1
|
Nezir M, Dinçtürk BA, Sarı C, Alp CK, Altınışık H. Effect of fiber-reinforced direct restorative materials on the fracture resistance of endodontically treated mandibular molars restored with a conservative endodontic cavity design. Clin Oral Investig 2024; 28:316. [PMID: 38750289 PMCID: PMC11096213 DOI: 10.1007/s00784-024-05720-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE This study aimed to evaluate the fracture strength of teeth restored using fiber-reinforced direct restorative materials after endodontic treatment with a conservative mesio-occlusal access cavity design. MATERIALS AND METHODS A total of 100 extracted intact mandibular first molars were selected and distributed into a positive control group where teeth left intact and the following four test groups comprised of teeth with conservative mesio-occlusal access cavities that had undergone root canal treatment (n = 20/group): access cavity without restoration (negative control), bulk-fill resin composite with horizontal glass fiber post reinforcement, fiber-reinforced composite with bulk-fill resin and bulk-fill resin composite. Following thermocycling (10,000 cycles), fracture resistance was measured using a universal testing machine. Statistical analyses (one-way analysis of variance and the Tamhane test) were performed, and statistical significance was set at p < 0.05. RESULTS Groups with minimally invasive access cavities had lower fracture strength than intact teeth, regardless of the restoration material (p < 0.05). Fiber-reinforced composite groups demonstrated higher fracture strength than bulk-fill resin composite alone (p < 0.05). Fracture types varied among groups, with restorable fractures predominant in the fiber-reinforced composite groups. CONCLUSION This study suggests that using fiber-reinforced composite materials, especially in combination with bulk-fill resin composites, can effectively enhance the fracture strength of endodontically treated teeth with conservative access cavities. However, using only bulk-fill resin composite is not recommended based on the fracture strength results. CLINICAL SIGNIFICANCE When teeth that undergo endodontic treatment are restored using a conservative access cavity design and fiber-reinforced composite materials, especially in combination with bulk-fill resin composites, the fracture strength of the teeth can be effectively increased.
Collapse
Affiliation(s)
- Merve Nezir
- Department of Restorative Dentistry, Faculty of Dentistry, Gazi University, Emek, Ankara, 06510, Turkey
| | - Beyza Arslandaş Dinçtürk
- Department of Restorative Dentistry, Faculty of Dentistry, Gazi University, Emek, Ankara, 06510, Turkey
| | - Ceyda Sarı
- Department of Restorative Dentistry, Faculty of Dentistry, İstanbul Medipol University, İstanbul, Turkey
| | - Cemile Kedici Alp
- Department of Restorative Dentistry, Faculty of Dentistry, Gazi University, Emek, Ankara, 06510, Turkey
| | - Hanife Altınışık
- Department of Restorative Dentistry, Faculty of Dentistry, Gazi University, Emek, Ankara, 06510, Turkey.
| |
Collapse
|
2
|
Hazar E, Hazar A. Effect of Long Glass Fiber Orientations or a Short-Fiber-Reinforced Composite on the Fracture Resistance of Endodontically Treated Premolars. Polymers (Basel) 2024; 16:1289. [PMID: 38732757 PMCID: PMC11085497 DOI: 10.3390/polym16091289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
This study aimed to evaluate the effect of direct restorations using unidirectional glass fiber orientations and a short-fiber-reinforced composite (SFRC) on the fracture resistance of endodontically treated premolars with mesio-occluso-distal cavities. Ninety double-rooted premolars were selected. Fifteen teeth were left intact/as a control group. The endodontic treatment and cavity preparations of seventy-five teeth were performed and divided into five experimental groups: Resin composite (RC), modified transfixed technique + RC, circumferential technique + RC, cavity floor technique + RC, and SFRC + RC. All teeth were fractured under oblique static loading at a 30° angle using a universal testing machine. The fracture patterns were observed and classified. Data were analyzed with one-way analysis of variance, Pearson chi-square, and Tukey HSD post hoc tests (p = 0.05). The highest fracture strength values were obtained in intact teeth (599.336 N), followed by modified transfixed + RC treated teeth (496.58 N), SFRC + RC treated teeth (469.62 N), RC (443.51 N), circumferential + RC treated teeth (442.835 N), and cavity floor + RC treated teeth (404.623 N) (p < 0.05). There was no significant difference between the RC and the circumferential technique + RC (p > 0.05). Unrepairable fractures were observed at low rates (20%) in the modified transfixed + RC and SFRC + RC teeth, and at higher rates in RC (73.3%), cavity floor + RC (60%), and circumferential + RC (80%) teeth. The application of an SFRC or the modified transfixed technique yielded an improved fracture strength and the fracture pattern of ETPs being restored with a universal injectable composite.
Collapse
Affiliation(s)
- Ecehan Hazar
- Department of Endodontics, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak 67600, Turkey
| | - Ahmet Hazar
- Department of Restorative Dentistry, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak 67600, Turkey;
| |
Collapse
|
3
|
Samran A, Hashem AW, Ali S, Al-Akhali M, Wille S, Kern M. Influence of post material and ferrule thickness on the fracture resistance of endodontically treated premolars: A laboratory study. J Prosthet Dent 2024:S0022-3913(24)00055-6. [PMID: 38402134 DOI: 10.1016/j.prosdent.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/26/2024]
Abstract
STATEMENT OF PROBLEM The influence of the ferrule thickness and post materials on the fracture resistance of endodontically treated teeth remains unclear. PURPOSE The purpose of this laboratory study was to evaluate the influence of post material and ferrule thickness on the fracture resistance of endodontically treated mandibular premolars. MATERIAL AND METHODS Sixty-four extracted and endodontically treated mandibular first premolars were used and divided into 4 test groups (n=16) depending on the ferrule thickness: F-0: without a ferrule, F-0.5: with a 0.5-mm ferrule thickness, F-1: with a 1-mm ferrule thickness, and F-1.5: with a 1.5-mm ferrule thickness. In groups with ferrules, the height ranged from 2 mm buccally/lingually to 1 mm proximally. Teeth in subgroups (n=8) were restored with either prefabricated glass fiber (FF) or titanium posts (FT) (ISO size 70 and length of 7.5 mm) and then adhesively restored with composite resin foundation materials. After foundation procedures, each specimen was restored with a cobalt chromium crown which was cemented with glass-ionomer cement. All specimens were subjected to dynamic loading in a masticatory simulator for 1 200 000 loading cycles with a nominal load of 5 Kg at 1.2 Hz and simultaneous thermocycling (5 to 55 °C). Specimens were then quasistatically loaded at 30 degrees in a universal testing machine until fracture. Fracture loads were analyzed by using 2-way ANOVA followed by the Tukey honestly significant difference test (α=.05). RESULTS Fracture loads ranged from 610 ±45 N (no ferrule - glass fiber post) to 1216 ±169 N (1.5 mm ferrule thickness - glass fiber post). A statistically significant increase in fracture resistance was observed with increasing ferrule thickness (P<.001). However, post materials did not show a statistically significant influence (P=.977). CONCLUSIONS Under the conditions of this laboratory study, increasing the ferrule thickness had a significant effect on the fracture resistance of endodontically treated teeth after thermomechanical fatigue, irrespective of post materials.
