Non-Cochrane · other · PM42645487
Impact of Thermocycling and Artificial Aging on the Flexural Strength and Fracture Resistance of CAD/CAM Dental Ceramics: A Systematic Review and Meta-Analysis.
Mora Bayas Joyce Michel, Chauca Bajaña Luis, Ortiz Bustamante Carol, et al. · Dentistry journal · 2026 · PubMed · doi:10.3390/dj14080513
Findings
25 findings
| Population | ||||
|---|---|---|---|---|
| CAD/CAM dental ceramic specimens used for indirect restorations | Thermocycling and/or artificial aging | Non-aged control or baseline specimens | Flexural strength After aging protocol · Laboratory · Overall | SMD -1.68 [-2.28, -1.08] GRADE not reported 5 studies · 404 participants |
| CAD/CAM dental ceramic specimens used for indirect restorations | Thermocycling and/or artificial aging | Non-aged control or baseline specimens | Flexural strength After aging protocol · Laboratory · Multilevel random-effects model (dependent comparisons within studies) | SMD -1.68 [-2.73, -0.62] GRADE not reported 5 studies |
| CAD/CAM dental ceramic specimens used for indirect restorations | Thermocycling and/or artificial aging | Non-aged control or baseline specimens | Flexural strength After aging protocol · Laboratory · Leave-one-out sensitivity: omitting Lauvahutanon VITABLOCS Mark II comparison (most negative pooled estimate) | SMD -1.84 GRADE not reported 5 studies |
| CAD/CAM dental ceramic specimens used for indirect restorations | Thermocycling and/or artificial aging | Non-aged control or baseline specimens | Flexural strength After aging protocol · Laboratory · Leave-one-out sensitivity: omitting Almansour Ceramill ZI-LT comparison (largest change) | SMD -1.49 GRADE not reported 5 studies |
| Zirconia-based CAD/CAM ceramics | Thermocycling and/or artificial aging | Non-aged control or baseline specimens | Flexural strength After aging protocol · Laboratory · Zirconia-based ceramics | SMD -3.31 [-4.27, -2.35] GRADE not reported 2 studies · 120 participants |
| Lithium disilicate and lithium silicate CAD/CAM ceramics | Thermocycling and/or artificial aging | Non-aged control or baseline specimens | Flexural strength After aging protocol · Laboratory · Lithium disilicate and lithium silicate ceramics | SMD -1.25 [-1.63, -0.87] GRADE not reported 3 studies · 132 participants |
| Hybrid and PICN CAD/CAM ceramics | Thermocycling and/or artificial aging | Non-aged control or baseline specimens | Flexural strength After aging protocol · Laboratory · Hybrid and PICN ceramics | SMD -1.37 [-1.74, -1.01] GRADE not reported 3 studies · 148 participants |
| Feldspathic and glass-based CAD/CAM ceramics | Thermocycling and/or artificial aging | Non-aged control or baseline specimens | Flexural strength After aging protocol · Laboratory · Feldspathic and glass-based ceramics | SMD -0.47 [-1.35, 0.42] GRADE not reported 2 studies · 68 participants |
| CAD/CAM dental ceramic specimens used for indirect restorations | Thermocycling and/or artificial aging (single-arm, post-aging values) | None (no non-aged control pooled) | Fracture resistance (N) After aging protocol · Laboratory · Leave-one-out sensitivity: omitting Choo (IPS e.max CAD) | Pooled mean 1222.26 [895.29, 1549.24] GRADE not reported 5 studies |
| CAD/CAM dental ceramic specimens (all categories) after artificial aging | Artificial aging (thermocycling, water storage, mechanical fatigue, thermomechanical aging) | None (single-arm post-aging values; no non-aged comparator) | Fracture resistance (N), load-to-fracture after aging In vitro laboratory testing · Sensitivity: leave-one-out, omitting Essam (IPS e.max CAD) | Pooled mean (N) 1283.71 [924.16, 1643.26] GRADE not reported 4 studies · 108 participants |
