RESEARCH AND EDUCATION

Current status and research trends of lithium disilicate in

dentistry: A bibliometric analysis
Yanning Chen, BDS, MDS,a Andy W. K. Yeung, BDS, PhD,b Edmond H. N. Pow, BDS, MDS, PhD,c and
James K. H. Tsoi, BSc, PhDd

The traditional metal-ceramic ABSTRACT

technique has been docu-
Statement of problem. Lithium disilicate (LD) is a popular dental ceramic and has been a focus of
mented to be a reliable clinical dental research. Nevertheless, a quantified literature analysis focusing on the research of lithium
application. However, ceramic disilicate is lacking.
restorative materials have
Purpose. The purpose of this bibliometric analysis was to review the progress of research into lithium
gained popularity in recent
1 disilicate in dentistry, including the identification of contributing researchers, organizations, countries
years. These can be catego- or regions, journals, and the analysis of high-impact keywords and research trending.
rized into glass-matrix ce-
ramics, polycrystalline Material and methods. The search was carried out within the topic field of the Web of Science
(WoS) database, collecting publications related to LD from between 1996 and 2019. Metadata
ceramics, and resin-matrix ce-
2
including the titles, abstracts, keywords, authors, affiliations, countries or regions, and references
ramics. Glass-matrix ceramics were extracted. Bibliometric indicators in terms of documents, authors, journals, and keywords
have an extensive history of were analyzed.
application in dentistry as their
Results. Between 1996 and 2019, the dental research on LD trended upward. Scholars in the United
chemical composition has a States, Germany, Switzerland, and Brazil actively participated in the research on LD, and
high amount of silica, making publications from the United States had the most citations. The Journal of Prosthetic Dentistry
the material highly trans- and Dental Materials were the major contributing journals. High-impact terms could be
lucent, biomimetic, and categorized into types of restorative material, types of prostheses, and properties or techniques
biocompatible.3 of materials. Co-occurrence and relative normalized citation analysis of keywords highlighted
Advances in material several research interests, such as comparison studies between LD and zirconia, computer-aided
properties have broadened the design and computer-aided manufacturing (CAD-CAM) techniques, and the performance of
complete coverage LD restorations.
application of glass ceramics.
The inherent brittleness and Conclusions. With the global upsurge in research on lithium disilicate, extensive collaborations and
low fracture resistance of glass citations have been noted among authors, institutions, and countries or regions. Research hotspots
include types of restorative material, types of prostheses, and properties or techniques of
ceramics were improved either
materials. (J Prosthet Dent 2020;-:---)
by incorporating reinforcing
materials such as leucite or by the application of new 2005, LD glass ceramics provided dentists with a ceramic
materials, including lithium disilicate (LD).3,4 With the with enhanced mechanical properties and natural
launch of IPS Empress 2 in 1998 and IPS e.max Press in appearance. With the flexural strength of over 300 MPa,

a
PhD student, Dental Materials Science, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special
Administrative Region, PR China.
b
Tutor in Radiography, Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong
Special Administrative Region, PR China.
c
Clinical Associate Professor, Prosthodontics, Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region, PR
China.
d
Assistant Professor, Dental Materials Science, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special
Administrative Region, PR China.

