d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) e131–e139

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Resin-matrix ceramics for occlusal veneers: Effect

of thickness on reliability and stress distribution

Mirelle Maria Ruggiero a , Rafael Soares Gomes a ,

Edmara Tatiely Pedroso Bergamo b , Mariana Itaborai Moreira Freitas a ,
Estevam Augusto Bonfante b , Altair Antoninha Del Bel Cury a,∗
a Department of Prosthodontics and Periodontology, University of Campinas – Piracicaba Dental School, Limeira
Avenue, 901, Piracicaba, SP, 13414-903, Brazil
b Department of Prosthodontics and Periodontology, University of São Paulo – Bauru School of Dentistry, Dr. Octávio

Pinheiro Brisolla Avenue, 9-75, Bauru, SP, 17012-901, Brazil

a r t i c l e i n f o a b s t r a c t

Keywords: Objective. To evaluate the influence of resin-matrix ceramic material and thickness on reli-
Ceramics ability and stress distribution of occlusal veneers (OV).
Dental veneers Methods. One hundred and twenty-six OV of a mandibular first molar were milled using a
Fractures CAD/CAM system and allocated according to materials (resin nanoceramic (RNC) or polymer-
Stress infiltrated ceramic network (PICN)) and thicknesses (0.5, 1.0 and 1.5 mm), totaling six groups
(RNC0.5, RNC1, RNC1.5, PICN0.5, PICN1, and PICN1.5). Step-stress accelerated-life testing was
performed (n = 21/group) with the load applied at the distobuccal cusp tip of the occlusal
veneer until failure or suspension. The use level probability Weibull curves and reliability
were calculated and plotted (90% CI). Finite element analysis evaluated the stress distribu-
tion according to maximum principal stress (␴max ) on the restoration and maximum shear
stress (␶max ) on the cement layer.
Results. There was no difference in the probability of survival for the estimated missions
among the groups, except at 600 N in which the results were significantly lower to PICN1.5
(6%) compared to RNC1 (55%) and RNC1.5 (60%). The ␴max values were higher for PICN
(31.85–48.63 MPa) than RNC (30.78–33.09 MPa) in the same thicknesses. In addition, 0.5
mm groups concentrated more stress in the restoration (33.09–48.63 MPa) than 1.0 mm
(31.11–35.36 MPa) and 1.5 mm (30.78–31.85 MPa) groups in the same material.
Significance. Both resin-matrix ceramic materials seem up-and-coming restorative systems
for occlusal veneers irrespective of the thicknesses as a consequence of the high reliability.
© 2020 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.

the detrimental effects caused by pathological wear of the

1. Introduction dental structure [1]. Conventionally, the treatment involves
non-conservative rehabilitations with metal-ceramic or all-
The increase and/or reestablishment of the occlusal ver-
ceramic crowns, demanding a significant reduction of healthy
tical dimension is essential to prevent the progression of

