Citation Information :
Pandey A, Kumar N, Sinha S, Kavita K, Raj R. Resistance against Fracture in Teeth Managed by Root Canal Treatment on Restoring with Onlays, Inlays, and Endocrowns: A Comparative Analysis. J Contemp Dent Pract 2021; 22 (7):799-804.
Aim and objective: To compare the fracture resistance in teeth managed by root canal treatment after restoring with different types of onlays, inlays, and endocrowns prepared with hybrid ceramics and pulp chambers restored with fiber-reinforced composite and resin composite that were radiopaque, light-cured, and flowable.
Materials and methods: The present study was carried out on 252 extracted mandibular molars. All the specimens were divided into six groups randomly. Each group consisted of 42 specimens. Group 1 consisted of intact teeth without any access cavity. It was the control group. Group 2 consisted of teeth with endocrown and empty pulp chamber. Group 3 consisted of teeth with mesio-occlusal-distal (MOD) onlay prepared with hybrid ceramics and pulp chamber filled with flowable, light-cured, radiopaque resin composite. Group 4 consisted of teeth with MOD onlay and pulp chamber filled with fiber-reinforced composite. Group 5 consisted of teeth with MOD inlay and pulp chamber filled with flowable, light-cured, radiopaque resin composite. Group 6 consisted of teeth with MOD inlay and pulp chamber filled with fiber-reinforced composite. Inlay, onlay, and endocrowns were prepared with computer-aided design (CAD) and computer-aided machine (CAM) using hybrid ceramics. Universal testing machine was used for the measurement of the fracture resistance of each specimen. Inferential statistics were performed by applying Fisher's exact test and chi-square test.
Results: Fracture strength was found to be maximum in the intact teeth group followed by the endocrown. The fracture strength was minimum in the inlay group. The fracture strength was intermediate in the onlay groups.
Conclusion: Endocrown showed maximum fracture resistance as compared to the inlay and onlay restorations.
Clinical significance: Proper management of root canal-treated teeth is one of the greatest challenges for endodontists. It has been observed that tooth preparation design and the material used for the restoration of root canal-treated teeth play a vital role in the resistance against fracture in the teeth.
Basaran ET, Gokce Y. Evaluation of the influence of various restoration techniques on fracture resistance of endodontically treated teeth with different cavity wall thicknesses. Niger J Clin Pract 2019;22(3):328–334. DOI: 10.4103/njcp.njcp_346_18.
Harsha MS, Praffulla M, Babu MR, et al. The effect of cavity design on fracture resistance and failure pattern in monolithic zirconia partial coverage restorations – an in vitro study. J Clin Diagn Res 2017;11(5):ZC45–ZC48. DOI: 10.7860/JCDR/2017/25305.9856.
Soares CJ, Rodrigues MP, Faria-E-Silva AL, et al. How biomechanics can affect the endodontic treated teeth and their restorative procedures? Braz Oral Res 2018;32(Suppl. 1):e76. DOI: 10.1590/1807-3107bor-2018.vol32.0076.
Plotino G, Grande NM, Isufi A, et al. Fracture strength of endodontically treated teeth with different access cavity designs. J Endod 2017;43(6):995–1000. DOI: 10.1016/j.joen.2017.01.022.
Salamoni Sinhori B, Vieira LCC, Baratieri LN. Influence of preparation reconstruction on the compressive strength of cad/cam ceramic inlays. Int J Biomater 2019;2019:7307649. DOI: 10.1155/2019/7307649.
Abou-Elnaga MY, Alkhawas MAM, Kim HC, et al. Effect of truss access and artificial truss restoration on the fracture resistance of endodontically treated mandibular first molars. J Endod 2019;45(6):813–817. DOI: 10.1016/j.joen.2019.02.007.
Dartora G, Rocha Pereira GK, Varella de Carvalho R, et al. Comparison of endocrowns made of lithium disilicate glass-ceramic or polymer-infiltrated ceramic networks and direct composite resin restorations: fatigue performance and stress distribution. J Mech Behav Biomed Mater 2019;100:103401. DOI: 10.1016/j.jmbbm.2019.103401.
