initial L: 0941
Diluting Liquid
VITA PM9 (SiO2: 62–67%, Al2O3: 16–19%, K2O: Vita PV 25870
6–8%, Na2O: 5–8%, B2O3: 1–3%, pigments) Zahnfabrik,
Investment: VITA PM Investment Bad Säckingen, P: 2851198 / L:
Germany 14540
Glaze: Vita SHEDING PASTE Glaze SP15 27010
IPS e.max ZirPress (SiO2: 57–62%, Al2O3: 12–16%, Ivoclar PC L28227
K2O: 2–4%, Na2O: 6–8%, F: 0.5–1%, P2O5: 1–2%, Vivadent,
other oxides: 0–6%, pigments:0.2–0.9%) Schaan, P: LL2004 / L:
Investment: IPS PressVest Liechtensten LL2053
P: L36521 / L:
Glaze: P: IPS e.max Ceram Glaze Powder / L: IPS 32899
e.max Ceram Glaze and Stain Liquid
Layered Zirox (SiO2: 55–75%, Al2O3: 7–23%, K2O: 3–10%, Wieland LZ 1/05
Na2O: 3–13%, TiO2: 0–1%, ZrO2: 0–8%, CaO: 0–1%, Dental,
B2O3: 0–4%, F: 0–1%, LiO2: 0–1%, pigments: 0–4%) Pforzheim,
Carving Liquid Germany 30/06
GC Initial ZR (SiO2: 65–70%, Al2O3: 8–10%, GC Europe, LG 4651
K2O: 5–6%, Na2O: 10–12%, CeO2: <1%, CaO: 4–6%, Leuven,
BaO: 0.5–1.5%, LiO2: <1%, pigments: 0.1–3%) Belgium
Zr/ Modelling Liquid 200506151
VITA VM9 (SiO2: 60–64%, Al2O3: 7–10%, Vita LV 13340
K2O: 7–10%, Na2O: 4–6%, TiO2: <0.5%, Zahnfabrik,
CeO2: <0.5%, ZrO2: 0–1%, CaO: 1–2%, B2O3: 3–5%, Bad Säckingen,
BaO: 1–3%, SnO2: <0.5%, P2O5: <1%, MgO: <1%, Germany
FeO: <0% pigments)
Modelling Liquid 10780
IPS e.max Ceram (SiO2: 60–65%, Al2O3: 8–12%, Ivoclar LC L37100
K2O: 6–8%, Na2O: 6–9%, CaO: <6%, B2O3: 0–4%, Vivadent,
F: <6%, P2O5: <6%, other oxides: 2–8.5%, Schaan,
pigments: 0.1–1.5%) Liechtensten
Build-Up Liquid L32826

Wassermann, Hamburg, Germany) using 50 µm alumina a carrier and firing was performed in a ceramic oven
particles (Renfert, Hilzingen, Germany) at 2 bar (Austromat D4, Dekema, Freilassing, Germany)
pressure. Then, the overpressed ceramic specimens were according to the recommendations of the manufacturers.
ground to the final dimensions using SIC P220, P500, After firing, the specimens were ground to the final
P1200. dimensions using SiC discs P220, P500 and P1200.
The layered ceramic specimens (N=60, n=15 per The three-point flexural strength was measured
group) were layered in a separable steel mold. Dentin (N=120) according to ISO 6872: 200820). The dimensions
ceramic powder was mixed with the respective liquid to of the specimens were measured to the next 0.01 mm.
form sticky slurry which was then filled into the mold. The specimens were placed in the appropriate sample
The specimens were placed on a layer of silica powder on holder and loaded in the Universal Testing Machine
556 Dent Mater J 2011; 30(4): 554–562

Fig. 1 Zirconia framework design retrieved from the used CAD/CAM


software.

(Zwick/Roell Z010, Zwick, Ulm, Germany) at a cross-head


speed of 1 mm/min until failure and the three-point
flexural strength was calculated.

