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Ceramic Fracture in Metal-Ceramic Restorations: The Aetiology

Article  in  Dental update · May 2017

DOI: 10.12968/denu.2017.44.5.448

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Army Medical College / Armed Forces Institute of Dentistry, Rawalpindi, Pakistan National University of Sciences and Technology
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 FixedProsthodontics

Ayesha Aslam

Danish Azeem Khan, Syed Hammad Hassan and Bilal Ahmed

Ceramic Fracture in Metal-Ceramic

Restorations: The Aetiology
Abstract: All dental restorations are liable to failure during function. Failure could be biologic, aesthetic, mechanical or a combination.
Ceramic restorations in particular, including metal-ceramics, are prone to mechanical fracture, especially the fracture of veneering
porcelain. Fracture of a metal-ceramic restoration jeopardizes function as well as aesthetics. It is equally onerous to manage for both
patient and dentist. Optimal management of such cases requires a detailed knowledge of the aetiology behind this phenomenon. The
current paper aims to highlight possible causative factors involved in the mechanical failures of metal-ceramic restorations.
CPD/Clinical Relevance: Ceramic fracture in metal-ceramic crowns and fixed partial dentures is routinely encountered in dental clinics.
Knowledge of the aetiology is required to diagnose and manage such cases accurately as well as to avoid these errors in future.
Dent Update 2017; 44: 448–456

Rehabilitation of teeth with crowns has with the aesthetics of ceramic materials,4
increased greatly over the last three resulting in restorations with considerable
decades.1 Despite rapid advancements clinical longevity.5 A survival rate of 97% for
in the development of newer and metal-ceramic restorations was reported by
stronger ceramic systems,2 metal-ceramic Eliasson et al6 after a period of ten years in
restorations still remain the ‘gold standard’ clinical service.
in prosthodontics since their introduction in All dental restorations are
the 1960s.3 Metal-ceramic systems combine liable to failure during function. Failure
the biomechanical advantages of metals may be biologic, aesthetic, mechanical
or a combination. Ceramic restorations in
particular, including metal-ceramics, are
more prone to mechanical fracture (Figure Figure 1. Fractured metal–ceramic restoration
Ayesha Aslam, BDS, CHPE, PG Resident 1), especially the fracture of veneering (UL1).
Prosthodontics, Army Medical College/ porcelain.7 A systematic review carried out
Armed Forces Institute of Dentistry, by Goodacre et al8 revealed that fracture
National University of Medical Sciences of veneering porcelain is a common
(NUMS), Islamabad, Danish Azeem restorations,11 and factors may also vary
complication associated with metal-
Khan, BDS, PG Resident Prosthodontics, depending on the type of fracture that has
ceramic prostheses. However, a review
Armed Forces Institute of Dentistry, occurred. Friedman12 classified porcelain
on the survival rate and complications
Rawalpindi, Syed Hammad Hassan, BDS, of metal-ceramic restorations reported a fractures into three types, namely:
FCPS, MSc Med Edu, Assistant Professor, mean chipping rate of 2.9% after a 5-year 1. Static fracture: where a segment of
Army Medical College/Armed Forces observation period.9 Such paradoxes in porcelain fractures but remains intact;
Institute of Dentistry, National University survival rate values exist because of a lack 2. Cohesive fracture: that occurs within the
of Medical Sciences (NUMS), Islamabad of detailed reporting systems for describing body of porcelain due to tensile loads; and
and Bilal Ahmed, FCPS, BDS, FFD FRCSI- fractures of ceramic-based restorations.10 3. Adhesive fracture: where failure of the
II(IRE), CMT, PhD, Res Associate Professor Restoration failures are often bonding interface between the porcelain
Department of Prosthodontics National a multi-factorial phenomenon. A number and the substrate is seen (Figure 2).
University of Science & Technology of different factors may be responsible for Haselton et al13 specifically
(NUST), Islamabad, Pakistan. the mechanical failure of metal-ceramic described metal-ceramic restoration
448 DentalUpdate May 2017
 FixedProsthodontics

