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. 2025 Jun;11(3):e70161.
doi: 10.1002/cre2.70161.

The Influence of Deep Margin Elevation and Immediate Dentin Sealing on the Fracture Strength of Premolars Restored With Indirect Inlays: An In Vitro Study

Lulwa E Al-Turki  1 , Osamah A Alsulimani  2 , Khadijah M Baik  1 , Haytham Othmani  3 , Naif M Alqarni  4 , Abdullah A Alqarni  5 , Raghad A Al-Dabbagh  1
Affiliations

The Influence of Deep Margin Elevation and Immediate Dentin Sealing on the Fracture Strength of Premolars Restored With Indirect Inlays: An In Vitro Study

Lulwa E Al-Turki et al. Clin Exp Dent Res. 2025 Jun.

Abstract

Objective: To evaluate the effect of deep margin elevation (DME) and immediate dentin sealing (IDS) on the fracture strength of premolars restored with lithium disilicate inlay restorations.

Materials and methods: Standard MOD inlays with proximal box preparations extending 3 mm apical to the cementoenamel junction were prepared on forty sound premolars (n = 10) randomly divided into four groups: inlays without DME and without IDS (G1); inlays without DME but with IDS (G2); inlays with DME but without IDS (G3); and inlays with both techniques applied (G4). Composite resin was applied incrementally to elevate the proximal cervical margin coronally to the cementoenamel junction. For immediate dentin sealing, bonding agent was applied immediately after tooth preparation. All teeth were restored with lithium disilicate inlays and, after adhesive resin cementation, specimens were thermomechanically aged for 500 cycles at 5°-55°C and then subjected to load failure testing. Failure loads and locations were recorded and analyzed using one- and two-way ANOVA with Tukey's post-hoc testing (α = 0.05). Failure modes were analyzed using descriptive statistics.

Results: The mean fracture loads were 565.76 ± 233.22 N, 978.47 ± 394.2 N, 974.31 ± 334.7 N, and 1108.21 ± 292.41 N for G1, G2, G3, and G4, respectively. Deep margin elevation (p = 0.011) and immediate dentin sealing (p = 0.010) were associated with significantly increased fracture loads. Fracture loads were significantly lower for G1 teeth than for G2-G4 teeth, but there were no significant differences between G2, G3, and G4. G1 teeth showed 50% catastrophic and non-catastrophic failures, which increased to 60% for G2 and decreased to 20% for G3 teeth. Samples with both seals and elevation (G4) had a 60% catastrophic failure rate.

Conclusions: When applied individually or together, deep margin elevation and immediate dentin sealing significantly increase the fracture strength of premolars restored with indirect lithium disilicate inlays.

Clinical implications: In the challenging setting of margin elevation, studies on the effects of immediate dentin sealing have generally been limited to evaluating marginal integrity and bond strength. The findings of this In Vitro study suggest that both deep margin elevation and immediate dentin sealing protocols are likely to improve clinical outcomes of indirect lithium disilicate inlay restorations and may be considered viable options in clinical practice.

Keywords: deep margin elevation; dentin sealing; fracture strength; lithium disilicate inlay restorations.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relathioships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1
Steps involved in sample preparation and testing.
Figure 2
Figure 2
Fracture strengths of tested groups (G1‐G4). A significant difference from G1 and test groups is denoted by * at p < 0.05.
Figure 3
Figure 3
Effect of dentin sealing and margin elevation on fracture strength.
Figure 4
Figure 4
Failure modes shown by representative samples.
Figure 5
Figure 5
Fracture modes of the tested groups (G1‐G4).
Figure 6
Figure 6
Effect of dentin sealing and margin elevation on fracture mode.
See this image and copyright information in PMC

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