Static and fatigue compression test for particulate filler composite resin with fiber-reinforced composite substructure

Impact of restorative material on fracture behaviors of class II restoration in endodontically treated deciduous molars

The purpose of this study was to investigate the fracture behavior of endodontically treated (ET) deciduous molar when directly restored with different restorative materials in Class II (MO) cavities in comparison with permanent teeth. MO cavities were prepared with 2.4-2.5 mm and 1.9-2.0 mm in buccolingual width, and mesiodistal width of each cavity walls, respectively, followed by direct restoration with different materials: resin-modified glass ionomer cement (RMGIC), composite resin (CR), and composite resin containing 25% short glass-fiber (SFRC). All specimens were subjected to mechanical loading tests at a speed of 1 mm/min and evaluated fracture resistance and fracture modes. A one-way ANOVA followed by a Tukey multiple comparisons analysis was used. Deciduous-SFRC (3,310.5±396.2 N) were significantly higher fracture resistance than permanent-RMGIC (1,633.8±346.8 N) (p<0.001), and permanent-CR (1,400.0±381.3 N) (p<0.001). For the direct restoration of MO cavity after endodontic treatment, SFRC demonstrated its promising performance in load-bearing capacity and failure mode, especially in ET deciduous molars.

Influence of remaining coronal tooth morphology with resin abutment and fiber post on static and dynamic fracture resistances

This study aimed to clarify the fracture resistance of resin abutments built on endodontically treated roots with the remaining coronal teeth via static and cyclic loading tests. Endodontically treated bovine roots, which had a remaining coronal tooth covered with an occupied area for a quarter and half of the circumference at the tensile side or covered the circumference at both the tensile and compressive sides, were fabricated to build up to the resin abutment. Fracture resistance was evaluated via static and cyclic loading tests by applying a load of 30° to the tooth axis. Half of the circumference of the remaining coronal tooth showed a significantly higher static fracture load and survival rate. The remaining coronal tooth on the compressive side improved the dynamic fracture resistance associated with severe fractures. The occupied area and location of the remaining coronal tooth affected the static and dynamic fracture resistances.

Compressive Strength Testing of Glass-Fibre-Reinforced Tooth Crown Tissues After Endodontic Treatment

The objective of this study was to compare the effects of using short and continuous fibres for repairing compression-induced tooth crown damage. Human teeth were used for the study. They were upper medial incisors and maxillary first premolars lost due to periodontal causes. The teeth were divided into two groups with Hahnenkratt and short glass fibres. Teeth compressive strength tests were carried out. Then micro-CT imaging of the teeth and their fractures obtained after compression was performed. The teeth restored with Hahnenkratt's glass fibre posts showed higher compressive strength than the teeth restored using the EverX Posterior material. The tooth's most weakened and sensitive point after endodontic treatment was the cervical area of the tooth. All cracks were parallel to the root canal.

Exploring the influence of placing bi-directional E-glass fibers as protective layer under a CAD-CAM resin composite on the fracture pattern

OBJECTIVES

To investigate the influence of the presence and position of bidirectional E-glass fibers under a CAD-CAM resin composite on the fracture pattern evaluated both after quasi-static mechanical loading and after fatigue.

METHODS

Rectangular specimens (10 mm-long, 5 mm-large and 4.2 mm-thick) were prepared and divided into four groups (n = 30/group). The control group (C-Group) consisted of a 4.2 mm-thick layer of monolithic CAD/CAM resin composite resin (Cerasmart, GC). In the 3 other groups including the placement of a fiber layer (F-Groups), the CAD/CAM resin composite layer was reduced to 3-, 2- and 1-mm thickness (F3-, F2- and F1-Groups, respectively). Two bonded layers of bidirectional E-glass FRC (Dentapreg, ADM A.S.) were bonded underneath and a light-curable resin composite base (Gaenial Posterior, GC) was then added to reach a total thickness of 4.2 mm for all samples. In each group, half of the specimens (n = 15) were submitted to quasi-static mechanical loading to failure in a universal testing machine. The other half (n = 15) was subjected to cyclic isometric stepwise loading until failure or completion of 105000 cycles (5000 cycles at 500 N, followed by five stages of 20000 cycles at 750 N, 1000 N, 1250 N, 1500 N, and 1750 N). The data were analyzed by Weibull statistics for quasi-static loading, and by the Kaplan-Meier product limit estimation procedure after fatigue. All fractured specimens were studied using light and electron microscopy techniques, and the types of fracture were determined.

RESULTS

For quasi-static mechanical loading, significant differences were observed for Weibull modulus and characteristic strength between groups, with values ranging from 10.8 to 22.4 for the former and from 2336.6 to 2974.7 for the latter. Also, survival after stepwise fatigue revealed statistically significant differences between groups (p < 0.05), the lowest values of cycles before failure being observed for F1-Group - Median = 61223 (50415; 65446) - as compared to the other groups - C-Group: Median = 89005 (86189; 98195); F3-Group: Median = 85198 (77279; 87860); F2-Group: Median = 89306 (87454; 97024). Both in quasi-static loading and after fatigue, the observation of fracture modes revealed major differences. While all fractures were vertical (split) in C-Group, the majority of the specimens in F-Groups presented some degree of horizontal deflection of the crack. In all deviated fractures, fractographic analysis confirmed a toughening effect of the fiber layer.

SIGNIFICANCE

The present in vitro work tends to show that the fracture pattern of CAD-CAM resin composites is favorably affected by the presence and position of an underlying bidirectional E-glass fiber layer. The placement of E-glass fibers under a CAD-CAM resin composite may therefore represent an interesting strategy to reduce the risk of catastrophic restoration failure, which could be integrated in the development of the new generation of indirect materials, possibly in 3D-printing approaches.

Short fiber-reinforced composite resins as post-and-core materials for endodontically treated teeth: A systematic review and meta-analysis of in vitro studies

STATEMENT OF PROBLEM

As the use of traditional posts has been associated with complications and failure outcomes, the introduction of novel materials and minimally invasive dentistry has shifted toward the use of composite resin post-and-core restorations for endodontically treated teeth. As a further process, to improve stress absorption environment in restored teeth, the invention of short fiber-reinforced composite resins (SFRCs) as post-and-core restorations has recently emerged. However, evidence regarding its performance is still scarce, and a synthesis of existing data is lacking.

