Effect of thermocycling on flexural strength of dental CAD/CAM ceramics of variable thicknesses and structures: an in vitro study

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Al-Dulaijan" }, { "@type": "Person", "name": "Nourhan M. Aly" }, { "@type": "Person", "name": "Turki Alshehri" }, { "@type": "Person", "name": "Shahad T. Alameer" }, { "@type": "Person", "name": "Sultan Akhtar" }, { "@type": "Person", "name": "Laila Al Dehailan" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " Background This study examined the effect of thermocycling on the flexural strength properties of four CAD/CAM ceramic materials at different thicknesses. Methods Four CAD/CAM ceramics of different types: advanced lithium disilicate (ALD), zirconia-reinforced lithium silicate (ZLS) lithium disilicate (LD), and leucite reinforced (LE), and at three varying thicknesses 0.5, 1.0 and 1.5 mm were examined. After subjecting all specimens to 5000 thermomechanical cycles, flexural strength was determined using a universal testing apparatus. Scanning electron microscopy (SEM) was employed for analysis. Two factorial ANOVA models assessed the association of different factors (ceramic type and thickness) with flexural strength and elastic modulus. The 95% confidence intervals (CIs) and adjusted means were computed. A p-value < 0.05 was designated significant. Results ZLS exhibited the highest flexural strength at 1.5 mm thickness, while LD showed the highest Young’s modulus of elasticity. The lowest flexural strength was observed in the 0.5 mm thickness group. There were notable variations in flexural strength across all ceramic materials, with the highest adjusted mean strength in the ZLS group, ALD, LD, and LE, respectively. Additionally, significant differences were noted in ceramic thickness, with 1.5 mm thickness showing the highest strength and 0.5 mm thickness the lowest. Conclusions Ceramic material thickness significantly impacts flexural strength, with 1.5 mm thickness deemed suitable for posterior restorations. Ceramic materials with zirconia fillers or matrix demonstrated higher flexural strength than other ceramics. 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F1000Research 2024, 13 :1310 ( https://doi.org/10.12688/f1000research.157128.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Effect of thermocycling on flexural strength of dental CAD/CAM ceramics of variable thicknesses and structures: an in vitro study [version 1; peer review: 1 approved, 1 not approved] Passent Ellakany https://orcid.org/0000-0002-2995-8111 1 , Yousif A. Al-Dulaijan https://orcid.org/0000-0002-8180-8903 2 , Nourhan M. Aly 3 , [...] Turki Alshehri https://orcid.org/0000-0001-7575-1587 2 , Shahad T. Alameer https://orcid.org/0009-0001-5469-3493 4 , Sultan Akhtar 5 , Laila Al Dehailan https://orcid.org/0000-0002-1240-7022 6 Passent Ellakany https://orcid.org/0000-0002-2995-8111 1 , Yousif A. Al-Dulaijan https://orcid.org/0000-0002-8180-8903 2 , [...] Nourhan M. Aly 3 , Turki Alshehri https://orcid.org/0000-0001-7575-1587 2 , Shahad T. Alameer https://orcid.org/0009-0001-5469-3493 4 , Sultan Akhtar 5 , Laila Al Dehailan https://orcid.org/0000-0002-1240-7022 6 PUBLISHED 31 Oct 2024 Author details Author details 1 Division of Prosthodontics, School of Dentistry, The University of Alabama at Birmingham, Birmingham, AL 35209, USA 2 Department of Substitutive Dental Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, 31441, Saudi Arabia 3 Pediatric Dentistry and Dental Public Health, Alexandria University Faculty of Dentistry, Alexandria, Alexandria Governorate, 21527, Egypt 4 Imam Abdulrahman Bin Faisal University College of Dentistry, Dammam, Eastern Province, 31441, Saudi Arabia 5 Department of Biophysics Research, Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, 31441, Saudi Arabia 6 Department of Restorative Dental Sciences, Imam Abdulrahman Bin Faisal University College of Dentistry, Dammam, Eastern Province, 31441, Saudi Arabia Passent Ellakany Roles: Conceptualization, Methodology, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Yousif A. Al-Dulaijan Roles: Visualization, Writing – Review & Editing Nourhan M. Aly Roles: Data Curation, Formal Analysis, Writing – Original Draft Preparation, Writing – Review & Editing Turki Alshehri Roles: Methodology, Writing – Original Draft Preparation Shahad T. Alameer Roles: Methodology, Writing – Original Draft Preparation Sultan Akhtar Roles: Methodology, Software Laila Al Dehailan Roles: Visualization, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background This study examined the effect of thermocycling on the flexural strength properties of four CAD/CAM ceramic materials at different thicknesses. Methods Four CAD/CAM ceramics of different types: advanced lithium disilicate (ALD), zirconia-reinforced lithium silicate (ZLS) lithium disilicate (LD), and leucite reinforced (LE), and at three varying thicknesses 0.5, 1.0 and 1.5 mm were examined. After subjecting all specimens to 5000 thermomechanical cycles, flexural strength was determined using a universal testing apparatus. Scanning electron microscopy (SEM) was employed for analysis. Two factorial ANOVA models assessed the association of different factors (ceramic type and thickness) with flexural strength and elastic modulus. The 95% confidence intervals (CIs) and adjusted means were computed. A p-value < 0.05 was designated significant. Results ZLS exhibited the highest flexural strength at 1.5 mm thickness, while LD showed the highest Young’s modulus of elasticity. The lowest flexural strength was observed in the 0.5 mm thickness group. There were notable variations in flexural strength across all ceramic materials, with the highest adjusted mean strength in the ZLS group, ALD, LD, and LE, respectively. Additionally, significant differences were noted in ceramic thickness, with 1.5 mm thickness showing the highest strength and 0.5 mm thickness the lowest. Conclusions Ceramic material thickness significantly impacts flexural strength, with 1.5 mm thickness deemed suitable for posterior restorations. Ceramic materials with zirconia fillers or matrix demonstrated higher flexural strength than other ceramics. READ ALL READ LESS Keywords CAD/CAM, Ceramics, Flexural Strength, Thickness, Composition Corresponding Author(s) Passent Ellakany ( [email protected] ) Close Corresponding author: Passent Ellakany Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Ellakany P et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Ellakany P, A. Al-Dulaijan Y, M. Aly N et al. Effect of thermocycling on flexural strength of dental CAD/CAM ceramics of variable thicknesses and structures: an in vitro study [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :1310 ( https://doi.org/10.12688/f1000research.157128.1 ) First published: 31 Oct 2024, 13 :1310 ( https://doi.org/10.12688/f1000research.157128.1 ) Latest published: 14 Aug 2025, 13 :1310 ( https://doi.org/10.12688/f1000research.157128.3 )  There is a newer version of this article available. Suppress this message for one day. Introduction Dental ceramics have evolved to offer restorations with superior esthetic and mechanical characteristics, serving as efficient alternatives to metal-ceramic restorations. 1 These dental ceramics can be categorized based on their fabrication method, composition, firing temperature, and microstructure. 2 All-ceramic restorations can be fabricated using different methods, including conventional techniques like stacking and sintering, split casting and infusion, and heat- or dry-pressing methods, as well as through computer-aided design and computer-aided manufacturing (CAD/CAM) techniques. 2 , 3 The homogeneity of ceramic CAD/CAM blocks has notably enhanced the strength of definitive prostheses by reducing crack development and defects compared to conventional ceramic fabrication methods. 4 Lithium disilicate glass-ceramic (LD) is one of the most common ceramic materials, with its (SiO 2 -Li 2 O) composition minimizing microcracks and enhancing mechanical properties. 5 , 6 Previous studies have demonstrated LD’s higher fracture resistance compared to leucite ceramics and improved flexural strength over lithium disilicate-strengthened lithium aluminosilicate glass. 7 , 8 Leucite glass-ceramic is another option for high-esthetic and translucent all-ceramic restorations, with comparable fracture strength to feldspathic ceramics and resin nano-ceramic. 