Collapse
Affiliation(s)
- Abdulaziz Samran
- Visiting Associate Professor, Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University, Kiel, Germany; Associate Professor, Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, Saudi Arabia; and Associate Professor, Department of Prosthodontics, College of Dentistry, Ibb University, Ibb, Yemen.
| | - Ahmed Wagdy Hashem
- Visiting Assistant Professor, Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University, Kiel, Germany; and Lecturer, Faculty of Dentistry, October University for Modern Sciences and Arts, Cairo, Egypt
| | - Shurouk Ali
- Assistant Professor, Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University, Kiel, Germany
| | - Majed Al-Akhali
- Visiting Assistant Professor, Department of Prosthodontics, Propaedeutics and Dental Materials, Dental School, Christian-Albrechts University, Kiel, Germany; and Assistant Professor, Department of Prosthodontics, College of Dentistry, Ibb University, Ibb, Yemen
| | - Sebastian Wille
- Research Associate, Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University, Kiel, Germany
| | - Matthias Kern
- Professor and Chairman, Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University, Kiel, Germany
| |
Collapse
|
4
|
Abdulrab S, Geerts G, Thiagarajan G. Fracture resistance and failure pattern of endodontically treated maxillary premolars restored with transfixed glass fiber post: an in vitro and finite element analysis. Comput Methods Biomech Biomed Engin 2024; 27:419-430. [PMID: 37655537 DOI: 10.1080/10255842.2023.2252954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/10/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
The aims of the study were to determine the effect of different types of endodontic sealers and the presence of a horizontal glass fiber post (HGFP) on the fracture resistance and fracture pattern of mesio-occluso-distal (MOD) restored upper premolars and to analyze the stress distribution. Sixty extracted upper premolars received root canal treatment (RCT) and a MOD cavity preparation. All MOD cavities were restored with the same composite resin (CR). The 60 teeth were divided randomly into 6 groups (n = 10); Group1= AH Plus sealer; Group 2= TotalFill BC sealer; Group 3= BioRoot RCS sealer; Group 4= AH plus sealer + HGFP; Group 5= TotalFill BC sealer + HGFP; and, Group 6= Bio Root RCS sealer + HGFP. All specimens were thermocycled and subjected to cyclic loading. Next, the specimens were subjected to a static load using a universal testing machine. Data were analyzed using two-way ANOVA. Two micro-CTs of the same upper premolar, one without the HGFP and later one with HGFP inserted were made and used to create two finite element (FE) models. For the fracture resistance, two-way ANOVA revealed significant differences for the effect of HGFP (p = 0.029), but no differences for the effect of root canal sealer type (p = 0.561). The HGFP groups showed higher restorable fracture compared to groups without HGFP (p = 0.013). Finite element analysis showed that the inclusion of HGFP reduces stress concentration at the occlusal interface and cervical region. Therefore, it can be concluded that HGFP significantly increased the fracture resistance of endodontically treated upper premolars with MOD cavities and reduced the risk for non-restorable fractures. The FE analysis supports the mechanical test results.
Collapse
Affiliation(s)
- Saleem Abdulrab
- Alkhor health centre, Primary health care corporation, Doha, Qatar
- Department of Restorative Dentistry, Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa
| | - Greta Geerts
- Department of Restorative Dentistry, Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa
| | - Ganesh Thiagarajan
- Civil and Mechanical Engineering Department of the University of Missouri, KS City, KS, USA
| |
Collapse
|
5
|
Naik A, de Ataide IDN, Fernandes M. Fracture Resistance of Endodontically Treated Premolars Using Nanohybrid Composite, Fiber-Reinforced Composite, Horizontal Glass Fiber Posts, and Ceramic Inlays: An In Vitro Study. J Endod 2023; 49:1739-1746. [PMID: 37595683 DOI: 10.1016/j.joen.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION This study evaluated the resistance to fracture of endodontically treated premolars (ETPs) with mesio-occluso-distal (MOD) cavities filled with nanohybrid composite (NHC), fiber-reinforced composite (FRC), horizontal glass fiber posts (HFP), and ceramic inlays (CI). METHODS Eighty-four intact maxillary premolars were taken, and endodontic treatment was performed followed by MOD cavity preparations (except in the control group). They were distributed into 7 groups based on type of restoration: intact teeth (control group), ETP + MOD (not restored), NHC, FRC + NHC, HFP + NHC, FRC + HFP + NHC, and CI groups. Samples were subjected to universal testing machine until the fracture occurred and failure mode was visually inspected. RESULTS Mean and standard deviation of fracture resistance of the 7 groups ranged from 265.6 ± 68.0 N to 1023.7 ± 76.5 N. The highest reading was noted for intact teeth followed by FRC + HFP + NHC group and then the CI group, with no significant difference among the 3 groups. The lowest reading was noted for the ETP + MOD group. Maximum unrepairable fractures were seen in the ETP + MOD and CI groups. CONCLUSION FRC + HFP + NHC combination and CIs increased the resistance to fracture of ETPs significantly.
Collapse
Affiliation(s)
- Asmita Naik
- Department of Conservative Dentistry and Endodontics, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Ida de Noronha de Ataide
- Department of Conservative Dentistry and Endodontics, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Marina Fernandes
- Department of Conservative Dentistry and Endodontics, Goa Dental College and Hospital, Bambolim, Goa, India.
| |
Collapse
|
6
|
Escobar LB, Pereira da Silva L, Manarte-Monteiro P. Fracture Resistance of Fiber-Reinforced Composite Restorations: A Systematic Review and Meta-Analysis. Polymers (Basel) 2023; 15:3802. [PMID: 37765654 PMCID: PMC10537351 DOI: 10.3390/polym15183802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Composite resin is universally used for posterior teeth restorations. Fibers have been suggested for the mechanical improvement of the restorations. This study assessed the fracture resistance of class II fiber-reinforced composite restorations and compared it with the fracture resistance of three control groups: (1) healthy teeth, (2) non-fiber-reinforced restorations and (3) unrestored cavities. A search was performed using PubMed, Web of Science and Google Scholar from 15 May to 12 June 2023. Only in vitro studies from the last 10 years were included for this systematic analysis. This study was registered in the PROSPERO database, it followed PRISMA guidelines and the risk of bias was assessed using the QUIN tool. Fracture resistance median values, in Newtons (N), were calculated for the experimental and control groups (95% confidence interval). For pairwise comparison, nonparametric tests (p < 0.05) were applied. Twenty-four in vitro studies met the inclusion criteria. The fracture resistance of the experimental group was 976.0 N and differed (p < 0.05) from all controls. The experimental group showed lower values of fracture resistance than healthy teeth (1459.9 N; p = 0.048) but higher values than non-fiber-reinforced restorations (771.0 N; p = 0.008) and unrestored cavities (386.6 N; p < 0.001). In vitro systematic outcomes evidenced that glass and/or polyethylene fibers improved the fracture resistance of composite restorations.
