The influence of core-build up materials on biaxial flexural strength of strength-gradient zirconia and lithium disilicate ceramics: an in-vitro study

The aim of this study was to investigate the effect of using different core build-up materials on biaxial flexural strength (BFS) of multilayered strength-gradient zirconia ceramic in comparison to lithium disilicate ceramic. Thirty zirconia discs were fabricated from IPS e.max ZirCAD Prime (Zir), 30 discs from IPS e.max CAD (LS2), 30 composite discs were prepared from Tetric N-Ceram (TNC) and 30 from MultiCore Flow (MCF). The ceramic discs were adhesively cemented to composite discs forming 4 groups (n = 15) (Zir-MCF, Zir-TNC, LS2-MCF and LS2-TNC). BFS was determined using a piston-on-3-ball test. The data were statistically analyzed with independent t-tests for significant differences (p = 0.05). In zirconia groups, significantly higher stress values were recorded in the composite and the ceramic for Zir-TNC, compared to Zir-MCF (p < 0.001), while for LS2 groups, no significant differences were found between the 2 composites (p = 0.157) but stresses in LS2 were significantly higher for LS2-TNC than LS2-MCF (p < 0.001). Comparing the values between the ceramic groups, stresses were significantly higher for zirconia than LS2 (p < 0.001). It was concluded that the tested composite materials significantly differ in their strength, which also influenced the strength of the overlying ceramics, and that strength-gradient zirconia had higher strength than LS2. Monolithic strength-gradient zirconia restorations supported by composite core build-up materials with superior mechanical properties can be durable restorative options for high stress-bearing areas.