Clinically relevant approach to failure testing of all-ceramic restorations

J. Robert Kelly, DDS, MS, DMedSca

National Institute of Standards and Technology, Gaithersburg, and Naval Dental Research Institute
Detachment, Naval Dental School, Bethesda, Md.
Statement of problem. One common test of single-unit restorations involves applying loads to clinically
realistic specimens through spherical indenters, or equivalently, loading curved incisal edges against flat
compression platens. As knowledge has become available regarding clinical failure mechanisms and the
behavior of in vitro tests, it is possible to constructively question the clinical validity of such failure testing
and to move toward developing more relevant test methods.
Purpose. This article reviewed characteristics of the traditional load-to-failure test, contrasted these with
characteristics of clinical failure for all-ceramic restorations, and sought to explain the discrepancies. Litera-
ture regarding intraoral conditions was reviewed to develop an understanding of how laboratory testing
could be revised. Variables considered to be important in simulating clinical conditions were described,
along with their recent laboratory evaluation.
Conclusions. Traditional fracture tests of single unit all-ceramic prostheses are inappropriate, because they
do not create failure mechanisms seen in retrieved clinical specimens. Validated tests are needed to elucidate
the role(s) that cement systems, bonding, occlusion, and even metal copings play in the success of fixed
prostheses and to make meaningful comparisons possible among novel ceramic and metal substructures.
Research over the past 6 years has shown that crack systems mimicking clinical failure can be produced in
all-ceramic restorations under appropriate conditions. (J Prosthet Dent 1999;81:652-61.)

CLINICAL IMPLICATIONS
Ideally, laboratory failure tests should provide meaningful information to clinicians
comparing all-ceramic restorative systems and aid in elucidating clinically important
variables. For test data to be relevant, laboratory tests should cause the same type(s) of
damage observed to occur in cases of clinical failure. Laboratory tests that create dam-
age uncharacteristic of clinical situations provide misleading guidance to clinicians.

L aboratory load-to-failure tests attempt to simulate

clinical failure to investigate variables thought to influ-
ence the success of fixed prostheses and to evaluate new
materials or designs. These tests involve loading the
occlusal surface of fixed prostheses with spherical
indenters, or equivalently using a flat compression
platen against a curved incisal edge.1-15 Although
investigators have evaluated parameters such as tooth
preparation, various core and veneering materials, lut-
ing agent type and thickness, and substructure elastic
modulus, little attention has been paid to the stress
state at failure or to the mechanism by which failures
occurred during testing. More importantly, no work
has been done to validate the clinical relevance of data
from such testing.
Many important characteristics associated with labo-
ratory testing are simply not consistent with common
Presented at the 80th annual meeting of the Academy of Prostho-
dontics, Colorado Springs, Colo., May 1998.
aGuest Scientist, Dental and Medical Research Group, National
Institute of Standards and Technology; and Associate Professor,
Research Department, Naval Dental School.
features reported from clinical experience or the exam-
ination of failed prostheses. Examination of clinically
failed glass-ceramic crowns revealed that failures initiat-
ed from flaws and stresses existing at the cementation
surface as opposed to damage on the occlusal sur-
face.16-18 In contrast, as will be discussed later, tradi-
tional laboratory tests induce failure from indentation
damage at the occlusal surface. Another problematic
characteristic of traditional load-to-failure testing is
that extremely high loads are required (often 1500 to
5000 N)1,2,4,5,9,13,15 compared with those measured
during mastication and swallowing (approximately 5 to
364 N),19-23 or the maximum force recorded during
clenching efforts (approximately 216 to 890 N).24-28
Further, traditional laboratory tests are suspect in that
failures involve the production of a great number of
fragments (versus the 2 fragments typical of clinical fail-
ure). Energy is required to create new surfaces during
fracture, with the stress at failure being directly related
to the surface area created. Crushing damage accompa-
nied by formation of powder-like debris is not uncom-
mon beneath the loading site during such tests, indi-

