d e n t a l m a t e r i a l s 3 3 ( 2 0 1 7 ) 1012–1020

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Monolithic zirconia dental crowns. Internal fit,

margin quality, fracture mode and load at fracture

Christian Schriwer ∗ , Anneli Skjold, Nils Roar Gjerdet, Marit Øilo

Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Norway

a r t i c l e i n f o a b s t r a c t

Article history: Objective. Dental all-ceramic restorations of zirconia, with and without an aesthetic veneer-
Received 10 March 2017 ing layer, have become a viable alternative to conventional metal-ceramic restorations. The
Received in revised form aim of this study was to evaluate whether factors of the production methods or the mate-
18 May 2017 rial compositions affect load at fracture, fracture modes, internal fit or crown margins of
Accepted 13 June 2017 monolithic zirconia crowns.
Methods. Sixty crowns made from six different commercially available dental zirconias were
produced to a model tooth with a shallow circumferential chamfer preparation. Internal
Keywords: fit was assessed by the replica method. The crown margin quality was assessed by light
Dental crowns microscopy on an ordinal scale. The cemented crowns were loaded centrally in the occlusal
Anatomic contour fossa with a horizontal steel cylinder with a diameter of 13 mm at 0.5 mm/min until fracture.
Zirconia Fractographic analysis was performed on the fractured crowns.
CAD/CAM Results. There were statistically significant differences among the groups regarding crown
Fractographic analysis margins, internal fit and load at fracture (p < 0.05, Kruskall Wallis). Fracture analyses revealed
Fracture strength that all fractures started cervically and propagated to the occlusal surface similar to clinically
Ceramics observed fractures. There was statistically significant correlation between margin quality
and load at fracture (Spearman’s rank correlation, p < 0,05).
Significance. Production method and material composition of monolithic zirconia crowns
affect internal fit, crown margin quality and the load at fracture. The hard-machined Y-TZP
zirconia crowns had the best margin quality and the highest load at fracture. Reduction
of margin flaws will improve fracture strength of monolithic zirconia crowns and thereby
increase clinical success.
© 2017 The Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

(Y-TZP) popularly called “zirconia” has been the most com-

1. Introduction mon dental high-strength ceramic for some years. Y-TZP
contains only polycrystalline particles in a metastable tetrag-
The production methods for dental ceramics have improved
onal crystal structure, and is the dental ceramic material
greatly over the years [1–3]. Increased proportion of crys-
with the highest fracture strength available today [5,6]. Dental
talline particles has led to higher resistance to functional
zirconias are mainly used for crowns, fixed dental pros-
loads, but also changed the optical properties of the mate-
theses and implant components. The strength of zirconia
rial [2,4]. An yttria-stabilized tetragonal zirconia polycrystal
depends on the density of the polycrystalline particles and
quality of the product [7–10]. The manufacturing process
among the zirconia restorations differs with regard to mate-
∗
Corresponding author at: Aarstadveien 19, NO-5009 Bergen, Norway. rial composition, processing and machining process of the
E-mail address: christian.schriwer@uib.no (C. Schriwer).
http://dx.doi.org/10.1016/j.dental.2017.06.009
0109-5641/© 2017 The Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
 d e n t a l m a t e r i a l s 3 3 ( 2 0 1 7 ) 1012–1020 1013

Table 1 – The materials used with brand name, production method, material composition and grain size. Data from the
manufacturers. N/A = not available.
Code Brand name, manufacturer Production method Material composition Grain size
BX Prismatik BruxZir Milling Soft-machined ZrO2 , Yttria, N/A N/A
Blank
Glidewell laboratories Temp: 1530 ◦ C

DD Dental Direkt Soft-machined ZrO2 + HfO2 + Y2 O3 > 99%, 0,26–0,38 ␮m

Al2 O < 0,5%, other
DD Bio ZX2 oxides < 0,25%, Y2 O3 3%
Dental Direkt GmbH Temp: 1450–1550 ◦ C

ZZ ZirkonZahn, Soft-machined ZrO2 , Y2 O3 4–6%, Al2 O3 < 1% 0,3 ␮m

SiO2 < 0.02%, Fe2 O3 < 0.01%
Na2 O < 0.04%
ICE Zirkonia—Prettau Temp: 1600 ◦ C
Zirconia

PZ NobelProcera Crown Soft-machined ZrO2 + Y2 O3 + HfO2 ≥ 99.0%, 0,3–0,5 ␮m

Zirconia Y2 O3 > 4.5 to ≤6.0, HfO2 ≤ 5%,
Al2 O ≤ 0.5%. Other
Nobel Biocare oxides ≤ 0.5%. Temp: N/A
DY Denzir Y-TZP Hard-machined, >99,95 wt%: <0,5 ␮m
ZrO2 + Y2 O3 + HfO2 + Al2 O3
Denzir AB Temp??

