Effect of a new restoration technique on fracture resistance of endodontically treated teeth

The effect of ferrule and core material on fracture resistance of endodontically treated anterior teeth restored with ceramic crowns after artificial aging

OBJECTIVES

To assess the influence of ferrule and core type on the fracture strength of endodontically treated anterior teeth (ETAT) and identify the failure mode type and distribution across different core types and ferrule conditions.

METHODS

Sixty extracted human central incisors were endodontically treated, decoronated and divided into two main groups (F=with ferrule, NF=no ferrule). Each main group was further subdivided into three subgroups according to the core material used: direct composite cores (DC), Ribbond fibre-reinforced composite cores (RIB-DC), and glass fibre post (GFP) with direct composite cores (GFP-DC). All specimens received E.max crowns and underwent thermal cycling and cyclic loading. Subsequently, the fracture resistance was tested with static loads applied to the crown restoration. Two-Way ANOVA and Chi square tests identified significant differences among the groups (p < 0.05).

RESULTS

The means and standard deviations (SD) of fracture loads in Newtons (N) for specimens in the F subgroups were RIB-DC: 465.0 (104.20), GFP-DC: 367.6 (79.59), DC: 275.8 (68.48), and in NF subgroups were RIB-DC: 110.8 (24.33), GFP-DC: 95.6 (25.47), DC: 67.4 (7.46). Specimens with ferrule yielded significantly higher fracture loads than those without ferrule (p = 0.0054). In the F groups, fracture loads of specimens with RIB-DC cores were significantly higher than those with GFP-DC (p = 0.0019) and those with DC (p = 0.0001). Moreover, fracture loads for the GFP-DC were significantly higher than those for the DC (p = 0.0026). The GFP-DC specimens showed the highest incidence of catastrophic failures (p = 0.0420).

CONCLUSIONS

Using fibre-reinforced composite (FRC) cores significantly increased fracture resistance in ETAT with ferrule. The failure modes repairable and possibly repairable were dominant in most specimens.

CLINICAL SIGNIFICANCE

When restoring ETAT with insufficient coronal tooth structure, preserving 2 mm of tooth structure ferrule and preparing cores with FRC can increase fracture resistance and reduce the incidence of non-repairable catastrophic fractures of teeth.

Stress Distribution of Endodontically Treated Tooth MOD Cavity Restored with Ribbon Fiber-Reinforced Composite (Wallpapering Technique) Using Finite Element Method

Purpose

This research aimed to describe the stress distribution of an endodontically treated tooth with a mesio-occluso-distal (MOD) cavity restored with direct composite reinforced with polyethylene and e-glass ribbon fiber.

Methods

This research was a descriptive study using the finite element method. A 3D model of the mandibular first molar solid after endodontic treatment with class II MOD preparation was prepared using Solidworks software. Finite element simulation was carried out using Abaqus software. In the first simulation, 180 N force was applied (vertically 90° perpendicular to the occlusal surface) at four points of loading: the tip of the mesiobuccal and distobuccal cusp, central fossa, and distal marginal ridge. For the second simulation, a 100 N force was applied at a 45° lateral angle to the occlusal surface at two loading points: the lingual slope of the mesiobuccal and distobuccal cusp.

Results

This study showed that the stress concentration was located in the occlusal pit and fissure, CEJ distal area, bifurcation in dentin, and the 1/3 cervical area of root dentin. The stress value generated after vertical and lateral force did not exceed the tooth and restoration's compressive and tensile strength value. The failure occurred at the interface of enamel and composite near the loading point area due to vertical load, both on polyethylene and e-glass fiber ribbon-reinforced composite restoration. Stress distribution of an endodontically treated tooth with a MOD cavity restored with ribbon fiber-reinforced composite using the finite element method showed that the highest stress concentration occurred on the surface close to the loading point, in narrow, concave, and sharp areas, and more apically for endodontically treated teeth.

Conclusion

Neither the tooth nor restoration failed after vertical and horizontal loads. The interface between enamel and composite on the occlusal surface failed.

Biomimetic approach to strengthen the incisal fracture composite build-up: an in vitro study

OBJECTIVE

Incisal composite build-up shows a high failure susceptibility. The incorporation of fiber-reinforced composite (FRC) during composite restoration could improve its strength. Hence the study was planned to compare the effect of various positions of FRC on the strength of composite resin incisal build-ups.

METHODS

In maxillary incisors (n = 90), 3 mm of the incisal edge was cut and teeth were categorized into three groups based on the location and number of fibers used during incisal composite build-up - Group I: composite resin; Group II: composite resin and a single fiber palatally and Group III: composite resin along with two fibers palatally.

RESULTS

The data showed that group II had the maximum load-bearing values followed by group I and group III.

CONCLUSION

Within the confines of our study, it can be concluded that the addition of FRC to the conventional incisal composite build-up increased the overall strength restoration. Such composite restoration reinforced with a single fiber on the palatal side showed the highest load-bearing capacity compared to two fibers reinforced and unreinforced composites. The common mode of failure in group I was in composite resin, in two fibers reinforced at fibers-composite junction, and in one fiber reinforced composite was in the remaining part of the tooth.

Effect of Different Silane Coupling Agents on the Bond Strength between Hydrogen Peroxide-Etched Epoxy-Based- Fiber-Reinforced Post and Composite Resin Core

The aim of the study was to evaluate the effect of various silane coupling agents on the micro-push-out bond strength between a hydrogen peroxide-etched epoxy-based fiber-reinforced post and composite resin core. Seventy-five cross-linked epoxy-based fiber-reinforced posts were etched with 24% hydrogen peroxide for 10 min. Then they were divided into five groups according to various silane coupling agents and bonded to a composite core. A Universal Testing Machine was utilized to evaluate the push-out bond strength. In addition, all groups' modes of failure were assessed. The push-out bond strength data in MPa were analyzed using ANOVA and a Tukey HSD post hoc test to reveal any difference between the groups. Results revealed that the application of a two-bottle silane coupling agent exhibited the highest bond strength, while the application of a one-bottle silane coupling agent demonstrated the lowest bond strength for a hydrogen peroxide-etched fiber post bonded to a composite core material, which was statistically significant (p < 0.05). The strongest association with the highest bond strength was found with the two-bottle silane coupling agent when compared to the one-bottle. The study highlighted that the application of a silane-coupling agent may affect the bond strength between composite and epoxy-based fiber-reinforced posts.