Collapse
Affiliation(s)
| | - Lígia Pereira da Silva
- FP-I3ID, Faculty of Health Sciences, University Fernando Pessoa, 4200-150 Porto, Portugal; (L.B.E.); (P.M.-M.)
| | | |
Collapse
|
7
|
Fatigue performance of endodontically treated molars reinforced with different fiber systems. Clin Oral Investig 2023:10.1007/s00784-023-04934-2. [PMID: 36862198 DOI: 10.1007/s00784-023-04934-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE The aim was to investigate the fatigue performance of root canal-treated (RCT) molars restored with different direct restorations utilizing discontinuous and continuous fiber-reinforced composite (FRC) systems. The impact of direct cuspal coverage was also evaluated. MATERIALS AND METHODS One hundred and twenty intact third molars extracted for periodontal or orthodontic reasons were randomly divided into six groups (n=20). Standardized MOD, regular cavities for direct restorations were prepared in all specimens, and subsequently, root canal treatment and root canal obturation was carried out. After the endodontic treatment, the cavities were restored with different fiber-reinforced direct restorations as follows: SFC group (control), discontinuous short fiber-reinforced composite (SFC) without cuspal coverage (CC); SFC+CC group, SFC with cuspal coverage; PFRC group, transcoronal fixation with continuous polyethylene fibers without CC; PFRC+CC group, transcoronal fixation with continuous polyethylene fibers with CC; GFRC group, continuous glass FRC post without CC; and GFRC+CC, continuous glass FRC post with CC. All specimens underwent a fatigue survival test in a cyclic loading machine until fracture occurred or 40,000 cycles were completed. The Kaplan-Meier survival analysis was conducted, followed by pairwise log-rank post hoc comparisons between the individual groups (Mantel-Cox). RESULTS The PFRC+CC group was characterized by significantly higher survival compared to all the groups (p < 0.05), except for the control group (p = 0.317). In contrast, the GFRC group showed significantly lower survival compared to all the groups (p < 0.05), except for the SFC+CC group (p = 0.118). The control group (SFC) showed statistically higher survival than the SFRC+CC group (p < 0.05) and GFRC group (p < 0.05), but it did not differ significantly from the rest of the groups in terms of survival. CONCLUSIONS Direct restorations utilizing continuous FRC systems (in the form of polyethylene fibers or FRC post) to restore RCT molar MOD cavities performed better in terms of fatigue resistance when CC was performed compared to the same FRC restorations without CC. On the contrary, teeth restored with SFC restorations performed better without CC compared to the ones where SFC was covered. CLINICAL RELEVANCE In the case of fiber-reinforced direct restorations for MOD cavities in RCT molars, direct CC is recommended when utilizing long continuous fibers for reinforcement, however, should be avoided when only SFC is used for their reinforcement.
Collapse
|
8
|
Abdulrab S, Geerts G, Al-Maweri SA, Alhajj MN, Alhadainy H, Ba-Hattab R. The influence of horizontal glass fiber posts on fracture strength and fracture pattern of endodontically treated teeth: A systematic review and meta-analysis of in vitro studies. J Prosthodont 2023. [PMID: 36705005 DOI: 10.1111/jopr.13654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/31/2022] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
PURPOSE This systematic review and meta-analysis aimed to summarize available evidence regarding the effect of horizontal glass fiber posts (HGFPs) on fracture strength and fracture pattern of endodontically treated teeth (ETT) compared to controls without HGFP. The review protocol was registered on the OSF registries. METHODS Literature searches were conducted in MEDLINE/PubMed, Scopus, Web of Science, Embase, Google Scholar, and ProQuest for all relevant studies published up to February 2022. All in vitro studies that assessed the influence of HGFPs on fracture strength and fracture pattern of ETT whether mesio-occluso-distal or mesio-occlusal or DO cavities were considered eligible. Review Manager (RevMan) was used for the meta-analysis. Subgroup and funnel plot analyses were also performed. Quality assessment was conducted by two independent reviewers. RESULTS A total of 12 articles met the inclusion criteria, and 10 studies underwent quantitative evaluation. The pooled effect showed that fracture resistance of molar teeth restored with HGFP was significantly higher than teeth without HGFP (standardized mean difference [SMD]: 1.61, 95% confidence interval [CI]: 0.14, 3.09, p = 0.03), whereas marginally significant for premolars (SMD: 1.36, 95% CI: -0.00, 2.73, p = 0.05). Regarding fracture patterns, the presence of an HGFP significantly increased the occurrence of restorable fracture patterns for premolars (odds ratios [OR]: 4.15, 95% CI: 1.60, 10.82, p = 0.004) compared to controls, whereas the difference was not significant for molars (OR: 1.09, 95% CI: 0.43, 2.77, p = 0.85). Moderate risk of bias was identified in 9/12 studies; one study showed a high risk of bias and two studies showed a low risk of bias. CONCLUSIONS Within the limitations of this study, there is evidence from in vitro studies that the use of HGFP increases the fracture resistance of the ETT when compared to teeth without HGFP and also reduces the occurrence of non-restorable fractures for premolars. However, well-conducted in vitro and prospective clinical studies are warranted to validate this finding.
Collapse
Affiliation(s)
- Saleem Abdulrab
- Al Khor Health Center, Primary Health Care Corporation, Doha, Qatar.,Department of Restorative Dentistry, Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa
| | - Greta Geerts
- Department of Restorative Dentistry, Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa
| | - Sadeq Ali Al-Maweri
- Department of Pre-Clinical Oral Health Sciences, College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Hatem Alhadainy
- Department of Endodontics, School of Dentistry, University of North Carolina, Charlotte, North Carolina, USA
| | - Raidan Ba-Hattab
- Department of Pre-Clinical Oral Health Sciences, College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| |
Collapse
|
9
|
Shi R, Meng X, Feng R, Hong S, Hu C, Yang M, Jiang Y. Stress Distribution and Fracture Resistance of repairing Cracked Tooth with Fiber-reinforced Composites and Onlay. AUST ENDOD J 2022; 48:458-464. [PMID: 34708907 DOI: 10.1111/aej.12578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/04/2021] [Accepted: 09/26/2021] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to explore the effects of fibre-reinforced composites and onlay restorations on the fracture resistance of the cracked teeth. The experiments were grouped as follows: intact teeth, cracked teeth, crown; onlay; annular ribbond + onlay, laminated ribbond + onlay and fibre post + onlay; annular ribbond + crown, laminated ribbond + crown and fibre post + crown. The maximal Von Mises stress of dentin, the maximal Von Mises stress at the crack, the fracture resistance and fracture pattern under static loading were analysed by single-factor analysis of variance (ANOVA) and post-test by LSD. The annular ribbond + crown had a significant difference in fracture resistance than the crown (P < 0.05). The annular ribbond + onlay had more favourable fractures than crown in fracture pattern, and there were significant differences (P < 0.05). Compared with crown restoration, fibre-reinforced composites and onlay can improve the fracture resistance of the cracked teeth.
