In the field of dentistry, the demand on aesthetics is ever increasing and therefore new glass ceramic materials are being developed for computer aided design/computer aided manufactory (CAD/CAM) technology. The aim of the manuscript is to help dental practitioners make informed decision of the choice of dental material, based on the relevant mechanical properties.
This paper overviews basic mechanical properties of materials, followed by a review of the mechanical properties of some popular CAD/CAM ceramic materials used by dentists.The mechanical properties are distilled from a comprehensive literature review and are then compared to mechanical properties of dentin and enamel.
The new glass ceramic materials come in different optical, mechanical, and color properties. The flush of this new information can be sometimes confusing for the dental professional.
Lithium disilicate glass ceramics is not only aesthetic, but also durable due to good mechanical properties such as fracture toughness, flexural strength, and elastic modulus. It appears to be a very suitable material in CAD/CAM technology in the production of the reconstruction, which will then be luted by adhesive resin.
Ceramics, Dental materials, CAD/CAM, Mechanical properties.
The word ceramic comes from the Greek word keramos, which means potter/pottery (1,2). Porcelain was known already in the 7th century BC in China. Ceramics as we know it today was discovered in the 7th century AD. In Europe, interest in porcelain can be observed in the 17th century when rich rulers brought porcelain from China and Japan. The largest collection owned by Augustus III. from Saxon, is exhibited in the Zwinger castle in Dresden (3). Due to its aesthetic properties, ceramics began to be used in dentistry in the 18th century. The main pioneer and pathfinder in the use of ceramics in this field was the Parisian pharmacist Alexander Duchateau, who made the first dental prosthesis made all of ceramics (4).
Ceramics are aesthetic materials that help us to restore natural smiles for our patients. It is a biocompatible and aesthetic material, but hard and brittle. It consists of two basic components: glass and crystalline phases. The ratio of these influences the properties of the material and the resulting prosthetic reconstruction (2).
Ceramics is usually classified not only based on the composition and its clinical use, but also based on microstructure and the processing techniques. Nowadays, modern technologies and increasing demand for processing time of dental products makes ceramics that are processed by CAD/CAM (computer aided design/computer aided manufactory) technology more and more desirable.
This paper first overviews basic mechanical properties of materials such as hardness, flexural strength, fracture toughness and modulus of elasticity. These mechanical properties are reviewed for glass CAD/CAM ceramics used in contemporary dentistry. The mechanical properties are distilled from a comprehensive literature review, and are then compared to mechanical properties of dentin and enamel.
The aim of the manuscript is to help dental practitioners make informed decision of the choice of dental material, based on the relevant mechanical properties.
Description of physical properties
Vickers hardness is the most common hardness test for dental ceramics. The method consists of pushing the indenter (the extruded body) into the material under a pressure. The indenter is a diamond four-sided pyramid with a top angle of 136° (Fig. 1) (5).
The Vickers hardness can then be calculated from the ratio of the force applied by the indenter to the surface (Fig. 2), where F is impression force, A is surface of indentation and d is diagonal imprint. The resulting value is denoted as VHN (Vickers Hardness Number) (6).
Flexural strength is defined as the maximum stress in the body that a material can withstand (caused by external bending forces before it breaks). The test is usually performed using a three-point flexural/bending test, where the beam is laid on two cylinders and the third cylinder is pushed against the centre of the beam (Fig. 3).
The bending strength can be calculated using the equation described in Figure 4, where F is the force acting on the beam, L is the distance between the lower cylinders, b is the width of the beam and d is the height of the beam. The resulting force is often expressed in Pa (5,7).
Fracture toughness represents an energy that is necessary for a formation of a fracture. It describes the ability of a material to resist propagation of cracks. The mathematical equation used to calculate this property is presented in Figure 5, where s is the internal stress in the material, a is the crack length and Y is the dimensionless shape coefficient of the body and crack. The value is denoted in MPa√m (5,7).
Elastic/Young Modulus describes the stiffness of material within the elastic region. It can be described by the mathematical equation given below (Fig. 6), where s is the stress (pressure acting on the inner surface perpendicular to the direction of external deformation forces) and e is the relative deformation (extension of the body to the original length of the body). The Elastic modulus is measured in Pa (5–7).
Distribution of glass CAD/CAM ceramics
Ceramics are widely used in dentistry due to their biocompatibility, chemical stability, high abrasion and compression resistance, low plaque accumulation (due to high polishing), high aesthetics and color stability.
