Post-Fatigue Fracture and Marginal Behavior of Endodontically Treated Teeth: Partial Crown vs. Full Crown vs. Endocrown vs. Fiber-Reinforced Resin Composite

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.

Keywords: ceramics; cusp stabilization; endocrown; endodontically treated teeth; fiber-reinforced; lithium disilicate ceramic; resin composites; zirconia; zirconia-reinforced silicate ceramic.

Figure 1

Specimen after MOD preparation and root canal obturation with standardized oro-buccal extension and MOD preparation.

Figure 2

Regimen for fundamental MOD preparations (a): rounded angles; (b): 90-degree transitions; (c): schematic overview. These preps were further prepared to partial or full crowns or filled directly with RC and FRC.

Figure 3

Adhesive pre-treatment in the inlay-style direct resin composite groups.

Figure 4

(a): Typical ceramic partial crown preparation with central FRC base. (b): Classic cast gold preparation with steps and bevels.

Figure 5

Experimental set up of the study. Abbreviations: F: Filling, DPC: direct partial crown, PC: Partial crown, RC: resin composite, FRC: Fiber-reinforced resin composite, EM: e.max CAD, CD: Celtra Duo, CG: Cast gold, ZI: Zirconia, EC: endocrown.

Figure 6

Schematic drawing of replaced cups in the ceramic groups.

Figure 7

Images of fractured specimens. In every failed restoration, catastrophic fractures were recorded, either vertical (a) or oblique (b).

Figure 8

SEM image of marginal gap between dentin (D) and resin composite (RC), 200× magnification.