Fracture Load of Mesio-Occluso-Distal Composite Restorations Performed with Different Reinforcement Techniques: An In Vitro Study

BACKGROUND

Mesio-occluso-distal (MOD) cavity preparations are often fragile due to the amount of tooth and carious structure removed. MOD cavities can often fracture if left unsupported.

AIM

The study investigated the maximum fracture load of mesi-occluso-distal cavities restored using direct composite resin restorations with various reinforcement techniques.

METHOD

Seventy-two freshly extracted, intact human posterior teeth were disinfected, checked, and prepared according to predetermined standards for mesio-occluso-distal cavity design (MOD). The teeth were assigned randomly into six groups. The first group was the control group restored conventionally with a nanohybrid composite resin (Group I). The other five groups were restored with a nanohybrid composite resin reinforced with different techniques: the ACTIVA BioACTIVE-Restorative and -Liner as a dentin substitute and layered with a nanohybrid composite (Group II); the everX Posterior composite resin layered with a nanohybrid composite (Group III); polyethylene fibers called "Ribbond" placed on both axial walls and the floor of the cavity, and layered with a nanohybrid composite (Group IV); polyethylene fibers placed on both axial walls and the floor of the cavity, and layered with the ACTIVA BioACTIVE-Restorative and -Liner as a dentin substitute and nanohybrid composite (Group V); and polyethylene fibers placed on both axial walls and the floor of the cavity and layered with the everX posterior composite resin and nanohybrid composite (Group VI). All teeth were subjected to thermocycling to simulate the oral environment. The maximum load was measured using a universal testing machine.

RESULTS

The highest maximum load was exhibited by Group III with the everX posterior composite resin, followed by Group IV, Group VI, Group I, Group II, and Group V. A statistically significant difference was demonstrated between groups (p = 0.0023). When adjusting for multiple comparisons, there were statistical differences specific to comparisons between Group III versus I, Group III versus II, Group IV versus II, and Group V versus III.

CONCLUSIONS

Within the limitations of the current study, it can be concluded that a higher maximum load resistance can be achieved (statistically significant) when reinforcing nanohybrid composite resin MOD restorations with everX Posterior.

Fracture Resistance of Endodontically Treated Maxillary Premolar Teeth Restored with Wallpapering Technique: A Comparative In Vitro Study

Objectives

This in vitro study aimed to evaluate and compare the fracture resistance and mode of failure of endodontically treated maxillary premolar teeth restored with different direct composite restorative techniques.

Materials and Methods

Forty freshly extracted maxillary premolar teeth with comparable sizes were used in this in vitro study. Each tooth received mesio-occluso-distal cavity preparation (3 mm width and 6 mm depth) followed by endodontic treatment. Canals were instrumented with RACE EVO rotary files (FKG, Dentaire, Switzerland) up to MAF 25/.06. Canals were obturated using a single cone technique, then the teeth were divided arbitrarily into five groups (n = 8): Group A: direct composite resin only using a centripetal technique, Group B: direct composite resin with glass fiber post, Group C: direct composite resin with short fiber-reinforced composite (everX Flow), Group D: direct composite resin with leno wave ultra high molecular weight polyethylene (LWUHMWPE) fibers placed on cavity floor, and Group E: direct composite resin with LWUHMWPE fibers placed circumferentially around the cavity walls (wallpapering technique). The teeth were then stored in distilled water at 37°C for 24 hr. The fracture resistance of each sample was measured using a universal testing machine in Newton (N). The data were analyzed using one-way analysis of variance (ANOVA) and the Bonferroni test with a significance level of 0.05.

Results

Group E recorded the maximum mean of fracture load (2,139.375 N), while Group A recorded the minimum mean of fracture load (689.6250 N). The one-way ANOVA test revealed a significant difference between the groups. The Bonferroni test showed a significant difference between each two groups, with the exception of those between Groups B and C and between Groups D and E, where there were no statistically significant differences (p > 0.05).

Conclusion

Restoration of endodontically treated teeth using the wallpapering technique recorded the highest mean of fracture resistance with a repairable mode of fracture.

Evaluation of Fracture Strength of Fiber-Reinforced Direct Composite Resin Restorations: An In Vitro Study

This in vitro study aimed to compare the fracture strength of direct non-reinforced class II composite resin restorations and polyethylene fiber-reinforced restorations, and also to investigate the influence of the locations of polyethylene fibers within the cavity on the fracture strength. Sixty freshly extracted human teeth were disinfected and prepared (class II cavity design). The teeth were assigned randomly into four groups (n = 13). Group I (control) was restored with nano-hybrid composite resin. The other three experimental groups were restored with the same composite resin material reinforced by polyethylene fibers (Ribbond) at different locations. Fibers were placed either on the axial wall (Group II), on the gingival floor (Group III), or on the axial wall and pulpal/gingival floor (Group IV) of the proximal cavity. All the teeth were subjected to thermocycling to simulate the oral environment. The fracture strength was measured using a universal testing machine. Group IV had the highest mean fracture strength at maximum load (148.74 MPa), followed by Group II (140.73 MPa), Group III (136.34 MPa), and Group I (130.08 MPa), with a statistically significant difference from the control group (p = 0.008) but not between groups II and III.

Influence of Access Cavity Design on the Fracture Strength of Endodontically Treated Teeth Restored Using Short Fiber-Reinforced Composite and High Strength Posterior Glass Ionomer Cement

Aim: This in vitro study aimed to determine the influence of access cavity design and residual tooth structure and to compare the fracture resistance of the teeth post endodontically restored with short fiber-reinforced composite (GC everX Posterior; GC, India) and conventional posterior high-strength GIC (Glass Ionomer Cement) (GC Gold Label IX; GC, India).