fractures, classifying them as: result in the immediate fracture of the such as nail-biting or biting a pen or pencil,
1. Simple: involving only porcelain; porcelain. exploit the brittle nature of porcelains and
2. Mixed: involving both metal and can lead to their fracture.
porcelain; and Occlusal interferences
3. Complex: where a large area of metal Occlusal interferences Injudicious use
framework is exposed. have important implications when If the patient, even after being
Fracture of a metal-ceramic contemplating anterior crowns.18 Any instructed otherwise, uses the prosthesis
restoration jeopardizes function as well premature contacts in centric and injudiciously such as to crack hard nuts,
as aesthetics. Optimal management of eccentric movements generate increased to bite harder foods such as sugar cane or
such cases requires a detailed knowledge localized stresses in the porcelain. These bones, it is likely to result in the failure of
of the aetiology behind this fracture stresses create ‘Hertzian cone cracks’ which the restoration.16
phenomenon.14 Unfortunately, there is a may lead to chipping fracture of surface
paucity of studies available that provide porcelain.16 Acidic beverages
a comprehensive review of the reasons Common beverages with low
leading to the failure of metal-ceramic pH ranges have been shown to promote
Increased overbite
restorations. The current paper aims to the breakdown of glass-containing dental
In increased overbite cases,
highlight the possible causative factors restorations.11,14 This occurs because of
where the patient exhibits a great amount
involved in the mechanical failures of release of basic ions which are less stable in
of vertical overlap with only a moderate
metal-ceramic restorations, thereby the glassy-phase. Such a breakdown results
amount of horizontal overlap, non-axial
helping clinicians avoid them in clinical in surface roughening of dental ceramics,
stresses are generated.19 Excessive non-
practice. thereby decreasing strength and promoting
axial forces may lead to fracture of the
failure.24
restoration. Designing a prosthesis, such
Factors affecting failure that the non-axial forces are reduced, will
increase the longevity of the restoration Factors related to clinicians
The success or failure of
and the restored tooth.20 However, this Insufficient tooth reduction
metal-ceramic restorations can be
factor affects anterior restorations only. An uneven tooth preparation
attributed to a variety of factors. These
can be divided into different categories may result in a porcelain layer of uneven
(Figure 3).15 Parafunctional habits thickness, creating areas of stress
Parafunctional habits, concentration and eventual fracture.14
namely clenching and bruxism, are Insufficient tooth reduction yields too little
Factors related to patient characterized by dynamic repetitive space to accommodate both the metal
Trauma loading.21 Parafunctional habits expose substructure and porcelain.25 The result
Physical trauma is one of the restorations to greater and often may be an over-contoured, bulky, opaque-
the major causes of porcelain fracture.16 unfavourably directed occlusal loads, looking crown,26 or, if the porcelain is too
Low fracture toughness makes porcelain thereby increasing the risk of mechanical thin, it will be more liable to failure.
a brittle material.17 Any blow to the failure.22 The risk is significantly higher
restoration, whether due to a fall, a fight, in patients who do not use a protective Knife-edge margins
a road-traffic or sports accident, will occlusal device.23 Abnormal biting habits, Knife-edge margin designs have

a b c

Metal Substrate Metal

Porcelain
Porcelain
Adhesive Failure
Static (metal exposed)
Fracture Cohesive
(porcelain remains Fracture
intact) (ceramic chips-off )

Figure 2. Pictorial representation of Friedman’s classification of porcelain fractures: (a) Static fracture; (b) Cohesive fracture; (c) Adhesive fracture.

May 2017 DentalUpdate 449

 FixedProsthodontics

coefficient of thermal contraction of metal

and ceramic, where ceramic contracts more
Metal - Ceramic
than the metal, can generate excessive
Restoration
tensile stresses in the ceramic layer, thus
promoting fracture.14 Moreover, if the
veneering porcelain has a coefficient of
thermal contraction lower than that of
Mechanical Failure
the core porcelain, tensile stresses will
be generated at the framework surface,
making the material more prone to
fracture.7,11 Such a thermal mismatch
Factors Related To Factors Related To Factors Related To Factors Related To between the core porcelain and the veneer
Patient Clinician Material Lab Fabrication porcelain may lead to increased failure of
metal-ceramic systems.
Figure 3. Factors associated with mechanical failure of metal-ceramic restorations.