CAD/CAM glass ceramics can be divided (based on the McLaren classification) into:
- i) mainly glass ceramics;
- ii) leucite reinforce glass ceramics;
- iii) lithium di silicate glass ceramics.
Ceramics consist of a certain proportion of glass and crystalline phases, and this ratio determines the properties of the final reconstruction. The glass adds aesthetics, natural appearance, translucency, but reduces the mechanical resistance of the material. Crystals increase mechanical resistance, but the more crystals the ceramics contains, the more opaque and less aesthetic it is (1,2,8).
Mostly glass ceramics
The ceramics, which best mimic the optical properties of enamel and dentine, are mostly glass ceramics. A well-known representative of this group of CAD/CAM processing is Vita Mark II (Vita Zahn Fabric, Bad Sakingen, Germany) (Fig. 7). It is a glass ceramics with homogeneously distributed fine grain feldspar particles in raw stage (30%, 3-4 um) undergoing a sintering process at 1170 °C under vacuum that can produce a homogenous microstructure ceramic block for the milling process (9–11). The mechanical properties found in the literature are the following.
Flexural strength: 106.67±18 (10) 112.4±3.2 (12) 102.77±3.6 (13) 137.83±12.4 (14) 128.87±5.41 (11) 113-154 (15) 100 (16) 97±8 (17) 122±13 (18) 154 (19) 113 (20) MPa.
Vickers hardness: 594.74±25.22 (10) 502.4 (6) 647.00±12.95 (11) 640±20 (21) VHN.
Elastic modulus: 57.2±3.6 (14) 47.7 (6) 68 (16) 63 (22) 45±0.5 (21) 65 (20) GPa.
Fracture toughness: 2.34±0.04 (12) 1.25 (14) 1.18±0.17 (20) 0.9 (16) 0.73±0.13 (23) MPa√m.
Indication for this ceramic are inlay, onlay, veneers, and frontal crown (12). Table 1 shows examples of other commercial names of mostly glass ceramic blocks.
Leucite reinforced glass ceramics
A well-known representative of this group is IPS. Empress CAD (Ivoclar Vivadent, Schaan, Liechtenstein) (Fig. 8). It is a glass ceramic reinforced with leucite crystals (KAlSi2O6), which promotes better mechanical properties. The crystal content is about 30- 45% and size of the crystals is 1-10 microns. Leucite is formed by adding potassium oxide to silica glass (1,8,24).
Leucite crystals can inhibit the propagation of cracks and thus enhance the mechanical properties of ceramics (2). The mechanical properties found in the literature are the following.
Flexural strength: 134.5±3.3 (12) 160 (8) 106±17 (18) 127 (16) 154.62±6.66 (11) 157.1±14.9 (25) 160 (13) MPa.
Vickers hardness: 565.8 (26) 610.16±4.55 (11) 525.6±21.3 (27) VHN.
Fracture toughness: 1.90±0.03 (12) 1.3 (28) 1.3 (16) 1.28±0.19 (29) MPa√m.
Elastic modulus: 62 (28) 62 (21) 70 (16) 65 (30) 65 (31) GPa.
Indications for this ceramic are inlay, onlay, veneers, and frontal crown (12).
Table 1 shows examples of other commercial names of leucite reinforced glass ceramic blocks.
Lithium disilicate glass ceramic
The most widely used ceramics in this group is the well-known ceramic material under its corporate name IPS e.max CAD (Ivoclar Vivadent, Schaan, Liechtenstein) (Fig. 9).
IPS e.max CAD is a ceramic-reinforced with lithium disilicate crystals (Li2SiO5). It contains 70% volume of lithium di silicate crystals of 1.5-5 microns in diameter (2,8,9). This ceramic has good aesthetic and mechanical properties. The ceramics is sold in a partially crystalized form (blue form) because it is easier to machine, less time consuming and causes less wear of diamond milling burs. The partially crystallized phase consists of meta silicate crystals (Li2SiO3) and some lithium disilicate (Li2SiO5) crystals (8,9,32,33). After milling, the restoration needs to undergo crystallization process (850°C in vacuum, 20-30 min). During this process, the bluish color change to natural color of the teeth, also the microstructure is changed. The metasilicates dissolve, and new lithium disilicate crystals are formed (8,24,33,34). Crystallization process includes 0,2% linear shrinkage which is accounted in the designer software (24,33).