Methods: Ninety extracted human mandibular molars were classified into five groups, i.e., one control group (n = 10) and four test groups based on the access cavity design (n = 20): Traditional access cavity (TAC), Conservative access cavity (CAC), Ninja access cavity (NAC), and Truss access cavity (TRAC). Then 80 teeth in test groups were endodontically treated and further subdivided (n = 10) based on post-endodontic restorative materials, i.e., short fiber-reinforced composite (SFC) and Type 9 GIC. Samples were then subjected to fracture resistance under a universal testing machine and fracture loads were compared statistically.

Results: The fracture resistance of various access cavity designs (TAC, CAC, NAC, and TRAC) varied significantly (P < .05). Regardless of access cavity design, teeth restored with SFC had higher fracture resistance than teeth restored with high strength posterior GIC (P = .001).

Conclusion: Using newer access cavity designs like (CAC, NAC, and TRAC) and reinforcing the teeth with a post-endodontic restoration such as SFC, fracture resistance of endodontically treated teeth can be improved notably. 

Comparison of Different Restoration Techniques for Endodontically Treated Teeth

The aim of the present study is to evaluate the physical properties of endodontically treated teeth restored with five different restorative techniques and materials. Hundred and forty extracted human molar teeth were used. In addition to five restoration groups, specimens with no restorations were used as the negative control, and intact molar teeth were used as the positive control. For flexural strength tests, material specimens were made from 5 different materials using a mould according to ISO 4049 standards. One-way ANOVA revealed that the fracture resistance was significantly affected by the restoration type. SFRC group showed the best fracture resistance values, while lowest values were seen in the GWF group. The test results of flexural strength showed values between 140 and 184 MPa and modulus of elasticity between 6.33 and 18.89 GPa ( $p<0.05$ ). Under the limits of this study, results showed that SFRC can be used to increase the fracture resistance of ETT.

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.

Comparative evaluation of the effect of adhesive restorative composite resins on the reinforcement of peri-cervical dentin: An in vitro study

Background:

Peri-cervical dentin (PCD) and its reinforcement play a crucial role in the fracture resistance of root canal-treated teeth.

Aims:

The aim of this study was to compare the fracture resistance of dual-cure, nano-hybrid, and short-fiber reinforced composite resins restored PCD with conventional hybrid composite (CHC) resin restored endodontically treated mandibular premolars.

Settings and Design:

Academic, in vitro study.

Materials and Methods:

The prepared mandibular premolar samples were randomly divided into five groups of 10 each. In Group 1, teeth were left intact. The remaining 40 teeth were endodontically treated and obturated as follows: In Group 2, teeth were obturated with gutta-percha till cementoenamel junction and restored with CHC. Teeth in Groups 3, 4, and 5 were obturated to a depth of 5 mm from the cervical line and restored with dual-cure, nano-hybrid, and short-fiber reinforced composite resins, respectively. Fracture resistance was tested using a universal testing machine.

Statistical Analysis Used:

One-way analysis of variance and post hoc Tukey's test.

Results:

Short-fiber reinforced composite resin showed a significantly higher mean fracture resistance value compared with other experimental groups. The mean fracture resistance values were obtained as Group 1 > Group 5 > Group 4 > Group 3 > Group 2.

Conclusions:

Reinforcement with short-fiber reinforced composite showed significantly higher fracture resistance compared with nano-hybrid and dual-cure composite resins.

Influence of fiber insertion and different material type on stress distribution in endocrown restorations: a 3D-FEA study

The study aimed to evaluate the effects of fibers insertion and restorative material type on the stress distribution in endocrowns with finite element analysis. Five 3D models of first mandibular molars were created and restored as follows: (1) IN: intact tooth, (2) IPS-E: tooth restored with lithium disilicat ceramic endocrowns, (3) C-E: tooth restored with composite endocrowns, (4) IPS-E + F: lithium disilicate ceramic endocrowns + fiber, (5) C-E + F: composite endocrowns + fiber. Vertical masticatory load was imitated with finite element analysis. The equivalent stress of von Mises failure criterion (mvM) was calculated. The maximum mvM stress, enamel/crown, dentin and cement were compared among models and strength of the materials. Endocrowns presented a lower mvM stress level than intact tooth. In IPS-E, the mvM stress values in the crown and dentin were higher than C-E, while the mvM stress values in cement were higher in C-E group. Fibers insertion did not affect the stress level of IPS-E and C-E groups. In IPS model, fiber showed more stress absorption than C-E. The restorative material type changed the stress distribution of endocrown restorations. The fiber application did not affect the stress distribution in either endocrown group. But, more stress absorption was observed in fiber under IPS-E than C-E.

Influence of Methodological Variables on Fracture Strength Tests Results of Premolars with Different Number of Residual Walls. A Systematic Review with Meta-Analysis

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.

Effect of fibre-reinforced composite as a post-obturation restorative material on fracture resistance of endodontically treated teeth: A systematic review

Background

Fracture resistance of endodontically treated tooth is affected due to large cavity designs and access cavities and an appropriate material capable to resist fracture plays an important role. This review aims to evaluate the effect of fibre-reinforced composite (FRC) as a post-obturation material on fracture resistance of endodontically treated teeth.

Objectives

To systematically gather and evaluate the fracture resistance of fibre-reinforced composite as a post-obturation restorative material in endodontically treated teeth.

Data Sources

A systematic search was conducted using PubMed, Ebsco Host, Scopus, Google Scholar, Hinari and manual search library resources from 1st Jan 2000 to 30th November 2019 to identify appropriate studies.

