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Ceramic Fracture in Metal-Ceramic Restorations: The Aetiology

Article  in  Dental update · May 2017

DOI: 10.12968/denu.2017.44.5.448

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Army Medical College / Armed Forces Institute of Dentistry, Rawalpindi, Pakistan National University of Sciences and Technology
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 FixedProsthodontics

Ayesha Aslam

Danish Azeem Khan, Syed Hammad Hassan and Bilal Ahmed

Ceramic Fracture in Metal-Ceramic

Restorations: The Aetiology
Abstract: All dental restorations are liable to failure during function. Failure could be biologic, aesthetic, mechanical or a combination.
Ceramic restorations in particular, including metal-ceramics, are prone to mechanical fracture, especially the fracture of veneering
porcelain. Fracture of a metal-ceramic restoration jeopardizes function as well as aesthetics. It is equally onerous to manage for both
patient and dentist. Optimal management of such cases requires a detailed knowledge of the aetiology behind this phenomenon. The
current paper aims to highlight possible causative factors involved in the mechanical failures of metal-ceramic restorations.
CPD/Clinical Relevance: Ceramic fracture in metal-ceramic crowns and fixed partial dentures is routinely encountered in dental clinics.
Knowledge of the aetiology is required to diagnose and manage such cases accurately as well as to avoid these errors in future.
Dent Update 2017; 44: 448–456

Rehabilitation of teeth with crowns has
increased greatly over the last three
decades.1 Despite rapid advancements
in the development of newer and
stronger ceramic systems,2 metal-ceramic
restorations still remain the ‘gold standard’
in prosthodontics since their introduction in
the 1960s.3 Metal-ceramic systems combine
the biomechanical advantages of metals
Ayesha Aslam, BDS, CHPE, PG Resident
Prosthodontics, Army Medical College/
Armed Forces Institute of Dentistry,
National University of Medical Sciences
(NUMS), Islamabad, Danish Azeem
Khan, BDS, PG Resident Prosthodontics,
Armed Forces Institute of Dentistry,
Rawalpindi, Syed Hammad Hassan, BDS,
FCPS, MSc Med Edu, Assistant Professor,
Army Medical College/Armed Forces
Institute of Dentistry, National University
of Medical Sciences (NUMS), Islamabad
and Bilal Ahmed, FCPS, BDS, FFD FRCSI-
II(IRE), CMT, PhD, Res Associate Professor
Department of Prosthodontics National
University of Science & Technology
(NUST), Islamabad, Pakistan.
448 DentalUpdate May 2017
with the aesthetics of ceramic materials,4
resulting in restorations with considerable
clinical longevity.5 A survival rate of 97% for
metal-ceramic restorations was reported by
Eliasson et al6 after a period of ten years in
clinical service.
All dental restorations are
liable to failure during function. Failure
may be biologic, aesthetic, mechanical
or a combination. Ceramic restorations in
particular, including metal-ceramics, are
more prone to mechanical fracture (Figure Figure 1. Fractured metal–ceramic restoration
1), especially the fracture of veneering (UL1).
porcelain.7 A systematic review carried out
by Goodacre et al8 revealed that fracture
of veneering porcelain is a common
restorations,11 and factors may also vary
complication associated with metal-
depending on the type of fracture that has
ceramic prostheses. However, a review
occurred. Friedman12 classified porcelain
on the survival rate and complications
of metal-ceramic restorations reported a fractures into three types, namely:
mean chipping rate of 2.9% after a 5-year 1. Static fracture: where a segment of
observation period.9 Such paradoxes in porcelain fractures but remains intact;
survival rate values exist because of a lack 2. Cohesive fracture: that occurs within the
of detailed reporting systems for describing body of porcelain due to tensile loads; and
fractures of ceramic-based restorations.10 3. Adhesive fracture: where failure of the
Restoration failures are often bonding interface between the porcelain
a multi-factorial phenomenon. A number and the substrate is seen (Figure 2).
of different factors may be responsible for Haselton et al13 specifically
the mechanical failure of metal-ceramic described metal-ceramic restoration

