Effects of different surface treatments on surface topography and bond strength in the repair of fiber-reinforced dentin composite.

OBJECTIVE: This study aimed to evaluate the effects of different surface treatments on the repair bond strength between a fiber-reinforced dentin composite and a posterior composite. METHODS: Forty fiber-reinforced dentin composite resin blocks (4 mm × 4 mm × 4 mm) were separated into eight groups (n = 5) according to the surface preparation methods: (G1) negative control group, (G2) adhesive application, (G3) 50% dimethylsulfoxide (DMSO) application, (G4) 50% DMSO + adhesive application, (G5) 37% phosphoric acid etch + adhesive application, (G6) air abrasion + adhesive application, (G7) 37% phosphoric acid etch + 50% DMSO application + adhesive application, and (G8) air abrasion +50% DMSO application + adhesive application group. The composite surfaces were repaired in two layers with a posterior composite. Composite sticks were subjected to a micro tensile bond strength (µTBS) test. Fractured surfaces were evaluated using a stereomicroscope (×25). Short fiber-reinforced composite samples' surfaces were investigated by scanning electron microscope (SEM). Shapiro Wilk, one-way ANOVA, and Tukey HSD tests were used for statistical evaluation. RESULTS: The highest average (µTBS) values were observed in G8, whereas the lowest mean µTBS values were evident in the G1 group. Statistically significant µTBS values were found in all adhesive-applied groups when compared with the negative control group. Notably, the application of 50% DMSO without adhesive did not lead to a statistically significant increase in µTBS values. SEM images demonstrated that acid etching partially eliminated residues on the composite surface, while air abrasion had a detrimental effect on the integrity of fiber structures. CONCLUSION: In the repair of fiber-reinforced dentin composite with a posterior composite, adhesive application is an effective approach. The treatment of 50% DMSO without adhesive did not confer a statistically significant advantage, and the supplemental use of acid etch or air abrasion did not show an additional benefit compared to adhesive-only repairs. CLINICAL SIGNIFICANCE: Adhesive application emerges as a potent and effective strategy for the repair of bur-roughened fiber-reinforced dentin composites. With its limitations, the study highlights the efficacy of adhesive-only repairs without the necessity for additional surface treatments.

The fracture strength and the failure mode of lithium disilicate or resin nano ceramics as a crown, overlay, or endocrown restoration on endodontically treated teeth.

INTRODUCTION: Different materials and restorative concepts have been proposed over the years to restore endodontically treated teeth (ETT). Monolithic ceramic and composite restoration can be lute to the tooh, without the use of a post. However, little is known how the material stiffness and presence of a composite core will affect the survival and failure mode. The objective of this in-vitro study was to evaluate the fracture strength and failure mode of endodontically treated molars, restored with ceramic or hybrid composite monolithic restoration, in the presence of absence of a composite core. MATERIALS AND METHODS: Sixty depulped molars were restored with a lithium-disilicate (e.max CAD) or hybrid composite (Cerasmart) restoration. Both materials were used in a monolithic approach, but with 3 different designs: (a) monolithic endocrown, (b) crown with a separate composite core, and (c) overlay without core buildup or pulpal extension. Ten sound teeth were used as control group. All groups were thermocycled (10,000 cycles), subsequently loaded in a chewing simulator (100,000 cycles) and finally loaded until fracture. RESULTS: Peak fracture loads and failure modes were registered. No significant differences were seen between the groups in terms of fracture load. Failure modes were statistically significantly different among groups with significant correlation between restoration type and material. (p < 0.001 and p = 0.033, respectively). No group presented significantly higher fracture resistance. Although ceramic crowns and overlays presented the highest repairability, all restored ETT were within the range of the intact tooth' fracture strength. CONCLUSION: No restoration presented significant different fracture loads. However, the type of restoration and material choice were correlated to the fracture mode.

Evaluation of mechanical properties of anatomically customized fiber posts using E-glass short fiber-reinforced composite to restore weakened endodontically treated premolars.

