journal of dentistry 35 (2007) 578–582

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Comparison of load-bearing capacity of direct

resin-bonded fiber-reinforced composite FPDs with
four framework designs

Qiufei Xie a,b,*, Lippo V.J. Lassila b, Pekka K. Vallittu b

a
Department of Prosthodontics, School and Hospital of Stomatology, Peking University, Beijing, China
b
Department of Prosthetic Dentistry and Biomaterials Science, Institute of Dentistry, Faculty of Medicine, University of Turku,
Turku, Finland

article info abstract

Article history: Objectives: This in vitro study was aimed to compare the fracture resistance of directly
Received 14 September 2006 fabricated inlay-retained fiber-reinforced composite (FRC) fixed partial dentures (FPDs) with
Received in revised form four types of framework designs.
27 March 2007 Methods: Forty-eight directly fabricated inlay retained FPDs were made of FRC and parti-
Accepted 2 April 2007 culate resin composite (everStick/Tetric flow and Ceram). Extracted human mandibular
first premolars and first molars were as abutments. The following framework designs were
tested: in the Group A (control group), the framework was made of two prepregs of
Keywords: unidirectional glass FRC; the Group B, two prepregs in pontic portion were covered with
Fiber-reinforced composite one layer of multidirectional fiber veil FRC; the Group C, the FRC prepregs were covered in
Fixed partial dentures pontic portion with four short unidirectional FRC pieces along the main prepregs; in Group
Fracture strength D, one short unidirectional FRC prepregs were placed on the main prepregs in 908 angle to
Framework design the main framework. After thermal cycling, FPDs of each group (n = 12) were randomly
divided into two subgroups (n = 6). Fracture test was performed at the universal testing
machine (1 mm/min) where FPDs were loaded from the occlusal direction to the occlusal
fossa or to the buccal cusp. Failure patterns were observed with stereomicroscope. Median
and 25%/75% percentile values were calculated and nonparametric analysis was
performed.
Results: Compared with three other framework designs, the FPDs in Group D showed the
highest resistance when loading to the occlusal fossa, with maximum load of 2353.8 N
(25%/75%: 2155.5/2500.0) ( p = 0.000, 0.000, and 0.005 for compared with Group A, B, and
C). The same group showed also higher resistance when loaded to the buccal cusp
(1416.3 N (1409.2/1480.8)) if compared to the FPDs of the Group A and Group C ( p = 0.044,
0.010). In general the FPDs showed higher resistant to loading at the occlusal fossa
( p < 0.05).
Conclusions: This in vitro study showed that inlay-retained FRC FPD constructed with direct
technique provided high fracture resistance. The framework design that provided support
for the veneering composite of the pontic contributed to the highest load-bearing capacity
even when loaded to the buccal cusp.
# 2007 Elsevier Ltd. All rights reserved.

