Evaluation of Cuspal Deflection and Fracture Strength of Endodontically Treated Teeth Restored with Different Restorative Material Combinations

Evaluation of Cuspal Deflection and Fracture Strength of Endodontically Treated Teeth Restored with Different Restorative Material Combinations | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of Cuspal Deflection and Fracture Strength of Endodontically Treated Teeth Restored with Different Restorative Material Combinations BURAK KOSE, SOLEY ARSLAN This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6189355/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Jul, 2025 Read the published version in Clinical Oral Investigations → Version 1 posted 9 You are reading this latest preprint version Abstract Objective: This study evaluated the effects of restorations using varied materials and their combinations on cuspal deflection and fracture resistance of endodontically treated MOD cavitated maxillary premolars. Materials and methods: 168 premolar teeth were used in the study. MOD cavities were prepared, and endodontic treatments were performed. Subsequently, the teeth were divided into 14 groups. Group 1 was the positive control (healthy teeth), and Group 2 was the negative control (MOD cavity only). In Groups 3-7 and Groups 9-13, EverX Posterior, SDR Plus Bulk Fill Flowable, G-aenial Universal Injectable, Biodentine, and Fuji II LC were used as the base layer, respectively. In Groups 3-7, Filtek One Bulk-Fill Restorative was used as the top layer, while in Groups 9-13, Tetric N-Ceram was used. Group 8 was entirely restored with Filtek One Bulk-Fill Restorative and Group 14 with Tetric N-Ceram. Cusp deflection was measured. Fracture resistance testing was performed. Results: Within each group, there was a statistically significant decrease in cusp deflection change values at all measured time points (p <0.05). In intergroup comparisons, significant differences were found in cusp deflection change values at all times only in groups where EverX Posterior was applied as the base layer (p <0.05). In the groups where Filtek One was used, differences were seen between the groups at all times (p0.05). In the comparison between groups, a significant difference was seen in terms of fracture strength only in the groups where EverX Posterior and SDR Plus Bulk Fill Flowable were used as the substrate (p <0.05). Conclusions: Different materials and combinations of these materials produced different fascial deflection and fracture strength endodontically treated teeth. Clinical Relevance: When performing coronal restoration of an endodontically treated tooth, it is recommended to select and use the appropriate restorative material, taking into account the position of the tooth in the mouth and the amount of material loss. Bulk fill composite resin Cuspal deflection Fiber-reinforced composite resin Flowable composite Fracture resistance Glass ionomer Figures Figure 1 INTRODUCTION Endodontic treatment aims to eliminate bacteria and infection foci from the root canal to maintain the continuity of teeth affected by caries, trauma, or periodontal disease within the oral cavity [1]. Teeth undergoing endodontic treatment are more prone to fracture than vital teeth due to decreased water content and loss of critical anatomical structures like the pulp chamber roof and marginal ridges [2]. Crowns, onlays/inlays and resin-based direct and indirect restorative materials are used in the treatment of teeth that have undergone root canal treatment [3, 4]. Different restorative materials are used in dental treatments. Today, composite resins are widely used in a wide range of applications due to their high aesthetic properties, ability to bond to enamel and dentin, and the ability to enhance the integrity of the tooth-restoration complex by creating a monoblock effect [5]. However, one of the major disadvantages of traditional resin composites routinely used for the restoration of endodontically treated teeth is polymerization shrinkage [6]. Polymerization shrinkage can lead to higher stress accumulation, cuspal deflection, and tooth fracture, especially in teeth with high substance loss [7]. It is recommended that resin composites be placed in layers of 2 mm thickness within the cavity to reduce polymerization shrinkage stress and ensure adequate curing depth. However, applying resin composites in layers can be time-consuming and may result in voids between the layers [8, 9]. Lately, bulk fill composite resins have been developed with modified initiator systems and formulations that allow conventional resin composites to be applied in layers up to 4 mm thick to reduce polymerization shrinkage [10]. The lower polymerization shrinkage of these materials is attributed to their high translucency due to low filler particle content and the use of additional photoactivation systems [11, 12]. In addition, it was showed that fiber-reinforced resin composites reduce polymerization shrinkage and strengthen coronal restorations, increasing fracture resistance. These resin composites are developed as base materials and contain e-glass fibers [13]. E-glass fibers have been reported to halt the progression of cracks and distribute occlusal loads in restorations [14–16]. Resin-modified glass ionomer types of cement (RMGICs) have been developed by adding photoactivated methacrylates, HEMA, or BisGMA resin to the composition of traditional glass ionomer cement (GICs) [17]. The physical and mechanical properties of RMGICs fall between those of conventional GICs and resin composites [18–20]. RMGICs are often recommended as base materials in large and deep cavities to reduce polymerization shrinkage stress [21, 22]. Biodentine is a water-based material containing tricalcium silicate designed to replace specific dentin tissue lost in the tooth. Produced using MTA-based cement technology, Biodentine has been enhanced with properties such as improved physical and handling characteristics [23]. It has been shown that Biodentine particularly supports the remaining tooth structure in teeth with thin dentin walls and increases fracture resistance [24, 25]. Flowable composite resins are hybrid composites with a low filler content and viscosity. When used as liners in deep cavities, they compensate for polymerization shrinkage and function as