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KELLY
Fig. 1. Cemented all-ceramic restorations comprise tri-material structures in which ceramic is
fully supported by and often bonded to dentin. High tensile stresses develop directly below
loaded area in ceramic at its interface with cement. These tensile stresses are far more sensi-
tive to stiffness of supporting material (core material or dentin) than to ceramic thickness.
cating that a high amount of energy was stored and
then released during testing.
On the basis of the above mentioned discrepancies,
the conditions created during traditional failure tests do
not appear to faithfully reproduce those seen clinically.
Therefore it is of interest to explore reasons why this
seemingly sensible traditional approach has led to spuri-
ous results and how such testing can be improved. Stress
conditions during contact loading and the subsequent
failure response of brittle materials are governed by
some well-known variables, including load, contact area,
and the elastic moduli of the 2 materials in contact.29 In
addition, intraoral failure most likely involves the active
participation of water, a phenomenon termed “chemi-
cally assisted crack growth” or “static fatigue.”30,31
This article examines these variables along with their
likely role in clinical failure from the perspective of a
person engaged in designing laboratory research. This
information will then be used to explore the develop-
ment of a meaningful laboratory fracture test for all-
ceramic single-unit fixed partial dentures.
DEFINING THE PROBLEM
Ceramics supported by dentin
Elementary beam theory cannot be used to examine
a cemented crown or to predict its clinical behavior.
Homogeneous all-ceramic restorations consist of a
layer of ceramic (approximately 1.0 to 2.0 mm thick)
atop a layer of cement (approximately 30 to 120 µm
thick) supported by a thickness of dentin (Fig. 1). This
structure is not well represented by simple bar-shaped
specimens such as those used in 3-point or 4-point
bending tests. For such bar specimens, tensile stresses
leading to fracture depend on distances between the
JUNE 1999
THE JOURNAL OF PROSTHETIC DENTISTRY
supports and load points (namely, the moment arm),
the width of the bar, and the square of the thickness of
the bar in a simple mathematical relationship derived
from solid mechanics.32 Unlike the simple specimen for
bending tests, clinical ceramics are uniformly support-
ed on a relatively elastic foundation (and often bonded
to it) (Fig. 1). This raises the complexity of the stress
solution such that only finite element methods or iter-
ative mathematical approximations can be used to solve
for the stresses as a function of load.33
For a ceramic layer uniformly supported by and
bonded to a less stiff material, high tensile stresses
develop in the ceramic at its interface with the cement,
directly below the loaded area as shown in the repre-
sentation of a finite element result in Figure 1.34,35
These interfacial stresses arise from strain differences in
the ceramic, cement, and dentin because of the ceram-
ic being much stiffer (higher elastic modulus) than
either the cement or the dentin. These tensile stresses
are extremely sensitive to the ratios of elastic moduli
between the ceramic and the cement and dentin, and to
a much lesser extent the thickness of the ceramic and
the cement.35 Figure 2 illustrates the calculated maxi-
mum tensile stresses as a function of thickness for iden-
tical bars of veneering ceramic either bonded to dentin
or loaded in 3-point bending (3 × 12 mm bar; 400 N
load; 10 mm support for 3-point bending). Compared
with the bar in 3-point bending, the bonded ceramic is
virtually insensitive to thickness variations from 0.5 to
2.5 mm and is actually predicted to sustain less stress
at 0.5 mm than at 1.5 mm or 2.5 mm (35.6 MPa,
44.6 MPa, and 39.5 MPa, respectively). Better perfor-
mance at 0.5 mm is attributed to the compressive
stresses directly below the indenter countering tensile
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Fig. 2. Calculated maximum tensile stresses as function of thickness for identical bars of
veneer porcelain either bonded to dentin or loaded in 3-point bending (10 mm support).
Stresses in bend bar follow (thickness)2 relationship, whereas bonded ceramic is virtually
insensitive to thickness variations from 1.0 to 2.5 mm.