PURPOSE

The purpose of this systematic review and meta-analysis was to assess the performance of SFRC post-and-core restorations, regarding fracture resistance and failure mode and considering both cyclic and static loading.

MATERIAL AND METHODS

An electronic search in 5 databases was conducted up to August 2022, and the protocol of the study was registered a priori. The search terms included "fiber reinforced composite," "core build-up," and "post." Studies were considered if they compared SFRC restorations with other types of conventional posts and teeth restored using bulk fill composite resin. The internal validity of the studies was assessed by using a custom-made risk of bias tool.

RESULTS

A total of 1271 records were identified, of which 13 were considered for full-text assessment. Eight were ultimately included, all being in vitro studies, and 7 of them were deemed eligible for quantitative syntheses. The results varied considerably across studies with divergent fracture resistance values and percentages of catastrophic failure being reported. Standard depth (6 mm) SFRCs presented fewer repetitions until fracture on average, compared with the individually made FRCs (3 studies: mean difference (MD): -4062; 95% CI: -6148, -1975; P<.001) under cyclic loading. Under static loading, SFRCs (standard depth) presented a nearly 300 N lower fracture force compared with that of intact teeth, (3 studies: MD: -297; 95%CI: -378, -216; P<.001).

CONCLUSIONS

Evidence on the laboratory fracture and failure performance of SFRCs is limited, and future studies should incorporate more standardized experimental conditions, as well as SFRCs with limited sacrifice of tooth substrate within the root canal of endodontically treated teeth.

Fatigue and wear of human tooth enamel: A review

Human tooth enamel must withstand the cyclic contact forces, wear, and corrosion processes involved with typical oral functions. Furthermore, unlike other human tissues, dental enamel does not have a significant capacity for healing or self-repair and thus the longevity of natural teeth in the oral environment depends to a large degree on the fatigue and wear properties of enamel. The purpose of this review is to provide an overview of our understanding of the fatigue and wear mechanisms of human enamel and how they relate to in vivo observations of tooth damage in the complex oral environment. A key finding of this review is that fatigue and wear processes are closely related. For example, the presence of abrasive wear particles significantly lowers the forces needed to initiate contact fatigue cracking while subsurface fatigue crack propagation drives key delamination wear mechanisms during attrition or attrition-corrosion of enamel. Furthermore, this review seeks to bring a materials science and mechanical engineering perspective to fatigue and wear phenomena. In this regard, we see developing a mechanistic description of fatigue and wear, and understanding the interconnectivity of the processes, as essential for successfully modelling enamel fatigue and wear damage and developing strategies and treatments to improve the longevity of our natural teeth. Furthermore, we anticipate that this review will stimulate ideas for extending the lifetime of the natural tooth structure and will help highlight where our understanding is too limited and where additional research into fatigue and wear of human tooth enamel is warranted.

Crack propagation and toughening mechanism of bilayered short-fiber reinforced resin composite structure -Evaluation up to six months storage in water

Clinically relevant parameters, such as stress intensity factor of bilayered resin composite structure with short fiber base and its stability over time, has yet to be investigated. This study investigated the stress intensity factor of pre-cracked bilayered specimens composed of short fiber resin composite base (SFC) and particulate filler resin composite (PFC) as veneering layer, with a crack located in the PFC layer, 0.5 mm away from the PFC-SFC interface. Monolayered specimens served as controls. All specimens were stored in water at 37°C either for 1 week, 1 month or 6 months before testing. Two-way ANOVA (p=0.05) was used to determine the differences among the groups. Results indicated that SFC base improve the brittleness of the PFC. The type of short fibers affected the crack propagation; fiber bridging in millimeter-scale SFC was the main crack arresting mechanism, whereas fiber pulling observed in micrometer-scale SFC mainly deviated the crack path.

Effect of fiber orientation and placement on fracture resistance of large class II mesio-occluso-distal cavities in maxillary premolars: An in vitro study

Background and Aim:

To analyze the outcome of fiber placement and orientation over fracture resistance in wide Class II (Mesio-occluso-distal [MOD]) cavities prepared on maxillary premolars.

Materials and Methods:

After selection of 120 extracted human maxillary premolars, Class II (MOD) cavities were prepared maintaining uniform dimensions and samples were divided into six groups randomly (n = 20 each): Group I, G-aenial posterior; Group II, G-aenial posterior + Horizontal Ribbond placement on gingival and pulpal floor; Group III, G-aenial posterior + Horizontal Ribbond placement only on pulpal floor; Group IV, G-aenial posterior + vertical Ribbond placement on gingival and pulpal floor; Group V, G-aenial posterior + Ribbond chips; Group VI, Ever-X posterior. After restorations and completion of thermocycling process, universal testing machine measured the fracture resistance of all samples. Fracture modes were inspected under stereomicroscope. Analyzation of data was performed using one-way ANOVA and Tukey test at significance levels of P < 0.05.

Results:

Fiber placement significantly increased fracture resistance. The highest fracture resistance was shown by Group 2 (1288.8 N) followed by Group 3 (976 N), group 4 (942.3 N), Group 5 (876.3 N), and Group 6 (833 N). Group 1 (No Fiber group) showed the least fracture resistance of 588.41 N. Repairable fractures were seen highest with Group 2 (80%) followed by Group 6 (70%) and least in Group 1 (30%).

Conclusions:

Horizontal orientation of polyethylene fiber on both pulpal and gingival floor of MOD cavities gives the highest fracture resistance in maxillary premolars and repairable mode of fracture.

