d e n t a l m a t e r i a l s 2 5 ( 2 0 0 9 ) 121–128

available at www.sciencedirect.com

journal homepage: www.intl.elsevierhealth.com/journals/dema

High-strength CAD/CAM-fabricated veneering material

sintered to zirconia copings — A new fabrication
mode for all-ceramic restorations

Florian Beuer a,∗ , Josef Schweiger a , Marlis Eichberger a , Heinrich F. Kappert b ,

Wolfgang Gernet a , Daniel Edelhoff a
a Department of Prosthodontics, Ludwig-Maximilians-University, Goethestr. 70, 80336 Munich, Germany
b Ivoclar Vivadent AG, Bendererstr. 2, 9494 Schaan, Liechtenstein

a r t i c l e i n f o a b s t r a c t

Article history: Objectives. With this in vitro study the fracture strength of zirconia-based crown copings
Received 30 October 2007 being veneered with a CAD/CAM generated high-strength ceramic cap by sintering is com-
Received in revised form pared with anatomically identical zirconia-based crowns, which were either overpressed or
7 March 2008 veneered by the layering technique for completion.
Accepted 15 April 2008 Methods. A 1.2 mm, 360◦ chamfer preparation was performed on a second maxillary molar
and was dublicated 15 times in a cobalt–chromium-alloy. A sample of 45 zirconia copings
was produced and divided into three groups. In the first group (VT) zirconia copings received
Keywords: conventional veneering in layering technique, in the second group the veneering porcelain
CAD/CAM was pressed over the zirconia coping (PT), and for the third group (ST) a CAD/CAM-fabricated
Zirconia high-strength anatomically shaped veneering cap was sintered onto the zirconia coping. All
High-strength glass-ceramic crowns were cemented conventionally onto their dies and tested in the universal testing
Veneer cap machine until clinical failure. The fracture load data were compared by a one-way analysis
Chipping of variance and a multiple comparison posthoc test (˛ < 0.05).
Results. Specimens from group VT showed a mean (S.D.) fracture load of 3700.39 (1238.72)
N, group OT 3523.73 (1181.11) N and group ST 6262.67 (2257.42) N. The difference between
groups VT/OT and ST were statistically significant (P < 0.001).
Significance. The new CAD/CAM-fabricated bilayered restorations (ST) were superior to the
present techniques (VT and OT) in terms of fracture load and offer the possibility to produce
cost-effective crowns and fixed partial dentures with a potential lower risk of chippings.
© 2008 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

1. Introduction the working sequence is carried out by means of industrial

machines [1,10–13]. On the one hand, frameworks can be fab-
Metal-free, all-ceramic restorations have become more widely ricated more efficiently. On the other hand, it is possible to
distributed due to their high esthetic potential and their achieve industrial quality standards, which are particularly
excellent biocompatible properties [1–9]. Today, many frame- important for ceramic materials. Every pore and imperfec-
work structures for prosthetic restorations are fabricated in tion is a potential starting point for cracks and thus for the
CAD/CAM procedures, which means that a major part in clinical failure of ceramic restorations. The frameworks made

∗
Corresponding author. Tel.: +49 89 51609550; fax: +49 89 51609502.
E-mail address: florian.beuer@med.uni-muenchen.de (F. Beuer).
0109-5641/$ – see front matter © 2008 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.dental.2008.04.019
122 d e n t a l m a t e r i a l s 2 5 ( 2 0 0 9 ) 121–128

