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The Journal of Adhesive Dentistry
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J Adhes Dent 20 (2018), No. 6     28. Dec. 2018
J Adhes Dent 20 (2018), No. 6  (28.12.2018)

Page 519-526, doi:10.3290/j.jad.a41635, PubMed:30564798


Direct or Indirect Restoration of Endodontically Treated Maxillary Central Incisors with Class III Defects? Composite vs Veneer or Crown Restoration
von Stein-Lausnitz, Manja / Mehnert, André / Bruhnke, Maria / Sterzenbach, Guido / Rosentritt, Martin / Spies, Benedikt C. / Bitter, Kerstin / Naumann, Michael
Purpose: The aim of this ex-vivo study was to evaluate the load capacity of direct or indirect endodontically restored maxillary central incisors with Class III defects, with or without glass-fiber posts.
Materials and Methods: Seventy-two extracted human maxillary central incisors were endodontically treated and bi-proximal Class III cavities were prepared. Specimens were randomly allocated to six groups (n = 12): direct restoration with composite (C); direct restoration with composite and additional glass-fiber post (CP); ceramic veneer restoration (V), ceramic veneer restoration and additional glass-fiber post (VP), ceramic crown restoration (Cr), ceramic crown restoration and additional glass-fiber post (CrP). Specimens were exposed to thermomechanical loading (TML: 1.2 million cycles, 1 to 50 N; 6000 thermal cycles between 5°C and 55°C for 1 min each), and subsequently linearly loaded until failure (Fmax [N]) at an angle of 135 degrees 3 mm below the incisal edge on the palatal side. Statistical tests were performed using the Kruskall-Wallis and Mann-Whitney U-Test.
Results: During dynamic loading by TML, one early failure occurred in group C, CP, and CrP. Subsequent linear loading resulted in mean fracture load values [N] of C = 483 ± 219, CP = 536 ± 281, V = 908 ± 293, VP = 775 ± 333, Cr = 549 ± 258, CrP = 593 ± 259. The Kruskal-Wallis test showed significant differences of load capacity between groups (p < 0.05). Mann-Whitney U-test revealed significantly lower maximum fracture load values of group C compared to group V (p = 0.014), after Bonferroni-Holm correction. Non-restorable root fracture was the most frequent type of failure.
Conclusion: Endodontically treated maxillary central incisors with Class III defects directly restored with composite are as loadable as indirect crown restorations. Compared to full-coverage restorations, less invasive veneers appear to be more beneficial. Additional placement of glass-fiber posts shows no positive effect.

Keywords: all-ceramic crown, Class III restorations, direct composite restorations, endodontically treated teeth, indirect restoration, post and core, veneers