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Resin composite polyethylene fiber reinforcement: Effect on fracture resistance of

weakened marginal ridges

Article  in  American Journal of Dentistry · June 2010

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Research Article
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Resin composite polyethylene fiber reinforcement: Effect on fracture

resistance of weakened marginal ridges
MOHAMED F. AYAD, BDS, MSCD, PHD, ABDULHAMAID A. MAGHRABI, BDS, MS, PHD & FRANKLIN GARCÍA-GODOY, DDS, MS
ABSTRACT: Purpose: To investigate the in vitro effect of polyethylene woven fiber reinforcement of resin composite
on the fracture resistance of weakened marginal ridges in molar teeth. Methods: 50 sound extracted human mandibular
molars were used. Specimens were divided into five groups (n=10). Group 1: served as a control for comparison; Group
2: Class I cavity preparation with resin composite (Prodigy); Group 3: Class I cavity preparation with polyethylene
ribbon fiber (Ribbond) and resin composite. Group 4: Class II cavity preparation with resin composite restoration;
Group 5: Class II cavity preparation with polyethylene woven fiber and resin composite. Specimens were stored in
100% humidity at 37°C for 7 days. Compressive loading of the teeth was performed with a universal testing machine at
a cross-head speed of 0.5 mm/minute until failure. The data were analyzed with 1-way ANOVA followed by the Ryan-
Einot-Gabriel-Welsch Multiple Range Test (α= 0.05). Results: Reinforcement with polyethylene fiber resulted in
significant differences for fracture resistance (P< 0.001). Mean fracture resistance (SD) was [1737.4 (84.8) N] for
control group. Among the experimental groups, the highest mean fracture resistance (SD) [1543.8 (71.1) N] was
associated with Class I cavity preparation with polyethylene fiber and resin composite. The lowest mean fracture
resistance (SD) [869.2 (91.7) N] was recorded for Class II cavity preparation with conventional resin composite. (Am J
Dent 2010;23:133-136).

CLINICAL SIGNIFICANCE: The fiber-reinforced composites tested improved the fracture resistance of Class I cavities.

: Dr. Mohamed F. Ayad, P.O. Box 80209, Jeddah 21589, Saudi Arabia. E- : [email protected]

Introduction significantly reduced after cavity preparation; others,16,17

however, report no significant difference between fracture
Dental treatment procedures are increasingly governed by resistance of intact teeth and the teeth that were prepared but
factors such as biocompatibility of restorative materials, unrestored. Morin et al18 showed that the mean relative
patient’s demands for esthetics, and a conservative approach deformation and stiffness values for acid-etched bonded teeth
to minimize loss of tooth structure.1 resemble the mean relative deformation and stiffness values
Following the traditional Black's principles for cavity for sound teeth. Simonsen et al19 showed that teeth restored
preparation, all undermined enamel should be removed even with resin composite were stronger than those restored with
for marginal ridges composed of healthy, sound and caries- amalgam when tested at cusp inclines.
free undermined enamel.2 This could be attributed to the An important clinical controversial condition is the
brittle nature of the undermined enamel and the inability of presence of undermined marginal ridge of full thickness of
the conventional cast inlays and amalgam restorations to enamel after cavity preparation. The clinician either leaves the
strengthen the remaining tooth structure.3,4 However, the undermined marginal ridge and restores the tooth, or removes
increased use of resin composites in posterior teeth violate the thin enamel preparing Class II and restores the tooth. The
these principles.5,6 conservative option depends mainly on the ability of the
Restoring teeth with minimal sacrifice of sound tooth bonded restoration to strengthen the enamel in the same way
structure depends mainly on adhesives that provide strong and that dentin gives strength and supports the enamel.20-22
durable bonding to the remaining sound enamel and dentin. In order for a dental material to reinforce the tooth, it must
Laboratory reports7 have proven that modern adhesives do bond to dentin. As such, an essential attribute of a good dentin
effectively bond to tooth tissue in the short term. However, adhesive system is the ability of the adhesive to wet and
clinically, marginal deterioration of composite restorations infiltrate the dentin. In restorative dentistry, numerous studies
remains problematic in the long term and still forms the major have demonstrated coronal reinforcement of the tooth through
reason to replace adhesive restorations.8-10 When resin bonded restorations.6 Bonded amalgams and resin composites
composite is bonded to tooth structure using adhesives, the have all been shown to reinforce remaining tooth structure by
initial and residual polymerization stresses that are present bonding to dentin and enamel.6,23,24 Similarly, bonding endo-
along the cavity walls may result in gap formation, leakage, dontic sealers to intra-radicular dentin after root obturation
recurrent caries and pulp irritation.11 The detrimental effect of could enhance resistance to fracture of endodontically-treated
marginal gap formation cannot be offset even with the use of teeth.25
fluoride-releasing adhesives or restorative materials that The development of fiber-reinforced composite tech-
prevent demineralization along cavity margins.12 Thus, only nology has created a new era in metal-free, adhesive, esthetic
hermetic sealing of restorations guarantees clinical success.13 dentistry. Resin impregnated fiber-reinforced composite has
The purpose of a restorative material is not only to restore been shown to possess adequate flexure modulus and flexural
the decayed or defective tooth and provide an effective seal strength to function successfully in the mouth.26 Moreover,
between the restoration and the tooth, but also to strengthen the system has demonstrated good results in a wide range of
the tooth. Studies14,15 showed that strength of the teeth was applications including crowns,27 veneering of metals,28 fixed
134 Ayad et al American Journal of Dentistry, Vol. 23, No. 3, June, 2010