of glass-infiltrated oxide ceramic fabricated in the slip tech- ing core and veneering leads to an increase in mechanical
nique exhibited large spectra of strength distribution related strength compared to traditional techniques enabling a lower
to the fabrication process resulting in a low-Weibull mod- clinical chipping rate of the veneering material.
ulus [14]. Using the same ceramic material in the form of
industrial prefabricated blocks and applying the milling tech-
nique, the Weibull modulus of oxide ceramics and thus the 2. Materials and methods
reliability of the restorations was significantly increased [14].
However, to-date the veneering material has been layered A 1.2 mm, 360◦ chamfer preparation was made on a maxillary
according to the well-known fabrication process of the metal- right second molar (Frasaco, Tettnang, Germany). To control
ceramic technique. According to ISO 6872 and 9693 standards volumetric reduction, a silicon impression (Optosil, Heraeus
a minimum flexural strength of 50 MPa for veneering glass- Kulzer, Hanau, Germany) was made prior to tooth prepara-
ceramics is required. The bond between veneering ceramic tion. Additionally, the provisional crown (Protemp Garant, 3M
and zirconia framework is currently the subject of compre- ESPE, Seefeld, Germany) was used to verify the thickness, thus
hensive investigations [15,16]. The typical failure pattern of a the circumferential and occlusal reductions could be quanti-
veneering material in the daily clinical practice is known as fied (Dial Caliper, Kori Seiki, Tokyo, Japan). The preparation
ceramic chipping [17,18]. This fracture pattern is associated was completed with a surveyor (F1, DeguDent) using a car-
with a thin layer of glass-ceramic that remains on the zir- bide bur (Komet H 356 RGE 103.031, Gebr. Brasseler, Lemgo,
conia framework [11,12,17,18]. This indicates a reliable bond Germany), to ensure that the preparation had an 8◦ tapered
of veneering ceramics to the framework, but also reveals a angle. 15 silicone impressions were made (Adisil blau, Siladent
weakness of the veneering porcelain. A possible reason for Dr. Boehme und Schoeps GmbH, Goslar, Germany) with a
the incidence of chippings may be found in the former lim- custom impression tray (U3 # 141163 Orbilock, Orbis Den-
ited CAD- software options by which crown and fixed dental tal, Munster, Germany) in order to duplicate the prepared
prosthesis (FDP) frameworks could not be machined to an tooth into metal-dies. The impressions were filled with wax
anatomically reduced form, offering adequate support to the (Nawax compact, Yeti Dental Products, Engen, Germany). After
veneering material. In contrast many systems could offer only cooling the wax patterns were removed and invested (rema
uni-thickness copings for crowns as well as bar-shaped con- dynamic S, Dentaurum, Ispringen, Germany). The wax was
nectors for FDPs. Therefore with these systems, veneering burnt out and metal-alloy (Remanium 2000, Dentaurum) was
ceramic had to be applied in thick layers to accomplish func- casted into the mold. The metal-dies were finished and capped
tional and esthetic demands without any cusp support [11,19]. into polymethylmethacrylate-resin (Paladur, HeraeusKulzer).
For metal-ceramic restorations, it was reported, that inad- To ensure the correct preparation angle, all 15 master casts
equate framework design represents one important reason were finished with the surveyor using a carbide bur. These 15