* Corresponding author at: Department of Prosthodontics, School and Hospital of Stomatology, Peking University, Zhongguancun
Southern Avenue 22 Haidian District, 100081 Beijing, China. Tel.: +86 10 62179977x2552; fax: +86 10 62173402.
E-mail address: xieqiuf@163.com (Q. Xie).
0300-5712/$ – see front matter # 2007 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jdent.2007.04.003
 journal of dentistry 35 (2007) 578–582
1. Introduction
The porcelain fused to metal fixed partial denture (FPD) is a
conventional approach to replace one or several missing
teeth and it provides great fracture strength and relatively
good long-term clinical success.1,2 One of significant dis-
advantages of the conventional, as well as modern all-
ceramic FPDs is that large amount of sound tooth substance of
the abutments needs be removed in FPD fabrication.
Although implant-supported FPDs are high quality alterna-
tives to the tooth supported FPDs, patients often refuse these
options since the reasons of high cost and/or surgical
intervention.
Fiber reinforced composites (FRC) are a new group dental
biomaterial with shorter history of clinical application. FRC
resin-bonded FPDs are considered as minimal invasive, metal-
free, and good aesthetic restorations for replacing missing
single or multiple anterior or posterior teeth.3–5 Inlay-retained
resin-bonded FRC FPDs can be used especially for patients
having occlusal or proximal carious lesions or existing fillings
in teeth adjacent to the edentulous space. The abutment teeth
are prepared for retaining the FPD without excessive removal
of sound tooth substance. Several types of FRC frameworks
were used and it was suggested that high-volume fraction
frameworks provide better clinical success than low-volume
fraction frameworks due to lack of support for the veneering
composite of the pontics.6 There are also other studies
showing the weak part of the inlay retained FRC FPD in the
region of pontics.7,8 It can be supposed that in occlusal loading
conditions where the load is applied to the buccal cusps of the
mandibular posterior teeth instead of central fossa, the
delamination of veneering composite can occur in lower load
levels. Attempts to overcome this problem by improving
adhesion of the veneering composite resin and FRC frame-
work have been done.9–11 To the authors’ knowledge, there are
lack of studies evaluating the differences in load-bearing
capacity of FRC FPDs with various designs of framework and
loading conditions.
The purpose of this in vitro study was to compare the
fracture resistance directly made inlay-retained resin-bonded
FPDs with four types of framework designs under two loading
conditions.
2. Materials and methods
A total of 48 extracted human mandibular first premolars and
48 first molars were collected, cleaned, and stored in 0.01%
chloramine T prior to experiment. The roots of teeth were
covered with a thin layer of polyether impression material
(Impregum, 3M-ESPE, Seefeld, Germany) to simulate the
resilience of the human periodontal ligament.12,13 Premolars
and molars were embedded in auto-polymerized PMMA resin
(Palapress Vario, Kulzer, Wehrheim Germany) to achieve
simulated clinical situation of missing tooth with mesiodistal
distance of 7 mm. The inlay cavities were prepared using new
diamond burs with enamel margin at least 1 mm above the
CEJ. The cavity size of the premolar was 2.5 mm (occlusal
depth), 3 mm (mesiodistal length), and 3 mm (width). Corre-
sponding size for the cavity in the molar was 2.5, 3 and 3 mm
579
wide. Dimensions of all cavities were checked using silicone
indexes and a digital micrometer.
All-etch technique was applied to the inlay cavities with
35% phosphoric acid for 15 s. The cavities were then
thoroughly rinsed with water for 15 s and gently air-dried.
Adhesive system containing separate primer and adhesive
resin (Scotchbond Multipurpose, 3M-ESPE, St. Paul, USA) was
used according to the manufacturers instructions. The
adhesive resin was polymerized using a light curing unit
(Optilux 501, Kerr, West Collins Orange, CA 92867) for 10 s.
A thin layer of flowable composite resin (Tetric Flowable,
Shade A2, Ivoclar Vivadent, Liechtenstein) was then applied to
bottom of the cavities and a piece of light-polymerizable
unidirectional glass FRC prepreg (everStick C&B, Stick Tech,
Turku, Finland) was placed in mesiodistal direction from
premolar to molar and slightly curved toward the alveolar
crest. The prepreg was light-cured for 40 s. Particulate filler
composite resin (Tetric Ceram Shade A2, Ivoclar Vivadent,
Liechtenstein) was applied on the FRC and another piece of
FRC prepreg was placed between the cavities. The following
modifications to the framework design were made (Fig. 1).
In the Group A, after the main framework completed, the
FPD was incrementally built up using Tetric Ceram particulate
filler composite resin and contoured with translucent poly-
ether impression model for standardizing the dimensions.
Finally, the restoration was light polymerized for 40 s. The
light output of curing unit was 770 mW/cm2. The Group A was
the control group. In the Group B, the pontic portion of the
