Journal of Dental Medicine

Statement of Problem: Because dental amalgam does not adhere to tooth structure, using adhesive cements in amalgam-bonded restorations have been increased.

Purpose: The goal of this in-vitro study was to compare the effects of three types of glass ionomer as adhesive liners as well as varnish liner in increasing fracture resistance of teeth restored with amalgam.

Materials and Methods: Seventy extracted human maxillary premolars were selected and MOD cavities were prepared on them excluding ten intact teeth as positive control group and ten cavity prepared teeth without restoration as negative control group. All the prepared teeth were then restored with spherical amalgam (gs.80) with one of the following liners silver alloy glass ionomer liner, conventional glass ionomer liner, varnish liner, resin-modified glass ionomer and resin-modified glass ionomer with delayed light curing. The teeth were stored in 37C distilled water for 7 days and were then loaded under compressive strength using an Instron testing machine. The force required to fracture teeth were recorded and the data were analyzed statistically using ANOVA and Tukey HSD tests.

Results: Statistically significant differences were observed in fracture resistance between restored and non-restored samples. Comparisons between groups attributed significant effects to resin-modified glass ionomer in increasing fracture resistance of amalgam restored teeth (P<0.05). In most specimens, one cusp was separated from tooth structure whereas amalgam remained bonded to the intact cusp. Conclusion: According to these findings, resin-modified glass ionomer put a statistically significant effect in fracture resistance of amalgam-restored teeth.

Background and Aim: The structural rehabilitation of a pulpless tooth is critically important to ensure a successful restorative outcome following endodontic treatment. A post and core is often indicated for the retention and reinforcement of the final restoration. But, the clinical situation is significantly challenging if the root exhibits immature development or there is a thin root wall that can compromise the prognosis for a long- term successful treatment. The purpose of this in vitro study was to evaluate different methods of intraradicular reinforcement in structurally compromised roots.

Materials and Methods: In this experimental study, seventy two extracted intact maxillary central incisors with similar size, shape and root anatomy were selected. After root canal therapy in 60 teeth, an acrylic laboratory bur was used to thin the cervical area and simulate the thin dentinal walls of immature teeth. The preparation was performed through the palatal access and extended 5mm apical to CEJ. The remaining 12 teeth remained unprepared to serve as positive control group. Cases were randomly divided into six groups of 12 teeth each and restored as follows. In the 12 cervically unprepared teeth (positive controls) the composite resin with dentin bonding agent (DBA) was placed in access cavity and cured for 120 seconds. This technique was also applied to other groups when the access was restored with composite. In the second group, the access cavity was restored with composite only to the level of CEJ. In the third group the cervically prepared teeth were reinforced with cement resin (Enforce) and a prefabricated post was placed in 5mm apical to the CEJ. In the fourth group, the cervically prepared teeth were reinforced with composite resin and DBA by a clear plastic post. In the fifth group the cervically prepared teeth were reinforced with composite resin and dba and a cast post. In the sixth group the cervically prepared teeth were restored with composite resin and dba with a prefabricated post. All of the specimens were mounted by rubberized technique and tested in the Instron universal testing machine. The fracture loads in samples were analyzed with ANOVA and Duncan tests with p<0.05 as the limit of significance.

Results: Significant differences in fracture resistance were observed between the first and second groups compared with others. The highest fracture resistance values were recorded for first group while the lowest were registered for the second group. Fracture resistance of the third, fourth and fifth groups had no significant statistical differences with others and fracture resistance of sixth group was the highest with significant difference (P<0.05).

Conclusion: From this study, it may be concluded that the use of a dba and a composite resin in thin-walled roots reinforces the immature teeth and facilitates the use of post.

Background and Aim: Considering flexural strength of fiber-reinforced composites (FRC) and also the role of conservative cavities in protecting sound tissue of abutments, the aim of this study was to evaluate the fracture resistance of these bridges by handmade samples in vitro.

Materials and Methods: In this experimental in vitro study, 44 sound newly extracted teeth were used to make 22 fixed inlay bridges including 11 three unit anterior upper inlay bridges substituting clinical model of upper central and 11 three unit posterior lower inlay bridges substituting clinical model of lower first molar. Specimens were prepared with FRC and mounted with artificial PDL in acryl. Cases were exposed to final load by using Universal Testing Machine (Instron 1195) with the speed of 1 mm/min. Statistical analysis was performed by Kolmogorov- Smirnov, independent sample T and Kaplan-Meier tests with p<0.05 as the level of significance.