Flexural strength of 130±30 (8) 130 (33) 130 (35) MPa and fracture toughness 0.9-1.25 (33) MPa√m. After crystallization of the ceramic, it gains more flexural strength as it is stated: 359.2±4.2 (12) 334.1±54.3 (23) 341.88±40.25 (10) 210.2 (36) 350-450 (8) 360-400 (9) 262-360 (33) 360-400 (37) 360-400 (2) 262±88 (35) 262±88 (18) 376.99±6.24 (11) 376.9±76.2 (38) 415±26 (17) 348.33±28.69 (39) 245.3±23.5 (25) 289±20 (32) 450-500 (40) MPa.
Vickers hardness: 731.63±30.64 (10) 617±44 (41) 452.9±16.2 (38) 602.79±6.38 (11) 645.5 (26) 606.917 (42) 596±18 (32) 539.7±16.4 (27) VHN.
Fracture toughness 1.67±0.03 (12) 1.8±0.29 (36) 2-2.5 (33) 2.5 (35) 2-2.5 (28) 2.01±0.13 (39) 1.23±0.26 (43) 2-2.5 (34) 1.88±0.62 (23) 1.83-2.76 (44) 2-2.5 (40) MPa√m.
Elastic modulus 95 (45) 100 (30) 90-100 (28) 95 (22) 67.2±1.3 (38) 60.61±1.64 (39) 63.9±4.8 (43) 95±5 (21) 95±5 (34) 58.97-02 (44) 100-110 (40) GPa.
Indications for this ceramic material are inlay, onlay, veneer, anterior and posterior crowns, three-unit bridges up to premolars, anterior and posterior implant abutments (12).
Table 1 shows examples of other commercial names of lithium disilicate glass ceramic blocks.
Co-operation of the basic properties of ceramic with enamel and dentin
Enamel is the surface layer of the crown of a tooth. It is ectodermal in origin and is produced by cells called ameloblasts. It has a blue-white to sometimes translucent color. It is the best mineralized tissue of human body and consists of 95% w/w inorganic tissue, predominantly hydroxyapatite (Fig. 10). It contains a small amount of water as compared to bone, dentin or cement. Organic tissue consists predominantly of soluble and insoluble proteins and lipids whose distribution differs from area to area (46). The properties of the enamel are particularly important because the choice of suitable ceramics should mimic these properties.
Flexural strength: 60-90 (5) MPa.
Vickers hardness: 313.3 (6) 274.8±18.1 (47) 343 (48) 352.5±13.8 (49) 395.01 (50) 350 (51) 408 (52) VHN.
Fracture toughness: 0.4-1 (53) 0.7-2.2 (54) 0.4-1.5 (55) MPa√m.
Elastic modulus: 59.7 (6) 84 (5) 50 (51) 84.1 (52) 80 (56) 84.1 (30) 84 (55) 70-120 (53) GPa.
Dentin is the basic internal tissue of a tooth. It is of mesodermal origin and its composition is very different from enamel, being closer to bone. Both primary and secondary dentin possesses yellow to ochre color, tertiary discolored to brownish brown. Dentin is produced by odontoblasts throughout the life of the dentin-pulpal border. This process occurs during the formation of a tooth on the dentin-enamel boundary. First, the odontoblasts produce a collagen matrix called the predentin, which is subsequently mineralized. Dentin consists of 70% inorganic tissues, 10% water, 20% organic tissue whose main representative is collagen type (Fig. 10) (46).
Flexural strength: 137.9-220.63 (48) 212.9 (31) 245-280 (5) 142.41±46.79 (57) MPa.
Vickers hardness: 62.3 (6) 65.6±3.9 (47) 64.75±73.75 (48) 60 (51) 60 (52) VHN.
Fracture toughness: 2 (54) 1-2 (58) 3.08 (55) MPa√m. Elastic modulus: 11-19 (45) 16.5 (6) 18.6 (56) 18.6 (31) 18.6 (30) 17 (5) 12 (51) 18.5 (52) 20-25 (58) 17 (55) GPa.
Table 2 reports the range of mechanical properties of glass ceramics, enamel and dentine. The ideal mechanical properties of dental material should match or be close to the mechanical properties of replacement dental tissues as dentin or enamel. The disadvantage of ceramic is its high hardness in comparison to dental hard tissues - this was confirmed for all three types of ceramics.