OBJECTIVE: This study was conducted to assess the influence of combining different forms of fiber-reinforced composites (FRC) on the mechanical behavior and bond strength of compromised endodontically treated teeth (ETT). MATERIALS AND METHODS: Eighty extracted human premolar teeth were randomly divided into five experimental groups according to the type of intra-radicular restoration and the canal preparation design which was either non-flared (Group 1), flared (Groups 2-5), closed-apex (Groups 1,3,5) or open-apex (Groups 2,4). Standard prefabricated fiber posts were used as intra-radicular restoration for Groups 1-3 while Groups 4-5 were restored with anatomically customized relined fiber posts. After composite core fabrication, all samples were sent for an artificial aging process. Fracture resistance and push-out bond strength tests were then carried out through a universal testing machine followed by mode of failure analysis via a stereomicroscope and scanning electron microscope. RESULTS: Pairwise Log-Rank comparisons revealed that the survival rate of Group 2 and Group 3 was significantly lower than all other groups after artificial aging. The highest fracture resistance value (1796 N) was recorded in Group 5 and was significantly higher than that of the other groups (p < 0.05), while Group 2 exhibited the lowest fracture resistance (758 N), which was significantly lower compared to the other groups. Group 5 and Group 4 demonstrated a significantly higher push-out bond strength, at all root thirds, than Group 3, Group 2, and Group 1 (p < 0.05). The most frequently observed failure mode in the tested groups occurred between the resin cement and radicular dentin. CONCLUSION: The use of short fiber-reinforced composite (SFRC) to reline the prefabricated FRC post has been proven to have superior fracture resistance with favorable failure patterns and increased push-out bond strength values compared to standard prefabricated FRC posts.

Biomimetic approach to strengthen the incisal fracture composite build-up: an in vitro study.

OBJECTIVE: Incisal composite build-up shows a high failure susceptibility. The incorporation of fiber-reinforced composite (FRC) during composite restoration could improve its strength. Hence the study was planned to compare the effect of various positions of FRC on the strength of composite resin incisal build-ups. METHODS: In maxillary incisors (n = 90), 3 mm of the incisal edge was cut and teeth were categorized into three groups based on the location and number of fibers used during incisal composite build-up - Group I: composite resin; Group II: composite resin and a single fiber palatally and Group III: composite resin along with two fibers palatally. RESULTS: The data showed that group II had the maximum load-bearing values followed by group I and group III. CONCLUSION: Within the confines of our study, it can be concluded that the addition of FRC to the conventional incisal composite build-up increased the overall strength restoration. Such composite restoration reinforced with a single fiber on the palatal side showed the highest load-bearing capacity compared to two fibers reinforced and unreinforced composites. The common mode of failure in group I was in composite resin, in two fibers reinforced at fibers-composite junction, and in one fiber reinforced composite was in the remaining part of the tooth.

Fracture resistance and failure mode of three esthetic CAD-CAM post and core restorations.

BACKGROUND: The rising demand for improved aesthetics has driven the utilization of recently introduced aesthetic materials for creating custom post and core restorations. However, information regarding the fracture resistance of these materials remains unclear, which limits their practical use as custom post and core restorations in clinical applications. AIM OF THE STUDY: This study aimed to evaluate the fracture resistance of three non-metallic esthetic post and core restorations and their modes of failure. MATERIALS AND METHODS: Thirty-nine single-rooted human maxillary central incisors were endodontically treated. A standardized post space preparation of 9mm length was performed to all teeth to receive custom-made post and core restorations. The prepared teeth were randomly allocated to receive a post and core restoration made of one of the following materials (n=13): glass fiber-reinforced composite (FRC), polyetheretherketone (PEEK) and polymer-infiltrated ceramic-network (PICN). An intraoral scanner was used to scan all teeth including the post spaces. Computer-aided design and computer-aided manufacturing (CAD-CAM) was used to fabricate post and core restorations. Post and core restorations were cemented using self-adhesive resin cement. All specimens were subjected to fracture resistance testing using a universal testing machine. Failure mode analysis was assessed using a stereomicroscope and SEM. The data was statistically analyzed using One-Way ANOVA test followed by multiple pairwise comparisons using Bonferroni adjusted significance level. RESULTS: Custom PEEK post and core restorations displayed the least fracture load values at 286.16 ± 67.09 N. In contrast, FRC exhibited the highest average fracture load at 452.60 ± 105.90 N, closely followed by PICN at 426.76 ± 77.99 N. In terms of failure modes, 46.2% of specimens with PICN were deemed non-restorable, while for PEEK and FRC, these percentages were 58.8% and 61.5%, respectively. CONCLUSIONS: Within the limitation of this study, both FRC and PICN demonstrated good performance regarding fracture resistance, surpassing that of PEEK.