Collapse
Affiliation(s)
- Rui Shi
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Xi'an Jiaotong University, Xi'an, China.,Department of Endodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Xingwang Meng
- Department of Mechatronic Engineering, College of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Rui Feng
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Xi'an Jiaotong University, Xi'an, China.,Department of Endodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Shanshan Hong
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Xi'an Jiaotong University, Xi'an, China
| | - Chen Hu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Xi'an Jiaotong University, Xi'an, China.,Department of Endodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Min Yang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Xi'an Jiaotong University, Xi'an, China
| | - Yuegui Jiang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Xi'an Jiaotong University, Xi'an, China.,Department of Endodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
10
|
Jakab A, Volom A, Sáry T, Vincze-Bandi E, Braunitzer G, Alleman D, Garoushi S, Fráter M. Mechanical Performance of Direct Restorative Techniques Utilizing Long Fibers for “Horizontal Splinting” to Reinforce Deep MOD Cavities—An Updated Literature Review. Polymers (Basel) 2022; 14:polym14071438. [PMID: 35406311 PMCID: PMC9002665 DOI: 10.3390/polym14071438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 02/04/2023] Open
Abstract
Excessive cavity preparation and root canal treatment leads to a weakened tooth structure with a lower resistance to fracture. Fiber reinforcement is frequently used to reinforce such teeth, and multiple fiber types and possible applications exist. Various methods for utilizing long fibers to internally splint the remaining cavity walls in the case of large mesio-occluso-distal (MOD) cavities have been proposed; however, no summary of their performance has been written up to now. Our study aims to review the available literature to evaluate and compare the mechanical performance of the different materials and methods utilized for horizontal splinting in large MOD cavities. Three independent authors performed a thorough literature search using PubMed, ScienceDirect, and Google Scholar up until January 2022. The authors selected in vitro studies that used long fibers placed horizontally in posterior teeth with large MOD cavities to reinforce these teeth. From 1683 potentially relevant articles, 11 publications met our inclusion criteria. Seven out of eleven studies showed that horizontal splinting with long fibers improved the fracture resistance of the restored teeth. Three articles showed no significant difference between the fracture resistance of the restored groups. Only one article reported a lower fracture resistance to the horizontally splinted group, compared to conventional direct composite restoration. Within the limitations of this review, evidence suggests that long fiber reinforcement could be used to improve the fracture resistance of heavily restored teeth.
Collapse
Affiliation(s)
- András Jakab
- Department of Operative and Esthetic Dentistry, Faculty of Dentistry, University of Szeged, H-6720 Szeged, Hungary; (A.J.); (T.S.); (E.V.-B.)
| | | | - Tekla Sáry
- Department of Operative and Esthetic Dentistry, Faculty of Dentistry, University of Szeged, H-6720 Szeged, Hungary; (A.J.); (T.S.); (E.V.-B.)
| | - Eszter Vincze-Bandi
- Department of Operative and Esthetic Dentistry, Faculty of Dentistry, University of Szeged, H-6720 Szeged, Hungary; (A.J.); (T.S.); (E.V.-B.)
| | | | - David Alleman
- The Alleman Center for Biomimetic Dentistry, South Jordan, UT 84095, USA;
| | - Sufyan Garoushi
- Department of Biomaterials Science and Turku Clinical Biomaterials Center-TCBC, Institute of Dentistry, University of Turku, FI-20520 Turku, Finland;
| | - Márk Fráter
- Department of Operative and Esthetic Dentistry, Faculty of Dentistry, University of Szeged, H-6720 Szeged, Hungary; (A.J.); (T.S.); (E.V.-B.)
- Correspondence:
| |
Collapse
|
11
|
Chhabra N, Desai K, Singbal KP. Comparative evaluation of fracture resistance of endodontically treated maxillary premolars reinforced by customized glass fiber post in two different ways: An in vitro study. J Conserv Dent 2022; 25:555-560. [PMID: 36506618 PMCID: PMC9733547 DOI: 10.4103/jcd.jcd_270_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 12/15/2022] Open
Abstract
Context Endodontically treated premolars are currently restored with direct bonded techniques in conservative manner enabling them to bear functional stresses homogeneously. Aim The study aimed to evaluate the effect of placement of compactable glass fibers in reinforcing the endodontically treated teeth in a novel conservative manner. Settings and Design Research laboratory, in vitro study. Materials and Methods Seventy-five extracted maxillary premolars were procured. Fifteen teeth were left untreated (Group A) and the remaining teeth were endodontically treated followed by standardized mesio-occluso-distal preparation and randomly assigned to experimental groups (n = 15) as follows: (B) no restoration, (C) restoration with composite, (D) EverStick® POST followed by composite, and (E) vertical glass fibers within 3 mm of the coronal root canal space and buccopalatal flaring of the coronal fibers followed by composite. After conditioning and thermocycling, specimens were loaded under a universal testing machine to evaluate fracture resistance and fracture pattern of specimens. Statistical Analysis Used Obtained scores were statistically analyzed using one-way analysis of variance test for stress analysis, post hoc Tukey's test for intergroup comparison, and Chi-square test for analysis of favorable and unfavorable fracture. Results The fracture resistance was highest to lowest as follows: Group A > E > C > D > B (P < 0.001). Conclusion EverStick®POST used in conservative manner improved fracture strength of teeth significantly.
Collapse
Affiliation(s)
- Naveen Chhabra
- Restorative Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia,Address for correspondence: Dr. Naveen Chhabra, Restorative Dentistry Division, School of Dentistry, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia. E-mail:
| | - Krupa Desai
- Consultant Endodontist, Thane, Mumbai, India
| | - Kiran Prabhakar Singbal
- Department of Restorative Dentistry, Faculty of Dentistry, Malaysian Allied Health Sciences Academy University, Selangor, Malaysia
| |
Collapse
|
12
|
Influence of Methodological Variables on Fracture Strength Tests Results of Premolars with Different Number of Residual Walls. A Systematic Review with Meta-Analysis. Dent J (Basel) 2021; 9:dj9120146. [PMID: 34940043 PMCID: PMC8699883 DOI: 10.3390/dj9120146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/13/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the current meta-analysis was to assess the impact of methodological variables in performing fracture strength tests of upper premolars. Medline (Pubmed), Embase and Google Scholar were screened for studies performing ex vivo fracture strength tests of intact upper premolars or premolars with 0, 1 or 2 walls lost. The outcome variable for each study was the maximum breaking load expressed in Newton (kg × m/s2). Methodological variables (i.e., simulation of the periodontal ligament, load inclination, tip position, tip diameter and thermocycling) were registered to perform subgroup analyses and meta-regression. Overall, 25 studies and 78 study groups were included in the meta-analysis. Intact premolars (17 study groups) were not significantly influenced by any of the methodological variables considered. Subgroup analysis for load inclination (30°/45° vs. 90°/150°) was significant for premolars with 0 (10 study groups), 1 (6 study groups) and 2 (45 study groups) walls lost; thermocycling was significant for premolars with 1 and 2 walls lost. A strong methodological heterogeneity across studies evaluating the fracture strength of upper premolars was highlighted, especially when 0, 1 or 2 walls were lost. Further studies are needed to standardize the methodology used in order to allow for across-studies comparisons.
Collapse
|
13
|
Yanık D, Turker N. Stress distribution of a novel bundle fiber post with curved roots and oval canals. J ESTHET RESTOR DENT 2021; 34:550-556. [PMID: 34766692 DOI: 10.1111/jerd.12835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to compare the stress distribution of teeth with curved and straight roots with oval and round canals restored with the bundle and conventional post systems. MATERIAL AND METHODS Six three-dimensional premolars were modeled with round and oval canals, and curved roots using the software. The bundle post and the round posts were modeled. All post models were placed on the canals. The models were subjected to 200 N oblique loading. The results were evaluated by von Mises stresses. RESULTS This study demonstrated that the bundle post showed higher stress values compared to the conventional post. The stresses in the oval canal were higher than those in the round canal. The highest stress values were found in the curved roots. The stress distribution on the curved roots was observed in the middle and apical third of the canal. CONCLUSION The bundle post presented higher stress compared to conventional posts. Besides, a more uniform stress distribution was observed in the bundle groups. CLINICAL SIGNIFICANCE When a post was required in extremely irregular, wide canals and curved roots, the bundle post was the material of choice. Canal and root morphology influenced stress distribution.