Fracture load of veneered crowns


The metal abutment21) was scanned (3Shape D 250,
Wieland Dental) and an anatomically supported Y-TZP
framework was constructed (Fig. 1) (ZENO TEC Wieland
Dental), milled (ZENO 4030 M1, Wieland Dental) and
sintered using a predefined firing schedule (ZENO TEC
Fire, Wieland Dental). The frameworks were randomly
divided into eight groups (N=120, n=15 per group)
including four overpressed ceramics and four layered
ceramics.
A master veneered crown was scanned to
manufacture the standardized dimensions (thickness
framework: 0.8–1.1 mm; thickness veneering ceramic:
max. 1.6 mm) of overpressed veneering ceramics (3Shape
D 250, Wieland Dental). (Fig 2). Sixty copings of wax
(ZENO TEC Wax Disc, Wieland Dental) for the
overpressed veneering (N=60, n=15 per group) were
produced using a CAD/CAM system (ZENO 4030 M1).
The zirconia framework and the wax coping were
prepared out of a thin layer of wax (THOWAX, YETI
Dentalprodukte, Engen, Germany). The crowns were Fig. 2 Lateral view of the cross-section of the
invested with the corresponding investment materials of veneered zirconia crown indicating the
the manufacturer. Subsequently, the frameworks were thickness of the core and the veneering
overpressed in a special press oven (EP 600, Ivoclar ceramic.
Dent Mater J 2011; 30(4): 554–562 557

Table 2 Pressing parameters of the overpressed ceramics tested


Investment Closing Heat Rate Final Fusion Time Pressure
Preheating Temperature (°C) (°C/min) Temperature (°C) (min) (bar)
PressX ZR Long heating 700 60 1,060 20 5
method
GC Initial IQ Quick heating 800 60  940 20 5
method
VITA PM9 Quick heating 700 50 1,000 20 5
method
IPS e.max ZirPress Long heating 700 60  900 15 5
method

Vivadent) by the corresponding overpressed ceramic


using the parameters of the manufacturers (Table 2).
The investment material was removed after cooling in a
sandblasting unit (CEMAT NT4, Wassermann) using 50
µm alumina particles (Renfert) at 2 bar pressure. The
extrusion flashes were removed using a water-cooled
air-turbine without pressure to protect the press ceramic
in order not to create overheating. Finally, glaze paste
was applied on the crowns and fired in the ceramic oven.
To achieve standardized shape and size of the
layered veneers (N=60, n=15 per group), a silicone key
was used during build-up. In a second firing, dentin was
added to compensate for the shrinkage of the sintering
process. Prior to the second firing, the slurry was
condensed into the mold using a vibrator for 2 s at 50 Hz
(Elektro Vibrator Porex, Renfert). After the final firing,
the veneering ceramic was glazed and the restoration
was finished. The all-ceramic crowns were cemented
with glass ionomer cement (KetacCem, 3M ESPE,
Seefeld, Germany) on their corresponding metal
abutment analog according to the manufacturers’
instructions.
The overpressed and layered crowns were cyclic
loaded under 49 N for 1.2 million times at the frequency
of 1.7 Hz. Simultaneously thermal aging was achieved
by changing the surrounding water temperature from
5°C to 50°C every 120 s22). As antagonist material,
polished flat composite form (Tetric EvoCeram, Ivoclar
Vivadent, Schaan, Liechtenstein) was used (Fig. 3). Load
Fig. 3 Chamber of the cyclic loading device where
was applied on the palatal surface of the crowns analog load is applied at 45 degrees to the long axis
to Voss test methods23) where load was applied at 45 of the abutment.
degrees to the long axis of the abutment.
After chewing simulation, the specimens were
loaded in the Universal Testing Machine (1 mm/min;
Zwick/Roell Z010) to measure the fracture load. The load
was induced with a flat jig on the palatal surface of the Switzerland) (×25) and categorized as follows: a) chipping
incisal edge at an angle of 45 degrees to the long axis of of the veneering ceramic or b) fracture of the veneering
the tooth23). To achieve even force distribution, a 0.5 mm ceramic together with total fracture of the framework
tin foil (Dentaurum, Ispringen, Germany) was placed (Fig. 4).
between the incisal edge and the loading jig. The fracture
load was registered as soon as fracture load decreased by Statistical analysis
10% of the maximum load (Fmax). The Statistical Package for the Social Science Version 15
The failure types were observed by two operators (SPSS INC, Chicago, IL, USA) and MINITAB Version
under an optical microscope (M3M, Wild, Heerbrugg, 14 (MINITAB, State College, PA, USA) for Weibull
558 Dent Mater J 2011; 30(4): 554–562