9 Lithium silicate CAD/CAM ceramics reinforced with zirconia (ZLS) integrate tetragonal zirconia fillers to improve ceramic strength, making them capable of withstanding occlusal forces. 10 Despite ZLS being challenging to section due to drill blunting, 11 its high biaxial flexural strength values have bolstered its utility in fabricating various restorations, including implant-supported molar crowns, occlusal veneers, and endo-crown restorations. 12 Advanced lithium disilicate (ALD), a recent addition to the market, comprises lithium disilicate (Li2Si2O5) and virgilite crystals which form a 0.5-μm-long needle-like shape within a zirconia glass matrix. 13 Research reporting the mechanical properties of ALD ceramics is scarce. 14 , 15 One of the published studies showed some positive results regarding the mechanical fatigue behavior of ALD, which is similar to LD but lower than lithium silicate-disilicate and Yttria-stabilized zirconia 14 In contrast, another study reported that ALD had lower fracture toughness 15 as well as lower flexural strengths when compared to LD. 16 The thickness and composition of ceramic restorations have a direct impact on flexural strength and esthetics, where varying restoration thicknesses offer solutions for some clinical challenges. 17 For example, thinner restorations can be used for ceramic veneers of high esthetics and translucency, 18 while thicker ceramics are more suitable for full-coverage restorations. 19 To create a restorative dental material that is highly sustainable, aesthetically pleasing, and safe, all of the material’s qualities must be thoroughly examined and tested. 20 Since chewing and biting put occlusal stress on all restorative materials used for tooth restorations, proper flexural strength is considered essential. 16 The maximum stress a material can withstand deformation under load is known as flexural strength. 21 On the other hand, the minimal and conflicting findings on ALD highlight the need for further studies to comprehensively assess its mechanical properties. 14 – 16 Additionally, understanding the impact of ceramic thickness and structure can guide the selection of appropriate restoration types for specific dental applications. Thus, this research aimed to evaluate the effect of thermocycling on the flexural strength of four CAD/CAM ceramics of varying thicknesses. According to the null hypothesis, no discernible relationship would be noticed between the flexural strength and the thickness and composition of CAD/CAM ceramics after exposure to thermocycling process. Methods Grouping of tested specimens Four CAD/CAM ceramics of low translucency and A1 shade were examined; advanced lithium disilicate (Cerec Tessera™, Sirona Dentsply, Milford, DE, USA; ALD), zirconia-reinforced lithium silicate (Celtra Duo ® , Sirona Dentsply, Milford, DE, USA; ZLS), lithium disilicate (IPS E.max ® CAD, Ivoclar Vivadent, Schaan, Liechtenstein; LD), and leucite reinforced (IPS Empress ® CAD, Ivoclar Vivadent, Schaan, Liechtenstein; LE) as shown in Figure 1 . Each ceramic type included 30 specimens, further categorized into three thicknesses of 0.5-, 1-, and 1.5mm. (n=10 specimens per thickness subgroup). As a result, 120 specimens made up the entire sample size that was evaluated in this study. In order to detect an effect size of 0.42, the total sample was computed using G*Power (Version 3.1.9.4), assuming a 5% alpha error and 80% research power. The least number of specimens required for each group was determined to be 9. However, 10 specimens were included to account for possible problems with the laboratory process. 22 As a consequence, the number of subgroups multiplied by the number of members in each subgroup yielded 12 × 10 = 120 specimens as the total sample size. 23 Figure 1. Flow chart representing the study grouping and design. Preparation of study specimens The specimens were sectioned utilizing a precision cutting device (Isomet 5000 machine; Buehler, Lake Bluff, IL, USA) under an abundance of water to produce the following thicknesses of 0.5, 1, and 1.5 mm × 4 mm × 12 mm. Following the specimens’ cutting, a 60-second polishing period was conducted utilizing silicon carbide discs (500-grit coarse) at 200 rpm in the presence of a water-cooling system. The polishing was executed employing a polishing device (MetaServ 250 Grinder-Polisher with Vector Power Head; Buehler, IL, USA). Post-polishing, the specimens were placed in a furnace of ceramic to crystallize. (Programat EP5010; Ivoclar Vivadent, Schann, Liechtenstein). Subsequently, an additional polishing step was performed utilizing the previously described polishing equipment and 400- and 600 grits of carbide discs in a moist atmosphere for 60 seconds at 200 rpm. To ensure dimensional consistency, a digital caliper (Mitutoyo Corp, Kawasaki, Japan) was employed to verify that all specimens maintained a thickness within 0.05 mm. 23 , 24 Application of the thermocycling process The specimens went through a simulated aging protocol, undergoing 5000 thermomechanical cycles in a thermomechanical aging apparatus (Thermocycler THE-1100 machine; SD Mechatronik Feldkirchen, Westerham, Germany). Water baths ranging in temperature from 5°C to 55°C were used for the alternating cycles, with a 10-second interval between each bath and a 30-second immersion period. This simulation replicated the aging impact equivalent to six months of natural aging. 25 – 28 Application of flexural strength test The flexural strength assessment was done using the universal testing machine (Instron 8871 Universal Testing Machine; Instron, Shakopee, MN, USA). A rounded-end steel indenter that was specially made with a 2.5-mm radius was employed. The crosshead speed was set at 1 mm/min, and an axial load of 30 N was directed vertically at the center of the ceramic specimens until fracture happened. 29 The maximum load at the point of fracture was noted in Newtons for each specimen. 25 Then, megapascals (MPa) were used to calculate the flexural strength based on recommendations outlined in the International Organization for Standardization’s (ISO) 6872 Dentistry—Ceramic Materials. 30 Equations listed below were employed to compute the flexural strengths and elastic modulus of specimens. Flexuralstrength = 3 FL / 2 bh 2 Where (b) is the tested specimen’s width, (h) is its thickness, (L) is the distance between the two supporting arms, and (F) is the force applied till fracture in Newton. Elastic modulus = FL3/4bh3d where (d) is the deflection measured at (F), and (F) is the load imposed on the linear section of the stress-strain curve (N). 27 Scanning Electron Microscopy (SEM) For surface qualitative evaluation via scanning electron microscopy (SEM), a randomly selected specimen from each subgroup was chosen to examine the topography of each sample following fracture. The SEM analysis was done using a scanning electron microscope (Inspect S50 model; FEI Company, Moravia, Czech Republic) operating at an increasing voltage of 20 KV and magnifications of ×10000. To reduce the impact of charging and enhance the clarity of the image, the specimens underwent a gold-coating process before examination. 24 Statistical analysis Plots (Q-Q plots and histograms), normality tests, and descriptive statistics were used to test for normality. All data showed normal distribution, so parametric analysis was adopted. Two factorial ANOVA models were performed to assess the association of different elements (type and thickness of tested ceramics) with flexural strength and elastic modulus. Calculations were done for adjusted means and 95% confidence intervals (CIs). P-value <0.05 was used as the significance threshold. Data analysis was done with Windows-based IBM SPSS (Version 26.0). Result Table 1 presents the flexural strengths and elastic moduli of the four studied ceramics at different thicknesses. At a thickness of 1.5 mm, ZLS exhibited the greatest flexural strength (mean (SD) = 309.08 (33.49)), while LE showed the most minor flexural strength (mean (SD)= 268.11 (7.48)). Table 1. Comparison of flexural strengths and elastic moduli of the four studied ceramics at different thicknesses. ALD ZLS LD LE P value 1 Flexural strength (MPa) 0.5 mm 198.50 (74.59) A 223.38 (46.54) A 210.65 (27.16) A 191.23 (14.41) A 0.44 1 mm 246.95 (48.23) B 275.99 (38.41) B 267.39 (37.71) B 231.45 (40.88) B 0.09 1.5 mm 281.18 (39.51) ab, B 309.08 (33.49) a, B 301.96 (28.04) ab, B 268.11 (7.48) b, B 0.01* P value 2 0.01* <0.001* <0.001* <0.001* Force at break (N) 0.5 mm 90.51 (6.27) A 95.76 (31.19) A 91.79 (13.13) A 85.38 (8.51) A 0.63 1 mm 230.00 (36.49) ab, B 258.96 (52.27) a, B 251.41 (47.00) a, B 195.27 (9.73) b, B 0.005* 1.5 mm 291.36 (67.42) a, C 416.56 (74.55) b, C 304.40 (85.99) a, B 204.04 (15.66) c, B <0.001* P value 2 <0.001* <0.001* <0.001* <0.001* Young’s modulus of elasticity (GPa) 0.5 mm 22.25 (6.90) ab, A 29.51 (7.57) a, A 21.95 (7.07) ab, A 19.06 (4.72) b, A 0.009* 1 mm 57.28 (16.35) B 52.11 (21.02) B 48.41 (13.80) B 59.65 (45.09) B 0.79 1.5 mm 67.84 (13.81) ab, B 82.80 (12.35) a, C 67.31 (12.81) ab, C 64.07 (15.81) b, B 0.02* P value 2 <0.001* <0.001* <0.001* 0.002* Moreover, at a 1.5 mm thickness, ZLS ceramic required the most significant amount of force to break (mean (SD) = 416.56 (74.55)) in contrast to the same thickness of LE, which required the least amount of force to be broken (mean (SD) = 204.04 (15.66)). Among the 1.5 mm thicknesses, ZLS had the highest Young’s modulus of elasticity (mean (SD)= 82.80 (12.35), while had the lowest (mean (SD)= 82.80 (12.35). The 0.5mm thickness across all ceramic groups had the lowest flexural strength, elastic modulus, and forces to break. These values were significantly higher at 1.5 mm thickness when compared to 0.5- and 1-mm thicknesses, with ZLS exhibiting the highest values (mean (SD)= 309.08 (33.49), 82.80 (12.35), and 416.56 (74.55)) respectively. Table 2 and Figure 2 illustrate the association of flexural strength with ceramic type and thickness. The findings indicated significant variations in flexural strength between the materials, with ZLS exhibiting the highest adjusted mean stress (269.49 MPa), followed by LD (260.00 MPa), ALD (242.21 MPa), and LE (230.26 MPa). Additionally, the materials’ thickness was a major factor, with the 1.5 mm thickness demonstrating the highest strength (290.08 MPa) and the 0.5 mm thickness presenting the least strength (205.94 MPa). Table 2. Factorial ANOVA showing the association of flexural strength with ceramic type and thickness. Flexural strength Adjusted mean (SE) 95% CI P value Ceramic type ALD 242.21 (7.03) a 228.29, 256.14 0.001* ZLS 269.49 (7.03) b 255.56, 283.41 LD 260.00 (7.03) ab 246.08, 273.92 LE 230.26 (7.03) a 216.34, 244.18 Thickness 0.5 205.94 (6.09) a 193.88, 218.00 <0.001* 1 255.45 (6.09) b 243.39, 267.50 1.5 290.08 (6.09) c 278.03, 302.14 Model F (P value) 23.07 (<0.001*) Adjusted R 2 0.48 Figure 2. Diagram showing the impact of ceramic type and thickness on flexural strength property. SEM images at ×10000 magnification showed the crystalline structure of ALD, ZLS, LD, and LE specimens ( Figure 3 ). ZLS showed a homogenous crystalline matrix ( Figure 3a ). At the same time, LD had needle-shaped fine-grained crystals within a glassy matrix ( Figure 3b ). LE and ALD images showed numerous pores with leucite crystals and lithium aluminum silicate crystals incorporated in a glassy matrix, respectively ( Figure 3c and 3d ). Figure 3. SEM representing surface morphology of tested CAD/CAM ceramics at x10000 magnification where (a) ALD; Advanced lithium disilicate (b) ZLS; Zirconia lithium silicate, (c) LD; Lithium disilicate, (d) LE; Leucite reinforced. Discussion This study assessed the flexural strength of four CAD/CAM ceramic materials of varying thicknesses and compositions. The results showed that 1.5 mm thickness in the ZLS group was the highest flexural strength. Similar findings were noted in ZLS of 1.5 mm thicknesses in terms of elasticity. The highest strength was noticed among the ZLS specimens, LD, ALD, and LE, respectively, which subsequently required higher force to fracture. Specimens with a thickness of 1.5 mm exhibited significantly greater strength compared to the 0.5 mm samples, which presented the least strength. Thus, the null hypothesis is rejected. Different thicknesses of ceramic material might yield varying flexural strength values on the ceramic materials. Ceramic materials of less thickness, such as 0.5 and 1mm, are suitable for minimally invasive procedures. 31 Schweiger J et al. 32 investigated three different types of CAD/CAM materials: LE, LD, and 3Y-TCP zirconia at five different thicknesses ranging from 0.4-1.6 mm. The lowest load required to fracture was recorded at the 0.4 mm thickness, while the highest load was required for the 1.6 mm thickness of zirconia, followed by LD and LE ceramics. This is consistent with the current study’s findings, where the 0.5 mm thickness of LE ceramics required the least force to fracture, while the 1.5 mm thickness of ZLS and LD required the highest force to fracture, respectively. The results of the flexural strength test of this study were compared to the readings of the biaxial flexural strength test described by Schweiger J et al. 32 due to the lack of similar studies assessing the relation between varying ceramic thickness and the flexural strengths characteristic. In assessing the relation between the ceramic composition of tested ceramics and flexural strength feature, ZLS of all thicknesses exhibited the highest flexural strengths compared to LD and ALD, respectively. Meanwhile, LE ceramics exhibited the least flexural strengths among all tested materials at different thicknesses. This comes in agreement with Attar et al. 33 findings, which reported that zirconia-reinforced lithium silicate ceramics (Vita suprinity) of 2 mm thickness exhibited higher flexural strengths than LD and LE, respectively. Similar findings were stated by Elsaka et al. 34 after assessing the flexural strengths and elastic moduli of Vita suprinity and LD of 1.2 mm thickness. The higher strengths and elastic modulus of zirconia-reinforced ceramics are related to the presence of ZrO 2 particles in the glassy matrix as in SEM images, resulting in a higher resistance to crack propagation. 33 , 34 In contrast, Corade et al. 35 showed increased flexural strength of LD specimens of 1.5 mm compared to both ZLS and other zirconia reinforced lithium disilicate ceramics of different manufacturers (Vita suprinity and Rosetta). This might be referred to the different methods used in both studies. The current results showed that LD reported higher flexural strength than ALD and LE ceramics. In agreement with these findings, another study reported that crystalized LD of 1 mm thickness exhibited higher flexural strength compared to ALD after exposure to different firing and glazing protocols. 36 Similarly, another study displayed that the highest flexural strength was reported among LD specimens of 3 mm thickness contrasted to ALD. 16 Furthermore, Sonmez et al. 37 found that LD specimens of 1.2 mm thickness showed higher flexural strength than those of LE ceramics. These superior properties of LD might be due to the difference in composition, where LD includes a tiny amount of glass phase and lithium disilicate crystals, as shown in SEM. Strengths of this study included assessing the flexural strengths of the most used CAD/CAM ceramics, varying in thicknesses relevant to fabricating different esthetic restorations such as dental veneers, veneered restorations, and all-ceramic prostheses. Moreover, a thermocycling procedure was applied to simulate an aging process equivalent to 6 months intraorally. Additionally, the study evaluated the flexural strengths and topography of Cerec tessera (ALD) ceramics, a type of ceramic that is relatively new in the CAD/CAM realm and has not been extensively studied in the literature, especially in variable thicknesses. Despite the strengths, the study has several limitations; one major limitation is that it is an in vitro study, which may not fully represent the complex oral environment. Therefore, further clinical studies are required to assess different restoration designs and a wider range of dental materials to better simulate oral conditions. Moreover, the study only assessed low translucency ceramics, and future studies should consider evaluating different levels of translucency to understand their impact on flexural strengths more comprehensively. Conclusions The increase in ceramic thickness significantly impacts the flexural strength. A thickness of 1.5 mm was found to be optimum in restoring teeth in the posterior region or subjected to heavy occlusal load. Additionally, the composition of CAD/CAM ceramics has a crucial role in the flexural strength property. Dental ceramics, including zirconia fillers, are more resistant to deformation under masticatory loads than other glass ceramics. This was noted in ZLS ceramics. However, ALD requires further investigations to validate the current findings. Data and software availability All the data analyzed during the study are included in the article. Underlying data FigShare: Flexural strength of ceramics data set. Ellakany, Passent (2024) https://doi.org/10.6084/m9.figshare.27095080.v1 This project contains the following underlying data: • Flexural strength ceramics data.xlsx. figshare. Dataset. https://doi.org/10.6084/m9.figshare.27095080.v1 Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Software availability statement IBM statistics software can be replaced by Open source Jamovi software free version. References 1. Mavriqi L, Valente F, Murmura G, et al. : Lithium disilicate and zirconia reinforced lithium silicate glass-ceramics for CAD/CAM dental restorations: biocompatibility, mechanical and microstructural properties after crystallization. J. Dent. 2022; 119 : 104054. PubMed Abstract | Publisher Full Text 2. Al-Dulaijan YA, Aljubran HM, Alrayes NM, et al. : Clinical outcomes of single full-coverage lithium disilicate restorations: A systematic review. Saudi Dent J. 2023; 35 (5): 403–422. PubMed Abstract | Publisher Full Text | Free Full Text 3. Sulaiman TA, Delgado AJ, Donovan TE: Survival rate of lithium disilicate restorations at 4 years: a retrospective study. J. Prosthet. 