Indirect restorations for severe tooth wear: Fracture risk and layer thickness

Available online 8 October 2013



This in vitro study investigated static failure risk related to restoration layer thickness for different indirect materials and compare them to direct composites.


Two ceramics (IPS e-max CAD, EmpressCAD (Ivoclar Vivadent)), two indirect composites (Estenia (Kuraray), Sinfony (3M)) and two direct composites (Clearfil AP-X (Kuraray), Tetric EvoCeram (Ivoclar Vivadent)) were chosen. Of each material, 25 discs varying in thickness (0.5–3.0 mm) were prepared and cemented to bovine dentine. For measuring compressive strength, samples were placed in a universal testing device. Each sample was uniaxially loaded until failure occurred. For each material a regression model based on the Weibull distribution was used to estimate the relation between restoration layer thickness and failure. Using these models, the chance of failure, standard error and 95% confidence interval for that chance is estimated. Groups of materials were compared as well.


Except for Tetric Evoceram, all materials show a significant positive association between layer-thickness and compressive strength, with an increased strength of increased thickness. ProCAD performed significantly worse than all other materials, especially when compared to the other ceramic material (IPS e-max CAD) (p = 0.001).


For most tested materials, a thicker layer offers more strength, however, this property seems to be material/brand specific.

Clinical relevance

As direct composites showed the best results within the limitations of this in vitro study, dentists should consider these materials as a good choice for restoring severe tooth wear, and may offer superior performance compared to indirect composites and ceramics. For some brands of materials thicker layers result in a stronger restoration.


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