DM Denzir Mg-PSZ Hard-machined 99,95 wt% av ZrO2 + MgO 30–40 ␮m

Denzir AB Temp: 1800 ◦ C

milling blanks [11,12]. The machining process can be “hard-

machining” or “soft-machining”. The hard-machined crowns
2. Material and method
are milled from a fully sintered milling blank of zirconia. In the
A synthetic premolar tooth was prepared with a circumferen-
soft-machining procedure a partially sintered milling blank of
tial shallow chamfer of 0.5 mm, a taper of 9–12◦ and rounded
zirconia is used, which is fully sintered after the milling [13].
edges. An A-silicone impression (Affinis, 3M Espe, Minneapo-
The soft-machined restorations are milled 20% oversized to
lis, USA) was taken of the preparation and sent to a dental
compensate the subsequent shrinking during sintering [13].
technician laboratory (Tannlab). The laboratory made a cast
Traditionally, zirconia has been used as a core material cov-
model and digitally scanned the model and designed a full-
ered entirely with a weak, veneering ceramic. This bi-layered
contour crown. The file was sent to 5 different manufacturers
core-veneer structure is prone to chipping and also requires
who made 10 identical crowns from 6 different brands. The
excessive removal of tooth substance [14,15]. Most dental zir-
crowns were tooth colored, monolithic zirconia crown mate-
conias can, however, be produced as monolithic restorations,
rial. The materials differed with regard to both composition
without veneering ceramic. The monolithic structure reduces
and manufacturing method (Table 1).
the chipping problems of veneering ceramic and reduces the
need for removal of sound tooth substance. In order to achieve
aesthetically acceptable monolithic restorations some alter-
ations in translucency, colour and appearance of the normally
very white Y-TZP have been necessary [16,17]. To achieve
2.1. Internal fit
clinically tooth-like translucency and colour of the zirconia
Internal fit was measured by the replica method [19]. Two
materials, several different alterations in the manufacturing
compatible impression materials (Fit-checker, GC Corporation
process can be applied [7,18]. For instance, smaller crystals
Tokyo, Japan and Xantropren, Heraus Kulzer, LLC) were used to
increase translucency [18]. A larger proportion of cubic crys-
make an impression of the gap between the abutment and the
tal structure achieved by higher sintering temperature and
crown with low viscosity silicone material. The thin silicone
increased yttria content, will also increase translucency [18].
cement film was stabilized with a contrast colored silicone
Inclusion of other oxides will alter colour and increase opacity
material after separation from the abutment and this unit was
[16]. It is uncertain to what extent the differences in the man-
removed from the crown and cut in two and the thickness
ufacturing process affect the properties and clinical success
was measured by light microscopy (Leica M205C, Heerbrugg,
of the final dental restorations.
Switzerland). The internal fit was measured at seven points.
The aim of this study was to assess whether factors of
Five crowns in each group were measured in a transverse cut
production methods and material composition affect load at
in the mesio-distal direction and five in the bucco-palatinal
fracture, fracture modes, internal fit and crown margins of
direction. Four measurements were measured from the gap
monolithic zirconia crowns.
on the axial walls and three from the occlusal part of the
preparation in each crown.
1014 d e n t a l m a t e r i a l s 3 3 ( 2 0 1 7 ) 1012–1020

Fig. 1 – Grading scale for crown margin quality assessment with images representing each grade. The horizontal white bar
indicates 0.5 mm. Arrows pointing out a defect.

2.2. Margin quality

Each crown was inspected in a light stereomicroscope (Leica

M205C) equipped with a LED ring light. The examination
was performed by two operators and pictures were taken at
10 and 20× magnification for documentation. The number
and severity of the margin defects were recorded and graded
according to a severity scale developed specifically for this pur-
pose (Fig. 1). The inter-operator reliability was 0.709 (Cohen’s
Kappa).

