Research and Education|Articles in Press

Fracture strength and three-dimensional marginal evaluation of biocompatible high-performance polymer versus pressed lithium disilicate crowns

  • Mahnaz Arshad
    Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran, Associate Professor, Department of Prosthodontics, School of Dentistry, International Campus, Tehran University of Medical Sciences, Tehran, Iran
    Search for articles by this author
  • Sahar Hassantash
    Graduate student, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
    Search for articles by this author
  • Shamim Chinian
    Graduate student, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
    Search for articles by this author
  • Alireza Sadr
    Professor, Biomimetics Biomaterials Biophotonics Biomechanics & Technology Laboratory, Department of Restorative Dentistry, University of Washington, Seattle, Wash
    Search for articles by this author
  • Sareh Habibzadeh
    Corresponding author: Dr Sareh Habibazdeh, Department of Prosthodontics, Tehran University of Medical Sciences, No. 14, Heravi Square, Zabeti St, Pasdaran Ave, Tehran, IRAN
    Associate Professor, Department of Prosthodontics, School of Dentistry, International Campus, Tehran University of Medical Sciences, Tehran, Iran, Associate Professor, Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
    Search for articles by this author


      Statement of problem

      Despite the acceptable physical properties of biocompatible high-performance polymer (BioHPP), little is known about the marginal accuracy and fracture strength of restorations made from this material.


      This in vitro study assessed the marginal and internal adaptation and fracture strength of teeth restored with lithium disilicate (LD) ceramics and BioHPP monolithic crowns.

      Material and methods

      Twenty-four extracted premolars were prepared for complete coverage crowns and divided into 2 groups to receive pressed IPS e.max LD, or computer-aided design and computer-aided manufacturing (CAD-CAM) BioHPP monolithic crowns. After adhesive cementation, the marginal and internal adaptations of the restorations were evaluated by microcomputed tomography at 18 points for each crown. Specimens were subjected to 6000 thermal cycles at 5 °C and 55 °C and 200 000 load cycles of 100 N at a frequency of 1.2 Hz. The fracture strength of the restorations was then measured in a universal testing machine at a crosshead speed of 0.5 mm/min. Data were analyzed via an independent-sample t-test (α=.05).


      The mean ±standard deviation of marginal gap was 138.8 ±43.6 μm for LD and 242.1 ±70.7 μm for BioHPP groups (P=.001). The mean ±standard deviation value of absolute marginal discrepancy was 193.8 ±60.8 μm for LD and 263.5 ±97.6 μm for BioHPP groups (P=.06). The internal occlusal and axial gap measurements were 547.5 ±253.1 μm and 197.3 ±54.8 μm for LD (P=.03) and 360 ±62.9 μm and 152.8 ±44.8 μm for BioHPP (P=.04). The mean ±standard deviation of internal space volume was 15.3 ±11.8 μm³ for LD and 24.1 ±10.7 μm³ for BioHPP (P=.08). The mean ±standard deviation of fracture strength was 2509.8 ±680 N for BioHPP and 1090.4 ±454.2 MPa for LD groups (P<.05).


