{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T16:06:32Z","timestamp":1784649992248,"version":"3.55.0"},"reference-count":35,"publisher":"Operative Dentistry","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>\n                      Catastrophic failures in lithium disilicate single-unit prostheses in the mandibular anterior region, particularly when subjected to endodontic access for root canal treatment, represent a significant clinical concern. This\n                      <jats:italic>in vitro<\/jats:italic>\n                      study evaluated the fracture resistance of CAD\/CAM-fabricated lithium disilicate intact and endodontically accessed crowns, with and without aging through thermocycling.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Materials:<\/jats:title>\n                    <jats:p>\n                      A mandibular right central incisor typodont was prepared and scanned for CAD\/CAM fabrication of a lithium disilicate crown. Eighty crowns were milled, treated, etched, primed, and cemented to printed resin dies. The crowns were divided into eight groups based on endodontic access location (facial, incisal, or lingual) and thermocycling condition (presence or absence). All groups underwent vertical loading until fracture, and fracture resistance was measured. Fractured crowns were analyzed for crack patterns and failure modes using scanning electron microscopy. Two-way ANOVA assessed the effects of access type on fracture resistance, while one-way ANOVAs with Tukey's HSD\n                      <jats:italic>post hoc<\/jats:italic>\n                      tests analyzed fracture resistance across aging conditions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Fracture resistance was significantly affected by endodontic access type and thermocycling (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). Non-thermocycled, intact crowns had the highest fracture resistance (1218.0 \u00b1 174.8 N), while thermocycled crowns with incisal access demonstrated the lowest resistance (720.9 \u00b1 98.3 N). Lingual access crowns displayed higher fracture resistance than facial and incisal access crowns, although resistance significantly decreased with thermocycling (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.008). SEM analysis revealed that lingual access crowns visually appeared to exhibit less irregular crack patterns compared to facial and incisal access crowns, which displayed more numerous and irregular crack lines.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      Endodontic access reduced fracture resistance; however, thermocycling had a statistically significant effect only in the lingual access group. A conservative lingual access preserved integrity similarly to intact crowns, making it preferable for mandibular restorations. All crowns met minimum clinical fracture resistance standards, suggesting that crown replacement may not be necessary with conservative access designs. Variations between aged and non-aged specimens should be considered when interpreting\n                      <jats:italic>in vitro<\/jats:italic>\n                      data.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2341\/24-144-l","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T12:24:54Z","timestamp":1783686294000},"page":"60-68","source":"Crossref","is-referenced-by-count":0,"title":["Influence of Endodontic Access and Thermocycling on the Fracture Resistance of CAD\/CAM Lithium Disilicate Anterior Crowns"],"prefix":"10.2341","volume":"51","author":[{"given":"CA","family":"Jurado","sequence":"first","affiliation":[{"name":"Carlos A. Jurado, DDS, MS, Associate Professor, Director Division of Operative Dentistry, Department of General Dentistry, University of Tennessee College of Dentistry, Memphis, TN, USA; Associate Professor, Ponce Health Sciences University School of Dental Medicine Ponce, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KI","family":"Afrashtehfar","sequence":"additional","affiliation":[{"name":"*Kelvin I. Afrashtehfar, Prof. Dr. med. dent., PhD, FRCDC, FDS RCS(Eng), Affiliate Scientist, Department of Reconstructive Dentistry and Gerodontology (RekGero), School of Dental Medicine, University of Bern, Bern, BE, Switzerland; Consultant Prosthodontist-Implantologist, Oral Implantology Research Institute (OIRI), Knowledge Park, Dubai, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Mekled","sequence":"additional","affiliation":[{"name":"Salwa Mekled, BDS, DMD, MPA, MsDe, Associate Professor, Director of Clinics, Restorative Dentistry Department, Temple University Kornberg School of Dentistry, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Abuhammoud","sequence":"additional","affiliation":[{"name":"Salahaldeen Abuhammoud, DDS, MS, Associate Professor and Director of the Advanced Standing Program, Department of Prosthodontics, University of Iowa College of Dentistry, Iowa City, IA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F","family":"Floriani","sequence":"additional","affiliation":[{"name":"Franciele Floriani, DDS, MSc, PhD, Assistant Professor, Department of Prosthodontics, University of Iowa College of Dentistry, Iowa City, IA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Vegh","sequence":"additional","affiliation":[{"name":"Daniel Vegh, DMD, MSc, PhD, Assistant Professor, Department of Prosthodontics, Semmelweis University Faculty of Dentistry, Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1188","reference":[{"issue":"7","key":"b1","series-title":"Clinical Oral Investigations","first-page":"3983","article-title":"Long-term survival of monolithic tooth-supported lithium disilicate crowns fabricated using a chairside approach: 15-year results","volume":"27","author":"Rauch A","year":"2023","unstructured":"Rauch A, Lorenz L, Reich S, Hahnel S, Schmutzler A, & Schierz O (2023) Long-term survival of monolithic tooth-supported lithium disilicate crowns fabricated using a chairside approach: 15-year results. 