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

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.

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.

Fracture resistance of endodontically treated premolars restored with bulk-fill composite resins: The effect of fiber reinforcement

BACKGROUND

Coronal restoration of endodontically treated teeth (ETT) with mesio-occluso-distal (MOD) cavities is of a great importance in long-term success of the treatment. This study evaluated the effect of fiber reinforcement on the fracture resistance (FR) of ETT restored with flowable or paste bulk (PB)-fill composite resin compared to conventional composite (CC) resin.

MATERIALS AND METHODS

In this in vitro experimental study, eighty maxillary premolars were divided into eight groups (n = 10). The first group was left intact (G₁) and the other groups received MOD cavities along with endodontic treatment. G₂: Remained unrestored while the other experimental groups were restored with three types of composite resin with or without fiber insertion. G₃: CC resin, G₄: PB fill, G₅: Flowable bulk fill (FB). G₆: Fiber + CC, G₇: Fiber + PB, and G₈: Fiber + FB. FR was tested at crosshead speed of 1 mm/min and recorded in Newton. Data were analyzed using one-way analysis of variance and Tukey's tests at significance level of P < 0.05.

RESULTS

G₁ and G2 revealed the highest and the lowest FR, respectively. The mean FR of the testing groups in Newton was as follows: G₁ = 1204.8 ^A, G₂ = 352.1 ^C, G₃ = 579.6 ^BD, G₄ = 596.7 ^BD, G₅ = 624.9 ^BDE, G₆ = 858.3 ^E, G₇ = 529.6 ^CB, and G₈ = 802.5^DE. Different uppercase letters indicate the significant difference between the groups.

CONCLUSION

The effect of fiber insertion on FR depended on the type of composite resin; the highest reinforcing effect was obtained in the CC resin + fiber, followed by bulk-fill flowable + fiber, and flowable bulk (FB)-fill composite resin. The strength of the former was significantly higher than the conventional and PB fill with and without fiber.