Skip to main content
Download PDF

Systematic review fracture resistance of endodontically treated posterior teeth restored with fiber reinforced composites- a systematic review

BMC Oral Health volume 23, Article number: 566 (2023) Cite this article

Abstract

Background

Large cavity designs and access cavities impair endodontically treated tooth fracture resistance. As the tooth’s strength is known to reduce significantly after the root canal treatment, occlusal loading as a result of functions such as chewing, biting and certain parafunctional tendencies makes the endodontically treated tooth vulnerable to fracture. Hence, after endodontic treatment, it is vital to give adequate and appropriate restorative material to avoid tooth fractures. Accordingly, the choice of such restorative material should be dictated by the property of fracture resistance.

Objective

The goal of this study was to conduct a systematic review and critical analysis of available data from in vitro studies examining the fracture resistance of endodontically treated posterior teeth restored with fiber-reinforced composites.

Methodology

The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRIS-MA) Statement was used to guide the reporting of this systematic review A comprehensive literature search was performed using MEDLINE (via PubMed), Scopus, ScienceDirect, Google Scholar, and LILACS. A manual search of the reference lists of the articles was also performed. The databases provided a total of 796 studies from the electronic systematic search. The databases provided a total of 796 studies from the electronic systematic search. Two reviewers scrutinized the papers for eligibility based on inclusion/exclusion criteria and extracted data. The studies were assessed for their potential risk of bias. Based on modified JBI & CRIS (checklist for reporting in vitro studies) guidelines, along with the methodology and treatment objective, we have formulated 13 parameters specifically to assess the risk of bias. A total of 18 studies met the inclusion criteria and were included for qualitative analysis. Considering the high heterogeneity of the studies included, a meta-analysis could not be performed.

Results

The majority of the included studies had a moderate or high risk of bias. When compared to traditional hybrid composites, fiber-reinforced composites showed increased fracture resistance of endodontically treated teeth in the majority of investigations. On the other hand, limited evidence was found for the bulk fill composites. Moreover, moderate evidence was found for the fracture resistance of inlays and fiber posts with fiber-reinforced composites for core build-up in endodontically treated teeth. No evidence could be found comparing the fracture resistance of endo crowns and fiber-reinforced composites in endodontically treated teeth.

Conclusion

According to the research, using fiber-reinforced composites instead of conventional hybrid composites improves the fracture resistance of endodontically treated teeth. However, there was a high risk of bias in the research considered. No judgments could be reached about the superiority of one material over another based-on comparisons between other core restorations.

Peer Review reports

Introduction

Root canal treated teeth are more likely to fracture, resulting in a decrease in the resistance and fracture toughness. Physical characteristics such as tooth structure loss, cusps, ridges, and the arching roof of the pulp chamber contribute to this [1]. Structure loss is caused by caries, access cavity preparation, trauma and radicular preparation. The effects of chemicals and intracanal medicaments, influence the fracture resistance of endodontically treated teeth [2]. Endodontic access cavity preparations increased cuspal deflection and increased the risk of cusp breakage during function [3, 4]. Proprioception is impaired in root canal treated teeth [1, 5]. The survival of root canal treated teeth is determined by the efficacy of root canal therapy, as well as the amount of surviving dentine thickness and post-endodontic healing [6]. Only after an adequate permanent coronal restoration has been placed should the root canal procedure be considered complete. In endodontic clinical practice, the quality of the final restoration is critical as it reduces the microleakage [6].

With advancements in both fillers and polymer processes, newer composite materials now offer a wide range of qualities to meet the needs of each individual clinical circumstance [6, 7]. The use of an optimum material with adequate fracture resistance when restoring endodontically treated teeth is an essential aspect to consider during post-endodontic rehabilitation. Newer fiber-reinforced composite materials reinforce weaker tooth structurally and chemically. Fiber-reinforced composite can help prevent endodontically treated teeth from fracturing [8]. Because of their improved physical and mechanical qualities, fiber-reinforced composites have been advocated for the biomimetic replacement of dentine in wider cavities and endodontically treated teeth. It promotes mechanical retention, prevents fracture propagation, and provides strong chemical bonding between glass fibers and the resin matrix.

Ribbond is a reinforced ribbon with a high elastic modulus constructed of ultra-high molecular weight polyethylene fiber. To improve adherence to synthetic restorative materials, it is treated with cold gas plasma. The material’s fiber network allows forces to be transferred. When polyethylene and glass fibers are employed in composite resins, they operate as a stress reliever [9] and have higher fracture resistance and flexural modulus [10, 11].

EverX posterior is a combination of e-glass type of fillers and glass filler with barium. This type of composite manufacturer affirms that the short-fiber composites strengthened the restoration by reducing the incidence of fracture, which leads to post-endodontic restoration failure. In vitro research showed that these two materials improved the resistance to fracture. There are a few unsolved problems about the fracture resistance of fiber-reinforced composites, such as whether they are more resistant to fracture than traditional microhybrid, nanohybrid composites, and other in-direct restorations?

We conducted a systematic review of published in vitro studies comparing the fracture resistance of fiber-reinforced composites with different restorations (hybrid composites, fiber posts, ceramic inlays, lithium disilicate endocrowns, and crowns) in endodontically treated teeth due to a lack of sufficient evidence. Therefore, the goal of this study is to compare the fracture resistance of endodontically treated teeth repaired using fiber-reinforced composites to that of other core restorations in vitro tests. The research question was: are fiber-reinforced composites more resistant to fracture than other core restorations in endodontically treated teeth? The null hypothesis states that fiber-reinforced composites are less resistant to fracture than conventional microhybrid and nanohybrid composites, fiber-reinforced posts, crowns (with or without posts), lithium disilicate endocrowns and ceramic inlay in endodontically treated teeth. Whereas the alternate hypothesis states fiber-reinforced composites are more resistant to fracture than conventional microhybrid and nanohybrid composites, fiber-reinforced posts, crowns (with or without posts), lithium disilicate endocrowns and ceramic inlay in endodontically treated teeth.

Materials and methods

The study protocol was registered on the PROSPERO database (http://www.crd.york.ac.uk) under number CRD42021295212 on 30/12/2021. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement was used to guide the reporting of this systematic review.Study Design/Study Setting- Only in vitro studies were considered for this review

The data sources and the literature search strategy

To find publications published in English only, a full electronic exploration was conducted in MEDLINE (via PubMed), Scopus, ScienceDirect, Google Scholar, and LILACS. The research question was written in its free form as follows: In endodontically treated teeth, are fiber-reinforced composites more resistant to fracture than alternative core restorations? For the structured review question, the PICOS (population, intervention, comparison, and outcome) technique was used

  • Population - Fully formed extracted human teeth which are endodontically treated.

  • Intervention - Dental restorative Fiber-reinforced Composites.

  • Comparison - Conventional hybrid and nanohybrid composites, fiber-reinforced posts, crowns (with or without posts), endocrowns, ceramic inlay.

  • Outcome - Evaluation of fracture resistance using a universal testing machine.

The published research papers between January 2000 and May 2023 were reviewed. The search terms were as follows: fiber-reinforced composites, short fiber composite, EverXposterior, Ribbond, fracture resistance and fracture strength. These keywords were combined as ((((((((((((Short fiber-reinforced composite) OR (short fiber-reinforced composite)) OR (fiber-reinforced composite)) OR (short fiber composite)) OR (e-glass fiber)) OR (Fiber-reinforced composites)) OR (EverX Posterior)) OR (Rib-bond)) OR (polyethylene fiber ribbon)) AND ((((((((((((nanocomposite) OR (nanofilled composite)) OR (nano hybrid composite)) OR (micro filled composite)) OR (microhybrid composite)) OR (fiber post)) OR (Fiber-reinforced composite post)) OR (Inlay)) OR (onlay)) OR (crowns)) OR (endo crowns)) OR (indirect restorations))) AND ((((endodontically treated teeth) OR (structurally compromised teeth)) OR (traditional access cavity)) OR (conventional access cavity))) AND (((((((Fracture resistance) OR (Flexural strength)) OR (Fracture toughness)) OR (Modulus of Rupture)) OR (Flexural Resistance)) OR (Fracture Strength)) OR (Bend Strength))). These terms and keywords were taken from published research papers in the journals: Journal of Endodontics, International Endodontic Journal, and Australian Endodontic Journal. Each database’s search terms were changed. Added research articles were not identified through the previous approaches, but were hand-searched in the reference lists of all included articles (Table 1a and 1b).