∗
Corresponding author.
E-mail addresses: delbelcury@gmail.com, altair@unicamp.br (A.A. Del Bel Cury).
https://doi.org/10.1016/j.dental.2020.11.002
0109-5641/© 2020 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.
e132 d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) e131–e139
dental tissues [2]. Nevertheless, less invasive techniques, such
as occlusal veneers (OV), may be indicated as a restorative
approach for patients where the dental structure has been
selectively lost by wear [3,4].
The restoration thickness is an important factor influenc-
ing its longevity, with a proportional increase in the load
required to initiate a fracture as a function of restoration
thickness [5]. Conventional occlusal surface rehabilitation of
posterior teeth requires a minimum thickness of 1.5 mm to
support chewing loads [6]. However, the possibility to treat
severe tooth wear using ceramic or composite resin OV with
reduced thicknesses of approximately 0.5 mm has shown
promising results [4,6–9]. Hence, the dental structure can be
preserved from conventional preparation, eventually reducing
the risk of endodontic complications and preserving enamel
for adhesive cementation [10]. Although the use of OV seems a
promising restorative alternative, the material and minimum
thickness combination for OV fabrication still requires further
investigation.
Resin-matrix ceramics (RMCs) are a group of CAD/CAM
restorative materials that combines the characteristics of
polymers, which have a similar modulus of elasticity to dentin,
with the reinforcement mechanism of ceramics [11–13]. One
of the RMCs is the resin nanoceramic (RNC), consisting of zir-
conia nanoparticles and zirconia-silica nanoclusters linked
by a highly cured resin matrix (Bis-GMA, UDMA, Bis-EMA,
TEGDMA) [14]. RNC presents a 12 GPa dentin-like elastic
modulus and a higher flexural strength (∼150 MPa) and
fracture toughness (∼1.2 MPA.m1/2 ) when compared to light-
cured composite resins (∼130 MPA and ∼0.9 MPA.m1/2 ) [15–19].
Another RMC is the polymer-infiltrated ceramic network
(PICN), consisting of a feldspathic ceramic matrix in which an
organic phase of dimethacrylate resin (UDMA and TEGDMA)
is infiltrated (159 MPa and 1.3 MPA1/2 ) [12,16]. PICN shows an
elastic modulus of approximately 37 GPa, which is also similar
to dental structures when compared to conventional ceramic
systems [11,12].
Considering that different thicknesses and resin matrix
ceramic material used for OV are yet to be investigated,
this study characterized the reliability and stress distribu-
tion of RNC and PICN occlusal veneers of 0.5, 1.0, and 1.5
mm thicknesses. The null postulated hypothesis was that the
resin-matrix ceramic system and restoration thickness would
not influence the probability of survival (reliability) and the
stress distribution of occlusal veneers.
2. Materials and methods
2.1. Specimen fabrication
A CAD-based three-dimensional (3D) model of a mandibu-
lar first molar was designed (SolidWorks 2013; SolidWorks
Corporation, Concord, MA, USA). A uniform reduction on
the occlusal surface was performed to produce by boolean
operations, three CAD models of restorations with different
thicknesses (0.5, 1.0, and 1.5 mm). For the milling parameters
of the restorations, a marginal gap of 0 ␮m and an internal gap
of 50 ␮m were established between the tooth and the restora-
tion. The restorations were milled (Ceramill Motion 2; Amann
Girrbach, Koblach, Austria) in two different materials (n =
21/material): resin nanoceramic (Lava Ultimate; 3 M Oral Care,
St Paul, MN, USA) and polymer-infiltrated ceramic network
(Enamic; Vita Zahnfabrik, Bad Sackingen, Germany), totaling
126 occlusal veneers. Finishing and polishing were performed
according to the manufacturers’ recommendations. The CAD-
modeled preparation replicas, simulating advanced wear of
the occlusal surfaces were milled in fiber-reinforced epoxy
resin (n = 21/group) (G10; Protec, São Paulo, SP, Brazil) due to
