Beruflich Dokumente
Kultur Dokumente
Department of Dentistry and Dental Hygiene, University Medical Center Groningen, University of Groningen, Clinical
2
This study compared the fracture strengths and analyzed the failure types of direct, surface-retained, anterior Àxed-partial-
dentures (FPD), reinforced with four types of Àber-reinforced composites (FRC) versus non-Àber-reinforced FPDs made of
three particulate Àller composites (PFC). To this end, surface-retained anterior FPDs (N=70, 10 per group) were prepared
and divided into seven experimental groups, where Group 1: FRC1 (everStick)+PFC1 (ClearÀl Photo Posterior); Group 2:
FRC2 (BR 100)+PFC1; Group 3: FRC3 (Interling)+PFC1; Group 4: FRC4 (Ribbond)+PFC1; Group 5: PFC1 only; Group 6:
PFC2 only (Sinfony); and Group 7: PFC3 only (Estenia). Fracture strength test was performed after water storage at 37ºC
for three days (universal testing machine, 1 mm/min). No signiÀcant differences were found among the four FRC types
veneered with PFC1 (1490 548‐1951 335 N) (p<0.05) (ANOVA, Tukey s test). Among all the experimental groups,
PFC1 presented a signiÀcantly higher mean value (2061 270 N) than PFC2 (1340 395 N) (p<0.05) and all the other FRC-
reinforced groups (p<0.05). Complete pontic fracture was 100% and 70% for PFC2 and PFC3 respectively.
about poor adhesion of polymers to UHMWPE Àbers, ished using water and Áuoride-free pumice with
it has been improved by various types of electrochem- a prophylaxis brush, rinsed with water, and dried
ical plasma treatments. However, this type of using an air syringe. Using a silicone mold and leav-
surface treatment has not increased the bond ing a space of 7.0 mm between the central incisor and
strength of resin composites to treated UHMWPE canine, which was approximately the mesiodistal size
Àbers as compared to untreated Àbers15). On this of a lateral incisor, the teeth were embedded in auto-
note, questions still exist whether UHMWPE Àbers polymerized polymethyl methacrylate (Vertex, Zeist,
can be used to fabricate high-quality dental compos- The Netherlands) resin blocks up to their cementoe-
ite structures17,18). namel junction.
The development and improvement of particu- Enamel surfaces to be bonded were rough-
late Àller composites (PFC) resulted in high-strength ened with a tungsten carbide bur (Komet No.
polymeric materials due to the increased Àller con- H22AGK.314, Lemgo, Germany, Lot No. 349934)
tent. Filler particles of different sizes and volume using a high-speed handpiece under water irriga-
contents are added to the polymer matrix. One of tion and acid-etched with 38% H3PO4 (TopDent Gel,
the latest developments, the so-called hybrid ceramic, TopDent, Vasteras, Sweden, Lot No. 031111) for 60
contains a mixture of high quantity of ultraÀne Àll- seconds23). After rinsing with water and air-drying,
ers (particle size: 0.02 μm) loaded into a microÀlled an intermediate adhesive resin (Quadrant UniBond,
(particle size: 2 μm) resin matrix. In this manner, a Cavex, Haarlem, The Netherlands, Lot No. 010044)
high volume percentage of Àllers could be embedded was applied onto the surfaces using a microbrush,
in the resin matrix. gently air-dried, and light-polymerized (Demetron
To date, studies that evaluated and compared LC, SDS Kerr, Orange, CA, USA; light intensity: 600
inlay-retained FPDs have been conducted20-22). How- mW/cm²) for 20 seconds. Concave, soft metal bands
ever, no studies have been undertaken to compare (Sectional Matrix System, Danville Engineering, CA,
the mechanical properties of surface-retained FRC USA, Lot No. 88039) were used as a pontic forming
FPDs with various PFCs or using non-Àber-rein- aid.
