journal article·2026-03-03Open access

Biomechanical Evaluation of CAD/CAM Inlay Restorations Through Experimental Flexural Strength Testing and Finite Element Analysis

Omer Sagsoz, Mehmet Yildiz, Hojjat Ghahramanzadeh Asl

Abstract

Background: This study aimed to investigate the biomechanical behavior of conservative inlay restorations fabricated from different CAD/CAM materials by combining experimental flexural strength testing with finite element analysis. Methods: Five CAD/CAM materials were evaluated: feldspathic ceramic (Cerec Blocs), leucite-reinforced ceramic (IPS Empress CAD), resin nano-ceramic (Lava Ultimate), polymer-infiltrated ceramic network (VITA Enamic), and lithium disilicate ceramic (IPS e.max CAD). Young’s modulus and Poisson’s ratio were experimentally determined using three-point bending and nanoindentation tests and used as inputs for 3D FEA. Von Mises (VM) stress distributions within the inlays were analyzed under simulated occlusal loading. Results: Maximum VM stresses showed an inverse relationship with material elasticity. IPS e.max CAD exhibited the highest maximum VM stress (45.571 MPa), whereas the resin nano-ceramic showed the lowest (25.419 MPa). Despite higher stress concentrations in high-modulus ceramics, VM values for all materials remained well below their FS limits. Conclusions: All materials demonstrated adequate mechanical stability under physiological loading. Lithium disilicate showed a comparatively larger margin between stress levels and flexural strength, while lower-modulus materials tended to promote greater stress transfer to supporting structures.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Dental materials and restorations · Endodontics and Root Canal Treatments · Bone Tissue Engineering Materials

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Department of Restorative Treatment, Faculty of Dentistry, Atatürk University, 25240 Erzurum, Türkiye

Department of Restorative Treatment, Faculty of Dentistry, Sakarya University, 54100 Sakarya, Türkiye

Department of Mechanical Engineering, Karadeniz Technical University, 61080 Trabzon, Türkiye

References (38)