its similarity in terms of adhesion (9 MPa) and elastic modulus
(18.6 GPa) to hydrated dentin (6.5 MPa and 18 GPa, respectively)
[3,4,20,21].
2.2. Cementation procedure
All OV were cemented to aged (stored in distilled and deion-
ized water at 37 ◦ C for 21 days) [20,21] fiber-reinforced epoxy
resin preparation preparations using a dual-cure resin cement
(RelyX Ultimate; 3 M Oral Care, St Paul, MN, USA). Epoxy resin
preparations were etched with 10% hydrofluoric acid (Con-
dac porcelana; FGM Produtos Odontológicos Ltda, Joinville, SC,
Brazil) for 120 s [22]. The pretreatment of the OV followed the
manufacturers’ instructions: RNC was sandblasted with alu-
minum oxide 50 ␮m grain size (Óxido de Alumínio, Bio-Art, São
Carlos, SP, Brazil), at a distance of ∼1 cm for 5 s at 2 bar, and
PICN was etched using 5% hydrofluoridric acid (Condac porce-
lana; FGM Produtos Odontológicos Ltda, Joinville, SC, Brazil)
for 60 s [23,24]. Then, both epoxy resin preparation and OV
were cleaned in an ultrasonic bath with distilled water for 2
min. The adhesive (Single Bond Universal; 3 M Oral Care, St
Paul, MN, USA) was applied on both ceramic and epoxy resin
preparation for 20 s, and then resin cement was applied on
the internal OV surface. After the restoration-to-preparation
setting, the assembly was maintained under a load of 10 N
[6,22] to standardize the cementation process thus promot-
ing a uniform cement spreading and thickness within the
intaglio surfaces. The cement excess was removed with a
micro-brush. The margins were light-cured (radii-cal; SDI Lim-
ited Bayswater, Victoria, Australia) for 20 s on each surface.
After that, the set was vertically embedded in acrylic resin
(Self-curing acrylic resin, Artigos Odontológicos Clássico Ltda,
Campo Limpo Paulista, SP, Brazil).
2.3. Step stress accelerated life testing (SSALT)
Three specimens per group were subjected to the single load-
to-failure (SLF) test in a universal testing machine (Instron
4411, Corona, CA, USA) with a load applied axially through a
tungsten carbide indenter on the central fossa of the occlusal
surface of the OV using a 5 kN load cell at a loading rate of
1 mm/min. Based on the SLF data, three different step-stress
profiles, mild, moderate, and aggressive, were designed.
The remaining specimens (n = 18/group) were allocated
to the three fatigue profiles: mild (n = 9), moderate (n = 6)
and aggressive (n = 3), following the distribution ratio of 3:2:1,
respectively, considering that the accuracy of the statistic pre-
diction is inversely proportional to its cycling length [25].
The SSALT test was performed in an electrodynamic fatigue
testing machine (ElectroPlus E3000 Linear-Torsion Test Instru-
mentTM; Instron, Norwood, GA, USA) in the presence of
 d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) e131–e139
Table 1 – Modulus of elasticity (GPa) and Poisson’s ratio (ı) for the simulated materials.
Material Modulus of elasticity
Resin Nanoceramic 12.7
Polymer-infiltraded ceramic network 37.8
Epoxy Resin 14.9
Resinous Cement 18.3
distilled water at 20 Hz [26]. In each cycle, the tungsten carbide
indenter contacted 0.5 mm lingual to distobuccal cusp tip of
the occlusal veneer in an axial direction. The test was consid-
ered finished when samples failed (considered as chipping or
delamination) or when suspended for no event being detected
throughout the designed cycles and 1500 N maximum load.
Based on the SSALT failure distribution, the use level prob-
ability Weibull curves were calculated and plotted (Synthesis
9, Alta Pro; Reliasoft, Tucson, AZ, USA) using the Weibull dis-
tribution and the inverse power law life-stress relationship
for damage accumulation. The reliability was calculated for
completion of a mission of 100,000 cycles at 200, 300, 400, 500
and 600 N, and the differences between groups were identi-
fied based on the non-overlap of the 90% two-sided confidence