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2 Volume
Clinical Implications
Lithium disilicate is a popular dental restorative
treatment option and an essential dental research
focus. This bibliometric analysis of lithium disilicate
overviewed its research status and its prospects for
dental professionals and researchers.
LD ceramics are suitable for veneers, inlays, onlays,
single crowns, and 3-unit fixed dental prostheses
(FDPs).4-6 Monolithic prostheses can be fabricated with
LD, omitting the veneering process and associated
complications.7,8 Apart from traditional press
manufacturing, LD could be conveniently integrated into
a digital workflow.9-15 It can be easily and efficiently
milled by either laboratory or chairside manufacturing.16-
19
Thus, LD has become a popular clinical option.1,7,20-23
The widespread application and versatile properties of
LD have also stimulated interest from dental researchers
worldwide. Studies on LD have constituted an important
part of research in prosthodontics.24-26 Research into
dental ceramics has been growing since the 1990s. In an
analysis of the 100 mostly cited articles in prosthodontic
journals from 1951 to 2019, 21 articles were on ce-
ramics.25 However, a quantified literature analysis
focusing on the research into LD is lacking.
The purpose of this study was to review the research
progress of LD in dentistry by using a bibliometric
approach, a powerful tool27-31 that can include the iden-
tification of contributing researchers, organizations,
countries or regions, and journals, and to provide an
analysis of high-impact keywords and research trends. In
addition, 2 research focuses were investigated: application
status of LD restorations and manufacturing technologies.
MATERIAL AND METHODS
The search was conducted in the Clarivate-owned Web
of Science (WoS) database, which included extensive and
high-quality literature resources in its core collection. The
electronic search was limited to the topic field, which
included the title, abstract, and keywords.
The search took place in April 2020. Articles published
before 31 December 2019 were screened, and pilot
searches were conducted to refine the search strategy.
The finalized search string consisted of the primary focus
(lithium disilicate) and keywords that included dent*,
oral, restorat*, prosthodont*, tooth, teeth, and implant*.
Studies of lithium disilicate in dentistry that were
classified as the document types of “article, proceeding
paper, review, or early access” (summarized by the WoS
database) were included. If the title, abstract, and key-
words of an article were not in English, it was excluded.
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The search results were exported as tab-delimited files
and processed by using a bibliometric software program
(VOSviewer v1.6.14.; Center for Science and Technology
Studies, Leiden University).28,32-34 The software program
analyzed the titles, abstracts, keywords, authors, affilia-
tions, countries or regions, and references. Data obtained
by the WoS functions of “analyze results” and “citation
report” were also collected.
Supplemental searches were conducted by using the
function “search within results” based on the research
focuses. Search targets and corresponding keywords
used are listed in Supplemental Table 1 (available online).
After extraction, data were summarized and pro-
cessed with a spreadsheet (Microsoft Office 2020 Excel
v16.35; Microsoft Corp.) and VOSviewer. During citation
analysis with the VOSviewer software program, word
derivatives were unified from the thesaurus files. The
information of most cited articles was analyzed with a
spreadsheet.3-7,16,17,20,35-46 For collaborated work, equal
weight was assigned to each collaborator.
The collaboration and citation network were visual-
ized by network or by overlay with VOSviewer. In a map,
the size of the bubble indicated the number of publica-
tions, the distance between bubbles reflected the relat-
edness of the 2 items, and the color of each bubble had
different meanings in different visualizations. Coauthor-
ships were presented with network visualization, in
which bubbles of the same color formed clusters, indi-
cating close cooperation in the research output. These are
described in the figure legends.
To determine trends of keywords with greater in-
fluence, the period of 2010-2019 was divided into five
2-year periods. The top 10 recurring terms were
identified in each period as high-impact terms. Their
impact was analyzed with periodic normalized citation
scores referring to the methods of examining annual
high-impact terms introduced in previous
studies.27,47,48 The relative citation score of each pub-
lication was acquired by dividing its number of cita-
tions by the average citation count of all publications
on LD in that period. A publication received more ci-
tations than average if its score was higher than 1. The
normalized citation score of each term was the average
of normalized citation scores of all publications con-
taining the term. The calculation was performed
automatically based on the term map visualizations in
the VOSviewer software program.
RESULTS
Searches conducted in the Web of Science database
identified 1101 studies published from 1996 to 2019. An
upward trend was seen in the number of articles pub-
lished each year (Fig. 1), especially after 2015. Of the
1101 publications, 848 (77.0%) articles belonged to the
Chen et al
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250
236

201
200

Number of Publications
150
150

118

100 89 87

53
50
30 33
24
10 10 10 9 14
9 9
1 0 0 0 3 3 3
0
96
97
98
99
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
19
19
19
19
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
Publication Year
Figure 1. Annual number of published articles from 1996 to 2019 with lithium disilicate.

