Flexural strength of translucent zirconia for single crowns and fixed dental prostheses-A systematic review
Clinical Snapshot
PICO Framework
| P — Population | Commercially available translucent zirconia materials (4Y-PSZ and 5Y-PSZ) |
| I — Intervention | Various specimen preparations, surface treatments, and test methods |
| C — Comparator | Different yttria content materials and processing parameters |
| O — Outcomes | Flexural strength values (MPa) for dental prosthetic applications |
Bottom Line
This systematic review of 78 laboratory studies demonstrates that 4Y-PSZ translucent zirconia exhibits significantly higher flexural strength (803±233 MPa) compared to 5Y-PSZ materials (570±116 MPa). The evidence supports using 4Y-PSZ for three-unit fixed dental prostheses in any location, while 5Y-PSZ is suitable for three-unit prostheses in anterior regions based on ISO 6872 standards. However, significant heterogeneity in processing parameters and test methods limits direct comparisons between studies. Clinicians should consider these material properties when selecting zirconia for prosthetic applications, particularly for posterior multi-unit restorations where higher flexural strength is advantageous. The findings emphasize the need for standardized testing protocols to improve evidence quality and clinical decision-making in restorative dentistry.
Key Findings
P Value: P = 0.005 for yttria content comparison
Effect Size: 4Y-PSZ: 803±233 MPa vs 5Y-PSZ: 570±116 MPa
Primary Outcome: Flexural strength of translucent zirconia materials
Nnt Or Sensitivity: 233 MPa higher flexural strength for 4Y-PSZ materials
Confidence Interval: Not reported
Clinical Application
High feasibility - commercially available materials with established clinical protocols Relevant to Australian dental practice with TGA-approved zirconia materials and alignment with international ISO 6872 standards for dental ceramics Dental practitioners selecting zirconia materials for single crowns and fixed dental prostheses
Abstract
PURPOSE: The aim of this systematic review was to analyze the reported flexural strength values of commercially available translucent zirconia materials. Additionally, data were evaluated to assess the impact of different specimen preparations and test methods. STUDY SELECTION: This systematic review was conducted according to the PRISMA guidelines. Electronic searches were performed to identify in vitro studies published between January 1, 2013, and March 15, 2025, that reported flexural strength values of translucent zirconia and included the names of the tested materials and manufacturers. Flexural strength values were analyzed to assess the effects of yttria content, specimen processing, surface treatments, and test methods using Kruskal-Wallis analysis of variance (α = 0.05) and forest plots. RESULTS: A total of 78 laboratory studies met the inclusion criteria. The overall flexural strength values were significantly higher for 4Y-PSZ (803± 233 MPa) than for 5Y-PSZ materials (570 ± 116 MPa) (P = 0.005). Specimen processing, surface treatments, and test methods significantly affected the flexural strength values for 5Y-PSZ (P < 0.001) but not for 4Y-PSZ (P > 0.05). CONCLUSIONS: This systematic review highlights the challenges in comparing the flexural strength values of translucent zirconia owing to differences in processing parameters. Further standardization of test methods and adherence to ISO 6872 would improve comparability. Our findings support the clinical use of 4Y-PSZ for three-unit fixed dental prostheses (FDPs) and 5Y-PSZ for three-unit FDPs in the anterior region based on ISO 6872.
References
- 1.Bernauer, S. A., Lirgg, N. M., Ioannidis, A., Zitzmann, N. U., & Rohr, N. (2026). Flexural strength of translucent zirconia for single crowns and fixed dental prostheses-A systematic review. Journal of Prosthodontic Research. https://doi.org/10.2186/jpr.JPR_D_24_00277
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