Comparing all values, the elastic modulus, fracture toughness and hardness of these glass ceramics are closer to enamel, while the values of flexural strength are closer to dentin. The highest values of the reported mechanical properties are mostly achieved by lithium disilicate glass ceramics.
Lithium disilicate glass ceramics is not only aesthetic, but also durable due to good mechanical properties such as fracture toughness, flexural strength, and elastic modulus. It appears to be very suitable material in the CAD/CAM technology indication in the production of the reconstruction, which will then be luted by adhesive resin.
- McLaren EA, Giordano R. Ceramics overview: classification by microstructure and processing methods. International Dentistry – African Edition. 2014;4(3):18–30.
- Helvey GA. Classification of Dental Ceramics. Inside dentistry. 2013;April 2013:62–76.
- Kelly J, Benetti P. Ceramic materials in dentistry: historical evolution and current practice: Ceramic materials in dentistry. Australian Dental Journal. 2011 Jun;56:84–96.
- McLaren EA, Figueira J. Updating Classifications of Ceramic Dental Materials: A Guide to Material Selection. Compendium of continuing education in dentistry. 2015;36(6):739–44.
- Sakaguchi, Powers. Craig’s RESTORATIVE DENTAL MATERIALS. Edition thirteen. Elsevier Mosby; 2012. 33–49; 85; 91; 253–258 p.
- Alamoush RA, Silikas N, Salim NA, Al-Nasrawi S, Satterthwaite JD. Effect of the Composition of CAD/CAM Composite Blocks on Mechanical Properties. BioMed Research International. 2018 Oct 23;2018:1–8.
- Anusavice K, Shen C, Rawls R. Philip’s Science od Dental Materials. Edition twelve. Elsevier; 2013. 48–64 p.
- Li RWK, Chow TW, Matinlinna JP. Ceramic dental biomaterials and CAD/CAM technology: State of the art. Journal of Prosthodontic Research. 2014 Oct;58(4):208–16.
- Fasbinder DJ. Materials for Chairside CAD/CAM Restorations. Compendium of continuing education in dentistry. 2010;31(9):702–9.
- Leung BTW, Tsoi JKH, Matinlinna JP, Pow EHN. Comparison of mechanical properties of three machinable ceramics with an experimental fluorophlogopite glass ceramic. The Journal of Prosthetic Dentistry. 2015 Sep;114(3):440–6.
- Atay DDS, PhD A, Sağirkaya DDS, PhD E. Effects of Different Storage Conditions on Mechanical Properties of CAD/CAM Restorative Materials. Odovtos - Int J Dent Sc. 2019 Aug 23;161–74.
- Sonmez N, Gultekin P, Turp V, Akgungor G, Sen D, Mijiritsky E. Evaluation of five CAD/CAM materials by microstructural characterization and mechanical tests: a comparative in vitro study. BMC Oral Health. 2018;18(5):1–13.
- Vichi A, Sedda M, Del Siena F, Louca C, Ferrari M. Flexural resistance of Cerec CAD/CAM system ceramic blocks. Part 1: Chairside materials. American Journal of Dentistry. 2013;26(5):255–9.
- Lu T, Peng L, Xiong F, Lin X-Y, Zhang P, Lin Z-T, et al. A 3-year clinical evaluation of endodontically treated posterior teeth restored with two different materials using the CEREC AC chair-side system. The Journal of Prosthetic Dentistry. 2018 Mar;119(3):363–8.
- D’Arcangelo C, Vanini L, Rondoni GD, De Angelis F. Wear properties of dental ceramics and porcelains compared with human enamel. The Journal of Prosthetic Dentistry. 2016 Mar;115(3):350–5.
- Low IM. Advances in Ceramic Matrix Composites. Edition secound. WOODHEAD PUBLISHING; 2018. 711–721 p.
- Sen N, Us YO. Mechanical and optical properties of monolithic CAD-CAM restorative materials. The Journal of Prosthetic Dentistry. 2018 Apr;119(4):593–9.
- Denry I, Holloway J. Ceramics for Dental Applications: A Review. Materials. 2010 Jan 11;3(1):351–68.
- Lauvahutanon S, Takahashi H, Shiozawa M, Iwasaki N, Asakawa Y, Oki M, et al. Mechanical properties of composite resin blocks for CAD/CAM. Dent Mater J. 2014;33(5):705–10.