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(2023) Traditional versus conservative endodontic access impact on fracture resistance of chairside CAD-CAM lithium disilicate anterior crowns: An in vitro study Journal of Prosthodontics 32(5) 728-734."},{"issue":"8","key":"b18","series-title":"Journal of Prosthodontics","first-page":"706","article-title":"Effect of endodontic access preparation on fracture load of translucent versus conventional zirconia crowns with varying occlusal thicknesses","volume":"30","author":"Nejat AH","year":"2021","unstructured":"Nejat AH, Dupree P, Kee E, Xu X, Zakkour W, Odom M, Bruggers K, & Mascarenhaus F (2021) Effect of endodontic access preparation on fracture load of translucent versus conventional zirconia crowns with varying occlusal thicknesses Journal of Prosthodontics 30(8) 706-710."},{"issue":"4","key":"b19","series-title":"Journal of Prosthetic Dentistry","first-page":"328","article-title":"The effect of endodontic access preparation on the failure load of lithium disilicate glass-ceramic restorations","volume":"106","author":"Qeblawi D","year":"2011","unstructured":"Qeblawi D, Hill T, & Chlosta K (2011) The effect of endodontic access preparation on the failure load of lithium disilicate glass-ceramic restorations Journal of Prosthetic Dentistry 106(4) 328-336."},{"issue":"2","key":"b20","series-title":"Journal of Prosthodontics","first-page":"163","article-title":"Fracture resistance of pressed and milled lithium disilicate anterior complete coverage restorations following endodontic access preparation","volume":"28","author":"Gerogianni P","year":"2019","unstructured":"Gerogianni P, Lien W, Bompolaki D, Verrett R, Haney S, Mattie P, & Johnson R (2019) Fracture resistance of pressed and milled lithium disilicate anterior complete coverage restorations following endodontic access preparation Journal of Prosthodontics 28(2) 163-170."},{"issue":"8","key":"b21","series-title":"Dental Materials","first-page":"902","article-title":"Biaxial flexure strength determination of 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Journal of Prosthodontic Research 68(2) 326-335."},{"issue":"7","key":"b32","series-title":"Journal of Prosthodontics","first-page":"684","article-title":"Fracture resistance, marginal and internal adaptation of innovative 3D-printed graded structure crown","volume":"33","author":"Zandinejad A","year":"2024","unstructured":"Zandinejad A, Zadeh RS, Khaniar LN, Barmak AB, & Refilla-Leon M (2024) Fracture resistance, marginal and internal adaptation of innovative 3D-printed graded structure crown Journal of Prosthodontics 33(7) 684-690."},{"issue":"2","key":"b33","series-title":"Materials","first-page":"365","article-title":"The effect of restoration thickness on the fracture resistance of 5 mol% yttria-containing zirconia crowns","volume":"17","author":"Chen PH","year":"2024","unstructured":"Chen PH, Elamin E, Ahmed AS, Givan DA, Fu C-C, & Lawson NC (2024) The effect of restoration thickness on the fracture resistance of 5 mol% yttria-containing zirconia crowns Materials 17(2) 365-372."},{"issue":"6","key":"b34","series-title":"Saudi Dental Journal","first-page":"920","article-title":"Fracture resistance of CAD\/CAM milled versus direct hand-made interim laminate veneers","volume":"36","author":"Abuhammoud S","year":"2024","unstructured":"Abuhammoud S, Emtier V, Fu C-C, Rojas-Rueda S, Jurado CA, & Afrashtehfar K (2024) Fracture resistance of CAD\/CAM milled versus direct hand-made interim laminate veneers Saudi Dental Journal 36(6) 920-925."},{"issue":"5","key":"b35","series-title":"Materials","first-page":"1096","article-title":"The effect of die material on the crown fracture strength of zirconia crowns","volume":"17","author":"Sayed Ahmed A","year":"2024","unstructured":"Sayed Ahmed A, Lawson NC, Fu C-C, Bora PV, Kee E, & Nejat AH (2024) The effect of die material on the crown fracture strength of zirconia crowns Materials 17(5) 1096-1103."}],"container-title":["Operative Dentistry"],"original-title":[],"link":[{"URL":"https:\/\/operative-dentistry.kglmeridian.com\/view\/journals\/odnt\/51\/1\/article-p60.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/operative-dentistry.kglmeridian.com\/downloadpdf\/journals\/odnt\/51\/1\/article-p60.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/operative-dentistry.kglmeridian.com\/downloadpdf\/journals\/odnt\/51\/1\/article-p60.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T15:35:55Z","timestamp":1784648155000},"score":1,"resource":{"primary":{"URL":"https:\/\/operative-dentistry.kglmeridian.com\/view\/journals\/odnt\/51\/1\/article-p60.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":35,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.2341\/24-144-l","relation":{},"ISSN":["1559-2863","0361-7734"],"issn-type":[{"value":"1559-2863","type":"electronic"},{"value":"0361-7734","type":"print"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}