main framework was wrapped with one layer of multi-
directionally oriented short fiber veil (experimental material)
in pontic portion (Fig. 1); in the Group C, 4 short pieces of
unidirectional FRC prepregs were placed parallel to the main
framework (1 on buccal, 1 on lingual and 2 on occlusal
surfaces); in the Group D, 1 short piece of prepreg was placed
on occlusal surface of the main framework in 908 angle to the
direction of fibers of the main framework. Veneering of the
composite was made according to the FPDs of the Group A.
The FPDs were stored in distilled water at 37 8C for 24 h and
then underwent thermocycling (6000, 5–55 8C). Twelve FPDs
of each group were randomly divided into two subgroups. Six
FPDs of a subgroup were loaded from the occlusal direction to
Fig. 1 – Scheme of four framework deigns of FRC (Occlusal
view). (a) Group A, (b) Group B, (c) Group C and (d) Group D.
580 journal of dentistry 35 (2007) 578–582
Fig. 2 – Boxplots depicting the maximum load values (in N)
of four groups after thermocycling and mechanical loading
(median, 25%/75% percentiles, and the highest and lowest
not extremely values are shown). The values of the group
Bbc and Cbc show non-normal distributions ( p = 0.022 and
0.010). BC = loaded at buccal cusp; OF = loaded at occlusal
fossa.
the occlusal fossa (OF) and the other to the buccal cusp (BC).
The loading was performed until final fracture using the
universal testing machine (Lloyd LRX, Lloyd Instruments,
Fareham, UK) with a steel ball of 6 mm in diameter and 1 mm/
min cross-head speed. After each fracture test, the failure type
and location of the fracture were examined visually with a
stereomicroscope.
Statistical analyses of the results were performed by means
of the SPSS 10.0 for Windows (SPSS Inc., Chicago, IL, USA). The
values of eight groups were first examined for normality using
Shapiro–Wilk W test. Because of the non-normal distribution
of two groups’ values (Fig. 2), statistical analyses were
performed with nonparameric tests. Median and 25%/75%
percentile values were calculated. Statistical differences were
calculated with the Mann–Whitney U test for comparison
between OF load and BC load in the same group. The Kruskal–
Wallis test was carried out for multiple comparisons among
four groups, which was performed for OF load and BC load,
respectively, because of significant differences in maximum
Table 1 – Comparison of maximum load values of four types of frameworks of FRC FPDs under loading to occlusal fossa
(OF) and buccal cusp (BC)
Group A Group B
OF BC OF
Median (N) 1497.8 1205.8 1563.0
25% 1292.7 1185.2 1430.0
75% 1614.8 1340.4 1652.8
p 0.044 0.014
p-Values for comparison between OF and BC loading of same group.
load values between loading sites. The statistical significance
level was a = 0.05.
3. Results
Significant differences in fracture load values were found
between loading the FPDs from occlusal fossa and buccal cusp
among the four groups (Table 1). Among the four types of
framework designs, the Group D showed the highest load
values when loaded to the occlusal fossa or to the buccal cusp
and the differences were significant, except one between the
Group B and D when loaded to the buccal cusp (Table 2). The
lowest values were found in the Group A when loaded to the
occlusal fossa and in the Group C loaded to the buccal cusp
(Table 1).
Patterns of failure for the four groups are shown in Table 3.
Under occlusal loading, the Groups B, and C did not
demonstrate a catastrophic failure and the most fractures
(5/6) occurred at the interface between additional fibers (Fig. 3)
(not in the main FRC framework), which resulted in veneering
composite delaminated with fibers. In the Group D, one third
of the FPDs exhibited fracture of the main FRC framework, half
the FRC FPDs presented only veneering composite cracks, and
one of FRC FPDs showed veneering composite delamination
with glass fibers. Under the buccal cusp loading condition,
none of the FPDs exhibited fracture of the main FRC frame-
work. The Group A and D showed veneering composite
delamination, and the Group B and the most of Group C still
presented veneering composite delamination with glass
fibers.
4. Discussion
In a clinical situation, a fixed partial denture may be subjected
to a variety of magnitude and direction of forces by chewing
and to high occlusal forces in patient with bruxism. The buccal
cusps of the mandibular premolars are supporting cusps and
play an important role in mastication. This study was
designed to load the FPDs not only at occlusal fossa but also
at buccal cusp of pontic to provocate the in vitro failure. All
experimental groups showed high fracture strength for FPDs
varying from 1497.8–2353.8 N to 1075.2–1416.3 N according to
the loading condition. Although clinical conditions are likely
more critical than used in this in vitro simulation, the values
obtained reveal considerably higher load bearing capacity
Group C Group D
BC OF BC OF BC
1106.7 1711.2 1075.2 2353.8 1416.3
1089.4 1543.9 1060.2 2155.5 1409.2
1212.5 2015.0 1292.1 2500 1480.8
0.001 0.000
 journal of dentistry 35 (2007) 578–582 581