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Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 31 Oct 2024 ADD YOUR COMMENT Comment Author details Author details 1 Division of Prosthodontics, School of Dentistry, The University of Alabama at Birmingham, Birmingham, AL 35209, USA 2 Department of Substitutive Dental Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, 31441, Saudi Arabia 3 Pediatric Dentistry and Dental Public Health, Alexandria University Faculty of Dentistry, Alexandria, Alexandria Governorate, 21527, Egypt 4 Imam Abdulrahman Bin Faisal University College of Dentistry, Dammam, Eastern Province, 31441, Saudi Arabia 5 Department of Biophysics Research, Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, 31441, Saudi Arabia 6 Department of Restorative Dental Sciences, Imam Abdulrahman Bin Faisal University College of Dentistry, Dammam, Eastern Province, 31441, Saudi Arabia Passent Ellakany Roles: Conceptualization, Methodology, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Yousif A. Al-Dulaijan Roles: Visualization, Writing – Review & Editing Nourhan M. Aly Roles: Data Curation, Formal Analysis, Writing – Original Draft Preparation, Writing – Review & Editing Turki Alshehri Roles: Methodology, Writing – Original Draft Preparation Shahad T. Alameer Roles: Methodology, Writing – Original Draft Preparation Sultan Akhtar Roles: Methodology, Software Laila Al Dehailan Roles: Visualization, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (3) version 3 Revised Published: 14 Aug 2025, 13:1310 https://doi.org/10.12688/f1000research.157128.3 version 2 Revised Published: 19 Jun 2025, 13:1310 https://doi.org/10.12688/f1000research.157128.2 version 1 Published: 31 Oct 2024, 13:1310 https://doi.org/10.12688/f1000research.157128.1 Copyright © 2024 Ellakany P et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Ellakany P, A. Al-Dulaijan Y, M. Aly N et al. Effect of thermocycling on flexural strength of dental CAD/CAM ceramics of variable thicknesses and structures: an in vitro study [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :1310 ( https://doi.org/10.12688/f1000research.157128.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 31 Oct 2024 Views 0 Cite How to cite this report: Zaniboni JF. Reviewer Report For: Effect of thermocycling on flexural strength of dental CAD/CAM ceramics of variable thicknesses and structures: an in vitro study [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :1310 ( https://doi.org/10.5256/f1000research.172537.r352365 ) The direct URL for this report is: https://f1000research.com/articles/13-1310/v1#referee-response-352365 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 27 Mar 2025 Joissi Ferrari Zaniboni , São Paulo State University, São Paulo, Brazil Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.172537.r352365 Dear Editor, Thank you for inviting me to review the article. Count on me for the next ones. The topic is relevant, especially because of the use of a material that has not been explored much ... Continue reading READ ALL Dear Editor, Thank you for inviting me to review the article. Count on me for the next ones. The topic is relevant, especially because of the use of a material that has not been explored much in the literature and also in clinical practice, such as Tessera. I think that what was missing in this study, to enrich it, is a comparison of the values ​​before and after thermocycling so that we can judge whether the aging process interferes with the material's performance or not. In addition, I suggest some changes: 1) Results in the Abstract: "The lowest flexural strength was observed in the 0.5 mm thickness group." Specify whether it was observed in all materials or in some specific materials. 2) In the Result section: "while had the lowest (mean (SD)= 82.80 (12.35)". Identify the LE group and correct the data. 3) Be careful to say that ZLS presented the best results, in relation to only the LE material, since there was no statistically significant difference in the others. 4) I don't see the need to present Table 2, since in Table 1 it is already possible to see that there is interaction between the factors and which groups have a significant difference or not. Therefore, I do not see the need for Figure 2. 5) In Figure 3, I suggest indicating with arrows where the pores are present. 6) Although, in the limitation of the study it was mentioned that they should evaluate the other translucency of the materials, I think that a limitation was also not evaluating the translucency in the different thicknesses of the current work. This could be additional data to add to the results of the work. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Ceramics, CAD-CAM, adhesion I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Zaniboni JF. Reviewer Report For: Effect of thermocycling on flexural strength of dental CAD/CAM ceramics of variable thicknesses and structures: an in vitro study [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :1310 ( https://doi.org/10.5256/f1000research.172537.r352365 ) The direct URL for this report is: https://f1000research.com/articles/13-1310/v1#referee-response-352365 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 10 Sep 2025 Passent Ellakany , Division of Prosthodontics, School of Dentistry, The University of Alabama at Birmingham, Birmingham, AL 35209, USA 10 Sep 2025 Author Response Response letter to reviewer We thank the editor and reviewer for their comments that are very important for improving our manuscript. We provide a point-by-point response here in addition to ... Continue reading Response letter to reviewer We thank the editor and reviewer for their comments that are very important for improving our manuscript. We provide a point-by-point response here in addition to using yellow highlight to mark modifications in the revised version of the manuscript “ Effect of Thermocycling on Flexural Strength of Dental CAD/CAM Ceramics of Variable Thicknesses and Structures: An in Vitro Study”. Reviewer comments: The topic is relevant, especially because of the use of a material that has not been explored much in literature and also in clinical practice, such as Tessera. I think that what was missing in this study, to enrich it, is a comparison of the values ​​before and after thermocycling so that we can judge whether the aging process interferes with the material's performance or not. Response: Thank you for this encouraging comment and will consider your valuable point in upcoming studies. In addition, I suggest some changes: Results in the Abstract: "The lowest flexural strength was observed in the 0.5 mm thickness group." Specify whether it was observed in all materials or in some specific materials. Response: Thank you for your comment. It was adjusted based on the recommendations. In the Result section: "while had the lowest (mean (SD)= 82.80 (12.35)". Identify the LE group and correct the data. Response: Thank you for your valuable comment. The data was adjusted. Be careful to say that ZLS presented the best results, in relation to only the LE material, since there was no statistically significant difference in the others. Response: Thank you for the constructive comment. The results were corrected. I don't