Table 1a Results of PUBMED bibliometric search engines between 2010–2023
Full size table
Table 1b Results of other bibliometric search databases between 2010–2023
Full size table

Screening and selection of the studies

Two independent reviewers assessed whether the title of the article identified through the electronic database was appropriate with the review question under the guidance of an expert third reviewer. After then, the abstracts were rigorously scrutinized in order to identify research that was eligible. If the information gathered from the title and abstract was not sufficient, the full text of the article was examined. In the event of disagreement between the reviewers on inclusion or exclusion of studies, a third reviewer was involved to achieve consensus. Only studies that matched all of the following criteria were considered for inclusion:

  • In vitro studies assessing the fracture resistance of fiber-reinforced composites in Endodontically treated teeth.

  • In vitro studies assessing the fracture resistance of fiber-reinforced composites in Endodontically treated posterior teeth.

  • Studies which assessed the fracture resistance of fiber-reinforced composites in different cavity configurations.

  • Studies comparing the resistance to fracture of root canal treated teeth treated with fiber-reinforced composites to conventional hybrid composites, inlays, crowns, fiber posts, and endocrowns.

Exclusion Criteria

  • Animal studies and case reports.

  • Studies that have used other material such as EverStick.

  • Studies assessing fracture resistance of fiber-reinforced composites in teeth without endodontic therapy.

  • Studies done in anterior teeth.

Assessment of risk of bias (ROB)

Since there is no clearly defined risk of bias tool to assess in vitro studies, based on modified JBI & CRIS (checklist for reporting in vitro studies) guidelines, along with the methodology and treatment objective [12], we have formulated 13 parameters specifically to study the fracture resistance. Randomization, use of control standard, standardization of teeth, age, method of sample size estimation, material based on manufacturer’s instructions, samples prepared by a single operator, observer blinding, thermocycling, cyclic loading, periodontal ligament simulation, mode of fracture were examined. The article will be marked a “Yes” on that parameter if the authors reported it; if the information could not be retrieved, then it’s reported as “No.“

Each article was evaluated by the means of Risk of Bias score. The important parameters for fracture resistance studies such as standardization of teeth dimensions, usage materials as directed by the manufacturer, thermocycling, cyclic loading, axial loading direction, periodontal ligament simulation and mode of fracture were given higher weightage and a score of “2” and other parameters were given a score of “1” if the articles recorded a “Yes” in these parameters. The articles were assessed to have a “High” if the ROB score was less than 10, “Moderate” if ROB score is between 10–14, and “Low” if ROB score was more than 14. The two reviewers made their assessments in-dependently, with any disputes addressed by consensus. Every attempt was undertaken to get any missing information from the listed research. Missing information was sought by sending emails to the authors of the papers listed.

Data extraction

All relevant papers’ full texts were retrieved, and the data was extracted simultaneously by two reviewers using a consistent outline. Authors names, published year, type of teeth, details of control groups, cavity configuration, techniques used for root canal preparation, apical diameter, disinfecting agents, method of canal obturation, sealer used, materials evaluated, material used for fracture testing and crosshead speed, interpretation of results (N, kg, or lb), and assessment of outcomes. The information was gathered from the tests to see how different fiber-reinforced composites and specific fibers affected the resistance to fracture. Every included paper was examined for commonalities in order to conduct a meta-analysis. A meta-analysis, however, was not possible due to the heterogeneity of the studies. The findings of investigations on the impact of fiber-reinforced composites on tooth fracture resistance were compiled. The following is an example of evidence synthesis: [12]

  1. 1.

    Strong evidence: information from two or more high-quality studies with usually consistent findings across all investigations (≥ 75%of studies found consistent findings).

  2. 2.

    Moderate evidence: 1 high-quality study and/or 2 or more low-quality studies with generally consistent findings across all investigations (≥ 75%of studies reported consistent findings).

  3. 3.

    Limited evidence: based on only one low-quality study.

  4. 4.

    Contradictory evidence: Inconsistent outcomes across several studies (< 75% of studies reported consistent results).

  5. 5.

    No evidence: There were no studies found.

Results

Search results

The databases provided a total of 796 studies from the electronic systematic search. PubMed identified 152 records, Scopus identified 217 records, ScienceDirect identified 148 items, and Google Scholar identified 279 records. The duplicates were removed using the Rayyan AI tool. After the removal of duplicates and data screening based on the title and abstract, 25 articles were selected for full-text reading. (Fig. 1). A total of 9 articles [13,14,15,16,17]2 [18] were eliminated after full text reading and the reason for exclusion has been discussed in Table 2. After full-text reading, 18 papers [19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35] were identified as being eligible for this systematic review (Table 3).

Fig. 1
figure 1

Flowchart of the systematic review process

*Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers).

**If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools.

Full size image
Table 2 Characteristics of excluded articles
Full size table
Table 3 Descriptive data of included studies
Full size table

Risk of bias

All the included studies were assessed for risk of bias. Of the 18 studies, 5 studies presented low risk of bias, 9 studies presented moderate risk of bias and 4 studies reported high ROB. The results are depicted in Table 4.

Table 4 Risk of bias of included studies
Full size table

Cavity configuration

In the included studies, two studies had evaluated the fracture resistance of fiber-reinforced composites on Mesial-Occlusal Distal with palatal cusp removed (MODP) [24, 45]. The study by [33] have assessed the fracture resistance of fiber-reinforced composites in Traditional and Conservative access cavities of endodontically treated teeth. Rest all of the studies have assessed the fracture resistance of fiber composites in Class-II Mesial Occlusal Distal cavities of endodontically treated teeth. The study done by [33, 34] have evaluated fracture resistance in Class-II Mesial Occlusal cavities in addition. All studies have considered these cavity configurations to simulate heavily weakened teeth. Only one study [40], reported fiber-reinforced composites were unable to entirely restore the lost fracture resistance of MOD cavities which are endodontically treated. This study [33] reported no difference in the fracture resistance of Endodontically treated teeth restored with fiber-reinforced composites in Traditional and Conservative access cavities. While the remaining 14 studies reported that fiber-reinforced composites improved the fracture resistance of MOD and MODP access cavities of endodontically treated teeth [19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34].

Type of teeth

The fracture resistance of fiber-reinforced composites in molars and premolars has been researched in the studies mentioned. Eight research [20, 22, 29, 33, 35, 49, 54, 55] assessed the fracture resistance of fiber-reinforced composites in endodontically treated molars, and ten looked at the fracture resistance of fiber-reinforced composites in endodontically treated premolars [21, 23,24,25,26,27,28, 30, 31, 34].The fracture resistance was greater in molars compared to premolars in Class II MOD access cavities of endodontically treated teeth as the volume of the remaining tooth structure was higher in molars.

Mechanical testing

Universal testing machine. spherical stainless-steel ball compression loading was applied and fracture resistance testing was done based on static and dynamic loading amongst all included studies. Most of the included studies have performed the fracture testing using the cross-head speed of 1 mm/minute, whereas remaining studies have performed with either 0.5 mm/minute or 2 mm/minute. Also, the diameter of the steel ball varied from 4 to 8 mm.

Fiber-reinforced composites vs. indirect core restorations

One study by [40] compared fracture resistance fiber-reinforced composites to Inlays in MOD access cavities of endodontically treated teeth reported that Inlays produced more favorable fractures which could be repaired if desired and may be recommended in restoring endodontically treated teeth indicating moderate evidence. One study by [54] assessed in vitro post-fatigue fracture behavior of endodontically treated molars with MOD cavities restored with fiber reinforced composites, partial and full crowns of e.max CAD, Celtra Duo, zirconia and cast gold restorations found that the indirect restorations of partial and full crowns should be considered than direct restorations with fiber reinforced composite or direct composite when restoring endodontically treated teeth with MOD cavities. The less invasive approach of direct restoration did not result in superior post-fatigue resistance but resulted in gap-free enamel margins compared to indirect restorations. Two studies assessed the use of fiber posts in endodontically treated teeth, of which one study [24] reported the use of fiber posts, polyethylene fibers and composite resin for core buildup resulted in higher fracture resistance of MODP access cavities of endodontically treated teeth and the study by [28] reported short fiber-reinforced composite (EverXposterior) possessed higher fracture strengths than Fiber-reinforced post (PWFP Ribbond) in MODP cavities of endodontically treated teeth. Therefore, the review found moderate evidence for the fracture resistance of fiber-reinforced posts with fiber-reinforced composites for core build-up compared to fiber-reinforced composites in MODP cavities of endodontically treated teeth.

Fiber-reinforced composites vs. amalgam

Fiber-reinforced composites had higher fracture resistance than amalgam used for core material in MOD cavities of endodontically treated teeth, according to one study [40], with moderate evidence. Also, the use of amalgam resulted in fractures with root involvement (Unfavorable).

