Fracture Resistance of Endodontically Treated Premolars with Extensive MOD Cavities Restored with Different Composite Restorations : An in Vitro Study

Abstract

Background: This in vitro study evaluated the fracture resistance of weakened endodontically treated premolars with class II MOD cavities restored with different composite restorations (Low-shrinkage Filtek P90, nanohybrid Filtek Z250 XT and SDR bulk fill). The type and mode of fracture were also assessed for all the experimental groups. Materials and Method: Fifty human adult maxillary premolar teeth were selected for this study. Standardized extensive class II MOD cavities with endodontic treatment were prepared for all teeth, except those that were saved as intact control. The teeth were divided into five groups of ten teeth each (n=10): (Group 1) intact control group, (Group 2) unrestored teeth with endodontic treatment, (Group 3) restored with (Filtek Z250 XT), (Group 4) restored with SDR bulk-fill flowable composite and (Group 5) restored with Filtek P90 composite. All specimens were subjected to compressive axial loading until fracture in a universal testing machine. The data were statistically analyzed using one-way ANOVA test and LSD test. Macroscopic fracture type were observed and classified into favorable and unfavorable. Specimens in group 3, 4 and 5 were examined by stereomicroscope at a magnification of 20× to evaluate the mode of failure into adhesive, cohesive or mixed. Results: The mean fracture load was (1.123 Kn) for group 1, (0.545 Kn) for group 2, (0.687 Kn) for group 3, (0.799 Kn) for group 4 and (0.672 Kn) for group 5. Using one way ANOVA test a highly significant difference (P < 0.01) were found among all groups. The use of bulk-fill flowable composite improved the fracture resistance significantly in comparison to silorane and non-significantly to Filtek Z250 XT. Filtek Z250 XT showed better improvement in fracture resistance but with no significant differences in comparison to Filtek P90 composite restorations. The type of failure was unfavorable for all the restored groups. Conclusion:All experimental composite restorations showed significant improvement in the resistance to cuspal fracture in comparison to unrestored one. However, under the conditions of this study, direct composite restorations should be considered as a valid interim restoration for weakened endodontically treated teeth before cuspal coverage can be provided.