Influence of Post-Core and Crown Type on the Fracture Resistance of Incisors Submitted to Quasistatic Loading

The aim of this paper was to evaluate the fracture resistance and failure type of maxillary incisor teeth, rebuilt with various types of post-core restorations and full crowns made of either direct conventional particulate filler composite (PFC, G-aenial Anterior, GC, Tokyo, Japan) or indirect CAD/CAM restorations (composite Cerasmart 270 and glass ceramic LiSi Block from GC). One hundred (n = 10/group) central incisors were cut and divided into 10 experimental groups restored with different approaches. In approach A, teeth were restored with a core build-up composite (Gradia Core, GC) for a core and full crown of PFC. Approach B had teeth restored using composite core and prefabricated fiber posts, and a complete crown of either PFC or CAD/CAM. Approach C contained teeth restored with a core of short fiber-reinforced composite (everX Flow, GC) and prefabricated fiber posts, and a complete crown of either PFC or CAD/CAM. In approach D, the teeth had a core of short fiber-reinforced composite only, and a complete crown of either PFC or CAD/CAM restorations. The root canals were prepared, and when posts were used, they were luted with either a dual-cure resin cement (LinkForce, GC) or everX Flow. As the control, sound teeth (n = 10) were used. Restorations were quasi-statically loaded until fracture. Failure type was visually investigated. The interface between the fiber post and luting cement was investigated using SEM, before and after completion of the loading test. The data were analyzed by analysis of variance (p = 0.05) followed by Tukey's test. None of the restorative approaches restored the fracture load strength of intact teeth (p < 0.05). Restorations with additional fiber posts (Approaches B and C) had higher load-bearing capacity (p < 0.05) than restorations without fiber posts (Approaches A and D). Restorations that had short fiber-reinforced composite cores with or without fiber posts presented more repairable failures. Using short fiber-reinforced composite as post-luting and core build-up material with conventional fiber posts proved to be a promising method to strengthen severely damaged incisors.

Influence of short-fiber composite base on fracture behavior of direct and indirect restorations

Objectives

The aim was to examine the influence of short-fiber composite (SFC) core on the fracture-behavior of different types of indirect posterior restorations. In addition, the effect of thickness ratio of SFC-core to the thickness of the veneering conventional composite (PFC) on fracture-behavior of bi-structured composite restorations was evaluated.

Materials and methods

MOD cavities with removed palatal cusps were prepared on 90 intact molars. Five groups of direct overlay restorations (n = 10/group) were fabricated having a SFC-core (everX Flow) with various thicknesses (0, 1, 2, 3, 4 mm) and layer of surface PFC (G-aenial Anterior), remaining the thickness of the bi-structure restoration to be 5 mm. Four groups of CAD/CAM-made restorations (Cerasmart 270 and e-max CAD) were fabricated either with 2-mm layer of SFC-core or without fiber reinforcement. Intact teeth (n = 10) were used as control group. Restorations were statically loaded until fracture. Fracture patterns were evaluated visually. Data were analyzed using ANOVA (p = 0.05).

Results

With indirect overlay restorations, no statistically significant differences (p > 0.05) were observed in the load-bearing capacities between restorations reinforced by 2-mm SFC-core (bi-structured) and those fabricated from plain restorative materials. ANOVA displayed that direct overlay restorations made from 4-mm layer thickness of SFC-core had significantly higher load-bearing capacities (3050 ± 574 N) (p < 0.05) among all the groups tested.

Conclusions

Restorations (direct/indirect) combining SFC-core and a surface layer of conventional material demonstrated encouraging achievement in reference to fracture behavior.

Clinical relevance

The use of flowable short-fiber composite as reinforcing base with large direct and indirect restorations may result in more repairable failure.

Characterization of restorative short-fiber reinforced dental composites

The aim was to evaluate and compare certain physical properties including surface-wear of five commercial short fiber-reinforced composites (SFRCs; Alert, NovaPro-Flow, NovaPro-Fill, everX Flow and everX Posterior). The following properties were examined according to ISO: flexural strength, flexural modulus, fracture toughness, water sorption. Degree of conversion was determined by FTIR-spectrometry. A wear test was conducted with 15,000 chewing-cycles using a chewing-simulator. Polymerization shrinkage-stress was measured using tensilometer. SEM was used to evaluate the microstructure of SFRCs. everX Flow exhibited the highest fracture toughness (2.8 MPa m^1/2) and the lowest wear depth (20.4 µm) values (p<0.05) among the SFRCs tested. NovaPro Fill (141.5 MPa) and everX Flow (147 MPa) presented the highest flexural strength values (p<0.05). everX Flow showed the highest shrinkage-stress value (5.3 MPa) while other SFRCs had comparable values. The use of SFRCs in dentistry can be advantageous, but special attention should be given to the selection of the materials.

Fatigue behavior and damage modes of high performance poly-ether-ketone-ketone PEKK bilayered crowns

OBJECTIVES

To evaluate and compare the fatigue behavior (fatigue limit and fatigue life) and damage modes of high-performance poly-ether-ketone-ketone (PEKK), zirconia and alloy bilayered crowns.

MATERIALS AND METHODS

A total of 110 crowns (n = 50 for fatigue limit and n = 60 for fatigue life) were fabricated and used in this study. Pekkton® ivory discs, yttrium stabilized zirconia blanks and NiCr casting alloy were used to produce the respective PEKK, zirconia and alloy copings for crown fabrication. The prepared crowns were veneered with composite resin and subjected to fatigue tests. The fatigue limit was evaluated using the staircase method and the fatigue life of the samples was evaluated by subjecting the crowns to a load lower than the fatigue limit of that particular group, and also with an intermediate load of 522 N. A graphical plot was generated from the shape parameter (β) and life parameter (α) values obtained through the Weibull analysis method. Kruskal-Wallis and Mann-Whitney tests were applied to determine the significance differences in the recorded fracture mode between the study groups. The damage modes of the samples were assessed using Burke's classification.

RESULTS

The recorded fatigue limits of the groups were 442.8 ± 42.1 N, 608.7 ± 7.6 N, and 790.4 ± 29.2 N for zirconia, NiCr and PEKK, respectively. A significant difference in the fatigue limit of the groups was observed (p < 0.05). PEKK samples demonstrated the highest survival cycles of 1,170,000 and the lowest survival cycles was observed with zirconia samples at 100,000 under 522 N loading. The fracture modes in PEKK samples were largely distributed between code 1 and 2 whereas the fracture modes in NiCr group was distributed between code 1 and 4 and YZ crowns exhibited more of code 5 fractures. The difference in fracture modes among the groups was statistically significant (p < 0.05).

