Load-bearing properties of minimal-invasive monolithic lithium disilicate and zirconia occlusal onlays: Finite element and theoretical analyses

Objective The aim of this study was to test the hypothesis that monolithic lithium disilicate glass-ceramic occlusal onlay can exhibit a load-bearing capacity that approaches monolithic zirconia, due to a smaller elastic modulus mismatch between the lithium disilicate and its supporting tooth structure relative to zirconia. Methods Ceramic occlusal onlays of various thicknesses cemented to either enamel or dentin were considered. Occlusal load was applied through an enamel-like deformable indenter or a control rigid indenter. Flexural tensile stress at the ceramic intaglio (cementation) surface - a cause for bulk fracture of occlusal onlays - was rigorously analyzed using finite element analysis and classical plate-on-foundation theory. Results When bonded to enamel (supported by dentin), the load-bearing capacity of lithium disilicate can approach 75% of that of zirconia, despite the flexural strength of lithium disilicate (400 MPa) being merely 40% of zirconia (1000 MPa). When bonded to dentin (with the enamel completely removed), the load-bearing capacity of lithium disilicate is about 57% of zirconia, still significantly higher than the anticipated value based on its strength. Both ceramics show slightly higher load-bearing capacity when loaded with a deformable indenter (enamel, glass-ceramic, or porcelain) rather than a rigid indenter. Significance When supported by enamel, the load-bearing property of minimally invasive lithium disilicate occlusal onlays (0.6-1.4 mm thick) can exceed 70% of that of zirconia. Additionally, a relatively weak dependence of fracture load on restoration thickness indicates that a 1.2 mm thin lithium disilicate onlay can be as fracture resistant as its 1.6 mm counterpart.