fractures, classifying them as:
1. Simple: involving only porcelain;
2. Mixed: involving both metal and
porcelain; and
3. Complex: where a large area of metal
framework is exposed.
Fracture of a metal-ceramic
restoration jeopardizes function as well
as aesthetics. Optimal management of
such cases requires a detailed knowledge
of the aetiology behind this fracture
phenomenon.14 Unfortunately, there is a
paucity of studies available that provide
a comprehensive review of the reasons
leading to the failure of metal-ceramic
restorations. The current paper aims to
highlight the possible causative factors
involved in the mechanical failures of
metal-ceramic restorations, thereby
helping clinicians avoid them in clinical
practice.
Factors affecting failure
The success or failure of
metal-ceramic restorations can be
attributed to a variety of factors. These
can be divided into different categories
(Figure 3).15
Factors related to patient
Trauma
Physical trauma is one of
the major causes of porcelain fracture.16
Low fracture toughness makes porcelain
a brittle material.17 Any blow to the
restoration, whether due to a fall, a fight,
a road-traffic or sports accident, will
a b
Metal Substrate
Porcelain
Static
Fracture
(porcelain remains
intact)
Figure 2. Pictorial representation of Friedman’s classification of porcelain fractures: (a) Static fracture; (b) Cohesive fracture; (c) Adhesive fracture.
May 2017 DentalUpdate 449
result in the immediate fracture of the
porcelain.
Occlusal interferences
Occlusal interferences
have important implications when
contemplating anterior crowns.18 Any
premature contacts in centric and
eccentric movements generate increased
localized stresses in the porcelain. These
stresses create ‘Hertzian cone cracks’ which
may lead to chipping fracture of surface
porcelain.16
Increased overbite
In increased overbite cases,
where the patient exhibits a great amount
of vertical overlap with only a moderate
amount of horizontal overlap, non-axial
stresses are generated.19 Excessive non-
axial forces may lead to fracture of the
restoration. Designing a prosthesis, such
that the non-axial forces are reduced, will
increase the longevity of the restoration
and the restored tooth.20 However, this
factor affects anterior restorations only.
Parafunctional habits
Parafunctional habits,
namely clenching and bruxism, are
characterized by dynamic repetitive
loading.21 Parafunctional habits expose
the restorations to greater and often
unfavourably directed occlusal loads,
thereby increasing the risk of mechanical
failure.22 The risk is significantly higher
in patients who do not use a protective
occlusal device.23 Abnormal biting habits,
Metal
Porcelain
Cohesive
Fracture
(ceramic chips-off )
FixedProsthodontics
such as nail-biting or biting a pen or pencil,
exploit the brittle nature of porcelains and
can lead to their fracture.
Injudicious use
If the patient, even after being
instructed otherwise, uses the prosthesis
injudiciously such as to crack hard nuts,
to bite harder foods such as sugar cane or
bones, it is likely to result in the failure of
the restoration.16
Acidic beverages
Common beverages with low
pH ranges have been shown to promote
the breakdown of glass-containing dental
restorations.11,14 This occurs because of
release of basic ions which are less stable in
the glassy-phase. Such a breakdown results
in surface roughening of dental ceramics,
thereby decreasing strength and promoting
failure.24
Factors related to clinicians
Insufficient tooth reduction
An uneven tooth preparation
may result in a porcelain layer of uneven
thickness, creating areas of stress
concentration and eventual fracture.14
Insufficient tooth reduction yields too little
space to accommodate both the metal
substructure and porcelain.25 The result
may be an over-contoured, bulky, opaque-
looking crown,26 or, if the porcelain is too
thin, it will be more liable to failure.
Knife-edge margins
Knife-edge margin designs have
c
Adhesive Failure
(metal exposed)
 FixedProsthodontics
Metal - Ceramic
Restoration
Mechanical Failure
Factors Related To Factors Related To
Patient Clinician
