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Clinical Oral Investigations
Published in: Clinical Oral Investigations 5/2015

01-06-2015 | Original Article

Influence of proximal box elevation on the marginal quality and fracture behavior of root-filled molars restored with CAD/CAM ceramic or composite onlays

Authors: Irina Ilgenstein, Nicola U. Zitzmann, Julia Bühler, Florian J. Wegehaupt, Thomas Attin, Roland Weiger, Gabriel Krastl

Published in: Clinical Oral Investigations | Issue 5/2015

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Abstract

Objectives

This study investigated the influence of proximal box elevation (PBE) with composite resin when applied to deep proximal defects in root-filled molars with mesio-occluso-distal (MOD) cavities, which were subsequently restored with computer-aided designed/computer-aided manufacturing (CAD/CAM) ceramic or composite restorations.

Materials and method

Root canal treatment was performed on 48 human mandibular molars. Standardized MOD cavities were prepared with the distal box located 2 mm below the cemento-enamel junction (CEJ). The teeth were randomly assigned to one of four experimental groups (n = 12). In groups G1 and G2, the distal proximal box was elevated up to the level of the CEJ with composite resin (PBE). No elevation was performed in the remaining two groups (G3, G4). CAD/CAM restorations were fabricated with feldspathic ceramic (Vita Mark II, CER) in groups G1 (PBE-CER) and G3 (CER) or with resin nano-ceramic blocks (Lava Ultimate, LAV) in groups G2 (PBE-LAV) and G4 (LAV). Replicas were taken before and after thermomechanical loading (TML; 1.2 Mio cycles; 49 N; 3,000 thermocycles between 50 °C and 5 °C). Following TML, load was applied until failure. Fracture analysis was performed under a stereomicroscope (×16). Marginal quality before and after TML (tooth restoration, composite restoration) was evaluated using scanning electron microscopy (×200).

Results

After TML, lower percentages of continuous margins were observed in groups G1–G3 compared with pre-TML assessments; however, the differences were not statistically significant. For group G4-LAV, the marginal quality after TML was significantly better than in any other group. The highest mean fracture value was recorded for group G4. No significant difference was found for this value between the groups with PBE compared with the groups without PBE, regardless of the material used. The specimens restored with ceramic onlays exhibited fractures that were mainly restricted to the restoration while, in teeth restored with composite onlays, the percentage of catastrophic failures (fractures beyond bone level) was increased.

Conclusion

PBE had no impact on either the marginal integrity or the fracture behavior of root canal-treated mandibular molars restored with feldspathic ceramic onlays. CAD/CAM-fabricated composite onlays were more favorable than ceramic onlays in terms of both marginal quality and fracture resistance, particularly in specimens without PBE.

Clinical relevance

Composite onlays with or without PBE may be a viable approach for the restoration of root-filled molars with subgingival MOD cavities.
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Metadata
Title
Influence of proximal box elevation on the marginal quality and fracture behavior of root-filled molars restored with CAD/CAM ceramic or composite onlays
Authors
Irina Ilgenstein
Nicola U. Zitzmann
Julia Bühler
Florian J. Wegehaupt
Thomas Attin
Roland Weiger
Gabriel Krastl
Publication date
01-06-2015
Publisher
Springer Berlin Heidelberg
Published in
Clinical Oral Investigations / Issue 5/2015
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI
https://doi.org/10.1007/s00784-014-1325-z

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