On crack growth in molar teeth from contact on the inclined occlusal surface

Evaluation of fracture behavior in short fiber-reinforced direct and indirect overlay restorations

OBJECTIVES

The aim was to assess how incorporating a short-fiber composite (SFC) core would affect the fracture behavior of direct and indirect overlays. Furthermore, to examine the relationship between the thickness ratio of SFC core to particulate-filled composite (PFC) veneering and the fracture-behavior of bilayered-structured restorations.

MATERIALS AND METHODS

A total of 120 molars were used to create MOD cavities, with palatal cusps removed. Four different groups of direct overlays were then made (n = 15/group), all of which featured a SFC core (everX Flow) with varying thicknesses (0, 1, 4, and 5 mm), as well as a surface layer of PFC (G-aenial Posterior), with the overall thickness of the bilayered-structured restoration set at 5 mm. Additionally, four groups of CAD/CAM restorations were created (Cerasmart 270 and Initial LiSi Block), with or without 2 mm of SFC core reinforcement. Following the fabrication of these restorations, cyclic fatigue aging was carried out for a total of 500,000 cycles, with an applied maximum load (Fmax) of 150 N. Subsequently, each restoration underwent quasi-static loading until fracture. The fracture mode was subsequently evaluated using optical microscopy and SEM.

RESULTS

There were no statistically significant differences (p > 0.05) observed in the fracture resistance of indirect overlays reinforced with a 2-mm SFC core compared to those made solely from restorative materials. Direct overlays constructed using plain SFC or with a 4-mm layer thickness of SFC core exhibited significantly higher fracture resistance values (2674 ± 465 and 2537 ± 561 N) (p < 0.05) when compared to all other groups tested, according to the statistical analysis ANOVA.

CONCLUSIONS

The most effective method for restoring large MOD cavities was found to be direct restoration using SFC either alone or as a bulk core in combination with PFC composite.

CLINICAL RELEVANCE

The use of SFC as bulk reinforcing base will significantly improve the loading performance of directly layered restorations.

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

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.

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.

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.

Influence of Cusp Inclination and Type of Retention on Fracture Load of Implant-Supported Crowns

There are few informations about the influence of cusp inclination on the fracture strength of implant-supported crowns. The study aimed to evaluate the influence of cusp inclination and retention type on fracture load in implant-supported metal-ceramic single crowns. Sixty crowns were made, classified as cemented and screw-retained with screw access hole (SAH) sealed or not. Standard (33°) and reduced (20°) cusp inclinations were tested for each group (n=10). To support crowns of a mandibular second molar, analogs of external hexagon implants 5.0 were used. The fracture load was measured in a universal testing machine EMIC DL2000 (10 kN load cell; 0.5 mm/min). Two-way ANOVA (retention and cusp inclination) followed by post hoc Tukey's honest significant difference test was used for the statistical analyses (a=0.05). Crowns with reduced cusp inclination exhibited significantly higher fracture load (p<0.01) than crowns with standard cusp inclination. Cemented crowns showed significantly higher fracture load (p<0.01) than screw-retained crowns. The interaction among these factors was not significant (p>0.05) for the fracture load. The sealing of SAH did not influence the fracture load of screw-retained crowns (p>0.05). In conclusion, fracture load of implant-supported metal-ceramic crowns was influenced by retention and cusp inclination, and there was no influence of the sealing of SAH.

On the importance of aging to the crack growth resistance of human enamel

With improvements in oral health and an overall increase in quality of life, the percentage of fully or largely dentate seniors is increasing. Understanding the effects of aging on the mechanical properties of teeth is essential to the maintenance of lifelong oral health. In this investigation the effects of aging on the fracture toughness of human enamel were evaluated from incremental crack growth experiments performed on tissue of donor teeth representing "young" (17 ⩽ age ⩽ 25) and "old" (age ⩾ 55) age groups. Results showed that the old enamel exhibited significantly lower resistance to fracture than that of the young tissue in two orthogonal directions of crack growth. For crack growth transverse to the enamel rods, the fracture toughness of the old enamel (0.37 ± 0.15 MPa m(0.5)) was nearly 70% lower than that of tissue from the young teeth (1.23 ± 0.20 MPa m(0.5)). Based on results from a mechanistic analysis of crack growth, the reduction in fracture resistance is attributed to a decrease in the degree of extrinsic toughening. The practice of restorative dentistry should account for these changes in tooth tissues in the treatment of senior patients.

STATEMENT OF SIGNIFICANCE

The mechanical behavior of enamel has been studied for over 3 decades. Due to the limited volume of tissue available for evaluation, past work has been largely based on indentation methods. In this investigation we have evaluated the resistance to fracture of human enamel using a conventional fracture mechanics approach and incremental crack growth. We compared the fracture resistance of cuspal enamel obtained from the teeth of representative "young" and "old" donor groups. Our results show that there is a substantial reduction in the resistance to fracture with age, that it is anisotropic, and that the degradation is more severe than that which occurs to dentin. As such, we feel this work is a significant contribution to the field.