Result

A total of 157 articles were examined out of which 55 articles were selected after reading the title. After removing the duplicates, 27 articles were screened for abstract and 1 article was eliminated as it did not meet the eligibility criteria. A thorough reading of the full text of the remaining 26 selected articles was assessed for eligibility. Amongst these, 1 article was then excluded from the study as the full text was not accessible. Lastly, 25 articles were included in the study.

Conclusion

FRC as a core material increases fracture resistance of endodontically treated teeth but they do not have the fracture resistance similar to the intact tooth. Both polyethylene and short fibre-reinforced composites showed greater fracture resistance when compared to glass FRC and restoration without reinforcement. Also, the fracture resistance increases if restored with FRC along with retention slots and are placed on the occlusal third surfaces of cavities. Also, favourable fractures were most commonly seen and it usually occurred at the level of enamel and dentin and adhesive fractures were seen.

Effect of Fiber Reinforcement Type on the Performance of Large Posterior Restorations: A Review of In Vitro Studies

To reinforce extensively prepared cavities, different types of fiber reinforcement are utilized. Polyethylene and glass fibers are the most commonly used fibers in that purpose; each type has its own advantages over the other type. Therefore, the aim of this study is to review the literature to evaluate and compare the influence of different fiber reinforcement types on the performance of posterior large composite restorations. Two independent authors performed a comprehensive literature search using MEDLINE/PubMed, Google Scholar, and a manual search for cross references until July 2021. Authors selected only studies that contain comparisons between glass (continuous or short) and polyethylene (woven) fiber-reinforced composites (FRCs) in posterior cavities of human teeth, and that report the effect of fiber inclusion on fracture resistance, microleakage, and marginal adaptation of restorations. A number of 2711 potentially relevant articles were obtained from the electronic search. After extensive assessment, 2696 articles were ineligible to be included in the review, and only 15 articles met the inclusion criteria. Four out of nine studies, which tested the fracture resistance of FRC restorations, revealed similar performance of the glass and polyethylene fibers. The rest of the studies (n = 5) revealed statistically significant differences between the two types of fiber reinforcement, with the majority showed superior reinforcement of glass fiber. Moreover, the reviewed studies revealed that, using fibers within the composite restorations would reduce the microleakage and improve the marginal adaptation of the restoration regardless of the fiber type. FRCs tend to strengthen the restorations of structurally compromised teeth and improve their performance compared to plain composite restorations.

Comparative Evaluation of Fracture Resistance of Endodontically Treated Teeth Restored with Different Core Build-up Materials: An In Vitro Study

The aim is to evaluate the fracture resistance of endodontically treated teeth restored with posterior direct composite (PRC) resin, bulk-fill composite resin, dual-cure composite (DCC) resin, and short fiber-reinforced composite (SFC) resin material.

Strengthening effect of different fiber placement designs on root canal treated and bleached premolars

To evaluate the strengthening effect of five different fibers with different placement designs in root canal treated and intracoronally bleached premolars. Seventy extracted single-rooted premolars were distributed into 7 groups (G1-G7). Group 1 (G1) included the intact (I) teeth as the negative control. Group 2 (G2) included root canal treated, intra-coronally bleached and composite (C) restored teeth as the positive control. In the other five test groups after root canal treatment the teeth were intra-coronally bleached and fiber materials were placed into standard MOD cavities in the following different designs: an intracanal rigid fiber/Reforpost (G3,RF), an intracanal flexible fiber/ Everstick (G4, FF), four intracanal flexible pin fibers/Dentapreg Pin (G5,PF), an intercuspal flexible fiber /Dentapreg SFU (G6, IF) or an intra-coronal horseshoe-shaped/ Dentapreg SFU (G7,CF). All cavities were filled with a microfilled resin composite. Fracture resistance was tested using a universal testing machine under a crosshead speed of 1 mm/minute. One-way ANOVA and Duncan's Multiple Range tests were used for statistical analysis. Fracture types were recorded. The fracture resistance values in descending order were G1(I): 1190.97 N > G6 (IF): 1138.78 N > G5 (PF): 942.45 N > G3 (RF): 737.40 N > G4 (FF):694.29 N > G2 (C): 611.83 N > G7 (CF): 542.78 N. There were statistically significant differences among the groups (p ≤ 0.05). In all groups, repairable coronal oblique fractures were mostly observed. Flexible fibers placed intercuspally exhibited a significantly better strengthening effect than those of the intracanal flexible and rigid fibers (p < 0.05).

The Effect of Different Cavity Designs and Temporary Filling Materials on the Fracture Resistance of Upper Premolars

INTRODUCTION

The aim of this study was to compare the fracture resistance of upper premolars undergoing root canal treatment that had been temporarily restored with 4 different temporary filling materials.

METHODS

This study was based on 120 extracted upper premolars. Eight teeth were left intact and served as the negative control group. Mesio-occluso-distal cavities with 2 different designs were prepared for the rest of the teeth (for group 1 a width of one third of the intercuspal distance and for group 2 a width of two thirds of the intercuspal distance). Then, the endodontic access cavities were prepared, and the root canals instrumented with Revo-S rotary files (MicroMega, Besancon, France). Thereafter, a total of 16 teeth consisting of 8 each from group 1 and group 2 served as the positive control group and did not have any temporary filling material. The teeth were randomly divided into 4 subgroups (n = 12) according to the temporary filling material: Cavit G (3M ESPE, St Paul, MN), Coltosol F (Coltène/Whaledent AG, Altstätten, Switzerland), Intermediate Restorative Material (Dentsply Sirona, Konstanz, Germany), or DiaTemp (DiaDent Europe BV, Almere, Netherlands). Each specimen was then subjected to a fracture resistance test using a universal testing machine until the fracture occurred. The force required to fracture each specimen was recorded, and the data were statistically analyzed.

RESULTS

The negative control group showed the highest fracture resistance values compared with the other groups, whereas the positive control groups showed the lowest fracture resistance values. There were no statistically significant differences in the fracture resistance of upper premolar teeth undergoing root canal treatment among Cavit G, Intermediate Restorative Material, Coltosol F, and DiaTemp, regardless of the cavity width (P > .05).