interval (CI). This analysis provides the beta (␤) value, which
describes the behavior of the failure rate over time (␤ <1: val-
ues indicate that the failure rate has decreased over time, ␤ ∼
1: failure rate does not vary over time, and ␤> 1: means that
the failure rate has increased over time) [25]. If the calculated
beta value was <1 for any group, then a Weibull 2-Parameter
Contour plot (Weibull modulus - m vs. characteristic strength
eta - ␩) was calculated using the final load to failure data of all
groups.
2.4. Fractographic analysis
Representative fractured specimens were sputter-coated with
gold (Emitech K650; Emitech Products Inc, Houston, TX, USA)
for scanning electron microscopy (SEM) analysis (JSM-5600LV,
Jeol, Boston, MA, USA) and fractographic evaluation.
2.5. Finite element analysis
The CAD models of preparation replicas and OV were imported
into the finite element analysis software (Ansys Workbench
15.0; Ansys, Inc, Canonsburg, PA, USA). A convergence test
of 10% [27–29] was performed to guarantee that no further
mesh refinement was required to achieve accurate numerical
results of the FEA model and, subsequently, the element size
was determined (0.5 mm). The three-dimensional solid mod-
els meshed with tetrahedral and hexahedral elements were
automatically generated. The number of elements and nodes
varied depending on the model (33,744 to 36,853 elements
and 81,738 to 88,153 nodes). All structures were considered
isotropic, homogeneous, and linearly elastic [29]. To simulate
the influence of different structures, physical and mechan-
ical properties (modulus of elasticity and Poisson’s ratio) of
each structure of the model were obtained from the litera-
ture (Table 1) and introduced on the software. All contacts
were considered perfectly bonded. An axial load of 600 N was
applied as a normal surface pressure load on the distobuccal
cusp tip of the occlusal veneer models. The stress distribution
e133
Poisson’s ratio References
0.45 Wendler et al. [30]
0.24 Wendler et al. [30]
0.31 Yi & Kelly [31]
0.33 Li-li et al. [32]
Fig. 1 – Use level probability Weibull plot showing the
probability of failure as a function of cycles for the PICN and
RNC occlusal veneers.
was evaluated according to the criteria of maximum principal
stress (␴max ) on the OV restoration and maximum shear stress
(␶max ) on the cement layer. A scale of values was determined
to compare stress patterns in the models.
3. Results
Use level probability Weibull curves at a use load of 300 N for
the occlusal veneers are plotted in Fig. 1. The mean beta (␤) val-
ues were lower than 1 for PICN0.5, PICN1, RNC0.5, and RNC1
groups, indicating that failure rate decreased over time and
was controlled by material strength. However, for PICN1.5 and
RNC1.5 beta (␤) values were higher than 1, indicating that fail-
ure rate increased over time and fatigue damage accumulation
dictated failures (Table 2).
The probability of survival for completion of a mission of
100,000 cycles from 200 to 600 N loads is presented in Table 2.
The probability of survival for the estimated mission at 600
N, was significantly lower to PICN1.5 compared to RNC1 and
RNC1.5. At 200 and 300 N, the reliability of all groups was
higher than 90%. However, when the load increased from 200
N to 400 N (72–88%) and from 400 N to 600 N (6–45%) reliabil-
ity reduced significantly for all groups, except for RNC1 and
RNC1.5.
The Weibull 2-parameter contour plot (Weibull modu-
lus vs. characteristic strength) is presented in Fig. 2. The
Weibull modulus was not significantly different between
groups (4.66–6.27). Characteristic strength values were not sig-
nificantly different between 0.5 mm (592 N), 1.0 mm (703 N)
and 1.5 mm (715 N) PICN OV, as noticed by the existing over-
lap in the contour plot between groups. In contrast, groups
RNC of 1.5 mm (875 N) and 1.0 mm (815 N) presented statisti-
e134 d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) e131–e139