Clinical performance of polyethylenefiber reinforced resin composite restorations in endodontically treated teeth: (a randomized controlled clinical trial).

AIM: The purpose of this study was to evaluate the performance of polyethylene fiber reinforced resin composite fillings compared to bulk fill resin composite fillings in endodontically treated teeth over a two-year monitoring period. METHOD: A total of 240 individuals with endodontically treated lower molars and a moderate amount of tooth structure were divided into two equal groups of 120 each. One group received polyethylene fiber reinforced bulk fill resin composite restorations while the other group received only bulk fill resin composite restorations, both applied as per manufacturer guidelines. Two proficient experienced blinded assessors assessed the restorations using modified USPHS criteria at baseline, 6, 12, and 24 months. STATISTICAL ANALYSIS USED: Data analysis involved the utilization of Mann-Whitney U, Friedman's test, and Nemenyi post hoc test, with age data being displayed as mean and standard deviation. The significance level was established as p < 0.05, and R software was utilized for statistical analysis. RESULTS: There were no notable distinctions in any parameters or scores between the intervention and comparator groups at various time points. Alpha scores were present for retention, gross fracture, and secondary caries at all follow up intervals. CONCLUSION: Both direct resin composite restorations reinforced with polyethylene fibers and direct bulk fill resin composite restorations placed in endodontically treated molars with moderate remaining tooth structure demonstrated satisfactory clinical outcomes during a 24-month follow-up period. CLINICAL RELEVANCE: Bulk fill resin composites directly placed in endodontically treated molars with moderate remaining tooth structure showed promise as a treatment option over a two-year period. CLINICAL TRIAL REGISTRATION: (06-01-2022) on https://ClinicalTrials.gov with the ID (NCT05180903).

Anterior provisional fixed partial dentures: A finite element analysis.

PURPOSE: The aim of this study was to analyze the stress distribution of fiber-reinforced composite provisional fixed partial denture utilizing a finite element analysis model. MATERIAL AND METHODS: Three anterior teeth were collected: upper right central, left central, and right lateral incisors. A fiber-reinforced composite strip was applied to the palatal surfaces of the teeth. Micro-computed tomographic scans were acquired of the models in order to generate three-dimensional geometrical replicas. Finite element analysis was used to assess the stress distribution of fiber-reinforced composite provisional fixed partial denture using different pontic types under static applied forces that were 100, 30, and 0 N. RESULTS: The maximum stress values were found on the unprepared natural pontic. Stress values ranged from 92.2 to 909.8, 116.4 to 646.7, and 93.8 to 393.5 MPa for composite, naturally prepared, and natural unprepared pontic, respectively. CONCLUSIONS: Using unprepared natural tooth pontic in anterior provisional fixed partial denture to replace missing central incisors is considered superior to other types in terms of stress distribution.

Evaluation of Fracture Resistance of Reattached Tooth Fragments Restored Using Fiber-reinforced Composites: A Systematic Review.

AIM AND BACKGROUND: This systematic review examined the current literature to evaluate the fracture resistance of the tooth fragments reattached using fiber-reinforced composites (FRC). MATERIALS AND METHODS: An electronic search was performed on Scopus, PubMed, and Web of Science databases according to specific inclusion and exclusion criteria to identify relevant articles to be included until January 2023. Articles with full text available in the English language for randomized control studies, observational studies, retrospective studies, and in vitro studies conducted on permanent human teeth were selected. The risk of bias was assessed in all studies using the OHAT tool. RESULTS: Out of 16 search results, seven in vitro studies with a total of 415 samples were included in the review. Three studies reported that reinforcement using rigid FRC posts improves fracture resistance of reattached anterior teeth, three studies reported that reinforcement using flexible fiber bundles enhances the fracture strength of reattached posterior teeth and one study reported that the use of flexible polyethylene fibers improves fracture resistance in molars with reattached cusps. CONCLUSION: Within the limitations of the studies included in the review, there is low-quality evidence that reinforcement of reattached fragments using FRC posts or fibers improves fracture resistance. CLINICAL SIGNIFICANCE: The reattached fractured fragments may be susceptible to re-fracture. The use of FRC to reinforce the resin composite used for reattachment may enhance the bond strength and increase resistance to fracture. How to cite this article: Albar NHM. Evaluation of Fracture Resistance of Reattached Tooth Fragments Restored Using Fiber-reinforced Composites: A Systematic Review. J Contemp Dent Pract 2024;25(6):605-615.