Fig. 4 Failure types observed after fracture test * total fracture ** chipping.

statistics were used (p<0.05).


The flexural strength and fracture load data were
analyzed with two-way and one-way ANOVA, followed
by a post hoc Bonferroni test, and two sample Student’s
t-test based on the assumption of normal data
distribution.
In addition, the Weibull statistics were calculated by
means of the parametric distribution analysis for right
censored data for fracture load. The parameters of the
Weibull distribution were estimated by Maximum
Likelihood and their 95% CI were computed. Bartlett’s
modified likelihood ratio tests for the equality of the
Weibull modulus and the equality of the characteristic
value of fracture load were conducted together with the
appropriate post-hoc test.
Failure types were classified as chipping and total Fig. 5 Boxpolts of fracture load (N) by manufacturer of
fracture, and the relative frequencies were computed veneering ceramic and veneering technique.
together with the corresponding 95% CI24). The fracture
load results were analyzed as censored data according to
the failure types using Weibull statistics.

RESULTS
All overpressed (PZ: 99±14 MPa, PG: 103±10 MPa, PV:
107±7 MPa, PC: 106±9 MPa) and layered (LZ: 104±14
MPa, LG: 102±10 MPa, LV: 109±12 MPa, LC: 100±9
MPa) veneering ceramics presented flexural strength
values in the same range. No statistical differences were
found between the four overpressed and four layered
veneering ceramic and within the corresponding
manufacturers (p>0.05).
The mean fracture load of the four overpressed
zirconia crown groups presented similar values. Within
the four different layered zirconia crown groups, PV
showed a significantly higher mean fracture load Fig. 6 Boxplots of fracture load (N) by manufacturer of
compared to PC. Within one manufacturer, the fracture veneering ceramic and veneering technique with
load of the overpressed zirconia crowns showed censored data chipping and fracture.
Dent Mater J 2011; 30(4): 554–562 559

Table 3 Mean (SD) and 95% confidence interval of the fracture load (N), p-value of the two sample Student’s t-test with
difference of the mean fracture load and 95% confidence intervals for the difference between layering and
pressing techniques by manufacturers

Wieland Dental GC Europe Vita Zahnfabrik Ivoclar Vivadent


Overpressed technique Mean (SD) 543 (234)a 573 (278)a 577 (287)a 628 (238)a
95% CI (413;673) (419;728) (417;736) (496;761)
t-test between layered and p-value <0.001 <0.001 <0.001 <0.001
overpressed technique
95% CI (−526;−213) (−531;−194) (−689;−291) (−335;−16)
Layered technique Mean (SD) 912 (181) A,B
936 (157) A,B
1,067 (243) B
804 (185)A
95% CI (874;1,057) (849;1,023) (932;1,202) (702;907)
The letters reflect the results from the one-way ANOVA within the same veneering technique. Different letters
represent a significant post-hoc test between the levels of the manufacturer factor.