      The marginal adaptation of pressed lithium disilicate crowns was better, while BioHPP crowns displayed greater fracture strength. Marginal gap width was not correlated with fracture strength in either group.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Prosthetic Dentistry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Pop-Ciutrila I.S.G.R.
        • Dudea D.
        • Ruiz-López J.
        • Pérez M.M.
        • Colosi H.
        The effects of thickness and shade on translucency parameters of contemporary, esthetic dental ceramics.
        J Esthet Restor Dent. 2021; 33: 795-806
        • Dolev E.
        • Bitterman Y.
        • Meirowitz A.
        Comparison of marginal fit between CAD-CAM and hot-press lithium disilicate crowns.
        J Prosthet Dent. 2019; 121: 124-128
        • Babu P.J.
        • Alla R.K.
        • Alluri V.R.
        • Datla S.R.
        • Konakanchi A.
        Dental ceramics: Part I – An overview of composition, structure and properties.
        Am J Mater Eng Technol. 2015; 3: 13-18
        • Hamza T.A.
        • Sherif R.M.
        Fracture resistance of monolithic glass-ceramics versus bilayered zirconia-based restorations.
        J Prosthodont. 2019; 28: e259-e264
        • Jovanović M.
        • Živić M.
        • Milosavljević M.
        A potential application of materials based on a polymer and CAD/CAM composite resins in prosthetic dentistry.
        J Prosthodont Res. 2021; 65: 137-147
        • Passaretti A.
        • Petroni G.
        • Miracolo G.
        • Savoia V.
        • Perpetuini A.
        • Cicconetti A.
        Metal free, full arch, fixed prosthesis for edentulous mandible rehabilitation on four implants.
        J Prosthodont Res. 2018; 62: 264-267
        • Blanch-Martínez N.
        • Arias-Herrera S.
        • Martínez-González A.
        Behavior of polyether-ether-ketone (PEEK) in prostheses on dental implants. A review.
        J Clin Exp Dent. 2021; 13: e520-e526
        • Wang B.
        • Huang M.
        • Dang P.
        • Xie J.
        • Zhang X.
        • Yan X.
        PEEK in fixed dental prostheses: application and adhesion improvement.
        Polymers (Basel). 2022; 14: 2323
        • Badran A.
        • Zaki A.
        • Rabie K.
        One year clinical evaluation of milled BioHPP polyetheretherketone (PEEK)-based versus metal ceramic single crowns (randomized controlled clinical trial).
        Braz Dent Sci. 2021; 24: 1-11
        • Elashmawy Y.
        • Elshahawy W.
        • Seddik M.
        • Aboushelib M.
        Influence of fatigue loading on fracture resistance of endodontically treated teeth restored with endocrowns.
        J Prosthodont Res. 2021; 65: 78-85
        • Georgiev J.
        • Vlahova A.
        • Kissov H.
        • Aleksandrov S.
        • Kazakova R.
        Possible application of BioHPP in prosthetic dentistry: a literature review.
        J of IMAB. 2018; 24: 1896-1898
        • Reda R.
        • Zanza A.
        • Galli M.
        • De Biase A.
        • Testarelli L.
        • Di Nardo D.
        Applications and clinical behavior of biohpp in prosthetic dentistry: A short review.
        J Compos Sci. 2022; 6: 90
        • Skirbutis G.
        • Dzingutė A.
        • Masiliūnaitė V.
        • Šulcaitė G.
        • Žilinskas J.
        PEEK polymer's properties and its use in prosthodontics. A review.
        Stomatologija. 2018; 20: 54-58
        • Qin L.
        • Yao S.
        • Zhao J.
        • et al.
        Review on development and dental applications of polyetheretherketone-based biomaterials and restorations.
        Materials (Basel). 2021; 14: 408
        • Schwitalla A.D.
        • Spintig T.
        • Kallage I.
        • Müller W.D.
        Flexural behavior of PEEK materials for dental application.
        Dent Mater. 2015; 31: 1377-1384
        • Park J.Y.
        • Bae S.Y.
        • Lee J.J.
        • Kim J.H.
        • Kim H.Y.
        • Kim W.C.
        Evaluation of the marginal and internal gaps of three different dental prostheses: comparison of the silicone replica technique and three-dimensional superimposition analysis.