for an unfavorable failure rate of the veneering material [20]. master casts functioned as testing models. From every testing
Modern CAD/CAM-systems are able to provide a considerably model an impression (Impregum, 3M ESPE, Seefeld) was taken
better anatomically cut back framework design, thus future using a plastic impression tray (Inlay, Heko, Berlin, Germany).
clinical long-term results may be more favorable [11,19]. After 24 h a resin-modified die material (Resin Rock, Whip-
From an economical point of view, the esthetic and mix, Dortmund, Germany) was poured into the impressions.
functional completion of crown and FDP frameworks involv- 15 master dies derived from 15 impressions. Each master die
ing traditional methods, such as the powder layering was scanned (InEos, Sirona, Bensheim, Germany) and three
technique, appears to be inefficient. One possibility for zirconia copings were manufactured by a CAD/CAM-system
increasing the cost-effectiveness involves the industrial fab- (InLab, Sirona) using pre-sintered zirconia (IPS e.max ZirCAD,
rication of glass-ceramic mono-blocks and machining of Ivoclar Vivadent (IV), Schaan, FL). A wall thickness of 0.5 mm
the entire restoration by means of CAD/CAM technologies and a virtual spacer layer of 10 ␮m were chosen. After the
[21]. In general these mono-block restorations use either milling procedure the enlarged copings were removed from
leucite-reinforced glass-ceramics with a flexural strength of the CAM-machine and final sintering was performed in a
around 100–150 MPa with mandatory adhesive cementation, special sinter furnace (Sintramat, IV). The frameworks were
or lithium-disilicate reinforced glass-ceramics exhibiting a examined for deformation and debris, corrected if necessary
flexural strength of 350–400 MPa, with the option of conven- and cleaned with steam. Each framework was seated on a
tional cementation. Therefore, the indication range is strongly definitive die. The frameworks were evaluated on the dies by
limited to single crowns and small FDPs [8,12,14,22–24]. visual inspection under a microscope with a magnification of
The combination of a CAD/CAM-fabricated framework with eight (Stemi DV 4, Zeiss) for marginal discrepancy. The inspec-
CAD/CAM-fabricated veneering would be of major interest, tion was performed by three previously calibrated evaluators
especially if considerably stronger veneering ceramics can be (two dental technicians, one dentist). Copings were rejected
applied. if the margin was rated visually unacceptable by two inves-
The authors introduced a new procedure for veneered tigators. Undercontoured frameworks and frameworks which
all-ceramic crown restorations using a CAD/CAM-fabricated could be rotated on the definitive die under finger pressure
high-strength zirconia coping and a corresponding CAD/CAM- were also rejected. New copings were fabricated on the same
fabricated lithium-disilicate glass-ceramic veneering mate- dies to replace the rejected specimens. Forty-five acceptable
rial. Both corresponding parts of the restoration can be frameworks were achieved from a total of 48 frameworks.
sintered together by means of a glass-ceramic powder in one Next, the acceptable frameworks were adapted until the best
bake. It can be assumed that the new procedure of sinter- possible fit was achieved. The adaptation was made by an
 d e n t a l m a t e r i a l s 2 5 ( 2 0 0 9 ) 121–128 123

