ORIGINAL RESEARCH PAPER Volume - 10 | Issue - 07 | July - 2021 | PRINT ISSN No. 2277 - 8179 | DOI : 10.

36106/ijsr

INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH

EVALUATION OF FRACTURE RESISTANCE OF ENDODONTICALLY TREATED
TEETH RESTORED WITH CONVENTIONAL, FIBRE REINFORCED AND DUAL
CURE CORE BUILD UP COMPOSITE : AN IN VITRO STUDY
Dental Science
Post graduate student , department of conservative dentistry and endodontics, kothiwal
Dr. Nipun Sharma* dental college and research centre. *Corresponding Author
Professor, Department of conservative dentistry and endodontics, kothiwal dental college
Dr. Chandrakar and research centre.
Dr. Udai pratap H.O.D and professor, department of conservative dentistry and endodontics, kothiwal
singh dental college and research centre.
ABSTRACT
The primary aims of biomimetic dentistry are to be as minimally invasive as possible, and to substitute the missing hard dental tissues with
restorative materials closely resembling the natural tissues regarding their mechanical features and properties
Methodology : 60 intact non-carious maxillary premolars extracted due to either periodontal or orthodontic reasons were collected and randomly
divided into six groups (n=10). Composite resin reinforced with glass bres Interlig bre (angelus) will be adapted to cavity oor and cavity and
then will be lled with posterior dental composites incrementally with the nanohybrid composite and group 6 EverX Posterior with nano hybrid
composite (Filtek ™ Z350XT after thermocycling fracture resistance for the samples were tested using universal testing machine.
Conclusion: The glass bre impregnated in owable composite resin with nano hybrid composite and short bre composite (everX posterior) nano
hybrid composite showed superior fracture resistance compared to other composite materials tested.
KEYWORDS
glass bre reinforced composite, short bre reinforced composite, core build up mateial , bulkll composite, nano hybrid composite
INTRODUCTION: Group 1 (NC): The teeth will be left intact without any tooth
The restoration of endodontically treated teeth has undergone preparation or root canal treatment. These samples will serve as
signicant changes in the last decade. Diverse opinion remains about negative control.
clinical procedures and materials to be used to restore these teeth.1
Endodontic treatment generally results in reduction in resilience and Remaining 50 samples will be subjected to following protocol.
fracture resistance of teeth.2Fractures are more common in pulpless
teeth than teeth with vital pulp, although some authors have related a Experimental design:
little difference of fracture incidence between non-endodontically Mesio-occluso-distal tooth preparation will be done in teeth with
treated teeth versus endodontically treated teeth.3 straight ssure bur mounted in high speed hand piece with water
coolant. Gingival cavosurface margin will be located 1mm above
During endodontic access preparation the strength of the tooth gets cementoenamel junction (CEJ). The buccolingual width of preparation
compromised as a result of deep and extensive cavity preparation will be half the intercuspal distance. The cavity will be without
which in turn causes the loss of dentin and various anatomic structures proximal steps, at oor and buccal and lingual wall parallel to each
such as marginal ridges, cusps thereby subjecting the tooth to the other. Endodontic access cavities will be then prepared. The teeth with
higher risk of fracture after nal restoration.4-5The decrease in the minimal apical le size 15 K le will be selected, cleaned and shaped
fracture resistance of occlusal cavity preparation in proportion to the using step back technique with 30 K le as nal apical diameter. The
width of the same has been established in restorative dentistry and the canals will be obturated with gutta percha and sealer using cold lateral
similar concept was later suggested in endodontics stating that cuspal condensation. The gutta percha will be removed below level of CEJ
deection was more with increased cavity size and most in the and orice sealed with GC Fuji II. These 50 prepared samples will be
endodontic access. allocated in 5 groups according to intervention protocol.