Table 2 – p-Values for multiple comparisons of max- composite and fibers exists.19,20 However, if unidirectional
imum load values among four groups (numbers with fibers are placed in the direction of perpendicular to stress,
normal face for loading at occlusal fossa and numbers no reinforcing effect is provided as described by Krenchel.21
with bold face for loading at buccal cusp)
When loading the FPD with the steel ball to the occlusal
Group A Group B Group C Group D fossa having inclined surfaces of buccal and lingual cusps
Group A – 0.363 0.095 0.000 facing the fossa, the pontic was subjected to compressive,
– 0.817 0.457 0.044 tensile and shear forces. The currently available FRC
prepregs provide main FRC framework of high strength
Group B 0.0363 – 0.319 0.000
0.817 – 0.715 0.065 but relatively low thickness and it does not support to the
veneering composite of the pontic. The results of the
Group C 0.095 0.319 – 0.005
present study showed that the additional fibers in pontic
0.457 0.715 – 0.010
were able to arrest crack development and propagation
Group D 0.000 0.000 0.005 – within the composite resin under loading. One additional
0.044 0.065 0.010 –
FRC bar, in 908 angle to the main framework supported the
cusps of the pontic most effectively. From clinical and
Table 3 – Failure patterns of different frameworks of FRC technical perspective, this framework design is also easy to
FPDs under loading to occlusal fossa (OF) and buccal cusp fabricate.
(BC) In the Group C, although four short bars of fibers were
VCC VCD VCD + GF FF added to the main framework for supporting veneering
Loading to OF
materials, the lowest value was observed for loading at buccal
Group A 6/6 – – – cusp, since additional fibers were parallel to the main
Group B – 1/6 5/6 – framework and provided no reinforcing effect for buccal
Group C – 1/6 5/6 – and lingual cusps. Fiber reinforcement with multidirectionally
Group D 3/6 – 1/6 2/6 oriented short fiber veil gives isotropic mechanical properties
Loading to BC for FRC in plane. However, in the Group B load values were low
Group A – 6/6 – – likely because of the low volume fraction of the fibers in FRC
Group B – – 6/6 – veil and because of the low theoretical reinforcing effect
Group C – 2/6 4/6 – (Krenchel’s factor) of multidirectional FRC in specific stress
Group D – 6/6 – –
directions.
VCC: veneering composite crack; VCD: veneering composite The failures of Group A, B, and C were related to the
delamination; VCD + GF: veneering composite delamination with veneering materials, such as veneering cracks or delamina-
glass fibers; FF: framework fracture. tion, and no crevice at bonding margin of inlay to the cavity
was observed even with the stereomicroscope. Two FRC FPDs
of the Group D presented a complete debonding between the
than the average maximum masticatory force of human can dentin and retaining inlay when FRC framework fracture,
produce to the FPD (500–600 N in posterior area).12,14 Recent which occurred under high loading stage (2500 N) and
experiments by FRC FPDs used loading conditions only to indicated lack of load-bearing capacity of the framework at
occlusal fossa3,8,15,16 and not the buccal cusp. Compared with that high load level. The failure pattern, in the form of
those studies, the loading condition of the present study could veneering composite delamination, in the Group A is in
be considered clinically more relevant. accordance with results by Cho et al.22 and Ozcan et al.8 The
It is known that the fiber position is an influential factor crack and chipping of veneering composite showed a two-
for reinforcing a restoration.17,18 Unidirectional fibers give phase failure pattern between the veneering composite and
anisotropic mechanical properties to the FRC and can the FRC framework or between additional fibers. The most of
effectively reinforce the composite in one direction parallel FRC FPDs of the present study and that of Ozcan et al. study
to stress direction, if adequate adhesion between the failed without main fiber framework fracture. Therefore, the
veneering composite, composite/FRC framework interface
were considered as the weakest part of the restoration. In
this study, only one framework design with additional fibers
(Group D) seemed to provide efficient support for the
veneering material.
Clinically, the design of high volume fraction framework
was shown to function better than low volume fraction
frameworks by Freilich et al.6 They added unidirectional fibers
by wrapping the main framework to enlarge the pontic
portion. This design could be employed to fabricate the FRC
FPDs with indirect technique. The present study showed that
technically simpler approach to add a piece of unidirectional
Fig. 3 – After loading at buccal cusp, one FRC FPD of Group C FRC on the main framework could provide sufficient support
showed veneering composite delamination with for the pontic. The approach could also be easier to use in
additional fibers. direct applications.
582 journal of dentistry 35 (2007) 578–582
5. Conclusion
As conclusions of this in vitro study, the following statements
were made:
 All four framework designs provided higher fracture
resistance if the load applied to the occlusal fossa rather
than to the buccal cusp.
 The load-bearing capacity was increased by placing one
additional piece of unidirectional FRC on the occlusal surface
of the main framework in the buccolingual direction.
 The FRC FPDs fabricated with direct technique had high
fracture strength compared to known maximal occlusal
forces.
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