Fiber-reinforced composites vs. bulk fill composites

In endodontically treated teeth, five papers investigated the fracture resistance of bulk fill composites with fiber-reinforced composites [20, 25, 26, 28, 33]. According to one study [26], there were no significant changes in fracture resistance values in endodontically treated teeth between conventional hybrid, bulk fill composites, and fiber-reinforced composites. SDR Bulk fill composite has higher resistance to fracture in root canal treated teeth than fiber-reinforced composites, according to one study ( [56,57,58,59,60]). Fiber-reinforced composites outperformed bulk fill composites in endodontically treated teeth, according to two investigations [20, 25, 26, 29]. As a result, the review found conflicting data concerning Bulk fill composites’ fracture resistance in endodontically treated teeth when compared to fiber-reinforced composites.

Fiber-reinforced composites vs. conventional hybrid composites

Sixteen of the included studies have compared fiber-reinforced composites to conventional hybrid composites in endodontically treated teeth [35, 49, 59, 61,62,63,64,65,66,67,68,69,70,71,72,73,74]. Root canal-treated teeth treated with fiber-reinforced composites and hybrid composites showed no significant differences in fracture resistance in three studies [54, 58, 75, 76]. Fifteen studies [60, 77,78,79,80,81,82,83,84,85,86,87,88,89,90]; [35, 49, 54] reported consistent findings that fracture resistance of fiber-reinforced composites is higher when compared to conventional hybrid composites in endodontically treated teeth indicating strong evidence.

Fiber-reinforced composites vs. silorane composites

The fracture resistance of endodontically treated teeth restored with fiber-reinforced composites was higher than that of silorane composites, according to one study [91], showing insufficient evidence.

Type of fiber-reinforced composites

EverXposterior is a packable restorative fiber-reinforced composite whereas Ribbond, Vectris and Interlig are strips of fibers which are cut, placed and retained in the cavity using a stabilizing composite or a flowable composite incrementally. Thirteen studies reported the use of EverXposterior in endodontically treated teeth [25,26,27,28,29,30,31,32,33,34,35, 49, 54]. The study by [26] reported no significant difference between EverXposterior and conventional hybrid composites. Low viscosity bulk fill composites (SDR) had stronger fracture resistance in endodontically treated teeth than fiber-reinforced composites, according to one study [33]. EverXposterior enhanced the fracture resistance of endodontically treated teeth, according to eight investigations [27,28,29,30,31,32, 34] providing substantial evidence. Ribbond was used in nine investigations [20,21,22,23,24,25, 30, 32, 34]. Three research [30, 32, 34] comparing Ribbond to EverXposterior indicated that EverXposterior had higher fracture resistance values than Ribbond, whereas one study [25] found the opposite, that Ribbond had higher fracture resistance. Ribbond increases the fracture strength compared to traditional hybrid composites and Vectris, according to three studies [22,23,24]. When fracture resistance Ribbond was compared to other fiber composites in endodontically treated teeth, it revealed inconsistent data. Interlig fibers were used in two experiments [21, 31]. According to one study [31], EverXposterior possessed higher fracture resistance values than Interlig, while composite impregnated with Interlig owned higher fracture strength values than Ribbond fiber composites, showing limited evidence.

Discussion

This is the first systematic review to evaluate the fracture resistance of fiber-reinforced composites in endodontically treated teeth. This review was con-ducted to assess the resistance to fracture of fiber-reinforced composites when compared to other core restorations following endodontic therapy. The fracture resistance of endodontically treated teeth was lower than that of untreated teeth. Endodontic therapy weakens the tooth structure and makes it more fracture-prone [92, 93]. When compared to traditional hybrid composites, fiber-reinforced compo-sites were able to recover the lost fracture resistance of teeth following root canal treatment in the majority of studies examined.

Discussing the failure mechanisms, brittle failure is caused by fiber-matrix adhesion. The increased matrix damage caused by a combination of the increased test speed and the interfacial bond strength can be seen, as the bunch fiber pull-out [93, 94]. This bunch fiber pull-out indicates that the fiber-matrix interfacial bond strength was exceeded before the composite’s tensile failure strength was reached at this loading rate. As a result of the increased strength of the glass fibers, the observed rate dependency of failure strength is explained. Also, increased test speed increases fiber tensile strength and modulus, allowing the fiber-matrix interfacial bond to be exceeded before the composite’s tensile failure strength [93, 94]. Matrix debonding happens as these fibers are pushed out, resulting in matrix cracking and disintegration [93, 94]. Because of the monoblock effect, fibres have the ability to alter the stress. This in turn aids in distributing stress throughout the tooth’s long axis [95]. Additionally, it can inhibit the formation of crack, as a result of stress transfer from the polymer matrix to the fibres [95, 96]. As core materials, fibres including polyethylene, glass, and short fiber-reinforced composites have been employed. Composite materials reinforced with polyethylene fibres aid in modifying the pat-tern of stresses as well as their distribution and transfer. Glass fibres are sufficiently aesthetically pleasing and have a strengthening capacity [97]. EverX posterior has multidirectional, discontinuous fibres that operate as a dentin substitute, boost strength, and increase the load-bearing capability of the material.

The utilization of high aspect ratio microstructural filler units and orienting these fillers away from the propagation of fracture were key strategies for strengthening this dental material [42, 43]. A Bis-GMA, PMMA, and TEGDMA semi-interpenetrating matrix network, as well as short E-glass fibers and barium glass, make up the Short Fiber-reinforced Composite (SFRC) substructure. It was designed to mimic the fibrous structure of dentin, which makes up around 75 per-cent of the total filler fraction and has a high aspect particle/fiber ratio [98, 99]. Filler loading in this manner improves mechanical qualities such as flexural strength and fracture resistance [99, 100]. Crack-deflecting or crack-bridging processes assist modify stress dynamics when the length of the fiber is more than the critical length of the fiber that is 0.5–1.6 mm [101]. Fracture occurs when interparticle cracks form as it passes through the resin matrix. The filler particles which are linear aid in fracture deflection by diverting the crack away from the region where there is high stress. The simple crack bending lowers the stress distribution and helps joining the particle and allowing the bridge to form. This bridge toughening phenomenon is caused by the twisting of reinforced fibers, which aids in elastic spanning as well as friction between the fibers and their enclosing through the debonding process known as frictional bridging [46]. The crack bridging zone does not degrade at the crack tale due to the high fracture toughness of Ever-X Posterior, which is around 2.4 Mpam1/2, increasing the crack resistance curve (R-Curve) [102]. These composites’ anisotropic polymerization contraction behavior helps to reduce shrinkage stress. The plastic IPN matrix is projected to absorb the residual contraction stresses during polymerization, closing the gap between the tooth-restoration continuum [98, 102].

The ability of a material to resist crack propagation under functional stresses is known as fracture toughness. The matrix-filler interface bonding, regardless of the filler form or size, is a significant element that determines fracture toughness. An important parameter to assess a material’s ability to withstand fracture is fracture toughness. It determines the amount of energy needed for a material to fracture and spread to the point of catastrophic failure. Since stresses that a material would typically accept build towards the defective edge in this case, the level of stress needed to trigger a fracture would typically be lower the larger the defect. The ability to fracture is a good indicator of the clinical performance of composite restorations. A material with a high rate of fracture toughness is less prone to chipping or fracture.

Ribbond has strong microtensile bond strength; therefore, employing it on the tensile side of a composite repair will improve its flexural qualities [9]. 215 fibers make up polyethylene longitudinal filaments. These fibers soak up and distribute stress on the tooth structure, reducing stress. The durability, stability, and shear strength of this polyethylene fiber are improved by a unique pattern of cross-linked locking stitched threads [9, 23]. Ribboned polyethylene fiber placed in the flowable composite bed helps to maintain the tooth by raising the elastic modulus and reducing fracture during a composite restoration. Fiber-reinforced composites might outperform traditional hybrid composites in endodontically treated teeth due to their increased physical qualities.

The modulating influence of these fibers on the interfacial tensions generated along the cavity walls through these multidirectional yarns and locked interlaced series of small stitches creating a myriad of load channels might be attributed to reinforcing potential of ribbond [8, 9]. This, in turn, aids in the dispersion of occlusal stresses across a larger area of the restorative material, avoiding rapid fracture formation. Fracture initiation occurs at the fiber particle - resin interface, which is caused primarily by the development of inter-particle cracks inside the resin matrix. Because they are engaged in the crack-blunting mechanism, the insertion of these high flexural modulus short fibers (15.2 Gpa) in this matrix decreases the stress intensity at the fracture tip [9].