Documentation regarding the use of direct restorative techniques with
the use of adhesive restorative system in large cavities have shown
good prognosis in vitro. 6 - 1 4 Treatment approaches using the
biomimetical concept of structural compatibility of restorative
material and tooth hard tissue to replace enamel, and composite resins
to replace dentine, combined with optimized bonding strategies have
been introduced. With their improved mechanical properties and wear
resistance, and given their more favourable cost, resin composites
have, for many, become the material of choice not only for dentine
replacement but also for the restoration of the whole posterior tooth in
the posterior region.
The insertion of bre posts within direct composite restorations has
been tested with the intention of providing increased fracture
resistance. An alternative method to increase the fracture resistance of
endodontically treated teeth is by the insertion of bres such as
polyethylene and glass bres, which are increasingly being used for
the reinforcement by the application of bre layer beneath the
restoration to mimic the natural behaviour of the dentin.15-19
MATERIAL AND METHOD:
Sixty intact non-carious maxillary premolars extracted due to either
periodontal or orthodontic reasons were thoroughly cleaned using
ultrasonic scaler and stored in saline at room temperature commencing
the experiment.
Teeth will be randomly distributed into six groups
12 International Journal of Scientific Research
Group 2 (PC): Kept unrestored after MOD preparation and
endodontic treatment. These samples will serve as positive control.
Group 3 (DCC): Access cavity and MOD Preparation will be restored
with dual cure core build up composite
Group 4 (PRC): Tooth restored with bulk ll dental composites and
rest of the cavity will be lled with posterior dental composite.
Group 5 (GRFC): Cavity surfaces will be lined with owable
composite. Composite resin reinforced with glass bres will be
adapted to cavity oor and cavity will be lled with posterior dental
composites incrementally.
Group 6 (SFC): Short ber-reinforced resin composite will be placed
using bulk ll technique and cured for 40 sec. The remaining part will
be restored with posterior dental composite incrementally.
The teeth will be handled in a moist gauge to prevent dehydration. In
addition, a thin coat of wax will be used initially to cover the external
root surface of all teeth, and later will get embedded in self cure acrylic
resin to the level of 1mm apical to CEJ, with long axis parallel to the
mold. Then, the wax on the root surface will be removed using boiling
water. The space so formed will be lled with silicone to stimulate the
periodontal ligament.3
EVALUATION OF FRACTURE RESISTANCE:
Ten samples from each group were subjected to axial compression test
in a universal testing machine (Instron, ADMET, Enkay Enterprises,
New Delhi) using the corresponding computer software. The
specimens were then placed, while a straight round tip stainless steel
Volume - 10 | Issue - 07 | July - 2021
rod was positioned parallel to long axis of teeth and centered over the
teeth until the bar just slightly contacted the occlusal surface.
Compressive loading of the teeth was performed at cross head speed of
1mm/min, and force necessary to fracture each tooth was recorded in
Newton (N). The results were then be subjected to statistical analysis.
STATISTICAL ANALYSIS:
The statistical analysis on fracture toughness was done using SPSS
(Statistical Package for Social Sciences) Version 21.0 statistical
analysis software.The statistical tools used were, TUKEY POST HOC
TEST and one-way ANOVA.
RESULTS:
The maximum was in group A, followed by group E, then group F, then
group D, then group C and least in then group B. The highest fracture
resistance value were found in group 5 (GFRC) and least fracture
resistance were found in group 2 (PC) respectively. The mean load
required to fracture rest of the samples was 2175.70 ± 536.46 for group
1 (NC), 1074.70 ± 255 for group 3 (DCC), 1274 ± 272.54 for group 4
(PRC) and 1634 ± 295.79 for group 6 (SFC). Among the materials
tested (GFRC) group 5 showed higher values when compared to other
group (p=0.0001).
GROUP MEAN (N±SD)
Group A NC 2175.70±526.46
Group B PC 491.30±248.06
Group C DCC 1074.70±255.00
Group D PRC 1274.40±272.54
Group E GFRC 1700.00±293.76
Group F SFC 1674.30±295.79
Different lowercase superscript letters indicate statistically
significant difference within the column (p < 0.05)
DISCUSSION
The remaining tooth structure and functional requirement are crucial
deciding factors required to judge the type of coronal restoration of the
endodontically treated posterior teeth.18 In the previous studies it has
been shown that the fracture resistance of the endodontically treated
teeth is decreased due to the excessive loss of tooth structure be it
through caries or wider access preparation or any additional
preparation that causes loss of marginal ridge thereby making the tooth
more prone to fracture.6,20,19,21 Some studies have suggested that
composite restoration strengthens the tooth better in comparison to
amalgam,5 ,22,7 while others found no difference stating that the large
cavities restored with amalgam show cuspal failure due to inefciency
of the bulk of material to strengthen the weakened cusps.22-26 So, the
choice of material selected as post endodontic restoration have a
crucial role in the tooth longevity.
Therefore, in this study the bulk ll composites, two bre reinforced
composites and a dual cure core build up composite with different
compositions have been used to analyse..
Maxillary premolars were used in this study because due the anatomic
shape of these teeth has the tendency for the separation of cusps while
mastication as they are more subjected to axial forces.27 Mesio-
occluso-distal (MOD) cavity was prepared, because according to Siso