Alshiddi IF, Aljinbaz A. Fracture resistance of endodontically treated teeth restored with indirect composite inlay and onlay restorations–an in vitro study. Saudi Dent J 2016;28(1):49–55. DOI: 10.1016/j.sdentj.2015.09.001. PMID: 26792970; PMCID: PMC4688433.
Oyar P, Durkan R. Effect of cavity design on the fracture resistance of zirconia onlay ceramics. Niger J Clin Pract 2018;21(6):687–689. DOI: 10.4103/njcp.njcp_424_17.
Sedrez-Porto JA, Rosa WL, da Silva AF, et al. Endocrown restorations: a systematic review and meta-analysis. J Dent 2016;52:8–14. DOI: 10.1016/j.jdent.2016.07.005. PMID: 27421989.
Altier M, Erol F, Yildirim G, et al. Fracture resistance and failure modes of lithium disilicate or composite endocrowns. Niger J Clin Pract 2018;21(7):821–826. DOI: 10.4103/njcp.njcp_175_17. PMID: 29984710.
Vianna ALSV, Prado CJD, Bicalho AA, et al. Effect of cavity preparation design and ceramic type on the stress distribution, strain and fracture resistance of CAD/CAM onlays in molars. J Appl Oral Sci 2018;26:e20180004. DOI: 10.1590/1678-7757-2018-0004. PMID: 30133672; PMCID: PMC6110459.
Doshi P, Kanaparthy A, Kanaparthy R, et al. A comparative analysis of fracture resistance and mode of failure of endodontically treated teeth restored using different fiber posts: an in vitro study. J Contemp Dent Pract 2019;20(10):1195–1199. DOI:10.5005/jp-journals-10024-2668. PMID: 31883256.
Mainjot AK, Dupont NM, Oudkerk JC, et al. From artisanal to CAD-CAM blocks: state of the art of indirect composites. J Dent Res 2016;95(5):487–495. DOI: 10.1177/0022034516634286. PMID: 26933136.
Taha D, Spintzyk S, Sabet A, et al. Assessment of marginal adaptation and fracture resistance of endocrown restorations utilizing different machinable blocks subjected to thermomechanical aging. J Esthet Restor Dent 2018;30(4):319–328. DOI: 10.1111/jerd.12396. PMID: 30113129.
Goujat A, Abouelleil H, Colon P, et al. Mechanical properties and internal fit of 4 CAD-CAM block materials. J Prosthet Dent 2018;119(3):384–389. DOI: 10.1016/j.prosdent.2017.03.001. PMID: 28552287.
Garoushi S, Gargoum A, Vallittu PK, et al. Short fiber-reinforced composite restorations: a review of the current literature. J Investig Clin Dent 2018;9(3):e12330. DOI: 10.1111/jicd.12330.
Sabeti M, Kazem M, Dianat O, et al. Impact of access cavity design and root canal taper on fracture resistance of endodontically treated teeth: an ex vivo investigation. J Endod 2018;44(9):1402–1406. DOI: 10.1016/j.joen.2018.05.006. PMID: 30049471.
Tang W, Wu Y, Smales RJ. Identifying and reducing risks for potential fractures in endodontically treated teeth. J Endod 2010;36(4):609–617. DOI: 10.1016/j.joen.2009.12.002.
Kadam P, Bhalerao S. Sample size calculation. Int J Ayurveda Res 2010;1(1):55–57. DOI: 10.4103/0974-7788.59946.
Panitiwat P, Salimee P. Effect of different composite core materials on fracture resistance of endodontically treated teeth restored with FRC posts. J Appl Oral Sci 2017;25(2):203–210. DOI: 10.1590/1678-77572016-0306.
Scotti N, Coero Borga FA, Alovisi M, et al. Is fracture resistance of endodontically treated mandibular molars restored with indirect onlay composite restorations influenced by fibre post insertion? J Dent 2012;40(10):814–820. DOI: 10.1016/j.jdent.2012.06.005. PMID: 22743344.