CONCLUSION

The PEKK group demonstrated better results compared to zirconia and NiCr based crowns. The PEKK group demonstrated high fatigue limit and survived the highest fatigue life cycles among the tested groups.

Bilayered composite restoration: the effect of layer thickness on fracture behavior

Purpose: By combining the increased toughness of a resin composite reinforced with discontinuous fibers and the surface wear resistance of a particulate filler composite (PFC), a bilayered composite technique was recently introduced. This study aimed to evaluate the effect of the thickness of the overlaying PFC placed over a fiber-reinforced composite (FRC) core, on the fracture-behavior of direct crown restorations. Methods: Six groups of posterior crown restorations (n = 8/group) were fabricated having a discontinuous FRC-core (everX Flow) and a layer of surface PFC (Essentia U) with various thicknesses (0.5, 1.0, 1.5, 2.0 mm), with the remaining thickness of the bilayered being 6 mm. Control groups were only made of PFC or FRC materials. Restorations were statically loaded until fracture. Failure-modes were visually examined. Data were analyzed using ANOVA (p = .05) and regression analysis. Results: The regression analysis showed that by decreasing the thickness of PFC layer, the load bearing capacity of restorations increased linearly (R²=0.7909). ANOVA revealed that crown restorations made only from everX Flow composite had significantly higher load-bearing capacities (3990 ± 331 N) (p < .05) among all the groups tested. With regard to the failure-mode analysis, crowns that had a FRC core material of everX Flow revealed delamination of the PFC surface composite from the core. Crowns which were made only of PFC i.e. with no fiber reinforcement, showed a crushing-like fracture pattern. Conclusions: Restorations combining a thick FRC-core and a thin surface layer of PFC (0.5-1 mm), displayed promising performance related to fracture-behavior and load-bearing capacity.

Fracture behavior of Bi-structure fiber-reinforced composite restorations

OBJECTIVE

The aim of this study was to evaluate the fracture-behavior of direct composite restorations made with two different composite-core materials. In addition, fracture toughness (FT), flexural strength (FS) and flexural modulus (FM) of tested composites were evaluated.

METHODS

Twenty groups of posterior crown restorations were fabricated (n = 6/group). The groups were made of a 4-5 mm layer of composite-core materials (everX Flow and SDR Flow⁺) and covered by a 2 mm layer of conventional composite (G-aenial Anterior & Posterior, G-aenial Universal Injectable, Essentia, CeramX, Filtek Z500). Control groups were only made of conventional composites or composite-core materials. Crowns were statically loaded until fracture. Failure-modes were then visually examined. FT, FS and FM were determined for each tested composite (n = 6).

RESULTS

ANOVA revealed that crown restorations made only from everX Flow composite had significantly higher load-bearing capacities (3866 ± 263 N) (p < 0.05) among all the groups tested. No statistically significant differences were found in the load-bearing capacities between crowns made with different composite-core materials (p > 0.05). everX Flow exhibited the highest FT (2.8 MPa m^1/2) and Z500 presented the highest FS values (197 MPa) (p < 0.05) among tested composites. With regard to the failure-mode analysis, crowns that had a fiber-reinforced core material of everX Flow revealed delaminating of surface conventional composite from the substructure layer. While in crowns that had a core material of SDR Flow⁺ or having only conventional composites with no fiber reinforcement, showed a crushing fracture pattern.

CONCLUSION

Restorations combining a fiber-reinforced composite core and a surface layer of conventional composite, displayed promising performance related to fracture-behavior.

Load-Bearing Capacity of Zirconia Crowns Screwed to Multi-Unit Abutments with and without a Titanium Base: An In Vitro Pilot Study

The static and dynamic load-bearing capacities and failure modes of zirconia crowns screwed to multi-unit abutments (MUAs) with and without a titanium base (T-base) were determined. Thirty-six monolithic zirconia crowns screwed to straight MUAs torqued to laboratory analogs (30 Ncm) were assigned to two groups (n = 18). In group A, the zirconia crowns were screwed directly to the MUAs; in group B, the zirconia crowns were cemented to the T-base and screwed to the MUAs. All specimens were aged in 100% humidity (37 °C) for one month and subjected to thermocycling (20,000 cycles). Afterwards, the specimens underwent static and dynamic loading tests following ISO 14801. The failure modes were evaluated by stereomicroscopy (20×). There was an unequivocally similar trend in the S-N plots of both specimen groups. The load at which the specimens survived 5,000,000 cycles was 250 N for both groups. Group A failed mainly within the metal, and zirconia failure occurred only at a high loading force. Group B exhibited failure within the metal mostly in conjunction with adhesive failure between the zirconia and T-base. Zirconia restoration screwed directly to an MUA is a viable option, but further studies with larger sample sizes are warranted.

Fracture behaviour of MOD restorations reinforced by various fibre-reinforced techniques - An in vitro study

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.

Fracture resistance and marginal gap formation of post-core restorations: influence of different fiber-reinforced composites

OBJECTIVES

The aim was to explore the fracture behavior and marginal gap within the root canal of endodontically treated (ET) premolars restored with different fiber-reinforced post-core composites (FRCs). Further aim was to evaluate the composite curing at different depths in the canal.

MATERIALS AND METHODS

Eighty-seven intact upper premolars were collected and randomly divided into six groups. After endodontic procedure, standard MOD cavities were prepared and restored with their respective fiber-reinforced post-core materials: group 1: prefabricated unidirectional FRC-post + conventional composite core; group 2: prefabricated unidirectional FRC-post + short fiber composite (SFRC) core; group 3: individually formed unidirectional FRC-post + conventional composite core; group 4: randomly oriented SFRC directly layered as post and core; group 5: individually formed unidirectional FRC + randomly oriented SFRC as post and core. After restorations were completed, teeth (n = 3/group) were sectioned and then stained. Specimens were viewed under a stereo microscope and the percentage of microgaps within the root canal was calculated. Fracture load was measured using universal testing machine.

RESULTS

SFRC application in the root canal (groups 4 and 5) showed significantly higher fracture load (876.7 N) compared to the other tested groups (512-613 N) (p < 0.05). Post/core restorations made from prefabricated FRC-post (group 1) exhibited the highest number of microgaps (35.1%) at the examined interphase in the root canal.

