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Fracture resistance of root canal-treated molars restored with ceramic overlays with/without different resin composite base materials: an in vitro study

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Abstract

The objective of the study was to evaluate the effect of different restorative protocols on fracture resistance of root canal-treated molars. 48 mandibular first molars were used and divided into six groups (n = 8); G1 (negative control): teeth kept intact. G2 (positive control): teeth had root canal treatment and standard MOD cavity preparations but kept unrestored. G3: prepared as G2 and directly restored with VitaEnamic ceramic overlays (CO). G4: as G3, but the pulp chamber was restored first with smart dental restorative (SureFil SDR flow = SDR) bulk-fill flowable composite base. G5: as G3, but the pulp chamber was restored first with SonicFill (SF) bulk-fill composite base. G6: as G3, but the pulp chamber was restored first with a fiber-reinforced composite (FRC) base. All samples were subjected to thermocycling between 5 °C and 55 °C in a water bath for a total of 2000 cycles with 10 s dwell time. Then specimens were individually mounted on a computer-controlled testing machine with a load cell of 5 kN, and the maximum load to produce fracture (N) was recorded. Data were analyzed using one-way ANOVA followed by Tukey’s post hoc test (P = 0.05). There was a significant difference between the groups (P < 0.001). Teeth restored with FRC and ceramic overlays had the highest load-bearing capacity. Pulp chamber restoration with either FRC or SDR before ceramic overlay fabrication provided significantly better tooth reinforcement than ceramic overlay alone (P < 0.001). Fracture modes were analyzed to determine the type of fracture as repairable or catastrophic, where FRC + CO and SDR + CO groups had favorable fracture modes that were mostly repairable. When restoring root canal-treated molars with overlays, the pulp chamber should be sealed with either FRC or SDR to ensure the best possible fracture resistance. The clinical relevance of the study is that a new simple restorative protocol is presented to enhance the survival of root canal-treated molars using ceramic overlays.

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References

  1. Eraslan O, Eskitascioglu G, Belli S. Conservative restoration of severely damaged endodontically treated premolar teeth: a FEM study. Clin Oral Investig. 2011;15:403–8.

    Article  PubMed  Google Scholar 

  2. Soares CJ, Rodrigues M, Faria-e-Silva AL, et al. How biomechanics can affect the endodontic treated teeth and their restorative procedures? Braz Oral Res. 2018;32:169–82.

    Article  Google Scholar 

  3. Nagasiri R. Long-term survival of endodontically treated molars without crown coverage: a retrospective cohort study. J Prosth Dent. 2005;93:164–70.

    Article  Google Scholar 

  4. Ramírez-Sebastià A, Bortolotto T, Cattani-Lorente M, et al. Adhesive restoration of anterior endodontically treated teeth: influence of post length on fracture strength. Clin Oral Investig. 2014;18:545–54.

    Article  PubMed  Google Scholar 

  5. Zarow M, Ramirez-Sebastia A, Paolone G, et al. A new classification for the restoration of root filled teeth. Int Endod J. 2018;51:318–34.

    Article  PubMed  Google Scholar 

  6. Magne P, Carvalho AO, Bruzi G, et al. Influence of no-ferrule and no-post buildup design on the fatigue resistance of endodontically treated molars restored with resin nanoceramic CAD/CAM crowns. Oper Dent. 2014;39:595–602.

    Article  PubMed  Google Scholar 

  7. Serin Kalay T, Yildirim T, Ulker M. Effects of different cusp coverage restorations on the fracture resistance of endodontically treated maxillary premolars. J Prosthet Dent. 2016;116:404–10.

    Article  PubMed  Google Scholar 

  8. Sedrez-Porto JA, Rosa WL, da Silva AF, et al. Endocrown restorations: A systematic review and meta-analysis. J Dent. 2016;52:8–14.

    Article  PubMed  Google Scholar 

  9. Biacchi GR, Basting RT. Comparison of fracture strength of endocrowns and glass fiber post-retained conventional crowns. Oper Dent. 2012;37:130–6.

    Article  PubMed  Google Scholar 

  10. Erturk K, Saridag S, Koseler E, et al. Fracture strengths of endocrown restorations fabricated with different preparation depths and CAD/CAM materials. Dent Mater J. 2018;37:256–65.

    Article  Google Scholar 

  11. Kwon OH, Kim DH, Park SH. The influence of elastic modulus of base material on the marginal adaptation of direct composite restoration. Oper Dent. 2010;35:441–7.

    Article  PubMed  Google Scholar 

  12. Li X, Pongprueksa P, Meerbeek BV, Munch J. Curing of bulk fill resin-based composite. J Dent. 2015;43:664–72.

    Article  PubMed  Google Scholar 

  13. Khan SIR, Anupama R, Deepalaksmi M, et al. Effect of two different types of fibers on the fracture resistance of endodontically treated molars restored with composite resin. J Adhes Dent. 2013;15:167–71.