“Dentistry, Oral surgery and medicine (DOSM)” JCR organizations centered on the University of Zurich, New
category, and the rest (253, 23.0%) belonged to non- York University, University of Sao Paulo, Sao Paulo State
DOSM categories related to materials science, engi- University, State University of Campinas, University of
neering, and chemistry. Kiel, University of Hong Kong, and University of Siena.
The research history of lithium disilicate is short but The distribution of highly productive countries or re-
dynamic. Publications on LD received 17 050 citations in gions was largely consistent with that of institutions. The
total. The h-index was 63, and each article received 15.49 United States contributed the highest number of articles
citations on average. Twenty-seven publications were (254, 23.1%), followed by Brazil (192, 17.4%) and Ger-
cited >100 times. Table 1 presents the 20 most cited ar- many (187, 17.0%). The work from several countries in
ticles, of which the majority are in vitro studies. The Asia (Turkey, China, South Korea, Japan, and Saudi
mostly cited topics were mechanical properties, micro- Arabia) appeared to be increasing (Table 4). Four coun-
structure, fatigue behavior, clinical indications, and tries received over 2000 citations each (United States,
performance. 5686 citations; Germany, 3969 citations; Brazil, 2291 ci-
A total of 3176 authors contributed to the included tations; and Switzerland, 2025 citations), which was
articles, an average of 2.88 authors per article. The 10 significantly higher than that of other countries or re-
most productive authors and 10 most cited authors are gions. International collaborations were mainly centered
reported in Table 2. The collaborative network was on the United States, Germany, Brazil, Switzerland, and
mainly centered on highly productive authors (Fig. 2A). China (Fig. 2C).
Prof. Ozcan M was the most productive author, and the Among 192 journals that had publications related to
work of Prof. Zhang Y gained the highest number of LD, only 2 journals accounted for more than 100 publi-
citations. Four scholars were included in both lists (Ozcan cations, the Journal of Prosthetic Dentistry (JPD) (150,
M, Kern M, Zhang Y, and Matinlinna JP), implying that 13.6%) and Dental Materials (108, 9.8%). They were fol-
they were the most productive and influential ones. lowed by the Journal of Prosthodontics (65, 5.9%) and
A total of 896 organizations from 68 countries or re- Journal of the Mechanical Behavior of Biomedical Materials
gions participated in the research on LD. According to (40, 3.6%). The JPD was the most productive but Dental
Table 3, the University of Zurich was not only the most Materials was cited most (Fig. 3).
productive but also the most cited institution (67 publi- Seventeen keywords were regarded as high-frequency
cations, 1210 citations). Most studies were conducted in keywords (more than 100 occurrences) in the research on
universities. One exception was a dental manufacturer, LD (Table 5). The term map (Fig. 4) revealed that the major
Ivoclar Vivadent AG, that had the highest number of applications of LD in dentistry were related to various
normalized citations. The University of Geneva, New restorations such as “crown” and “fixed dental prosthe-
York University, and RWTH Aachen University had high ses.” Both mechanics-related keywords (“flexural
citations per article, reflecting their high-impact research strength” and “fracture toughness”) and esthetics-related
on LD. Figure 2B showed several clusters of cooperative keywords (“optical properties,” “translucency,” and “final

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Table 1. Information on 20 most cited articles in research into lithium disilicate3-7,16,17,20,35-46