Results: Based on the statistical tests, the 95% confidence interval of mean was 450-562 N in anterior and  1473- 1761 N in posterior area. Fracture strength was high in the studied groups. Fractures in both groups occurred on composite facing, and the framework remained intact. The highest percentage of fracture in posterior teeth was in the middle of pontic towards the distal connector and in the anterior teeth in the lateral connector, between central pontic and lateral abutment. Using the independent sample T  test a significant statistical difference was observed between two groups (P<0.001). The fracture resistance of anterior samples was lower than the posterior ones.

Conclusion: Based on the results of this study regarding the high fracture resistance in both areas FRC inlay bridges could be recommended for upper anterior and lower posterior teeth in clinical dentistry certainly more studies are needed to ascertain this treatment option.

Background and Aim: Polymerization shrinkage of resin cements during setting leads to stress on teeth receiving indirect esthetic restorations. Some methods like blocking out undercuts during cavity preparation with glass Ionomer can reduce the mass of resin cement and therefore the amount of stress. The aim of this study was to evaluate the fracture resistance of molar teeth, receiving class I ceramic inlays with two different methods of blocking out undercut.

Materials and Methods: In this experimental study, thirty intact molar teeth were randomly divided into three groups of 10 each. One group was maintained intact as the control group. Similar class I cavities with identical undercuts were prepared on the other groups. In group 2 the undercut was filled with light cured glass Ionomer (vitremer 3M) before making impression, and in group 3 they were blocked out in the lab before preparation of the inlay. All the teeth in test groups were restored with indirect ceramic inlays.(vitadur - Alpha/ single bond / Rely X ARC). After thermocycling load causing fracture was assessed by universal testing machine. All the specimens were examined under a steriomicroscope (X40) to determine type of fracture. The results were analyzed by one way ANOVA and Tukey HSD tests. P< 0.05 was considered as the level of significance.

Results: The restored groups showed significantly less fracture resistance than the control group. The difference between two test groups was not significant. The fracture in group2 had less destruction.

Conclusion: According to the findings of this study, blocking out the undercut with two different methods (using glass ionomer/ or blocking it out on the die) made no diferrence in fracture resistance.

Background and Aim: Because of stable aesthetic and minimum destructive technique, Porcelain laminate veneer has an important role in aesthetic dentistry. But main reason of failure in this treatment is restoration fracture. Therefore tooth preparation have an important role in fracture resistance of porcelain laminate veneer. The aim of this in vitro study was to evaluate the fracture resistance of porcelain laminate veneer dependent on tooth preparation after exposure to dynamic loading.

Materials and Methods: In this study, 30 caries free mandibular incisors were devided into 3 groups. First group (Control group) remained unprepared. In second group (Window preparation) facial surface was prepared with 0.3, 0.5, 0.7 mm in cervical, middle and incisal, respectively. In third group (Incisal lap preparation) the preparation was like second group and included 2 mm of incisal edge. 20 feldespatic ceramic veneer were bonded adhesively with dual-cure luting cement (Rely X). All specimens were subjected to cyclic mechanical loading (720000 cycles, 1.3Hz, 30N) and thermal cycling (5-55 C, dwell time 60seconds, 500 cycles). The specimens were exposed to Universal testing machine until failure occurred with a constant crosshead speed of 1mm/min.

Results: Five specimens of first group, one specimen of second group and two specimens of third group fractured during cyclic loading. The mean failure loads(MPa) after exposure to continues load were as follows: First group: 168/96 (561.01-1115.08), second group: 394.10 (248.92- 641.33) and third group: 273.47 (135.45 - 479.80). Data analysis was performed by ANOVA, LSD and chi Square test.

Conclusion: Significant difference between 3 groups were found. Fracture resistance of control group was significantly higher than other groups and window group preparation was significantly higher than incisal lap group. The samples were under the cyclic loads before they put under the continuous pressures of universal testing machine. It was clear that incisal lap preparation is more resistance against fatigue failure compared to window preparation.

Background and Aim: A key factor in restoring the endodontically treated teeth is ferrule preparation. When the ferrule is absent, occlusal loads may cause the post or root to fracture. The purpose of this in vitro study was to evaluate the effect of ferrule preparation on fatigue resistance of teeth restored with quartz-fiber posts.

Materials and Methods: Twenty single-rooted lower premolars having similar dimentions were randomly devided into two groups of 10. In control group the teeth were prepared with 3-mm of remaining coronal tooth structure and in test group teeth were prepared with 1-mm of remaining coronal tooth structure. The teeth were endodontically treated. 9-mm long Post holes were prepared, and D.T. light quartz-fiber(RTD,France) posts were cemented with Panavia F2(Kuraray,Japan).Then the core build up was done with Bisco core build up composite(Bisco,USA) and full metal crowns were cemented with Zinc phosphate(Harvard cement, Germany). All specimens were mounted in acrylic resin blocks and intermittently loaded (180 N) at an angulation of 45- degree to the long axis of the teeth at a frequency of 4 loads per second, until failure occurred.