Table 2 – Calculated reliability (%) for a given mission of 100,000 cycles at set loads of 200, 300, 400, 500 and 600 N for
materials and thickness.
RNC PICN

0.5 mm 1.0 mm 1.5 mm 0.5 mm 1.0 mm 1.5 mm

Upper bound 100 100 100 100 100 100
200 N 99 aA 100 aA 100 aA 100 aA 99 aA 99 aA
Lower bound 95 96 98 97 97 95
Upper bound 98 99 100 99 99 98
300 N 93 aAB 97 aAB 99 aAB 95 aAB 96 aAB 93 aAB
Lower bound 83 86 91 84 88 80
Upper bound 89 97 99 91 95 86
400 N 79 aBC 90 aABC 94 aABC 79 aBC 88 aBC 72 aBC
Lower bound 61 69 77 55 70 49
Upper bound 68 91 94 68 85 56
500 N 53 aCD 77 aBC 82 aBC 45 aCD 70 aCD 35 aCD
Lower bound 34 47 56 19 46 15
Upper bound 40 78 79 32 66 22
600 N 24 abD 55 aC 60 aC 11 abD 45 abD 6 bD
Lower bound 11 25 32 2 21 0
Upper bound 0.25 1.33 2.51 0.65 0.63 3.26
Beta (␤) 0.12 0.37 1 0.23 0.16 1.29
Lower bound 0.05 0.1 0.4 0.08 0.04 0.51
Different lowercase letters represent statistical difference between occlusal veneers thicknesses and/or materials. Different uppercase letters
mean statistical difference between missions. Differences between groups were identified based on the non-overlap of 90% two-sided confidence
interval.

Table 3 – Stress (MPa) generated in the models

(restoration and cement) due to the effect of different
materials (RNC and PICN) and thickness (0.5 mm, 1.0
mm and 1.5 mm) at 600 N.
600 N

0.5 mm 1.0 mm 1.5 mm

␴max 33.09 31.11 30.78
RNC
␶max 28.60 26.73 19.18
␴max 48.63 35.36 31.85
PICN
␶max 21.53 17.54 15.16

Fig. 2 – Contour plot showing Weibull modulus (m) and
characteristic strength (␩).
RNC models groups (Fig. 5). In PICN groups, the intaglio surface
accumulated more stress in restoration than RNC in the same
thickness (Fig. 5b). The higher values of ␶max were noticed in
the RNC groups compared to PICN groups in the same thick-
ness (Fig. 6) and the stress accumulated just below the load
application area. Both ␴max and ␶max values increased as the
restoration thickness decreased.

cally higher characteristic strength relative to 0.5 mm (636 N) 4. Discussion

(Fig. 2).
All samples failed by delamination, in which an adhesive
failure exposing the epoxy resin preparation was observed.
Competitive failure mode was observed between the occlusal
surface under the loading area where hackle lines and arrest
lines were observed, and at the intaglio surface where a radial
crack was shown and an arrest line pointing towards this ori-
gin was confirmed (Fig. 3). This pattern was mostly observed
in 1.0 and 1.5 mm specimens. Occlusal wear from the inden-
ter contact preceded the fractures and were always observed
(Fig. 4). This pattern predominated in for 0.5 mm specimens.
Values of ␴max and ␶max are presented in Table 3. Higher val-
ues of ␴max were found in PICN occlusal veneers compared to
This study evaluated the probability of survival (reliability)
and stress distribution of CAD/CAM resin nanoceramic and
polymer-infiltrated ceramic network occlusal veneers of 0.5,
1.0 and 1.5 mm thicknesses. The null postulated hypothesis
that there would be no differences in the reliability and stress
distribution of OV fabricated by different resin-matrix ceramic
materials and thicknesses was partially rejected due to the
influence of material on reliability at 600 N and the difference
in stress distribution due to OV material and thickness.
Fatigue testing has shown to be an efficient method for
evaluating the lifetime of restorative materials [25]. The load
interval used in SSALT was distributed across the profiles to
 d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) e131–e139 e135

Fig. 3 – SEM micrographs of a representative delamination surface of a 1.0 mm specimen with an occlusal (a-1) and buccal
(b-1) overview of the failure. (a-2) and (a-3) are minor and higher magnification of occlusal view micrographs. Radial fracture
was observed (arrow). Dotted arrows indicate the direction of crack propagation, which is supported by the presence of
multiple hackle lines (H). (b-2) and (b-3) are minor and higher magnification of buccal view micrographs and show arrest
lines (AL) with its concave portion pointing towards fracture origin (*) on the loading area. Note: asterisk (*) is showing the
fracture originated in the loading area.