Publication Total Average
Title Authors Journals Year Citations per Year Type of Study Research Focus
Current ceramic materials and systems Conrad, HJ.; Seong, Journal of Prosthetic 2007 429 30.64 Systematic Material properties
with clinical recommendations: A W-J; Pesun, GJ. Dentistry review and clinical
systematic review indications
Fracture resistance of lithium disilicate-, Tinschert, J; Natt, G; International Journal of 2001 264 13.2 Laboratory Mechanical
alumina-, and zirconia-based three-unit Mautsch, W; Augthun, Prosthodontics study properties
fixed partial dentures: A laboratory study M; Spiekermann, H
Strength, fracture toughness and Guazzato, M; Albakry, Dental Materials 2004 246 14.47 Laboratory Mechanical
microstructure of a selection of M; Ringer, SP; Swain, study properties
all-ceramic materials. Part I. Pressable MV
and alumina glass-infiltrated ceramics
A comparison of the microstructure and Holand, W; Schweiger, Journal of Biomedical 2000 220 10.48 Laboratory Microstructure
properties of the IPS Empress (R) 2 and M; Frank, M; Materials Research study
the IFS Empress (R) glass-ceramics Rheinberger, V
The clinical Success of All-ceramic Della Bona, a; Journal of the 2008 213 16.38 Narrative Clinical indications
Restorations Kelly, JR American Dental review
Association
Effect of etching and airborne particle Borges, GA; Sophr, Journal of Prosthetic 2003 202 11.22 Laboratory Microstructure and
abrasion on the microstructure of AM; de Goes, MF; Dentistry study adhesion
different dental ceramics Sobrinho, LC; Chan, DCN
All-ceramic or metal-ceramic tooth- Sailer, I; Makarov, NA; Dental Materials 2015 199 33.17 Systematic Clinical performance
supported fixed dental prostheses (FDPs)? Thoma, DS; Zwahlen, review
A systematic review of the survival M; Pjetursson, BE
and complication rates. Part I: Single
crowns (SCs)
Monolithic CAD/CAM lithium disilicate versus Guess, PC; Zavanelli, International Journal of 2010 178 16.18 Laboratory Fatigue behavior
veneered Y-TZP crowns: RA; Silva, NRFA; Prosthodontics study
comparison of failure modes and Bonfante, EA; Coelho,
reliability after fatigue PG; Thompson, VP
Ceramics for dental applications: a review Denry, I; Holloway, Materials 2010 171 15.55 Narrative Microstructure and
JA review fabrication technique
Making Yttria-stabilized Tetragonal Zhang, Y Dental Materials 2014 147 21 Theoretical Optical properties
Zirconia Translucent study
In vitro shear bond strength of cementing Piwowarczyk, A; Journal of Prosthetic 2004 141 8.29 Laboratory Adhesion
agents to fixed prosthodontic restorative Lauer, HC; Sorensen, Dentistry study
materials JA
Biaxial flexural strength, elastic moduli, Albakry, M; Guazzato, Journal of Prosthetic 2003 131 7.28 Laboratory Mechanical
and x-ray diffraction characterization of three M; Swain, MV Dentistry study properties and
pressable all-ceramic materials microstructure
Clinical results of lithium-disilicate crowns Gehrt, M; Wolfart, S; Clinical Oral 2013 125 15.63 Clinical study Clinical performance
after up to 9 years of service Rafai, N; Reich, S; Investigations
Edelhoff, D
Fractographic analyses of three ceramic Quinn, JB; Quinn, GD; Dental Materials 2005 125 7.81 Laboratory Fatigue behavior
whole crown restoration failures Kelly, JR; Scherrer, SS study
Strength and reliability of four-unit all- Luthy, H; Filser, F; Dental Materials 2005 122 7.63 Laboratory Fatigue behavior
ceramic posterior bridges Loeffel, O; study
Schumacher, M;
Gauckler, LJ; Hammerle,
CHF
Wear Characteristics of Current Aesthetic Moermann, WH; Journal of the 2013 120 15 Laboratory Wear behavior
dental Restorative CAD/CAM Materials: Stawarczyk, B; Ender, Mechanical Behavior of study
Two-body Wear, gloss Retention, a; Sener, B; Attin, T; Biomedical Materials
Roughness and Martens Hardness Mehl, a
Translucency of zirconia copings made Baldissara, P; Journal of Prosthetic 2010 120 10.91 Laboratory Optical properties
with different CAD/CAM systems Llukacej, A; Ciocca, L; Dentistry study
Valandro, FL; Scotti, R
Wear of ceramic and antagonist - A Heintze, S. D.; Dental Materials 2008 120 9.23 Systematic Wear behavior
systematic evaluation of influencing Cavalleri, A.; Forjanic, review &
factors in vitro M.; Zellweger, G.; laboratory
Rousson, V. study
Ceramic dental biomaterials and Li, RWK; Chow, TW; Journal of 2014 117 16.71 Narrative Material properties
CAD/CAM technology: State of the art Matinlinna, JP Prosthodontic Research review and clinical
performance
A comparison of the marginal fit of Ng, J; Ruse, D; Journal of Prosthetic 2014 115 16.43 Laboratory Marginal fit
crowns fabricated with digital and Wyatt, C Dentistry study
conventional methods