experienced dental technician with a magnification of eight from heat damage. Finally glaze paste (IPS e.max Ceram Glaze
(Stemi DV 4, Zeiss) according to the literature [25]. paste, IV) was mixed with the respective liquid (IPS e.max
As the result of the framework fabrication three copings for Glaze and Stain Liquid, IV) to the desired consistency, applied
each of the 15 testing models were available. The sample of 45 evenly on the crown shapes and fired at a temperature of
copings was divided into three groups so that for each of the 750 ◦ C.
15 testing models one adapted coping existed.
2.3. Group ST: sintering technique
2.1. Group VT: veneering technique
The first step using the sintering technique advantageously
The traditional layering technique was applied to veneer the and to produce comparable test specimens within the scope
copings of the first group. A calibrated dental technician who of this study, was to generate glass-ceramic veneer caps which
was experienced in veneering metal or ceramic frameworks fitted onto the zirconia copings on one side and correspond
for 31 years produced the specimens. First a special liner (IPS almost exactly to the outer shape of the crowns fabricated by
e.max, ZirLiner, IV) was applied onto the zirconia frameworks the other two techniques applied for groups VT and PT. The
and fired in a calibrated ceramic furnace (Programmat 700, IV) objective to acquire an exact copy of the veneered restorations
at a temperature of 960 ◦ C. A nano-fluorapatite-glass-ceramic from group VP by CAD/CAM-technologies was easily achieved.
(IPS e.max Ceram, IV) was applied in a dentin-enamel-layering The copings of group ST and the outer surfaces of crowns from
and fired at a temperature of 750 ◦ C. With a final firing, the group VT were dimmed by applying a contrast spray (Den-
porcelain was glazed and the restoration finished. taco, Bad Homburg, Germany). Each coping of group ST was
One major goal of the study was to fabricate exact dupli- scanned by a white-light-scanner (Everest Scan, KaVo, Biber-
cates of these veneered crowns using alternative veneering ach, Germany) and treated like a prepared tooth, additionally
techniques. Therefore an impression of each crown fixed the outer surface of each crown from group VT was scanned
onto the testing model (fit checker, GC-Germany, Munich, (Everest Scan, KaVo).
Germany) was taken using a putty silicone material (optosil, The CAD/CAM-system used (Everest, KaVo) provided the
HeraeusKulzer, Hanau, Germany). These impressions were cut function of a double scan. So the outer and the inner shape
from buccal to oral to get the fixed crown and the testing model could be scanned, matched together and the CAD/CAM-
removed. system permitted the manufacture of the space between
both scans from a material of choice. Lithium-disilicate
2.2. Group OT: overpressing technique glass-ceramic blocks are available for the CAD/CAM-system
used. This ceramic is ideally suitable for the sinter bond
First a layer of the system’s liner (IPS e.max, ZirLiner, IV) technique with zirconia frameworks due to the appropri-
was applied to the copings similar to group VT and fired at ate match of the coefficients of thermal expansion (CTE
a temperature of 960 ◦ C. Then the copings were fixed onto of IPS e.max ZirCAD = 10.75 × 10−6 K−1 , CTE of IPS e.max
their testing models by a silicone material (fit checker, GC- CAD = 10.25 × 10−6 K−1 ). The internal dimensions of the veneer
Germany, Munich, Germany). The impressions made from cap correspond to the external dimensions of the frame-
the outer surface of the crowns from group VT were used work. A joining gap should be available on the internal
to create the shape of the restorations. Both parts of the aspect of the veneer cap to join the two components. The
impressions were filled with wax (Nawax compact, Yeti Den- external dimensions of the veneer cap corresponds to the
tal Products, Engen, Germany) in the area of the crown, and shape of the full anatomical crown (Fig. 1). The two com-
the testing models with the fixed copings were put into one ponents (CAD/CAM framework and CAD/CAM veneer) were
part of the impression. The two parts of the impression were joined by means of a low-fusing ceramic material (experimen-
set together and the resulting wax-up was arranged onto the tal connector material, IV). Requirements of the connector
coping in order to obtain an equivalent veneering structure material were a suitable CTE between the zirconia frame-
of the corresponding crown from group VT. The wax surface work and the lithium-disilicate veneering ceramic and an
was smoothed, finished and invested into a special investing appropriate firing temperature, which would not deform
material (IPS PressVEST, IV) in a muffle of size two accord- or destroy the veneer cap made out of lithium-disilicate
ing to the manufacturer’s instructions. The wax was burnt ceramic.
out and the muffle was heated. The copings were overpressed The connector material was applied at a low-viscous
by a special porcelain (IPS e.max ZirPress, IV), which had consistency to the internal aspects of the veneer cap. Sub-
an appropriate coefficient of thermal expansion with respect sequently, the veneer was fitted on the framework structure
to zirconia. After cooling, the investment was removed in a with slight pressure. This step was performed on the dies of
sandblasting unit (Eurosab, Tissi, San donato Milanese, Italy) the master model. Subsequently, excess low-viscosity ceramic
using 50 ␮m glass beads at 2 bar pressure. The reaction layer material was removed with a brush. Since IPS e.max CAD
formed during the press procedure was removed by immers- restorations are milled in a pre-crystalline state, they have
ing the crowns into HF solution (IPS e.max Press Invex Liquid, to be subjected to a crystallization firing in a conventional
Lot H31070, IV) in an ultrasonic cleaner (Sonorex, Bandelin, ceramic furnace after milling. This firing cycle served simul-
Berlin, Germany) for 5 min. Subsequently, the crowns were taneously as the sinter bonding firing at a temperature of
cleaned under running water for 3 min and dried. The pressing 850 ◦ C. Scanning electron microscope pictures have shown a
sprues and extrusion flashes were removed using a water- sound bond between the connector material, internal frame-
cooled air-turbine without pressure to protect the porcelain work material and external veneer cap (Fig. 2).
124 d e n t a l m a t e r i a l s 2 5 ( 2 0 0 9 ) 121–128