stresses at the ceramic-cement interface.35 It remains to
be seen whether this effect can be taken advantage of
clinically, although the phenomenon may partially help
to explain the high success experienced with veneer
restorations.
In addition to not following the thickness-squared
relationship for stresses developed in simple beams,
bonded ceramics develop higher stresses for a given
load as the elastic modulus of the supporting materials
is decreased; 33 therefore stiffer cores may be better.
One prediction from this effect is that at a given load,
ceramic crowns cemented to cores of either a high alu-
mina ceramic or a nickel-chromium alloy will develop
less cementation surface stress than crowns cemented
to resin composite cores. Taking this reasoning one
step further, the predicted ranking of core materials
based on such structural considerations would be as
follows: high alumina ceramic (most appropriate; for
example, In-Ceram, Vita Zahnfabrik, Bad Sackingen,
Germany) ≅ nickel-chromium alloy > gold-based or
palladium-based alloy > high leucite ceramic (OPC,
Jeneric/Pentron, Wallingford, Conn.; or Empress,
Ivoclar AG, Schaan, Liechtenstein) > dentin > resin
composite (least appropriate).
Contact stresses and crack systems
There are at least 3 distinctly different crack systems
that can develop in a uniformly supported piece of
ceramic, arising from 3 distinctly different stress
states29,35: (1) sharp indentation stresses, (2) blunt
indentation stresses, and (3) cementation surface
(interfacial) stresses. If the contact area is small, as in
the case of sharp indentation, median-radial crack sys-
tems occur (Fig. 3, A). These cracks open onto the sur-
face on unloading, and the surface crack traces are
clearly visible. Lateral cracks can also develop during
the unloading phase of sharp indentation (Fig. 3, A).
Such lateral cracks can propagate to the surface resulting
in material loss by chipping. Under blunt indentation,
Hertzian cone cracks will pop-in from initial ring cracks
located just outside of the contact area on the loaded
surface (Fig. 3, B). For bonded dental ceramics, Hertz-
ian-origin cracks may not propagate to the cement inter-
face, but instead have been observed to turn away from
the interface as indicated by the dotted line extension to
the cone crack illustrated in Figure 3, B.35 When surface
contact stresses around a blunt indenter are kept low
enough to avoid Hertzian ring and cone formation, a
single crack can preferentially be developed from the
cementation surface of the ceramic and propagated
toward the loaded surface (Fig. 3, C). Initially, while
still under the original load, this crack will be arrested
as it encounters a large compressive stress field below
the indenter. However, once this large crack exists in

654 VOLUME 81 NUMBER 6

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A B

Fig. 3. Three crack systems that can result from indentation or loading of bonded ceramics:29, 35
(A) sharp indentation radial, median, and lateral cracks (shown in both surface and sectional
views); (B) blunt indentation Hertzian cone cracks (surface and sectional views shown); and
(C) cracks originating from cementation surface (sectional view only). Hertzian cone cracks
(B) observed to deviate away from bonded interface for dental porcelain bonded to less stiff
material, as indicated by dashed line.35

the ceramic part, complete failure is virtually assured

under loading from a slightly different angle or under
cyclic loading conditions.
Cracks in clinically failed and laboratory-
tested prostheses
Clinically failed ceramic crowns reveal features that
are quite consistent with those of the cementation sur-
face crack type in Figure 3, C.16-18 Cracks in clinical
crowns were not reported to begin from damage at the
occlusal surface, as would be the case for the crack sys-
tems presented in Figure 3, A and B. Clinical failures
were found to initiate from flaws and stresses located at
the cementation surface of ceramic crowns. In some
fracture surface views from clinical cases, wear facets are Fig. 4. Gold-coated fracture surface of glass-ceramic canine
loaded to failure against flat compression platen (at row of
seen directly opposite from the failure origin, providing
small arrows). Numerous fracture surface features,36 includ-
strong evidence that these crowns were broadly loaded ing twist hackle (A), crack branching (A), and Wallner lines
in the manner of Figure 3, C and that failures did not (B) indicate that crack propagated from damage at cusp tip,
originate from damage at the wear facets. not from ceramic-cement interface (C).
In contrast, traditional laboratory load-to-failure
tests appear to create cracks consistent with those
shown in Figure 3, A and B. Figure 4 illustrates a gold-
coated, glass-ceramic canine broken as part of a tradi- interpretation that crack propagation occurred from
tional load-to-failure experiment. Numerous fracture contact damage at the cusp tip, not from the ceramic-
surface features, for example, twist hackle, crack cement interface. The crown in Figure 4 was from a set
branching, Wallner lines,36 are consistent with the of 50 glass-ceramic canines found to belong to a single