partial dentures,29 splints,30 and implant prostheses.31 Clinical plastic needle-nose application tip. This was followed by
studies32,33 on fiber-reinforced restorations have shown a rinsing with water for 30 seconds and air drying. OptiBond
relatively high success rate over a relatively short evaluation Solo Plusd bonding agent was placed according to manu-
period. However, their use to reinforce structurally com- facturer's directions, gently dried, and light polymerized for
promised marginal ridges has not been shown. This study 20 seconds using a curing unit (Demetronh). Light intensity
tested the hypothesis by which a fiber-reinforced resin com- output was monitored with a curing radiometerh to be less
posite would enhance the performance of resin composites in than 750 mW/cm2. Verification of the unit light intensity
the marginal ridge area. The null hypothesis was that glass output was checked every five samples.
fiber-reinforced composite would have no influence on the Cavities of Group 2 and Group 4 were then restored with a
fracture resistance of weakened marginal ridges in molar resin composite (Prodigy) using a bulk technique and cured
teeth. for 40 seconds.14 To standardize the curing distance, the tip of
the polymerization unit was applied to the occlusal surface of
Materials and Methods the teeth. A matrix band was applied to each cavity of Group
Fifty intact recently extracted human mandibular molar 3 and Group 5 and a flowable resin composite (PermaFlod)
teeth with similar dimensions were debrided to remove was added to the floor of the cavities but not cured. A 3 mm-
remnants of periodontal ligaments. The teeth were stored in wide leno weave ultra high modulus (LWUHM) polyethylene
distilled water with 0.1% thymol disinfectanta at room ribbon fibere was cut and saturated with adhesive resin
temperature. To minimize the influence of variations in size and (Optibond Solo Plus). The excess adhesive resin was removed
shape on the results, the teeth were classified according to their with a hand instrument and then placed into the bed of
mesiodistal and buccolingual dimensions and randomly divided uncured flowable resin composite at the area of marginal
into five groups (n=10) according to the restoration used. Each ridge from a buccal to lingual direction. This combination was
tooth was aligned vertically in an individual polymeric tube and then cured for 20 seconds from the occlusal surface using the
embedded with epoxy resin (Epoxideb) within 2 mm of the same curing unit and the exposed fiber surface was covered
cemento-enamel junction. A dental surveyorc was used to with resin composite (Prodigy), and cured for 40 seconds.
position the long axis of each tooth parallel to the tube. Excess material was removed and final polishing was
Mounted teeth were stored in 100% humidity. The mounted performed with stone points, rubber, and wheel instruments
teeth of the five experimental groups were assigned as: (1) (Polierseti), following the manufacturer’s recommendations.
intact teeth without cavity preparation or restoration (control), The restored teeth were then stored in distilled water at room
(2) Class I cavity preparation restored with conventional resin temperature for 7 days before testing.
composite (Prodigyd), (3) Class I cavity preparation restored The marginal ridge of each tooth was adjusted with a fine