        J Adv Prosthodont. 2017; 9: 159-169
        • Attia M.A.
        • Shokry T.E.
        Effect of different fabrication techniques on the marginal precision of polyetheretherketone single-crown copings.
        J Prosthet Dent. 2020; 124: 565.e1-565.e7
        • Beleidy M.
        • Ziada A.
        Marginal accuracy and fracture resistance of posterior crowns fabricated from CAD/CAM PEEK cores veneered with HIPC or nanohybrid conventional composite.
        Egypt Dent J. 2020; 66: 2541-2552
        • Fonseca R.B.
        • Carlo H.L.
        • Neto A.J.
        • Soares C.J.
        Correlation between marginal accuracy and fracture resistance of indirect composite restorations varying cavity preparation design.
        Braz J Oral Sci. 2007; 6: 1260-1264
        • Al Hamad K.Q.
        • Al Quran F.A.
        • AlJalam S.A.
        • Baba N.Z.
        Comparison of the accuracy of fit of metal, zirconia, and lithium disilicate crowns made from different manufacturing techniques.
        J Prosthodont. 2019; 28: 497-503
        • Bae S.Y.
        • Park J.Y.
        • Jeong I.D.
        • Kim H.Y.
        • Kim J.H.
        • Kim W.C.
        Three-dimensional analysis of marginal and internal fit of copings fabricated with polyetherketoneketone (PEKK) and zirconia.
        J Prosthodont Res. 2017; 61: 106-112
        • Ferrairo B.M.
        • Piras F.F.
        • Lima F.F.
        • et al.
        Comparison of marginal adaptation and internal fit of monolithic lithium disilicate crowns produced by 4 different CAD/CAM systems.
        Clin Oral Investig. 2021; 25: 2029-2036
        • Mously H.A.
        • Finkelman M.
        • Zandparsa R.
        • Hirayama H.
        Marginal and internal adaptation of ceramic crown restorations fabricated with CAD/CAM technology and the heat-press technique.
        J Prosthet Dent. 2014; 112: 249-256
        • McLean J.W.
        • von Fraunhofer J.A.
        The estimation of cement film thickness by an in vivo technique.
        Br Dent J. 1971; 131: 107-111
        • Roy M.S.
        • Tewary S.
        • Sanyal P.
        • Kamnoor S.
        • Vande A.
        An in vivo study to compare the marginal fit accuracy of crowns prepared using two different materials.
        J Evol Med Dent Sci. 2019; 8: 1930-1934
        • Contrepois M.
        • Soenen A.
        • Bartala M.
        • Laviole O.
        Marginal adaptation of ceramic crowns: a systematic review.
        J Prosthet Dent. 2013; 110: 447-454.e10
        • Neves F.D.
        • Prado C.J.
        • Prudente M.S.
        • et al.
        Micro-computed tomography evaluation of marginal fit of lithium disilicate crowns fabricated by using chairside CAD/CAM systems or the heat-pressing technique.
        J Prosthet Dent. 2014; 112: 1134-1140
        • El Sokkary A.
        • Allah L.S.
        • El Khodary N.
        One year clinical evaluation of fracture and marginal integrety of milled biohpp polyetheretherketon (PEEK) versus zirconia veneered single crowns.
        Braz Dent Sci. 2021; 24: 1-13
        • Baciu S.
        • Berece C.
        • Florea A.
        • et al.
        Three-dimensional marginal evaluation of two pressed materials using micro-CT technology.
        Rev Chim. 2017; 68: 615-618
        • Riccitiello F.
        • Amato M.
        • Leone R.
        • Spagnuolo G.
        • Sorrentino R.
        In vitro evaluation of the marginal fit and internal adaptation of zirconia and lithium disilicate single crowns: Micro-CT comparison between different manufacturing procedures.
        Open Dent J. 2018; 12: 160-172
        • Demir N.
        • Ozturk A.N.
        • Malkoc M.A.
        Evaluation of the marginal fit of full ceramic crowns by the microcomputed tomography (micro-CT) technique.
        Eur J Dent. 2014; 8: 437-444
        • Shakal M.A.S.
        Comparative fracture resistance of composite veneered polyether ether ketone crowns with ceramic and composite veneered zirconia crowns.
        Egypt Dent J. 2018; 64: 711-719
        • Mohamed M.
