Influence of Preparation Design and Restorative Material on Fatigue and Fracture Strength of Restored Maxillary Premolars

SUMMARY Statement of Problem: Extensive carious lesions and/or large preexisting restorations possibly contribute to crack formation, ultimately resulting in a fracture that may lead to the loss of a tooth cusp. Hence, preparation design strategy in conjunction with the restorative material selected could be influential in the occurrence of a cuspal fracture. Purpose: The purpose of this in vitro study was to evaluate the fatigue behavior and fracture strength of maxillary premolars restored with direct composite and indirect ceramic inlays and overlays, with different preparation depths in the presence or absence of cuspal coverage, and analyze their failure types. Methods and Materials: Sound maxillary premolars (N=90; n=10) were divided into nine groups: group C: control; group DCI3: direct composite inlay 3 mm; group DCI5: direct composite inlay 5 mm; group ICI3: indirect ceramic inlay 3 mm; group ICI5: indirect ceramic inlay 5 mm; group DCO3: direct composite overlay 3 mm; group DCO5: direct composite overlay 5 mm; group ICO3: indirect ceramic overlay 3 mm; group ICO5: indirect ceramic overlay 5 mm. In indirect ceramic, lithium disilicate restoration groups, immediate dentin sealing was applied. After restoration, all specimens were tested in fatigue (1,200,000 cycles, 50 N, 1.7 Hz). Samples were critically appraised, and the specimens without failure were subjected to a load to failure test. Failure types were classified and the data analyzed. Results: Zero failures were observed in the fatigue testing. The following mean load to failure strengths (N) were recorded: group ICO5: 858 N; group DCI3: 829 N; group ICO3: 816 N; group C: 804 N; group ICI3: 681 N; group DCO5: 635 N; group DCI5: 528 N; group DCO3: 507 N; group ICI5: 482 N. Zero interaction was found between design-depth-material (p=0.468). However, significant interactions were found for the design-depth (p=0.012) and design-material (p=0.006). Within restorations at preparation depth of 3 mm, direct composite overlays obtained a significantly lower fracture strength in comparison to indirect ceramic onlays (p=0.013) and direct composite inlays (p=0.028). In restorations at depth 5 mm, significantly higher fracture load values were observed in indirect ceramic overlays compared with the inlays (p=0.018). Indirect ceramic overlays on 3 mm were significantly stronger than the deep inlays in ceramic (p=0.002) and tended to be stronger than the deep direct composite inlays. Severe, nonreparable fractures were observed with preparation depth of 5 mm within ceramic groups. Conclusions: The preparation depth significantly affected the fracture strength of tooth when restored with either composite or ceramic materials. Upon deep cavity preparations, cuspal coverage proved to be beneficial when a glass ceramic was used as the restorative material. Upon shallow cavity preparations, a minimally invasive approach regarding preparation design used in conjunction with a direct composite material was favorable.

Adhesive Luting in Ceramic Inlays and Porcelain Laminate Veneers

Ceramic inlays, composite inlay-onlays and porcelain or zircon laminate veneers relay to a great extent on the acceptable clinical performance of adhesive luting as it considered the weakest point of the indirect restoration. Although most authors augment the opinion that bonding to enamel is more predictable and has better bond strength than bonding to dentin substrate, but it cannot completely depend on good enamel bond as a process of success of luting adhesive. An additional dentin bond is important not only for improvement the over-all bond strength but also to decrease postoperative hypersensitivities.

MICROLEAKAGE OF CLASS II RESTORATION WITH COMPOSITE INLAY: AN IN VITRO STUDY

Background: Overcoming the obstacles of Class II restoration, especially the microleakage, is a polemic issue. The present study was performed to evaluate the microleakage of Class II restorations using three different techniques. Aims: The aim of this in vitro study was to evaluate the microleakage of Class II restorations using three different techniques. Materials and methods: The study was carried out in the laboratory with paired comparision between groups. Thirty Class II cavities were prepared on extracted non-carious human permanent molars, randomly divided into 3 groups, which were then restored with 3 different methods. Group 1: indirect composite inlay (Tetric N-Ceram) cemented with resin-modified glass ionomer cement (Fuji Plus); Group 2 indirect composite inlay (Tetric N-Ceram) cemented flowable composite (Tetric N-flow); Group 3: direct composite restoration using Tetric N-Ceram. Before immersed to 2% methylene blue solution for 12 hours, all restorations were subjected to thermal cycling (100 cycles 50C – 55 0C). The extent of dye penetration along the gingival wall was assessed using a grade scale from 0 to 3 under 40 times magnification using digital camera Nikon D7000. Results: All types of restorations showed some rate of microleakage. In comparing the three techniques, group 1 demonstrated the significantly higher rate of leakage compared to the others (p<0.05), whereas group 2 and 3 showed no significant difference. Conclusion: Different luting materials have different influences on the microleakage degree along gingival wall of Class II restoration. Key word: composite inlay, class II restoration, microleakage