CONCLUSIONS

The restoration of ET premolars with the use of SFRC as post-core material displayed promising performance in matter of microgap and load-bearing capacity.

CLINICAL SIGNIFICANCE

Fracture resistance of ET premolar restored by bilayered composite restoration that includes both SFRC as post-core material and surface conventional resin seems to be beneficial.

Recent advances in understanding the fatigue and wear behavior of dental composites and ceramics

Dental composite and ceramic restorative materials are designed to closely mimic the aesthetics and function of natural tooth tissue, and their longevity in the oral environment depends to a large degree on their fatigue and wear properties. The purpose of this review is to highlight some recent advances in our understanding of fatigue and wear mechanisms, and how they contribute to restoration failures in the complex oral environment. Overall, fatigue and wear processes are found to be closely related, with wear of dental ceramic occlusal surfaces providing initiation sites for fatigue failures, and subsurface fatigue crack propagation driving key wear mechanisms for composites, ceramics, and enamel. Furthermore, both fatigue and wear of composite restorations may be important in enabling secondary caries formation, which is the leading cause of composite restoration failures. Overall, developing a mechanistic description of fatigue, wear, and secondary caries formation, along with understanding the interconnectivity of all three processes, are together seen as essential keys to successfully using in vitro studies to predict in vivo outcomes and develop improved dental restorative materials.

An overview of development and status of fiber-reinforced composites as dental and medical biomaterials

Fibr-reinforced composites (FRC) have been used successfully for decades in many fields of science and engineering applications. Benefits of FRCs relate to physical properties of FRCs and versatile production methods, which can be utilized. Conventional hand lamination of prefabricated FRC prepregs is utilized still most commonly in fabrication of dental FRC devices but CAD-CAM systems are to be come for use in certain production steps of dental constructions and medical FRC implants. Although metals, ceramics and particulate filler resin composites have successfully been used as dental and medical biomaterials for decades, devices made out of these materials do not meet all clinical requirements. Only little attention has been paid to FRCs as dental materials and majority of the research in dental field has been focusing on particulate filler resin composites and in medical biomaterial research to biodegradable polymers. This is paradoxical because FRCs can potentially resolve many of the problems related to traditional isotropic dental and medical materials. This overview reviews the rationale and status of using biostable glass FRC in applications from restorative and prosthetic dentistry to cranial surgery. The overview highlights also the critical material based factors and clinical requirement for the succesfull use of FRCs in dental reconstructions.

Mechanical properties and fracture behavior of flowable fiber reinforced composite restorations

OBJECTIVE

The aim was to evaluate the effect of short glass-fiber/filler particles proportion on fracture toughness (FT) and flexural strength (FS) of an experimental flowable fiber-reinforced composite (Exp-SFRC) with two methacrylate resin formulations. In addition, we wanted to investigate how the fracture-behavior of composite restorations affected by FT values of SFRC-substructure.

METHODS

Exp-SFRC was prepared by mixing 50wt% of dimethacrylate based resin matrix (bisGMA or UDMA based) to 50wt% of various weight fractions of glass-fiber/particulate filler (0:50, 10:40, 20:30, 30:20, 40:10, 50:0wt%, respectively). FT and FS were determined for each experimental material following standards. Specimens (n=8) were dry stored (37°C for 2 days) before they were tested. Four groups of posterior composite crowns (n=6) composed of different Exp-SFRCs as substructure and surface layer of commercial particulate filler composite were fabricated. Crowns were statically loaded until fracture. Failure modes were visually examined. The results were statistically analysed using ANOVA followed by post hoc Tukey's test.

RESULTS

ANOVA revealed that ratio of glass-fiber/particulate filler had significant effect (p<0.05) on tested mechanical properties of the Exp-SFRC with both monomer systems. Exp-SFRC (50wt%) had significantly higher FT (2.6MPam^1/2) and FS (175.5MPa) (p<0.05) compared to non-reinforced material (1.3MPam^1/2, 123MPa). Failure mode analysis of crown restorations revealed that FT value of the substructure directly influenced the failure mode.

SIGNIFICANCE

This study shows that short glass-fibers can significantly reinforce flowable composite resin and the FT value of SFRC-substructure has prior importance, as it influences the crack arresting mechanism.

METHODS FOR THE CHARACTERIZATION OF THE LONG-TERM MECHANICAL PERFORMANCE OF CEMENTS FOR VERTEBROPLASTY AND KYPHOPLASTY: CRITICAL REVIEW AND SUGGESTIONS FOR TEST METHODS

There is a growing interest towards bone cements for use in vertebroplasty and kyphoplasty, as such spine procedures are becoming more and more common. Such cements feature different compositions, including both traditional acrylic cements and resorbable and bioactive materials. Due to the different compositions and intended use, the mechanical requirements of cements for spinal applications differ from those of traditional cements used in joint replacement. Because of the great clinical implications, it is very important to assess their long-term mechanical competence in terms of fatigue strength and creep. This paper aims at offering a critical overview of the methods currently adopted for such mechanical tests. The existing international standards and guidelines and the literature were searched for publications relevant to fatigue and creep of cements for vertebroplasty and kyphoplasty. While standard methods are available for traditional bone cements in general, no standard indicates specific methods or acceptance criteria for fatigue and creep of cements for vertebroplasty and kyphoplasty. Similarly, a large number of papers were published on cements for joint replacements, but only few cover fatigue and creep of cements for vertebroplasty and kyphoplasty. Furthermore, the literature was analyzed to provide some indications of tests parameters and acceptance criteria (number of cycles, duration in time, stress levels, acceptable amount of creep) for possible tests specifically relevant to cements for spinal applications.