stress absorbers [26]. In recent years, high filler content flowable composites have been developed. Due to their improved fracture resistance, edge stability, and wear resistance, they are recommended for permanent restoration material in shallow cavities [27]. Few studies compare the effects of fiber-reinforced resin composite, resin-modified glass ionomer cement, and Biodentine when combined with traditional and bulk-fill composites on cuspal deflection and fracture resistance in endodontically treated teeth. Therefore, this study aims to contribute further information on this topic to the literature. The null hypothesis of our research is that the cuspal deflection and fracture resistance of endodontically treated MOD cavity teeth restored with different restorative material combinations are different. MATERIALS AND METHODS Sample Selection and Preparation In vitro in this study, a total of 168 human maxillary premolar teeth extracted for orthodontic reasons were used (Fig. 1 ). Teeth with mesio-distal widths ranging from 6 to 8 mm and bucco-lingual widths ranging from 8 to 10 mm were included. Any attachments on the teeth were removed using a periodontal hand instrument without causing damage to the teeth. Subsequently, the teeth were cleaned with pumice using a low-speed micromotor (Kavo, Germany). Teeth were examined under surgical microscopy (Leica, Germany) at 20x magnification to check for decay, cracks, or defects. Faulty teeth were excluded from the study. The teeth were stored in distilled water at 37°C until the start of the experiment. The teeth were immersed in 0.1% thymol solution at 37°C for one week for disinfection until preparation was made. To measure cusp deflection, guide points were created on the buccal and palatal tubercles of the teeth using composite resin cylinders with a height of 2 mm. These guide points were then colored with water-resistant dye. The teeth were randomly distributed and in order to detect a difference between any two groups with an effect size of 0.8, 80% power and 5% type 1 error, a sample size of 12 teeth was calculated in each group (Fig. 1 ). [28]. Then the intertubercular distance of each group's teeth was measured using a stereo microscope (Leica, Germany) and ImageJ software. MOD cavities were prepared with the cavity floor 1.0 mm above the cement-enamel junction and isthmus width one-third of the intertubercular distance. Diamond burs (Diatech, Heerbrugg, Germany) used for preparation were changed after each four cavities. After cavity preparation, canal lengths were determined, and the canals were shaped up to F3 (#30) using ProTaper Next (Dentsply-Maillefer, Ballaigues, Switzerland). After each instrument, root canals were irrigated with 2 mL of 5.25% sodium hypochlorite (NaOCl, Endosolve HP, Imycril, Türkiye). Prepared root canals were washed with 5 mL of 17% ethylenediaminetetraacetic acid (Pulpdent Corporation, Watertown, MA, USA), followed by a final rinse with 5 mL of distilled water, and then dried with paper points. Subsequently, the canals were filled with F3 gutta-percha (ProTaper, Dentsply-Maillefer, Ballaigues, Switzerland) and epoxy resin-based sealer (AH Plus, Dentsply DeTrey, Konstanz, Germany). After canal filling, the gutta-percha was cut at the level of the cement-enamel junction, and the cavity was cleaned with alcohol. Following root canal treatment, the roots of the teeth were wrapped with aluminum foil to mimic the periodontal ligaments and create space for the elastomeric impression material. The roots were wrapped with aluminum foil, leaving a thickness of no more than 1 mm around them, and the foil was placed 2 mm below the cement-enamel junction. Subsequently, the teeth were embedded in acrylic resin (Paladent RR, Heraeus Kulzer GmbH Co., Germany) in a vertical position with the long axis of the roots perpendicular to the ground and 2 mm below the cement-enamel junction. After polymerization of the acrylic resin, the teeth were removed from the molds, and the aluminum foil with a thickness of 1 mm wrapped around the tooth roots was removed. Silicone impression material (Oranwash L, Zhermack, Italy) was placed into the acrylic molds, and the teeth were repositioned in the molds to proceed with the restoration phase. Restoration of Teeth 37% phosphoric acid (3M ESPE, St. Paul, MN, USA) was applied to the enamel for 15 seconds on the prepared MOD cavity surfaces. After the acid treatment, the teeth were rinsed for 30 seconds and dried with gentle air for 5 seconds. According to the manufacturer's instructions, a two-step self-etch dental adhesive system was applied to the dried cavities. The Primer (Clearfil SE Primer, Kuraray Co, Ltd, Osaka, Japan)(Table 1 ) was applied to the cavity for 20 seconds, followed by the application of Bond (Clearfil SE Bond, Kuraray Co, Ltd, Osaka, Japan) to all cavity surfaces. A uniform bond layer was created by applying gentle air pressure. Then, polymerization was achieved by exposing the teeth to LED light (Valo Cordless, Ultradent Products, South Jordan, USA) for 10 seconds. Before placing the restorative materials, a transparent matrix system (Transparent Adapt SuperCap Matrix, Kerr, Switzerland) was placed at the gingival base of the tooth to ensure no gap remained Before placing the restorative materials, a transparent matrix system (Transparent Adapt SuperCap Matrix, Kerr, Switzerland) was placed at the gingival base of the tooth to ensure no gap remained. The positive control group received no treatment. MOD cavities were prepared after endodontic therapy in the negative control group, but no restoration was performed. In Groups 3–7, a lower layer of G-aenial Universal Injectable (GC Corporation, Tokyo, Japan), EverX Posterior (GC, Leuven, Belgium), SDR Plus Bulk Fill Flowable (Dentsply, Milford, DE, USA), Fuji II LC (GC Corporation, Tokyo, Japan), Biodentin (Septodont, France)(Table 1 ) was applied to a total thickness of 4 mm. All layers were polymerized by applying light for 40 seconds. Then, the upper layer of the cavity was restored with Filtek One Bulk-Fill Restorative (3M ESPE, Seedfeld, Germany)(Table 1 )and polymerized with light for 40 seconds. Group 8 was restored entirely with Filtek One Bulk-Fill Restorative (in 4 mm increments) (Fig. 1 ). In Groups 9–13, a lower layer of G-aenial UI, EverX, SDR