forced PFCs only. It is noteworthy that with the
recently introduced microÀlled composites, properties Experimental groups
of high strength could be achieved in indirect resto- Table 1 lists the brand names, codes, compositions,
rations where polymerization takes place in a special manufacturers, and batch numbers of the materials
light curing device under heat and light. As these used in this investigation. PFC was incrementally
PFC materials also involve camphorquinone, it was applied onto the prepared enamel surface and light-
hypothesized that direct light polymerization using polymerized for 40 seconds in all directions (Fig. 1).
halogen lamps could also lead to sufÀcient polym- In groups involving Àber reinforcement, a thin
erization of these PFCs. If this were so, then these layer of Áowable composite resin (StickFlow, Stick
PFCs could similarly be used for direct FPD applica- Tech, Finland, Lot No. 302591) was applied onto the
tions with comparable fracture strength. tooth surface and light-polymerized together with the
Therefore, the objectives of this study were two- FRC material for 40 seconds. At the same time, gen-
fold: (1) to compare the fracture strengths of direct tle pressure was exerted over the Àber using a sili-
surface-retained anterior FPDs, reinforced with four cone instrument (Silicone ReÀx, Stick Tech, Finland).
types of Àbers preimpregnated with UTMA, PMMA/ FRC4, the non-impregnated Àber, was impregnated
Bis-GMA, or Bis-GMA monomers, versus direct non- using an intermediate adhesive resin (Quadrant
Àber-reinforced FPDs made of three types of PFCs UniBond). Fiber surfaces were thus completely cov-
with varied monomer matrices and Àller contents; ered with composite resin, and each layer was again
and (2) to analyze the types and sites of failure. light-polymerized for 40 seconds in all directions.
In groups without any Àber reinforcement, the
whole restoration was completed with the incremen-
MATERIALS AND METHODS
tal application of the individual PFC. Subsequently,
Tooth specimens pontic dimensions were measured with a digital
A total of 140 (70 central incisors, 70 canines) micrometer (accurate to 0.005 microns) (Mitutoyo
caries-free, freshly extracted maxillary human teeth Ltd., Andover, UK) and kept at 6 mm in the
were used in this study. The teeth were stored in buccolingual (BL) direction, 6.5 mm in the
distilled water with 0.1% thymol solution at room mesiodistal (MD) direction, and 9 mm in the cervico-
temperature. All teeth were evaluated under blue occlusal (CO) direction.
light transillumination to make sure that the enamel Finally all restorations were Ànished using Àne
was free of crack lines. Specimens were stored in diamond burs (model number 012, Intensiv, Grancia,
distilled water up to three months until the experi- Switzerland) to remove the excess PFC and polished
ments. The enamel surfaces were cleaned and pol- with coarse, medium, Àne, and ultraÀne Ànishing
KUMBULOGLU et al. 197
Table 1 Brand names, codes, compositions, manufacturers, and batch numbers of the materials used in this study.
FRC1, 2, 3, and 4 were veneered with PFC1
Batch
Brand name Code Composition Manufacturer
number
StickTeck Ltd, Turku,
everStick FRC1 E-glass/PMMA/Bis-GMA 000088
Finland
Kuraray, Okayama,
BR-100 FRC2 E-glass/UTMA 00006A
Japan
Angelus, Londrina,
interling FRC3 E-glass/Bis-GMA 2199
Brazil
Ribbond FRC4 Ultra High Molecular Weight Polyethylene Ribbond, Seatlle,USA 9543
Fig. 1 Representative photo from one of the specimens of FRC3 group showing the position of the FRC during the
experimental procedure.
198 Fiber effect on strength of Àxed-partial-dentures
Table 2 Mean ( standard deviation, SD) fracture Table 3 Failure types and distributions in percentage for
strength (N) values of the experimental groups. each experimental group. Type A=Detachment
*: Same superscripted letters indicate no signiÀ- of veneering composite from the Àber; Type
cant differences (Tukey s test, α=0.05). For B=Complete pontic fracture; Type C=Chipping in
abbreviations, see Table 1 the veneering composite; Type D=Fiber fracture.