Fracture behavior of single-structure fiber-reinforced composite restorations

Objective: The applications of single-structure fiber-reinforced composite (FRC) in restorative dentistry have not been well reported. This study aimed to clarify the static mechanical properties of anterior crown restorations prepared using two types of single-structure FRC. Materials and methods: An experimental crown restoration was designed for an upper anterior incisor. The restorations were made from IPS Empress CAD for CEREC (Emp), IPS e.max^® CAD (eMx), experimental single-structure all-FRC (a-FRC), Filtek™ Supreme XTE (XTE), and commercially available single-structure short-FRC (everX Posterior™) (n = 8 for each material) (s-FRC). The a-FRC restorations were prepared from an experimental FRC blank using a computer-aided design and manufacturing (CAD/CAM) device. A fracture test was performed to assess the fracture load, toughness, and failure mode. The fracture loads were vertically applied on the restorations. The surface micromorphology of the FRC restorations was observed by scanning electron microscopy (SEM). The data were analyzed by analysis of variance (p = .05) followed by Tukey's test. Results: s-FRC showed the highest mean fracture load (1145.0 ± 89.6 N) and toughness (26.2 ± 5.8 Ncm) among all the groups tested. With regard to the micromorphology of the prosthetic surface, local crushing of the fiberglass was observed in s-FRC, whereas chopped fiberglass was observed in a-FRC. Conclusions: The restorations made of short-FRC showed a higher load-bearing capacity than those made of the experimental all-FRC blanks for CAD/CAM. The brittle-like fractures were exhibited in the recent dental esthetic materials, while local crushing fractures were shown for single-structure FRC restorations.

In Vitro Fatigue Resistance of Teeth Restored With Bulk Fill versus Conventional Composite Resin

The aim of this study was to compare the fatigue resistance of restored teeth with bulk fill composite resin, conventional composite resin with incremental insertion and unprepared sound teeth. Twenty-eight extracted maxillary premolars were selected and divided into 4 groups based on composite resin and insertion technique: control (C), conventional composite resin with incremental insertion (I) and bulk fill composite resin with three (BF3) or single increment (BF1). The restored specimens were submitted to fatigue resistance test with a 5 Hz frequency. An initial application of 5,000 sinusoidal load cycles with a minimum force of 50 N and a maximum force of 200 N was used. Next, were applied stages of 30,000 load cycles with the maximum force increasing gradually: 400, 600, 800, 1000, 1200 and 1400 N. The test was concluded when 185,000 load cycles were achieved or the specimen failed. The fatigue resistance data were recorded for comparison, using the Kaplan-Meier survival curve and analyzed by log-rank test at 0.05 significance. Fractures were classified based on the position of the failure - above or below the cementoenamel junction (CEJ). Statistical analysis of the Kaplan-Meier survival curve and log-rank test showed a significant difference between groups (p=0.001). The fracture analysis demonstrated that only 28.58% of failures were below the CEJ in group C, while for groups I, BF1 and BF3 they were 42.85%, 85.71% and 85.71%, respectively. Teeth restored with composite bulk fill in both techniques present similar fatigue resistance values compared with those restored with a conventional incremental insertion of composite, while the fatigue strength values of unprepared sound teeth were higher. Furthermore, unprepared sound teeth showed a lower percentage of fractures below the CEJ.

The effect of short polyethylene fiber with different weight percentages on diametral tensile strength of conventional and resin modified glass ionomer cements

Background

The aim of this study was to investigate the effect of polyethylene fiber on diametral tensile strength of conventional and resin modified glass ionomer cements.

Material and Methods

60 specimens in 6 groups (n=10) were prepared. In group 1 conventional glass ionomer (Fuji GC) and in group 2 resin modified glass ionomer (Fuji LC) were as control groups. In group 3 and 4 conventional glass ionomers mixed with short polyethylene fibers in proportion of 1 wt% and 3 wt%, respectively. In fifth and sixth groups, resin modified glass ionomer and short polyethylene fibers were mixed in 1 and 3% wt, respectively. Samples were prepared in a round brass mold (6.5×2.5 mm). After thermo-cycling, the diametral tensile strength of the specimens were tested and data were analyzed with ANOVA and post-hoc tests (p<0.05).

Results

Diametral tensile strength of both conventional and resin modified glass ionomer cements increased after mixing with polyethylene fiber (p<0.001). Also, reinforcement occurred as the mixing percentage increased from 1% wt to 3% wt in either conventional and resin modified glass ionomer (p<0.001).

Conclusions

The polyethylene fiber was shown to have a significant positive influence on diametral tensile strength of two types of glass ionomers.

Key words:Conventional glass ionomer, diametral tensile strength, polyethylene fiber, resin modified glass ionomer.

Mechanical properties, fracture resistance, and fatigue limits of short fiber reinforced dental composite resin

STATEMENT OF PROBLEM

Cycling masticatory loads decrease the strength of particulate filler composites (PFCs) and initiate the failure process by fatigue. The life expectancy of a composite resin restoration under stress remains difficult to predict.

PURPOSE

The purpose of this study was to determine the fracture resistance and the compressive fatigue limits (CFL) of anterior crown restorations made of a short-fiber reinforced composite resin (SFC), to investigate selected mechanical properties of the material following standard test methods, and to observe their correlation with the CFL.

MATERIAL AND METHODS

Specimens (n=10) were fabricated either from SFC (everX Posterior, GC Corp) or PFC (G-ænial anterior, GC Corp). The properties investigated were flexural strength (FS), compression strength (CS), diametral-tensile strength (DTS), and single-edge-notched-bend fracture toughness (FT) following ISO standards. Fracture resistance was determined by static load (n=10) and the CFL at 10000 cycles was determined using a staircase approach (n=20), both on anterior composite resin crowns. The results were analyzed with 1-way ANOVA (α=.05) or 2-way ANOVA (α=.05) followed by a Tukey B post hoc test and the Pearson-correlation analysis.

RESULTS

The SFC crowns had higher fracture resistance (954 ±121 N) than the PFC crowns (415 ±75 N) (P<.001) and higher CFL (267 ±23 N) than the PFC crowns (135 ±64 N) (P<.001). SFC revealed also higher FT (2.6 ±0.6 MPa·m(1/2)) than the PFC (1.0 ±0.2 MPa·m(1/2)) (F=69.313, P<.001). A significant correlation was observed only between the FT and the CFL (r(2)=0.899; P<.001).

CONCLUSIONS

SFC crowns showed good performance under static and fatigue loading. FT was the only in vitro test method that filtered as a clinically relevant parameter.