Keçeci AD, Heidemann D, Kurnaz S. Fracture resistance and failure mode of endodontically treated teeth restored using ceramic onlays with or without fiber posts-an ex vivo study. Dent Traumatol 2016;32(4):328–335. DOI: 10.1111/edt.12252.
Clausson C, Schroeder CC, Goloni PV, et al. Fracture resistance of CAD/CAM lithium disilicate of endodontically treated mandibular damaged molars based on different preparation designs. Int J Biomater 2019:2475297. DOI: 10.1155/2019/2475297.
Gré CP, de Ré Silveira RC, Shibata S, et al. Effect of silanization on microtensile bond strength of different resin cements to a lithium disilicate glass ceramic. J Contemp Dent Pract 2016;17(2):149–153. DOI: 10.5005/jp-journals-10024-1818. PMID: 27207004.
Yoon HI, Sohn PJ, Jin S, et al. Fracture resistance of CAD/CAM-fabricated lithium disilicate MOD inlays and onlays with various cavity preparation designs. J Prosthodont 2019;28(2):e524–e529. DOI: 10.1111/jopr.12787. PMID: 29533499.
Atalay C, Yazici AR, Horuztepe A, et al. Fracture resistance of endodontically treated teeth restored with bulk fill, bulk fill flowable, fiber-reinforced, and conventional resin composite. Oper Dent 2016;41(5):E131–E140. DOI: 10.2341/15-320-L. PMID: 27352045.
Özkır S. Effect of restoration material on stress distribution on partial crowns: a 3D finite element analysis. J Dent Sci 2018;13:311-317. DOI: 10.1016/j.jds.2017.03.010.
Goracci C, Cadenaro M, Fontanive L, et al. Polymerization efficiency and flexural strength of low-stress restorative composites. Dent Mater 2014;30(6):688–694. DOI: 10.1016/j.dental.2014.03.006. PMID: 24703547.
Ilgenstein I, Zitzmann NU, Bühler J, et al. Influence of proximal box elevation on the marginal quality and fracture behavior of root-filled molars restored with CAD/CAM ceramic or composite onlays. Clin Oral Investig. 2015 Jun;19(5):1021-8. doi: 10.1007/s00784-014-1325-z. Epub 2014 Sep 25. PMID: 25248949.
Forster A, Braunitzer G, Tóth M, et al. In vitro fracture resistance of adhesively restored molar teeth with different MOD cavity dimensions. J Prosthodont 2019;28(1):e325–e331. DOI: 10.1111/jopr.12777. PMID: 29508474.
Yang H, Park C, Shin JH, et al. Stress distribution in premolars restored with inlays or onlays: 3D finite element analysis. J Adv Prosthodont 2018;10(3):184–190. DOI: 10.4047/jap.2018.10.3.184. PMID: 29930787; PMCID: PMC6004358.
Ereifej NS, Oweis YG, Altarawneh SK. Fracture of fiber-reinforced composites analysed via acoustic emission. Dent Mater J 2015;34(4):417–424. DOI: 10.4012/dmj.2014-325.
Yasa B, Arslan H, Yasa E, et al. Effect of novel restorative materials and retention slots on fracture resistance of endodontically-treated teeth. Acta Odontol Scand 2016;74(2):96–102. DOI: 10.3109/00016357.2015.1046914. PMID: 25982519.
Morimoto S, Rebello de Sampaio FB, Braga MM, et al. Survival rate of resin and ceramic inlays, onlays, and overlays: a systematic review and meta-analysis. J Dent Res 2016;95(9):985–994. DOI: 10.1177/0022034516652848. PMID: 27287305.
Sekhri S, Mittal S, Garg S. Tensile bond strength of self-adhesive resin cement after various surface treatment of enamel. J Clin Diagn Res 2016;10(1):ZC01–ZC04. DOI: 10.7860/JCDR/2016/13409.7026.