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Table 2. Top 10 productive authors and top 10 cited authors

Top 10 Productive Authors Top 10 Cited Authors
Country or Number of Country or Number of
Author Institution Region Articles Author Institution Region Citations
Ozcan, Mutlu University of Zurich Switzerland 49 Zhang, Yu New York University United States 691
Kern, Matthias University of Kiel Germany 31 Albakry, University of Sydney Australia 536
Mohammad
Valandro, Luiz Federal University of Brazil 24 Guazzato, University of Sydney Australia 536
Felipe Santa Maria Massimiliano
Edelhoff, Daniel Ludwig Maximilians Germany 21 Guess, Petra C University of Freiburg Germany 520
University
Zhang, Yu New York University United States 20 Kern, Matthias University of Kiel Germany 492
Bottino, Marco State University of Brazil 19 Ozcan, Mutlu University of Zurich Switzerland 420
Antonio Sao Paulo
Holand, Wolfram Ivoclar Vivadent AG Liechtenstein 17 Wolfart, Stefan RWTH Aachen Germany 386
University
Pereira, Gabriel Federal University of Brazil 15 Sailer, Irena University of Geneva Switzerland 385
Kalil Rocha Santa Maria
Matinlinna, Jukka The University of Hong Kong SAR, 15 Matinlinna, Jukka The University of Hong Hong Kong SAR, 384
Pekka Hong Kong China Pekka Kong China
Ferrari, Marco University of Siena Italy 15 Apel, Elke Ivoclar Vivadent AG Liechtenstein 337

Figure 2. Collaboration networks. A, Among authors with more than 5 publications. B, Among institutions with more than 10 publications. C, Among
countries or regions with more than 10 publications. Bubble size indicates number of documents. Link length indicates closeness of collaboration.

color”) gained high normalized citations as did keywords Seventeen highly recurring keywords were identified
related to clinical assessment such as “clinical evaluation,” in the periodic top 10 recurring terms lists of 2010-2019
“clinical performance,” “complication rate,” and “obser- (Table 6). “Lithium disilicate” and “restoration” were
vation period.” excluded in the summary because they were the

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Table 3. Top 10 contributing institutions Table 4. Top 10 contributing countries or regions

Country or Number of Number of Citations per Country or Number of Proportion of Articles Number of
Institution Region Articles Citations Article Region Articles (%) Citations
University of Zurich Switzerland 67 1210 18.06 United States 254 23.07 5686
State University of Brazil 55 331 6.02 Brazil 192 17.44 2291
Sao Paulo Germany 187 16.99 3969
University of Munich Germany 39 473 12.13 Turkey 105 9.54 1089
New York University United States 34 1041 30.62 Switzerland 104 9.45 2025
University of Sao Brazil 33 477 14.45 Italy 90 8.17 829
Paulo
China 81 7.36 1018
University of Kiel Germany 33 642 19.45
England 44 4.00 636
Federal University of Brazil 31 371 11.97
Santa Maria South Korea 35 3.18 420
RWTH Aachen Germany 22 529 24.05 Japan 33 3.00 383
University Saudi Arabia 33 3.00 351
University of Geneva Switzerland 22 696 31.64
Ivoclar Vivadent AG Liechtenstein 21 736 35.05