| CAD/CAM dental ceramic specimens used for indirect restorations | Thermocycling and/or artificial aging (single-arm, post-aging values) | None (no non-aged control pooled) | Fracture resistance (N) After aging protocol · Laboratory · Leave-one-out sensitivity: omitting Alnajjar (Lava Ultimate) | Pooled mean 1299.02 [941.25, 1656.78] GRADE not reported 5 studies |
| CAD/CAM dental ceramic specimens used for indirect restorations | Thermocycling and/or artificial aging (single-arm, post-aging values) | None (no non-aged control pooled) | Fracture resistance (N) After aging protocol · Laboratory · Leave-one-out sensitivity: omitting Al-Akhali (IPS e.max CAD) | Pooled mean 1368.52 [1056.60, 1680.43] GRADE not reported 5 studies |
| CAD/CAM dental ceramic specimens used for indirect restorations | Thermocycling and/or artificial aging (single-arm, post-aging values) | None (no non-aged control pooled) | Fracture resistance (N) After aging protocol · Laboratory · Leave-one-out sensitivity: omitting Choo (Katana UTML) | Pooled mean 1252.45 [901.45, 1603.46] GRADE not reported 5 studies |
| CAD/CAM dental ceramic specimens used for indirect restorations | Thermocycling and/or artificial aging (single-arm, post-aging values) | None (no non-aged control pooled) | Fracture resistance (N) After aging protocol · Laboratory · Leave-one-out sensitivity: omitting Elsayed (Celtra Duo) | Pooled mean 1252.77 [901.15, 1604.40] GRADE not reported 5 studies |
| CAD/CAM dental ceramic specimens used for indirect restorations | Thermocycling and/or artificial aging (single-arm, post-aging values) | None (no non-aged control pooled) | Fracture resistance (N) After aging protocol · Laboratory · Leave-one-out sensitivity: omitting Choo (Rosetta SM) | Pooled mean 1234.16 [894.66, 1573.66] GRADE not reported 5 studies |
| CAD/CAM dental ceramic specimens used for indirect restorations | Thermocycling and/or artificial aging (single-arm, post-aging values) | None (no non-aged control pooled) | Fracture resistance (N) After aging protocol · Laboratory · Leave-one-out sensitivity: omitting Alnajjar (IPS e.max CAD) | Pooled mean 1287.35 [928.00, 1646.69] GRADE not reported 5 studies |
| CAD/CAM dental ceramic specimens used for indirect restorations | Thermocycling and/or artificial aging (single-arm, post-aging values) | None (no non-aged control pooled) | Fracture resistance (N) After aging protocol · Laboratory · Leave-one-out sensitivity: omitting Al-Akhali (Vita Suprinity) | Pooled mean 1347.68 [1015.87, 1679.49] GRADE not reported 5 studies |
| CAD/CAM dental ceramic specimens used for indirect restorations | Thermocycling and/or artificial aging (single-arm, post-aging values) | None (no non-aged control pooled) | Fracture resistance (N) After aging protocol · Laboratory · Leave-one-out figure: overall random-effects model | Pooled mean 1289.07 [965.14, 1613.01] GRADE not reported 5 studies |
| CAD/CAM dental ceramic specimens used for indirect restorations | Thermocycling and/or artificial aging (single-arm, post-aging values) | None (no non-aged control pooled) | Fracture resistance (N) After aging protocol · Laboratory · Leave-one-out sensitivity: omitting Al-Akhali (Vita Enamic) | Pooled mean 1384.43 [1091.89, 1676.98] GRADE not reported 5 studies |
| CAD/CAM dental ceramic specimens used for indirect restorations | Thermocycling and/or artificial aging (single-arm, post-aging values) | None (no non-aged control pooled) | Fracture resistance (N) After aging protocol · Laboratory · Leave-one-out sensitivity: omitting Elsayed (IPS e.max CAD) | Pooled mean 1246.85 [898.44, 1595.27] GRADE not reported 5 studies |