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THE JOURNAL OF PROSTHETIC DENTISTRY
failure distribution and for which crushing damage and
both Hertzian cone cracks and median cracks (Fig. 3, A
and B) were commonly observed with no instances of
cementation interface crack initiation.37 Similar obser-
vations can be made from published photographs of in
vitro test specimens.7,9,10,13 Thus, data collected dur-
ing this type of laboratory testing are clinically invalid
as a result of: (1) an incorrect stress state, (2) failure
occurring from contact damage flaws instead of “nat-
ural” cementation surface flaws, (3) crack systems caus-
ing failure not seen in bulk clinical fracture, and (4) the
failure loads being too high for clinical significance.
These crowns failed from artificial damage caused by
inappropriate loading under the wrong environmental
conditions.
UNDERSTANDING CLINICAL
CONDITIONS TO BE MODELED
Clinical contact stresses
Loaded restorations and teeth develop features that
have come to be called “wear facets.” Clinicians recog-
nize that wear facets are usually not point contacts, but
have dimensions of approximately 0.5 to 3.0 mm in
diameter. Unfortunately, the sizes and size distributions
of wear facets does not appear to have been document-
ed in the literature, except for anthropologic studies of
aboriginal populations38, 39 and hominid remains.40,41
However, the size of this contact area along with the
loads generated during chewing and bruxism have a
significant influence on which damage mechanisms are
likely to predominate intraorally. Therefore it is impor-
tant to at least determine a likely range for these values
as a guide to laboratory test development.
Average total contact area on posterior teeth during
maximum intercuspation has been reported to be
52 mm2 for females and 64 mm2 for males.42 On the
basis of these contact areas, even at an extreme load of
3500 N, simple contact pressures would only reach
between 55 and 67 MPa. However, chewing or brux-
ism forces are more likely being delivered not to the
whole arch but to opposing quadrants or tooth groups.
Further, it is more realistic for purposes of experimen-
tal design to consider functional forces (that is, chew-
ing, swallowing, and bruxism) than to base tests on the
maximum force achievable by extreme persons. It is
also common in experimental design to chose average
values or a range of values that fall within the “enve-
lope” of reported data. One research group extensively
involved with simulating the conditions of mastication
has chosen the range of 9 to 180 N.43 Average maxi-
mum biting forces on premolars and molars are report-
ed to be between 150 and 665 N.44 Posterior forces,
especially when high, are not likely to be delivered to
only 1 tooth but will be distributed. With the previ-
ously mentioned caveats in mind, calculated contact
pressures range between 3.5 and 890 MPa assuming:
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KELLY
(1) simple contact between 2 facets of similar material;
(2) contact occurring simultaneously at 4 circular wear
facets of between 0.5 mm and 3.0 mm in diameter; and
(3) the load range being 100 to 700 N.
Simulating clinical contact stresses
It also is of interest to know how to design a labora-
tory experiment with spherical indenters to create the
range of contact pressures calculated previously (3.5 to
890 MPa). Contact pressures (P) between spheres and
flat surfaces of different materials, as used in tradition-
al load-to-failure testing, can be calculated with the
following relationships29:
1 4kr2
3E1 2⁄3 L1⁄3
P= •
π
where k is given by:
9 E1
k= ·[(1 – v12)+(1 – v22)· ]
16 E2
with elastic modulus E1 of the flat surface material and
E2 of the spherical surface material; v1 and v2 are the
respective Poisson’s ratios; L the applied load; and r the
radius of the spherical indenter. Figures 5 and 6 depict
the contact pressures and contact radii developed
below steel spheres (E2 = 180 GPa; v2 ≈ 0.25) loading
dental porcelain (E1 = 70 GPa; v1 ≈ 0.25) for various
ball sizes.
Steel indenter balls would need to have diameters
between 40 mm to 1 m so as to develop clinically real-
istic contacts (Fig. 5); namely, 0.5 to 3 mm diameter
(clinical wear facet size) at contact pressures of 5 to
890 MPa for loads between 100 to 700 N (encom-
passing the range of realistic average maximum bite
forces as developed previously). Traditional load-to-
failure tests have typically used spherical steel indenters
of well below 10 mm in diameter, conditions that can
be placed into perspective with reference to Figure 6.
Contact pressures beneath a 5-mm diameter steel ball
on dental porcelain (for 100 to 700 N loads) would be
1384 to 2648 MPa on contacts of only 0.3 to 0.6 mm
in diameter. Traditional tests often require loads of
1500 to 3000 N to generate failure.1,2,4,5,9,13,15 For
comparison purposes, Figure 6 illustrates this tradition-
al failure test region (2 to 4 mm diameter balls; 1500
to 3000 N load).
Tooth-to-tooth contacts do not appear to be well
represented experimentally by small steel balls. Such
spherical indenters cause failure from mechanisms not
seen clinically. Similarly, high contact stresses would be
generated between a curved incisal edge and a flat com-
pression platen. High contact pressures favor the medi-
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KELLY THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 5. Calculated contact facet size and contact pressure developed by steel intenter balls of
various sizes on dental porcelain. For loads of between 100 to 700 N, steel indenter balls
would need to have diameters between 40 mm to 1 m to develop clinically sized contacts of
0.5 to 3 mm diameter at pressures of 5 to 890 MPa. Load ranges for mastication and bruxism
are defined in text.