with fiber-reinforced composite restoration (Ribbonde), (4) diamond point at high speed under air-water spray, so that
Class II cavity preparation restored with conventional each marginal ridge provides a uniform contact for the load
composite restoration, and (5) Class II cavity preparation applicator. Resistance to fracture was measured by applying a
restored with fiber-reinforced composite restoration. vertical compression force sufficient to fracture the marginal
Occlusal Class I and compound Class II cavities were ridge of each specimen with a universal testing machine
designed and standardized to be cut at the corresponding (model 4204j), with a 1000 N load cell and 0.5 mm/minute
experimental groups. Each cavity preparation was prepared cross-head speed. A 5 mm-diameter stainless steel bar with
using a water-cooled #56 straight fissure tungsten carbide burf round-shape end was affixed to the upper stage of the Instron.
in a high-speed hand piece. A new bur was used after each The upper stage was positioned so that the bar was centered
preparation. Class I cavity preparation had a bucco-lingual over the marginal ridge until the bar end just contacted the
width of 2 mm, pulpal depth of 2.5 mm on the occlusal marginal ridge. Mean values for each group were calculated,
surface, and one marginal ridge thickness to be tested was 1.0 and differences between the groups were tested for statistical
mm while the other marginal ridge was 2 mm. The Class II significance. One-way ANOVA and the Ryan-Einot-Gabriel-
cavity preparation had a bucco-lingual width of 2.0 mm and Welsch Multiple Range Test at α= 0.05, were used. The
pulpal depth of 2.5 mm on the occlusal surface, and the Ryan-Einot-Gabriel-Welsch Multiple Range Test was used as
proximal box had an axial depth of 2.0 mm, a bucco-lingual it appears to be the most powerful, yet valid, step-down
width of 4.0 mm and an occluso-gingival height of 5.0 mm. multiple-stage test in the current literature.34
The buccal and lingual walls were cut parallel to each other
on both the occlusal and proximal portions of the cavity.
Results
Similarly, the axial wall of the Class II cavity was kept The one-way ANOVA for the results of marginal ridge
parallel to the long axis of the tooth. The gingival margins reinforcement revealed a statistically significant difference
were maintained 1.5 mm above the cemento-enamel junction. among the group means (P< 0.001) (Table 1). The Ryan-
Bevels and retentive grooves were not used in the study. Einot-Gabriel-Welsch Multiple Range Test disclosed a
Cavity preparation was finished by using binangle chisel and significant difference between groups (P< 0.001) (Table 2).
enamel hatchet and cavosurface margins were finished to 90°. The marginal ridges of the sound teeth showed significantly
The internal line angles were not altered with hand higher resistance to fracture (1737.4 N). Class I cavities with
instruments but left as cut by the #56 bur. fiber-reinforced resin composite had the highest fracture
Each cavity preparation was cleaned, dried, and etched strength (1543.8 N) of the experimental groups, which was
with 32% phosphoric acidg for 15 seconds applied with a 10.2% higher than Class I cavities with conventional resin
American Journal of Dentistry, Vol. 23, No. 3, June, 2010
Fiber-reinforced composite 135