Plus, Fuji II LC, Biodentin (Fig. 1 ) was applied to a total thickness of 4 mm, and all layers were polymerized by applying light for 40 seconds. Then, the upper layer of the cavity was restored with Tetric N-Ceram (Ivoclar Vivadent, Schaan, Liechtenstein)(Table 1 ) and polymerized with light for 40 seconds. Group 14 was entirely restored with Tetric N-Ceram (in 2 mm increments) (Fig. 1 ). Measurement of Cusp Deflection Stereo microscopy was used at five minutes, 24 hours, and 48 hours post-restoration to measure tubercle movements resulting from polymerization shrinkage after restoration in the experimental groups. ImageJ software was used for measurements. Measurement of Fracture Resistance A universal testing machine (Instron, Lloyd, UK) was used to measure fracture resistance. A steel spherical tip with a diameter of 6 mm was placed perpendicular to the long axis of the tooth, and force was applied at a rate of 1 mm/min. The force at which the restoration or tooth fractured was recorded in Newtons (N). The fracture types of the broken samples were examined under a light microscope (Leica, Germany) at 20x magnification and classified as follows: Type 1: Minimum loss of tooth and restoration material Type 2: Minimal loss of a tubercle, intact restoration Type 3: Loss of at least one tubercle up to halfway through the restoration Type 4: Loss of at least one tubercle encompassing more than halfway through the restoration Type 5: Loss of more than halfway through the restoration, with tubercle fracture below the cement-enamel junction Statistical Analysis Statistical analyses were performed using SPSS 22.0 software (SPSS; Chicago, IL, USA). Two-way ANOVA analysis was used for repeated measurements of deflection values, comparison of fracture values using General Linear Models, and comparison of positive and negative control groups with other studies. RESULTS Table 2 presents the groups' deflection values at five minutes, 24 hours, and 48 hours post-restoration. When the deflection values of each sub-layer within each upper layer were compared across measurement times, significant differences in tubercle movement change values were found among the groups at 5 minutes, 24 hours, and 48 hours (p < 0.05). In intergroup comparisons, significant differences were found in tubercle movement change at each time interval in Groups 4 and 10, where EverX was used as the lower layer (p 0.05). When the deflection values at each measurement time were compared with the sub-layers, statistically significant differences were found among the time intervals in groups using Filtek One (p 0.05). The fracture resistance values of the groups are presented in Tables 3 and 4 . In groups where Filtek One was used as the upper layer, no significant difference in fracture resistance was observed among Groups 3–5 (p > 0.05). Still, the fracture resistance of these groups was significantly higher than that of the other groups (p 0.05). Still, the fracture resistance of these groups was significantly higher than that of the other groups (p < 0.05). When comparing fracture resistance among groups, significant differences were observed between groups using EverX and SDR Plus as the lower layer (p 0.05). The fracture values of the negative control group were significantly lower than those of all other groups (p 0.05) but were statistically higher than those of all other groups (p < 0.05). Fracture types according to groups is presented in Table 5 . One hundred thirty-one teeth (78%) exhibited MOD 4 and MOD 5 fracture types, indicating fractures that could not be repaired below the cement-enamel junction. Thirty-seven teeth (22%) exhibited repairable fractures above the cement-enamel junction (Table 3 ). DISCUSSION Our study aimed to measure cuspal deflection due to polymerization shrinkage at specific intervals and test fracture resistance by restoring endodontically treated MOD cavitated maxillary premolar teeth using varied materials and combinations. The results of our study accepted our null hypothesis. Cuspal deflection is a biomechanical event in teeth restored with composite resin. It occurs due to the interaction between the materials' polymerization stress and the remaining tooth structure's adaptation post-preparation [29]. Cuspal deflection may cause changes in occlusion points, postoperative pain, enamel cracking, and tooth fracture [30, 31]. Extracted teeth are commonly used in cuspal deflection measurement studies as they eliminate the compatibility issue between the test system and supporting structures. This study used maxillary first premolar teeth to ensure uniformity in size, shape, and form. The crown shape of maxillary premolars make it easier cusp fractures under occlusal forces [32, 33]. Additionally, cuspal deflection is more commonly observed in maxillary premolars than in other posterior teeth. Crown volume/shape, and crown/root ratio may contribute to this complication [34]. For these reasons, extracted upper first premolar teeth were used in this study. There is a clear relationship between cuspal deflection and structural loss of the tooth. The literature has reported that teeth with large cavity preparations show more deflection than teeth with smaller cavities [35]. Increasing the width of marginal ridges and isthmus areas reduces tooth hardness and increases tooth flexibility [36]. MOD cavity preparation was performed in this study to weaken the tooth structure and allow for tooth deflection. Inter-cuspal measurements were conducted using a digital microscope. This method facilitates the storage of deflection data and repeat measurements without damaging the samples. Unlike other methods of measuring inter-cuspal distance, such as traditional calipers, this method measures deflection without touching the tooth, allowing cusps to move freely [37]. Cuspal deflection values ranging from 6 to 47 µm have been reported in the literature, depending on restoration size, cavity design, composite rigidity, flowability, placement technique, applied adhesive system, and intensity and mode of light curing [38–42]. In our study, this range was found to be 22.8–53.3. In some studies investigating cuspal deflection, baseline measurements were taken before procedures began, and measurements were taken at specific times after the completion of the restoration. According