Fracture strength of non-invasively reinforced MOD cavities on endodontically treated teeth

The purpose of this in-vitro study was to evaluate the fracture resistance and failure mode of non-invasively reinforced endodontically treated mandibular molars. Sixty freshly extracted defect-free mandibular molars were divided into four experimental groups with extensive MOD cavities on endodontically treated teeth with different restoration types and one control group with intact teeth (n  = 12). The groups were as follows: "Normal": direct resin composite; "Ring": glass fiber-reinforced strip (Dentapreg) wrapped around buccal and lingual walls followed by direct resin composite; "Inlay": indirect CAD/CAM resin composite inlay; "Onlay": indirect CAD/CAM resin composite onlay; "Intact": Intact teeth (Control). Tetric EvoCeram and Adhese Universal (Ivoclar Vivadent) were used for direct restorations and Tetric CAD (Ivoclar Vivadent) adhesively luted with Adhese Universal and Variolink Esthetic LC (Ivoclar Vivadent) were used for indirect restorations. All teeth were submitted to thermo-mechanical cyclic loading. All samples were then submitted to a compressive load until fracture. Fracture load was noted and teeth were analyzed to classify the failure mode as either catastrophic (C) or non-catastrophic (NC). No statistically significant difference was found between fracture strength of the five groups when all specimens were considered (p = 0.1461). Intact group showed the lowest percentage of catastrophic failures (41.67%). Ring group presents less catastrophic failures (75%) than Normal group (83.34%), and failures of indirect restorations-Inlay and Onlay-were almost all catastrophic (91.67% and 100%, respectively).