CONCLUSIONS

The cavity design was found to be an effective factor on the fracture resistance of upper premolar teeth undergoing root canal treatment. The temporary filling materials tested did not affect the fracture resistance.

Fracture resistance of root-filled teeth after cavity preparation with conventional burs, Er: YAG and Er,Cr: YSGG lasers

Purpose

The aim of the present study is to compare the fracture resistance of teeth after access cavity preparation with conventional rotary burs, Erbium-doped yttrium aluminum garnet laser (Er:YAG) and Erbium, cromium: yttrium scandium gallium garnet laser (Er,Cr:YSGG) lasers.

Materials and methods

Fifty five intact mandibular molars were divided into 3 negative groups (groups 1, 2, 3; n=5 for each), 3 study groups (groups 4, 5, 6; n=10 for each) and 1 positive control group (intact teeth; n=10). Access cavities of groups 1, 2 and 3 were prepared with conventional burs, Er:YAG laser and Er,Cr:YSGG laser respectively. After root canal obturation, their coronal portions were left non-restored. Access cavities of groups 4, 5 and 6 were prepared by using the same equipment but their coronal portions were restored with composite resinafter root canal obturation. Following thermocycling, fracture strength was evaluated with a Universal Testing Machine. Mean force at which each sample is fractured was recorded in Newton unit and statistically analyzed.

Results

Fracture resistance of group 7 (intact teeth) was significantly higher than all other groups (p<0.001). Differences among the fracture resistance values of groups 4, 5 and 6 were not significantly different but they were significantly higher than those of groups 1, 2 and 3 (p<0.001). No significant difference was found between Groups 1, 2 and 3.

Conclusion

Preparing access cavities with either laser or bur has no effect on the fracture resistance of teeth with root canal treatment.

Can Fiber Application Affect the Fracture Strength of Endodontically Treated Teeth Restored with a Low Viscosity Bulk-Fill Composite?

Objective

The aim of this study is to evaluate the effects of different fiber insertion techniques and thermomechanical aging on the fracture resistance of endodontically treated mandibular premolar teeth restored using bulk-fill composites.

Materials and Methods

Eighty human mandibular premolar teeth were randomly divided into eight groups: Group IN, Group BF, Group PRF1, Group PRF2, Group IN-TMA, Group BF-TMA, Group PRF1-TMA ,and Group PRF2-TMA. Group IN (intact) and Group IN-TMA (intact but subjected to thermomechanical aging) served as control groups. In the other six groups, endodontic treatment was performed and standardized mesio-occluso-distal (MOD) cavities were prepared. In BF, PRF1, and PRF2, the cavities were restored with bulk-fill composite only, bulk-fill/Ribbond, and bulk-fill/additional Ribbond, respectively. In BF-TMA, PRF1-TMA, and PRF2-TMA, the teeth were subjected to thermomechanical aging after the restorations. All of the teeth were fractured on the universal testing machine. Fracture surfaces were analyzed with a stereomicroscope.

Results

Control groups showed significantly higher fracture strengths than tested groups (P<0.05). No statistically significant difference was observed among the tested groups (P>0.05). Most of the favorable fractures were seen in PRF1, PRF2, and PRF2-TMA. Most of the unfavorable fractures were seen in BF-TMA.

Conclusions

Although fiber insertion with different techniques did not increase the fracture strength of teeth restored with bulk-fill composites, it increased the favorable fracture modes. Thermomechanical aging did not change the fracture strength of the groups.

The effect of the different restorations on fracture resistance of root-filled premolars

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.

Stress-reduced Direct Composites for the Restoration of Structurally Compromised Teeth: Fiber Design According to the "Wallpapering" Technique

PURPOSE

The purpose of this work was to present a restoration technique based on an understanding of the biomechanical properties of the dentinoenamel complex (DEC) and the physical-mechanical properties of the resin-based composite including the stress generated from both polymerization shrinkage and occlusal forces. Technique Summary: The DEC is a functional interphase that provides crack tip shielding; the DEC should be preserved during restorative procedures. Dentists can design the strategic placement of restorative materials into the cavity to both resist the mode of failure and mimic the performance characteristics of the intact natural tooth. The term "wallpapering" describes a concept of covering the cavity walls with overlapping closely adapted pieces of Leno weaved ultra-high-molecular-weight polyethylene (LWUHMWPE) ribbons. The key for success is that the ribbons are adapted and polymerized as closely as possible against the contours of residual tooth substrate. The resulting thin bond line between the fibers and the tooth structure creates a "bond zone" that is more resistant to failing due to the intrinsic stress and energy absorbing mechanism of the LWUHMWPE ribbons. The formation of defects and voids, from which crack propagation may start, is also reduced. The fibers' tight adaptation to tooth structure allows a dramatic decrease of the composite volume between the tooth structure and the fiber, thus protecting the residual weakened walls from both the stress from polymerization shrinkage and the occlusal load.

CONCLUSION

By using a similar approach, fiber-reinforced stress-reduced direct composite restorations may be performed in the restoration of structurally compromised vital and nonvital teeth.

In vitro fracture strength and patterns in root-filled teeth restored with different base materials

BACKGROUND

There is little research on the effects of an intermediate base on the fracture strength of root-filled teeth. This study compared the fracture strengths and patterns of root-filled teeth restored with intermediate bases of glass-ionomer cement (GIC), zinc polycarboxylate cement (ZPC), dual-cured resin composite (DCRC) and Biodentine^® under resin composite.

METHODS

Standardized cavities were prepared in 100 extracted human maxillary and mandibular premolars, and root canal treatment was performed. The teeth were stratified and randomly allocated to five groups (n = 20): (i) GIC; (ii) ZPC; (iii) DCRC; (iv) Biodentine; and (v) prepared but unrestored (control). The teeth were subjected to an oblique, ramped load until fracture. The fracture loads, level, mode and location were recorded.

