Original Article

Effect of Direct Composite and Indirect Ceramic Onlay Restorations on Fracture Resistance of Endodontically Treated Maxillary Premolars

Abstract

Objectives: Fracture of endodontically treated restored teeth is a common concern. Premolars are subjected to high shear and tensile forces. This study aimed to assess the fracture resistance and fracture mode of endodontically treated premolars restored with direct and indirect onlay restorations.
Materials and Methods: In this in-vitro experimental study, 45 human maxillary premolars were divided into three groups (n=15) of control (sound teeth), direct onlay, and indirect onlay. In groups 2 and 3, the teeth underwent endodontic treatment. Mesio-occluso-distal cavities were prepared and restored with direct composite (P60) and indirect IPS e.max ceramic onlays, respectively. The teeth were subjected to vertical forces after cyclic loading. The maximum load causing fracture was recorded in Newtons. Data were analyzed using analysis of variance, chi-square test, and Tukey’s test.
Results: The highest and the lowest fracture resistances were noted in sound teeth and direct onlay restorations, respectively. The difference in fracture resistance was significant among the three groups (P<0.001). Pairwise comparisons revealed a significant difference in the fracture resistance of sound teeth and the two restoration groups (P<0.001). However, the difference in the fracture resistance of direct and indirect onlay restorations was not significant (P=0.6). Chi-square test showed a significantly higher frequency of irreparable fractures in the indirect onlay group (P=0.005).
Conclusion: Direct and indirect onlay restorations were not significantly different in terms of the fracture resistance but the frequency of irreparable fractures was higher in indirect restorations.