        The effect of thermocycling and mechanical loading on the fracture resistance of all-ceramic and high performance polymers fixed partial dentures.
        Egypt Dent J. 2018; 64: 2603-2613
        • Meshreky M.
        • Halim C.
        • Katamish H.
        vertical marginal gap distance of CAD/CAM milled BioHPP PEEK coping veneered by HIPC compared to zirconia coping veneered by CAD-ON lithium disilicate “in-vitro study.
        ADJC. 2020; 2: 43-50
        • Shillingburg H.T.
        • Hobo S.
        • Whitsett L.D.
        • Jacobi R.
        • Brackett S.
        Fundamentals of Fixed Prosthodontics.
        4th ed. Quintessence Publishing Company Chicago, IL1997
        • Shahmoradi M.
        • Wan B.
        • Zhang Z.
        • Wilson T.
        • Swain M.
        • Li Q.
        Monolithic crowns fracture analysis: The effect of material properties, cusp angle and crown thickness.
        Dent Mater. 2020; 36: 1038-1051
        • Alfaro D.P.
        • Ruse N.D.
        • Carvalho R.M.
        • Wyatt C.C.
        assessment of the internal fit of lithium disilicate crowns using micro-CT.
        J Prosthodont. 2015; 24: 381-386
        • Mostafa N.Z.
        • Ruse N.D.
        • Ford N.L.
        • et al.
        Marginal fit of lithium disilicate crowns fabricated using conventional and digital methodology.
        J Prosthodont. 2018; 27: 145-152
        • Kim J.H.
        • Jeong J.H.
        • Lee J.H.
        • Cho H.W.
        Fit of lithium disilicate crowns fabricated from conventional and digital impressions assessed with micro-CT.
        J Prosthet Dent. 2016; 116: 551-557
        • Peroz I.
        • Mitsas T.
        • Erdelt K.
        • Kopsahilis N.
        Marginal adaptation of lithium disilicate ceramic crowns cemented with three different resin cements.
        Clin Oral Investig. 2019; 23: 315-320
        • Pimenta M.A.
        • Frasca L.C.
        • Lopes R.
        • Rivaldo E.
        Evaluation of marginal and internal fit of ceramic and metallic crown copings using x-ray microtomography (micro-CT) technology.
        J Prosthet Dent. 2015; 114: 223-228
        • Gassino G.
        • Barone Monfrin S.
        • Scanu M.
        • Spina G.
        • Preti G.
        Marginal adaptation of fixed prosthodontics: a new in vitro 360-degree external examination procedure.
        Int J Prosthodont. 2004; 17: 218-223
        • Holmes J.R.
        • Bayne S.C.
        • Holland G.A.
        • Sulik W.D.
        Considerations in measurement of marginal fit.
        J Prosthet Dent. 1989; 62: 405-408
        • Heintze S.D.
        • Eser A.
        • Monreal D.
        • Rousson V.
        Using a chewing simulator for fatigue testing of metal ceramic crowns.
        J Mech Behav Biomed Mater. 2017; 65: 770-780
        • Preis V.
        • Hahnel S.
        • Behr M.
        • Bein L.
        • Rosentritt M.
        In-vitro fatigue and fracture testing of CAD/CAM-materials in implant-supported molar crowns.
        Dent Mater. 2017; 33: 427-433
        • Steiner M.
        • Mitsias M.E.
        • Ludwig K.
        • Kern M.
        In vitro evaluation of a mechanical testing chewing simulator.
        Dent Mater. 2009; 25: 494-499
        • Gerogianni P.
        • Lien W.
        • Bompolaki D.
        • et al.
        Fracture resistance of pressed and milled lithium disilicate anterior complete coverage restorations following endodontic access preparation.
        J Prosthodont. 2019; 28: 163-170
        • Burke F.J.
        • Watts D.C.
        Fracture resistance of teeth restored with dentin-bonded crowns.
        Quintessence Int. 1994; 25: 335-340
        • Borges G.A.
        • Faria J.S.
        • Agarwal P.
        • Spohr A.M.
        • Correr-Sobrinho L.
        Miranzi BA In vitro marginal fit of three all-ceramic crown systems before and after cementation.
        Oper Dent. 2012; 37: 641-649
        • Shim J.S.
        • Lee J.S.
        • Lee J.Y.
        • Choi Y.J.
        • Shin S.W.
        • Ryu J.J.
        Effect of software version and parameter settings on the marginal and internal adaptation of crowns fabricated with the CAD/CAM system.
        J Appl Oral Sci. 2015; 23: 5