RESULTS

Mean fracture strengths of all restored groups were not significantly different amongst the groups. There were significant overall effects on mean fracture strength for tooth type (P = 0.002) and buccolingual width of the crown (P = 0.001).

CONCLUSIONS

The four materials were appropriate intermediate bases. The laminate restorative technique promoted fracture strengths that are likely to withstand normal and maximum masticatory function. The base material can influence failure mode, which may have implications for the clinical presentation of fractures of root-filled teeth.

Influence of Different Restoration Techniques on Fracture Resistance of Root-filled Teeth: In Vitro Investigation

OBJECTIVE

The purpose of this study was to determine the fracture strength of endodontically treated mandibular premolar teeth restored with composites and different reinforcement techniques.

METHODS AND MATERIALS

Forty-eight freshly extracted human mandibular premolar teeth were randomly divided into four groups: group IN, group CR, group FRC, and group PRF. Group IN consisted of teeth with intact crowns and served as the control group. In the other three groups, endodontic treatment was performed and standard mesio-occluso-distal (MOD) cavities were prepared. Then cavities were restored with hybrid resin composite only, flowable composite and hybrid resin composite, and Ribbond, flowable composite and hybrid resin composite in groups CR, FRC and PRF, respectively. All of the teeth were subjected to fracture by means of a universal testing machine, and compressive force was applied with a modified stainless-steel ball at a crosshead speed at 0.5 mm/min.

RESULTS

The highest values were observed in group IN, while the lowest values were determined in group CR. There was not any statistically significant difference between group CR and group FCR ( p>0.05). When groups CR, FCR, and PRF were compared, group PRF showed significantly better fracture strength than did groups CR and FCR ( p<0.05). It was determined that there was not any significant difference between group IN and group PRF ( p>0.05).

CONCLUSIONS

Polyethylene ribbon fiber considerably increases the fracture strength of mandibular premolar teeth with MOD cavities restored with composite.

Effect of fibre-reinforced composite on the fracture resistance of endodontically treated teeth

The aim of this study is to evaluate the fracture resistance of root-filled teeth restored with fibre-reinforced composite (everX posterior). Fifty mandibular molars were divided into five groups (n = 10). Group 1: no treatment was applied (intact teeth). Group 2-5: canals were prepared and root filled. Group 2: no coronal restoration was placed. Group 3: teeth were coronally restored with composite. Group 4: composite restorations were performed following polyethylene fibre insertion at the cavity base. Group 5: composite resin placed over everX posterior. After thermocycling (5-55°C, 5000×), fracture resistance was measured. Mean force load for each sample was recorded in Newtons (N). Results were statistically analysed with one-way analysis of variance and post hoc Tukey's tests. The mean force required to fracture samples and standard deviations are as follows: group 1: 2859.5 ± 551.27 N, group 2: 318.97 ± 108.67 N, group 3: 1489.5 ± 505.04 N, group 4: 1958.3 ± 362.94 N, group 5: 2550.7 ± 586.1 N. everX posterior (group 5) was higher than groups 2, 3 and 4 (P < 0.05). There were no significant differences between everX posterior and intact teeth (P > 0.05). Placing fibre-reinforced composite under composite increased the fracture strength of root-filled teeth to the level of intact teeth.

Finite Element Analysis of the Endodontically-treated Maxillary Premolars restored with Composite Resin along with Glass Fiber Insertion in Various Positions

AIM

This study evaluated the effect of three methods of glass fiber insertion on stress distribution pattern and cusp movement of the root-filled maxillary premolars using finite element method (FEM) analysis.

MATERIALS AND METHODS

A three-dimensional (3 D) FEM model of a sound upper premolar tooth and four models of root-filled upper premolars with mesiocclusodistal (MOD) cavities were molded and restored with: (1) Composite resin only (NF); (2) Composite resin along with a ribbon of glass fiber placed in the occlusal third (OF); (3) Composite resin along with a ribbon of glass fiber placed circumferentially in the cervical third (CF), and (4) Composite resin along with occlusal and circumferential fibers (OCF). A static vertical load was applied to calculate the stress distributions. Structural analysis program by Solidworks were used for FEM analysis. Von-Mises stress values and cusp movements induced by occlusal loading were evaluated.

RESULTS

Maximum Von-Mises stress of enamel occurred in sound tooth, followed by NF, CF, OF and OCF. Maximum Von-Mises stress of dentin occurred in sound tooth, followed by OF, OCF, CF and NF. Stress distribution patterns of OF and OCF were similar. Maximum overall stress values were concentrated in NF. Although stress distribution patterns of NF and CF were found as similar, CF showed lower stress values. Palatal cusp movement was more than buccal cusp in all of the models.

CONCLUSION

The results of our study indicated that while the circumferential fiber had little effect on overall stress concentration, it provided a more favorable stress distribution pattern in cervical region. The occlusal fiber reduced the average stress in the entire structure but did not reduce cuspal movement.

CLINICAL SIGNIFICANCE

Incorporating glass fiber in composite restorations may alter the stress state within the structure depending on fiber position.

Fracture resistance of endodontically treated maxillary premolars restored by silorane-based composite with or without fiber or nano-ionomer

PURPOSE

This in vitro study investigated the fracture resistance of endodontically treated premolars restored using silorane- or methacrylate-based composite along with or without fiber or nano-ionomer base.

MATERIALS AND METHODS

Ninety-six intact maxillary premolars were randomly divided into eight groups (n = 12). G1 (negative control) was the intact teeth. In Groups 2-8, root canal treatment with mesio-occlusodistal preparation was performed. G2 (positive control) was kept unrestored. The other groups were restored using composite resin as follows: G3, methacrylate-based composite (Z250); G4, methacrylate composite (Z250) with polyethylene fiber; G5 and G6, silorane-based composite (Filtek P90) without and with the fiber, respectively; G7 and G8, methacrylate- and silorane-based composite with nano-ionomer base, respectively. After aging period and thermocycling for 1000 cycles, fracture strength was tested and fracture patterns were inspected. The results were analyzed using ANOVA and Tukey HSD tests (α=0.05).

