Analysis of Fracture Resistance of Endodontically Treated Teeth with Different Restorative Materials: An In vitro Study

Abstract

Objectives:

The objective of the study is to compare the fracture resistance of endodontic treated tooth restored with GIC, amalgam, and composite cements.

Materials and Methods:

Forty teeth were divided into 4 groups of 10 teeth each. Group I teeth were restored with silver amalgam. Group II teeth were restored with GIC. Group III teeth were restored with composite and Group IV teeth were control in which no alteration was performed. Testing machine applied force on teeth to detect fracture resistance.

Results:

The mean fracture resistance was maximum in Group IV (1050.2 N) followed by Group III (956.2 N), Group I (836.4 N), and Group II (766.4 N). The difference was statistically significant (P < 0.05). The mean difference of fracture resistance was significant (P > 0.05).

Conclusion:

Composite resin possesses highest fractures resistance as compared to GIC and silver amalgam.

INTRODUCTION

There are numerous restorative materials available to restore the teeth. Fracture is a common phenomenon in root canal-treated tooth. However, placing crown over tooth is one of the protective measures to minimize the fracture.[1]

The successful endodontic therapy is judged by factors such as how long tooth remains in the oral cavity, its ability to perform all functions such as chewing and biting and resistance against fracture. Different restorative materials such as glass ionomer cement, silver amalgam, miracle mix are commonly employed. Silver amalgam may be used in posterior teeth but it requires extensive tooth preparation. Recently, composite resins have been considered to be material of choice due to various reasons such as color similarity with the tooth.[2] The present study was conducted to compare the fracture resistance of endodontic treated tooth restored with GIC, amalgam, and composite cements.

MATERIALS AND METHODS

Forty teeth were divided into four groups of 10 teeth each. Group I teeth were restored with silver amalgam. Group II teeth were restored with GIC. Group III teeth were restored with composite and Group IV teeth were control in which no alteration was performed. Ethical clearance was obtained from the institutional ethical committee before starting the study.

In all teeth except Group IV biomechanical preparation and obturating the canals with gutta percha, teeth were filled with different restorative materials such as silver amalgam, GIC, and composite.

To assess the fracture resistance of all teeth in different groups, testing machine was used which applied vertical lad along long axis of teeth. The amount of force required to fracture was recorded in all teeth. Results thus obtained were subjected to statistical analysis using Chi-square test and using Statistical Package for Social Sciences version 20.0 for Windows (SPSS Inc., Chicago, IL, USA). P < 0.05 was considered significant.

RESULTS

Graph 1 shows that the mean fracture resistance was maximum in Group IV (1050.2 N) (control). In other groups, maximum fracture resistance was seen in Group III (956.2 N) followed by Group I (836.4 N) and Group II (766.4 N). The difference was significant (P < 0.05). Table 1 shows that mean difference was 70 when Group I was compared with Group II, 119.8 when Group I was compared with Group III and 214 when Group I was compared with Group IV. The difference was significant (P < 0.05) except in Groups I and II (P = 0.4). It was 189.8 and 283.8 when Group II was compared with Group III and Group IV, respectively. The difference was significant (P < 0.05). It was statistical significant when Group III was compared with Group IV (P = 0.01).

Graph 1.

Mean fracture resistance in all groups

Table 1.

Multiple comparison between all groups using Tukey’s Honest Significant Difference

Groups	Comparison	Mean differences	P
Group I	Group II	70	0.4
	Group III	119.8	0.001
	Group IV	214	0.00
Group II	Group III	189.8	0.01
	Group IV	283.8	0.00
Group III	Group IV	94	0.01

DISCUSSION

The success of any endodontic-treated teeth depends on many factors such as type of obturating material used, type of irrigating solution employed for the procedure, maintenance of apical seal, and type of restorative material used for coronal restoration.[3]

Dalpino et al. found that cavity preparation, access cavity, filing, removal of pulp with reamers, files, and canal preparation with different numbers of files make the tooth weak as the considerable amount of tooth structure gets lost in successive steps.[4]

Chutinan et al. compared six direct core materials and found that composite exhibits micro-mechanical bonding to tooth, thus possess better fracture resistance.[5] Moosavi et al. found that composite exhibits higher fracture resistance than other restorative materials.[6] Shivanna and Gopeshetti observed 524 N fracture resistance in premolars restored with composite.[7] Wendt et al. found composite to be the preferred restorative material than silver amalgam due to its easy handling.[8] The operator clinical experience, presence of moisture during restoration, and antagonist teeth and type of teeth also determine the fracture tendency.

CONCLUSION

Composite resin was comparatively better in terms of fracture resistance. Composite exhibited higher fracture resistance than silver amalgam which had higher fracture resistance than GIC. Factors such as antagonist tooth, type of tooth, moisture in oral cavity while cavity preparation determines the fracture resistance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.