see the need to present Table 2, since in Table 1 it is already possible to see that there is interaction between the factors and which groups have a significant difference or not. Therefore, I do not see the need for Figure 2. Response: We appreciate the reviewer’s comment. However, we believe Table 2 and Figure 2 are both important and complementary to Table 1 for the following reasons: Table 2 presents adjusted means, and 95% confidence intervals derived from the factorial ANOVA model. These adjusted values offer a more statistically robust interpretation by accounting for interactions and controlling for potential confounders, which are not directly visible in Table 1. Figure 2 provides a visual summary of the interaction between ceramic type and thickness on flexural strength, helping to communicate complex patterns in a more accessible and intuitive format. In Figure 3, I suggest indicating with arrows where the pores are present. Response: Thank you for the comment. Arrows were added. Although, in the limitation of the study it was mentioned that they should evaluate the other translucency of the materials, I think that a limitation was also not evaluating the translucency in the different thicknesses of the current work. This could be additional data to add to the results of the work. Response: Thank you for your comment. The limitation was modified. Response letter to reviewer We thank the editor and reviewer for their comments that are very important for improving our manuscript. We provide a point-by-point response here in addition to using yellow highlight to mark modifications in the revised version of the manuscript “ Effect of Thermocycling on Flexural Strength of Dental CAD/CAM Ceramics of Variable Thicknesses and Structures: An in Vitro Study”. Reviewer comments: The topic is relevant, especially because of the use of a material that has not been explored much in literature and also in clinical practice, such as Tessera. I think that what was missing in this study, to enrich it, is a comparison of the values ​​before and after thermocycling so that we can judge whether the aging process interferes with the material's performance or not. Response: Thank you for this encouraging comment and will consider your valuable point in upcoming studies. In addition, I suggest some changes: Results in the Abstract: "The lowest flexural strength was observed in the 0.5 mm thickness group." Specify whether it was observed in all materials or in some specific materials. Response: Thank you for your comment. It was adjusted based on the recommendations. In the Result section: "while had the lowest (mean (SD)= 82.80 (12.35)". Identify the LE group and correct the data. Response: Thank you for your valuable comment. The data was adjusted. Be careful to say that ZLS presented the best results, in relation to only the LE material, since there was no statistically significant difference in the others. Response: Thank you for the constructive comment. The results were corrected. I don't see the need to present Table 2, since in Table 1 it is already possible to see that there is interaction between the factors and which groups have a significant difference or not. Therefore, I do not see the need for Figure 2. Response: We appreciate the reviewer’s comment. However, we believe Table 2 and Figure 2 are both important and complementary to Table 1 for the following reasons: Table 2 presents adjusted means, and 95% confidence intervals derived from the factorial ANOVA model. These adjusted values offer a more statistically robust interpretation by accounting for interactions and controlling for potential confounders, which are not directly visible in Table 1. Figure 2 provides a visual summary of the interaction between ceramic type and thickness on flexural strength, helping to communicate complex patterns in a more accessible and intuitive format. In Figure 3, I suggest indicating with arrows where the pores are present. Response: Thank you for the comment. Arrows were added. Although, in the limitation of the study it was mentioned that they should evaluate the other translucency of the materials, I think that a limitation was also not evaluating the translucency in the different thicknesses of the current work. This could be additional data to add to the results of the work. Response: Thank you for your comment. The limitation was modified. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 10 Sep 2025 Passent Ellakany , Division of Prosthodontics, School of Dentistry, The University of Alabama at Birmingham, Birmingham, AL 35209, USA 10 Sep 2025 Author Response Response letter to reviewer We thank the editor and reviewer for their comments that are very important for improving our manuscript. We provide a point-by-point response here in addition to ... Continue reading Response letter to reviewer We thank the editor and reviewer for their comments that are very important for improving our manuscript. We provide a point-by-point response here in addition to using yellow highlight to mark modifications in the revised version of the manuscript “ Effect of Thermocycling on Flexural Strength of Dental CAD/CAM Ceramics of Variable Thicknesses and Structures: An in Vitro Study”. Reviewer comments: The topic is relevant, especially because of the use of a material that has not been explored much in literature and also in clinical practice, such as Tessera. I think that what was missing in this study, to enrich it, is a comparison of the values ​​before and after thermocycling so that we can judge whether the aging process interferes with the material's performance or not. Response: Thank you for this encouraging comment and will consider your valuable point in upcoming studies. In addition, I suggest some changes: Results in the Abstract: "The lowest flexural strength was observed in the 0.5 mm thickness group." Specify whether it was observed in all materials or in some specific materials. Response: Thank you for your comment. It was adjusted based on the recommendations. In the Result section: "while had the lowest (mean (SD)= 82.80 (12.35)". Identify the LE group and correct the data. Response: Thank you for your valuable comment. The data was adjusted. Be careful to say that ZLS presented the best results, in relation to only the LE material, since there was no statistically significant difference in the others. Response: Thank you for the constructive comment. The results were corrected. I don't see the need to present Table 2, since in Table 1 it is already possible to see that there is interaction between the factors and which groups have a significant difference or not. Therefore, I do not see the need for Figure 2. Response: We appreciate the reviewer’s comment. However, we believe Table 2 and Figure 2 are both important and complementary to Table 1 for the following reasons: Table 2 presents adjusted means, and 95% confidence intervals derived from the factorial ANOVA model. These adjusted values offer a more statistically robust interpretation by accounting for interactions and controlling for potential confounders, which are not directly visible in Table 1. Figure 2 provides a visual summary of the interaction between ceramic type and thickness on flexural strength, helping to communicate complex patterns in a more accessible and intuitive format. In Figure 3, I suggest indicating with arrows where the pores are present. Response: Thank you for the comment. Arrows were added. Although, in the limitation of the study it was mentioned that they should evaluate the other translucency of the materials, I think that a limitation was also not evaluating the translucency in the different thicknesses of the current work. This could be additional data to add to the results of the work. Response: Thank you for your comment. The limitation was modified. Response letter to reviewer We thank the editor and reviewer for their comments that are very important for improving our manuscript. We provide a point-by-point response here in addition to using yellow highlight to mark modifications in the revised version of the manuscript “ Effect of Thermocycling on Flexural Strength of Dental CAD/CAM Ceramics of Variable Thicknesses and Structures: An in Vitro Study”. Reviewer comments: The topic is relevant, especially because of the use of a material that has not been explored much in literature and also in clinical practice, such as Tessera. I think that what was missing in this study, to enrich it, is