The most cited articles of LD included reviews, lab-

universal focus in LD-related research. Five terms
recurred in every searched period, namely “CAD-CAM,”
“ceramic,” “crown,” “strength,” and “zirconia.” Most
terms presented fluctuating trends in relative citation
scores. In general, “CAD-CAM,” “ceramic,” “flexural
strength,” and “marginal adaptation” showed an
increasing trend, while “composite resin,” “crown,”
“fixed partial dentures,” “fracture resistance,” and
“strength” presented a declining trend for citation.
The supplemental searches reflected researchers’ in-
terests toward various applications and manufacturing
technologies of LD restorations. Complete coverage LD
restoration was most commonly investigated with 627
published articles. Next were the veneer and partial
coverage restoration (288 and 270 articles, respectively)
(Fig. 5). In terms of restored tooth position, 170 studies
focused on the anterior teeth, while 351 studies focused
on the posterior region. There were 510 CAD-CAM ar-
ticles and 287 pressed manufacturing articles. CAD-
CAMerelated research was initiated later than that of
pressed technology, but the former prevailed after year
2013 (Fig. 6).
DISCUSSION
The authors are unaware of a previous bibliometric
analysis focusing on research into dental lithium dis-
ilicate, a material with the advantages of high trans-
lucency, biomimetic appearance, and satisfactory
mechanical properties.7,46 Over 100 million placements
of LD restorations promoted investigations on the ma-
terial properties and clinical performance of LD.21 From
1996 to 2019, a total of 3176 authors contributed to 1101
publications, presenting a markedly rising trend. The
substantial growth of studies on LD was consistent with
the trend of more output and citations in general
dentistry and prosthodontics.30,31
oratory studies, and clinical assessments. Publications
before 2010 mainly focused on mechanical strength,
fractographic analysis, microstructure, and clinical rec-
ommendations, with researchers exploring the properties
and potentials of LD.4,6,39,40,42,43 Since 2010, the wear
behavior, optical properties, and clinical survival analysis
became the emphasis of studies.36-38,45 After several
years of service, the survival condition and complications
of LD became the focus of researchers.8,19,20,22,41 The
cumulative Kaplan-Meier survival rate of pressed LD
single crowns was reported to be 97.4% after 5 years and
94.8% after 8 years,20 while that of chairside-fabricated
LD single crowns was 83.5% after 10 years 19 The most
recent clinical data reported that the 10-year estimated
cumulative survival of pressed e.max complete-coverage
restorations was 99.6%.8 In the future, studies with
longer observation periods should be expected, which
will provide valuable data on the long-term performance
of LD.
Two patterns of author impact could be summarized:
publishing a high number of articles to consolidate the
foundation of the topic (for instance, Ozcan M); or pos-
sessing influential publications with high citations (for
instance, Zhang Y). There were many overlaps in the top
10 productive and cited lists of institutes, countries, or
regions, reported as the “contributing” lists. The United
States, Brazil, Germany, and Switzerland can be regarded
as impactful because of their large numbers of articles
and over 2000 citations. Some Asian countries appeared
in the top 10 contributing list, which might have resulted
from extensive academic visits and collaborations of
prominent researchers.25 The patent owner and the first
manufacturer of dental lithium disilicate, IPS e.max,
Ivoclar Vivadent AG, contributed significantly in terms of
research and development on LD such that data and the
results of publications of e.max from Ivoclar Vivadent AG
were frequently cited.38

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Figure 3. Citation map of journals whose total link strength was higher than 50. Bubble size indicates number of documents. Color of bubble indicates
relative citation count. Yellow color of bubbles indicates higher average normalized citations.