et al, the unrestored teeth with MOD preparation leads to the
signicant decrease of strength i.e. up to 50% due to the loss of
marginal ridges when compared to the intact teeth thereby simulating
the worst clinical scenario.5,28-31
Elastomeric material had been used to simulate how the occlusal load
is distributed evenly to the alveolar bone via periodontal ligament.7,32-35
In this study, the group 1 (NC) showed highest fracture resistance as no
preparation was done in this group where in group 2(PC) showed the
least fracture resistance, proving the low strength of tooth due to loss of
tooth structure after extensive tooth preparation and access cavity and
no restoration in the tooth to strengthen the same. This is in accordance
with previous studies done by Sedgley and Messer which stated that
the biomechanical properties of non-vital teeth such as tenacity,
microhardness, shear and fracture resistance do not change, suggesting
that cumulative loss of dental structure by caries, trauma, restorative
and endodontic procedures lead susceptibility to fracture also study
suggested that cusp elongation due to cavity preparation may be the
major factor in fracture susceptibility, mainly in endodontically treated
upper premolars whose anatomy tends to separate the buccal and
PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr
palatal cusps under occlusal load.36
Mondelli et al in his study concluded that fracture strength is inversely
propotional to the amount of tooth structure removed and the direct
composite preparation have higher resistance to occlusal load fracture
than indirect preparation.37
These bres despite of having strengthening properties might lead to
the failure of restoration at the interface due to the creation of a
discontinuous phase between the bres and the polymer resin matrix
resulting in delamination.19,38-39
Hence, the effectuality of the bre reinforcers might depend on various
factors like resin used, the quantity, length and the orientation of bres,
impregnation of the bres to resin matrix.27,39-40 So, may be the
comparable results of our study somehow attributes to one of these
factors.
Fibre reinforced composites consist of bre material held together by a
resinous matrix. They offer good exure strength and other physical
qualities required in a prosthesis substructure material and for
replacement of lost tooth structure.41-42
everX posterior is a bre reinforced composite which is manly
composed of short E-glass bre llers. These bres can control
polymerization shrinkage and marginal microleakage because of their
bre orientation.43 The other important function of this short bre
composite substructure is to prevent crack propagation apart from
distributing the stresses.44-46
SFC group (EverX posterior) showed signicant increase in the
fracture resistance comparable with NC, which may be due to the bulk
SFC sub structure to overlying conventional composite thereby
transferring the stress from polymer to the individual bres which acts
as crack propagation inhibitors. 32 A research by Frater et al
demonstrated that the use of layering technique with SFC led to
increase fracture risk.47 Hence the bulk ll technique was used in our
study.
Oskeen et al showed that the fracture resistance of teeth increased
when glass bres were placed on the occlusal third instead of the
gingival third of the cavities The proximity of the bre location to the
force exertion point (shortening of the working arm according to the
lever principle) and maintaining the buccal and lingual cusps close to
each other by occlusal surface bres protect the natural cusps, resulting
in higher fracture resistance.48
There was no signicant difference in the experimental groups
restored with dual cure core build up composite and bulk ll composite
used. MultiCore Flow (DCC group) has an elastic modulus of 6 GPa,
which is much less than the elastic modulus of dentin. Because
owable resins have lower ller volume (42%–53%), they have
reduced hardness,49 also, according to the study by Kouretas et al in
which he examined the impact of self-curing (SC) and light-curing
(LC) mechanisms on the curing efciency of dual-cured build-up
restorative materials found that multi core ow showed more efcient
self-cure mechanism during the early setting stages (even 20 minutes
after mixing).however the delay of the DCB materials reaching the
curing efciency of their LC analogues when initiated only by the SC
mechanism, indicates development of less polymerization shrinkage
and lower contraction stress rates50 where in our study the cavity was
immediately light cured after the placement of the DCC which might
lead to the increase in composite stiffness and build-up of interfacial
stress as documented in the cases of fast reaction rate where the
polymerizing matrix reaches the critical conversion for gelation within
a short time hence increasing the stiffness of composite and can cause
stress hype in the interfacial area which could lead to gap formation
and detachment of the restoration.51,52 These reasons could have caused
the poor performance of DCC when compared with the NC, GFRC and
SFC groups.
In Tetric N Ceram bulk ll in addition to camphorquinone amine
initiator system, they have introduced initiator booster 'ivocerin' to
increase its depth of cure. However, not much of literature is available
that concerns with the polymerisation mechanism and the chemical
nature of the initiator.53 This may be the reason of lowest fracture
resistance in the bulk ll group among the tested group. These ndings
are in agreement with the previous studies done by eapen et al and
International Journal of Scientific Research 13
Volume - 10 | Issue - 07 | July - 2021 PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr

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14 International Journal of Scientific Research