to the results, the interval with the highest level of cuspal movement was reported to be between completion of the restoration and measurements were taken at five minutes thereafter [330, 43]. This peak in cuspal movement during this time interval is attributed to large cavity sizes and dehydration of the tooth [41]. Consistent with the findings of these studies, our study also observed that intra-group comparisons revealed the highest cuspal movement at 5 minutes, with a gradual decrease in cuspal movement at 24 and 48 hours. In the inter-group comparisons of this study, significant differences were observed only between Group 4 and Group 10, where EverX Posterior was used as the base layer in all measurement time intervals. In contrast, no significant differences were observed among other groups. The deflection values were significantly higher in the group where Tetric N-Ceram was used as the top layer. Considering that the base layer was the same, this difference may be attributed to the selection of the top layer. Ilie et al. [44], El-Damanhoury et al. [45], Tsujimoto et al. [46], and Garcia et al. [47] reported in their studies investigating the effects of bulk-fill and traditional composite resins on polymerization shrinkage and cuspal movements that, regardless of the technique used for measurement, bulk-fill composite resins caused less cuspal movement compared to conventional composite resins. This may be attributed to the structure of Filtek One, which contains the AUDMA monomer balancing volumetric shrinkage-induced stress and polymer matrix rigidity, and the AFM monomer facilitating stress reduction by simplifying the monomer structure. In this study, when Ever-X was used as the base layer in both groups where both Filtek One and Tetric N-Ceram were used, numerically higher deflection values were observed after 48 hours. Fronza et al. [48], in their study, evaluated conversion degree, Knoop microhardness, internal adaptation, and polymerization shrinkage stress of four bulk-fill (Surefill SDR, Filtek Bulk Fill Posterior, Tetric Evo Ceram Bulk Fill, EverX Posterior), and one conventional composite (Herculite Classic). Similar to our study, they reported that the EverX Posterior group showed the highest polymerization shrinkage. In this study and our study, EverX Posterior shows higher shrinkage than other materials, possibly due to its high elastic modulus, elevated levels of inorganic filler content and being more affected by stress at the gingival base. Unrestored vital teeth and teeth that have undergone endodontic treatment are structurally different [49]. Teeth undergoing endodontic treatment are more prone to fracture due to structural hard tissue loss and dentin dehydration [50]. Advances in adhesive technology allow for the restoration of endodontically treated posterior teeth with different restorative materials and composite resins [51]. Therefore, the materials used to restore endodontically treated posterior teeth have become essential in terms of fracture resistance, tensile and stress resistance, and modulus of elasticity. Compared with the positive control group, Group 4 (EverX Posterior + Filtek Bulk-fill Posterior) and Group 5 (SDR Plus + Filtek One) had fracture resistance similar to the positive control group. In contrast, other groups' fracture resistance was statistically lower than the positive control group. Similarly to our study, Garoushi et al. [16] compared the fracture resistance of fiber-reinforced composite resin with bulk-fill and conventional composite resin, showing that fiber-reinforced composite resin had higher fracture resistance than other materials. The effect of fiber-containing composite resins Based on the stress transfer from the polymer matrix to the fibers and the crack arresting tendency of the fibers. Atiyah et al. [52] stated in a study that, similar to our study, there was no significant difference in the fracture resistance of premolar teeth restored with SDR bulk fill compared to sound teeth. These results may have been seen due to the elastic buffering effect of the low viscosity flowable composite, SDR's low polymerization shrinkage stress, and low elasticity modulus. In our study, when the fracture resistance of groups was compared according to the base-top layer, G-aenial UI, EverX Posterior, and SDR Plus showed similar values. G-aenial UI provides high fracture and wear resistance by containing ultrafine strontium glass particles that reduce the risk of restoration fracture during chewing forces and by increasing the filler monomer content from 20–25–69% compared to traditional flowable composites [53, 54]. The continued hardening and development of Biodentine until it reaches a fracture resistance similar to natural dentin is a specific characteristic. Butt et al. [55] reported in a study examining the physical properties of Biodentine that it exhibited a fracture resistance of 170 MPa at 24 hours, and this value significantly increased to 304 MPa by day 28. This value was reported to be close to the fracture resistance of human dentin (297 ± 24 MPa). The numerically lowest fracture resistance values observed in the groups where Biodentine was applied in our study may be because our fracture resistance test was conducted at the end of 48 hours without completing maturation. In this study, regardless of the restoration type, it was observed that most fractures were of MOD 4 and MOD 5, which were below the enamel-dentine junction and at an irreparable level. Our findings, contradict the results of Atalay et al. [28], who used the same fracture mode classification system while being consistent with the studies by Yasa et al. [56] and Toz et al. [57], which reported that the majority of fractures in endodontically treated teeth were irreparable. Although the systems classifying fracture types in these studies differed, the results were similar. In the studies mentioned, fractures were classified as repairable or irreparable when they were above the CEJ or within 1 mm apical to the CEJ (including vertical root fractures). However, this study used a more detailed fracture classification system. CONCLUSIONS Within the limitations of this current study, it was concluded that: 1. The highest cuspal deflection value was seen at the fifth minute in each group 2. While there was a significant difference in cuspal deflection values between the groups at each time point in the Filtek One groups, there was no significant difference in the Tetric N-Ceram groups. 