with similar characteristics can vary by as much as 200 N, pre-

Fig. 4 – Occlusal micrograph showing the wear (dark gray
areas) induced by the indenter during fatigue, resulting in
fracture (dotted squares), exposing the epoxy resin (arrows)
of a 0.5 mm specimen.
produce timely fractures at clinically relevant load levels that
are within the range of masticatory to maximum bite force
levels. Also, the range of load magnitudes for the predicted
reliability for a complete mission was determined by the max-
imum bite force in the first molar region in adults with no
history of parafunction, which varies widely in the literature.
Regalo et al. (2008) [33] found values for maximum bite force
in the first molar varying approximately in 262 N to 315 N in
women, and 464 N to 505 N in men, whereas Palinkas et al.
(2010) [34] reported 221 N to 247 N in women and 339 N to 348
N in men. Moreover, de Abreu et al. (2014) [35] show values
for maximum bite force approximately 424 N for women and
630 N for men. Once the maximum bite force in populations
dicting the reliability of the OV submitted to different loads is
essential. Considering that the outcomes can change accord-
ing to the different loads applied in the restoration, the results
can differ from individuals from the same populations.
The reliability of all occlusal veneer groups was high for a
mission of 100,000 cycles at set loads of 200 N and 300 N, up
to 100%. In addition, the predicted reliability for posterior OV
was significantly higher for 200 N when compared to 400 N,
and for 400 N compared to 600 N for all groups, except RNC1
and RNC1.5. The decrease of OV thickness had no significant
effect for the PICN or RNC groups in any load. Such results
corroborate with the study of Abu-Izze et al. (2018) [21] that
showed high survival rates after fatigue for OV fabricated in
PICN 0.5 mm and 1.0 mm thicknesses, 83% for both thick-
ness at 450 N load and 500,000 cycles, no differences found
between thicknesses. Similarly, our results presented 79 and
88% of probability of survival at 400 N and 100,000 cycles for
PICN0.5 and PICN1, respectively.
In addition, the probability of survival for the estimated
mission at 600 N, was significantly lower to PICN1.5 compared
to RNC1 and RNC1.5. A possible explanation for this fact lies
on PICN microstructure that exhibits few microcracks in the
network boundaries [12], possibly accelerating the failure [36].
These microcracks possibly are resulted from the stresses gen-
erated by the substantial shrinkage of the curing resin and
the feldspatic ceramic matrix, which results in debonding
between the two phases [37].
The beta values were <1 for 0.5 and 1.0 mm groups,
meaning that the restorative system failure was controlled
by material strength rather than damage accumulation from
fatigue testing [25]. Beta values for 1.5 mm groups were >1,
indicating that, failure rate increased over time and fatigue
damage accumulation was an acceleration factor for failure.
Also, the Weibull modulus (indicating the homogeneity of the
e136 d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) e131–e139

Fig. 5 – (a) Maximum principal stress (MPa) induced on the restoration occlusal surface and (b) maximum principal stress
(MPa) induced on the restoration intaglio surface.