Collapse
Affiliation(s)
- Deniz Yanık
- Faculty of Dentistry, Department of Endodontics, Antalya Bilim University, Antalya, Turkey
| | - Nurullah Turker
- Faculty of Dentistry, Department of Prosthodontics, Akdeniz University, Antalya, Turkey
| |
Collapse
|
14
|
Yamakami SA, Gallas JA, Petean IBF, Souza-Gabriel AE, Sousa-Neto M, Macedo AP, Palma-Dibb RG. Impact of Endodontic Kinematics on Stress Distribution During Root Canal Treatment: Analysis of Photoelastic Stress. J Endod 2021; 48:255-262. [PMID: 34699903 DOI: 10.1016/j.joen.2021.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Structural defects created by endodontic treatment are the most common cause of major dental failures. This study analyzed levels of stress produced by endodontic instruments during the root canal treatment by photoelastic analysis of stress. METHODS Twenty-four human premolars were randomly divided into 4 groups (n = 6) according to instrumentation protocol: ProTaper Next (GPT), One Shape (GOS), Wave One Gold (GWO), and TF Adaptive (GTF). The evaluation of the photoelastic model was performed at 4 dental zones: dental-crown region, cervical third of root, middle third of root, and apical third of root. Silicone molds were prepared (2 × 15 mm), and pinjets were used inside the root canals to fixate teeth. Photoelastic resin (2:1 ratio) was poured into the silicone molds to form photoelastic models. A transmission polariscope was used to analyze the positions of interest and recorded with a digital camera. Tardy's method was used to quantify the fringe order (n) and calculate the maximum stress value (τ) at each selected point. Data were analyzed with two-way analysis of variance, Tukey test (P < .05), fringe descriptive analysis. RESULTS All groups showed a significant increase in the level of stress created during biomechanical preparation of the root canals. In the quantitative analysis, there was no statistically significant difference among the groups (P > .05). In the qualitative analysis, GPT and GTF instruments achieved greater levels of stresses compared with GWO and GOS instruments. At the beginning of instrumentation, stresses were concentrated at the coronary level and the end of instrumentation at the middle and apical root level. CONCLUSIONS All endodontic systems resulted in accumulation of stress along the dental structure. Stress was found in different concentrations along the tooth and at different levels.
Collapse
Affiliation(s)
- Shelyn Akari Yamakami
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Julia Adornes Gallas
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Igor Bassi Ferreira Petean
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Aline Evangelista Souza-Gabriel
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Manoel Sousa-Neto
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ana Paula Macedo
- Department of Dental Materials and Prosthesis, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Regina Guenka Palma-Dibb
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, SP, Brazil.
| |
Collapse
|
15
|
Cetin MS, Simsek N. Evaluation of fracture strength of different restoration techniques applied to C-shaped 3D model teeth. Odontology 2021; 110:262-268. [PMID: 34495439 DOI: 10.1007/s10266-021-00655-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
The aim of this study is to investigate the effect of different restoration methods applied to model teeth with a C-shaped root canal configuration on fracture strength. A total of 76 artificial tooth models were made using images of a molar tooth with a C-shaped root canal anatomy. The teeth were randomly divided into seven groups and different restorations, such as resin composite (2), bundled fiber post and resin composite (3), vertical fiber post and resin composite (4), horizontal fiber post and resin composite (5), woven fiber post and resin composite (6) and composite endocrown (7) were applied to the different groups except control group (1). The artificial teeth were embedded in acrylic blocks and subjected to fracture tests. The data were analyzed using one-way analysis of variance, Monte Carlo Pearson Chi-square, Pearson Chi-square, and Fisher's exact test (P < 0.05). All groups differed in terms of fracture strength (P = 0.001). The highest fracture strength observed in group 6, and there was a significant difference between group 6 and group 4 based on a least significant difference pairwise comparison test. In terms of fracture type, the highest reparability percentage (100%) observed in group 7. The fracture strength values of endocrown restorations and woven fiber-reinforced resin composite restorations were found to be as high as those of the intact models. Considering also fracture restorability, endocrown restorations may be recommended for teeth with C-shaped root canal anatomy. The usage of the 3D tooth models in the studies offer a valuable opportunity in terms of the standardization of the samples, particularly in teeth with anatomical variations. This study shows that using of this technology, homogeneous groups can be created and experimental studies can be improved.
Collapse
Affiliation(s)
- Melis Sila Cetin
- Department of Endodontics, Faculty of Dentistry, Inonu University, 44280, Malatya, Turkey
| | - Neslihan Simsek
- Department of Endodontics, Faculty of Dentistry, Inonu University, 44280, Malatya, Turkey.
| |
Collapse
|
16
|
Stress Concentration of Endodontically Treated Molars Restored with Transfixed Glass Fiber Post: 3D-Finite Element Analysis. MATERIALS 2021; 14:ma14154249. [PMID: 34361443 PMCID: PMC8347937 DOI: 10.3390/ma14154249] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 01/08/2023]
Abstract
The loss of dental structure caused by endodontic treatment is responsible for a decrease in tooth resistance, which increases susceptibility to fracture. Therefore, it is important that minimally invasive treatments be performed to preserve the dental structure and increase the resistance to fracture of endodontically treated posterior teeth. To evaluate under axial loads, using the finite element method, the stress distribution in endodontically treated molars restored with both transfixed or vertical glass fiber posts (GFP) and resin composite. An endodontically treated molar 3D-model was analyzed using finite element analyses under four different conditions, class II resin composite (G1, control model), vertical glass fiber post (G2), transfixed glass fiber posts (G3) and vertical and transfixed glass fiber posts (G4). Ideal contacts were considered between restoration/resin composite and resin composite/tooth. An axial load (300 N) was applied to the occlusal surface. The resulting tensile stresses were calculated for the enamel and dentin tissue from five different viewports (occlusal, buccal, palatal, mesial and distal views). According to the stress maps, similar stress trends were observed, regardless of the glass fiber post treatment. In addition, for the G1 model (without GFP), a high-stress magnitude can be noticed in the proximal faces of enamel (7.7 to 14 MPa) and dentin (2.1 to 3.3 MPa) tissue. The use of transfixed glass fiber post is not indicated to reduce the stresses, under axial loads, in both enamel and dentin tissue in endodontically treated molar with a class II cavity.