Dental Materials (IF2020=4.495) and the Journal of Table 5. List of high-frequency keywords (>100 occurrences in
Prosthetic Dentistry (IF2020=2.444) were the 2 largest co-occurrence analysis) in descending order of their occurring
contributors to the research on LD. They were also frequencies
Keywords Occurrence Average Normalized Citations
regarded as highly impactful journals on prosthodontic
lithium disilicate 414 1.02
research in other bibliometric analyses.24,25 These 2
restoration 293 1.05
journals, together with the Journal of Prosthodontics and
ceramic 280 1.21
Journal of the Mechanical Behavior of Biomedical Materials,
crown 257 1.20
accounted for one-third of all included publications. zirconia 237 1.12
According to Bradford’s law, they were identified as core strength 223 1.03
journals in the research on LD.27,49 CAD-CAM 180 1.30
The frequency and average normalized citation score fracture resistance 157 0.91
of keywords might reflect the prevalent research focus of system 144 0.90
scholars. In this analysis, high-impact keywords were glass ceramic 143 0.89
roughly divided into 3 categories: types of restorative in vitro 141 0.98
material, types of prostheses, and properties or porcelain 127 0.96
techniques of materials. It was noted that “zirconia,” a ceramic crown 111 1.22
popular dental ceramic, appeared as the keyword for LD- fixed dental prostheses 111 1.25

related researches with high frequency and impact and survival 110 1.13
flexural strength 103 1.57
often served as a control material to lithium disilicate.
composite resin 101 1.21
Compared with LD, zirconia has a significantly higher
mechanical strength and fracture resistance but poorer CAD-CAM, computer-aided design and computer-aided manufacturing.

optical properties and bonding durability.3,7,9 A biblio-

metric analysis on dental zirconia showed a steady in-
crease in the number of publications from 2004 to 2014,
and the major research interest was its application as a
restorative material.29 However, none of the restorative
materials can be regarded as ideal for all clinical in-
dications. Inasmuch as the research was the clinical quest
for a better material, efforts were made to optimize the
properties of materials by means of, for example,
microstructure modification, fabrication process optimi-
zation, or synthesis of hybrid materials.16,18,35,36
The CAD-CAM technique improves time efficiency
and has lower technique sensitivity and fewer human
errors than traditional laboratory fabrication.16,26 In the
present analysis, CAD-CAM ranked seventh among the

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Figure 4. Term map of keywords whose total link strength was higher than 50. Bubble size indicates occurring frequency of term as keyword of
publications. Color of bubble indicates average normalized citations. Red color of bubbles indicates higher average normalized citations. CAD-CAM,
computer-aided design and computer-aided manufacturing.

high-frequency terms and had higher periodic citations Table 6. Periodic average normalized citation scores of high-impact
than the average in 2010-2019. The number of CAD- terms from 2010 to 2019
CAMerelated articles increased considerably after 2013, 2010- 2012- 2014- 2016- 2018-
Term 2011 2013 2015 2017 2019
exceeding that of press manufacturing. After the launch CAD-CAM 1.37 1.17 1.54 1.41 1.20
of IPS e.max CAD in 2006, CAD-CAM and heat-pressing ceramic 1.08 1.28 1.22 1.19 1.29
became the 2 major manufacturing methods of LD res- ceramic crown 1.33 1.80 1.11 1.25 1.18
torations. No significant difference was found in the composite resin N/A 1.35 1.62 1.27 1.04
mechanical properties or esthetic performance of crown 1.54 1.13 1.27 1.16 1.15
heat-pressed and CAD-CAM LD restorations.9,11,12 fixed dental N/A 2.86 0.92 1.21 1.46
Evaluations on the marginal and internal fit showed prostheses
fixed partial dentures 1.53 1.70 1.23 0.68 0.89
controversial results, yet all were regarded as clinically
flexural strength 1.33 0.66 1.25 2.10 1.64
acceptable.10,13,14,17 In survival analysis, pressable LD
fracture resistance N/A 1.44 0.97 0.96 0.78
restorations showed slightly higher survival rates than
glass ceramic 0.62 0.71 0.98 1.38 0.80
CAD-CAM restorations, but both were reported to be in vitro N/A 0.99 1.05 0.84 1.10
reliable treatment options.15,22 marginal adaptation N/A 1.29 1.24 0.90 1.62
Because of the popularity of complete coverage LD mechanical properties 0.91 1.19 0.92 1.55 1.12
restorations,1 most clinical studies reported on the per- porcelain 1.65 0.77 0.63 0.83 1.03
formance and complications of single crowns.19,20,22,23 strength 1.04 1.08 1.10 1.02 0.97
Next were veneers and partial coverage restorations system 1.03 0.77 1.21 0.78 0.78
(including inlay, onlay, partial crown, and endocrown). zirconia 1.71 1.33 0.97 1.04 1.13
The estimated cumulative survival of posterior complete CAD-CAM, computer-aided design and computer-aided manufacturing; N/A, not available.
coverage restorations was significantly higher than that Top 10 highly recurring terms in each period included in this list and their periodic
average normalized citation scores calculated.
of posterior partial coverage restorations (96.75% at 16.9
years and 95.27% at 10.5 years, respectively).50 Further-
more, onlays presented a significantly higher cumulative restoration, LD is also a good alternative because of its
survival rate than inlays (98.3% at 9.8 years and 93.9% at adequate flexural strength, similar elastic modulus to
9.9 years, respectively).51 With regard to veneers, LD is dentin, and wear-friendly features.2,15,37 Moreover, pre-
an ideal material because of its high translucency and dictable and durable bonding can be achieved after
natural appearance. In terms of the partial coverage etching with hydrofluoric acid and by applying silane