Table 4 Failure types with relative frequencies and 95% confidence interval for all tested groups and all failure types

Veneering Failure types with relative frequency (95% CI)


Groups
technique Total fracture Framework intact, chipping
Overpressed PZ n=3 n=12
(n=15) 20.0 (4.3;48.1) % 80.0 (51.9;95.7) %
PG n=4 n=11
(n=15) 26.7 (7.7;55.1) % 73.3 (44.9;92.3) %
PV n=3 n=12
(n=15) 20.0 (4.3;48.1) % 80.0 (51.9;95.7) %
PC n=5 n=10
(n=15) 33.3 (11.8;61.7) % 66.7 (38.4;88,2) %
Layered LZ n=9 n=6
(n=15) 60.0 (32.2;83.7) % 40.0 (16.3;67.8) %
LG n=10 n=5
(n=15) 66.7 (38.4;88.2) % 33.3 (11.8;61.7) %
LV n=10 n=5
(n=15) 66.7 (38.4;88.2) % 33.3 (11.8;61.7) %
LC n=7 n=8
(n=15) 46.7 (21.2;73.4) % 53.3 (26.5;78.8) %

significantly lower results than the layered ones (Table


3, Fig. 5).
Chipping of the veneering ceramic, were
predominantly observed among the overpressed crowns.
The layered crowns showed mainly total fracture (Table
4).
The fracture load analyzed depending on the failure
type, showed that within the overpressed crowns, the
total fracture occurred at a lower fracture load level than
chipping (Fig. 6). The opposite was true for the layered
crowns namely: chipping occurred at a lower fracture
load level.
The Weibull statistics for the fracture load (all
failure types) resulted in significantly lower Weibull
moduli for PZ (overpressed), PV (overpressed) and LZ
(layered) compared to PC (overpressed). The Fig. 7 Weibull statistic with fracture load results of all
characteristic value for the fracture load was significantly failure types.
lower for PZ (overpressed), PV (overpressed), LZ
560 Dent Mater J 2011; 30(4): 554–562

Table 5 Weibull modulus (m), characteristic fracture load (0) with the corresponding 95% confidence intervals and their
difference for censored data chipping and total fracture and for complete data
Failure type: chipping Failure type: total fracture All fracture types
Veneering
Groups Weibull Characteristic Weibull Characteristic Weibull Characteristic
technique modulus (m) fracture load (0) modulus (m) fracture load (0) modulus (m) fracture load (0)
and 95% CI and 95% CI (N) and 95% CI and 95% CI (N) and 95% CI and 95% CI (N)
Overpressed PZ 3.4 (2.3;5.0)a   686 (576;819)a   1.0 (0.3;3.0)a 2659 (385;18,336)ab 2.5 (1.7;3.8)a   609 (493;752)a
PG 3.5 (1.7;7.1)a 1235 (946;1613)b   8.1 (5.2;12.3)b 1084 (997;1,178)ab 5.7 (3.8;8.3)ab   984 (895;1,082)ab
PV 5.4 (3.4;8.5)a
  775 (690;870)ab
  0.8 (0.3;2.0)a
3095 (441;21,722) ab
2.3 (1.4;3.5)a
  644 (509;815)a
PC 3.6 (1.6;7.9)a 1311 (949;1,812)ab 11.8 (7.7;18.1)b 1067 (1,010.3;1,127.5)ab 7.3 (4.8;10.9)b   999 (928;1,076)b
Layered LZ 3.0 (1.9;4.7)a   747 (615;909)ab   1.0 (0.3;2.8)a 3000 (419;21,441)ab 2.2 (1.4;3.4)a   654 (514;830)a
LG 3.1 (1.6;6.1)a 1605 (1,155;2,231)b   4.6 (3.1;6.8)ab 1296 (1,129;1,487)b 4.1 (2.9;5.7)ab 1164 (1,018;1,330)b
LV 4.5 (2.9;6.9)a   826 (715;954)ab   1.5 (0.7;3.4)a 1327 (630;2,794)ab 3.0 (2.0;4.4)ab   704 (587;844)a
LC 3.2 (1.7;6.0)a 1025 (814;1,291)ab 14.8 (8.8;24.6)b   993 (942;1,047)a 5.5 (3.6;8.3)ab   874 (793;963)a
Significantly different p=0.652 p<0.001 p<0.001 p=0.013 p<0.001 p<0.001
The letters reflect the results from the Bartlett’s modified likelihood ratio test (for equal shape and for equal scale) within the same
Weibull moduli and characteristic fracture load groups. Different letters represent a significant post-hoc Bonferroni test between the
levels of the test groups factor.