Collapse
|
17
|
Lin F, Ordinola-Zapata R, Xu H, Heo YC, Fok A. Laboratory simulation of longitudinally cracked teeth using the step-stress cyclic loading method. Int Endod J 2021; 54:1638-1646. [PMID: 33852743 DOI: 10.1111/iej.13530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/14/2022]
Abstract
AIM To simulate in a laboratory setting longitudinal cracking in root filled premolar teeth, using cyclic mechanical fatigue. METHODOLOGY Mesial-occlusal-distal (MOD) cavities were prepared in twenty root filled, single-rooted, mandibular premolars restored with fibre posts and resin composites. The samples were randomly divided into two groups based on the loading approaches: static loading with a crosshead speed of 0.5 mm/min and step-stress cyclic loading (1 Hz) with increasing amplitude. The loads and numbers of cycles to failure were recorded. Micro-CT was also used to identify the fracture modes. Statistical analysis was performed using Student's t-test. The level of significance was set at 0.05. RESULTS The mean fracture loads for the static loading and cyclic loading groups were 769 ± 171 N and 720 ± 92 N, respectively. There was no significant difference between the two groups (P > 0.05). The proportions of longitudinal, cuspal and mixed-mode fractures under cyclic loading were 50%, 20% and 30%, respectively. Longitudinal fractures occurred with larger numbers of cycles and higher average loads per cycle compared with the other fractures. Static loading produced only cuspal fractures. CONCLUSIONS Longitudinally cracked premolar teeth with root fillings were successfully produced using the step-stress cyclic loading method. This provides a more clinically representative methodology for studying cracked teeth in a laboratory setting.
Collapse
Affiliation(s)
- F Lin
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, China.,Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, USA
| | - R Ordinola-Zapata
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, USA
| | - H Xu
- Department of Stomatology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Y C Heo
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, USA
| | - A Fok
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, USA
| |
Collapse
|
18
|
de Mesquita CB, Melara R, Luisi SB, Burnett LH, de Melo TAF. Influence of dental crown topography on fracture resistance of premolars with MOD preparation and subjected to different restorative protocols. AUST ENDOD J 2021; 47:493-498. [PMID: 33793027 DOI: 10.1111/aej.12511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 12/01/2022]
Abstract
To evaluate whether dental crown topography influences the fracture resistance of premolars treated endodontically and with MOD preparation subjected to different restorative protocols. Sixty-four human premolars with one or two roots in equal numerical proportions (n) were selected and randomly divided into four groups (n = 8): (S = single-rooted; D = double-rooted) SS: sound single-rooted; SNR: endodontics (E) + MOD cavity preparation; SR: E + MOD + resin restoration (RS); SP: E + MOD + RS + horizontal zirconia post (ZP); DS: sound double-rooted; DNR: E + MOD; DR: E + MOD + RS; and DP: E + MOD + RS + ZP. After allocation to the groups, the samples were thermocycled and then subjected to the fracture resistance test. Failures after the fracture test were classified as irreparable (with pulp floor fracture) or reparable (without pulp floor fracture). Data were analysed using one-way anova and the Tukey test (α = 0.05). Single-rooted premolars were more resistant to fracture than double-rooted premolars. The restorative treatment using a horizontally transfixed zirconia post improved fracture resistance, resembling that of a healthy tooth.
Collapse
Affiliation(s)
| | - Rafael Melara
- Restorative Dentistry Division, Department of Conservative Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Simone Bonato Luisi
- Endodontic Division, Department of Conservative Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Luiz Henrique Burnett
- Post-Graduate Program, Clinical Department, Dental School, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Tiago André Fontoura de Melo
- Endodontic Division, Department of Conservative Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
19
|
Kim SG, Kim SS, Levine JL, Piracha YS, Solomon CS. A Novel Approach to Fracture Resistance Using Horizontal Posts after Endodontic Therapy: A Case Report and Review of Literature. J Endod 2020; 46:545-550. [DOI: 10.1016/j.joen.2019.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 12/12/2019] [Accepted: 12/23/2019] [Indexed: 12/01/2022]
|
20
|
Sáry T, Garoushi S, Braunitzer G, Alleman D, Volom A, Fráter M. Fracture behaviour of MOD restorations reinforced by various fibre-reinforced techniques - An in vitro study. J Mech Behav Biomed Mater 2019; 98:348-356. [PMID: 31302584 DOI: 10.1016/j.jmbbm.2019.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim was to evaluate the fracture resistance of various direct restorative techniques utilizing different fibre-reinforced materials for restoring deep class II. MOD cavities in molar teeth. MATERIAL AND METHODS Two hundred forty intact mandibular third molars were randomly divided into twelve groups (n = 20). Except for the control group (G12), deep mesio-occluso-distal (MOD) cavities were prepared all other groups. After adhesive treatment and rebuilding the missing interproximal walls with composite, the specimen were restored with different fibres and a final occlusal layer of composite as follows: composite only (G1), short fibre-reinforced composite (SFRC) (G2), glass fibre net (GFN) on the base of the cavity bucco-lingually (BL) and SFRC (G3), SFRC and GFN on top of it BL (G4), SFRC and occlusal splinting with GFN (G5), GFN circumferentially and SFRC (G6), polyethylene fibres (PF) on the base of the cavity BL and composite (G7), composite and PF on top of it BL (G8), composite and occlusal splinting with PF (G9), PF circumferentially and composite (G10), transcoronal splinting with PF (G11). Fracture-resistance for the restored teeth were tested using universal-testing machine. Fracture thresholds and fracture patterns were measured and evaluated. RESULTS The transcoronal splinting (G11) yielded the highest fracture resistance among the restored groups. Groups 1, 3 and 4 showed significantly lower fracture resistance values compared to intact teeth. CONCLUSION Incorporating polyethylene or a combination of short and bidirectional glass fibres in certain positions in direct restorations seems to be able to restore the fracture resistance of sound molar teeth.
Collapse
Affiliation(s)
- Tekla Sáry
- Department of Operative and Esthetic Dentistry, Faculty of Dentistry, University of Szeged, Szeged, Hungary
| | - Sufyan Garoushi
- Department of Biomaterials Science and Turku Clinical Biomaterials Center -TCBC, Institute of Dentistry, University of Turku, Turku, Finland
| | | | - David Alleman
- The Alleman Center for Biomimetic Dentistry, Utah, USA
| | - András Volom
- Department of Operative and Esthetic Dentistry, Faculty of Dentistry, University of Szeged, Szeged, Hungary
| | - Márk Fráter
- Department of Operative and Esthetic Dentistry, Faculty of Dentistry, University of Szeged, Szeged, Hungary.
| |
Collapse
|
21
|
Abou-Elnaga MY, Alkhawas MBA, Kim HC, Refai AS. Effect of Truss Access and Artificial Truss Restoration on the Fracture Resistance of Endodontically Treated Mandibular First Molars. J Endod 2019; 45:813-817. [DOI: 10.1016/j.joen.2019.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/23/2019] [Accepted: 02/05/2019] [Indexed: 01/21/2023]
|
22
|
Mergulhão VA, de Mendonça LS, de Albuquerque MS, Braz R. Fracture Resistance of Endodontically Treated Maxillary Premolars Restored With Different Methods. Oper Dent 2019; 44:E1-E11. [DOI: 10.2341/17-262-l] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
Purpose:
The purpose of this in vitro study was to evaluate the resistance and patterns of fracture of endodontically treated maxillary premolars (ETPs) restored with different methods.