Fatigue failure
All intra-oral restorations are
ceramic. 11 exposed to small alternating forces during
mastication. Such repeated loading may
lead to fatigue failure of the restoration.11,14
Factors related to the selected dental
material
Low thermal conductivity
Use of weak material with low fracture
Low thermal conductivity of
toughness
core porcelain, as compared to that of
Fracture toughness is the
veneering porcelain, creates a temperature
ability of the material to resist crack
difference between the core and the
propagation when subjected to tensile
veneering porcelain.15 Tensile stresses arise
stress.15 Materials with low fracture
in the deeper layers of the material and
toughness are more prone to fracture. Of
facilitate crack propagation.
Figure 4. Metal extending too far incisally makes all the ceramics, traditional feldspathic
the unsupported porcelain prone to fracture. porcelain has the lowest fracture
toughness of 0.7 MPa.m1/2.17 Ageing
Premature failure of restorations
may ensue in the humid oral cavity. The
Elastic modulus of the metal
been shown to be more susceptible to oral environment expedites the ageing of
The support available for dental ceramics, reducing flexural strength
chipping and fracture, especially during porcelain by the framework is directly
the try-in and cementation.15 and lowering fracture toughness. Studies
proportional to the elastic modulus of the have shown that silicate bonds present in
metal.11 The higher the elastic modulus, ceramics are susceptible to hydrolysis by
Inadequate impression recording the stiffer will be the material and better moisture present in the oral environment.17
This factor affects all able to resist deformation under loading. The phenomenon, termed as ‘static fatigue’,
restorations, and not just metal– An alloy with low modulus of elasticity is further exaggerated in the presence of
ceramic ones. An impression of the will flex under loading, yield poor support mechanical loading.11 Ceramics undergo
prepared tooth that has been poorly to porcelain and increase the risk of ‘stress corrosion cracking’ in the presence
recorded, with no attention to details, porcelain fracture.28 of water.29 This results in a reduced metal-
will result in a restoration more likely ceramic bond strength, leading to crack
to fail, both in aesthetics and in Presence of scratches or pits on ceramic propagation and eventual failure of the
function.25 In addition to impressions, Scratches, pits or similar flaws restoration.
occlusal registration may also affect present on the surface of the ceramic
the accuracy of a restoration. Dental material behave as sharp notches with Type of prosthesis
laboratories receive a large number of narrow tips. Tensile stresses, generated Metal-ceramic restorations on
unreliable and poorly recorded bite during occlusal loading, are concentrated implant-supported prostheses are more
registrations.27 Incorrect registration at the tips of these defects, leading to prone to fracture as compared to the
of occlusion and articulation yields crack propagation and fracture.14,15 ones on tooth-supported prostheses.30
premature contacts. Premature This is probably because implants lack the
contacts, if not detected and relieved, Thermal incompatibility of materials resilient periodontal ligaments and their
act as stress-bearing zones on A large difference in the associated neurosensory mechanisms that
450 DentalUpdate May 2017
 FixedProsthodontics

Extent of area to be veneered:

The porcelain on the facial surface usually
extends over the cusp tip and about
halfway down the palatal incline of the
facial cusp on posterior teeth (Figure 6a).
There must be a rounded ledge of metal
under the facial cusp to support the
porcelain. Without a supporting ledge, the
ceramic will fracture.11 This design is more
resistant to fracture than those in which
the porcelain extends to the central groove
a or covers the entire occlusal surface (Figure
b
6b).25
Figure 5. Maxillary posterior metal–ceramic coping with (a) proper metal support and (b) without Design of facial margin:
proper metal support under facial cusp. Porcelain-covered metal margin design
requires either a heavy chamfer or a
beveled shoulder finish line with the metal
coping extending to the cavo-surface
help in the detection of excessive occlusal contoured metal framework is better able margin and thinned to the minimum
loads or occlusal interferences.31 to withstand stress. The metal should thickness possible.25 Porcelain is extended
be contoured so that the overlying to cover this metal. This design may lead
Factors related to laboratory fabrication veneering porcelain will be subject to to metal distortion during firing and metal
compressive forces when a load is applied. flexure with resulting porcelain fracture
Coping design
Examples of this consideration include as a result of excessive thinning of the
Metal coping design is
avoiding the extension of lingual metal coping.32
paramount to the success of metal-
to the incisal edge of a maxillary anterior Lack of aesthetics with the
ceramic restorations and yet it is often
restoration (Figure 4) and establishing a conventional metal collar led to the use
overlooked. The coping must be designed
supporting ledge under the facial cusp of the all-porcelain facial margins.34They
so as to allow the porcelain to remain in
of a maxillary premolar or molar metal- utilize special shoulder porcelains that
compression by supporting the incisal
ceramic restoration (Figure 5).32 Failing to are stronger in flexure than conventional
region, the occlusal table and the marginal
meet these criteria will expose the brittle porcelains,15 making the margin more
ridges32 or the unsupported porcelain will
porcelain veneer to shearing forces and may resistant to fracture.
fracture.
A metal–ceramic restoration is lead to premature porcelain fracture.
likely to fail if the coping does not meet Metal thickness: Copings should Antero-posterior span of fixed partial denture
six important design features including: be rigid to avoid flexing during seating or Long span fixed partial
1. Thickness of the porcelain veneer; under occlusal loads. Rigidity of the coping dentures flex more under heavy occlusal
2. Support of the porcelain veneer; is directly proportional to the thickness loads, leading to the fracture of porcelain.
3. Thickness of metal underlying and of the metal used. A noble metal coping If all other parameters are kept constant,
adjoining the porcelain; should be at least 0.3−0.5 mm thick, while a four-unit fixed partial denture replacing
4. Placement of occlusal and proximal a base metal alloy with a higher yield two teeth will bend eight times more as
contacts; strength and higher melting temperature compared to a three-unit fixed partial
5. Extent of the area to be veneered; and may be as thin as 0.2 mm.14 A metal coping denture with a single pontic (Figure
6. Design of the facial margin. with lesser thickness is likely to flex and 7).11,15,25 Where a large number of missing
Porcelain thickness: Relatively cause porcelain fracture. teeth need to be replaced, considering an
thin porcelain, of uniform thickness and Occlusal/proximal contacts: implant-supported prosthesis may help
supported by rigid metal, is strongest. The Contact near the metal–ceramic junction decrease the span length and yield better
absolute minimum thickness of porcelain can lead to metal flow and subsequent results.11
is 0.7 mm, and the desirable thickness is porcelain fracture. The porcelain-metal
1.0−1.5 mm. Extensions of porcelain beyond junction should be placed 1.0 mm from Thickness of pontics
2.0 mm are prone to fracture, even if these occlusal contacts at the position of maximal Occluso-gingival thickness
thick areas of porcelain are not in areas of intercuspation.25,33 Proximal contacts for of the pontic affects the deflection of
force concentration.11 Stresses generate anterior teeth should be on porcelain and framework. Deflection varies inversely with
in the thick bulk of porcelain during initial the metal should be placed more lingually. the cube of the occluso-gingival thickness
firing and cooling. Placing the porcelain-metal junction lingual of the pontic. If the pontic thickness is
Support of porcelain: Porcelain to the proximal contact areas leads to halved, the framework deflection will be
veneer that is supported by an evenly improved stress distribution.11,32 increased eight times.24,32
May 2017 DentalUpdate 453
 FixedProsthodontics

8 times more deflection

Figure 7. Deflection of a fixed dental prosthesis (FDP) is directly proportional to the cube of the length
of its span. An FDP with 2 pontics will deflect 23 ie 8 times as much as an FDP with 1 pontic.

a entrapped within the ceramic particles, material with low thermal conductivity
porosities occur in the final restoration, will be incompletely baked, hence
reducing its strength and increasing the becoming more prone to chipping
chances of fracture.25,33 Porosities may be fracture.17 Also, any mismatch between
introduced in the dental porcelain due to the coefficient of thermal expansion of
faulty condensation, incorrect powder/ the core porcelain and the veneering
liquid ratio or firing time and temperature porcelain will generate residual stresses
disparities.35-37 This factor is applicable and promote fracture. During the
to all restorations that use feldspathic cooling phase, the difference in thermal
porcelain. conductivity of core and veneer porcelain
results in residual stresses. These stresses
Method of adding the veneering layer bring about adhesive failure of the
Hot isostatically pressed (HIP) restoration.15
glass ceramic materials are less prone to
chipping and fracture as compared to Faulty polishing and glazing
hand layered veneering porcelains.11,25 Glazing helps reduce the
depth and width of flaws present in the
b Poor metal-ceramic bond ceramic surface,15 hence is considered
Clinical success of a metal- a ceramic-strengthening method.35
Figure 6. Coping design for a metal–ceramic
ceramic restoration largely depends upon Any fault in glazing or polishing would
restoration with (a) buccal cusp in porcelain and
(b) full porcelain occlusal coverage. the bond formed between the metal hamper the strength of ceramic.
and the porcelain. A metal-ceramic bond
results from the interplay of a number
of different factors including mechanical Conclusion
bonding, chemical bonding, Van der Failure of a metal-ceramic
Waals forces and compression fit due restoration is a complex phenomenon. A
Design of connectors
to a difference in coefficient of thermal critical review of the available literature
For clinical longevity,
expansion.38 A poor metal-ceramic bond revealed a multitude of factors that may
connectors of a fixed partial denture can be due to poor choice of metal, eg play a role in the mechanical failure
should be thick enough to resist the one that does not form oxides, or by of metal-ceramic restorations. These
occlusal loads.25,32 However, for optimal inadequate preparation of metal to be factors may be as simple as a single
aesthetics, occlusal and gingival bonded to porcelain.15 When the metal- episode of blunt trauma or may be
embrasures must be created.11 ceramic bond fails, it leads to delamination complex, involving a combination of
of porcelain from the metal or adhesive issues related to material properties,
Poor porcelain adaptation failure. restoration design and fabrication. To
One of the most common optimize the performance of metal-
fabrication flaws is the incorporation Firing protocols ceramic restorations, the clinician needs
of air in the ceramic mix.35 If air is During firing procedures, a to understand all the factors affecting the
454 DentalUpdate May 2017
 FixedProsthodontics