The flexural strength and flexural modulus values are highly correlated with the filler volume percentage. The fibers’ involvement in making the material stiffer and more resistant to bending forces both during testing and possibly during use [100]. Previous studies on the assessment of flexural modulus have shown that fibers in composite were able to withstand flexure even at greater load relative to greater sample thickness, but with more deformation before final failure, due to less matrix polymerization and the resulting lack of rigidity. These findings, if validated by more research, would shed more light on a crucial issue pertaining to the amount of deformation and distortion of the material caused by the reduced stiffness, particularly in the interface region.

While comparing inlays and fiber-reinforced composites, moderate evidence was found for fracture resistance of inlays than fiber-reinforced composites in endodontically treated teeth while no evidence could be found for other indirect restorations like crowns or endocrowns. Fracture resistance of inlays and fiber posts using fiber-reinforced composite as core material was found to be moderate, while fracture resistance of bulk fill composites in endodontically treated teeth was found to be contradictory. Surefil SDR, a bulk fill composite, had greater fracture resistance values than SFRC [26, 33]. A polymerization modulator in SureFil SDR Flow decreases the stress that occurs during light polymerization [103, 104]. SDR was shown to have lower polymerization stress and cuspal flexure than other typical flowable composites and was comparable to low shrinkage resin composites [105]. SureFil SDR Flow’s favorable results could be due to its attributes of reduced flexural modulus and slower contraction rate. The evidence was moderate, however fiber-reinforced composites exhibited stronger fracture resistance values than amalgam utilized for core material in MOD cavities of endodontically treated teeth.

Fiber-reinforced composites have higher fracture strength than silorane composites, according to the evidence. In comparison to the nanohybrid group, Silorane is a microhybrid composite with a greater size and lower percentage of filler particles, resulting in early crack propagation and poor fracture resistance.

The disparities in outcomes could be attributed to differences in study designs among the studies examined. The majority of studies found that fiber-reinforced composites restored samples had favorable fractures that were above the CEJ level and could be repaired if desired. However, samples repaired using fiber-reinforced composites cracked unfavorably in research by [29]. This study has a high risk of bias because no periodontal ligament simulation was done. The use of periodontal ligament simulation to assess fracture resistance is controversial. Periodontal ligament and bone must be included in these types of testing, according to Rees and others’ finite element analyses. This reduces the occlusal forces acting on the samples [29].

The artificial periodontal ligament may influence fracture modes, also, the simulation of periodontal ligament has an impact on resistance to fracture [106]. Simulating the periodontal ligament, on the other hand, showed no effect on fracture resistance [107]. According to a study by [108], the microstructure of root dentin changes with age, lowering strength and fatigue resistance. Near the apex, the most severe degradation was discovered, which contributed to the occurrence of vertical root fracture. The final apical diameter differed amongst the studies included in this analysis. Previous studies [109, 110] demonstrated that different canal tapering preparation procedures using various files systems in rotary motion decreased the fracture resistance.

According to [111], increasing apical expansion or canal taper did not enhance the probability of root fracture. Endodontically treated teeth’s fracture susceptibility may be affected by the subsequent irrigation treatment [112, 113]. NaOCl solution was used as the final irrigation in the majority of the clinical trials. On the other side, the concentration, amount, and application time of these solutions varied between investigations. Root canal dentin microhardness was reduced by these irrigant solutions, which could lead to vertical root fracture [114, 115]. The plunger tip diameter, position, and speed varied between experiments. Future research should look into the impact of these variables on fracture resistance testing. Only two studies [20, 24] used cyclic loading prior to fracture resistance testing. In vitro studies measuring the fracture resistance of composite material benefit from cyclic loading of samples because it mimics the dynamic masticatory loads on the restorative material in the oral cavity.

Blinding was not used in any of the trials in this review. Sample size computation and the clinical steps were not completed by a single clinician in the majority of trials. This raised the possibility of bias. According to the current review’s quality evaluation, the majority of the included studies exhibited a moderate or high ROB. As a consequence, the review’s findings should be treated with caution. Although randomized controlled trials produce the most precise and reliable results, well-designed in vitro research with high methodological quality could help solve clinical difficulties [107]. Systematic reviews of in vitro studies can also aid in the area for future research by recognizing the need for more investigation and re-solving the limitations of previous studies.

By combining different results, meta-analysis is a valuable technique for accumulating and summarizing knowledge in a research field and identifying the overall measure of a treatment’s effect [116]. The listed studies were compared in order to construct a meta-analysis in this study. A meta-analysis was not possible due to the heterogeneity of the included studies. Even modest breaches of some meta-analysis guidelines can result in incorrect conclusions [116]. The meta-analysis may be inaccurate due to differences in root canal treatment processes (thermocycling, cyclic fatigue limit, type and concentration of disinfecting agent, canal preparation and obturation method, and so on) among the included research.

To eliminate inter-operator variability in further in vitro fracture resistance research, it is recommended that each process, including canal preparation, disinfection, obturation, cavity preparation, and restoration, be conducted by a single operator. Also included are thermocycling, cyclic loading, and periodontal ligament simulation, as well as following the manufacturer’s guidelines for preparation and restoration. The plunger tip’s diameter, orientation, and pace may have an impact on the end output. As a result, some test requirements should be addressed when designing these studies. With such standardizations, the quality and transparency of in vitro fracture resistance investigations of endodontically treated teeth will increase.

Implications for research

Well-designed randomized controlled trials should be done to provide evidence-based principles for clinical practice.

Conclusion

Within the scope of this review, research suggests that using fiber-reinforced composites in endodontically treated teeth might increase fracture resistance compared to traditional hybrid composites although the quality of evidence of included studies was low. This review strongly suggests the development of well-designed randomized clinical trials to test the clinical performance of fiber-reinforced composites compared to other core restorations in endodontically treated teeth.

Data Availability

The data will be available on reasonable request from the corresponding author.

References

  1. Trope M, Langer I, Maltz D, Tronstad L. Resistance to fracture of restored endodontically treated premolars. Endod Dent Traumatol. 1986;2:35–8.

    PubMed  Google Scholar 

  2. Maxwell EH, Braly BV, Eakle WS. Incompletely fractured teeth–a survey of endodontists. Oral Surg Oral Med Oral Pathol. 1986;61:113–7.

    PubMed  Google Scholar 

  3. Gutmann JL. The dentin-root complex: anatomic and biologic considerations in restoring endodontically treated teeth. J Prosthet Dent. 1992;67:458–67.

    PubMed  Google Scholar 

  4. Panitvisai P, Messer HH. Cuspal deflection in molars in relation to endodontic and restorative procedures. J Endod. 1995;21:57–61.

    PubMed  Google Scholar 

  5. Randow K, Glantz PO. On cantilever loading of vital and non-vital teeth. An experimental clinical study. Acta Odontol Scand. 1986;44:271–7.

    PubMed  Google Scholar 

  6. Santos JM, Palma PJ, Ramos JC, Cabrita AS, Friedman S. Periapical inflammation subsequent to coronal inoculation of dog teeth root filled with resilon/epiphany in 1 or 2 treatment sessions with chlorhexidine medication. J Endod. 2014;40:837–41.

    PubMed  Google Scholar 

  7. Cramer NB, Stansbury JW, Bowman CN. Recent advances and developments in composite dental restorative materials. J Dent Res. 2011;90:402–16.

    PubMed  PubMed Central  Google Scholar 

  8. Eskitaşcioğlu G, Belli S, Kalkan M. Evaluation of two post core systems using two different methods (fracture strength test and a finite elemental stress analysis). J Endod. 2002;28:629–33.

    PubMed  Google Scholar 

  9. Belli S, Cobankara FK, Eraslan O, Eskitascioglu G, Karbhari V. The effect of fiber insertion on fracture resistance of endodontically treated molars with MOD cavity and reattached fractured lingual cusps. J Biomed Mater Res B Appl Biomater. 2006;79:35–41.

    PubMed  Google Scholar 

  10. Vallittu PK. The effect of glass fiber reinforcement on the fracture resistance of a provisional fixed partial denture. J Prosthet Dent. 1998;79:125–30.

    PubMed  Google Scholar 

  11. Dua N, Kumar B, Arunagiri D, Iqbal M, Pushpa S, Hussain J. Comparative evaluation of the effect of different crown ferrule designs on the fracture resistance of endodontically treated mandibular premolars restored with fiber posts, composite cores, and crowns: an ex-vivo study. J Conserv Dent. 2016;19:264–9.

    PubMed  PubMed Central  Google Scholar 

  12. Uzunoglu-Özyürek E, Küçükkaya Eren S, Karahan S. Effect of root canal sealers on the fracture resistance of endodontically treated teeth: a systematic review of in vitro studies. Clin Oral Investig. 2018;22:2475–85.

