The influence of FRC base and bonded CAD/CAM resin composite endocrowns on fatigue behavior of cracked endodontically-treated molars

• Published in: Journal of the mechanical behavior of biomedical materials Vol. 121; p. 104647
• Main Authors: Anton Y Otero, Clara, Bijelic-Donova, Jasmina, Saratti, Carlo Massimo, Vallittu, Pekka K., di Bella, Enrico, Krejci, Ivo, Rocca, Giovanni Tommaso
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01-09-2021
• Subjects: Bidirectional fiber; Computer-aided design; Dental restoration; Devitalized teeth; Discontinous fiber; Onlay; Short fiber; Short fiber; Dental restoration; Bidirectional fiber; Onlay; Computer-aided design; Devitalized teeth; Discontinous fiber
• ISSN: 1751-6161; 1878-0180
• DOI: 10.1016/j.jmbbm.2021.104647

Cracked endodontically treated molars (ETMs) are commonly treated with full crowns. Less invasive techniques could include fiber-reinforced composite (FRC) base and adhesively bonded endocrowns. The purpose of this study was to assess the fatigue resistance of ETMs restored with CAD/CAM resin composite endocrowns and reinforced with different FRC bases. Cracks were simulated in fifty mandibular molars by cutting the teeth longitudinally and reassembling the two parts. After performing endodontic treatments and preparing cavities, teeth were restored in one of the following methods (n = 10). In Group 1, cavity floors were lined with 0.5 mm of flowable composite (Universal Injectable; GUI, shade A2). In Groups 2 and 3, the cavity floors were covered with one and three layers of FRC-net (ES Net) respectively, whereas in Groups 4 and 5 with 1 mm and 2 mm of flowable FRC-resin (EverX Flow Dentin; EXFD) respectively. Endocrowns (Cerasmart 270; CE, A2 HT) with 5 mm thickness were adhesively luted with preheated composite and all specimens were subjected to cyclic loading in water at 5 Hz, starting with a load of 600 N (5000 cycles), followed by stages of 1000, 1300, 1600, 1900, 2200 and 2500 at a maximum of 20 000 cycles each. Results were analyzed using Kaplan-Meier survival analysis and the Log-Rank test (p = 0.05). The fatigue failure load of ES Net applied in three layers (1617 N ± 371) or in one layer (1499 N ± 306), as well as EXFD applied in 2 mm (1496 N ± 264) or in 1 mm (1434 N ± 372) did not differ significantly (p > 0.05). Control teeth fractured at 1255 N ± 350 (p > 0.05). In the fiber-reinforced groups, restorable fractures were observed in 50%–80%, with only 30% deemed restorable in the control group. The fractures originated mainly at the occlusal contact points and the main crack propagated in the corono-apical direction. No crack origin (primary or secondary) starting from the artificial pre-existing crack was observed in fractured specimens. FRC bases did not improve the fatigue resistance of cracked ETMs, but favorably influenced the failure mode.
•The fiber reinforcement did not improve the fatigue resistance of cracked endodontically-treated molars.•The presence of fiber base beneath composite resin endocrown deviated the crack path and increased the chances for re-restorability.•The fractures originated at the occlusal contact points and the main crack propagated in the corono-apical direction.