restoration’s longevity. This will enable the porcelain veneer failure − a clinician’s 26. Newsome P, Owen S. Improving your
clinician to exploit the material’s strengths observations. Compend Contin Educ Dent margins. Int Dent SA 2009; 11: 36−42.
and compensate for its flaws. 1998; 19: 625−628. 27. Boksman L. Optimizing occlusal results for
13. Haselton DR, Diaz-Arnold AM, Dunne crown and bridge prostheses. Dent Today
References JT. Shear bond strengths of 2 intraoral 2011; 20: 154−157.
1. Steele JG, Wassell RW, Walls AWG. porcelain repair systems to porcelain or 28. Prakash P, D’Souza D, Kumar M,
Changing patterns and the need for metal substrates. J Prosthet Dent 2001; Viswambaran M. Effect of firing cycle and
quality. Br Dent J 2002; 192: 144−148. 86: 526−531. surface finishing on the sag resistance of
2. Silva GR, Roscoe MG, Ribeiro CP, Mota 14. Özcan M. Fracture reasons in ceramic‐ long-span metal ceramic framework using
ASd, Martins LRM, Soares CJ. Impact fused‐to‐metal restorations. J Oral base metal alloys − an in vitro study. Med
of rehabilitation with metal-ceramic Rehabil 2003; 30: 265−269. J Armed Forces India 2012; 68: 145−150.
restorations on oral health-related quality 15. Anusavice KJ, Shen C, Rawls HR. Phillips’ 29. Taskonak B, Griggs JA, Mecholsky JJ, Jr, Yan
of life. Braz Dent J 2012; 23: 403−408. Science of Dental Materials 12th edn. St JH. Analysis of subcritical crack growth in
3. Zarone F, Russo S, Sorrentino R. From Louis, Missouri, USA: Saunders Elsevier dental ceramics using fracture mechanics
porcelain-fused-to-metal to zirconia: Inc, 2013. and fractography. Dent Mater 2008; 24:
clinical and experimental considerations. 16. Malhotra N, Acharya SR. Conservative 700−707.
Dent Mater 2011; 27: 83−96. approach for esthetic repair of fractured 30. Kinsel RP, Lin D. Retrospective analysis of
4. Michalakis KX, Stratos A, Hirayama H, ceramic facing in ceramic-fused-to-metal porcelain failures of metal ceramic crowns
Kang K, Touloumi F, Oishi Y. Fracture crowns: a case series. Compend Contin and fixed partial dentures supported by
resistance of metal ceramic restorations Educ Dent 2012; 33: E123−129. 729 implants in 152 patients: patient-
with two different margin designs after 17. Sakaguchi RL, Powers JM. Craig’s specific and implant-specific predictors of
exposure to masticatory simulation. Restorative Dental Materials 13th edn. ceramic failure. J Prosthet Dent 2009; 101:
J Prosthet Dent 2009; 102: 172−178. Philadelphia: Mosby Elsevier Inc, 2012. 388−394.
5. Mizrahi B. The anterior all-ceramic crown: 18. Steele J, Nohl F, Wassell R. Crowns and 31. El-Sheikh AM, Hobkirk JA, Howell PG,
a rationale for the choice of ceramic and other extra-coronal restorations: occlusal Gilthorpe MS. Passive tactile sensibility in
cement. Br Dent J 2008; 205: 251−255. considerations and articulator selection. edentulous subjects treated with dental
6. Eliasson A, Arnelund C-F, Johansson A. Br Dent J 2002; 192: 377−387. implants: a pilot study. J Prosthet Dent
A clinical evaluation of cobalt-chromium 19. Mizrahi B. The Dahl principle: creating 2004; 91: 26−32.
metal-ceramic fixed partial dentures space and improving the biomechanical 32. Shillingburg HT, Hobo S, Whitsett LD,
and crowns: a three- to seven-year prognosis of anterior crowns. Brackett SE. Fundamentals of Fixed