    PubMed  Google Scholar 

  13. Sharma A, Amirtharaj LV, Sanjeev K, Mahalaxmi S. Fracture resistance of Endodontically treated Premolars restored with Flowable Short Fibre-Reinforced Resin Composite–An in Vitro Study. Eur Endodontic J. 2022;7:161.

    Google Scholar 

  14. Aslan T, Sagsen B, Er Ö, Ustun Y, Cinar F. Evaluation of fracture resistance in root canal-treated teeth restored using different techniques. Niger J Clin Pract. 2018;21:795. https://doi.org/10.4103/njcp.njcp_330_17

    Article  PubMed  Google Scholar 

  15. Rocca GT, Saratti CM, Cattani-Lorente M, Feilzer AJ, Krejci I. The effect of a fiber reinforced cavity configuration on load bearing capacity and failure mode of endodontically treated molars restored with CAD/CAM resin composite overlay restorations. J Dent. 2015;43. https://doi.org/10.1016/j.jdent.2015.06.012

  16. Scotti N, Forniglia A, Tempesta RM, Comba A, Saratti CM, Pasqualini D, et al. Effects of fiber-glass-reinforced composite restorations on fracture resistance and failure mode of endodontically treated molars. J Dent. 2016;53. https://doi.org/10.1016/j.jdent.2016.08.001

  17. Basaran ET, Gokce Y. Evaluation of the influence of various restoration techniques on fracture resistance of endodontically treated teeth with different cavity wall thicknesses. Niger J Clin Pract. 2019;22:328.

    PubMed  Google Scholar 

  18. Patnana AK, Vanga NRV, Vabbalareddy R, Chandrabhatla SK. Evaluating the fracture resistance of fiber reinforced composite restorations - an in vitro analysis. Indian J Dent Res. 2020;31:138.

    PubMed  Google Scholar 

  19. de Kuijper M, Gresnigt M, van den Houten M, Haumahu D, Schepke U, Cune MS. Fracture strength of various types of large direct composite and Indirect Glass ceramic restorations. Oper Dent 2019;44. https://doi.org/10.2341/18-111-L

  20. Cobankara FK, Unlu N, Cetin AR, Ozkan HB. The effect of different restoration techniques on the fracture resistance of endodontically-treated molars. Oper Dent. 2008;33:526–33.

    PubMed  Google Scholar 

  21. Srirekha A, Hegde J, Karale R, Tyagi S, Bhaskaran S, Luthria A. The reinforcement effect of polyethylene fibre and composite impregnated glass fibre on fracture resistance of endodontically treated teeth: an in vitro study. J Conservative Dentistry. 2012;15:372. https://doi.org/10.4103/0972-0707.101914

    Article  Google Scholar 

  22. Khan SI, Anupama R, Deepalakshmi M, Kumar KS. Effect of two different types of fibers on the fracture resistance of endodontically treated molars restored with composite resin. J Adhes Dent. 2013;15:167–71.

    PubMed  Google Scholar 

  23. Kalburge V, Yakub SS, Kalburge J, Hiremath H, Chandurkar A. A comparative evaluation of fracture resistance of endodontically treated teeth, with variable marginal ridge thicknesses, restored with composite resin and composite resin reinforced with Ribbond: an in vitro study. Indian J Dent Res. 2013;24:193–8.

    PubMed  Google Scholar 

  24. Costa S, Silva-Sousa Y, Curylofo F, Steier L, Sousa-Neto M, Souza-Gabriel A. Fracture resistance of mechanically compromised premolars restored with polyethylene fiber and adhesive materials. Int J Adhes Adhes. 2014;50:211–5. https://doi.org/10.1016/j.ijadhadh.2014.01.030

    Article  Google Scholar 

  25. Kemaloglu H, Kaval ME, Turkun M, Kurt SM. Effect of novel restoration techniques on the fracture resistance of teeth treated endodontically: an in vitro study. Dent Mater J. 2015;34:618–22. https://doi.org/10.4012/dmj.2014-326

    Article  PubMed  Google Scholar 

  26. Atalay C, Yazici AR, Horuztepe A, Nagas E, Ertan A, Ozgunaltay G. Fracture resistance of endodontically treated Teeth restored with bulk fill, Bulk fill Flowable, Fiber-reinforced, and Conventional Resin Composite. Oper Dent. 2016;41:E131–40.

    PubMed  Google Scholar 

  27. Bilgi PS, Shah NC, Patel PP, Vaid DS. Comparison of fracture resistance of endodontically treated teeth restored with nanohybrid, silorane, and fiber reinforced composite: an in vitro study. J Conserv Dent. 2016;19. https://doi.org/10.4103/0972-0707.186458

  28. Gürel MA, Kivanç BH, Ekıcı A, Alaçam T. Fracture resistance of Premolars restored either with short Fiber or polyethylene Woven Fiber-Reinforced Composite. J Esthetic Restor Dentistry. 2016;28:412–8. https://doi.org/10.1111/jerd.12241

    Article  Google Scholar 

  29. Yasa B, Arslan H, Yasa E, Akcay M, Hatirli H. Effect of novel restorative materials and retention slots on fracture resistance of endodontically-treated teeth. Acta Odontol Scand. 2016;74:96–102.

    PubMed  Google Scholar 

  30. Ozsevik AS, Yildirim C, Aydin U, Culha E, Surmelioglu D. Effect of fibre-reinforced composite on the fracture resistance of endodontically treated teeth. Aust Endod J 2016;42. https://doi.org/10.1111/aej.12136

  31. Eapen AM, Vijay Amirtharaj L, Sanjeev K, Mahalaxmi S. Fracture resistance of endodontically treated Teeth restored with 2 different Fiber-reinforced composite and 2 conventional composite Resin Core Buildup Materials: an in Vitro Study. J Endod. 2017;43:1499–504. https://doi.org/10.1016/j.joen.2017.03.031

    Article  PubMed  Google Scholar 

  32. Garlapati TG, Krithikadatta J, Natanasabapathy V. Fracture resistance of endodontically treated teeth restored with short fiber composite used as a core material—An in vitro study. J Prosthodontic Res. 2017;61:464–70. https://doi.org/10.1016/j.jpor.2017.02.001

    Article  Google Scholar 

  33. Özyürek T, Ülker Ö, Demiryürek E, Yılmaz F. The Effects of Endodontic Access Cavity Preparation Design on the fracture strength of endodontically treated Teeth: traditional Versus Conservative Preparation. J Endod. 2018;44:800–5.

    PubMed  Google Scholar 

  34. Shah S, Shilpa-Jain DP, Velmurugan N, Sooriaprakas C, Krithikadatta J. Performance of fibre reinforced composite as a post-endodontic restoration on different endodontic cavity designs— an in-vitro study. J Mech Behav Biomed Mater. 2020;104:103650. https://doi.org/10.1016/j.jmbbm.2020.103650

    Article  PubMed  Google Scholar 

  35. Volom A, Vincze-Bandi E, Sáry T, Alleman D, Forster A, Jakab A, et al. Fatigue performance of endodontically treated molars reinforced with different fiber systems. Clin Oral Investig. 2023. https://doi.org/10.1007/s00784-023-04934-2

    Article  PubMed  Google Scholar 

  36. Aslan T, Sagsen B, Er Ö, Ustun Y, Cinar F. Evaluation of fracture resistance in root canal-treated teeth restored using different techniques. Niger J Clin Pract. 2018;21:795. https://doi.org/10.4103/njcp.njcp_330_17

    Article  PubMed  Google Scholar 

  37. Kassis C, Khoury P, Mehanna CZ, Baba NZ, Bou CF, Daou M, et al. Effect of Inlays, Onlays and Endocrown Cavity Design Preparation on Fracture Resistance and Fracture Mode of Endodontically treated Teeth: an in Vitro Study. J Prosthodont. 2021;30. https://doi.org/10.1111/jopr.13294

  38. Fráter M, Sáry T, Vincze-Bandi E, Volom A, Braunitzer G, Szabó PB et al. Fracture behavior of Short Fiber-Reinforced Direct Restorations in large MOD cavities. Polymers 2021;13. https://doi.org/10.3390/polym13132040

  39. Sharma A, Amirtharaj LV, Sanjeev K, Mahalaxmi S. Fracture resistance of Endodontically treated Premolars restored with Flowable Short Fibre-Reinforced Resin Composite–An in Vitro Study. Eur Endodontic J. 2022;7:161.