Show source-provided references
1. Comparative evaluation of stress distribution in maxillary premolar restored with onlay fabricated with different restorative materials: A three-dimensional finite element analysis study10.4103/JCDE.JCDE_788_24 ↗
2. Influence of the indirect restoration design on the fracture resistance: A finite element study10.1186/s12938-015-0115-4 ↗
3. Bite force and influential factors on bite force measurements: A literature review10.1055/s-0039-1697833 ↗
4. Maximum bite force analysis in different age groups10.1055/s-0034-1374647 ↗
5. Virtual prototyping of adhesively restored, endodontically treated molars10.1016/S0022-3913(10)60074-1 ↗
6. Chirca, O., Biclesanu, C., Florescu, A., Stoia, D.I., Pangica, A.M., Burcea, A., Vasilescu, M., and Antoniac, I.V. (2021). Adhesive-ceramic interface behavior in dental restorations: FEM study and SEM investigation. Materials, 14.10.3390/ma14175048 ↗
7. Clinical longevity of indirect composite resin inlays and onlays: An up to 9-year prospective study10.1055/s-0041-1735420 ↗
8. Microstructural investigation of hybrid CAD/CAM restorative dental materials by micro-CT and SEM10.1016/j.dental.2024.04.006 ↗
9. Stress analysis and risk of failure during clenching in ceramic assembly models: A three-dimensional finite element analysis10.1016/j.jds.2023.01.015 ↗
10. Munoz, A., Zhao, Z., Paolone, G., Louca, C., and Vichi, A. (2023). Flexural strength of CAD/CAM lithium-based silicate glass–ceramics: A narrative review. Materials, 16.10.3390/ma16124398 ↗
11. Ceramics in dentistry—Part I: Classes of materials
12. A new classification system for all-ceramic and ceramic-like restorative materials10.11607/ijp.4244 ↗
13. Stress distribution in molars restored with inlays or onlays with or without endodontic treatment: A three-dimensional finite element analysis10.1016/S0022-3913(09)60206-7 ↗
14. Effects of different ceramic and composite materials on stress distribution in inlay and onlay cavities: A 3D finite element analysis10.4012/dmj.28.661 ↗
15. Effect of ceramic thickness and composite bases on stress distribution of inlays: A finite element analysis10.1590/0103-6440201300258 ↗
16. Shayanfard, P., Tan, X., Karl, M., and Wendler, F. (2024). Finite element combined design and material optimization addressing wear in removable implant prosthodontics. J. Funct. Biomater., 15.10.3390/jfb15110344 ↗
17. Influence of connector dimensions on stress distribution of monolithic zirconia and lithium disilicate inlay-retained fixed dental prostheses: A 3D finite element analysis10.1016/j.tdj.2015.01.001 ↗
18. Biomechanical assessment of the influence of inlay/onlay design and material on stress distribution in nonvital molars10.1055/s-0041-1736463 ↗
19. Finite element analysis and nanomechanical properties of composite and ceramic dental onlays10.1080/10255842.2022.2032004 ↗
20. Fracture strength and bending of all-ceramic and fiber-reinforced composites in inlay-retained fixed partial dentures10.1016/j.jds.2012.03.013 ↗
21. In silico finite element analysis of implant-supported CAD/CAM resin composite crowns10.1111/jopr.13531 ↗
22. Effect of uniaxial bending methods on the flexural strength and Weibull analysis of heat-polymerized, CAD/CAM milled, and 3D-printed denture base resins10.1016/j.dental.2024.12.015 ↗
23. Nano-indentation method for the measurement of the Poisson’s ratio of MEMS thin films10.1016/j.sna.2003.07.001 ↗
24. Biomechanical examination of inlay geometries: Is there a basic biomechanical principle?
25. Effect of adhesive layer properties on stress distribution in composite restorations: A 3D finite element analysis10.1016/S0109-5641(01)00042-2 ↗
26. Influence of preparation design on failure risks of ceramic inlays: A finite element analysis
27. Nikolova, N., Raykovska, M., Petkov, N., Tsvetkov, M., Georgiev, I., Koytchev, E., Iankov, R., Dimova-Gabrovska, M., and Gusiyska, A. (2025). Integration of micro-CT imaging and finite element simulations for modelling tooth–inlay systems. J. Funct. Biomater., 16.10.3390/jfb16070267 ↗
28. Three-dimensional finite element analysis of cavity design and 3D-printed resin composite restorations in endodontically treated molars10.21608/edj.2025.355494.3357 ↗
29. Influence of inlays/onlays and their material on stress distribution in mandibular molars: Finite element analysis10.34172/ajdr.2022.578 ↗
30. Three-dimensional finite element analysis of strength and adhesion of composite resin versus ceramic inlays in molars10.1016/S0022-3913(08)60029-3 ↗
31. Impact of dental materials on stress concentration and distribution in inlay restorations: A three-dimensional finite element analysis
32. Baldi, A., Scattina, A., Comba, A., Peroni, L., Rossi, T., and Scotti, N. (2025). Effects of different cement–restorative material combinations in full-coverage onlay restorations: A finite element analysis study. Dent. Mater., in press.10.1016/j.dental.2025.09.011 ↗
33. Mechanical and thermal stress analysis of hybrid ceramic and lithium disilicate CAD/CAM inlays using 3D finite element analysis10.14295/bds.2021.v24i3.2453 ↗
34. Fracture resistance of lithium disilicate and hybrid resin inlays: A finite element analysis study
35. Ceramic inlays: Is the inlay thickness an important factor influencing fracture risk?10.1016/j.jdent.2013.04.010 ↗
36. Melc, T., Attin, T., Eyüboğlu, T.F., and Özcan, M. (2024). Flexural strength of modern CAD/CAM restoratives after artificial aging. Materials, 17.10.3390/ma17215178 ↗
37. Mechanical properties of direct composite resins and CAD/CAM composite blocks10.3390/oral4020017 ↗
38. Alanazi, K.K., Alzaid, A.A., Elkaffas, A.A., Bukhari, S.A., Althubaitiy, R.O., Alfaifi, K.A., Alfahdi, I.M., and Alqahtani, H.A. (2024). Mechanical assessment of CAD/CAM fabricated hybrid ceramics: An in vitro study. Appl. Sci., 14.10.3390/app14177939 ↗