2.3. Load at fracture

The crowns were cemented to epoxy (EpoFix, Struers A/S,

Denmark) model copies of the preparation using glassionomer
cement (Fuji One, GC Corporation Tokyo, Japan). Excess
cement was removed, and the crowns placed in distilled water
at 37 ◦ C for 24 (±1) hours. The crowns were subsequently
Fig. 2 – The crowns were cemented to epoxy models of the
loaded centrally at the occlusal surface with a horizontal steel
preparation with glassionomer cement and subsequently
cylinder with a diameter of 13 mm a in a servo hydraulic mate-
loaded in the central fossa at 0.5 mm/min until fracture.
rial testing system (MTS 852 MiniBionix II, Minn., USA) at
The horizontal steel cylinder indenter was cushioned with
0.5 mm/min until fracture. The steel cylinder was cushioned
a rubber disc to avoid contact damages.
with a 3 mm thick rubber disc of hardness 90 Shore A, to avoid
contact damages (Fig. 2). The specimens were submerged in
water at 37 ◦ C during loading. Load at fracture was recorded.

Spearman’s rank correlation test was used to evaluate cor-

2.4. Fracture modes
relations between the variables.

The fractured crowns were analyzed by fractographic methods

by light microscopy to detect the location of fracture origin and
to determine the crack propagation [20]. Some specimens were
further examined by scanning electron microscopy (SEM). The
fracture modes were compared to fracture modes of compa-
rable crowns fractured during clinical function to assess the
clinical relevancy of the results. One fractured crown from
each group was examined in Scanning Electron Microscope
(SEM) to assess the microstructure and to validate the fracto-
graphic analyses.
2.5. Statistical analysis
Kruskall Wallis test was used for overall statistical anal-
ysis, and supplemented with Kruskall–Wallis equality-of-
populations rank test to analyze to differences among the
groups. Significance level was set to 0.05.
3. Results
3.1. Internal fit
There were statistically significant differences in internal fit
among the groups at the occlusal cement gap, (Kruskall Wallis,
p < 0.05, Fig. 3) There were no statistically significant differ-
ences among the groups regarding the axial gap.
3.2. Margin quality
There were statistically significant differences among the
groups regarding crown margin quality (Kruskall Wallis,
p < 0.05). The crowns in the hard-machined yttria-stabilized
DY-group had almost flawless margins and had statistically
significant fewer and less severe margin defects than the
 d e n t a l m a t e r i a l s 3 3 ( 2 0 1 7 ) 1012–1020
Fig. 3 – Tukey’s boxplot of the internal fit of the crowns. The
boxes represent the gap between the abutment and the
crown at the occlusal and axial walls. The bottom and top
of the box represent the first and third quartiles, with the
line within the box representing the median. The
maximum and minimum whisker represents the 1.5
interquartile range (IQR). The dots represent outliers
outside 3 IQR. There were statistically significant
differences in internal fit among the groups at the occlusal
internal fit (Kruskall Wallis-test, p < 0.05).
other groups (Kruskall–Wallis equality-of-populations rank
test, p < 0.05). The hard-machined magnesia-stabilized zirco-
nia had multiple severe flaws. The soft-machined crowns all
had flaws, but some groups had more severe defects than oth-
ers.
3.3. Load at fracture
There was a statistically significant difference in the load at
fracture among the different tested material groups (Kruskall
Wallis, p < 0.05, Fig. 4). Nineteen crowns did not fracture due
to the limitation value of the test set-up, their value were set
to 3200N. None of the crowns in the DY control group frac-
tured. The BX and the PZ group had statistically significant
weaker load at fracture than the other groups (Kruskall–Wallis
equality-of-populations rank test, p < 0.05).
There was a statistically significant correlation between the
severity of margin defects and the load of fracture (Spearman‘s
rank correlation, p < 0,05). The more and severe defects the
crown had, the lower load at fracture. There was no correlation
between the internal fit and load at fracture.
3.4. Fracture modes
The fractographic analyses showed that all fractures started
cervically at the crown margin. Most fracture origins could
also be traced back to defects localized at the crown margins
observed before the fracture. The fracture propagated towards
the occlusal surfaces and to the opposite cervical margin sim-
ilar to clinically observed fractures (Figs. 5–7). The appearance
of the fracture surfaces differed greatly among the groups. The
larger grained material (DM) displayed more tortuous fracture
1015
Fig. 4 – A Tukey’s boxplot of the mean load at fracture of
the different crown types tested. There were statistically
significant differences among the test groups (p < 0.05,
Kruskall Wallis). None of the crowns in the DY control
group fractured, their value was set to 3200N. The BX and
the PZ group had statistically significant lower load at
fracture than the other groups (Kruskall–Wallis
equality-of-populations rank test, p < 0.05).
See legend to Fig. 3 for explanation of labels.
surfaces than the smaller grained material (Fig. 7). Some mate-
rials displayed very obvious hackle lines (Fig. 6), while others
displayed relatively smooth fracture surfaces with a distinct
compression curl (Fig. 5). Their microstructure on the fracture
surface differed greatly among the groups (Fig. 8).
4. Discussion
Production of dental ceramic restorations involves several
processing steps that could cause defects in the finished
product [13]. The aim of this laboratory study was to iden-
tify whether the variables in the production process could
affect the clinical success of monolithic zirconia crowns. Over-
all, the present results indicate that both the production
method and the material composition influence the quality
of the crown margin, the internal fit as well as the load at
fracture. This study shows that the composition and proper-
ties of the milling blanks, defects and cracks developed during
the manufacturing process are important factors that influ-
ence the fracture load of ceramic crowns [7–10]. The different
manufacturers have blanks with different sintering tempera-
tures and grain sizes (Table 1) However, it is not possible to
determine whether it is sintering temperature, sintering time,
grain size or machining defects that affects the strength the
most, since some of the materials investigated varies in more
than one respect in the present study. The grain sizes of the
tested 3Y-TZP products vary from 0.26 to 0.5 ␮m. A grain size
between 0,2–1,0 ␮m for the 3Y-TZP is recommended to allow
sufficient t ⇒ m transformation for achieving crack arrest and
fracture toughness, but not an unwanted spontaneous t ⇒ m
transformation [21]. The products tested are all within this
1016 d e n t a l m a t e r i a l s 3 3 ( 2 0 1 7 ) 1012–1020