    Google Scholar 

  40. Cobankara FK, Unlu N, Cetin AR, Ozkan HB. The effect of different restoration techniques on the fracture resistance of endodontically-treated molars. Oper Dent. 2008;33:526–33.

    PubMed  Google Scholar 

  41. Khan SI, Anupama R, Deepalakshmi M, Kumar KS. Effect of two different types of fibers on the fracture resistance of endodontically treated molars restored with composite resin. J Adhes Dent. 2013;15:167–71.

    PubMed  Google Scholar 

  42. Costa S, Silva-Sousa Y, Curylofo F, Steier L, Sousa-Neto M, Souza-Gabriel A. Fracture resistance of mechanically compromised premolars restored with polyethylene fiber and adhesive materials. Int J Adhes Adhes. 2014;50:211–5. https://doi.org/10.1016/j.ijadhadh.2014.01.030

    Article  Google Scholar 

  43. Kemaloglu H, Kaval ME, Turkun M, Kurt SM. Effect of novel restoration techniques on the fracture resistance of teeth treated endodontically: an in vitro study. Dent Mater J. 2015;34:618–22. https://doi.org/10.4012/dmj.2014-326

    Article  PubMed  Google Scholar 

  44. Bilgi PS, Shah NC, Patel PP, Vaid DS. Comparison of fracture resistance of endodontically treated teeth restored with nanohybrid, silorane, and fiber reinforced composite: an in vitro study. J Conserv Dent. 2016;19. https://doi.org/10.4103/0972-0707.186458

  45. Gürel MA, Kivanç BH, Ekıcı A, Alaçam T. Fracture resistance of Premolars restored either with short Fiber or polyethylene Woven Fiber-Reinforced Composite. J Esthetic Restor Dentistry. 2016;28:412–8. https://doi.org/10.1111/jerd.12241

    Article  Google Scholar 

  46. Yasa B, Arslan H, Yasa E, Akcay M, Hatirli H. Effect of novel restorative materials and retention slots on fracture resistance of endodontically-treated teeth. Acta Odontol Scand. 2016;74:96–102.

    PubMed  Google Scholar 

  47. Eapen AM, Vijay Amirtharaj L, Sanjeev K, Mahalaxmi S. Fracture resistance of endodontically treated Teeth restored with 2 different Fiber-reinforced composite and 2 conventional composite Resin Core Buildup Materials: an in Vitro Study. J Endod. 2017;43:1499–504. https://doi.org/10.1016/j.joen.2017.03.031

    Article  PubMed  Google Scholar 

  48. Garlapati TG, Krithikadatta J, Natanasabapathy V. Fracture resistance of endodontically treated teeth restored with short fiber composite used as a core material—An in vitro study. J Prosthodontic Res. 2017;61:464–70. https://doi.org/10.1016/j.jpor.2017.02.001

    Article  Google Scholar 

  49. Bijelic-Donova J, Keulemans F, Vallittu PK, Lassila LVJ. Direct bilayered biomimetic composite restoration: the effect of a cusp-supporting short fiber-reinforced base design on the chewing fracture resistance and failure mode of molars with or without endodontic treatment. J Mech Behav Biomed Mater. 2020;103. https://doi.org/10.1016/j.jmbbm.2019.103554

  50. Khan SI, Anupama R, Deepalakshmi M, Kumar KS. Effect of two different types of fibers on the fracture resistance of endodontically treated molars restored with composite resin. J Adhes Dent. 2013;15:167–71.

    PubMed  Google Scholar 

  51. Costa S, Silva-Sousa Y, Curylofo F, Steier L, Sousa-Neto M, Souza-Gabriel A. Fracture resistance of mechanically compromised premolars restored with polyethylene fiber and adhesive materials. Int J Adhes Adhes. 2014;50:211–5. https://doi.org/10.1016/j.ijadhadh.2014.01.030

    Article  Google Scholar 

  52. Kemaloglu H, Kaval ME, Turkun M, Kurt SM. Effect of novel restoration techniques on the fracture resistance of teeth treated endodontically: an in vitro study. Dent Mater J. 2015;34:618–22. https://doi.org/10.4012/dmj.2014-326

    Article  PubMed  Google Scholar 

  53. Eapen AM, Vijay Amirtharaj L, Sanjeev K, Mahalaxmi S. Fracture resistance of endodontically treated Teeth restored with 2 different Fiber-reinforced composite and 2 conventional composite Resin Core Buildup Materials: an in Vitro Study. J Endod. 2017;43:1499–504. https://doi.org/10.1016/j.joen.2017.03.031

    Article  PubMed  Google Scholar 

  54. Frankenberger R, Winter J, Dudek M-C, Naumann M, Amend S, Braun A, et al. Post-fatigue fracture and marginal behavior of endodontically treated Teeth: partial Crown vs. full crown vs. endocrown vs. Fiber-Reinforced Resin Composite Materials. 2021;14. https://doi.org/10.3390/ma14247733

  55. Garlapati TG, Krithikadatta J, Natanasabapathy V. Fracture resistance of endodontically treated teeth restored with short fiber composite used as a core material—An in vitro study. J Prosthodontic Res. 2017;61:464–70. https://doi.org/10.1016/j.jpor.2017.02.001

    Article  Google Scholar 

  56. Cobankara FK, Unlu N, Cetin AR, Ozkan HB. The effect of different restoration techniques on the fracture resistance of endodontically-treated molars. Oper Dent. 2008;33:526–33.

    PubMed  Google Scholar 

  57. Kemaloglu H, Kaval ME, Turkun M, Kurt SM. Effect of novel restoration techniques on the fracture resistance of teeth treated endodontically: an in vitro study. Dent Mater J. 2015;34:618–22. https://doi.org/10.4012/dmj.2014-326

    Article  PubMed  Google Scholar 

  58. Atalay C, Yazici AR, Horuztepe A, Nagas E, Ertan A, Ozgunaltay G. Fracture resistance of endodontically treated Teeth restored with bulk fill, Bulk fill Flowable, Fiber-reinforced, and Conventional Resin Composite. Oper Dent. 2016;41:E131–40.

    PubMed  Google Scholar 

  59. Yasa B, Arslan H, Yasa E, Akcay M, Hatirli H. Effect of novel restorative materials and retention slots on fracture resistance of endodontically-treated teeth. Acta Odontol Scand. 2016;74:96–102.

    PubMed  Google Scholar 

  60. Özyürek T, Ülker Ö, Demiryürek E, Yılmaz F. The Effects of Endodontic Access Cavity Preparation Design on the fracture strength of endodontically treated Teeth: traditional Versus Conservative Preparation. J Endod. 2018;44:800–5.

    PubMed  Google Scholar 

  61. Cobankara FK, Unlu N, Cetin AR, Ozkan HB. The effect of different restoration techniques on the fracture resistance of endodontically-treated molars. Oper Dent. 2008;33:526–33.

    PubMed  Google Scholar 

  62. Srirekha A, Hegde J, Karale R, Tyagi S, Bhaskaran S, Luthria A. The reinforcement effect of polyethylene fibre and composite impregnated glass fibre on fracture resistance of endodontically treated teeth: an in vitro study. J Conservative Dentistry. 2012;15:372. https://doi.org/10.4103/0972-0707.101914

    Article  Google Scholar 

  63. Khan SI, Anupama R, Deepalakshmi M, Kumar KS. Effect of two different types of fibers on the fracture resistance of endodontically treated molars restored with composite resin. J Adhes Dent. 2013;15:167–71.

    PubMed  Google Scholar 

  64. Kalburge V, Yakub SS, Kalburge J, Hiremath H, Chandurkar A. A comparative evaluation of fracture resistance of endodontically treated teeth, with variable marginal ridge thicknesses, restored with composite resin and composite resin reinforced with Ribbond: an in vitro study. Indian J Dent Res. 2013;24:193–8.

    PubMed  Google Scholar 

  65. Costa S, Silva-Sousa Y, Curylofo F, Steier L, Sousa-Neto M, Souza-Gabriel A. Fracture resistance of mechanically compromised premolars restored with polyethylene fiber and adhesive materials. Int J Adhes Adhes. 2014;50:211–5. https://doi.org/10.1016/j.ijadhadh.2014.01.030

    Article  Google Scholar 

  66. Kemaloglu H, Kaval ME, Turkun M, Kurt SM. Effect of novel restoration techniques on the fracture resistance of teeth treated endodontically: an in vitro study. Dent Mater J. 2015;34:618–22. https://doi.org/10.4012/dmj.2014-326

    Article  PubMed  Google Scholar 

  67. Atalay C, Yazici AR, Horuztepe A, Nagas E, Ertan A, Ozgunaltay G. Fracture resistance of endodontically treated Teeth restored with bulk fill, Bulk fill Flowable, Fiber-reinforced, and Conventional Resin Composite. Oper Dent. 2016;41:E131–40.