Methods and Materials:
Mesio-occluso-distal cavities were prepared in 50 extracted caries-free human maxillary premolars after endodontic treatment. The teeth were divided into five groups (n=10), according to the restorative method. G1: intact teeth (control group); G2: conventional composite resin; G3: conventional composite resin with a horizontal glass fiber post inserted between buccal and palatal walls; G4: bulk-fill flowable and bulk-fill restorative composites; and G5: ceramic inlay. For direct restorations, Filtek Z350 XT, Filtek Bulk Fill Flowable Restorative, and Filtek Bulk Fill Posterior Restorative were used. Indirect restorations were fabricated from a pressable lithium disilicate glass-ceramic (IPS e-max Press) and adhesively cemented (RelyX Ultimate). All specimens were subjected to thermocycling (5°C to 55°C/5000 cycles) and additionally submitted to cyclic loading 50,000 times in an Electro-Mechanical Fatigue Machine. Next, the specimens were subjected to a compressive load at a crosshead speed of 1 mm/min until fracture. The fractured specimens were analyzed to determine the fracture pattern using a stereomicroscope, and then representative specimens were carbon coated to allow for the studying of the fracture surface under scanning electron microscopy. One-way analysis of variance (ANOVA) was used to compare fracture resistance of the groups. The results of fracture patterns were submitted to the Fisher exact test (α=0.05).
Results:
All specimens survived fatigue. Mean (standard deviation) failure loads (N) for groups were as follows: G1: 949.6 (331.5); G2: 999.6 (352.5); G3: 934.5 (233.6); G4: 771.0 (147.4); and G5: 856.7 (237.5). The lowest fracture resistance was recorded for G4, and the highest ones were recorded for G2, followed by that of G1 and G3. One-way ANOVA did not reveal significant differences between groups (p>0.05). The highest repairable fracture rates were observed in G1 (100%) and G3 (80%).
Conclusions:
ETPs restored with conventional composite resin with or without horizontal fiber post, bulk-fill composite, and ceramic inlay showed fracture resistance similar to that of sound teeth. Conventional composite resin restorations exhibited the highest prevalence of unrepairable fractures, and the insertion of a horizontal fiber post decreased this prevalence. Intact teeth showed 100% of repairable fractures. It is difficult to extrapolate the results directly to a clinical situation due to the limitations of this study.
Collapse
Affiliation(s)
- VA Mergulhão
- Viviane A Mergulhão, PhD, Department of Restorative Dentistry, University of Pernambuco, Brazil
| | - LS de Mendonça
- Luciana S de Mendonça, PhD student, University of Pernambuco, Camaragibe, Brazil
| | - MS de Albuquerque
- Mônica S de Albuquerque, PhD student, Department of Restorative Dentistry, University of Pernambuco, Brazil
| | - R Braz
- Rodivan Braz, PhD, DDS, professor, Department of Restorative Dentistry, University of Pernambuco, Camaragibe, Brazil
| |
Collapse
|
23
|
Göktürk H, Karaarslan EŞ, Tekin E, Hologlu B, Sarıkaya I. The effect of the different restorations on fracture resistance of root-filled premolars. BMC Oral Health 2018; 18:196. [PMID: 30497451 PMCID: PMC6267872 DOI: 10.1186/s12903-018-0663-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 11/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study investigated the fracture resistance of root-filled maxillary premolars with class II cavities restored by different restorations. METHODS A total of 55 intact maxillary premolar teeth were included (n = 11). G1 as positive control group, 44 teeth underwent root canal treatment, and MOD cavities were prepared. (G2) no restoration, (G3) direct composite restoration, (G4) direct composite strengthened with buccal to lingual pre-impregnated glass-fibers and (G5) ceramic inlay restoration. After thermocycling, fracture resistance test was performed and fracture type was recorded. Data were analyzed with one-way ANOVA and Chisquare test. RESULTS The mean fracture resistance was as follows: G1 had the highest fracture resistance, G2 had the lowest (p < 0.05). There were no significant differences between the fracture resistance values of the groups that underwent different restorations (G3, G4, G5) (p > 0.05). According to fracture type, the groups showed similar results (p > 0.05). A significant level of unrestorable fracture was detected in G5 (ceramic inlay) (p < 0.05). CONCLUSIONS All of the restoration techniques investigated herein increased the fracture strength of teeth; however, all of these values were lower than the fracture resistance of intact teeth. There were no significant differences between the fracture resistance values of the groups that underwent different restorations.
Collapse
Affiliation(s)
- Hakan Göktürk
- Department of Endodontics, Bolu Abant İzzet Baysal University Faculty of Dentistry, Bolu, Turkey
| | - Emine Şirin Karaarslan
- Department of Restorative Dentistry, Gaziosmanpasa University Faculty of Dentistry, Tokat, Turkey
| | - Elif Tekin
- Department of Endodontics, Gaziosmanpasa University Faculty of Dentistry, Tokat, Turkey
| | - Bilal Hologlu
- Department of Prosthodontics, Gaziosmanpasa University Faculty of Dentistry, 60100, Tokat, Turkey
| | - Işıl Sarıkaya
- Department of Prosthodontics, Gaziosmanpasa University Faculty of Dentistry, 60100, Tokat, Turkey.
| |
Collapse
|
24
|
Fracture Resistance of Endodontically Treated Anterior Teeth Restored with Different Post Systems: An In Vitro Study. Eur Endod J 2018; 3:174-178. [PMID: 32161874 PMCID: PMC7006576 DOI: 10.14744/eej.2018.70299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 06/13/2018] [Accepted: 06/13/2018] [Indexed: 11/20/2022] Open
Abstract
Objective: This in vitro study aimed to evaluate the fracture resistance of endodontically treated maxillary central incisors with different post systems. Methods: Fifty-six extracted intact maxillary permanent central incisors were used, treated endodontically (except for the control group), and distributed into the following seven test groups (n=8) depending on the post type: UHT (control group: root-filled teeth without endodontic post), ZRP (prefabricated zirconia post), GFP (prefabricated glass fiber post), CFP (prefabricated carbon fiber post), CPC (custom-made cast post and core), TIP (prefabricated titanium post), and MIP (prefabricated mixed post). The specimens were loaded in a universal testing machine until fracture occurrence. Failure loads were then analyzed with one-way analysis of variance (ANOVA), followed by multiple comparisons by using Tukey’s honest significant difference test (α=0.05). Results: Mean (SD) failure loads for groups ranged from 524±73.2 N for CPC to 764.1±156 N for GFP. One-way ANOVA showed significant differences in terms of fracture resistances among groups (P<0.001). Tukey’s honest significant difference test showed significant differences in fracture resistance within groups (P≤0.05), whereas no difference was observed between the UHT (control group) and CFP and CPC groups (P≥0.05). Conclusion: Endodontically treated teeth restored with zirconia post, glass fiber post, titanium post, or mixed post were more resistant to fracture loads compared with those that were not restored (control group) or restored with either carbon fiber post or cast post and core.
Collapse
|
25
|
Restoration Strategies of Endodontically Treated Teeth among Dental Practitioners in Saudi Arabia. A Nationwide Pilot Survey. Dent J (Basel) 2018; 6:dj6030044. [PMID: 30177593 PMCID: PMC6162440 DOI: 10.3390/dj6030044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/24/2018] [Accepted: 08/30/2018] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to determine dental practitioners' opinions, techniques, and materials used for the restoration of endodontically treated teeth (ETT) in Saudi Arabia. A comprehensive nationwide survey regarding treatment strategies of ETT, on the post types and material used for core foundations were distributed either by email or by hard copies to general dentists in different parts of Saudi Arabia (North, South, West, East, and Center). Descriptive statistics were used to analyze the responses to the questions. A total of 164 participants were included in the survey: 72.6% of them were male, and 27.4% were female. 42.1% of the participants were Saudi dental practitioners, whereas 57.9% were non-Saudi dental practitioners. Out of the surveyed dentists, 52% consider post placement for almost every post-endodontic restoration of ETT. The majority of the dentists (54%) believe that a post strengthens ETT. Cast posts and cores were used by 55% of all the dentists, whereas 34% used prefabricated posts exclusively. Screw posts were the most popular prefabricated post type (47%). Composite resin (51%) was preferred for the core foundation, followed by glass ionomer cements (GICs) (26%). Amalgam was seldom used (0.5%). Posts were placed primarily with zinc phosphate cement (51%), followed by GIC (38%). Within the limitations of this survey-based investigation among dental practitioners in Saudi Arabia, it was concluded that the treatment strategies of ETT are in accordance with the current state of evidence-based knowledge.