Table 1. One-way ANOVA procedure. Table 2. Fracture strength of structurally compromised marginal ridges (Mean
____________________________________________________________________________________________________
± SD; n= 10).
____________________________________________________________________________________________________
Source df MS F P
____________________________________________________________________________________________________
Groups Fracture strength
____________________________________________________________________________________________________
Between groups 4 1099050.93 165.79 < 0.001
Error 45 6629.29 Control 1737.4 (84.8)a
____________________________________________________________________________________________________
Class I cavity with resin composite 1400.1 (79.5)b
Class I cavity with fiber-reinforced resin composite 1543.8 (71.1)c
composite (1400.1 N). Class II cavities restored with fiber- Class II cavity with resin composite 869.2 (91.7)d
Class II cavity with fiber-reinforced resin composite 1214.5 (78.6)e
reinforced resin composite had intermediate fracture strength ____________________________________________________________________________________________________

(1214.5 N), which was 39.7% higher than Class II cavities Values with different case letters were significantly different at P< 0.001.
restored with conventional resin composite (869.2 N).
undermined, healthy intact marginal ridge during cavity
Discussion preparation. In the current study, during the preparation of the
The data supports the null hypothesis of the study, that samples, composite restorations were inserted in bulk and
glass fiber-reinforced composite increases the fracture cured from the occlusal surface for 40 seconds although
resistance of weakened marginal ridges in molar teeth. The incremental composite curing has been favored in clinical
strengthening effect of polyethylene fibers in weakened conditions. Using the bulk technique, the effect of restoration
marginal ridge is a significant concern. Investigators23,24,35 placement was eliminated. The results obtained from this
have evaluated the effect of polyethylene fibers to prevent the study are only introductory and comparative. There were
undesirable fractures in cuspal coverage restorations. Fibers some limitations in the present study. Although fracture
have demonstrated their ability to withstand tensile stress and resistance was evaluated, marginal gap which could possibly
to stop crack propagation in composite material.36 Moreover, jeopardize restoration longevity was not estimated. Another
changing the internal stress patterns of the restorative material limitation of this study was that the forces applied were at a
by the application of the fiber layer may also lead to an constant direction and speed, although forces generated
increase in the load-bearing capacity of the restoration.37 intraorally vary in magnitude, speed of application and
Traditionally, weakened undermined marginal ridges of direction. Furthermore, only one type of fiber and resin
molar teeth during cavity preparation include extension of the composite was used. Further investigation is required to
occlusal cavity into the corresponding proximal surface. Class evaluate the effect of mechanical, thermal and chemical stress
II cavities may initiate caries recurrence at the gingival area, on the durability of restoration.
weakening of the tooth structure due to actual cutting of the Further laboratory and clinical studies are required to
tooth tissue holding the buccal and lingual cusps together at confirm the results of the present study.
the marginal ridge area, in addition to periodontal problems.18 a. Sigma Chemical Co., St. Louis, MO, USA.
Adhesive restorative materials have been recommended as b. Leco Corp., St. Joseph, MI, USA.
c. Ney Company, Bloomfield, CT, USA.
cost effective and more esthetic alternative options for d. Kerr, Romulus, MI, USA.
protecting weakened tooth structure.19 In the present study, e. Ribbond Inc., Seattle, WA, USA.
control sound teeth had the highest fracture resistance at the f. Abrasive Technology Inc., Westerville, OH, USA.
marginal ridge area as it seems logical that a tooth with no g. Bisco Inc., Schaumburg, IL, USA.
h. Demetron/Kerr, Danbury, CT, USA.
preparation will be stronger than a tooth with either a small or i. Ivoclar Vivadent Inc, Amherst, NY, USA.
large restoration. j. Instron Corp., Canton, MA, USA.
Results of the current study also showed that Class I Acknowledgement: Research supported by the Deanship of Scientific
cavity preparation restored with fiber-reinforced resin Research, King Abdulaziz University, Jeddah, Saudi Arabia, Project number
composite was stronger than Class II cavities restored with 054/428.
either resin composite or fiber-reinforced resin composite Disclosure statement: The authors report no conflict of interest.
when tested at the marginal ridge area. It was assumed that
polyethylene fiber had a stress modifying effect along the Dr. Ayad is Professor, Section of Restorative Dentistry, Prosthodontics and
Endodontics, College of Dentistry, University of Tanta, Egypt, and King
restoration and dentin interface. The other possible Abdulaziz University, Jeddah, Saudi Arabia. Dr. Maghrabi is Associate
explanation may be due to the properties of the fiber itself, the Professor, Section of Oral and Maxillofacial Rehabilitation, Dr. García-
degree of chemical bonding between the resin and the fiber Godoy is Professor and Senior Executive Associate Dean for Research,
and the effect of the leno weave with regard to crack Director, Bioscience Research Center, College of Dentistry, University of
Tennessee Health Science Center, Memphis, Tennessee, USA.
resistance and deflection as well as resistance to shifting
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