Biocompatibility of fiber-reinforced composite (FRC) and woven-coated FRC: an in vivo study.

OBJECTIVES: To investigate biocompatibility and bone contact area of FRC and woven-coated FRC (FRC-C) in rats. MATERIALS AND METHODS: Sixty rats were allocated to three groups: FRC (n=20), FRC-C (n=20), and control group (n=20). Subgroups were determined as 4th (n=10) and 12th weeks (n=10). The specimens were placed in the femur of rats. In the control group, the bone defects were left empty and sutured. Four and 12 weeks after implantation, the rats were sacrificed. Histopathological examinations were performed in a semi-quantitative manner. Twenty rats (n=20) were used for scanning electron microscopy (SEM) examination. Bone contact surfaces were calculated in SEM analysis. A chi-square test was performed to analyze the data. RESULTS: No statistical difference was detected between the 4th and 12th weeks in the quality of bone union. Quality of bone union was lower in FRC compared to the control group in the 4th week (p=0.012) and the 12th week (p=0.017). The periosteal reaction at the 12th week was lower in FRC than in the control group (p=0.021). Bone contact of FRC and FRC-C was 85.5% and 86.3%, respectively. CONCLUSIONS: FRC and FRC-C were biocompatible and showed no inflammation. The woven coating did not increase the quality of bone union and bone contact area, while not reducing biocompatibility. CLINICAL RELEVANCE: The biocompatibility and good bone response of the woven glass fiber net were demonstrated to have the potential as a scaffold for the augmentation of alveolar bone deficiencies and the reconstruction of maxillofacial defects.

Wear behavior at margins of direct composite with CAD/CAM composite and enamel.

OBJECTIVES: The aim was to investigate the two-body wear at the marginal area between direct filling composites and substrate of CAD/CAM composites or enamel. MATERIALS AND METHODS: Flat specimens were prepared from CAD/CAM composites (CERASMART 270 and SFRC CAD) and bovine enamel. A box-shaped cavity cut into CAD/CAM composites and enamel surfaces was made. The prepared cavity in CAD/CAM composites was treated with a primer, while in enamel, the cavity was treated with an adhesive. Three conventional composites (Universal Injectable, G-aenial A'Chord, and Filtek Bulk Fill) and one short fiber composite (everX Flow) were placed and cured in the prepared cavities. A two-body wear test was conducted with 15,000 chewing cycles using a dual-axis chewing simulator. The specimens (n = 5/per group) were positioned to produce wear (load = 20 N) across the marginal area between filling composites and substrates. The wear depth was analyzed using a 3D optical profilometer. SEM was used to evaluate the wear behavior and margins between the filling and substrate materials. RESULTS: All composites used displayed different wear behavior (20-39 µm) (p < 0.05). The highest wear values were recorded for A'Chord and Filtek, while the lowest values were for Injectable and CERASMART 270. The data analysis showed that the wear behavior of substrate materials depends on the filling materials used at margins (p < 0.05). The marginal breakdown was seen only between bovine enamel and filling composites. CONCLUSIONS: The use of the two-body wear simulation method revealed important information about the behavior of the filling composites at the marginal area with CAD/CAM composites or bovine enamel substrates. CLINICAL RELEVANCE: The marginal breakdown related to the material combination at the bonding region.

Crack propensity of different direct restorative procedures in deep MOD cavities.