Collapse
|
26
|
Influence of Different Post Luting Cements on the Fracture Strength of Endodontically Treated Teeth: An In Vitro Study. Eur Endod J 2018; 3:113-117. [PMID: 32161866 PMCID: PMC7006569 DOI: 10.14744/eej.2018.03522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/12/2018] [Accepted: 03/09/2018] [Indexed: 12/01/2022] Open
Abstract
Objective: To evaluate the fracture resistance of endodontically treated mandibular premolars restored with glass fiber posts using different luting agents. Methods: Twenty-four extracted single-rooted mandibular premolars were endodontically treated, and post spaces were prepared to receive fiber posts. They were assigned to three test groups (n=8) according to the type of cement used for the cementation of glass fiber posts: RC group: adhesive resin cement group (etch and rinse), SC group: self-adhesive resin cement group, and GC group: glass ionomer cement group. Teeth in all groups were adhesively restored with a composite resin core material and crowned with Ni-Cr crowns. All specimens were subjected to tangential loading using a universal testing machine until fracture at 30°. Failure loads were recorded, and data were analyzed using one-way ANOVA followed by Tukey’s HSD test (α=0.05). Results: Specimens in the RC group were more resistant (258.3±12.7 N) to fracture than those in the SC (218.7±11.1 N) and GC (165.4±8.9 N) groups (P≤0.001). One-way ANOVA indicated that the type of cement had a significant effect on the fracture resistance of endodontically treated lower premolars (P≤0.001). Conclusion: The type of cement that was used to fix glass fiber posts was a determining factor of the fracture resistance of endodontically treated lower premolars.
Collapse
|
27
|
Evaluation of Different Restoration Combinations Used in the Reattachment of Fractured Teeth: A Finite Element Analysis. Appl Bionics Biomech 2018; 2018:8916928. [PMID: 29736185 PMCID: PMC5875023 DOI: 10.1155/2018/8916928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/28/2018] [Indexed: 11/18/2022] Open
Abstract
Objective. The purpose of this study was to test different restoration combinations used for constructing fractured endodontically treated incisors by reattaching their fractured fragments. Methods. Seven types of 3-D FEM mathematical root canal-filled models were generated, simulating cases of (OB) reattaching fractured fragments; (CrPL) reattaching fractured fragments + ceramic palatinal laminate; (CmPL) reattaching fractured fragments + composite palatinal laminate; (CM) reattaching fractured fragments + coronal 1/3 of the root was filled using core material; (BP) reattaching fractured fragments + glass fiber post; (CP) composite resin restoration + glass fiber post; and (OC) composite resin restoration. A 100-N static oblique force was applied to the simulated teeth with 135° on the node at 2 mm above the cingulum to analyze the stress distribution at the tooth. Results. For enamel tissue, the highest stress values were observed in model BP, and the lowest stress values were observed in model CmPL. For dentine tissue, the highest stress concentrations were observed around the fracture line for all models. Conclusions. Reattachment of fractured fragments by bonding may be preferred as a restoration option for endodontically treated incisors; also, palatinal laminate decreases the stress values at tooth tissues, especially at the enamel and the fracture line.
Collapse
|
28
|
Scotti N, Forniglia A, Tempesta RM, Comba A, Saratti CM, Pasqualini D, Alovisi M, Berutti E. Effects of fiber-glass-reinforced composite restorations on fracture resistance and failure mode of endodontically treated molars. J Dent 2016; 53:82-7. [PMID: 27492772 DOI: 10.1016/j.jdent.2016.08.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 07/17/2016] [Accepted: 08/01/2016] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES The study evaluated the fracture resistance and fracture patterns of endodontically treated mandibular first molars restored with glass-fiber-reinforced direct composite restorations. METHODS In total, 60 extracted intact first molars were treated endodontically; a mesio-occluso-distal (MOD) cavity was prepared and specimens were then divided into six groups: sound teeth (G1), no restoration (G2), direct composite restoration (G3), fiber-post-supported direct composite restoration (G4), direct composite reinforced with horizontal mesio-distal glass-fibers (G5), and buccal-palatal glass-fibers (G6). Specimens were subjected to 5000 thermocycles and 20,000 cycles of 45° oblique loading force at 1.3Hz and 50N; they were then loaded until fracture. The maximum fracture loads were recorded in Newtons (N) and data were analyzed with one-way ANOVA and post-hoc Tukey tests (p<0.05). Fractured specimens were analyzed with a scanning electron microscope (SEM). RESULTS The mean static loads (in Newtons) were: G1, 831.83; G2, 282.86; G3, 364.18; G4, 502.93; G5, 499.26; and G6, 582.22. Fracture resistance did not differ among G4, G5, and G6, but was significantly higher than G3 (p=0.001). All specimens fractured in a catastrophic way. In G6, glass fibers inducted a partial deflection of the fracture, although they were not able to stop crack propagation. CONCLUSIONS For the direct restoration of endodontically treated molars, reinforcement of composite resins with glass-fibers or fiber posts can enhance fracture resistance. The SEM analysis showed a low ability of horizontal glass-fibers to deviate the fracture, but this effect was not sufficient to lead to more favorable fracture patterns above the cement-enamel junction (CEJ). CLINICAL SIGNIFICANCE The fracture resistance of endodontically treated molars restored with direct composite restorations seems to be increased by reinforcement with fibers, even if it is insufficient to restore sound molar fracture resistance and cannot avoid vertical fractures.
Collapse
Affiliation(s)
- Nicola Scotti
- Department of Surgical Sciences, Dental School Lingotto, University of Turin, Via Nizza 230, Turin, Italy.
| | - Alberto Forniglia
- Department of Surgical Sciences, Dental School Lingotto, University of Turin, Via Nizza 230, Turin, Italy
| | | | - Allegra Comba
- Department of Surgical Sciences, Dental School Lingotto, University of Turin, Via Nizza 230, Turin, Italy
| | - Carlo Massimo Saratti
- Division of Cariology and Endodontology, School of Dentistry, University of Geneva, Rue Barthèlemy-Menn, Geneva, Switzerland
| | - Damiano Pasqualini
- Department of Surgical Sciences, Dental School Lingotto, University of Turin, Via Nizza 230, Turin, Italy
| | - Mario Alovisi
- Department of Surgical Sciences, Dental School Lingotto, University of Turin, Via Nizza 230, Turin, Italy
| | - Elio Berutti
- Department of Surgical Sciences, Dental School Lingotto, University of Turin, Via Nizza 230, Turin, Italy
| |
Collapse
|