Figure 3. Factors associated with mechanical failure of metal-ceramic restorations.
Figure 4. Metal extending too far incisally makes
the unsupported porcelain prone to fracture.
been shown to be more susceptible to
chipping and fracture, especially during
the try-in and cementation.15
Inadequate impression recording
This factor affects all
restorations, and not just metal–
ceramic ones. An impression of the
prepared tooth that has been poorly
recorded, with no attention to details,
will result in a restoration more likely
to fail, both in aesthetics and in
function.25 In addition to impressions,
occlusal registration may also affect
the accuracy of a restoration. Dental
laboratories receive a large number of
unreliable and poorly recorded bite
registrations.27 Incorrect registration
of occlusion and articulation yields
premature contacts. Premature
contacts, if not detected and relieved,
act as stress-bearing zones on
450 DentalUpdate May 2017
Factors Related To Factors Related To
Material Lab Fabrication
ceramic. 11
Factors related to the selected dental
material
Use of weak material with low fracture
toughness
Fracture toughness is the
ability of the material to resist crack
propagation when subjected to tensile
stress.15 Materials with low fracture
toughness are more prone to fracture. Of
all the ceramics, traditional feldspathic
porcelain has the lowest fracture
toughness of 0.7 MPa.m1/2.17
Elastic modulus of the metal
The support available for
porcelain by the framework is directly
proportional to the elastic modulus of the
metal.11 The higher the elastic modulus,
the stiffer will be the material and better
able to resist deformation under loading.
An alloy with low modulus of elasticity
will flex under loading, yield poor support
to porcelain and increase the risk of
porcelain fracture.28
Presence of scratches or pits on ceramic
Scratches, pits or similar flaws
present on the surface of the ceramic
material behave as sharp notches with
narrow tips. Tensile stresses, generated
during occlusal loading, are concentrated
at the tips of these defects, leading to
crack propagation and fracture.14,15
Thermal incompatibility of materials
A large difference in the
coefficient of thermal contraction of metal
and ceramic, where ceramic contracts more
than the metal, can generate excessive
tensile stresses in the ceramic layer, thus
promoting fracture.14 Moreover, if the
veneering porcelain has a coefficient of
thermal contraction lower than that of
the core porcelain, tensile stresses will
be generated at the framework surface,
making the material more prone to
fracture.7,11 Such a thermal mismatch
between the core porcelain and the veneer
porcelain may lead to increased failure of
metal-ceramic systems.
Fatigue failure
All intra-oral restorations are
exposed to small alternating forces during
mastication. Such repeated loading may
lead to fatigue failure of the restoration.11,14
Low thermal conductivity
Low thermal conductivity of
core porcelain, as compared to that of
veneering porcelain, creates a temperature
difference between the core and the
veneering porcelain.15 Tensile stresses arise
in the deeper layers of the material and
facilitate crack propagation.
Ageing
Premature failure of restorations
may ensue in the humid oral cavity. The
oral environment expedites the ageing of
dental ceramics, reducing flexural strength
and lowering fracture toughness. Studies
have shown that silicate bonds present in
ceramics are susceptible to hydrolysis by
moisture present in the oral environment.17
The phenomenon, termed as ‘static fatigue’,
is further exaggerated in the presence of
mechanical loading.11 Ceramics undergo
‘stress corrosion cracking’ in the presence
of water.29 This results in a reduced metal-
ceramic bond strength, leading to crack
propagation and eventual failure of the
restoration.
Type of prosthesis
Metal-ceramic restorations on
implant-supported prostheses are more
prone to fracture as compared to the
ones on tooth-supported prostheses.30
This is probably because implants lack the
resilient periodontal ligaments and their
associated neurosensory mechanisms that