OBJECTIVE: The purpose was to evaluate the crack formation associated with different direct restorative procedures of the utilized resin composites (RC) right after and 1 week later of the restoration. MATERIALS AND METHODS: Eighty intact, crack-free third molars with standard MOD cavities were included in this in vitro study and randomly divided into four groups of 20 each. After adhesive treatment, the cavities were restored either with bulk (group 1) or layered (group 2) short-fiber-reinforced resin composites (SFRC); bulk-fill RC (group 3); and layered conventional RC (control). Right after the polymerization and a week later, crack evaluation on the outer surface of the remaining cavity walls was performed with a transillumination method utilizing the D-Light Pro (GC Europe) with the "detection mode." Between- and within-groups comparisons Kruskal-Wallis and Wilcoxon tests were used, respectively. RESULTS: Post-polymerization crack evaluation showed significantly lower crack formation in SFRC groups compared to the control (p<0.001). There was no significant difference within SFRC groups and non-SFRC groups (p=1.00 and p=0.11, respectively). Within group comparison revealed significantly higher number of cracks in all groups after 1 week (p≤0.001), however, only the control group differed significantly from all the other groups (p≤0.003). CONCLUSIONS: Post-polymerization shrinkage induced further crack formation in the tooth 1 week after the restoration. SFRC was less prone to shrinkage-related crack formation during the restorative procedure; however, after 1 week, besides SFRC, bulk-fill RC also showed less prone to polymerization shrinkage-related crack formation than layered composite fillings. CLINICAL RELEVANCE: SRFC can decrease the shrinkage stress-induced crack formation in MOD cavities.

Fatigue performance of endodontically treated molars reinforced with different fiber systems.

OBJECTIVE: The aim was to investigate the fatigue performance of root canal-treated (RCT) molars restored with different direct restorations utilizing discontinuous and continuous fiber-reinforced composite (FRC) systems. The impact of direct cuspal coverage was also evaluated. MATERIALS AND METHODS: One hundred and twenty intact third molars extracted for periodontal or orthodontic reasons were randomly divided into six groups (n=20). Standardized MOD, regular cavities for direct restorations were prepared in all specimens, and subsequently, root canal treatment and root canal obturation was carried out. After the endodontic treatment, the cavities were restored with different fiber-reinforced direct restorations as follows: SFC group (control), discontinuous short fiber-reinforced composite (SFC) without cuspal coverage (CC); SFC+CC group, SFC with cuspal coverage; PFRC group, transcoronal fixation with continuous polyethylene fibers without CC; PFRC+CC group, transcoronal fixation with continuous polyethylene fibers with CC; GFRC group, continuous glass FRC post without CC; and GFRC+CC, continuous glass FRC post with CC. All specimens underwent a fatigue survival test in a cyclic loading machine until fracture occurred or 40,000 cycles were completed. The Kaplan-Meier survival analysis was conducted, followed by pairwise log-rank post hoc comparisons between the individual groups (Mantel-Cox). RESULTS: The PFRC+CC group was characterized by significantly higher survival compared to all the groups (p < 0.05), except for the control group (p = 0.317). In contrast, the GFRC group showed significantly lower survival compared to all the groups (p < 0.05), except for the SFC+CC group (p = 0.118). The control group (SFC) showed statistically higher survival than the SFRC+CC group (p < 0.05) and GFRC group (p < 0.05), but it did not differ significantly from the rest of the groups in terms of survival. CONCLUSIONS: Direct restorations utilizing continuous FRC systems (in the form of polyethylene fibers or FRC post) to restore RCT molar MOD cavities performed better in terms of fatigue resistance when CC was performed compared to the same FRC restorations without CC. On the contrary, teeth restored with SFC restorations performed better without CC compared to the ones where SFC was covered. CLINICAL RELEVANCE: In the case of fiber-reinforced direct restorations for MOD cavities in RCT molars, direct CC is recommended when utilizing long continuous fibers for reinforcement, however, should be avoided when only SFC is used for their reinforcement.

Effect of different designs of minimally invasive cantilever resin-bonded fixed dental prostheses replacing mandibular premolar: Long-term fracture load and 3D finite element analysis.