RESULTS

Mean fracture resistance for the eight groups (in Newton) were G1: 1200 ± 169^a, G2: 360 ± 93^b, G3: 632 ± 196^c, G4: 692 ± 195^c, G5: 917 ± 159^d, G6: 1013 ± 125^ad, G7: 959 ± 148^d, G8: 947 ± 105^d (different superscript letters revealed significant difference among groups). Most of the fractures in all the groups were restorable, except Group 3.

CONCLUSION

Silorane-based composite revealed significantly higher strength of the restored premolars compared to that of methacrylate one. Fiber insertion demonstrated no additional effect on the strength of both composite restorations; however, it increased the prevalence of restorable fracture of methacrylate-based composite restored teeth. Using nano-ionomer base under methacrylate-based composite had a positive effect on fracture resistance and pattern. Only fiber-reinforced silorane composite restoration resulted in a strength similar to that of the intact teeth.

How can stress be controlled in endodontically treated teeth? A 3D finite element analysis

The aim of this study was to analyze the stresses that develop by oblique and vertical forces in endodontically treated maxillary second premolars that were restored with resin composite. Additionally, in our study the effects of the different restorative approaches and use of different base materials on stress formation were analyzed using three-dimensional finite element stress analysis. For restoration, the models representing both cusp capping, palatinal cusp capping, standard MOD restoration, and use of woven fiber in occlusal part were prepared. In all models, oblique forces caused more stress than did vertical forces. Materials with low elastic moduli cause high amounts of stress, whereas materials with elastic moduli similar to that of dental tissues cause low amounts of stress. Additional approaches such as cusp capping, functional cusp capping, and woven fiber use do not affect stress formation on the tooth after endodontic treatment.

Fracture Resistance of Endodontically-treated Maxillary Premolars Restored with Composite Resin along with Glass Fiber Insertion in Different Positions

Background and aims

The aim was to evaluate the effect of three methods of fiber insertion on fracture resistance of root-filled maxillary premolars in vitro.

Materials and methods

Sixty extracted human maxillary premolars received endodontic treatment followed by preparation of mesioocclusodistal (MOD) cavities, with gingival cavosurface margin 1.5 mm coronal to the cementoenamel junction (CEJ). Subsequently, the samples were randomly divided into four groups: no-fiber group; occlusal fiber group (fiber was placed in the occlusal third); circumferential fiber group (fiber was placed circumferentially in the cervical third); and dual-fiber group (occlusal and circumferential fibers). Subsequent to restoring with composite resin and thermocycling, a compressive force was applied until fracture. Data was analyzed using one-way ANOVA and Tukey test at significance levels of P < 0.05 and P < 0.02, respectively.

Results

Fiber placement significantly increased fracture resistance. Fracture resistance in the dual-fiber group was significantly higher than that in the circumferential fiber group (P < 0.007); however, there were no significant differences between the dual-fiber and occlusal fiber groups (P = 0.706). The highest favorable fracture rate was observed in the circumferential fiber group (60%).

Conclusion

Composite resin restoration along with glass fiber in the occlusal and gingival thirds can be an acceptable treatment option for restoring root-filled upper premolars.

The effect of composite fiber insertion along with low-shrinking composite resin on cuspal deflection of root-filled maxillary premolars

AIM

The aim of the present study was to evaluate the effect of three methods of composite fiber placement along with siloranebased composite resin on cuspal deflection and fracture strength of root-filled maxillary premolars.

MATERIALS AND METHODS

Mesio-occluso-distal cavities were prepared in 60 extracted premolars subsequent to endodontic treatment. The remaining thickness of buccal and lingual walls at height of contour was 2.5 ± 0.2 mm and the gingival cavosurface margin was 1.5 mm coronal to cementoenamel junction. Subsequent to measurement of primary intercuspal distances, the teeth were randomly divided into four groups. In group 1, the cavities were only filled with Filtek Silorane composite resin. In the other three groups, preimpregnated glass fibers were placed at gingival, middle and occlusal thirds respectively, and the cavities were restored similar to the group 1. Cuspal deflection was recorded in micrometer using a stereomicroscope. Fracture strength of the samples was measured in Newton subsequent to thermocycling. Data was analyzed using Kruskal-Wallis, Mann-Whitney U, one-way ANOVA and post-hoc Tukey tests at a significance level of p < 0.05.

RESULTS

The highest cuspal deflection was recorded in the group 1, and the difference between group 1 and other groups was significant (p < 0.001). Fracture resistance in group 4 was significantly higher than that in other groups (p < 0.001).

CONCLUSION

In restoring root-filled premolars with siloranebased composite resins, cuspal deflection decreased with the use of preimpregnated glass fibers.

CLINICAL SIGNIFICANCE

Using preimpregnated glass fibers along with silorane-based composite resin may lead to better results in cuspal deflection and fracture resistance of endodonticallytreated maxillary premolars.

Fracture resistance of premolars restored by various types and placement techniques of resin composites

To verify the fracture resistance of premolars with mesioocclusodistal preparations restored by different resin composites and placement techniques. Sixty premolars were randomly divided into two groups based on type of composite resin: Filtek P60 or Nulite F, and then each group was separated into three subgroups: bulk, centripetal, and fiber insert according to the type of placement method (n = 10). Single-bond adhesive system was used as composite bonding according to the manufacturer's instructions. Specimens were restored in Groups 1, 2, and 3 with Filtek P60 and in Groups 4, 5, and 6 with Nulite F. After being stored 24 hours at 37°C, a 4 mm diameter steel sphere in a universal testing machine was applied on tooth buccal and lingual cusps at a cross-head speed of 5 mm/min until fracture occurred. Groups 3 and 6 showed higher fracture resistance than Groups 1, 2, 4, and 5. Among the placement techniques, the fiber insert method had a significant effect, but the type of composite was ineffective. The insertion technique in contrast to the type of material had a significant influence on the fracture resistance of premolar teeth.