a or covers the entire occlusal surface (Figure
Figure 5. Maxillary posterior metal–ceramic coping with (a) proper metal support and (b) without
proper metal support under facial cusp.
help in the detection of excessive occlusal
loads or occlusal interferences.31
Factors related to laboratory fabrication
Coping design
Metal coping design is
paramount to the success of metal-
ceramic restorations and yet it is often
overlooked. The coping must be designed
so as to allow the porcelain to remain in
compression by supporting the incisal
region, the occlusal table and the marginal
ridges32 or the unsupported porcelain will
fracture.
A metal–ceramic restoration is
likely to fail if the coping does not meet
six important design features including:
1. Thickness of the porcelain veneer;
2. Support of the porcelain veneer;
3. Thickness of metal underlying and
adjoining the porcelain;
4. Placement of occlusal and proximal
contacts;
5. Extent of the area to be veneered; and
6. Design of the facial margin.
Porcelain thickness: Relatively
thin porcelain, of uniform thickness and
supported by rigid metal, is strongest. The
absolute minimum thickness of porcelain
is 0.7 mm, and the desirable thickness is
1.0−1.5 mm. Extensions of porcelain beyond
2.0 mm are prone to fracture, even if these
thick areas of porcelain are not in areas of
force concentration.11 Stresses generate
in the thick bulk of porcelain during initial
firing and cooling.
Support of porcelain: Porcelain
veneer that is supported by an evenly
May 2017 DentalUpdate 453
b
contoured metal framework is better able
to withstand stress. The metal should
be contoured so that the overlying
veneering porcelain will be subject to
compressive forces when a load is applied.
Examples of this consideration include
avoiding the extension of lingual metal
to the incisal edge of a maxillary anterior
restoration (Figure 4) and establishing a
supporting ledge under the facial cusp
of a maxillary premolar or molar metal-
ceramic restoration (Figure 5).32 Failing to
meet these criteria will expose the brittle
porcelain veneer to shearing forces and may
lead to premature porcelain fracture.
Metal thickness: Copings should
be rigid to avoid flexing during seating or
under occlusal loads. Rigidity of the coping
is directly proportional to the thickness
of the metal used. A noble metal coping
should be at least 0.3−0.5 mm thick, while
a base metal alloy with a higher yield
strength and higher melting temperature
may be as thin as 0.2 mm.14 A metal coping
with lesser thickness is likely to flex and
cause porcelain fracture.
Occlusal/proximal contacts:
Contact near the metal–ceramic junction
can lead to metal flow and subsequent
porcelain fracture. The porcelain-metal
junction should be placed 1.0 mm from
occlusal contacts at the position of maximal
intercuspation.25,33 Proximal contacts for
anterior teeth should be on porcelain and
the metal should be placed more lingually.
Placing the porcelain-metal junction lingual
to the proximal contact areas leads to
improved stress distribution.11,32
FixedProsthodontics
Extent of area to be veneered:
The porcelain on the facial surface usually
extends over the cusp tip and about
halfway down the palatal incline of the
facial cusp on posterior teeth (Figure 6a).
There must be a rounded ledge of metal
under the facial cusp to support the
porcelain. Without a supporting ledge, the
ceramic will fracture.11 This design is more
resistant to fracture than those in which
the porcelain extends to the central groove
6b).25
Design of facial margin:
Porcelain-covered metal margin design
requires either a heavy chamfer or a
beveled shoulder finish line with the metal
coping extending to the cavo-surface
margin and thinned to the minimum
thickness possible.25 Porcelain is extended
to cover this metal. This design may lead
to metal distortion during firing and metal
flexure with resulting porcelain fracture
as a result of excessive thinning of the
coping.32
Lack of aesthetics with the
conventional metal collar led to the use
of the all-porcelain facial margins.34They
utilize special shoulder porcelains that
are stronger in flexure than conventional
porcelains,15 making the margin more
resistant to fracture.
Antero-posterior span of fixed partial denture