Fig. 5 – A fractographic map of a broken crown NobelProcera (PZ) where the fracture origin can be traced back to machining
flaws on the outside of the crown margins. Red triangle indicates the origin of fracture. Dotted large arrows indicate
direction of crack propagation through the specimen. Small full arrows indicate direction of fracture features such as hackle.
The two images at the bottom show the location of the fracture origin at the two fracture surfaces remounted. Seen from the
inside (left) and from the outside of the crown margin (right). (For interpretation of the references to color in this figure
legend, the reader is referred to the web version of this article.)

range. The grain size of 3Y-TZP can be manipulated with the
sintering temperature. With higher temperature of the sinter-
ing process, larger grain size is the result [22]. Lower sintering
temperature, results in smaller grain size and thus less t ⇒ m
transformation. Too low sintering temperature also causes
insufficient material density [23]. The sintering temperature
of the 3Y-TZP is normally between 1350–1550 ◦ C. The products
tested have sintering temperatures between 1450–1600 ◦ C and
thus in the normal area.
The hard-machined groups, DM and DY, had less varia-
tion in the internal fit than the soft-machined groups. This
may reflect the more complex production processes where
sintering shrinkage must be counterweighed during the pro-
cess involved in soft-machining. The mean cement gap in this
study ranged from 49,5 ␮m to 141,6 ␮m, indicating that the dig-
itally calculated shrinkage incorporated in the 3D models, may
not compensate for the actual shrinkage occurring during sin-
tering after machining. The mean variation is in accordance
with other studies [24,25]. However, there is no consensus on
the limit for clinical acceptable values for internal fit.
Variation in cement thickness can give different mechan-
ical and clinical complications. Previous studies have shown
 d e n t a l m a t e r i a l s 3 3 ( 2 0 1 7 ) 1012–1020 1017

Fig. 6 – The fracture origin is on the inside of the crown margin of this soft-machined zirconia Dental Direkt (DD). This is
probably due to a small machining crack form the processing, although it was not detected before the fracture loading.
Explanations of the symbols see Fig. 6.