Fig. 6. Expansion of Figure 5 to include higher contact pressures developed during tradition-
al tests. Such tests often use 2 to 4 mm diameter balls and require loads of 1500 to 3000 N
to generate failure, conditions contained within gray box to right. Clinically relevant region
from Figure 5 appears as tall box region to left (filled dots represent realistic ball sizes/load
conditions).

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THE JOURNAL OF PROSTHETIC DENTISTRY
an-radial cracks and Hertzian cone cracks that occur at
the contact surface as illustrated in Figure 3, A and B,
and in an actual test specimen in Figure 4, which was
produced using a curved canine against a flat platen.
These cracks do not involve either the flaws or stresses
located at the cementation interface that are responsi-
ble for clinical failure. In addition, the critical load to
initiate a Hertzian crack (Pc) increases linearly as the
radius of the indenter (r) increases in a proportionality
known as the Auerbach Law (Pc ∝ r).45 For spherical
indenters larger than 35 mm in radius the proportion-
ality shifts from linear to quadratic (Pc ∝ r2).46 The
Auerbach effect has been shown for dental porcelains37
and poses special problems where the prosthesis pro-
vides a curved surface (namely, central incisor and pos-
terior occlusal anatomy) because radii of curvature are
not easily controlled in fired dental porcelain.
Influence of cyclic loading under low loads
Chewing obviously consists of high numbers of low
cyclic loads. Certain engineering ceramics, including one
similar to the dental glass-ceramic Dicor (Dentsply
International, York, Pa.), accumulate damage during
low-load cyclic blunt indentation that is not seen during
single-load failure testing.47,48 This accumulated subsur-
face damage can weaken the ceramic specimen and is
thought by some to explain clinical failure.49 However,
2 factors suggest that this indentation-related concept
lacks any general clinical relevance in the case of bulk
fracture. First, no accumulated microstructural damage,
as reported in other works,47-49 was identified during
SEM examination of the failure origins of clinically failed
glass-ceramic crowns.16-18 Such damage would have
been quite prominent if it existed. Second, cemented
feldspathic (leucite-filled) crowns were not weakened by
cyclic loading for 1 million cycles at loads well above
those associated with chewing (up to 800 N).50 The
mean failure loads for these crowns was found to be
1563 N, regardless of whether they were cyclically
loaded or what load was used (200, 400, 600, or
800 N). It may be significant that the cementation sur-
face of these silane-treated and resin-bonded crowns was
likely quite dry and well-protected from atmospheric
moisture. Under dry conditions, low cyclic loads alone
do not appear to lead to any cementation surface dam-
age accumulation in feldspathic ceramics and cannot
alone be used to induce failure under appropriate clini-
cal loads. The mean load of 1563 N is still too high for
clinical significance, even though the correct crack sys-
tem was involved (cementation surface cracks without
any Hertzian ring or cone cracks).
Role of water in brittle fracture
Since 1958, it has been recognized that water can
act chemically at crack tips to decrease the strength of
glasses and ceramics.30,31 Dental ceramics have been
658
KELLY
shown to be sensitive to water in static strength
tests,51,52 under cyclic loading,53 and in measurements
of the fatigue (or slow crack growth) exponent.54,55 At
least 1 research group has evaluated hydrophobic
silanes as moisture barriers to improve clinical longevi-
ty.56 Water is available to all external surfaces from sali-
va; however, it should be noted that the cementation
surface is also exposed to water available from the
dentin and from transport through dental cements.
Although chemically assisted crack growth is likely to
be involved in clinical failure, it is rarely if ever includ-
ed in traditional laboratory tests. No known work
attempts to link slow crack growth behavior of various
ceramics to clinical failure rates.
TOWARD SIMULATING CLINICAL
FAILURE
Producing the appropriate crack system
The use of large balls (>40 mm in diameter) to load
all-ceramic prostheses is unrealistic for laboratory
experimentation. However, large radii can be machined
onto the ends of steel pistons to create contact stresses
and contact areas within the target range calculated
previously, based on clinical observations and measure-
ments. Flat pistons should be avoided because they can
become edge-loading as the ceramic deforms slightly
beneath the piston. Another benefit to large radii is that
contact pressures do not increase as fast with increasing
load as they do with small balls (Figs. 5 and 6), so that
it is easier to avoid the initiation of Hertzian and medi-
an-radial cracks. Thin sheets of polyethylene can also be
interspersed between the large radius piston and the
specimen to further assure a broad even contact. Such
a technique35 has been tested successfully, routinely
creating cementation surface cracks beneath bars of a
feldspathic porcelain, and it has been further developed
for single units, to be discussed as follows.
Creating meaningful failure data
Ceramic restorations should fail in the laboratory
from the same flaw type and size, causing failure intra-
orally. To enhance this probability, the cementation
surface of laboratory specimens should be created and
treated as closely as possible to clinical situations. Flaws
can either be inherent to the microstructure of the
ceramic, for example, cracking around leucite grains
during cooling, or can result from processing steps
(such as sandblasting, diamond grinding). It is unlikely
that the same flaw populations would exist at the sur-
face of ceramic test bars machined from large blocks as
in test bars fabricated of the same material that was
pressed into and then recovered from a gypsum mold.
Correct failure stresses also need to be created to
induce realistic fracture. Cementation surface stresses
are a function of the elastic moduli of the support and
