Investigation of the Fracture

Resistance of Three Types of

Seung-Mi Jeong, DDS, PhDa
Zirconia Posts in All-Ceramic Klaus Ludwig, Dr Rer Nat, PhDb
Post-and-Core Restorations Matthias Kern, DDS, PhDc

Purpose: All-ceramic post-and-core restorations offer a number of advantages compared

with systems that use metal cores. In certain clinical cases, however, fractures at the
junction between the post and the core have been reported. The objective is therefore to
improve the strength between the post and the core. Materials and Methods: Three
different methods were used to fabricate all-ceramic post-and-core restorations: pressing
IPS Empress cores directly to CosmoPost zirconia posts, adhesively luting IPS Empress
cores to CosmoPost zirconia posts, and Celay milling In-Ceram zirconia blanks to one-
piece post-and-core restorations. Ten restorations were prepared with each of the three
methods. The post-and-core complexes were tested to failure with the load applied
perpendicular to the post axis. The load and deflection at fracture were recorded. Results:
The highest breaking load and highest deflection were recorded for the luting technique,
with values of 25.3 N and 394 µm, respectively. The corresponding values for the pressed
cores and the milled zirconia cores were 22 N and 301 µm, and 13 N and 160 µm. All
differences were statistically significant at P < .05. Regarding the load dependence of the
deflection, the luted cores again demonstrated the highest mean value, with 15.5 µm/N,
while this value was 13.6 µm/N and 13 µm/N for the pressed-on and milled cores,
respectively. These differences were not statistically significant. Conclusion: Adhesively
luted all-ceramic cores on zirconia posts offer a viable alternative to the conventional
pressed technique. Int J Prosthodont 2002;15:154–158.

A ll-ceramic post-and-core restorations offer distinct

advantages of tissue compatibility and esthetic
appearance compared to cast-metal cores. 1–5
Zirconium oxide, also called zirconia, offers superior
mechanical strength and fracture toughness when
compared to other dental ceramics.4,6,7 High fracture
resistance can therefore be expected of industrially pre-
fabricated zirconia posts.8–11 Nevertheless, failures of
a Assistant Professor, Department of Prosthodontics, School of
Dentistry, University of Chosun, Kwang-Ju, Korea.
b Professor, Department of Prosthodontics, Propaedeutics and
Dental Materials, School of Dentistry, Christian-Albrechts
University, Kiel, Germany.
cProfessor and Chair, Department of Prosthodontics, Propaedeutics
and Dental Materials, School of Dentistry, Christian-Albrechts
University, Kiel, Germany.
Reprint requests: Prof Dr Klaus Ludwig, Department of
Prosthodontics, Propaedeutics and Dental Materials, School
of Dentistry, University of Kiel, Arnold-Heller Strasse 16,
D-24105 Kiel, Germany. Fax: + 49 431 5972860. e-mail:
kludwig@proth.uni-kiel.de
the system at the post-and-core junction have been re-
ported clinically.11
Using the lost-wax technique, a special ceramic
material (Empress Cosmo, Ivoclar) is heat pressed
onto the zirconia post (Ivoclar).12,13 It is unknown
whether the stresses generated between the post and
the core through this press-on technique negatively
influence the fracture strength at the junction of the
post. A possible alternative to this method would be
heat pressing the core separately and then luting it to
the post with composite resin.14 Another possibility
would be to fabricate the entire post-and-core com-
plex from presintered, zirconia-reinforced alumina
ceramic blanks (In-Ceram zirconia, Vita) using copy
milling4,15,16 or computer-aided design/manufactur-
ing (CAD/CAM) techniques.17–19
The purpose of this study was to evaluate the frac-
ture resistance of the post in such post-and-core
restorations by using a copy-milling method com-
pared to the technique of pressing the core onto the
post.