a comparison of the values ​​before and after thermocycling so that we can judge whether the aging process interferes with the material's performance or not. Response: Thank you for this encouraging comment and will consider your valuable point in upcoming studies. In addition, I suggest some changes: Results in the Abstract: "The lowest flexural strength was observed in the 0.5 mm thickness group." Specify whether it was observed in all materials or in some specific materials. Response: Thank you for your comment. It was adjusted based on the recommendations. In the Result section: "while had the lowest (mean (SD)= 82.80 (12.35)". Identify the LE group and correct the data. Response: Thank you for your valuable comment. The data was adjusted. Be careful to say that ZLS presented the best results, in relation to only the LE material, since there was no statistically significant difference in the others. Response: Thank you for the constructive comment. The results were corrected. I don't see the need to present Table 2, since in Table 1 it is already possible to see that there is interaction between the factors and which groups have a significant difference or not. Therefore, I do not see the need for Figure 2. Response: We appreciate the reviewer’s comment. However, we believe Table 2 and Figure 2 are both important and complementary to Table 1 for the following reasons: Table 2 presents adjusted means, and 95% confidence intervals derived from the factorial ANOVA model. These adjusted values offer a more statistically robust interpretation by accounting for interactions and controlling for potential confounders, which are not directly visible in Table 1. Figure 2 provides a visual summary of the interaction between ceramic type and thickness on flexural strength, helping to communicate complex patterns in a more accessible and intuitive format. In Figure 3, I suggest indicating with arrows where the pores are present. Response: Thank you for the comment. Arrows were added. Although, in the limitation of the study it was mentioned that they should evaluate the other translucency of the materials, I think that a limitation was also not evaluating the translucency in the different thicknesses of the current work. This could be additional data to add to the results of the work. Response: Thank you for your comment. The limitation was modified. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Altonbary G. Reviewer Report For: Effect of thermocycling on flexural strength of dental CAD/CAM ceramics of variable thicknesses and structures: an in vitro study [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :1310 ( https://doi.org/10.5256/f1000research.172537.r339059 ) The direct URL for this report is: https://f1000research.com/articles/13-1310/v1#referee-response-339059 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 10 Dec 2024 Gilan Altonbary , Department of Removable Prosthodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt Approved VIEWS 0 https://doi.org/10.5256/f1000research.172537.r339059 the authors are to be complimented for conducting this study. Its design is very good and materials and methods appropriate , in the introduction section the authors mentioned that research reporting the mechanical properties of ALD is ... Continue reading READ ALL the authors are to be complimented for conducting this study. Its design is very good and materials and methods appropriate , in the introduction section the authors mentioned that research reporting the mechanical properties of ALD is scarce however an invitro study by Freitas et al 2023 [Ref 1] investigated surface properties and fatigue mechanical behavior of advanced lithium disilicate (ALD), and compared it to a conventional lithium disilicate (LD) and to a translucent polycrystalline zirconia-based ceramic (4Y-PSZ) this study can also be included in the discussion section as it reported that (ALD) has lower roughness among the tested materials (lithium disilicate and yttrium-stabilized zirconia ceramics). Regarding flexural fatigue strength, ALD presented lower values and greater variability in mechanical performance (resulting in a lower structural reliability) when compared to the other materials in the conclusion section the authors stated that the increase in ceramic thickness significantly impacts the flexural strength according to the study results, however this was not fully addressed in the discussion; as the increase thickness of material from 0.5 to 1.5 mm lead to increase transformation toughness, Also, greater the thickness will decrease the bending force in ceramic material which explain increasing in flexural strength with higher thicknesses another limitation for this invitro study is the specimens shape and design( please mention in the methodology section), which do not mimic the geometry of crown-bridge restorations. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes References 1. Freitas JS, Souza LFB, Pereira GKR, May LG: Surface properties and flexural fatigue strength of an advanced lithium disilicate. J Mech Behav Biomed Mater . 2023; 147 : 106154 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: prosthodontics, CAD/CAM I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Altonbary G. Reviewer Report For: Effect of thermocycling on flexural strength of dental CAD/CAM ceramics of variable thicknesses and structures: an in vitro study [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :1310 ( https://doi.org/10.5256/f1000research.172537.r339059 ) The direct URL for this report is: https://f1000research.com/articles/13-1310/v1#referee-response-339059 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 31 Oct 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 4 Version 3 (revision) 14 Aug 25 read read read Version 2 (revision) 19 Jun 25 read read Version 1 31 Oct 24 read read Gilan Altonbary , Mansoura University, Mansoura, Egypt Joissi Ferrari Zaniboni , São Paulo State University, São Paulo, Brazil Amr Rizk , King Salman International University, El-Tur, Egypt Rania Moussa , Taibah University, Madinah, Saudi Arabia Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Altonbary G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 05 Sep 2025 | for Version 3 Gilan Altonbary , Department of Removable Prosthodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt 0 Views copyright © 2025 Altonbary G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I think that the authors have adequately addressed the comments made by the reviewers in the revised version of the manuscript. Therefore, I have no further comments. Competing Interests No competing interests were disclosed. Reviewer Expertise CAD/CAM , implant prosthodontics I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Altonbary G. Peer Review Report For: Effect of thermocycling on flexural strength of dental CAD/CAM ceramics of variable thicknesses and structures: an in vitro study [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :1310 ( https://doi.org/10.5256/f1000research.185985.r405529) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1310/v3#referee-response-405529 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Moussa R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 04 Sep 2025 | for Version 3 Rania Moussa , Department of Substitutive Dental Science, College of Dentistry, Taibah University, Madinah, Saudi Arabia 0 Views copyright © 2025 Moussa R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I would like to thank the authors for addressing the previous comments and making the necessary adjustments. The revisions have significantly improved the clarity and quality of the manuscript. I acknowledge the efforts made, and based on the current version, I recommend the paper for indexing. Competing Interests No competing interests were disclosed. Reviewer Expertise prosthodontic materials and dental implant restorations. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Moussa R. Peer Review Report For: Effect of thermocycling on flexural strength of dental CAD/CAM ceramics of variable thicknesses and structures: an in vitro study [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :1310 ( https://doi.org/10.5256/f1000research.185985.r405530) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1310/v3#referee-response-405530 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Rizk A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 25 Aug 2025 | for Version 3 Amr Rizk , Prosthetic Dentistry, King Salman International University, El-Tur, South Sinai, Egypt 0 Views copyright © 2025 Rizk A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I would like to thank the authors for enhancing the overall quality of the manuscript. Please put the following in consideration. The formula of lithium disilicate, the numbers should be in subscripts. It was mentioned “Post-polishing, the pre-crystallized specimens were placed in a furnace of ceramic to crystallize”. That is incorrect as ALD comes in a crystallized form, although it still requires firing for the development of Virgilite. Competing Interests No competing interests were disclosed. Reviewer Expertise Ceramics, color, translucency, marginal adaptation, internal fit, flexure strength, fracture resistance, dental materials and recent innovative restorations. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Rizk A. Peer Review Report For: Effect of thermocycling on flexural strength of dental CAD/CAM ceramics of variable thicknesses and structures: an in vitro study [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :1310 ( https://doi.org/10.5256/f1000research.185985.r405531) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1310/v3#referee-response-405531 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Moussa R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 04 Aug 2025 | for Version 2 Rania Moussa , Department of Substitutive Dental Science, College of Dentistry, Taibah University, Madinah, Saudi Arabia 0 Views copyright © 2025 Moussa R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear authors, Thank you for your efforts. The research addressed the impact of ceramic material composition in varying thicknesses on the flexural strength and elastic modulus. This study is well-designed and addresses a significant question in restorative dentistry. It provides valuable comparative data on the flexural strength of current CAD/CAM ceramics after simulated ageing. The introduction is clear and well written. The methodology is clear and provides sufficient details. Results are clearly presented. Tables and figures effectively summarise flexural strength, force at break, and Young’s modulus across groups and thicknesses. Statistical significance is clearly marked. However, Some parts in the results need adjustment: 1- 2nd paragraph in the results: "while LE had the lowest ( mean (SD) = 82.80 (12.35 )."this value is different from the data in table 1, please check and correct 2-paragraph 3 in the results: The 0.5mm thickness across all ceramic groups had the lowest f lexural strength, elastic modulu s, and forces to break; the arrangement of the mechanical test does not match the arrangement of the values for the materials reported: "highest values (mean (SD) = 309.08 (33.49), 416.56 (74.55) and 82.80 (12.35) ), please revise and correct either the textual part or the order of the values. 3- SEM results: the legends in the text are not matching the legends on Figure 3, e.g., 3a is not ZLS and so on for all the materials." ZLS showed a homogenous crystalline matrix ( Figure 3a ). At the same time, LD had needle-shaped fine-grained crystals within a glassy matrix ( Figure 3b ). LE and ALD images showed numerous pores with leucite crystals and lithium-aluminium silicate crystals incorporated in a glassy matrix, respectively ( Figure 3c and 3d). The discussion is well written, as it explains the results and compares them to the current literature; however, 1- The study does not attempt to correlate flexural strength values with clinical performance or failure rates, which would aid in translating findings to practice. Please discuss the clinical relevance and relate flexural strength thresholds to actual clinical failure rates or guidelines, enhancing the practical value of the findings. 2- 5000 thermocycles, corresponding to six months of clinical aging, is relatively a short period of functional use of a restoration, and this point should be highlighted in the limitations of the study Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise prosthodontic materials and dental implant restorations. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Moussa R. Peer Review Report For: Effect of thermocycling on flexural strength of dental CAD/CAM ceramics of variable thicknesses and structures: an in vitro study [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :1310 ( https://doi.org/10.5256/f1000research.183704.r395480) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1310/v2#referee-response-395480 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Rizk A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 28 Jul 2025 | for Version 2 Amr Rizk , Prosthetic Dentistry, King Salman International University, El-Tur, South Sinai, Egypt 0 Views copyright © 2025 Rizk A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This manuscript entitled “Effect of thermocycling on flexural strength of dental CAD/CAM ceramics of variable thicknesses and structures: an in vitro study" aims to compare mechanical properties of glass ceramics of varying composition and thickness. The topic is relevant and falls within the scope of the journal. Overall, the manuscript is well-written and excuted. However, several points require clarification as detailed below. Title: In the title it was mentioned thermocycling and again in the abstract it was mentioned that samples were subjected to thermomechanical cycling and again in the methodology in figure 1, it was mentioned thermocycling. Both are different please be concise and adjust accordingly. Introduction: It was mentioned that “Advanced lithium disilicate (ALD), a recent addition to the market”. Actually, it is not recent anymore being introduced over more than 3 years. Please adjust accordingly. “(Li2Si2O5)” this is incorrect formula for lithium disilicate. Please revise as numbers are subscript. Please tell the readers what is Virgilite formula. Materials and methods: In figure 1, add to each material n=30 and total 120 samples, add the number of thermomechanical/thermocycles and the magnification used for SEM. It was mentioned that “Post-polishing, the specimens were placed in a furnace of ceramic to crystallize.”. This is not correct as some of the materials are fully crystallized although still require firing. Were samples glazed and what is the reason for post firing polishing? Again what are the parameters for the mechanical cycling? You only mentioned the thermal part. “Flexuralstrength= 3FL/2bh2 is that formula correct”. Please add space between flexure and strength and write it using equation editor in MS word. Do the same in elastic modulus formula. Please add that measurements for L, b and h are in mm. Results: “Among the 1.5 mm thicknesses, ZLS had the highest Young’s modulus of elasticity (mean (SD) = 82.80 (12.35), while LE had the lowest (mean (SD) = 82.80 (12.35).” at the end of both presented numbers a “)” is missing to be consistent in all of the manuscript. In figure 3, there are no apparent red arrows as mentioned by the authors. Discussion: It was mentioned “The results of the flexural strength test of this study were compared to the readings of the biaxial flexural strength test described by Schweiger J et al.32 due to the lack of similar studies assessing the relation between varying ceramic thickness and the flexural strengths characteristic.” Please review this study as it assessed the biaxial flexure strength of ALD with a thickness of 0.5 and 1-mm. DOI: 10.1007/s00784-024-05746-8 Again, what did the authors adopt thermomechanical or thermocycling? If samples were not glazed, that might be considered a limitation, together with the lack of cementation. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes References 1. Rizk A, Abdou A, Ashraf R, Omar S: Effect of multiple firings on optical and mechanical properties of Virgilite-containing lithium disilicate glass-ceramic of varying thickness. Clinical Oral Investigations . 2024; 28 (7). Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Ceramics, color, translucency, marginal adaptation, internal fit, flexure strength, fracture resistance, dental materials and recent innovative restorations. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Rizk A. Peer Review Report For: Effect of thermocycling on flexural strength of dental CAD/CAM ceramics of variable thicknesses and structures: an in vitro study [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :1310 ( https://doi.org/10.5256/f1000research.183704.r393621) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1310/v2#referee-response-393621 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Zaniboni J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 27 Mar 2025 | for Version 1 Joissi Ferrari Zaniboni , São Paulo State University, São Paulo, Brazil 0 Views copyright © 2025 Zaniboni J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear Editor, Thank you for inviting me to review the article. Count on me for the next ones. The topic is relevant, especially because of the use of a material that has not been explored much in the literature and also in clinical practice, such as Tessera. I think that what was missing in this study, to enrich it, is a comparison of the values ​​before and after thermocycling so that we can judge whether the aging process interferes with the material's performance or not. In addition, I suggest some changes: 1) Results in the Abstract: "The lowest flexural strength was observed in the 0.5 mm thickness group." Specify whether it was observed in all materials or in some specific materials. 2) In the Result section: "while had the lowest (mean (SD)= 82.80 (12.35)". Identify the LE group and correct the data. 3) Be careful to say that ZLS presented the best results, in relation to only the LE material, since there was no statistically significant difference in the others. 4) I don't see the need to present Table 2, since in Table 1 it is already possible to see that there is interaction between the factors and which groups have a significant difference or not. Therefore, I do not see the need for Figure 2. 5) In Figure 3, I suggest indicating with arrows where the pores are present. 6) Although, in the limitation of the study it was mentioned that they should evaluate the other translucency of the materials, I think that a limitation was also not evaluating the translucency in the different thicknesses of the current work. This could be additional data to add to the results of the work. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Ceramics, CAD-CAM, adhesion I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (1) Author Response 10 Sep 2025 Passent Ellakany, Division of Prosthodontics, School of Dentistry, The University of Alabama at Birmingham, Birmingham, AL 35209, USA Response letter to reviewer We thank the editor and reviewer for their comments that are very important for improving our manuscript. We provide a point-by-point response here in addition to using yellow highlight to mark modifications in the revised version of the manuscript “ Effect of Thermocycling on Flexural Strength of Dental CAD/CAM Ceramics of Variable Thicknesses and Structures: An in Vitro Study”. Reviewer comments: The topic is relevant, especially because of the use of a material that has not been explored much in literature and also in clinical practice, such as Tessera. I think that what was missing in this study, to enrich it, is a comparison of the values ​​before and after thermocycling so that we can judge whether the aging process interferes with the material's performance or not. Response: Thank you for this encouraging comment and will consider your valuable point in upcoming studies. In addition, I suggest some changes: Results in the Abstract: "The lowest flexural strength was observed in the 0.5 mm thickness group." Specify whether it was observed in all materials or in some specific materials. Response: Thank you for your comment. It was adjusted based on the recommendations. In the Result section: "while had the lowest (mean (SD)= 82.80 (12.35)". Identify the LE group and correct the data. Response: Thank you for your valuable comment. The data was adjusted. Be careful to say that ZLS presented the best results, in relation to only the LE material, since there was no statistically significant difference in the others. Response: Thank you for the constructive comment. The results were corrected. I don't see the need to present Table 2, since in Table 1 it is already possible to see that there is interaction between the factors and which groups have a significant difference or not. Therefore, I do not see the need for Figure 2. Response: We appreciate the reviewer’s comment. However, we believe Table 2 and Figure 2 are both important and complementary to Table 1 for the following reasons: Table 2 presents adjusted means, and 95% confidence intervals derived from the factorial ANOVA model. These adjusted values offer a more statistically robust interpretation by accounting for interactions and controlling for potential confounders, which are not directly visible in Table 1. Figure 2 provides a visual summary of the interaction between ceramic type and thickness on flexural strength, helping to communicate complex patterns in a more accessible and intuitive format. In Figure 3, I suggest indicating with arrows where the pores are present. Response: Thank you for the comment. Arrows were added. Although, in the limitation of the study it was mentioned that they should evaluate the other translucency of the materials, I think that a limitation was also not evaluating the translucency in the different thicknesses of the current work. This could be additional data to add to the results of the work. Response: Thank you for your comment. The limitation was modified. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Zaniboni JF. Peer Review Report For: Effect of thermocycling on flexural strength of dental CAD/CAM ceramics of variable thicknesses and structures: an in vitro study [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :1310 ( https://doi.org/10.5256/f1000research.172537.r352365) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1310/v1#referee-response-352365 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Altonbary G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 10 Dec 2024 | for Version 1 Gilan Altonbary , Department of Removable Prosthodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt 0 Views copyright © 2024 Altonbary G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions the authors are to be complimented for conducting this study. Its design is very good and materials and methods appropriate , in the introduction section the authors mentioned that research reporting the mechanical properties of ALD is scarce however an invitro study by Freitas et al 2023 [Ref 1] investigated surface properties and fatigue mechanical behavior of advanced lithium disilicate (ALD), and compared it to a conventional lithium disilicate (LD) and to a translucent polycrystalline zirconia-based ceramic (4Y-PSZ) this study can also be included in the discussion section as it reported that (ALD) has lower roughness among the tested materials (lithium disilicate and yttrium-stabilized zirconia ceramics). Regarding flexural fatigue strength, ALD presented lower values and greater variability in mechanical performance (resulting in a lower structural reliability) when compared to the other materials in the conclusion section the authors stated that the increase in ceramic thickness significantly impacts the flexural strength according to the study results, however this was not fully addressed in the discussion; as the increase thickness of material from 0.5 to 1.5 mm lead to increase transformation toughness, Also, greater the thickness will decrease the bending force in ceramic material which explain increasing in flexural strength with higher thicknesses another limitation for this invitro study is the specimens shape and design( please mention in the methodology section), which do not mimic the geometry of crown-bridge restorations. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes References 1. Freitas JS, Souza LFB, Pereira GKR, May LG: Surface properties and flexural fatigue strength of an advanced lithium disilicate. J Mech Behav Biomed Mater . 2023; 147 : 106154 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise prosthodontics, CAD/CAM I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Altonbary G. Peer Review Report For: Effect of thermocycling on flexural strength of dental CAD/CAM ceramics of variable thicknesses and structures: an in vitro study [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :1310 ( https://doi.org/10.5256/f1000research.172537.r339059) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1310/v1#referee-response-339059 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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