cement, the thickness of the ceramic and cement, the
VOLUME 81 NUMBER 6
KELLY
shape of the ceramic, and the applied load. Again, as for
flaws, the best approach is to test specimens that are as
close to clinical restorations as possible. Thickness and
shape are best controlled by creating clinically relevant
test specimens. Popular cements should be chosen (and
these have a narrow range of elastic properties), which
leaves only the dentin to be correctly modeled. Because
the stresses of interest are being created during blunt
loading, it makes sense to evaluate candidate dentin
substitutes in a similar fashion. Stress-strain behavior
(both elastic and plastic) can be evaluated by blunt
indentation at various loads.57 On the basis of such
testing, an epoxy matrix containing woven glass fibers
was chosen as approximately representing the elastic
and plastic (permanent deformation) response of
dentin during blunt loading.58 Such materials are easi-
ly machined into replicas of prepared teeth (or disks)
for use during laboratory testing.
As previously stated, cracks originating from the
cementation surface can be reproducibly formed dur-
ing static testing when blunt loading is used under con-
ditions that avoid Hertzian cone cracking. However,
the usual method of detecting breakage or failure, a
sharp drop in load, cannot be used. The “pop-in” of a
cementation surface crack is not accompanied by any
drop in the load, because the test piece is still uniform-
ly supported on its base and continues to fully support
the loading piston. For bars of feldspathic porcelain,
the load for crack pop-in could be determined by trans-
illumination.35 Cracks were identified both visually and
with a digital photometer. However, when testing full
crowns, it is quite difficult to detect the occurrence of
crack pop-in by such a technique during loading. For
full-crown specimens, acoustic monitoring was found
to be a reliable method for crack detection.58
Failure under wet cyclic loading
Loads for cementation-surface cracking under dry,
static testing were still too high to be meaningful clini-
cally (1563 N), even after cyclic loading for 1 million
cycles at 800 N, which represents approximately 1 year
of constant bruxism. However, when identical speci-
mens modified with tiny channels (pseudodentin
tubules) were submerged in water for 2 months before
testing and then cyclically loaded under water, the mean
failure load dropped to 275 N, well within the range
reported for clinical loads.50 In this experiment, the
presence or absence of cracking was evaluated by transil-
lumination at the end of the 1 million cycles of loading.
Subsurface (cementation surface originating) cracks
were easily detected when present, and there were no
instances of Hertzian ring or cone cracking or cracking
from damage at the loaded surface (examined by
Nomarski interference contrast microscopy at ×10).50
This mean failure load of 275 N was that measured
after the equivalent of approximately 1 year of function;
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THE JOURNAL OF PROSTHETIC DENTISTRY
1 million cyclic loads that included contributions from
mastication and swallowing.44,59 Such a mean cyclic
load would be expected to be lower than that measured
from a static test (single increasing load until failure)
under wet conditions as predicted from mathematical
models describing the relationship between static and
cyclic stress states.60 Likewise, mean failure load might
also be expected to shift to even lower loads at 2 or 3
years. Time to failure under cyclic versus static condi-
tions is quite sensitive to the slow crack growth expo-
nent (n, describing the sensitivity of the ceramic to
chemically assisted crack growth), as per the following
approximation60:
tc σs n
ts
≅ g –11 2
σa
where tc = time to failure under cyclic conditions;
ts = time to failure under static conditions; σs = static
failure stress; σa = cyclic stress amplitude; and factor,
g-1, is obtained using a series solution for sinusoidal
stresses.60
On the basis of the above relationship, the predicted
wet static mean failure load would be 684 N, or
approximately 44% of the 1563 N value found during
dry static testing (assuming: [1] linear elastic fracture
mechanics, so load and stress can be directly related;
[2] a static failure time of approximately 5 seconds; [3]
a mean 1-year cyclic failure load of 275 N; and [4] n =
27 for the slow crack growth exponent.)55
Figure 7 illustrates calculated mean failure loads ver-
sus days of function, assuming 1 million cycles per year,
data that were collected from analogs of single-unit
prostheses that were fabricated and cemented accord-
ing to common dental laboratory and clinical prac-
tices.50 It is noted that the prediction in Figure 6 that
mean failure loads decrease most dramatically in the
first days after insertion and are not predicted to
decrease in likewise fashion beyond 1 year. The predic-
tions in Figure 7 and the relationship between failure
loads and failure rates of a population of crowns are
worth exploring.
This lack of substantive linkage between traditional
laboratory results and clinical behavior leaves a number
of basic design questions unanswered. For example, is
the success of metal-ceramic crowns simply because of
the rigidity of the cast metal substructure? Alternative-
ly, does this successful prosthesis depend on unique
stress distributions, moisture barrier effects, or crack
bridging that can be replicated by materials other than
cast alloys? How thin can the metal be and where must
it be used within the substructure? How does one eval-
uate different coping designs and materials, including
powder metallurgy and various foil products? Can an
appropriate cement be developed to substitute for the
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Fig. 7. Measured and calculated failure loads for wet and dry conditions under both static and
cyclic loading. Measured failure loads (dots) were collected from analogs of single unit pros-
theses fabricated and cemented according to common practices.50 Graph assumes that 1 mil-
lion cyclic loads (mastication and swallowing) occur per year.