    PubMed  Google Scholar 

  14. Belli S, Erdemir A, Ozcopur M, Eskitascioglu G. The effect of fibre insertion on fracture resistance of root filled molar teeth with MOD preparations restored with composite. Int Endod J. 2005;38:73–80.

    Article  PubMed  Google Scholar 

  15. Abdelrahman M, Othman H, Metwally M. Fracture resistance of molar teeth restored by endocrown and onlay cad/cam monolithic ceramic materials. An in-vitro study. Al-Azhar J Dent Sci. 2020;23:95–102.

    Article  Google Scholar 

  16. Schäfer E, Diez C, Hoppe W, et al. Roentgenographic investigation of frequency and degree of canal curvatures in human permanent teeth. J Endod. 2002;28:211–6.

    Article  PubMed  Google Scholar 

  17. Moosavi H, Zeynali M, Pour Z. Fracture resistance of premolars restored by various types and placement techniques of resin composites. Int J Dent. 2012. https://doi.org/10.1155/2012/973641.

    Article  PubMed  PubMed Central  Google Scholar 

  18. DeLong R, Douglas WH. An artificial oral environment for testing dental materials. IEEE Trans Biomed Eng. 1991;38:339–45.

    Article  PubMed  Google Scholar 

  19. Kern M, Strub JR, Lü XY. Wear of composite resin veneering materials in a dual-axis chewing simulator. J Oral Rehabil. 1999;26:372–8.

    Article  PubMed  Google Scholar 

  20. Steiner M, Mitsias ME, Ludwig K, et al. In vitro evaluation of a mechanical testing chewing simulator. Dent Mater. 2009;25:494–9.

    Article  PubMed  Google Scholar 

  21. Dere M, Ozcan M, Gohring T. Marginal quality and fracture strength of root-canal treated mandibular molars with overlay restorations after thermocycling and mechanical loading. J Adhes Dent. 2010;4:287–94.

    Google Scholar 

  22. Gulabivala K, Stock CJR, Gulabivala K, et al. Root canal system preparation. In: Endodontics. Edinburgh, New York: Elsevier, Mosby; 2004. p. 142–4.

    Google Scholar 

  23. Abdou J, Sambrook R. Longevity of ceramic onlays: a systematic review. J Esthet Restor Dent. 2018;30:193–215.

    Article  Google Scholar 

  24. Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures. J Endod. 1989;15:512–6.

    Article  PubMed  Google Scholar 

  25. St-Georges AJ, Sturdevant JR, Swift EJ Jr, et al. Fracture resistance of prepared teeth restored with bonded inlay restorations. J Prosthet Dent. 2003;89:551–7.

    Article  PubMed  Google Scholar 

  26. Allara FW Jr, Diefenderfer KE, Molinaro JD. Effect of three direct restorative materials on molar cuspal fracture resistance. Am J Dent. 2004;17:228–32.

    PubMed  Google Scholar 

  27. Hood J. Biomechanics of the intact, prepared and restored tooth: some clinical implication. Int Dent J. 1999;41:25–32.

    Google Scholar 

  28. Garoushi S, Vallittu PK, Lassila L. Direct restoration of severely damaged incisors using short fiber-reinforced composite resin. J Dent. 2007;35:731–6.

    Article  PubMed  Google Scholar 

  29. Mangoush E, Garoushi S, Lassila L, et al. Effect of fiber reinforcement type on the performance of large posterior restorations: a review of invitro studies. Polymers. 2021;13:3682.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Garoushi S, Vallittu PK, Lassila LVJ. Short glass fiber reinforced restorative composite resin with semi-interpenetrating polymer network matrix. Dent Mater. 2007;23:1356–62.

    Article  PubMed  Google Scholar 

  31. Taher H, Haridy M. Fracture resistance of maxillary premolars restored with different fiber-reinforced composites: an invitro study. Egy Dent J. 2019;65:1833–43.

    Article  Google Scholar 

  32. Krenchel H. Fiber reinforcement theoretical and practical investigations of the elasticity and strength of fiber reinforced materials. Copenhagen: Academisk Forlag; 1964.

    Google Scholar 

  33. Van Ende A, De Munck J, Van Landuyt KL, et al. Bulk-filling of high C-factor posterior cavities: effect on adhesion to cavity-bottom dentin. Dent Mater. 2013;29:269–77.

    Article  PubMed  Google Scholar 

  34. Rosatto C, Bicalho A, Verissimo C, Soares C, et al. Mechanical properties, shrinkage stresses, cuspal strain and fracture resistance of molars restored with bulk-fill composites and incremental filling technique. J Dent. 2015;43:1519–28.

    Article  PubMed  Google Scholar 

  35. Ahmad I. Deep resins, white fillings: a new technique for composite restorations. Cosm Dent. 2013;1:12–8.

    Google Scholar 

  36. Demicri M, Tuncer S, Yuceokur AA. Prevalence of caries on individual tooth surfaces and its distribution by age and gender in university clinic patients. Eur J Dent. 2010;4:270–9.