PURPOSE: To evaluate the fracture load and stress magnitude of different retainer designs of minimally invasive cantilever resin-bonded fixed dental prostheses (RBFDPs) after artificial aging. MATERIALS AND METHODS: Fifty caries-free human mandibular molars were prepared as abutments for cantilever fixed dental prostheses using different retainer designs: one wing (OW), two wings (TW), inlay ring (IR), lingual coverage (LC), and occlusal coverage (OC). Computer-aided design and computer-aided manufacturing were used for milling the RBFDPs using fiber-reinforced composite (FRC), and the restorations were adhesively bonded. The specimens were then subjected to thermomechanical aging and loaded until failure. The 3D finite element analysis (FEA) was performed with five models of retainer designs similar to the in vitro test. Modified von Mises stress values on enamel, dentine, luting resin, and restorations were examined. Data were analyzed with Kruskal-Wallis and Mann-Whitney U tests (p < 0.001). RESULTS: A statistically significant difference (p < 0.001) was found between all groups except between IR and LC and between OW and TW designs, with the highest mean failure load detected for OC (534.70 N) and the lowest detected for OW (129.80 N). With regard to failure mode, OW, TW, and LC showed more incidences of favorable failure patterns than IR and OC designs. FEA showed that FRC transmitted low stresses in tooth structure and high stresses to the luting resin. CONCLUSIONS: LC and OC designs can be used to design cantilever RBFDPs in premolar area. IR design transmitted more stresses to the tooth structure and resulted in 30% catastrophic failure. OW and TW were below the normal occlusal force and should be carefully used.

FIBER REINFORCED COMPOSITE RETAINERS MAY BE AS EFFECTIVE AS MULTISTRANDED STAINLESS-STEEL WIRES IN FAILURE RATES AND MINIMAL ADVERSE EFFECT, BUT SUPERIOR IN TERMS OF RELAPSE AND PATIENT SATISFACTION.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Liu S, Silikas N, Ei-Angbawi A. Analysis of the effectiveness of the fiber-reinforced composite lingual retainer: A systematic review and meta-analysis. Am J Orthod Dentofacial Orthop. 2022 Aug 26:S0889-5406(22)00,432-2. doi: 10.1016/j.ajodo.2022.07.003. Epub ahead of print. PMID: 36,031,511. SOURCE OF FUNDING: Not reported. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

The impact of splinting timepoint of mobile mandibular incisors on the outcome of periodontal treatment-preliminary observations from a randomized clinical trial.

OBJECTIVES: To compare the outcome of periodontal parameters in mobile mandibular incisors which were splinted before or after full-mouth disinfection (FMD). MATERIALS AND METHODS: Thirty-four periodontitis patients with ≥ 1 mobile mandibular incisor (mobility degree II/III, clinical attachment loss (CAL) ≥ 5 mm, relative bone loss ≥ 50%) were randomly allocated to group A or B. Patients received periodontal treatment (PT) including splinting of teeth 33-43 before (A) or after FMD (B). Patient (age/sex/smoking status/systemic diseases/number of teeth) and tooth-related parameters (mean probing pocket depth (PPD)/CAL/oral hygiene indices; for the overall dentition and region 33-43) were assessed prior to PT and 12 months after FMD by a blinded examiner. Therapy-related information was added (group/antibiotic therapy/surgical intervention). RESULTS: Twenty-six patients (A: 12; B:14) were re-examined. Two patients of group B did not need splinting after FMD because of reduction in mobility after FMD. Regression analysis revealed a positive association of antibiotic therapy with CAL_overall, PPD_overall, and PPD_33-43 (p ≤ 0.01). There is a trend toward a higher reduction of periodontal parameters at teeth 33-43 in group A (PPD_33-43: - 0.91 vs. - 0.27 mm; CAL_33-43: - 1.02 vs. - 0.47 mm). CONCLUSIONS: Teeth splinted before or after FMD show a significant improvement in periodontal parameters 12 months after FMD. Splinting after FMD offered the option to detect reduction in mobility. CLINICAL RELEVANCE: Despite a higher, but not statistically significant, improvement in periodontal parameters on teeth splinted before FMD, the results do not indicate which timepoint of splinting is more beneficial. The decision for the therapeutic procedure should therefore be made individually.

Fatigue performance of endodontically treated premolars restored with direct and indirect cuspal coverage restorations utilizing fiber-reinforced cores.