metal coping if the cement is well-bonded to the
ceramic and dentin? Why did glass-ceramic crowns
bonded with methacrylate-based cements have such
improved survival rates versus crowns cemented with
zinc phosphate cements?61 A new cement adaptation
theory addressing this last question was recently pro-
posed and awaits testing.62
These are all questions of genuine interest that
deserve far more fundamental thought than they have
received. Answers to these and related questions await
the use of validated structural tests and mathematical
models developed in conjunction with further elucida-
tion of clinical failure mechanisms.
CONCLUSIONS
Significant differences were found between the fail-
ure behavior created during traditional load-to-failure
tests and that observed to have occurred during clinical
failure of all-ceramic restorations. Traditional loading
conditions created contact stresses that favor the for-
mation of median-lateral crack systems, Hertzian cone
cracks, and localized crushing damage: None of which
are reported to cause the bulk failure of clinical all-
ceramic restorations. Thus, it appears that traditional
laboratory tests do not (1) create appropriate stress
states, (2) cause failure from clinically relevant flaws, or
(3) create crack systems modeling clinical failure.
Much information in dental literature may be mis-
leading regarding comparative “strengths” of single
unit prostheses and the function of some clinically
important variables, including tooth preparation,
ceramic thickness, coping and veneering materials,
cementation and bonding procedures, cement type and
thickness, and coping design. Cracks that mimick clin-
ical failure can be produced at realistic intraoral loads
under the modified testing protocol described in this
article. It remains to be seen whether this testing
approach creates damage having relevance to modeling
the clinical behavior of metal-ceramic restorations.
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Reprint requests to:
DR J. ROBERT KELLY
DENTAL AND MEDICAL MATERIALS GROUP
NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY
100 BUREAU DR, MAIL STOP 8545
GAITHERSBURG, MD 20899-8545
FAX: (301)963-9143
E-MAIL: robert.kelly@nist.gov
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