Fig. 3 – Testing setup in the universal testing machine,

polyethylene foil between test specimen and piston.

and the cement was spaced out by a disposable brush until

Fig. 1 – Veneer cap after CAD/CAM-fabrication process. the complete surface was coated. The retainer was set back
onto the definitive die with finger pressure, and the excess
cement was removed. A special cementing device was used to
Finally, the restorations were completed with one stain and ensure that the crown was loaded centrally at a force of 50 N
glaze firing cycle at a temperature of 750◦ C. for 10 min [26]. All cementations were done by the same team
of an experienced dentist, who sat the crowns onto the defini-
2.4. Cementation of the crowns tive die, and a dental assistant, who activated the capsule of
cement and started the mixing procedure.
After glaze firing, each crown from group VT was fixed onto All restorations were stored in distilled water at a temper-
its corresponding testing model by glass ionomer cement ature of 37 ◦ C for at least 48 h until they were loaded for the
(KetacCem Aplicap, 3M ESPE). The internal walls of the fracture test.
crowns were cleaned with steam (Triton, Bego, Bremen, Ger-
many) and degreased (80% ethanol) while the surfaces of the 2.5. Load until fracture
cobalt–chromium abutments were aluminium oxide abraded
(50 ␮m particle size, 0.5 bar pressure) and degreased prior All crowns were put into the universal testing machine (Zwick,
to cementation. The capsule of glass ionomer cement was Ulm, Germany) at a 15◦ inclination relative to the long-axis
activated for 2 s (Aplicap Activator, 3M ESPE) and mixed auto- and finally loaded until fracture occurred. Before the load was
matically (Rotomix, 3M ESPE) for 10 s. The abutments of the applied, the specimens were adjusted to the piston to ensure
framework were filled (Aplicap Applier, 3M ESPE) with cement, a three-point-contact between the stainless steel ball and the
occlusal surface. The load was applied with an 8 mm diam-
eter stainless steel ball placed on the occlusal surface of the
crowns and a crosshead speed of 0.5 mm min−1 [27–29]. To dis-
tribute the applied force over a larger area and avoid loading
stress peaks on the veneering material, a 1 mm thin piece
of polyethylene vacuum-forming foil (copyplast 1.0, Scheu-
Dental, Iserlohn, Germany) was placed between the piston and
the crown (Fig. 3).
Fracture was defined as occurrence of visible cracks in com-
bination with load drops and acoustic events or by chipping
which made the crown clinically unusable.
After the testing of group VT, the fragments of the crowns
were removed and the testing models were cleaned by an
ultrasonic cleaner (Sonorex, Bandelin) and steam (Triton).
Afterwards the crowns of group OT were cemented and tested
as described above. The fragments were removed, the testing
models were cleaned as described above and restorations from
group ST were cemented and tested.
Fig. 2 – SEM picture of connecting area between veneer cap The loads at fracture were registered, and differences
(VC), experimental connecting material (ECM) and zirconia between the groups were calculated using a one-way
coping (ZC) (magnification factor 700×). analysis of variance test (ANOVA) at a significance level
 d e n t a l m a t e r i a l s 2 5 ( 2 0 0 9 ) 121–128 125

Table 1 – Mean, standard deviation, maximum and minimum of fracture loads from three experimental groups (VT, OT,
ST)
Experimental group Mean Standard deviation Minimum Maximum

VT 3700.39 1238.72 2100.65 6231.84

OT 3523.73 1181.11 1530.00 6224.08
ST 6262.67 2257.42 2915.96 10503.50*

Fig. 5 – Cohesive fracture of a specimen from group VT.

Fig. 4 – Fracture load of different experimental groups.