3. EverX - Filtek One and SDR Plus - Filtek One applied teeth showed similar fracture strength to healthy teeth. 4. In both upper layers, G-aenial, EverX and SDR Plus applied groups showed the best fracture strength compared to the other lower layers. 5. MOD 4-5 fracture type was seen in 78% of the teeth. Declarations ACKNOWLEDGEMENT We would like to thank the Proofreading & Editing Office of the Dean for Research at Erciyes University for copyediting and proofreading service for this manuscript. ComplIance wIth EthIcal Standards Ethical approval The study was conducted in accordance with the Declaration of Helsinki. This study was approved by the Erciyes University Health Sciences Research Ethics Committee with protocol number 2020/594. Competing interests The authors declare that they have no financial or non-financial interests in the companies whose materials are included in this article. Funding This study was supported by the Erciyes University Research Unit (TDH-2021-10820). 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Dent Mater 33: e329-e335. https://doi.org/10.1016/j.dental.2017.06.001 Salem H, Elhefnawy S, Moharam M (2018) Effect of different restoration techniques and cavity designs on cuspal deflection of posterior teeth restored with resin composite inlays. Future Dent J 4:146-149. https://doi.org/10.1016/j.fdj.2018.09.004 Tamse A, Fuss Z, Lustig J, Kaplavi J (1999) An evaluation of endodontically treated vertically fractured teeth. J Endod 25:506-508. https://doi.org/10.1016/S0099-2399(99)80292-1 Suliman AA, Boyer DB, Lakes RS (1993) Cusp movement in premolars resul ting from composite polymerization shrinkage. Dent Mater 9:6-10. https://doi.org/10.1016/0109-5641(93)90096-9 Pearson GJ, Hegarty SM (1989) Cusp movement of molar teeth with com posite filling materials in conventional and modified MOD cavities. Br Dent J 166:162-5. https://doi.org/10.1038/sj.bdj.4806750 Shabayek N, Hassan F, Mobarak E (2013) Effect of using silorane based resin composite for restoring conservative cavities on the changes in cuspal deflection. Oper Dent 38: E42-E9. https://doi.org/10.1038/sj.bdj.4806750 Cara RR, Fleming GJ, Palin WM, Walmsley AD, Burke FJ. Cuspal deflection and microleakage in premolar teeth restored with resin-based composites with and without an intermediary flowable layer. J Dent. 2007;35(6):482–489. https://doi.org/10.1016/j.jdent.2007.01.005 Meredith N, Setchell DJ (1997) In vitro measurement of cuspal strain and displacement in composite restored teeth. J Dent 25:331-337. https://doi.org/10.1016/s0300-5712(96)00047-4 Versluis A, Tantbirojn D, Pintado MR, et al. (2004) Residual shrinkage stress distributions in molars after composite restoration. Dent Mater 20:554-564. https://doi.org/10.1016/j.dental.2003.05.007 Suliman AA, Boyer DB, Lakes RS (1993) Cusp movement in premolars resulting from composite polymerization shrinkage. Dent Mater 9:6-10. https://doi.org/10.1016/0109-5641(93)90096-9 Pearson GJ, Hegarty SM (1989) Cusp movement of molar teeth with composite filling materials in conventional and modified MOD cavities. Br Dent J 166:162-165. https://doi.org/10.1038/sj.bdj.4806750 Karaman E, Ozgunaltay G (2013) Cuspal deflection in premolar teeth restored using current composite resins with and without resin-modified glass ionomer liner. Oper Dent 38:282-289. https://doi.org/10.2341/11-400-L Ilie N, Hickel R (2011) Investigations on a methacrylate-based flowable composite based on the SDR™ technology. Dent Mater 27:348-55. https://doi.org/10.1016/j.dental.2010.11.014 El-Damanhoury H, Platt J (2014) Polymerization shrinkage stress kinetics and relate properties of bulk-fill resin composites. Oper Dent 39:374-82. https://doi.org/10.2341/13-017-L Tsujimoto A, Nagura Y, Barkmeier WW, Watanabe H, Johnson WW, Takamizawa T, et al. (2018) Simulated cuspal deflection and flexural properties of high viscosity bulk-fill and conventional resin composites. J Mech Behav Biomed Mater 87:111-118. https://doi.org/10.1016/j.jmbbm.2018.07.013 Garcia D, Yaman P, Dennison J, Neiva G (2014) Polymerization shrinkage and depth of cure of bulk fill flowable composite resins. Oper Dent 39:441-448. https://doi.org/10.2341/12-484-L Fronza BM, Rueggeberg FA, Braga RR, Mogilevych B, Soares LE, Martin AA, et al. (2015) Monomer conversion, microhardness, internal marginal adaptation, and shrinkage stress of bulk-fill resin composites. Dent Mater 31:1542-1551. https://doi.org/10.1016/j.dental.2015.10.001 Oskoee PA, Ajami AA, Navimipour EJ, Oskoee SS, Sadjadi J (2009) The effect of three composite fiber insertion techniques on fracture resistance of root-filled teeth. J Endod 35:413-416. https://doi.org/10.1016/j.joen.2008.11.027 Hshad M, Dalkılıç E, Ozturk G, Dogruer I, Koray F (2018) Influence of different restoration techniques on fracture resistance of root-filled teeth: in vitro investigation. Oper Dent 43:162-169. https://doi.org/10.2341/17-040-L Belli S, Erdemir A, Yildirim C (2006) Reinforcement effect of polyethylene fibre in root‐filled teeth: comparison of two restoration techniques. Int Endod J 39:136-142. https://doi.org/10.1111/j.1365-2591.2006.01057.x Atiyah AH, Baban LM (2014) Fracture resistance of endodontically treated premolars with extensive MOD cavities restored with different composite restorations (An In vitro study). J Bagh Coll Dent 15:7-15. https://doi.org/10.12816/0015139 Shaalan OO, Abou-Auf E, El Zoghby AF (2017) Clinical evaluation of flowable resin composite versus conventional resin composite in carious and noncarious lesions: Systematic review and meta-analysis. J Conserv Dent 20:380. https://doi.org/10.4103/JCD.JCD_226_17 Haugen HJ, Marovic D, Par M, Thieu MKL, Reseland JE, Johnsen GF (2020) Bulk fill composites have similar performance to conventional dental composites. Int J Mol Sci 21:5136. https://doi.org/10.3390/ijms21145136 Butt N, Talwar S, Chaudhry S, Nawal RR, Nawal RR, Yadav S, Bali A (2014) Comparison of physical and mechanical properties of mineral trioxide aggregate and Biodentine. Indian J Dent Res 25:692. https://doi.org/10.4103/0970-9290.152163 Plasmans P, Creugers N, Mulder J (1998) Long-term survival