For abbreviations, see Table 1
Experimental Groups Mean SD(N) Type A Type B Type C Type D
AB
FRC1 1693 304 FRC1 50 10 40 -
A
FRC2 1951 335 FRC2 40 10 40 10
FRC3 1490 548AB FRC3 30 10 40 20
FRC4 1658 377AB FRC4 60 - 40 -
A
PFC1 2061 270 PFC1 - 40 60 -
B
PFC2 1340 395 PFC2 - 100 - -
AB
PFC3 1503 475 PFC3 - 70 30 -
Fig. 2 Representative SEM pictures after fracture strength test: (a) everStick-ClearÀl Photo Posterior FPD. Note the
delamination of the veneering resin into mainly two pieces; (b) Ribbond-ClearÀl Photo Posterior FPD. Note the
catastrophic delamination of the veneering resin (original magniÀcation 10).
KUMBULOGLU et al. 199
pontics, it revealed that the weakest part of the FPD in this study ― be it with or without Àber reinforce-
was the connector area where the resin cross-section ment ― were higher than those reported by Behr
was expected to be the smallest. et al.20). In the latter study, glass Àbers (Vectris)
In FRC3 and FRC4 groups, delamination of the were used as the Àber framework in box-shaped and
veneering composite occurred in a more catastrophic tube-shaped preparations and where Ànal fracture
manner than FRC1, where failure was predominantly strength values of 696 N and 722 N were obtained
separation of the veneering composite into two lami- respectively for three-unit indirect FRC FPDs.
nates. It should be mentioned that failure involving It is noteworthy that failures in non-reinforced
several laminates with Ànal complete detachment of FPDs particularly occurred at the pontic-abutment
the veneering composite from the FRC is clinically contact area. Therefore, FPD restorations without
more difÀcult to repair, as compared to one layer of Àber reinforcement should not be recommended for
detached or chipped veneering composite. On this use as long-term, durable restorations despite their
issue, SEM pictures showed that FRC4 fractured into considerably high fracture strengths. On the other
more pieces when compared to FRC1. This can be hand, to avoid costly FRC materials for interim or
explained on the ground that FRC4, a non-impreg- semi-permanent restorations, PFC1 could be the
nated Àber, was impregnated using an intermediate next best option. To date, no clinical studies have
adhesive resin. This manual impregnation technique reported on the performance of PFCs without Àber
probably did not lead to complete wetting of the Àber, reinforcement. Therefore, its durability for semi-
as compared to FRC1 which was preimpregnated. permanent treatment in real clinical situations
Another probable reason was that the intermediate remains unclear.
adhesive resin used was not suitable for the veneer- At the onset of failure, an important parameter
ing composite, although the manufacturer did not could be the initial failure point. Some studies have
advise against any adhesive resin. established the fracture forces of FPDs by deter-
In all the experimental groups, the weakest fea- mining the initial failure from the force-deÁection
tures of the FPD restorations remained to be the pon- curve5,22). Previous loading events could cause inter-
tic area and the low resistance of the veneering resin nal failures to the material and which can progress
composite against occlusal forces. Unfortunately, with subsequent higher levels of stress. It has been
laminated composites do not well absorb the impact reported in earlier studies that initial failure occurs
energy stemming from local damage when loading at a stress level lower than the Ànal fracture. Unfor-
direction is normal to the lamina plane. For this tunately, in a clinical setting, initial failures are not
reason, it might seem that the load-bearing capacity easy to detect and intervention is often not intro-
of the FPD structure could be improved by increasing duced until catastrophic failure, including chipping
the Àller volume fraction. However, this approach failure, occurs. Against this background, compari-
could lead to exposure of Àbers, which would then sons among materials in this study were made based
impair the esthetics especially in the anterior region. on strength values at Ànal failure. However, it must
Furthermore, failures in FRC1 and FRC2 were be emphasized that FRCs and PFCs might vary and
primarily in the mesiodistal direction, indicating that differ in their initial fracture strengths.