The International Journal of Prosthodontics 154 Volume 15, Number 2, 2002

 Jeong et al
∅ 3.5
∅5 ∅ 1.45
5 1
Fig 1a Dimensions of the core in cross section (mm).
Materials and Methods
To facilitate the mounting of the samples for the frac-
ture tests and to ensure a reproducibility in the di-
mensions of the cores, a cylindric shape that incorpo-
rated a cylindric countersink at the transition to the post
was chosen for each core (Fig 1). The size of the core
corresponded to that of a typical anterior restoration.
Two groups combined CosmoPost zirconia posts
with the Empress Cosmo pressing ceramic. In the
third group, the entire post-and-core complex was
fabricated by copy milling it from In-Ceram zirconia
blanks using the Celay technique (Mikrona) and a
resin core model as a pattern. Ten test specimens
were fabricated for each group.
Zirconia Posts with Pressed Cores
Cylindric patterns with the dimensions shown in Fig
1a were fabricated from 5-mm-diameter acrylic rods.
These were bonded to the CosmoPost zirconia posts
using cyanoacrylate such that the end surfaces of the
post and the core were even (Fig 1b). The patterns
were invested in accordance with the IPS Empress
method following the instructions of the manufac-
turer. After preheating to 850°C, Empress Cosmo Type
2 pressing ceramic was pressed onto the post at 900°C.
The post-and-core assemblies were divested and air
abraded with 50-µm Al2O3 particles at 1-bar pressure.
Zirconia Posts with Luted Cores
Cylindric acrylic cores (Fig 1a) were invested, burned
out, and pressed using the Empress Cosmo ingots
with the IPS Empress method. After divesting, the
surfaces and canal of each core were air abraded with
50-µm Al2O3 particles at 1 bar. The surface of the
canal was etched with hydrofluoric acid ceramic-
etching gel (Ivoclar) for 1 minute. After rinsing off the
etching gel and drying, the surfaces of the canals
were silaned with Monobond S (Ivoclar) and coated
Volume 15, Number 2, 2002
Fracture Resistance of Zirconia Posts in All-Ceramic Restorations
∅ 1.4
14
Fig 1b Dimensions of the core with post in cross section (mm).
with Heliobond (Ivoclar). The luting surfaces of the
posts were air abraded with 50-µm Al2O3 particles at
1 bar and silanated. The contact surfaces of the post
and the walls of the core canal were lightly coated
with a luting agent (Panavia 21, Kuraray). Finally, the
post was inserted into the core using slight rotating
movements.
Copy-Milled Posts and Cores
In-Ceram zirconia blanks (ZB 33) for posterior teeth
were cut into four pieces using a water-cooled dia-
mond saw. Then, posts and cores were machined in
one part using the Celay copy-milling technique. An
acrylic resin core such as the one used in the first se-
ries with an inserted post served as the milling pat-
tern (Fig 1b). Following a firing cycle at 700°C for 5
minutes to remove any moisture, the milled ingots
were infiltrated with Z 22 zirconia glass powder at
1,140°C for 40 minutes according to the In-Ceram
procedure. After removing excess glass using dia-
mond stones, the all-ceramic posts and cores were air
abraded with 50-µm corundum at 6 bar (cervical 3
bar) and then fired at 1,000°C for 5 minutes to ensure
that they had been fully infiltrated with glass.
Prior to fracture testing of the completed test pieces,
the diameter of the posts was measured at the junc-
tion of the post and the core using an electronic slid-
ing caliper at 10-µm resolution (type CD-15D,
Mitutoyo). The breaking load and the deflection up
to breakage of the posts at the point of load applica-
tion were measured. The test pieces were secured
with the post axis horizontal in a pneumatic testing
apparatus using a split chuck to grip the cylindric core
(Fig 2). The load was applied at a load rate of 250
N/min perpendicular to the post axis at a distance of
10 mm from the core. Deflection was measured with
an inductive displacement sensor. The force and de-
flection values were recorded as x-y plots.
Data were evaluated by one-way analysis of vari-
ance (ANOVA) and the Bonferroni multiple range test
155 The International Journal of Prosthodontics
 Fracture Resistance of Zirconia Posts in All-Ceramic Restorations Jeong et al

Force transducer Amplifier

HBM PW2-2 HBM MGT 231 X-ray recorder

Hewlett-Packard
x 7001 AM
DC

360 N µm

10 mm

Amplifier
HBM ME 50
N
y
4.8 kHz
Feinprüf 1304-k DT

Force Force
250 N/min

Fig 2 Measurement setup. DT = inductive displacement transducer; HBM = Hottinger Baldwin

Messtechnik (manufacturer).

Table 1 Results of Testing in Groups 1 to 3

Post diameter (µm) Breaking load (N) Breaking load deflection (µm) Deflection (µm/N)
Group Mean SD Mean SD Mean SD Mean SD

1 1,380 11 22.0 3.6 301 71 13.5 2.3

2 1,380 11 25.3 4.2 394 91 15.5 1.7
3 1,290 26 13.0 1.9 160 22 13.0 1.6
SD = standard deviation.