of extensive amalgam restorations. J Dent Res 77:453-460. https://doi.org/10.1177/00220345980770030401 Eklund SA (2010) Trends in dental treatment, 1992 to 2007. J Am Dent Assoc 141:391-399. https://doi.org/10.14219/jada.archive.2010.0191 Tables Table 1. Materials Used in the Study Materials Type Content Tetric N-Ceram (Ivoclar Vivadent, Schaan, Liechtenstein) Nanohybrid composite resin Bis-GMA, UDMA, TEGDMA Bis-EMA, Barium glass, Ytterbium Trifluoride, Mixed oxide Silicon dioxide, Prepolymers Filtek One Bulk-Fill Restorative (3M ESPE, Seefeld, Germany) High-viscosity bulk-fill composite resin UDMA, 1,12-DDMA, AFM, AUDMA (CQ), 20 nm silica, 4–11 nm zirconia, ytterbium trifluoride filler consisting of agglomerate 100 nm particles SDR Plus Bulk Fill Flowable (Dentsply, Milford, DE, USA) Low-viscosity bulk-fill composite resin TEGDMA, EBADMA, UDMA EBPADMA, Barium Strontium aluminofluorosilicate Ever-X Posterior (GC, Leuven, Belgium) Fiber-reinforced high-viscosity bulk-fill composite resin Bis-GMA, PMMA, TEGDMA Short E-type glass fiber filler Barium glass G-aenial Universal Injectable (GC Corporation, Tokyo, Japan) High viscosity flowable composite resin UDMA, Bis-MEPP, TEGDMA Silicon dioxide, Strontium glass Fuji II LC (GC Corporation, Tokyo, Japan) Resin-modified glass ionomer Powder: Fluoroalumino silicate glass Liquid: Polyacrylic acid, Maleic acid, HEMA, Water, CQ. Biodentine (Septodont, France) Calcium silicate Tricalcium silicate, Calcium oxide, Calcium carbonate, Zirconium oxide, Iron oxide, Water, Calcium chloride Clearfil SE Bond ( Kuraray, Tokyo, Japan) 2-step Self-etch Adhesive System Primer: Water, MDP, HEMA, CQ, DET, Hydrophilic DMA Bond: MDP, BisGMA, HEMA, Hydrophilic DMA, CQ, DET, Silanized Colloidal Silica Table 2. Deflection values of the groups at 5 minutes, 24 hours, and 48 hours post-restoration LOWER LAYER MEASUREMENT TIMES UPPER LAYER Test Statistics † Filtek One Tetric N-Ceram se sh F p G-aenial UI Dk5 51,8 a,xy 1,1 48,7 a 1,1 0,056 0,814 S24 35,0 b,xy 0,7 34,3 b 0,7 0,046 0,831 S48 26,0 c,xy 0,5 26,7 c 0,5 0,041 0,84 Test Statistics ‡ F =1008,3; p <0,001 F =976,7; p <0,001 EverX Dk5 49,4 a,x 1,1 52,2 a 1,1 5,124 0,025 S24 34,9 b,x 0,7 38,3 b 0,7 5,146 0,025 S48 27,2 c,x 0,5 29,8 c 0,5 5,129 0,025 Test Statistics ‡ F =1011,9; p <0,001 F =1192,5; p <0,001 SDR Plus Dk5 48,6 a,y 1,1 49,5 a 1,1 1,587 0,21 S24 31,7 b,y 0,7 33,4 b 0,7 1,569 0,213 S48 23,7 c,y 0,5 24,9 c 0,5 1,582 0,211 Test Statistics ‡ F =855,2; p <0,001 F =922,1; p <0,001 Fuji II LC Dk5 51,6 a,y 1,1 52,3 a 1,1 1,071 0,303 S24 33,3 b,y 0,7 34,0 b 0,7 1,069 0,303 S48 23,8 c,y 0,5 25,1 c 0,5 1,061 0,305 Test Statistics ‡ F =921,4; p <0,001 F =976,9; p <0,001 Biodentine Dk5 49,6 b,xy 1,1 49,7 a 1,1 3,307 0,071 S24 32,0 c,xy 0,7 32,2 b 0,7 3,309 0,071 S48 22,9 d,xy 0,5 23,2 c 0,5 3,318 0,071 Test Statistics ‡ F =853,9; p <0,001 F =863,2; p <0,001 Filtek One / Tetric N-Ceram Dk5 51,8 a,xy 1,1 53,3 a 1,1 0,963 0,328 S24 32,2 b,xy 0,7 34,8 b 0,7 0,982 0,324 S48 22,8 c,xy 0,5 25,8 c 0,5 0,989 0,322 Test Statistics ‡ F =893,3; p <0,001 F =1022,8; p <0,001 Test İstatistikleri & F Dk5 =5,224; p <0,001 F Dk5 =1,864; p =0,105 F S24 =5,158; p <0,001 F S24 =1,808; p =0,116 F S48 =5,148; p <0,001 F S48 =1,796; p =0,118 : Mean, se : Standard error † : Comparison of deflection values in the lower layers with respect to the upper layers at each measurement time, ‡ : Comparison of deflection values of each lower layer within each upper layer according to measurement times, & : Comparison of deflection values at each measurement time within each upper layer with respect to the lower layers, F Dk5 : 5th Minute, F S24 : 24th Hours, F S48 : 48th Hours. Superscripts a, b, and c indicate the difference between each measurement time in each upper layer for each lower layer. Superscripts x and y indicate differences between lower layers at each measurement time within each upper layer. Table 3. Comparison of the Fracture Strengths of Positive and Negative Control Groups with Other Study Groups Fracture Value Test Statistics & se F p Group 1 (Pozitive Control) 951,7 37,4 17,785 <0,001 Group 2 (Negative Control) 325,7 16,8 Group 3 (G-aenial UI + Filtek One) 813,6 †* 34,8 Group 4 (EverX + Filtek One) 886,3 † 44,0 Group 5 (SDR Plus + Filtek One) 834,2 † 33,9 Group 6 (Fuji II LC + Filtek One) 528,7 †* 36,3 Group 7 (Biodentin + Filtek One) 501,6 †* 36,5 Group 8 Filtek One + Filtek One) 675,1 †* 32,1 Group 9 (G-aenial UI + Tetric N-Ceram) 703,5 †* 56,6 Group 10 (EverX+Tetric N-Ceram) 685,0 †* 59,9 Group 11 (SDR Plus + Tetric N-Ceram) 667,2 †* 24,9 Group 12 (Fuji II LC + Tetric N-Ceram) 517,7 †* 57,3 Group 13 (Biodentin + Tetric N-Ceram) 482,1 †* 50,3 Group 14 (Tetric N-Ceram +Tetric N-Ceram) 634,0 †* 36,3 : Mean, se: Standard error, &: One-Way Analysis of Variance, † : Groups different from the negative control, *Groups different from the positive control Table 4. Comparison of the Fracture Strength of Groups According to the Lower and Upper Layers LOWER LAYER UPPER LAYER Test Statistics † Filtek One Tetric N-Ceram se se F p G-aenial UI 813,6 x 43,3 703,5 x 43,3 3,235 0,074 EverX 886,3 x 43,3 685,0 x 43,3 10,796 0,001 SDR Plus 834,2 x 43,3 667,2 x 43,3 7,427 0,007 Fuji II LC 528,7 y 43,3 517,7 yz 43,3 0,032 0,858 Biodentin 501,6 y 43,3 482,1 z 43,3 0,101 0,751 Filtek One/Tetric N-Ceram 675,1 z 43,3 634,0 xy 43,3 0,449 0,504 Test Statistics ‡ F =14,354; p <0,001 F =4,575; p= 0,001 : Mean, sh: Standard error † : Comparison of upper layers within each lower layer, ‡ : Comparison of lower layers within each upper layer, superscripts x , y ve z indicate comparisons of lower layers within each upper layer. Lower layers with the same letters are statistically similar. Table 5. Distribution of Fracture Types among Groups Experimental Groups MOD 1 N (%) MOD 2 N (%) MOD 3 N (%) MOD 4 N (%) MOD 5 N (%) Group 1 (Positive Control Group) 0 (0,0) 0 (0,0) 3 (25,0) 4 (33,3) 5 (41,7) Group 2 (Negative Control Group) 0 (0,0) 3 (25,0) 0 (0,0) 5 (41,7) 4 (33,3) Group 3 (G-aenial UI + Filtek One) 3 (25,0) 0 (0,0) 0 (0,0) 2 (16,7) 7 (58,3) Group 4 (Ever X + Filtek One) 1 (8,3) 1 (8,3) 1 (8,3) 3 (25,0) 6 (50,0) Group 5 (SDR Plus + Filtek One) 2 (16,7) 0 (0,0) 1 (8,3) 0 (0,0) 9 (75,0) Group 6 (Fuji II LC + Filtek One) 0 (0,0) 2 (16,7) 0 (0,0) 2 (16,7) 8 (66,7) Group 7 Biodentin + Filtek One) 0 (0,0) 0 (0,0) 1 (8,3) 2 (16,7) 9 (75,0) Group 8 Filtek One +Filtek One) 0 (0,0) 1 (8,3) 1 (8,3) 4 (33,3) 6 (50,0) Group 9 (G-aenial UI + Tetric N-Ceram) 2 (16,7) 2 (16,7) 3 (25,0) 0 (0,0) 5 (41,7) Group 10 (EverX Posterior + Tetric N-Ceram) 3 (25,0) 1 (8,3) 0 (0,0) 2 (16,7) 6 (50,0) Group 11 (SDR Plus + Tetric N-Ceram) 1 (8,3) 2 (16,7) 0 (0,0) 0 (0,0) 9 (75,0) Group 12 (Fuji II LC + Tetric N-Ceram) 0 (0,0) 1 (8,3) 1 (8,3) 2 (16,7) 8 (66,7) Group 13 (Biodentin + Tetric N-Ceram) 0 (0,0) 1 (8,3) 0 (0,0) 0 (0,0) 11 (91,6) Group 14 (Tetric N-Ceram + Tetric N-Ceram) 1 (8,3) 0 (0,0) 1 (8,3) 3 (25,0) 7 (58,3) Total 15 (8,9) 14 (8,3) 8 (4,8) 28 (16,7) 103 (61,3) Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6189355","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":444760988,"identity":"d8e6d7b7-8438-4cf3-b80c-59ab078e3991","order_by":0,"name":"BURAK KOSE","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYBACAwYGZsYGIMkP4iUUEK/FgEGyAaTFgGgtQMrgAJRLEJhL5D42nFHwR874/OrEDw8MGOT5xQ7g12I5I904cYOBgbHZjbebJYAOM5w5O4GAw26kMR98YGCQuO3G2Q0gLQkGt4nVsnnG2c0/iNYCcljiBv7ebcTZYtnzjNlwhoGxscQN3m0WCQYShP1izp7GLNnzR06Ov//s5ps/Kmzk+aUJaEEACbBKCWKVgwD/AVJUj4JRMApGwUgCAFErQsHzMj/8AAAAAElFTkSuQmCC","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"BURAK","middleName":"","lastName":"KOSE","suffix":""},{"id":444760993,"identity":"f8fbf28f-6177-44df-81f4-890422e8a030","order_by":1,"name":"SOLEY ARSLAN","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"SOLEY","middleName":"","lastName":"ARSLAN","suffix":""}],"badges":[],"createdAt":"2025-03-09 15:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6189355/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6189355/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00784-025-06452-9","type":"published","date":"2025-07-09T15:57:32+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":81055223,"identity":"771a9a16-ccb0-4c62-b83c-df3725c959da","added_by":"auto","created_at":"2025-04-21 17:23:04","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":60997,"visible":true,"origin":"","legend":"\u003cp\u003eWorkflow Diagram\u003c/p\u003e","description":"","filename":"groupimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6189355/v1/34f5e3f548fcc9180daeae5b.jpeg"},{"id":86699408,"identity":"4d0fd853-c7a9-4996-9ea2-b67919690ff6","added_by":"auto","created_at":"2025-07-14 16:09:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1159812,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6189355/v1/2dfbe47d-53dc-4353-bf8e-3e12a0ca508b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of Cuspal Deflection and Fracture Strength of Endodontically Treated Teeth Restored with Different Restorative Material Combinations","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEndodontic treatment aims to eliminate bacteria and infection foci from the root canal to maintain the continuity of teeth affected by caries, trauma, or periodontal disease within the oral cavity [1]. Teeth undergoing endodontic treatment are more prone to fracture than vital teeth due to decreased water content and loss of critical anatomical structures like the pulp chamber roof and marginal ridges [2]. Crowns, onlays/inlays and resin-based direct and indirect restorative materials are used in the treatment of teeth that have undergone root canal treatment [3, 4].\u003c/p\u003e \u003cp\u003eDifferent restorative materials are used in dental treatments. Today, composite resins are widely used in a wide range of applications due to their high aesthetic properties, ability to bond to enamel and dentin, and the ability to enhance the integrity of the tooth-restoration complex by creating a monoblock effect [5]. However, one of the major disadvantages of traditional resin composites routinely used for the restoration of endodontically treated teeth is polymerization shrinkage [6]. Polymerization shrinkage can lead to higher stress accumulation, cuspal deflection, and tooth fracture, especially in teeth with high substance loss [7]. It is recommended that resin composites be placed in layers of 2 mm thickness within the cavity to reduce polymerization shrinkage stress and ensure adequate curing depth. However, applying resin composites in layers can be time-consuming and may result in voids between the layers [8, 9].\u003c/p\u003e \u003cp\u003eLately, bulk fill composite resins have been developed with modified initiator systems and formulations that allow conventional resin composites to be applied in layers up to 4 mm thick to reduce polymerization shrinkage [10]. The lower polymerization shrinkage of these materials is attributed to their high translucency due to low filler particle content and the use of additional photoactivation systems [11, 12].\u003c/p\u003e \u003cp\u003eIn addition, it was showed that fiber-reinforced resin composites reduce polymerization shrinkage and strengthen coronal restorations, increasing fracture resistance. These resin composites are developed as base materials and contain e-glass fibers [13]. E-glass fibers have been reported to halt the progression of cracks and distribute occlusal loads in restorations [14\u0026ndash;16].\u003c/p\u003e \u003cp\u003eResin-modified glass ionomer types of cement (RMGICs) have been developed by adding photoactivated methacrylates, HEMA, or BisGMA resin to the composition of traditional glass ionomer cement (GICs) [17]. The physical and mechanical properties of RMGICs fall between those of conventional GICs and resin composites [18\u0026ndash;20]. RMGICs are often recommended as base materials in large and deep cavities to reduce polymerization shrinkage stress [21, 22].\u003c/p\u003e \u003cp\u003eBiodentine is a water-based material containing tricalcium silicate designed to replace specific dentin tissue lost in the tooth. Produced using MTA-based cement technology, Biodentine has been enhanced with properties such as improved physical and handling characteristics [23]. It has been shown that Biodentine particularly supports the remaining tooth structure in teeth with thin dentin walls and increases fracture resistance [24, 25].\u003c/p\u003e \u003cp\u003eFlowable composite resins are hybrid composites with a low filler content and viscosity. When used as liners in deep cavities, they compensate for polymerization shrinkage and function as stress absorbers [26]. In recent years, high filler content flowable composites have been developed. Due to their improved fracture resistance, edge stability, and wear resistance, they are recommended for permanent restoration material in shallow cavities [27].