Results: There was significant difference between the loads cycles of two groups studied. (p<0.0001).

Conclusion: The results of this study showed that an increased amount of coronal dentin significantly increases the fracture resistance of teeth restored with quartz-fiber posts.

Background and Aims: Metal-free and fiber-reinforced composite (FRC) restorations have drawn considerable attention and interest in recent years for restoring in the posterior area due to their improved esthetics. Fracture resistance is one of the most important mechanical properties of materials because of 500-600 N load of occlusion. The restorations should tolerate this load. The purpose of this in vitro study was to compare the fracture resistance of FRC with that of zirconia all-ceramic for posterior partial dentures.

Materials and Methods: Forty extracted human intact teeth (20 first premolars and 20 first molars) selected for fabricating 10 pairs of fiber-reinforced composite and 10 pairs of zirconia all-ceramic bridges. After receiving standard tooth preparation, the teeth were mounted with 7.5 mm distance between each other. The bridges were made and cemented on the teeth. Then the restorations were stored in 37ºC water for 30 days. The fracture resistance was measured using mechanical testing machine with cross-head speed of 1mm/min. Data were evaluated by Independent Sample T test.

Results: The mean fracture resistance in the ceramic group was 1329.41 N and for the F.R.C group was 1118.528 N with significant differences between them (P=0.034). The failure modes were mainly cohesive at pontic area for ceramic samples, but adhesive for FRC samples at pontic area.

Conclusion: Both systems showed sufficient fracture resistance for using in posterior area.

Background and Aims: Endodontically treated teeth are prone to fracture because they loose a big amount of their structure. The treatment plan of those teeth is completed when they are rehabilitated with a strong and functional restoration. The purpose of this study was to evaluate the fracture resistance of endodontically treated teeth restored with amalgam cuspal coverage in comparison with other restorative techniques.

Materials and Methods: 40 human healthy maxillary premolars were divided into 4 groups: group1 (S): sound teeth, group 2(Co): endodontically treated teeth with MOD cavity restored with bonding and composite, group 3(Am-B): endodontically treated teeth with MOD cavity restored with bonding and amalgam and group 4 (Am-CC): endodontically treated teeth with MOD cavity restored with amalgam cuspal coverage. Then the restorations were stored in water and room temperature for 100 days at then thermocycled for 500 cycles between water baths at (5.5 ± 1) and (55 ± 1) ⁰ C. The fracture resistance was evaluated by universal testing machine (Instron, 1195 UK) with the compressive force of about 2000 N in 0.5 mm/min. The fracture modes were evaluated in four groups by a stereomicroscope. Statistical analysis (Scheffe test) was done for all groups (P<0.05 was considered as the level of meaningfulness).

Results: The highest fracture resistance was found in group 4 (Am-CC) (976 ± 23.27 N) that had no significant difference with sound tooth (P>0.05). The lowest fracture resistance was found in group 2 (Co) (384 ± 137.4 N) that had no significant difference with group 3 (Am-B) (P>0.05). The fracture resistance in group 4 was significantly higher than group 2 (Co) and 3 (Am-B). The fracture mode in group 1 was cohesive within tooth and in group 2 (Co) and 3 (Am-B) was mixed cohesive and adhesive, and in group 4 was cohesive within in restorative material.

Conclusion: The highest fracture resistance was found in teeth that received amalgam cuspal coverage.

  Background and Aims : The root fracture resistance of endodontically treated teeth depends on the types of posts. The aim of this study was to compare the effect of two types of bonded non-metallic posts with different elasticity modulus on the fracture resistance of endodontically treated teeth under compressive loads.

  Materials and Methods: In this in vitro experimental study, 20 fresh extracted mandibular premolars were selected and sectioned adjacent to the CEJ and then were endodontically treated. The specimens were randomly divided into two groups (n=10). After post space preparations, the fiber RTD Light posts (R.T.D, France) and zirconia coated fiber posts (ICE light, Danville) were cemented into the root canals. Composite resin (Lumiglass R.T.D, France) cores were built up. Aluminium foil was used to mimic the PDL, and the specimens were embedded in acrylic resin and tested in a Universal Testing Machine. A compressive load was applied at a 90 degree angle until fracture at a crosshead speed of 1mm/min. Data were analyzed using one-way ANOVA and T test .

  Results: The mean fracture resistance of R.T.D group was (1083.11 ± 156.74 (N)) and the mean of ICE light group was (865.18 ± 106.24 (N)). The highest mean fracture resistance was observed in RTD fiberglass and a statistically significant difference was observed between the two groups (P<0.001).

  Conclusion: FRC posts with zirconia coating due to unfavorable fractures of the teeth should be used with caution, and thus, fiber posts are preferred.