| CAD/CAM dental ceramic specimens used for indirect restorations | Thermocycling and/or artificial aging (single-arm, post-aging values) | None (no non-aged control pooled) | Fracture resistance (N) After aging protocol · Laboratory · Sensitivity: excluding Al-Akhali et al. 2019 | Pooled mean 1570.68 [1385.12, 1756.23] GRADE not reported 4 studies · 126 participants |
| CAD/CAM dental ceramic specimens used for indirect restorations | Thermocycling and/or artificial aging (single-arm, post-aging values) | None (no non-aged control pooled) | Fracture resistance (N) After aging protocol · Laboratory · Overall | Pooled mean 1312.85 [1131.59, 1494.10] GRADE not reported 5 studies · 150 participants |
| Lithium disilicate (IPS e.max CAD) restorations | Thermocycling and/or artificial aging (single-arm, post-aging values) | None (no non-aged control pooled) | Fracture resistance (N) After aging protocol · Laboratory · Lithium disilicate (IPS e.max CAD) | Pooled mean 1372.55 [1080.02, 1665.08] GRADE not reported 5 studies · 88 participants |
| Zirconia and ZLS CAD/CAM restorations | Thermocycling and/or artificial aging (single-arm, post-aging values) | None (no non-aged control pooled) | Fracture resistance (N) After aging protocol · Laboratory · Zirconia and zirconia-reinforced lithium silicate (ZLS) | Pooled mean 1528.18 [1320.70, 1735.67] GRADE not reported 3 studies · 34 participants |
| Hybrid, PICN and resin nanoceramic CAD/CAM restorations | Thermocycling and/or artificial aging (single-arm, post-aging values) | None (no non-aged control pooled) | Fracture resistance (N) After aging protocol · Laboratory · Hybrid ceramics, PICN and resin nanoceramics | Pooled mean 766.92 [-43.59, 1577.44] GRADE not reported 2 studies · 28 participants |
Included primary studies 17
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Al-Akhali 2019 Fabricating a reduction guide for parallel guiding planes with computer-aided design and computer-aided manufacturing technology DOI:10.1016/j.prosdent.2018.07.010 | 2019 | this review only | not stated | not extracted yet |
| Al-Akhali 2019 Influence of thermomechanical fatigue on the fracture strength of CAD-CAM-fabricated occlusal veneers. PMID:30711291 | 2019 | this review only | Fracture resistance (N) | not extracted yet |
| Almansour 2018 The Effect of <i>in vitro</i> Aging and Fatigue on the Flexural Strength of Monolithic High-translucency Zirconia Restorations DOI:10.5005/jp-journals-10024-2349 | 2018 | this review only | not stated | not extracted yet |
| Almansour 2018 The Effect of in vitro Aging and Fatigue on the Flexural Strength of Monolithic High-translucency Zirconia Restorations. PMID:30066693 | 2018 | this review only | Flexural strength | not extracted yet |
| Alnajjar 2024 Fracture Resistance of Posterior Milled Nanoceramic Crowns after Thermomechanical Aging. PMID:39057293 | 2024 | this review only | Fracture resistance (N) | not extracted yet |
| Choo 2023 Fatigue resistance of anterior monolithic crowns produced from CAD-CAM materials: An in vitro study DOI:10.1016/j.prosdent.2021.09.034 | 2023 | this review only | not stated | not extracted yet |
| Choo 2023 Fatigue resistance of anterior monolithic crowns produced from CAD-CAM materials: An in vitro study. PMID:34980473 | 2023 | this review only | Fracture resistance (N) | not extracted yet |
| Elraggal 2023 Effect of acidic media on flexural strength and fatigue of CAD-CAM dental materials DOI:10.1016/j.dental.2022.11.019 | 2023 | this review only | not stated | not extracted yet |
| Elraggal 2023 Effect of acidic media on flexural strength and fatigue of CAD-CAM dental materials. PMID:36496258 | 2023 | this review only | Flexural strength | not extracted yet |