at the P < .05 level using the program Statgraphics
Plus, Version 7 for Dos (Statistical Graphics).
Results
The posts in the zirconia ceramic post groups demon-
strated a similar mean diameter, whereas the milled
zirconia posts had a 90-µm-smaller mean diameter
(Table 1). The difference between the maximum and
minimum values in groups 1 and 2 was 40 µm.
Cracks propagated differently in the three test series.
For the pressed-on cores, the posts always fractured
where they exited the cores (Fig 3). The luted posts and
cores fractured within the cores, resulting in breakage
of the countersink position or cracking of the core (Fig
4). Because of the copy-milling technique, the posts
of group 3 possessed a small curvature at the junction
of the post and the core. Consequently, the fracture
occurred within the post in front of the core (Fig 5).
The highest mean breaking load was recorded for the
group in which the cores were luted to the posts, and
the smallest was recorded for the milled restorations
(Table 1). The relative standard deviation was of the
same order for all groups, with 15% to 16% of the
mean values. The differences between the groups were
statistically significant (P < .05, Bonferroni).
The maximum deflection of the posts at fracture
load showed the same order of groups. The highest
mean deflection was recorded for the luted cores, and
the posts milled from In-Ceram zirconia ceramic
again had the smallest deflection until fracture (Table
1). The differences between all groups were statisti-
cally significant (P < .05, Bonferroni).
The slope of the x-y plots, ie, the load dependence
of the post deflection, was higher for the luted cores
compared to the other two groups (P < .05), which
exhibited similar values not differing from each other
(P > .05, Bonferroni; Table 1).
Discussion
The three groups demonstrated clear differences for
all tested parameters. For the pressed cores with the
rigid joint between the core and the post, the crack

The International Journal of Prosthodontics 156 Volume 15, Number 2, 2002

 Jeong et al
Fig 3 (right) Fracture surface of a zirconia CosmoPost with a
pressed-on core (original magnification ! 120).
Fig 4 (below) Fracture surface of a zirconia CosmoPost with
a luted core (original magnification ! 120).
Fig 5 (below right) Fracture surface of a copy-milled In-Ceram
zirconia ceramic post and core (original magnification ! 120).
propagation path shows that the maximum tensile
load was located at the inferior surface of the post
where it exited the core. In the luted post-and-core
complexes, the posts failed under loads that were
15% higher than in the group with the pressed-on
cores. Depending on the properties of the compos-
ite layer, the crack propagation differs from that of the
pressed cores.20,21 The lower breaking load as well
as the crack propagation characteristics in the milled
ceramic restorations are related to the material and
the fabrication procedure. Because of the different
chemical and physical properties of In-Ceram zirco-
nia, its flexural strength is about 40% lower than
that of industrially densely sintered zirconia ce-
ramic.22 In addition, larger deviations in the di-
mensions are to be expected in the copy-milling
technique compared with industrial fabrication pro-
cedures. Also, the In-Ceram ceramic surfaces must be
reground after the glass-infiltration procedure. As a
result, the average post diameter was reduced by
about 90 µm, and the standard deviation of 26 µm
was 120% higher than in the industrial fabrication
Volume 15, Number 2, 2002
Fracture Resistance of Zirconia Posts in All-Ceramic Restorations
procedures of the posts. Therefore, inhomogeneities,
surface damage, and superficial microcracks—un-
avoidable during manual working procedures such
as glass infiltration—and the smaller fracture tough-
ness of In-Ceram zirconia might be an additional
explanation for the reduced fracture resistance of
the milled cores.22 The milled In-Ceram zirconia
restorations and the CosmoPosts with the pressed
cores, however, did not demonstrate large differ-
ences in load dependence of the measured post de-
flection.
Given the increased breaking loads, luting the
core to the post offers a viable alternative to the con-
ventional pressing technique. Results of the long-
term clinical effectiveness of this method using zir-
conia posts are not yet available.
Acknowledgments
This research was supported by the Korean Science & Engineering
Foundation and the German Science Foundation (Deutsche
Forschungsgemeinschaft) (grant No. 995-0700-002-2).
157 The International Journal of Prosthodontics
 Fracture Resistance of Zirconia Posts in All-Ceramic Restorations Jeong et al

References 11. Simon M. Präprothetische Rekonstruktionen mit Zirkondioxid-

1. Kern M, Knode H. Stiftkernaufbauten aus In-Ceram. Direkte und
indirekte Methode. Quintessenz Zahntech 1991;17:917–925.
2. Kern M, Pleimes AW, Strub JR. Bruchfestigkeit metallischer und vol-
lkeramischer Stiftaufbauten. Dtsch Zahnarztl Z 1995;50:451–453.
3. Hegenbarth EA. Das Procera-System. Ästhetik, Präzision und
Stabilität eines neuen vollkeramischen Systems. Quintessenz
Zahntech 1996;22:1098–1114.
4. Koutayas SO, Kern M. All-ceramic posts and cores. State of the
art. Quintessence Int 1999;30:383–392.
5. Rosentritt M, Furer C, Behr M, Lang R, Handel G. Comparison
of in vitro fracture strength of metallic and tooth-coloured posts
and cores. J Oral Rehabil 2000;27:595–601.
6. Hulbert SF, Morrison SJ, Klawitter JJ. Tissue reaction to three ce-
ramics of porous and non-porous structure. J Biomed Mater Res
1972;6:347–374.
7. Morgano SM, Brackett E. Foundation restorations in fixed
prosthodontics: Current knowledge and future needs. J Prosthet
Dent 1999;82:643–657.
8. Meyenberg KH, Luethy H, Schaerer P. Zirconia posts: A new all-
ceramic concept for nonvital abutment teeth. J Esthet Dent 1995;7:
73–80.
9. Simon MHP, Paffrath J. Neue Perspektiven zur vollkeramischen
Stabilisierung und zum Aufbau devitaler Zähne. Die Quintessenz
1995;46:1085–1101.
10. Fischer H, Edelhoff D, Marx R. Mechanische Beanspruchbarkeit
von Zirkonoxid-Wurzelstiften. Dtsch Zahnarztl Z 1998;53:
854–858.
Wurzelstiften. Phillip J 1997;14:95–100.
12. Unterbrink G. IPS-Empress. New full ceramic system. Zahnarztl
Welt 1991;100:786–791.
13. Hochman N, Zalkind M. New all-ceramic indirect post-and-core
system. J Prosthet Dent 1999;81:625–629.
14. Sorensen JA, Mito WT. Rationale and clinical technique for esthetic
restoration of endodontically treated teeth with the CosmoPost and
IPS Empress post system. Quintessence Dent Technol 1998;21:
81–90.
15. Hunt PR, Gogarnoiu D. Evaluation of post and core systems. J
Esthet Dent 1996;8:74–83.
16. Kern M, Simon MHP, Strub JR. Erste klinische Erfahrungen mit
Wurzelstiften aus Zirkonoxidkeramik. Dtsch Zahnarztl Z 1998;53:
266–268.
17. Becker J, Heidemann D. Entwicklungsstand und Probleme des
Einsatzes von CAD/CAM-Systemen. Dtsch Zahnarztl Z 1993;48:
611–617.
18. Luthardt R. Stand und Perspektiven der Bearbeitung von
Zirkondioxid-Keramik. Dent Labor 1997;12:2187–2193.
19. Luthardt R, Musil R. Das Precident-DCS-System CAD/CAM
gefertigter Zahnersatz aus Titan und Zirkondioxid. Phillip J
1996;13:217–225.
20. White SN, Yu Z. Physical properties of fixed prosthodontic,
resin composite luting agents. Int J Prosthodont 1993;6:384–389.
21. Li ZC, White SN. Mechanical properties of dental luting cements.
J Prosthet Dent 1999;81:597–609.
22. Kappert HF. Dental materials: New ceramic systems. Trans
Acad Dent Mater 1996;9:180–190.

Literature Abstract

Long-term results of implants treated with guided bone regeneration: A 5-year

prospective study.

Seventy-five patients were observed for between 55 and 70 months to determine the clinical
outcome of Brånemark implants (Nobel Biocare) treated with guided bone regeneration (GBR).
The patients who were included had at least one of two implants that required GBR. There
were 112 implants that received a xenogenic graft material (Bio-Oss, Osteohealth) and a colla-
gen graft (Bio-Gide, Osteohealth); 41 sites were treated with Bio-Oss and an e-PTFE mem-
brane (Gore-Tex, 3i/WL Gore); and 112 implant represented control sites that did not require
GBR. There were no significant differences among the groups in implant survival rate (success
criteria according to Albrektsson). The mean marginal bone loss ranked in descending order
was Gore-Tex, Bio-Gide, and control groups. The difference was statistically significant. A pos-
itive correlation was found between plaque accumulation and mucosal problems. Plaque accu-
mulation appeared to decrease with increasing height of keratinized mucosa. The highest fre-
quencies of plaque accumulation and mucosal problems were found in association with
overdentures as compared to fixed single-tooth restorations and fixed partial dentures. The au-
thors concluded that the use of GBR techniques with the membranes studied did not alter the
implant survival rate but significantly increased the marginal bone loss.

Zitzmann NU, Schärer P, Marinello CP. Int J Oral Maxillofac Implants 2001;16:355–366. References: 22.
Reprints: Dr Nicola Zitzmann, Clinic of Fixed and Removable Prosthodontics and TMJ Disorders, Dental
School, University of Basel, Hebelstrasse 3, CH-4056 Basel, Switzerland. Fax: + 41-61-267 26 60. e-mail:
N.Zitzmann@unibas.ch—JC

The International Journal of Prosthodontics 158 Volume 15, Number 2, 2002