strength data, thus expressing structural reliability) was calcu-
lated and characteristic strength (load at which 63.2% of the
specimens of each group would fail), according to final load
at failure during fatigue, disregarding the cycles [25]. Fatigue
load levels observed when a failure occurred were high for all
groups (between 592 and 872 N), considering that both mate-
rials fractured in loads close or above to the occlusal forces
range at the molar region [33–35].
Concerning failure, there was an interplay between near-
field contact damage and tensile stresses at the cementation
interface characterizing competitive failure modes originat-
ing from occlusal indentation area and radial cracking from
the intaglio surface. Competitive failure modes have already
been reported for brittle materials subjected to concentrated
cyclic load in liquid environments [38]. Also, fractographic
marks such as arrest lines, which indicate fracture origin and
direction of crack propagation, were observed with its concave
portion pointing to both occlusal indentation area as well as
to the cementation surface where a radial crack was observed.
This was likely due to the flexing under the loading behavior
of this class of materials that present lower flexural modulus.
Although the fractographic analysis has shown radial frac-
ture resulting from materials being of lower modulus of
elasticity than glass-ceramics [39] bonded to a compliant
dentin-like substrate [20], the dominant failure originated
from the occlusal surface likely originated from inner cone
cracking shown to express either as a cohesive failure or
a delamination failure when it reached the intaglio surface
 d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) e131–e139
Fig. 6 – Maximum shear stress (MPa) induced on the cement layer at 600 N simulated load.
[40]. Although the latter failure mode has been reproduced in
one of the resin-matrix ceramics investigated herein where
implant-supported crowns chiefly failed cohesively [41], fur-
ther damage mapping through in situ monitoring of crack
development of thin occlusal veneers loaded on cusps is
warranted to clarify the interplay between inner cone and
radial cracking in defining first crack initiation in resin-matrix
ceramics.
The finite element analysis was performed only at 600 N
because since this was a linear analysis, the results are propor-
tional to the load applied. In other words, if the analysis was
performed on the other SSALT loads (200, 300, 400, and 500
N), the result values would change, however, the inferences
between one group and another would be the same. About
the results, there was a difference in the stress concentration
in PICN and RNC occlusal veneers in the FEA analysis. The
higher stress concentration in PICN restorations can be related
to its greater modulus of elasticity when compared to RNC
[36]. Moreover, the PICN groups accumulated more stress in
the restoration intaglio surface than RNC groups, and thinner
PICN restorations accumulated more stress in the restoration
intaglio surface than thicker. These results suggest that PICN
groups may tend to develop radial cracks, especially in the
thinner groups. These findings corroborate with the study by
Abu Izze et al. 2018 [21] in which most of PICN occlusal veneers
cracks originated on the cementation surface, where the great-
est stress concentration was detected. In addition, Monteiro
et al. 2018 [42] assessed the maximum principal stress in
ceramic specimens of different thicknesses and, similarly to
the present study, found greater stress concentration in the
cementation surface of thinner specimens.
Furthermore, thinner restorations models accumulated
more stress in the structures (OV and cement) than thicker
restorations models, which can induce the formation of cracks
and increase the failure risk in critical thickness restorations
[21,35]. In addition, RNC induced more stress in the cement
layer compared to the PICN models in the same thicknesses.
e137
Considering that RNC has a lower modulus of elasticity com-
pared to PICN [36], it led to lower stress concentration in its
bulk and more stress accumulated in the cement layer. These
facts may increase the number of failures starting at the RNC
restoration/cement interface, such as radial cracks starting
from the intaglio surface. Nevertheless, when the cementa-
tion is carefully and correctly made, the cement layer is very
thin, which reduces the possibility of this type of crack to form.
The findings of the present study indicate that minimally
invasive OV of PICN and RNC can withstand physiological
clinical conditions irrespective of the restoration thickness.
Nevertheless, the study presented limitations, which included
the application of only axial loads (without sliding to simu-
late chewing forces) and use of a dentin-like substrate where
enamel bonding was disregarded. Thus, prospective clini-
cal investigations are necessary to evaluate the long-term
behavior of the polymer-infiltrated ceramic network and resin
nanoceramic to confirm these current in vitro findings.
5. Conclusion
Within the limitations of this study we can conclude that
both resin-matrix ceramic materials seem up-and-coming
restorative systems for occlusal veneers irrespective of the
thicknesses as a consequence of the high reliability.
Acknowledgments
This study was supported by the Coordenação de
Aperfeiçoamento de Pessoal de Nível Superior (CAPES) -
Brazil – Grant 001, Conselho Nacional de Desenvolvimento
Científico e Tecnológico (CNPq) - Brazil – Grant 306275/2016-3
and São Paulo Research Foundation (FAPESP) - Brazil - Grant
2012/19078-7 and through the scholarship 2018/21317-6.
e138 d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) e131–e139

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