Keuls test indicated two subgroups, which exhibited statisti-

of 5%. Additionally a multiple comparison posthoc test cally significant differences (Table 3).
(Student–Newman–Keuls) was performed to evaluate differ-
ences between the experimental groups.
4. Discussion

3. Results It has been suggested that test specimens should have the
same critical flaws as crowns made for clinical use and the
The mean and standard deviation of fracture strength values environmental influences should be reflected in the laboratory
for the three experimental groups are shown in Table 1 and settings [32]. The approach chosen in the present study was
Fig. 4. considered justified as the study design took aspects regarding
Two failure types were observed: total fracture, through test specimens, environmental influences and test mode into
both core and veneer and partial fracture through the veneer account.
only (chipping). Total fractures were more frequent in the ST
group (six) while four total fractures occurred in the OT group 4.1. Test specimens
and no total fracture was observed in group VT. In all instances
of partial fracture, the fracture was cohesive within the veneer The recommendations concerning tooth preparation design,
material (Fig. 5). dimensions, and shape of the zirconia core are identical for
Crowns fabricated with the sintering technique (ST) crowns veneered with porcelain or overpressed by ceramic.
showed significantly (P < 0.001) higher fracture strengths com- The approach for the new way of veneering was to pro-
pared to crowns made with veneering porcelain (VT) and duce identical restorations concerning dimension and core
over pressing technique (OT) (Table 2). The Student–Newman–

Table 3 – Multi-comparison posthoc test

Table 2 – One-way ANOVA of experimental groups (VT, (Student–Newman–Keuls) indicating two statistically
OT, ST) different (P < 0.05) homogeneous subgroups
Factor Experimental group Experimental group N Subgroup 1 Subgroup 2

Sum of squares 7E + 007 OT 15 3523.73

d.f. 2 VT 15 3700.39
Mean squares 33,648,922 ST 15 6262.67
F 12.8662
P-value 0.000* Significance 0.769 1.000
126 d e n t a l m a t e r i a l s 2 5 ( 2 0 0 9 ) 121–128