    Article  Google Scholar 

  37. Bhanderi S. Facts about cracks in teeth. Prim Dent J. 2021;10:20–7.

    Article  PubMed  Google Scholar 

  38. Kalburge V, Yakub SS, Kalburge J, et al. A comparative evaluation of fracture resistance of endodontically treated teeth, with variable marginal ridge thicknesses, restored with composite resin and composite resin reinforced with Ribbond: an in vitro study. Ind J Dent Res. 2013;24:193–8.

    Article  Google Scholar 

  39. Lee MR, Cho BH, Son HH, et al. Influence of cavity dimension and restoration methods on the cusp deflection of premolars in composite restoration. Dent Mater. 2007;3:288–95.

    Article  Google Scholar 

  40. Vinagre A, Ramos J, Messias a, et al. Cuspal displacement induced by bulk fill composite resin polymerization: biomechanical evaluation using fiber Bragg grating sensors. Int J Biomat. 2016;2016:7134283.

    Article  Google Scholar 

  41. Oskoee SS, Oskoee PA, Navimipour EJ, et al. In vitro fracture resistance of endodontically—treated maxillary premolars. Oper Dent. 2007;32:510–4.

    Article  PubMed  Google Scholar 

  42. Soares CJ, Pizi EC, Fonseca RB, Martins LR. Influence of root embedment material and periodontal ligament simulation on fracture resistance tests. Braz Oral Res. 2005;19:11–6.

    Article  PubMed  Google Scholar 

  43. Rees JS. An investigation into the importance of the periodontal ligament and alveolar bone as supporting structures in finite element studies. J Oral Rehabil. 2001;28:425–32.

    Article  PubMed  Google Scholar 

  44. Keulemans F, Garoushi S, Lassila L. Fillings and core-built ups (Book Chapter). In: Vallittu Ö, editor. A clinical guide to principles of fibre reinforced composites (FRCs) in dentistry. Sawston: Woodhead Publishing; 2017.

    Google Scholar 

  45. Lassila L, Keulemans F, Säilynoja E, et al. Mechanical properties and fracture behavior of flowable fiber reinforced composite restorations. Dent Mater. 2018;34:598–606.

    Article  PubMed  Google Scholar 

  46. Chai H. On crack growth in molar teeth from contact on the inclined occlusal surface. J Mech Behav Biomed Mater. 2015;44:76–84.

    Article  PubMed  Google Scholar 

  47. Hartanto C, Farahanny W, Dennis D. Comparative evaluation of short fiber-reinforced composite resin thickness on fracture resistance of class II composite restoration: an invitro study. J Contemp Dent Pract. 2020;21:1201–4.

    PubMed  Google Scholar 

  48. Zhang Y, Kelly JR. Dental ceramics for restoration and metal-veneering. Dent Clin North Am. 2017;61:797–819.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Coldea A, Swain MV, Thiel N. Mechanical properties of polymer infiltrated-ceramic network materials. Dent Mater. 2013;29:419–26.

    Article  PubMed  Google Scholar 

  50. Mörmann WH, Stawarczyk B, Ender A, et al. Wear characteristics of current aesthetic dental restorative CAD/ CAM materials: two-body wear, gloss retention, roughness and Martens hardness. J Mech Behav Biomed Mater. 2013;20:113–25.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank the Digital Dentistry Hub, at the Center of Innovative Dental Sciences (CIDS) at the British University in Egypt, for providing the intraoral scanner and software.

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Authors and Affiliations

  1. Department of Conservative Dentistry, Faculty of Dentistry, The British University, Al Shorouk city, Egypt

    Mohamed F. Haridy & Hend S. Ahmed

  2. Department of Conservative Dentistry, Faculty of Dentistry, Cairo University, Cairo, Egypt

    Mohamed F. Haridy

  3. Department of Endodontics, Faculty of Dentistry, The British University, Al Shorouk city, Egypt

    Mohamed M. Kataia & Shehabeldin M. Saber

  4. Department of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt

    Shehabeldin M. Saber

  5. Central Interdisciplinary Ambulance in the School of Dentistry, University of Münster, Münster, Germany

    Edgar Schafer

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  1. Mohamed F. Haridy
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  2. Hend S. Ahmed
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  4. Shehabeldin M. Saber
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  5. Edgar Schafer
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Correspondence to Mohamed F. Haridy.

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Conflict of interest

Mohamed Haridy declares that he has no conflict of interest. Hend Sayed declares that she has no conflict of interest. Mohamed Kataia declares that he has no conflict of interest. Shehabeldin Mohamed Saber declares that he has no conflict of interest. Edgar Schäfer declares that he has no conflict of interest.

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Ethical approval was obtained from the research ethics committee of the faculty of dentistry, Ain Shams University. This study does not contain any studies with human participants or animals performed by any of the authors.

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Haridy, M.F., Ahmed, H.S., Kataia, M.M. et al. Fracture resistance of root canal-treated molars restored with ceramic overlays with/without different resin composite base materials: an in vitro study. Odontology 110, 497–507 (2022). https://doi.org/10.1007/s10266-021-00682-5

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