OBJECTIVES: The aim of this in vitro study was to investigate the fatigue survival and fracture behavior of endodontically treated (ET) premolars restored with different types of post-core and cuspal coverage restorations. MATERIALS AND METHODS: MOD cavities were prepared on 108 extracted maxillary premolars. During the endodontic treatment, all teeth were instrumented with rotary files (ProTaper Universal) to the same apical enlargement (F2) and were obturated with a matched single cone obturation. After the endodontic procedure, the cavities were restored with different post-core and overlay restorations (n = 12/group). Three groups (A1-A3) were restored with either conventional composite core (PFC; control) or flowable short-fiber-reinforced composite (SFRC) core with/without custom-made fiber posts and without overlays. Six groups had similar post-core foundations as described above but with either direct PFC (B1-B3) or indirect CAD/CAM (C1-C3) overlays. Fatigue survival was tested for all restorations using a cyclic loading machine until fracture occurred or 50,000 cycles were completed. Kaplan-Meyer survival analysis was conducted, followed by pairwise post hoc comparisons. RESULTS: None of the restored teeth survived all 50,000. Application of flowable SFRC as luting-core material with fiber post and CAD/CAD overlays (Group C3) showed superior performance regarding fatigue survival (p < 0.05) to all the other groups. Flowable SFRC with fiber post and direct overlay (Group B3) showed superior survival compared to all other direct techniques (p < 0.05), except for the same post-core foundation but without cuspal coverage (Group A3). CONCLUSIONS: Custom-made fiber post and SFRC as post luting core material with or without cuspal coverage performed well in terms of fatigue resistance and survival when used for the restoration of ET premolars. CLINICAL RELEVANCE: The fatigue survival of direct and indirect cuspal coverage restorations in ET MOD premolars is highly dependent on whether the core build-up is fiber-reinforced or not. The combination of short and long fibers in the form of individualized post-cores seems to offer a favorable solution in this situation.

Vertical root fracture resistance and crack formation of root canal-treated teeth restored with different post-luting systems.

The aim was to investigate the vertical root fracture (VRF) resistance and crack formation of root canal-treated teeth restored with different post-luting systems. Human maxillary lateral incisors of similar size were decoronated, assigned to five groups (n = 18, power = 0.9) and embedded in acrylic blocks with artificial periodontal ligament. After root canal filling, post spaces were prepared to place coated fiber-reinforced composite (FRC) or sandblasted titanium (Ti) posts of the same shape and size. Half of the posts were zinc phosphate cemented (C), while the other half was adhesively luted (A). Untreated teeth served as control. After thermal cycling and staircase loading in a chewing simulator, the crack formation on the root dentin surface was microscopically examined and classified as no defect, craze line, vertical crack, and horizontal crack. Subsequently, the samples were loaded until root fracture. Data were analyzed by one-way ANOVA, Tukey's test, and Fisher's exact test. All samples survived the chewing simulation without VRF, but crack formation was significantly different between the groups (P = 0.009). The control showed significantly fewer defects than FRC/C, Ti/C, and Ti/A (P = 0.001, P = 0.008, P = 0.008, respectively). FRC/C showed the highest incidence of vertical cracks. FRC/A had the lowest incidence of defects. There was no significant difference in VRF resistance between the groups (P = 0.265). Adhesively luted FRC posts did not increase VRF resistance but reduced the risk of defects. Most defects were craze lines and vertical root cracks.

Fracture resistance of root canal-treated molars restored with ceramic overlays with/without different resin composite base materials: an in vitro study.