Effect of three different core materials on the fracture resistance of endodontically treated deciduous mandibular second molars: an in vitro study

Endodontic treatment makes the tooth brittle due to loss of bulk of tooth structure, decrease in the moisture content of dentin and dentin elasticity. The following study was carried out to evaluate the effect of endodontic treatment on the fracture resistance of the tooth and reinforcing ability of three different core materials. The following study comprised of sample size of 30 deciduous second molars divided into control group (6) and test group (24). Access opening was done in 24 and 18th teeth with access opening were restored with three different core materials namely IRM (6), silver amalgam (6), GIC (6). All the 30 were subjected to fracture test using UTM (Universal testing machine)- Instron 95. Result showed a drastic reduction in the fracture resistance of the tooth on access opening (1/3rd) and out of the three core materials glass ionomer was shown to be the best core material giving the highest fracture registrance followed by silver amalgam and IRM.

Comparison of fracture resistance of endodontically treated teeth using different coronal restorative materials: An in vitro study

AIM/OBJECTIVE

To evaluate the in vitro effect of bonded restorations on the fracture resistance of root canal-treated teeth.

MATERIALS AND METHODS

One hundred twenty extracted, maxillary, permanent premolars were collected. After preparing the access cavity, the teeth were biomechanically prepared and obturated. Samples were divided into six groups based on the type of restorative material used to restore them. Teeth were embedded in acrylic resin and their fracture strength was measured using a Universal Testing Machine. Data were evaluated statistically using one-way ANOVA-F and unpaired t-test.

RESULTS

Teeth restored with bonded amalgam and composite resin showed higher fracture resistance than those restored with conventional amalgam. Fracture strengths of bonded restorations and intact teeth were not statistically different. The results suggested that the group restored with conventional amalgam had the lowest fracture resistance. No statistically significant differences were found between the bonded amalgam and composite resin groups.

CONCLUSION

Conventional amalgam core showed the least fracture resistance whereas; composite resin and bonded amalgam core showed fracture resistance was similar to that of natural tooth.

Influence of cusp coverage on the fracture resistance of premolars with endodontic access cavities

AIM

To assess the influence of cusp reduction and coverage with composite resin on the fracture resistance of premolars with prepared access cavities.

METHODOLOGY

Endodontic access cavities were prepared in 60 premolar teeth that were divided into four test groups: R1, R2, R3 and NR (n=15). In all test groups, MOD cavities were prepared and extended towards one of the cusps. The remaining cusp-wall thickness was: 1-1.5 mm in R1, 1.5-2 mm in R2 and 2-3 mm in both R3 and NR groups. In addition, in group R1, R2 and R3 the same cusp was reduced in height to 3.5 mm. Cuspal coverage and MOD restorations were performed using composite resin. Ten intact premolars served as positive controls and another ten MOD-prepared unrestored premolars as negative controls. Teeth were submitted to cyclic fatigue of 1.2 million cycles. A compressive load was applied 30° to the long axis of the teeth until fracture. Fracture loads were recorded and the means and the Confidence Intervals were compared.

RESULTS

The mean fracture resistance of each of the cusp-reduced groups R1, R2 and R3 (603, 712 and 697 N, respectively) was significantly higher than the non-reduced cusp group (305 N) and was comparable to the intact-premolar group (653 N).

CONCLUSIONS

Cusp reduction and coverage with composite resin significantly increased the fracture resistance of premolar teeth with MOD and endodontic access cavities.

Influence of several fibre-reinforced composite restoration techniques on cusp movement and fracture strength of molar teeth

AIM

To compare mean cusp movement in molar teeth with endodontic access and mesial-occlusal-distal (MOD) cavities before and after restoration with several fibre-reinforced composite restoration techniques under loading and to evaluate the effect of restoration technique on fracture strength.

METHODOLOGY

Reference points were marked at the mesial cusp ridges of extracted human mandibular molar teeth. Digital images were taken under loading (300 N) using a stereomicroscope (Leica MZ16A; Wetzlar, Germany). Three-dimensional (3D) distances between the reference points were recorded (Leica, Stereo-Explorer, 2.1) as controls. Standard MOD cavities were prepared and restored as follows (n = 10), group 1: composite restoration (Clearfil AP-X; Kuraray, Tokyo, Japan); group 2: cavity lined with polyethylene fibre (Ribbond, Ribbond Inc., Seattle, WA, USA) in combination with flowable resin (Protect-Liner F; Kuraray, Tokyo, Japan) before composite restoration; group 3: polyethylene fibre inserted on occlusal surface of the tooth from buccal to lingual after finishing the composite restoration; group 4: missing walls were restored with composite resin and inner surfaces of the axial walls were then reinforced with polyethylene fibre placed circumferentially before the composite restoration. The restored teeth were re-loaded, digital images were re-taken and the 3D distance between the reference points was recorded in μm. Comparisons of the restoration techniques, the effectiveness of restoration for each group were analysed statistically (Kruskall-Wallis, paired-samples t-test). The teeth were then loaded until failure (5 mm min(-1) ), the data were recorded (N) and analysed statistically (Kruskall-Wallis test).

RESULTS

A significant difference occurred amongst the groups in terms of cusp movement (P = 0.018). All the groups revealed a decrease in inter-cuspal width when compared to their initial records. The mean values of these decreases were as follows: group 1 17.6 (P = 0.003), group 2 6.7 (not sig), group 3 6.6 (not sig) and group 4 0.85 (not sig) μm. No significant difference was found amongst the fracture strength values (P = 0.22). In group 1, 90% of the fractures were non-restorable, whereas in group 3 100% of the fractures were restorable.

CONCLUSIONS

Regardless of restoration technique, fibre reinforcement of composite restorations decreased cusp movement in molar teeth with MOD and endodontic access cavities but did not affect fracture strength.