Long span fixed partial
dentures flex more under heavy occlusal
loads, leading to the fracture of porcelain.
If all other parameters are kept constant,
a four-unit fixed partial denture replacing
two teeth will bend eight times more as
compared to a three-unit fixed partial
denture with a single pontic (Figure
7).11,15,25 Where a large number of missing
teeth need to be replaced, considering an
implant-supported prosthesis may help
decrease the span length and yield better
results.11
Thickness of pontics
Occluso-gingival thickness
of the pontic affects the deflection of
framework. Deflection varies inversely with
the cube of the occluso-gingival thickness
of the pontic. If the pontic thickness is
halved, the framework deflection will be
increased eight times.24,32
 FixedProsthodontics
a entrapped within the ceramic particles,
b Poor metal-ceramic bond
Figure 6. Coping design for a metal–ceramic
restoration with (a) buccal cusp in porcelain and
(b) full porcelain occlusal coverage.
Design of connectors
For clinical longevity,
connectors of a fixed partial denture
should be thick enough to resist the
occlusal loads.25,32 However, for optimal
aesthetics, occlusal and gingival
embrasures must be created.11
Poor porcelain adaptation
One of the most common
fabrication flaws is the incorporation
of air in the ceramic mix.35 If air is
454 DentalUpdate May 2017
8 times more deflection
Figure 7. Deflection of a fixed dental prosthesis (FDP) is directly proportional to the cube of the length
of its span. An FDP with 2 pontics will deflect 23 ie 8 times as much as an FDP with 1 pontic.
porosities occur in the final restoration,
reducing its strength and increasing the
chances of fracture.25,33 Porosities may be
introduced in the dental porcelain due to
faulty condensation, incorrect powder/
liquid ratio or firing time and temperature
disparities.35-37 This factor is applicable
to all restorations that use feldspathic
porcelain.
Method of adding the veneering layer
Hot isostatically pressed (HIP)
glass ceramic materials are less prone to
chipping and fracture as compared to
hand layered veneering porcelains.11,25
Clinical success of a metal-
ceramic restoration largely depends upon
the bond formed between the metal
and the porcelain. A metal-ceramic bond
results from the interplay of a number
of different factors including mechanical
bonding, chemical bonding, Van der
Waals forces and compression fit due
to a difference in coefficient of thermal
expansion.38 A poor metal-ceramic bond
can be due to poor choice of metal, eg
one that does not form oxides, or by
inadequate preparation of metal to be
bonded to porcelain.15 When the metal-
ceramic bond fails, it leads to delamination
of porcelain from the metal or adhesive
failure.
Firing protocols
During firing procedures, a
material with low thermal conductivity
will be incompletely baked, hence
becoming more prone to chipping
fracture.17 Also, any mismatch between
the coefficient of thermal expansion of
the core porcelain and the veneering
porcelain will generate residual stresses
and promote fracture. During the
cooling phase, the difference in thermal
conductivity of core and veneer porcelain
results in residual stresses. These stresses
bring about adhesive failure of the
restoration.15
Faulty polishing and glazing
Glazing helps reduce the
depth and width of flaws present in the
ceramic surface,15 hence is considered
a ceramic-strengthening method.35
Any fault in glazing or polishing would
hamper the strength of ceramic.
Conclusion
Failure of a metal-ceramic
restoration is a complex phenomenon. A
critical review of the available literature
revealed a multitude of factors that may
play a role in the mechanical failure
of metal-ceramic restorations. These
factors may be as simple as a single
episode of blunt trauma or may be
complex, involving a combination of
issues related to material properties,
restoration design and fabrication. To
optimize the performance of metal-
ceramic restorations, the clinician needs
to understand all the factors affecting the
 FixedProsthodontics
restoration’s longevity. This will enable the
clinician to exploit the material’s strengths
and compensate for its flaws.
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