Comparing the Repair of Veneered Zirconia Crowns with Ceramic or Composite Resin: An in Vitro Study

Statement of problem: Current techniques for repairing porcelain-chipped restorations have several limitations. With advances in CAD/CAM technology, the combination of resin cements and high-strength ceramic materials might offer new options for repairing the chipping of veneering ceramic. Purpose: The purpose of this study is to compare the load-to-failure of veneered zirconia crowns repaired by different materials. Material and Methods: Veneered zirconia crowns were made on aluminum dies (n = 10/group). Feldspathic porcelain (Vita VM9, Vident) was applied to the zirconia coping (Vita In-Ceram YZ, Vident) in a cylindrical shape (Ø 10.5 mm, height 7.5 mm). A bevel cut on the porcelain veneer (45 degree, 3 mm width) was made at one side of each crown to simulate porcelain chipping. The crowns were then divided into four different groups according to the repair materials: 1. Conventional resin composite (A; Tetric EvoCeram, Ivoclar Vivadent); 2. Flowable resin composite (B; G-aenial Universal Flo, GC america); 3. CAD/CAM milled feldspathic ceramic (C; Vita Trilux Forte, Vident); 4. CAD/CAM milled lithium disilicate glass-ceramic (D; IPS e.max CAD, Ivoclar Vivadent). Resin cement (Multilink Automix, Ivoclar Vivadent) was used to cement the CAD/CAM ceramic materials to the beveled crowns. Each crown underwent 5000 cycles of thermocycling. The strength test was performed on an Instron universal testing machine by loading force on the center of repaired part to record load-to-failure. Data were analyzed by ANOVA and Tukey HSD post-hoc tests (α = 0.05). Results: Mean loads-to-failure (in Newton +/− SD) of repaired veneered zirconia crowns were: Gr. A: 660.0 ± 200.5; Gr. B: 681.7 ± 175.9; Gr. C: 1236.0 ± 188.8; Gr. D: 1536.3 ± 286.1. Catastrophic failure was the most dominant failure mode in every group. Few specimens exhibited cohesive failure. Only one specimen in group D had adhesive failure. Conclusions: Within the limitation of the study, veneered zirconia crowns repaired with CAD/CAM ceramic materials have significantly higher load-to-failure than veneered crowns repaired with resin composite (p ≤ 0.05). Clinical Implications: Traditionally, porcelain-chipped restorations are often repaired with resin composite and bonding technique. Repairing chipped porcelain with CAD/CAM ceramics fitting the fractured parts can be alternative option with potential advantages. More well-designed studies are necessary to justify this novel repair technique.