(layered), LV (layered) and LC (layered) than in PC ceramics within the same manufacturer. This could be
(overpressed) and LG (layered). The Weibull moduli for attributed to similar chemical compositions of the
chipping of the overpressed and layered crowns were not ceramics. After ceramic overpressing, while the FDPs in
significant (Table 5, Fig. 7). The characteristic fracture this system were retrieved followed by sandblasting that
load for chipping resulted in a significantly lower value was used for removing the investment material, with the
for PZ (overpressed) compared to PG (overpressed) and layered ceramics, sandblasting was not practiced. The
LG (layered). The Weibull moduli for total fracture sandblasting process could be held responsible for the
resulted in a significantly higher value for PG damage on the zirconia surface that negatively influences
(overpressed), PC (overpressed) and LC (layered) the mechanical properties of zirconia25). It has been
compared to PZ (overpressed), PV (overpressed) and LV reported that zirconia is subjected to a different type of
(layered). The characteristic fracture load for total surface damage as a result of milling and grinding
fracture resulted in a significantly higher value for LC procedures, which introduces surface flaws. Such surface
(layered) compared to LG (layered) (Table 4, Fig.7). flaws act as stress concentration sites and create crack
initiation and propagation, even though they are
microscopic in nature26,27).
DISCUSSION
Between the overpressed ceramics also no significant
Although the mean flexural strength of veneering difference was found in flexural strength and fracture
ceramics of both veneering techniques presented similar load. Although the overpressing parameters were not
values, the mean fracture load of the overpressed identical with the tested materials, sandblasting has
ceramics was significant lower compared to the layered possibly created internal stresses in the FDP, which
ones. Therefore, the null-hypothesis of this study is eventually weakened the ceramic and yielded to chipping.
rejected. In all overpressed groups, predominantly In fact, final temperature of 1,000°C or above of final
chipping of the veneering ceramic was observed. In temperature, regeneration affect could have been
addition, while considering the fracture load values by expected from the tested overpressed ceramic types,
failure type, fractures of the framework were observed at namely PressX ZR and Vita PM9. However, due to
a lower fracture load than chipping with the overpressed insignificant differences in mean fracture load values,
ceramics. Based on this fact, it can be suggested that this statement could not be made. In a previous study,
zirconia frameworks are durable under the load until regeneration firing of layering ceramics has shown a
chipping failure. Under the similar loading magnitude significant decrease of shear bond strength between
the layered crowns presented predominantly total zirconia and veneering ceramic18). It could be anticipated
fracture. Thus, the failure type chipping was observed that anatomical geometry of the FDP might have affected
with lower fracture load values than the fracture of the results compared to standard geometrical
framework. specimens18).
The flexural strength values did not significantly One clinical study reported significantly less
differ between the overpressed and layered veneering fractures and chippings with overpressed FDPs compared
Dent Mater J 2011; 30(4): 554–562 561

to layered ones28). One other study observed no chipping


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veneering ceramic showed similar results.
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ACKNOWLEDGMENTS 18) Fischer J, Grohmann P, Stawarczyk B. Effect of zirconia
The authors would like to thank Wieland Dental, GC surface treatments on the bond strength to veneering
ceramics. Dent Mater J 2008; 27: 448-454.
Europe, Vita Zahnfabrik and Ivoclar Vivadent for their
19) Fischer J, Stawarczyk B, Sailer I, Hämmerle CH. Shear bond
support with the materials. We are grateful to Martina strength between veneering ceramic and ceria-stabilized
A. Schmid for the support in writing the manuscript. zirconia/alumina. J Prosthet Dent 2010; 103: 267-274.
20) ISO DIN 6872: 2008 Dentistry-ceramic materials. Geneva,
Switzerland: International Organization for Standard; 2008.
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