Robust dental systems obtained by computer-aided design and manufacture (CAD/CAM) have been introduced and, in parallel, the strength of the ceramic materials used in fabricating dental crowns has improved. Yet all-ceramic crowns suffer from near-surface damage, limiting their clinical success, especially on posterior teeth. Factors directly associated with CAD/CAM fabrication that contribute to the degree of damage include material selection and machining parameters and strategies. However, a number of additional factors also either create new damage modes or exacerbate subcritical damage, potentially leading to catastrophic failure of the crown. Such factors include post-fabrication manipulations in the laboratory or by the clinician, fatigue associated with natural occlusal function, and stress fields created by compliance or distortion within the supporting tooth structure and/or adhesive material holding the crown to the tooth. Any damage reduces the strength of a crown, increasing the probability of catastrophic failure. The challenge is to understand and manage the combination of competing damage initiation sites and mechanisms, limitations imposed by the demand for aesthetics, and biologically related constraints.