design. In all three groups, the cores were accomplished a very high fracture load. Second the CAD/CAM-process uses
as if they were intended for clinical use. The veneer firing high quality material with a minimum of flaws compared to
and the over pressing procedure were performed according the manual procedures of veneering or heat pressing. The fact
to the manufacturer’s instructions, with appropriate dimen- that nine cohesive fractures were observed in group ST also
sions and identical for all three groups. Cementations were indicates that a good interfacial bond is achieved using the
made according to the manufacturer’s recommendations, sintering technique.
with glass ionomer cement on metal-dies. According to Scher- Catastrophic failure as a result of contact loading has made
rer, increasing elastic modulus of the supporting material it difficult to identify whether cone cracking or subsurface
results in increased fracture strength [30]. The elastic modulus damage was responsible. It is supposed that both processes
of the supporting die was 200 GPa, superior to that of dentin may occur at the failure site as reported by previous studies
which is 12 GPa [30]. If natural teeth were used as the support- [35]. In contrast to previous studies, fractures of the zirconia
ing model, the fracture strength of the crowns might have been core occurred in group OT and ST. This might be explained by
lower [31]. However, natural teeth would have been destroyed the greater flexural strength of the veneering materials.
during the testing at the high fracture loads [32]. Loading con- The specimens of group ST were fabricated merely by the
ditions and cementation were identical for all specimens. CAD/CAM technique, which leads to a significant reduction
in the fabrication time for such restorations. The increase in
4.2. Results the strength of such systems may result in greater clinical
reliability of restorations.
Ceramic structures tend to fail because of surface tension, All groups evaluated showed greater fracture loads than
where cracks and flaws propagate by slow crack growth lead- most available literature and exceeded the maximum chew-
ing to the catastrophic failure [33]. In all-ceramic systems, the ing forces [13,22,34]. However, clinical failure of zirconia-based
flaw population (size, number and distribution) can be related restorations was reported [18,19,36,37]. It is supposed that
to the material, or be affected by the fabrication process. Thus, fatigue has a major effect on the mechanical stability and
it might be expected that the heat pressing introduces fewer explains the high values compared to similar studies, such as
flaws than layering, resulting in better strength properties, as fatigue, not taken into account in this study [13,34]. The abut-
it is a more controlled procedure. By comparison, the layer- ment material, as mentioned above, has a significant influence
ing technique is more sensitive and subject to variability due and increased the fracture load in this study [30,31]. Similar
to the individual building and firing procedures. Nevertheless, fracture loads have been reported with titanium abutments
no statistically significant differences were found in the frac- [28]. The diameter of the loading piston can also influence the
ture loads between group VT and OT. A study which compared fracture strength of all-ceramic restorations [38]. This study
fatigue of veneered and heat pressed zirconia crown systems used a piston with a larger diameter than comparable studies
also found no statistical difference between veneering by lay- to ensure the three-point-contact of the piston to the occlusal
ering and by heat pressing in terms of mechanical stability surface of the specimen. Increasing the loading angle can lead
[34]. The homogeneity and the distribution of flaws may be to lower fracture strength [38]. However, comparable studies
similar between test groups VT and OT. However, there were did not mention the angle of the loading direction [34] or
four catastrophic failures reported in the overpressed group, showed similar angles [13,22].
which might be caused by the greater strength (110 MPa) of the The standard deviation of up to 36% was in the same range
heat pressed veneer material and structure. It is reasonable [22] or higher compared to similar studies [13,34]. This can
that the failure mode of zirconia-based all-ceramic restora- be explained by the design of the specimens as they were
tions veneered with a relatively weak porcelain – assuming a designed as crowns for clinical use in this study. Other stud-
good bond – tends more to cohesive chipping of the porcelain ies reporting lower standard deviations used more simplified
at lower fracture loads whereas higher-strength veneer mate- shapes of the occlusal surface [13,34].
rial provokes to a certain extent total fracture at higher loads. In principal, the sinter technology described, involving
Thus, the relatively weak veneering porcelain (90 MPa) of the custom made CAD/CAM veneer caps could also be applied
specimens from group VT led to cohesive fractures, where a to all-ceramic FDPs and even for metal-ceramic crowns and
thin porcelain layer still remained on the zirconia coping. This FDPs, if ceramic blocks with an appropriate thermal expan-
type of failure indicates the good interfacial bond between the sion coefficient were available. Certain requirements of the
core and the veneer material that is critical for the success of framework geometry have to be met: the taper of the abutment
these composite structures [35]. core has to be more than 0◦ . If a slight chamfer preparation is
The fracture strength of specimens with a sintered veneer performed, the framework has to reach up to the preparation
cap was significantly higher (P < 0.001) than that of the other margin. Having a pronounced chamfer or shoulder prepara-
groups tested. Two main reasons might be responsible for tion, the framework can be designed in a reduced fashion, i.e.
the greater strength. First the lithium-disilicate ceramic used the CAD/CAM veneer forms a circular shoulder. In the case
for the veneer cap (IPS e.max CAD LT) has a greater flexural of FDP frameworks a special pontic design without undercuts
strength of 360 MPa in comparison to the veneering porce- would be required. Appropriate software has to be developed
lain used for the layering technique (IPS e.max ceram: 90 MPa) to ease the CAD phase for the construction of veneer caps
and the heat pressing material (IPS e.max ZirPress: 110 MPa). for FDP frameworks. However, CAD/CAM manufacturers have
The number of total fractures also expresses the stability of to provide the prerequisites regarding the software and accu-
the zirconia-based crowns in combination with the sintered racy in the milling process before this technique can be widely
veneer cap. Six of the 15 specimens failed catastrophically at advocated for immediate implementation in the market.
 d e n t a l m a t e r i a l s 2 5 ( 2 0 0 9 ) 121–128 127

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