that cement thickness can influence failure loads by to high
cement thickness can reduce failure loads on feldspathic
ceramics [26]. Too narrow axial cement gap prevent cement
escape at the crown margin, and thus result in poor seat-
ing and a thick occlusal cement layer. The present results do
not, however, indicate a correlation between occlusal cement
thickness and fracture load. The specimens in this experiment
were, however, not exposed to any aging or fatigue regimens
which may have an impact on the results for this parameter.
It is likely that the observed margin flaws are a result of the
machining procedure, since the restorations were not handled
further by hand after the milling before the margin inspections
were performed [27]. There are obvious differences in the two
processes for soft-machining and hard machining. It has been
expected that the hard machining procedure results in more
machining damage [28], but our results suggest that this is not
the case.
The finding that the magnesia-stabilized hard-machined
zirconia crowns had more flaws at the margins than the
yttria-stabilized ones, may be a result of a larger grain size
of the magnesia-stabilized zirconia, between 30 and 40 ␮m,
compared to the conventional Y-TZP with a grain size of
approximately 0,2–0,5 ␮m [29].
The limitation of the present study is that it has been
performed with static loading on pristine specimens. Future
research should include aging, fatigue and dynamic loading to
failure to further increase the clinical relevancy of the results.
It can be expected that aging of the zirconia would result in
lower loads due to low temperature degradation (LTD) [30].
Every crown in clinical use is subjected to complex forces,
thermal and chemical exposure, which would lead to LTD.
Moreover, adjustments performed by the dentist or the den-
tal technician will further weaken the crowns. The absence
of these factors can explain the high loads at fracture in this
experiment.
The method used for fracturing crowns in this study has
previously demonstrated to create clinically relevant fracture
modes [31]. Fracture analysis showed that all the 41 fractured
in this study started cervically similar to the mode observed
in clinically failed zirconia crowns [32,33]. Fracture initiation
at a defect is expected as predicted by fractography theory
[34,35]. Other fracture modes have been observed in clinical
all-ceramic crown failures as well, such as inner radial cracks
starting from the intaglio surface [36,37] and surface chipping
[38,39]. The present study addressed the margin initiated fail-
ure modes as observed in multiple zirconia-based crowns [31].
1018 d e n t a l m a t e r i a l s 3 3 ( 2 0 1 7 ) 1012–1020

Fig. 7 – The fracture origin of this hard machined magnesia stabilized crown Denzir Mg-PSZ(DM) was in the proximal
region, but no obvious flaws could be detected. The grinding marks form the processing are, however, very distinct and
have probably functioned as stress concentrators. The very tortuous fracture surface is due to the large grain structure.
Explanations of the symbols see Fig. 6.

4.1. Clinical significance
Both technical and biological complications can make it nec-
essary to replace a dental crown [15]. Strong and well-fitting
restoration are needed to reduce failures and subsequent
replacement. Each replacement increases the risk of adverse
effects, pulpal complications, and eventually tooth loss.
Increased longevity of dental restorations will reduce cost,
time and risk for both patients and health care providers
and patient satisfaction. The finding that all crowns fractured
at higher loads than considered clinical relevant, suggests
that monolithic zirconia crowns can withstand even excessive
mastication forces. The finding that 19 crowns did not fracture
further supports this.
Based on the current findings more emphasis should be
made on developing manufacturing techniques for dental zir-
conia that limit processing damages in the crown margins.
The correlation between the severity of the margin defects
and the load at fracture indicates that efforts should be made
 d e n t a l m a t e r i a l s 3 3 ( 2 0 1 7 ) 1012–1020
Fig. 8 – Microstructure of the fractured surfaces imaged by SEM showing the different materials; (A) BruxZir, (B) Dental
Direkt, (C) ZirkonZahn, (D) NobelProcera, (E) Denzir Y-TZP, and (F) Denzir Mg-PSZ.
to minimize both number and size of margin defects in order
to improve crown survival.
5. Conclusion
Production method and material composition of monolithic
zirconia-based crowns affect internal fit, crown margin qual-
ity and the load at fracture of the crowns. The hard-machined
Y-TZP crowns had the best margin quality and the highest
load at fracture. Margin defects affect the load of fracture.
Flawless crown margins will reduce the fracture susceptibility
and increase margin integrity and thus reduce the risk of both
biological and technical complications.
Acknowledgement
The authors gratefully acknowledge Harald Gjengedal, Odd
Johan Lundberg, Siri Ljøkjell, Maren Ladstein and Stein Atle Lie
for contributing to this article. The authors thank Tannlab for
providing the specimens. Different manufacturers supported
the study with either free specimens (Denzir AB) or speci-
mens at reduced cost (Nobel Biocare, ZirkonZahn, Glidewell
laboratories and Dental Direkt GmbH).
The authors declare no conflicts of interest. This research
received funding through University of Bergen.
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