    PubMed  Google Scholar 

  68. Bilgi PS, Shah NC, Patel PP, Vaid DS. Comparison of fracture resistance of endodontically treated teeth restored with nanohybrid, silorane, and fiber reinforced composite: an in vitro study. J Conserv Dent. 2016;19. https://doi.org/10.4103/0972-0707.186458

  69. Gürel MA, Kivanç BH, Ekıcı A, Alaçam T. Fracture resistance of Premolars restored either with short Fiber or polyethylene Woven Fiber-Reinforced Composite. J Esthetic Restor Dentistry. 2016;28:412–8. https://doi.org/10.1111/jerd.12241

    Article  Google Scholar 

  70. Ozsevik AS, Yildirim C, Aydin U, Culha E, Surmelioglu D. Effect of fibre-reinforced composite on the fracture resistance of endodontically treated teeth. Aust Endod J 2016;42. https://doi.org/10.1111/aej.12136

  71. Eapen AM, Vijay Amirtharaj L, Sanjeev K, Mahalaxmi S. Fracture resistance of endodontically treated Teeth restored with 2 different Fiber-reinforced composite and 2 conventional composite Resin Core Buildup Materials: an in Vitro Study. J Endod. 2017;43:1499–504. https://doi.org/10.1016/j.joen.2017.03.031

    Article  PubMed  Google Scholar 

  72. Garlapati TG, Krithikadatta J, Natanasabapathy V. Fracture resistance of endodontically treated teeth restored with short fiber composite used as a core material—An in vitro study. J Prosthodontic Res. 2017;61:464–70. https://doi.org/10.1016/j.jpor.2017.02.001

    Article  Google Scholar 

  73. Özyürek T, Ülker Ö, Demiryürek E, Yılmaz F. The Effects of Endodontic Access Cavity Preparation Design on the fracture strength of endodontically treated Teeth: traditional Versus Conservative Preparation. J Endod. 2018;44:800–5.

    PubMed  Google Scholar 

  74. Shah S, Shilpa-Jain DP, Velmurugan N, Sooriaprakas C, Krithikadatta J. Performance of fibre reinforced composite as a post-endodontic restoration on different endodontic cavity designs— an in-vitro study. J Mech Behav Biomed Mater. 2020;104:103650. https://doi.org/10.1016/j.jmbbm.2020.103650

    Article  PubMed  Google Scholar 

  75. Belli S, Cobankara FK, Eraslan O, Eskitascioglu G, Karbhari V. The effect of fiber insertion on fracture resistance of endodontically treated molars with MOD cavity and reattached fractured lingual cusps. J Biomedical Mater Res Part B: Appl Biomaterials. 2006;79B:35–41. https://doi.org/10.1002/jbm.b.30508

    Article  Google Scholar 

  76. Cobankara FK, Unlu N, Cetin AR, Ozkan HB. The effect of different restoration techniques on the fracture resistance of endodontically-treated molars. Oper Dent. 2008;33:526–33.

    PubMed  Google Scholar 

  77. Cobankara FK, Unlu N, Cetin AR, Ozkan HB. The effect of different restoration techniques on the fracture resistance of endodontically-treated molars. Oper Dent. 2008;33:526–33.

    PubMed  Google Scholar 

  78. Srirekha A, Hegde J, Karale R, Tyagi S, Bhaskaran S, Luthria A. The reinforcement effect of polyethylene fibre and composite impregnated glass fibre on fracture resistance of endodontically treated teeth: an in vitro study. J Conservative Dentistry. 2012;15:372. https://doi.org/10.4103/0972-0707.101914

    Article  Google Scholar 

  79. Khan SI, Anupama R, Deepalakshmi M, Kumar KS. Effect of two different types of fibers on the fracture resistance of endodontically treated molars restored with composite resin. J Adhes Dent. 2013;15:167–71.

    PubMed  Google Scholar 

  80. Kalburge V, Yakub SS, Kalburge J, Hiremath H, Chandurkar A. A comparative evaluation of fracture resistance of endodontically treated teeth, with variable marginal ridge thicknesses, restored with composite resin and composite resin reinforced with Ribbond: an in vitro study. Indian J Dent Res. 2013;24:193–8.

    PubMed  Google Scholar 

  81. Costa S, Silva-Sousa Y, Curylofo F, Steier L, Sousa-Neto M, Souza-Gabriel A. Fracture resistance of mechanically compromised premolars restored with polyethylene fiber and adhesive materials. Int J Adhes Adhes. 2014;50:211–5. https://doi.org/10.1016/j.ijadhadh.2014.01.030

    Article  Google Scholar 

  82. Kemaloglu H, Kaval ME, Turkun M, Kurt SM. Effect of novel restoration techniques on the fracture resistance of teeth treated endodontically: an in vitro study. Dent Mater J. 2015;34:618–22. https://doi.org/10.4012/dmj.2014-326

    Article  PubMed  Google Scholar 

  83. Atalay C, Yazici AR, Horuztepe A, Nagas E, Ertan A, Ozgunaltay G. Fracture resistance of endodontically treated Teeth restored with bulk fill, Bulk fill Flowable, Fiber-reinforced, and Conventional Resin Composite. Oper Dent. 2016;41:E131–40.

    PubMed  Google Scholar 

  84. Bilgi PS, Shah NC, Patel PP, Vaid DS. Comparison of fracture resistance of endodontically treated teeth restored with nanohybrid, silorane, and fiber reinforced composite: an in vitro study. J Conserv Dent. 2016;19. https://doi.org/10.4103/0972-0707.186458

  85. Gürel MA, Kivanç BH, Ekıcı A, Alaçam T. Fracture resistance of Premolars restored either with short Fiber or polyethylene Woven Fiber-Reinforced Composite. J Esthetic Restor Dentistry. 2016;28:412–8. https://doi.org/10.1111/jerd.12241

    Article  Google Scholar 

  86. Yasa B, Arslan H, Yasa E, Akcay M, Hatirli H. Effect of novel restorative materials and retention slots on fracture resistance of endodontically-treated teeth. Acta Odontol Scand. 2016;74:96–102.

    PubMed  Google Scholar 

  87. Ozsevik AS, Yildirim C, Aydin U, Culha E, Surmelioglu D. Effect of fibre-reinforced composite on the fracture resistance of endodontically treated teeth. Aust Endod J 2016;42. https://doi.org/10.1111/aej.12136

  88. Eapen AM, Vijay Amirtharaj L, Sanjeev K, Mahalaxmi S. Fracture resistance of endodontically treated Teeth restored with 2 different Fiber-reinforced composite and 2 conventional composite Resin Core Buildup Materials: an in Vitro Study. J Endod. 2017;43:1499–504. https://doi.org/10.1016/j.joen.2017.03.031

    Article  PubMed  Google Scholar 

  89. Garlapati TG, Krithikadatta J, Natanasabapathy V. Fracture resistance of endodontically treated teeth restored with short fiber composite used as a core material—An in vitro study. J Prosthodontic Res. 2017;61:464–70. https://doi.org/10.1016/j.jpor.2017.02.001

    Article  Google Scholar 

  90. Shah S, Shilpa-Jain DP, Velmurugan N, Sooriaprakas C, Krithikadatta J. Performance of fibre reinforced composite as a post-endodontic restoration on different endodontic cavity designs— an in-vitro study. J Mech Behav Biomed Mater. 2020;104:103650. https://doi.org/10.1016/j.jmbbm.2020.103650

    Article  PubMed  Google Scholar 

  91. Bilgi PS, Shah NC, Patel PP, Vaid DS. Comparison of fracture resistance of endodontically treated teeth restored with nanohybrid, silorane, and fiber reinforced composite: an in vitro study. J Conserv Dent. 2016;19. https://doi.org/10.4103/0972-0707.186458

  92. Tang W, Wu Y, Smales RJ. Identifying and reducing risks for potential fractures in endodontically treated teeth. J Endod. 2010;36:609–17.

    PubMed  Google Scholar 

  93. Khasnis SA, Kidiyoor KH, Patil AB, Kenganal SB. Vertical root fractures and their management. J Conserv Dent. 2014;17:103–10.

    PubMed  PubMed Central  Google Scholar 

  94. Okoli OI, Smith GF. Failure modes of fibre reinforced composites: the effects of strain rate and fibre content. J Mater Sci. 1998;33:5415–22.