1. Kazemi Yazdi H, Aryan N, Shahbazi moghadam M. A comparison of the effect of three direct composite restoration techniques on the fracture resistance of endodontically treated maxillary premolars. J Res Dent Maxillofac Sci. 2014;11(4):199-208.
2. Alshiddi IF, Aljinbaz A. Fracture resistance of endodontically treated teeth restored with indirect composite inlay and onlay restorations - An in vitro study. Saudi Dent J. 2016 Jan;28(1):49-55.
3. Monga P, Sharma V, Kumar S. Comparison of fracture resistance of endodontically treated teeth using different coronal restorative materials: An in vitro study. J Conserv Dent. 2009 Oct;12(4):154-9.
4. Sarabi N, Taji H, Jalayer J, Ghaffari N, Forghani M. Fracture resistance and failure mode of endodontically treated premolars restored with different adhesive restorations. J Dent Mater Tech. 2015 Mar;4(1):13-20.
5. Mynampati P, Babu MR, Saraswathi DD, Kumar JR, Gudugunta L, Gaddam D. Comparison of fracture resistance and failure pattern of endodontically treated premolars with different esthetic onlay systems: An in vitro study. J Conserv Dent. 2015 Mar-Apr;18(2):140-3.
6. Bianchi E Silva AA, Ghiggi PC, Mota EG, Borges GA, Burnett LH Jr, Spohr AM. Influence of restorative techniques on fracture load of endodontically treated premolars. Stomatologija. 2013;15(4):123-8.
7. Xie KX, Wang XY, Gao XJ, Yuan CY, Li JX, Chu CH. Fracture resistance of root filled premolar teeth restored with direct composite resin with or without cusp coverage. Int Endod J. 2012 Jun;45(6):524-9.
8. Seow LL, Toh CG, Wilson NH. Strain measurements and fracture resistance of endodontically treated premolars restored with all-ceramic restorations. J Dent. 2015 Jan;43(1):126-32.
9. Eakle WS, Maxwell EH, Braly BV. Fractures of posterior teeth in adults. J Am Dent Assoc. 1986 Feb;112(2):215-8.
10. Fennis WM, Tezvergil A, Kuijs RH, Lassila LV, Kreulen CM, Creugers NH, et al. In vitro fracture resistance of fiber reinforced cusp-replacing composite restorations. Dent Mater. 2005 Jun;21(6):565-72.
11. Kivanç BH, Alaçam T, Görgül G. Fracture resistance of premolars with one remaining cavity wall restored using different techniques. Dent Mater J. 2010 May;29(3):262-7.
12. Heydecke G, Butz F, Strub JR. Fracture strength and survival rate of endodontically treated maxillary incisors with approximal cavities after restoration with different post and core systems: an in-vitro study. J Dent. 2001 Aug;29(6):427-33.
13. Yamada Y, Tsubota Y, Fukushima S. Effect of restoration method on fracture resistance of endodontically treated maxillary premolars. Int J Prosthodont. 2004 Jan-Feb;17(1):94-8.
14. Ragauska A, Apse P, Kasjanovs V, Berzina-Cimdina L. Influence of ceramic inlays and composite fillings on fracture resistance of premolars in vitro. Stomatologija. 2008;10(4):121-6.
15. Takahashi CU, De Cara AA, Cotin I. [Resistance to fracture of direct restorations with cuspal coverage in endodontically treated upper bicuspids]. [Article in Portuguese]. Pesqui Odontol Bras. 2001 Jul-Sep;15(3):247-51.
16. Fennis WM, Kuijs RH, Kreulen CM, Verdonschot N, Creugers NH. Fatigue resistance of teeth restored with cuspal-coverage composite restorations. Int J Prosthodont. 2004 May-Jun;17(3):313-7.
17. Rezvani MB, Mohammadi Basir M, Mollaverdi F, Moradi Z, Soboot AR. Comparison of direct and indirect composite resin restorations effect on the fracture resistance of maxillary premolars: An in vitro study. J Dent Sch Shahid Beheshti Univ Med Sci. 2012 Winter;29(5):299-305.
18. Moezizadeh M, Mokhtari N. Fracture resistance of endodontically treated premolars with direct composite restorations. J Conserv Dent. 2011 Jul;14(3):277-81.
19. Jiang W, Bo H, Yongchun G, LongXing N. Stress distribution in molars restored with inlays or onlays with or without endodontic treatment: a three-dimensional finite element analysis. J Prosthet Dent. 2010 Jan;103(1):6-12.
20. Santos MJ, Bezerra RB. Fracture resistance of maxillary premolars restored with direct and indirect adhesive techniques. J Can Dent Assoc. 2005 Sep;71(8):585.
21. Al Amri MD, Al-Johany S, Sherfudhin H, Al Shammari B, Al Mohefer S, Al Saloum M, et al. Fracture resistance of endodontically treated mandibular first molars with conservative access cavity and different restorative techniques: An in vitro study. Aust Endod J. 2016 Dec;42(3):124-131.
22. Brunton PA, Cattell P, Burke FJ, Wilson NH. Fracture resistance of teeth restored with onlays of three contemporary tooth-colored resin-bonded restorative materials. J Prosthet Dent. 1999 Aug;82(2):167-71.
23. Taha NA, Palamara JE, Messer HH. Fracture strength and fracture patterns of root-filled teeth restored with direct resin
composite restorations under static and fatigue loading. Oper Dent. 2014 Mar-Apr;39(2):181-8.
24. Wang RR, Lu CL, Wang G, Zhang DS. Influence of cyclic loading on the fracture toughness and load bearing capacities of all-ceramic crowns. Int J Oral Sci. 2014 Jun;6(2):99-104.
25. Xible AA, de Jesus Tavarez RR, de Araujo Cdos R, Conti PC, Bonachella WC. Effect of cyclic loading on fracture strength of endodontically treated teeth restored with conventional and esthetic posts. J Appl Oral Sci. 2006 Aug;14(4):297-303.
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IssueVol 17 (Continuously Published Article-Based) QRcode
SectionOriginal Article
DOI https://doi.org/10.18502/fid.v17i8.4126
Keywords
Ceramics Composite Resins Dental Onlay Endodontically-Treated Teeth

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How to Cite
1.
Kazemi Yazdi H, Sohrabi N, Nasser Mostofi S. Effect of Direct Composite and Indirect Ceramic Onlay Restorations on Fracture Resistance of Endodontically Treated Maxillary Premolars. Front Dent. 2020;17.