The effect of a fiber reinforced cavity configuration on load bearing capacity and failure mode of endodontically treated molars restored with CAD/CAM resin composite overlay restorations

OBJECTIVES

To evaluate the fracture strength and the mode of failure of endodontically treated molars restored with CAD/CAM overlays with fiber reinforced composite build-up of the pulp chamber.

METHODS

40 Devitalized molars were cut over the CEJ and divided into five groups (n=8). The pulp chamber area was filled with: group 0 (control), no resin build-up; group 1, hybrid composite build-up (G-aenial posterior, GC); group 2, as in group 1 but covered with 3 nets of bi-directional E-glass fibers (EverStickNET, Stick Tech Ltd.); group 3, a FRC resin (EverX posterior, GC); group 4, as in group 3 but covered by the bi-directional fibers. The crowns were restored with CAD-CAM composite restorations (Lava Ultimate, 3M ESPE). Maximum fracture loads were recorded in Newton and data were analyzed using Kruskal-Wallis test (p<0.05). Fragments were analyzed using SEM.

RESULTS

The mean static loads in Newton were: group 0: 2448 (546); group 1: 2817 (873); group 2: 2128 (952); group 3: 2429 (1091); group 4: 2577 (833). No significant differences were found between the groups (p>0.05). All specimens fractured in a catastrophic way, under the CEJ. The main crack evolved in the corono-apical direction. In groups 2 and 4 secondary fracture paths with apico-coronal direction were detected close to the bi-directional fibers' layer.

CONCLUSIONS

For the restoration of endodontically treated molars, the incorporation of FRCs did not influence the load-bearing capacity of the tooth-restoration complex. The SEM analysis showed a low ability of the bi-directional fibers net in deviating the fracture but this effect was not sufficient to lead more favorable fracture patterns, over the CEJ.

CLINICAL SIGNIFICANCE

The use of FRCs to reinforce the "core" of devitalized molars against vertical fractures under static loads seems useless when the thickness of the CAD/CAM composite overlay restoration is high.

The effect of short fiber composite base on microleakage and load-bearing capacity of posterior restorations

Objectives: To determine the marginal microleakage of Class II restorations made with different composite base materials and the static load-bearing capacity of direct composite onlay restorations.

Methods: Class II cavities were prepared in 40 extracted molars. They were divided into five groups (n = 8/group) depending on composite base material used (everX Posterior, SDR, Tetric EvoFlow). After Class II restorations were completed, specimens were sectioned mid-sagitally. For each group, sectioned restorations were immersed in dye. Specimens were viewed under a stereo-microscope and the percentage of cavity leakage was calculated. Ten groups of onlay restorations were fabricated (n = 8/group); groups were made with composite base materials (everX Posterior, SDR, Tetric EvoFlow, Gradia Direct LoFlo) and covered by 1 mm layer of conventional (Tetric N-Ceram) or bulk fill (Tetric EvoCeram Bulk Fill) composites. Groups made only from conventional, bulk fill and short fiber composites were used as control. Specimens were statically loaded until fracture. Data were analyzed using ANOVA (p = 0.05).

Results: Microleakage of restorations made of plain conventional composite or short fiber composite base material showed statistically (p < 0.05) lower values compared to other groups. ANOVA revealed that onlay restorations made from short fiber-reinforced composite (FRC) as base or plain restoration had statistically significant higher load-bearing capacity (1593 N) (p < 0.05) than other restorations.

Conclusion: Restorations combining base of short FRC and surface layer of conventional composite displayed promising performance related to microleakage and load-bearing capacity.

Short fiber reinforced composite: a new alternative for direct onlay restorations

Objectives:

To determine the static load-bearing capacity of direct composite onlay restorations made of novel filling composite resin system which combines short fiber-reinforced composite resin (FC) and conventional particulate filler composite resin (PFC).

Methods:

Three groups of onlay restorations were fabricated (n = 8/group); Group A: made from conventional particulate filler composite resin (Z250, 3M-ESPE, USA, control), Group B: made from short fiber-reinforced composite resin (EverX posterior, StickTeck Ltd, member of GC group, Turku, Finland) as substructure with 1 mm surface layer of PFC, Group C: made from FC composite resin. The specimens were incrementally polymerized with a hand-light curing unit for 80 s before they were statically loaded with two different sizes (3 & 6 mm) of steel ball until fracture. Failure modes were visually examined. Data were analyzed using ANOVA (p = 0.05).

Results:

ANOVA revealed that onlay restorations made from FC composite resin had statistically significantly higher load-bearing capacity (1733 N) ( p < 0.05) than the control PFC composite resin (1081 N). Onlays made of FC composite resin with a surface layer of PFC gave force values of 1405 N which was statistically higher than control group ( p < 0.05). No statistically significant difference was found in the load-bearing capacity between groups loaded by different ball sizes

Significance:

Onlay restorations combining base of short fiber reinforced composite resin as substructure and surface layer of conventional composite resin displayed promising performance in high load bearing areas.

In vitro evaluation of ferrule effect and depth of post insertion on fracture resistance of fiber posts

Purpose. The analysis of the complex model of fiber post and ferrule is given and studied in this paper. A novel approach and a solution to the evaluation of stress of post and core system within the ferrule effect are proposed. Methods. Sixty freshly extracted premolars were selected for the study. The following experimental groups were therefore defined (n = 10): (1) 5 mm, (2) 7 mm, (3) 9 mm, (4) ferrule-5 mm, (5) ferrule-7 mm, and (6) ferrule-9 mm. Preshaping drills (C) were used to prepare the root canals at 5, 7, and 9 mm in depth. In specimens of groups 3–6 a circumferential collar of tooth structure of 2 mm in height. Fluorocore 2 core build-up material (I) was used for fiber post luting. With the same material, a buildup of 2 mm in height was created. A controlled compressive load (crosshead speed: 0.75 mm/min) was applied by means of a stainless steel stylus (Ø 1 mm) at the coronal end of the post extruding out of the root. Results. In all the tests the level of significance was set at P < 0.05 . Significantly higher fracture strengths were measured in the presence of a ferrule effect. In groups 1, 2, and 3 (ferrule group), the mean fracture values were, respectively, 163,8 N, 270,9 N, and 254,7 N. These data are higher and statistically significantly different when compared with the three groups 4, 5, and 6 (no-ferrule group), in which the values obtained were, respectively, 40,5 N, 41,7 N, and 44,9 N. Conclusion. The ferrule effect in the endodontically treated teeth positively affects the fracture strength of the fiber post. Conversely, post depth insertion did not affect the resistance to fracture.