retrospective study. J Prosthet Dent 2007; Quintessence Int 2006; 37: 245−251. Prosthodontics 4th edn. Illinois, USA:
98: 6−16. 20. Torbjörner A, Fransson B. Biomechanical Quintessence Publishing Co Inc, 2012.
7. Kimmich M, Stappert CF. Intraoral aspects of prosthetic treatment of 33. Özcan M, Niedermeier W. Clinical study on
treatment of veneering porcelain structurally compromised teeth. Int the reasons for and location of failures of
chipping of fixed dental restorations: a J Prosthodont 2004; 17: 135−141. metal-ceramic restorations and survival
review and clinical application. J Am Dent 21. Karl M, Fischer H, Graef F, Wichmann of repairs. Int J Prosthodont 2002; 15:
Assoc 2013; 144: 31−44. MG, Taylor TD, Heckmann SM. Structural 299−302.
8. Goodacre CJ, Bernal G, Rungcharassaeng changes in ceramic veneered three- 34. Bulbule N, Motwani BK. Comparative
K, Kan JY. Clinical complications in fixed unit implant-supported restorations as study of fracture resistance of porcelain
prosthodontics. J Prosthet Dent 2003; 90: a consequence of static and dynamic in metal ceramic restorations by using
31−41. loading. Dent Mater 2008; 24: 464−470. different metal coping designs − an
9. Sailer I, Pjetursson BE, Zwahlen M, 22. Johansson A, Omar R, Carlsson GE. in vitro study. J Clin Diagn Res 2014; 8:
Hämmerle CH. A systematic review of Bruxism and prosthetic treatment: a ZC123−ZC127.
the survival and complication rates critical review. J Prosthodont Res 2011; 35. Rashid H. The effect of surface roughness
of all‐ceramic and metal–ceramic 55: 127−136. on ceramics used in dentistry: a review of
reconstructions after an observation 23. Brägger U, Aeschlimann S, Bürgin W, literature. Eur J Dent 2014; 8: 571.
period of at least 3 years. Part II: fixed Hämmerle CH, Lang NP. Biological and 36. Zhang Y, Griggs JA, Benham AW.
dental prostheses. Clin Oral Implants Res technical complications and failures with Influence of powder/liquid mixing ratio
2007; 18: 86−96. fixed partial dentures (FPD) on implants on porosity and translucency of dental
10. Anusavice KJ. Standardizing failure, and teeth after four to five years of porcelains. J Prosthet Dent 2004; 91:
success, and survival decisions in clinical function. Clin Oral Implants Res 2001; 12: 128−135.
studies of ceramic and metal–ceramic 26−34. 37. Cheung K, Darvell B. Sintering of dental
fixed dental prostheses. Dent Mater 2012; 24. Kukiattrakoon B, Hengtrakool C, porcelain: effect of time and temperature
28: 102−111. Kedjarune-Leggat U. Effect of acidic on appearance and porosity. Dent Mater
11. Shadid RM, Sadaqah NR, Abu-Naba’a agents on surface roughness of dental 2002; 18: 163−173.
L, Al-Omari WM. Porcelain fracture of ceramics. Dent Res J (Isfahan) 2011; 8: 38. Deepak K, Ahila S, Muthukumar B,
metal-ceramic tooth-supported and 6−15. Vasanthkumar M. Comparative evaluation
implant-supported restorations: a review. 25. Rosenstiel SF, Land MF, Fujimoto J. of effect of laser on shear bond strength
Open Journal of Stomatology (OJST) 2013; Contemporary Fixed Prosthodontics 4th of ceramic bonded with two base metal
3: 411. edn. St Louis, Missouri: Mosby Elsevier alloys: an in-vitro study. Indian J Dent Res
12. Friedman M. A 15-year review of Inc, 2006. 2013; 24: 610−615.
456 DentalUpdate May 2017
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