    Google Scholar 

  95. Ayna B, Celenk S, Atakul F, Uysal E. Three-year clinical evaluation of endodontically treated anterior teeth restored with a polyethylene fibre-reinforced composite. Aust Dent J. 2009;54:136–40.

    PubMed  Google Scholar 

  96. Garoushi S, Vallittu PK, Lassila LVJ. Short glass fiber reinforced restorative composite resin with semi-inter penetrating polymer network matrix. Dent Mater. 2007;23:1356–62.

    PubMed  Google Scholar 

  97. Tekçe N, Pala K, Tuncer S, Demirci M, Serim ME. Influence of polymerisation method and type of fibre on fracture strength of endodontically treated teeth. Aust Endod J. 2017;43:115–22.

    PubMed  Google Scholar 

  98. Vallittu PK. High-aspect ratio fillers: fiber-reinforced composites and their anisotropic properties. Dent Mater. 2015;31:1–7.

    PubMed  Google Scholar 

  99. Garoushi SK, Hatem M, Lassila LVJ, Vallittu PK. The effect of short fiber composite base on microleakage and load-bearing capacity of posterior restorations. Acta Biomater Odontol Scand. 2015;1:6–12.

    PubMed  PubMed Central  Google Scholar 

  100. Abouelleil H, Pradelle N, Villat C, Attik N, Colon P, Grosgogeat B. Comparison of mechanical properties of a new fiber reinforced composite and bulk filling composites. Restor Dent Endod. 2015;40:262–70.

    PubMed  PubMed Central  Google Scholar 

  101. Shah MB, Ferracane JL, Kruzic JJ. R-curve behavior and micromechanisms of fracture in resin based dental restorative composites. J Mech Behav Biomed Mater. 2009;2:502–11.

    PubMed  Google Scholar 

  102. Bijelic-Donova J, Garoushi S, Vallittu PK, Lassila LVJ. Mechanical properties, fracture resistance, and fatigue limits of short fiber reinforced dental composite resin. J Prosthet Dent. 2016;115:95–102.

    PubMed  Google Scholar 

  103. Salis SG, Hood JA, Stokes AN, Kirk EE. Patterns of indirect fracture in intact and restored human premolar teeth. Endod Dent Traumatol. 1987;3:10–4.

    PubMed  Google Scholar 

  104. Burgess J, Cakir D. Comparative properties of low-shrinkage composite resins. Compend Contin Educ Dent. 2010;31(Spec No 2):10–5.

    PubMed  Google Scholar 

  105. Ilie N, Hickel R. Investigations on a methacrylate-based flowable composite based on the SDR™ technology. Dent Mater. 2011;27:348–55.

    PubMed  Google Scholar 

  106. Rees JS. An investigation into the importance of the periodontal ligament and alveolar bone as supporting structures in finite element studies. J Oral Rehabil. 2001;28:425–32.

    PubMed  Google Scholar 

  107. Marchionatti AME, Wandscher VF, Broch J, Bergoli CD, Maier J, Valandro LF, et al. Influence of periodontal ligament simulation on bond strength and fracture resistance of roots restored with fiber posts. J Appl Oral Sci. 2014;22:450–8.

    PubMed  PubMed Central  Google Scholar 

  108. Yan W, Montoya C, Øilo M, Ossa A, Paranjpe A, Zhang H, et al. Reduction in fracture resistance of the Root with Aging. J Endod. 2017;43:1494–8.

    PubMed  Google Scholar 

  109. Prado M, de Lima NRB, de Lima CO, Gusman H, Simão RA. Resistance to vertical root fracture of root filled teeth using different conceptual approaches to canal preparation. Int Endod J. 2016;49:898–904.

    PubMed  Google Scholar 

  110. Çiçek E, Aslan MA, Akkoçan O. Comparison of the resistance of Teeth Instrumented with different Nickel-Titanium Systems to Vertical Root fracture: an in Vitro Study. J Endod. 2015;41:1682–5.

    PubMed  Google Scholar 

  111. Lam PPS, Palamara JEA, Messer HH. Fracture strength of tooth roots following canal preparation by hand and rotary instrumentation. J Endod. 2005;31:529–32.

    PubMed  Google Scholar 

  112. Uzunoglu E, Yilmaz Z, Erdogan O, Görduysus M. Final irrigation regimens affect fracture resistance values of Root-filled Teeth. J Endod. 2016;42:493–5.

    PubMed  Google Scholar 

  113. Turk T, Kaval ME, Sarikanat M, Hülsmann M. Effect of final irrigation procedures on fracture resistance of root filled teeth: an ex vivo study. Int Endod J. 2017;50:799–804.

    PubMed  Google Scholar 

  114. Baldasso FER, Roleto L, da Silva VD, Morgental RD, Kopper PMP. Effect of final irrigation protocols on microhardness reduction and erosion of root canal dentin. Braz Oral Res. 2017;31:e40.

    PubMed  Google Scholar 

  115. Aslantas EE, Buzoglu HD, Altundasar E, Serper A. Effect of EDTA, sodium hypochlorite, and chlorhexidine gluconate with or without surface modifiers on dentin microhardness. J Endod. 2014;40:876–9.

    PubMed  Google Scholar 

  116. Greco T, Zangrillo A, Biondi-Zoccai G, Landoni G. Meta-analysis: pitfalls and hints. Heart Lung Vessel. 2013;5:219–25.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

None.

Funding

This research received no external funding.

Author information

Authors and Affiliations

  1. Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, 152006005, India

    Harish Selvaraj

  2. Department of Cariology, Saveetha Dental College & Hospitals, SIMATS, Chennai, India

    Jogikalmat Krithikadatta

  3. Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Saudi Arabia

    Deepti Shrivastava & Mohammad Khursheed Alam

  4. Department of Operative Dentistry and Endodontics, College of Dentistry, Jouf University, Sakaka, 72345, Saudi Arabia

    Meshal Aber Al Onazi & Hmoud Ali Algarni

  5. Restorative and Prosthetic Dental Sciences, College of Dentistry, King Saud Bin, Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Swapna Munaga

  6. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

    Swapna Munaga

  7. Department of Prosthetic Dental Sciences, College of Dentistry, Jouf University, Sakaka, Saudi Arabia

    May Osman Hamza

  8. General Dentist, Ministry of Health, Riyadh, Saudi Arabia

    Turki saad Al-fridy

  9. Department of Conservative Dentistry and Endodontics, Mamata Institute of Dental Sciences, Mamata Educational Society, Bachupally, Hyderabad, 500 090, India

    Kavalipurapu Venkata Teja

  10. Department of Conservative Dentistry and Endodontics, SRM Dental College, SRM Institute of Science & Technology, Chennai, India

    Krishnamachari Janani

  11. Department of Dental Research Cell, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Chennai, 600077, India

    Mohammad Khursheed Alam

  12. Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, 1207, Bangladesh

    Mohammad Khursheed Alam

  13. Department of Oral & Maxillofacial Surgery & Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka, Saudi Arabia

    Kumar Chandan Srivastava

  14. Department of Oral Medicine and Radiology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, 602105, India

    Kumar Chandan Srivastava

Authors
  1. Harish Selvaraj
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jogikalmat Krithikadatta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Deepti Shrivastava
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Meshal Aber Al Onazi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hmoud Ali Algarni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Swapna Munaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. May Osman Hamza
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Turki saad Al-fridy
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kavalipurapu Venkata Teja
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Krishnamachari Janani
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mohammad Khursheed Alam
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Kumar Chandan Srivastava
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization, J.K. and K.C.S.; methodology, H.S., J.K., D.S., K.V.T., K. J., and M.K.A., validation, H.S., J.K., D.S., K.V.T., and K.C.S.; formal analysis, K. J., and K.C.S.; investigation, S.M., K.V.T., and K. J., writing—original draft preparation, H.S., D.S., K. J., and K.C.S.; writing—review and editing, H.S., J.K., D.S., M.A.O., H.A.G., S.M., M.O.H., T.S.F., K.V.T., K. J., M.K.A., and K.C.S.; supervision, J.K.; project administration, K.C.S.; funding acquisition, K.C.S.; S.M., M.O.H., T.S.F., and K.C.S.;. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Jogikalmat Krithikadatta or Kumar Chandan Srivastava.

Ethics declarations

Ethics approval and consent to participate

Not Applicable.

Consent for publication -

Not Applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Selvaraj, H., Krithikadatta, J., Shrivastava, D. et al. Systematic review fracture resistance of endodontically treated posterior teeth restored with fiber reinforced composites- a systematic review. BMC Oral Health 23, 566 (2023). https://doi.org/10.1186/s12903-023-03217-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12903-023-03217-2

Keywords

BMC Oral Health

ISSN: 1472-6831

Contact us