The effects of environment and cyclic fatigue on the mechanical properties of an indirect composite

OBJECTIVES

The purpose of this study was to examine the flexure strength (σ) and fracture toughness (K(IC)) of three indirect dental composites (dentin, body, and incisal) with respect to loading (static and cyclic), testing environments (air and water) and ageing (0 (controls) and 6 months in air and water).

METHODS

The specimens were 3 mm × 3 mm × 25 mm bars with the fracture toughness specimens having a 0.75 mm notch machined in the midspan. Static testing utilized 15 bars and cyclic testing 25 bars for each testing variable. All bars were tested using three-point loading and the cyclic testing was for 1000 cycles using a staircase approach.

RESULTS

For flexure strength and fracture toughness, all specimen groups showed a decrease in mean values when exposed to cyclic loading as compared to the static loading mean and when exposed to ageing compared to the control specimens. ANOVA analysis demonstrated that dentin specimens had higher flexure strength and fracture toughness means than incisal and body specimens and that control and water specimens had higher flexure strength and fracture toughness means than aged and air specimens.

CONCLUSIONS

Degradation of these materials, as a result of cyclic loading and ageing in an aqueous environment, appears to be influenced by more than just the processing of the composite.

Effect of filler size and morphology on viscoelastic stability of resin-composites under dynamic loading

Effect of variation in filler particle size, morphology and wet conditioning on the viscoelastic stability of resin-composites under dynamic loading was investigated. Eight experimental light cured resin-composites were selected. For each of the eight resin-composites, ten cylindrical specimens (4 × 6 mm), divided into two subgroups (n = 5) were prepared. Group 1 and 2 were loaded dynamically after 1 day of dry storage and 1 week of wet storage, respectively. A cyclic load between 1 and 50 MPa was applied for both groups at a frequency of 0.25 Hz for 30 min to obtain the 'dynamic' creep strain (%). Data was analysed by univariate ANOVA. Unimodal spherical and irregular resin-composites showed a significant influence of particle size and shape on dynamic creep under dry condition, but not for wet conditions. Irregular filler particles in both unimodal and multimodal resin-composites were more resistant to dynamic creep under wet conditions and showed higher stiffness.

Preliminary clinical evaluation of short fiber-reinforced composite resin in posterior teeth: 12-months report

This preliminary clinical trial evaluated 12 month clinical performance of novel filling composite resin system which combines short fiber-reinforced composite resin and conventional particulate filler composite resin in high stress bearing applications. A total of 37 class I and II restorations (compound and complex type) were placed in 6 premolars and 31 molars. The restorations were reviewed clinically at 6 months (baseline) and 12 months using modified USPHS codes change criteria for marginal adaptation, post-operative sensitivity, pulpal pain and secondary caries criteria. Photographs and x-rays were obtained for restorative analysis. Results of 12 months evaluation showed 5 restorations having little marginal leakage (B score) and 1 patient had minor pulpal symptom and post-operative sensitivity (B score). No secondary caries or bulk fracture was detected. The majority of restorations exhibited A scores of the evaluated criteria. After 12 months, restorations combining base of short fiber reinforced composite resin as substructure and surface layer of hybrid composite resin displayed promising performance in high load bearing areas.

Effect of fiber orientation and type of restorative material on fracture strength of the tooth

Aim:

To determine the effect of fiber and its orientation on the fracture resistance of composite restorations in root-filled premolars.

Materials and Methods:

50 sound human premolars were collected and assigned to five groups of ten specimens each. In group 1 (control), specimens were not root-filled. In the other four groups, MOD cavities were prepared and the cusps were reduced to 1.5 mm. In groups 2 and 3, the samples were filled with Z-250 and spectrum composites respectively without fiber reinforcement. Groups 4 and 5 were reinforced with Fiber-Ribbon-(Angelus) and restored with spectrum composite. Fibers were placed in the U-shaped design in group 4 while they were placed in the cross-shape in occlusal region in group 5. The fracture resistance was tested using a mechanical testing machine at crosshead speed of 1mm/min.

Results:

The fracture strength of control group was 1271.16±722.04 N while it was 952.05±330.16 N for group 2, 918.52±256.6 N for group 3, 857.13±184.58 N for group 4 and 1138.81±406.64 N for group 5. Fracture strength of group 5 was more than other groups except for group 1, there was no statistically significant differences.

Conclusions:

The reinforcement of composite with fiber does not increase fracture resistance of root-filled premolars significantly.

Influence of nanometer scale particulate fillers on some properties of microfilled composite resin

The aim of this study was to evaluate the effect of different weight fractions of nanometer sized particulate filler on properties of microfilled composite resin. Composite resin was prepared by mixing 33 wt% of resin matrix to the 67 wt% of silane treated microfine silica particulate fillers with various fractions of nanometer sized fillers (0, 10, 15, 20, 30 wt%) using a high speed mixing machine. Test specimens made of the composites were tested with a three-point bending test with a speed of 1.0 mm/min until fracture. Surface microhardess (Vicker's microhardness) was also determined. The volumetric shrinkage in percent was calculated as a buoyancy change in distilled water by means of the Archimedes principle. The degree of monomer conversion (DC%) of the experimental composites containing different nanofiller fractions was measured using FTIR spectroscopy. Surface roughness (Ra) was determined using a surface profilometer. Nanowear measurements were carried out using a nanoindentation device. The water uptake of specimens was also measured. Parameters were statistically analysed by ANOVA (P < 0.05). The group without nanofillers showed the highest flexural strength and modulus, DC% and Ra value. The group with 30% nanofillers had the highest water uptake and volumetric shrinkage. No significant difference was found in Vicker's microhardness and the nanowear of the composites. The plain microfilled composite demonstrated superior properties compared to the composites loaded with nanofillers with the exception of surface roughness.