Effect of Endodontic Access Preparation on Fracture Load of Translucent versus Conventional Zirconia Crowns with Varying Occlusal Thicknesses

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Journal of Prosthodontics


Purpose: To evaluate the effect of endodontic access hole preparation on fracture resistance of translucent zirconia (5Y) and conventional zirconia crowns (3Y) with varying occlusal thicknesses. Materials and Methods: Polymethylmethacrylate (PMMA) dies, representing a prepared tooth, were milled. Zirconia crowns with 1 mm thick axial walls and varying occlusal thicknesses were milled from 3Y (Cercon HT) or 5Y (Cercon XT) zirconia discs and sintered. 160 crowns were divided into 16 groups (n = 10 per group) based on the zirconia type (3Y, 5Y), occlusal thickness (0.5, 1.0, 1.5, 2.0 mm), and access hole preparation (with access hole, control). Crowns were cemented on the PMMA dies with resin-modified glass ionomer cement (Rely X Luting Plus) under constant weight (500 g) and thermocycled for 10,000 cycles. In half of the samples, following 5000 cycles of thermocycling, a uniform endodontic access hole was created using a diamond bur and restored immediately with resin composite (Filtek Supreme Ultra, 3M ESPE). The fracture resistance of the specimens was tested on an Instron 5566 universal testing machine with a stainless steel ball indenter (9.0 mm dia.) and the maximum load before failure was recorded as fracture load (N). Three-way ANOVA testing examined the effect of zirconia type, occlusal thickness, and access hole preparation on fracture loads of the crowns. Statistical tests were two-sided and significance level was set at 95% (α = 0.05). Results: Fracture load was significantly affected by the type of zirconia, occlusal thickness, and access hole preparation (p < 0.001). Pairwise comparisons revealed that access hole preparation significantly reduced the fracture load of 3Y crowns with 0.5 or 1.0 mm of occlusal thickness and 5Y zirconia crowns with 0.5, 1.0, or 1.5 mm of occlusal thickness (p < 0.05). Increasing occlusal thickness reduced the effect of access hole preparation on fracture load. Conclusion: Type of zirconia, occlusal thickness, and access hole preparation had significant effects on the fracture load of zirconia crowns. The effect of endodontic access was significant on the 3Y and 5Y zirconia crowns with ≤1.0 and ≤1.5 mm occlusal thicknesses, respectively.

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Wiley; American College of Prosthodontists