Abstract
Objectives: To investigate in vitro post-fatigue fracture behavior of endodontically treated molars having been differently restored. Methods: A total of 120 extracted human molars were used. A total of 120 specimens in 14 test groups and one control group (n = 8) were root canal treated. After postendodontic sealing and build-up (AdheSE Universal, SDR), additional MOD preparations were cut. Postendodontic restorations were: Direct restorations (Tetric EvoCeram BulkFill bonded with AdheSE Universal and EverX Posterior/Essentia bonded with G-Premio Bond; as filling (F) or direct partial crown (DPC) after reducing the cusps 2 mm; indirect adhesive restorations (partial crown/PC vs. full crown/FC): e.max CAD, Celtra Duo, both luted with Variolink Esthetic; indirect zirconia restorations (partial crown/PC vs. full crown/FC), luted with RelyX Unicem 2; indirect non-bonded cast gold restorations (partial crown/PC vs. full crown/FC; Degunorm), luted with Ketac Cem. Before and after 300,000 thermocycles (5/55 °C) and 1.2 Mio. A total of 100 N load cycles, replicas were analyzed under a SEM for marginal quality in enamel and dentin (where applicable) and finally, specimens were loaded until fracture. Results: In direct groups, there was no difference between RC and FRC in fracture strength (p > 0.05); however, direct partial crowns showed higher post-fatigue fracture resistance. Regarding marginal quality, intracoronal FRC restorations exhibited more gap-free margins in enamel than RC. In the indirect groups, there was no significant difference between partial and full crowns in any of the adhesively luted ceramic groups regarding post-fatigue fracture resistance. Zirconia partial crowns exhibited significantly lower marginal quality in enamel. Indirect groups performed significantly better than direct groups in fracture resistance. Within the indirect restorations, both cast gold groups and zirconia full crowns exhibited the highest fracture resistance being superior to control teeth. Significances: Within the limits of this in vitro investigation, it can be concluded that any kind of indirect restoration with cusp replacement is suitable for ETT restoration when a certain cavity extension is exceeded. All indirect restorations, i.e., endocrowns, partial crowns, and full crowns showed a promising performance after in vitro fatigue-loading.
Highlights
Today there is sufficient evidence that vital teeth may be effectively restored even when substantially decayed [1,2,3,4]; after root canal treatment the prognosis is considerably worse [5,6,7] because both pre-existing defects and endodontic access cavities significantly weaken the tooth complex [8,9,10]
We evaluated the influence of direct vs. indirect and intracoronal (MO/MOD) vs. coverage restorations [19]
0.05); DPC performed significantly better compared fillingsstrength (p < 0.05)
Summary
Today there is sufficient evidence that vital teeth may be effectively restored even when substantially decayed [1,2,3,4]; after root canal treatment the prognosis is considerably worse [5,6,7] because both pre-existing defects and endodontic access cavities significantly weaken the tooth complex [8,9,10]. Clinical studies are still the preferable test for dental biomaterials, but they are coming with extremely high efforts and potential patient drop out, and always involve the risk that after several years of clinical service the tested materials are not on the market anymore [1,2,3,4] This is the reason in vitro studies are so important, primarily when fatigue phenomena are involved [6,7,16,19,26,27,28,29]— in vitro studies have limitations
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