\u003c/p\u003e \u003cp\u003eFew studies compare the effects of fiber-reinforced resin composite, resin-modified glass ionomer cement, and Biodentine when combined with traditional and bulk-fill composites on cuspal deflection and fracture resistance in endodontically treated teeth. Therefore, this study aims to contribute further information on this topic to the literature. The null hypothesis of our research is that the cuspal deflection and fracture resistance of endodontically treated MOD cavity teeth restored with different restorative material combinations are different.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSample Selection and Preparation\u003c/h2\u003e \u003cp\u003eIn vitro in this study, a total of 168 human maxillary premolar teeth extracted for orthodontic reasons were used (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Teeth with mesio-distal widths ranging from 6 to 8 mm and bucco-lingual widths ranging from 8 to 10 mm were included. Any attachments on the teeth were removed using a periodontal hand instrument without causing damage to the teeth. Subsequently, the teeth were cleaned with pumice using a low-speed micromotor (Kavo, Germany). Teeth were examined under surgical microscopy (Leica, Germany) at 20x magnification to check for decay, cracks, or defects. Faulty teeth were excluded from the study. The teeth were stored in distilled water at 37\u0026deg;C until the start of the experiment. The teeth were immersed in 0.1% thymol solution at 37\u0026deg;C for one week for disinfection until preparation was made.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTo measure cusp deflection, guide points were created on the buccal and palatal tubercles of the teeth using composite resin cylinders with a height of 2 mm. These guide points were then colored with water-resistant dye. The teeth were randomly distributed and in order to detect a difference between any two groups with an effect size of 0.8, 80% power and 5% type 1 error, a sample size of 12 teeth was calculated in each group (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). [28].\u003c/p\u003e \u003cp\u003eThen the intertubercular distance of each group's teeth was measured using a stereo microscope (Leica, Germany) and ImageJ software.\u003c/p\u003e \u003cp\u003eMOD cavities were prepared with the cavity floor 1.0 mm above the cement-enamel junction and isthmus width one-third of the intertubercular distance. Diamond burs (Diatech, Heerbrugg, Germany) used for preparation were changed after each four cavities.\u003c/p\u003e \u003cp\u003eAfter cavity preparation, canal lengths were determined, and the canals were shaped up to F3 (#30) using ProTaper Next (Dentsply-Maillefer, Ballaigues, Switzerland). After each instrument, root canals were irrigated with 2 mL of 5.25% sodium hypochlorite (NaOCl, Endosolve HP, Imycril, T\u0026uuml;rkiye). Prepared root canals were washed with 5 mL of 17% ethylenediaminetetraacetic acid (Pulpdent Corporation, Watertown, MA, USA), followed by a final rinse with 5 mL of distilled water, and then dried with paper points. Subsequently, the canals were filled with F3 gutta-percha (ProTaper, Dentsply-Maillefer, Ballaigues, Switzerland) and epoxy resin-based sealer (AH Plus, Dentsply DeTrey, Konstanz, Germany). After canal filling, the gutta-percha was cut at the level of the cement-enamel junction, and the cavity was cleaned with alcohol.\u003c/p\u003e \u003cp\u003eFollowing root canal treatment, the roots of the teeth were wrapped with aluminum foil to mimic the periodontal ligaments and create space for the elastomeric impression material. The roots were wrapped with aluminum foil, leaving a thickness of no more than 1 mm around them, and the foil was placed 2 mm below the cement-enamel junction. Subsequently, the teeth were embedded in acrylic resin (Paladent RR, Heraeus Kulzer GmbH Co., Germany) in a vertical position with the long axis of the roots perpendicular to the ground and 2 mm below the cement-enamel junction. After polymerization of the acrylic resin, the teeth were removed from the molds, and the aluminum foil with a thickness of 1 mm wrapped around the tooth roots was removed. Silicone impression material (Oranwash L, Zhermack, Italy) was placed into the acrylic molds, and the teeth were repositioned in the molds to proceed with the restoration phase.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRestoration of Teeth\u003c/h3\u003e\n\u003cp\u003e37% phosphoric acid (3M ESPE, St. Paul, MN, USA) was applied to the enamel for 15 seconds on the prepared MOD cavity surfaces. After the acid treatment, the teeth were rinsed for 30 seconds and dried with gentle air for 5 seconds. According to the manufacturer's instructions, a two-step self-etch dental adhesive system was applied to the dried cavities. The Primer (Clearfil SE Primer, Kuraray Co, Ltd, Osaka, Japan)(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) was applied to the cavity for 20 seconds, followed by the application of Bond (Clearfil SE Bond, Kuraray Co, Ltd, Osaka, Japan) to all cavity surfaces. A uniform bond layer was created by applying gentle air pressure. Then, polymerization was achieved by exposing the teeth to LED light (Valo Cordless, Ultradent Products, South Jordan, USA) for 10 seconds. Before placing the restorative materials, a transparent matrix system (Transparent Adapt SuperCap Matrix, Kerr, Switzerland) was placed at the gingival base of the tooth to ensure no gap remained Before placing the restorative materials, a transparent matrix system (Transparent Adapt SuperCap Matrix, Kerr, Switzerland) was placed at the gingival base of the tooth to ensure no gap remained.\u003c/p\u003e\u003cp\u003eThe positive control group received no treatment. MOD cavities were prepared after endodontic therapy in the negative control group, but no restoration was performed.\u003c/p\u003e \u003cp\u003eIn Groups 3\u0026ndash;7, a lower layer of G-aenial Universal Injectable (GC Corporation, Tokyo, Japan), EverX Posterior (GC, Leuven, Belgium), SDR Plus Bulk Fill Flowable (Dentsply, Milford, DE, USA), