Evaluating fatigue resistance in occlusal veneers: a comparative study of processing techniques and material thickness of lithium disilicate (IPS e.max Press vs. IPS e.max CAD).

Background: Lithium disilicate occlusal veneers are popular for minimally invasive posterior teeth restoration. The aim of this study was to compare the fatigue resistance and crack pattern of lithium disilicate occlusal veneers fabricated using pressing and milling techniques with varying thicknesses.

Methods: Sixty lithium disilicate discs, representing occlusal veneers, were divided into four groups (n = 15) based on processing technique (IPS e.max Press or IPS e.max CAD) and thickness (0.5 or 0.8 mm). A step-stress fatigue test was applied with axial loading, consisting of 10,000 cycles/step with a step size of 50 N until failure. Fractographic analysis was performed using SEM. Statistical analysis was performed using the Kaplan-Meier test, Mantel-Cox test, and Weibull analysis.

Results: Both processing techniques resulted in similar fatigue resistances at 0.5 mm and 0.8 mm thicknesses. However, the 0.8 mm lithium disilicate restorations showed a significantly higher survival rate than the 0.5 mm lithium disilicate restorations (log-rank tests, χ = 58.6; df = 3; P < 0.001). Fractographic analysis revealed radial cracks originating from defects on the ceramic surface at the cementing interface, extending towards the occlusal surface.

Conclusions: At 0.5 mm or 0.8 mm material thickness, the processing technique did not affect the fatigue resistance or crack patterns of the lithium disilicate occlusal veneers. However, the lithium disilicate with a thickness of 0.8 mm exhibited a superior survival probability compared to that with a thickness of 0.5 mm.