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Pi Is 0002817714637351
Pi Is 0002817714637351
than 92.0 percent Alfa, indicating no appreciable with surface porcelain. There was no significant dif-
change in the crowns during the two years of the ference between the two crown types for any of the
study. USPHS scores. One of the monolithic ceramic
All of the crowns cemented with MA were clini- crowns fractured at 12.0 months, and one of the
cally acceptable at two years. Two crowns layered ceramic crowns fractured at 42.5 months.
cemented with EC debonded: one at one year and The Kaplan-Meier probability for survival was 91.7
the other at two years. Both of the debonded percent for the layered ceramic crowns and 94.4
crowns were intact, and the treating clinician used percent for the monolithic ceramic crowns after a
MA to recement them. mean ± standard deviation of 44.7 ± 10.3 months.
Bindl and colleagues11 compared 208 monolithic
DISCUSSION posterior ceramic crowns on the basis of the tooth
There are limited clinical studies of an early version type and three types of crown preparation designs:
of lithium disilicate glass ceramic. IPS Empress 2 reduced, classic or “endo.” Only two crowns in the
(Ivoclar Vivadent) was a lithium disilicate glass reduced preparation group fractured after two
ceramic fabricated by means of a lost-wax and heat- years, with no fractures in the classic or endo
pressed technique. The substructure was veneered preparation groups. By 55 months, two crowns in
with fluorapatite-based porcelain. Marquardt and the classic preparation group fractured, and three
Strub7 evaluated 58 IPS Empress 2 restorations more from the reduced preparation group fractured.
(27 posterior crowns and 31 three-unit fixed partial After 55 ± 15 months, the investigators reported a
dentures [FPDs]) after five years of clinical service. Kaplan-Meier probability of survival for premolars
Two of the crowns had repairable fractures in the of 97.0 percent for those in the classic preparation
veneering porcelain. Six complete failures occurred group, 92.9 percent for those in the reduced prepa-
within the FPDs. Taskonak and Sertgöz8 evaluated ration group and 68.8 percent for those in the endo
20 IPS Empress 2 crowns and 20 FPDs after two preparation group. For molars, they reported a
years. They reported no crown fractures and 10 fail- Kaplan-Meier probability of survival of 94.6 percent
ures with the FPDs. This early lithium disilicate is for those in the classic preparation group, 92.1 per-
not the same material as IPS e.max CAD or IPS cent for those in the reduced preparation group and
e.max Press ceramics. There is a substantial differ- 87.1 percent for those in the endo preparation
ence in the microstructure of the lithium disilicate group. These study results support the assertion
crystals and the matrix, resulting in improved phys- that monolithic ceramic crowns have good success
ical properties and translucency of the IPS e.max across five years of clinical service.
lithium disilicate.9 The results from comprehensive and systematic
There are few published clinical studies of mono- reviews indicated that the five-year survival rate of
lithic ceramic crowns. Bindl and Mörmann10 com- all-ceramic crowns was greater than 93 percent.12-14
pared monolithic ceramic crowns (Vitablocs Mark The most common mode of failure for all-ceramic
II, Vident, Brea, Calif.) with layered ceramic restorations reported in the comprehensive and
crowns (Vita In-Ceram Spinell, Vident). The mono- systematic reviews was complete fracture of the
lithic ceramic crowns were fabricated with a substructure, the veneer porcelain or both,
CEREC 2 (Sirona Dental Systems) unit. The sub- requiring the layered all-ceramic crown to be
structures of the layered ceramic crowns were remade.12-14 The most common minor problem was
milled with a CEREC 2 unit and then veneered chipping or cracking limited to the veneer porce-