| Elsayed 2023 DOI:10.26355/eurrev_202302_31180 | NR | this review only | not stated | not extracted yet |
| Elsayed 2023 Marginal gap distance and cyclic fatigue loading for different all-ceramic endocrowns. PMID:36808333 | 2023 | this review only | Fracture resistance (N) | not extracted yet |
| Essam 2023 Influence of thickness and surface conditioning on fracture resistance of occlusal veneer DOI:10.1186/s12903-023-02932-0 | 2023 | this review only | not stated | not extracted yet |
| Essam 2023 Influence of thickness and surface conditioning on fracture resistance of occlusal veneer. PMID:37138255 | 2023 | this review only | Fracture resistance (N) | not extracted yet |
| Lauvahutanon 2014 Mechanical properties of composite resin blocks for CAD/CAM DOI:10.4012/dmj.2014-208 | 2014 | this review only | not stated | not extracted yet |
| Lauvahutanon 2014 Mechanical properties of composite resin blocks for CAD/CAM. PMID:25273052 | 2014 | this review only | Flexural strength | not extracted yet |
| Melc 2024 Flexural Strength of Modern CAD/CAM Restoratives After Artificial Aging. PMID:39517453 | 2024 | this review only | Flexural strength | not extracted yet |
| Shafter 2017 Effect of Thermocycling on Flexural Strength of Different CAD/CAM Material DOI:10.26420/jdentoraldisord.2017.1071 | 2017 | this review only | Flexural strength | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | In vitro studies of CAD/CAM dental ceramics for indirect restorations (lithium disilicate, zirconia, ZLS, feldspathic, glass ceramic, hybrid, PICN) | CAD/CAM ceramics: lithium disilicate, lithium silicate, zirconia, ZLS, PICN, hybrid, resin nanoceramic, feldspathic and glass ceramics (n=10 studies) |
| Intervention | Thermocycling and/or artificial aging (hydrothermal, water storage, autoclave, mechanical fatigue, cyclic loading, chewing simulation) | Thermocycling, water storage, mechanical fatigue, thermomechanical aging (n=10 studies) |
| Comparison | Non-aged control specimens or baseline values (flexural strength); no comparator required for fracture resistance | Non-aged controls (flexural strength, n=5 studies); none for fracture resistance (n=5 studies) |
| Outcomes | Flexural strength (MPa) and fracture resistance (N); secondary: hardness, fracture toughness, elastic modulus, Weibull modulus, fatigue strength, survival | Flexural strength (n=5 studies, 16 comparisons); fracture resistance (n=5 studies, 11 comparisons) |
| Study designs | In vitro studies | In vitro studies (n=10) |
| Timing | Not specified | Not specified |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | NR | Yes | no |
| 2Protocol established before the reviewcritical | NR | Partial Yes | no |
| 3Choice of study designs explained | NR | No | no |
| 4Comprehensive literature searchcritical | NR | Yes | no |
| 5Study selection in duplicate | NR | Yes | no |
| 6Data extraction in duplicate | NR | Yes | no |
| 7List of excluded studies with reasonscritical | NR | No | no |
| 8Included studies described in detail | NR | Partial Yes | no |
| 9Risk of bias assessed satisfactorilycritical | NR | RCT: Yes · NRSI: N/A | no |
| 10Funding of included studies reported | NR | No | no |
| 11Appropriate meta-analysis methodscritical | NR | RCT: Partial Yes · NRSI: N/A | no |
| 12Impact of risk of bias on the pooled results | NR | No | no |
| 13Risk of bias accounted for in interpretationcritical | NR | Yes | no |
| 14Heterogeneity explained | NR | Yes | no |
| 15Publication bias investigatedcritical | NR | Partial Yes | no |
| 16Conflicts of interest reported | NR | Yes | no |
| Overall | NR | Low | no |