- Porto T, Roperto R, Akkus A, Akkus O, Porto-Neto S, Teich S, et al. Mechanical properties and DIC analyses of CAD/CAM materials. J Clin Exp Dent. 2016;8(5):512–6.
- Lambert H, Durand J-C, Jacquot B, Fages M. Dental biomaterials for chairside CAD/CAM: State of the art. J Adv Prosthodont. 2017;9:486–95.
- de Kok P, de Jager N, Veerman IAM, Hafeez N, Kleverlaan CJ, Roeters JFM. Effect of a retention groove on the shear bond strength of dentin-bonded restorations. The Journal of Prosthetic Dentistry. 2016 Sep;116(3):382–8.
- Badawy R, El-Mowafy O, Tam L. Fracture toughness of chairside CAD/CAM materials – Alternative loading approach for compact tension test. Dental Materials. 2016 Jul;32:847–52.
- Brenes DC, Duqum I, Mendonza G. Materials and systems for all c• eramic CAD/CAM restorations. Dental tribute. 2016;3:10–5.
- Pitiaumnuaysap L, Phokhinchatchanan P, Suputtamongkol K, Kanchanavasita W. Fracture resistance of four dental computer-aided design and computer-aided manufacturing glass- ceramics. Mahidol Dental Journal. 2017;37(2):201–8.
- Sagsoz O, Yildiz M, Asl HG, Alsaran A. In vitro Fracture Strength and Hardness of Different Computer‑aided Design/Computer‑aided Manufacturing I Nigerian Journal of Clinical Practice. 2018;21(3):380–7.
- Demir N, Karci M, Ozcan M. Effects of 16% Carbamide Peroxide Bleaching on the Surface Properties of Glazed Glassy Matrix Ceramics. BioMed Research International. 2020 Feb 10;2020:1–7.
- Ritzberger C, Apel E, Höland W, Peschke A, Rheinberger V. Properties and Clinical Application of Three Types of Dental Glass-Ceramics and Ceramics for CAD-CAM Technologies. Materials. 2010 Jun;3(6):3700–13.
- Byeon S-M, Song J-J. Mechanical Properties and Microstructure of the Leucite-Reinforced Glass-Ceramics for Dental CAD/CAM. J Dent Hyg Sci. 2018 Feb;18(1):42–9.
- Zhu J, Rong Q, Wang X, Gao X. Influence of remaining tooth structure and restorative material type on stress distribution in endodontically treated maxillary premolars: A finite element analysis. The Journal of Prosthetic Dentistry. 2017 May;117(5):646–55.
- Hamssund N. Degree project. KTH Royal Institute of Technology, Stockholm, Sweden;
- Furtado de Mendonca A, Shahmoradi M, Gouvêa CVD de, De Souza GM, Ellakwa A. Microstructural and Mechanical Characterization of CAD/CAM Materials for Monolithic Dental Restorations: Characterization of CAD/CAM Materials. Journal of Prosthodontics. 2019 Feb;28(2):587–94.
- Willard A, Gabriel Chu T-M. The science and application of IPS e.Max dental ceramic. The Kaohsiung Journal of Medical Sciences. 2018 Apr;34(4):238–42.
- Sacher E, Franca R. Dental Biomaterials. Vol. secound. New Jersey: World Scientific; 2018. 148–203 p.
- Zarone F, Ferrari M, Mangano FG, Leone R, Sorrentino R. “Digitally Oriented Materials”: Focus on Lithium Disilicate Ceramics. International Journal of Dentistry. 2016;2016:1–10.
- Goujat A, Abouelleil H, Colon P, Jeannin C, Pradelle N, Seux D, et al. Mechanical properties and internal fit of 4 CAD-CAM block materials. The Journal of Prosthetic Dentistry. 2018 Mar;119(3):384–9.
- Culp L, McLaren EA. Lithium Disilicate: The Restorative Material of Multiple Options. Compendium of continuing education in dentistry. 2010;31(9):716–25.
- Lawson NC, Bansal R, Burgess JO. Wear, strength, modulus and hardness of CAD/CAM restorative materials. Dental Materials. 2016 Nov;32(11):275–83.
- Elsaka SE, Elnaghy AM. Mechanical properties of zirconia reinforced lithium silicate glass- ceramic. Dental Materials. 2016 Jul;32(7):908–14.
- Zhang Y, Lawn BR. Novel Zirconia Materials in Dentistry. Journal of Dental Research. :9.
- Ludovichetti FS, Trindade FZ, Werner A, Kleverlaan CJ, Fonseca RG. Wear resistance and abrasiveness of CAD-CAM monolithic materials. The Journal of Prosthetic Dentistry. 2018 Aug;120(2):318.e1-318.e8.
- Alammari MR, Binmahfooz AM. Assessment of the Hardness of Disks Fabricated by Zirconia Reinforced Lithium Silicate Glass Ceramic; VITA Suprinity and IPS E-max CAD. EC Dental Science. 2018;1309–17.
- Ramos N de C, Campos TMB, Paz IS de L, Machado JPB, Bottino MA, Cesar PF, et al. Microstructure characterization and SCG of newly engineered dental ceramics. Dental Materials. 2016 Jul;32(7):870–8.
- Chen X-P, Xiang Z-X, Song X-F, Yin L. Machinability: Zirconia-reinforced lithium silicate glass ceramic versus lithium disilicate glass ceramic. Journal of the Mechanical Behavior of Biomedical Materials. 2020 Jan;101:1–10.
- Jassim Z, A. Majeed M. Comparative Evaluation of the Fracture Strength of Monolithic Crowns Fabricated from Different all-ceramic CAD/CAM Materials (an in vitro study). Biomed Pharmacol J. 2018 Sep 28;11(3):1689–97.
- Gurel G. The Science and Art of Porcelain Laminate Veneers. Berlin: Quintessence Publishing; 2003. 115–118 p.
- Chun KJ, Lee JY. Comparative study of mechanical properties of dental restorative materials and dental hard tissues in compressive loads. Journal of Dental Biomechanics. 2014 Oct 14;5(0):5/0/1758736014555246.
- Santander SA, Vargas AP, Escobar JS, Monteiro FJ, Tamayo LFR. CERAMICS FOR DENTAL RESTORATIONS – AN INTRODUCTION. 2010;12.
- Montasser MA, El-Wassefy NA, Taha M. In vitro study of the potential protection of sound enamel against demineralization. Prog Orthod. 2015 Dec;16(1):12.
- Mettu S, Srinivas N, Reddy Sampath C, Srinivas N. Effect of casein phosphopeptide-amorphous calcium phosphate (cpp-acp) on caries-like lesions in terms of time and nano-hardness: An in vitro study. J Indian Soc Pedod Prev Dent. 2015;33(4):269–73.
- McCabe, Walls. Applied of Dental Materials. Edition ninth. Blackwell Publishing; 2008. 186
- Dental Material and Their Selection. Edistion third. Quintessence Publishing Co,Inc; 2002. 122 p.
- Weng ZY, Liu Z, Ritchie R, Jiao D, Li DS, Wu HL, et al. Giant panda׳s tooth enamel: Structure, mechanical behavior and toughening mechanisms under indentation. Journal of the Mechanical Behavior of Biomedical Materials. 2014;64:125–38.
- Lucas PW, Casteren A van, Al-Fadhalah K, Almusallam AS, Henry AG, Michael S, et al. The Role of Dust, Grit and Phytoliths in Tooth Wear. Annales Zoologici Fennici. 2014 Apr;51(1– 2):143–52.
- Donova JB. DISCONTINUOUS FIBER-REINFORCED COMPOSITE FOR DENTAL APPLICATIONS Studies of the fracture resistance and the mechanical properties of the material used for extensive direct restorations. Thesis. Faculty of Medicine, University of Turku, Finland.;
- Singh S, Appanna P, Manjunath KH, Rai N, Jingade RRK, Manjunath KH. Mechanical Behaviour of Ceramic Layered Zirconia Restorations: A Three Dimensional Finite Element Analysis using Microcomputed Tomography Data. JCDR. 2018;12(7):39–43.
- Vieira C, Silva-Sousa YTC, Pessarello NM, Rached-Junior FAJ, Souza-Gabriel AE. Effect of high-concentrated bleaching agents on the bond strength at dentin/resin interface and flexural strength of dentin. Braz Dent J. 2012;23(1):28–35.
- Ritchie RO, Kinney JH, Kruzic JJ, Nalla RK. A fracture mechanics and mechanistic approach to the failure of cortical bone. Fatigue & Fracture of Engineering Materials & Structures. 2005 Apr;28(4):345–71.