unidirectional Àbers changed the crack path. There- It is probable that the stress distribution pattern
fore, future studies should concentrate not only on in a three-point bending test is the most common
fracture strength, but also the failure type and frac- pattern of stress distribution in three-unit FPDs.
ture behavior of FRCs and/or PFC FPDs. This is because masticatory forces are normally con-
FRC restorations are expected to withstand mas- centrated on a single point, thus justifying the clini-
ticatory forces4,6,20). Different testing methods and cal relevancy of the fracture strength test where the
the difÀculty in measuring masticatory forces have load is applied on the pontic21). However, for success-
resulted in a wide range of bite force values. Stress ful use of FRCs in dental applications, the restora-
applied during mastication may range between 441 tion should be of the right dimensions to withstand
and 981 N, 245 and 491 N, 147 and 368 N, and 98 not only static stress, but also cyclic stresses caused
and 270 N in the molar, premolar, canine, and inci- by mastication. Under the inÁuence of cyclic com-
sor regions respectively28). Based on these values, a pressive stresses, the damage associated with delam-
restoration should be able to withstand stresses up ination and the separation of Àber-reinforced layers
to approximately 500 N in the premolar region and that are stacked together to form laminates must
500-900 N in the molar region. In the present study, also be taken into account. The presence of delami-
the mean values acquired well exceeded the high- nation may reduce the overall stiffness as well as the
est reported masticatory force of 1000 N27). Direct residual strength, leading to structural failure. Low
comparison with previous studies is difÀcult due to delamination resistance causes delamination cracks.
differences in test plan and specimen design. Not- Therefore, the behavior of PFCs with and without
withstanding, the fracture strength values obtained Àber reinforcement under fatigue conditions requires
KUMBULOGLU et al. 201
20) Behr M, Rosentritt M, Lang R, Handel G. Flexural ties of unidirectional glass Àber-reinforced compos-
properties of Àber reinforced composite using ites. Biomaterials 2002; 23: 2221-2229.
a vacuum/pressure or a manual adaptation 25) Minesaki Y. In vitro wear of indirect composite
manufacturing process. J Dent 2000; 28: 509-514. restoratives. J Prosthet Dent 2002; 88: 431-436.
21) Gohring TN, Roos M. Inlay-Àxed partial dentures 26) Yamaga T, Sato Y, Akagawa Y, Taira M, Wakasa
adhesively retained and reinforced by glass Àbers: K, Yamaki M. Hardness and fracture toughness of
clinical and scanning electron microscopy analysis four commercial visible light-cured composite resin
after Àve years. Eur J Oral Sci 2005; 113: 60-69. veneering materials. J Oral Rehabil 1995; 22: 857-
22) Özcan M, Breuklander MH, Vallittu PK. The effect 863.
of box preparation on the strength of glass Àber- 27) Özcan M. Longevity of repaired composite and
reinforced composite inlay-retained Àxed partial metal-ceramic restorations: 3.5-year clinical study.
dentures. J Prosthet Dent 2005; 93: 337-345. J Dent Res 2006; 85: Abstract No. 0076.
23) Behr M, Rosentritt M, Latzel D, Handel, G. Frac- 28) Vallittu PK, Kononen M. Biomechanical aspects and
ture resistance of Àber-reinforced vs. non-Àber-rein- material properties. In: A textbook of Àxed prosth-
forced composite molar crowns. Clin Oral Investig odontics: the Scandinavian approach, Karlsson S,
2003; 7: 135-139. Nilner K, Dahl BL (eds), Gothia, Stockholm, 2000,
24) Lassila LV, Nohrstrom T, Vallittu PK. The inÁuence pp.116-130.
of short-term water storage on the Áexural proper-