The objective of the study was to evaluate the effect of different restorative protocols on fracture resistance of root canal-treated molars. 48 mandibular first molars were used and divided into six groups (n = 8); G1 (negative control): teeth kept intact. G2 (positive control): teeth had root canal treatment and standard MOD cavity preparations but kept unrestored. G3: prepared as G2 and directly restored with VitaEnamic ceramic overlays (CO). G4: as G3, but the pulp chamber was restored first with smart dental restorative (SureFil SDR flow = SDR) bulk-fill flowable composite base. G5: as G3, but the pulp chamber was restored first with SonicFill (SF) bulk-fill composite base. G6: as G3, but the pulp chamber was restored first with a fiber-reinforced composite (FRC) base. All samples were subjected to thermocycling between 5 °C and 55 °C in a water bath for a total of 2000 cycles with 10 s dwell time. Then specimens were individually mounted on a computer-controlled testing machine with a load cell of 5 kN, and the maximum load to produce fracture (N) was recorded. Data were analyzed using one-way ANOVA followed by Tukey's post hoc test (P = 0.05). There was a significant difference between the groups (P < 0.001). Teeth restored with FRC and ceramic overlays had the highest load-bearing capacity. Pulp chamber restoration with either FRC or SDR before ceramic overlay fabrication provided significantly better tooth reinforcement than ceramic overlay alone (P < 0.001). Fracture modes were analyzed to determine the type of fracture as repairable or catastrophic, where FRC + CO and SDR + CO groups had favorable fracture modes that were mostly repairable. When restoring root canal-treated molars with overlays, the pulp chamber should be sealed with either FRC or SDR to ensure the best possible fracture resistance. The clinical relevance of the study is that a new simple restorative protocol is presented to enhance the survival of root canal-treated molars using ceramic overlays.

Light Transmission of Various Aesthetic Posts at Different Depths and Its Effect on Push-Out Bond Strength, Microhardness of Luting Cement.

Background and Objectives: One requirement for the cemented post is the light transmittance on its entire length up to the deepest portion of a root canal to ensure the complete polymerization of resin cement. This study aimed to determine the light transmission ability in different aesthetic posts at different depths and its effect on the push-out bond strength and microhardness of luting cement at the corresponding interface. Materials and Methods: Twenty endodontic posts from glass fiber posts (GFP), zirconia ceramic posts (ZCP), and highly translucent zirconium oxide posts (HTZP) were sequentially sectioned into 12.8 and 4 mm lengths after recording the light intensity using a dental radiometer. Sixty single rooted premolar teeth root canals were treated and implanted vertically in a resin block. The post space was prepared and cemented with GFP, ZCP, and HTZP posts with twenty samples each. The root portion of teeth samples were sectioned into cervical, middle, and apical portion. A universal testing machine was utilized for the push-out bond strength test for the first ten samples from each group. The remaining ten samples from each group were used for the microhardness test using a micro-indenter instrument. The data were statistically analyzed using one-way Analysis of variance and Tukey HSD tests at p < 0.05. Results: The GFP endodontic postpresented with significant highest light translucency compared to HTZP, which was significantly higher than ZCP. GFP posts showed significantly higher bond strength per unit area compared to ZCP at analogous cross sections. The hardness of luting cement was also significantly higher amongst all tested endodontic posts. Conclusions: GFP high light translucency enhanced the curing of the luting resin cement that resulted in harder cement and a stronger bond supported by hardness and push-out tests. These findings suggest that GFP is preferred to be used with light-cured luting cements for restoration of endodontically treated teeth.

Fatigue failure load of immature anterior teeth: influence of different fiber post-core systems.

The aim was to explore the fracture-behavior, survival and marginal-microgaps within the root-canal of immature anterior teeth restored with different fiber-reinforced post-core composites (FRCs). 180 bovine-incisors were randomly divided into 6 groups (n = 30). One group served as control (group 6). The rest of the teeth were prepared to an internal diameter of 1.6 mm and the apex was sectioned. After application of an MTA-plug, teeth were restored with FRC materials: Group 1: Bioblock technique with short fiber-reinforced composite (SFRC); Group 2: Bioblock technique with flowable SFRC; Group 3: Individually-made FRC post; Group 4: Conventional FRC post; Group 5: dual-cure core build-up composite. After restorations were completed, teeth (n = 5/group) were sectioned and then stained. Specimens were viewed under a stereo microscope and the percentage of microgaps within the root-canal was calculated. Fatigue-survival was measured using a cyclic-loading testing machine in the rest of the specimens. Flowable SFRC application in the root-canal (Group 2) did not differ from intact-teeth regarding fatigue-survival (p > 0.05). The rest of the groups produced significantly lower survival (p < 0.05) compared to intact-teeth. Post/core restorations made from conventional FRC post (Group 4) exhibited a high number of microgaps (38.3%) at the examined interphase in the root-canal. The restoration of immature incisors with the use of flowable SFRC as post-core material displayed promising performance in a matter of fatigue-resistance and survival.