THE JOURNAL OF PROSTHETIC DENTISTRY Chen et al

- 2020 9

700

600 627

Number of Publications 500

400

300
288
270
200
187
170
100
67
0
Veneer Tabletop Partial coverage Complete Fixed partial Implant
restoration coverage denture prostheses
restoration
Type of Restoration
Figure 5. Number of publications in regard to various types of dental prostheses.

140

120
Number of Publications

100

80

60

40

20

0
96
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
19
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20

Publication Year
CAD-CAM Pressed Manufacture

Figure 6. Annual trend in number of publications on different manufacturing technologies of lithium disilicate. CAD-CAM, computer-aided design and
computer-aided manufacturing.

coupling agents.4,42,52-54 Overall, LD restorations materials research articles were listed in WoS, which has
exhibited outstanding clinical performance with an esti- been reported to have better coverage than other major
mated risk less than 0.4% per year.8,50,51 Given the databases.55 In addition, the removal of overlapping
excellent material properties and innovations in bonding, literature and visualizing different patterns of data when
LD potentially has broader applications such as multiple combining extracted data from various databases would
unit FDPs and implant-supported prostheses. have been difficult. In addition, generalized synonyms of
Limitations of the present study included that only “lithium disilicate,” such as “glass-ceramic,” “ceramic,”
articles from the WoS database were included in the or “porcelain,” were not included in the search string.
bibliometric analysis. Although some articles on LD Some relevant studies that did not mention “lithium
might have been omitted, all the major dentistry and disilicate” might have been omitted. However, if these

Chen et al THE JOURNAL OF PROSTHETIC DENTISTRY

10
general terms had been used, a large number of studies
regarding other types of ceramic would have been
included, and the subsequent screening would have been
challenging.
CONCLUSIONS
Based on the findings of this bibliometric analysis, the
following conclusions were drawn:
1. With the global upsurge in research on lithium
disilicate, extensive collaborations and citations
were identified among authors, institutions, and
countries or regions.
2. Popular research topics included types of restorative
material, types of prostheses, properties of mate-
rials, and techniques.
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Corresponding author:
Dr James K.H. Tsoi
Dental Materials Science
Applied Oral Sciences and Community Dental Care
Faculty of Dentistry, The University of Hong Kong
1/F, Prince Philip Dental Hospital, 34 Hospital Rd
Sai Ying Pun
Hong Kong
PR CHINA
Email: jkhtsoi@hku.hk
Acknowledgments
The authors thank Ms Ying Gu for her help in the revision and proofreading of the
manuscript. This work was done in partial fulfilment of the requirements of the
degree of Doctor of Philosophy for the first author.
Copyright © 2020 by the Editorial Council for The Journal of Prosthetic Dentistry.
https://doi.org/10.1016/j.prosdent.2020.08.012

Chen et al THE JOURNAL OF PROSTHETIC DENTISTRY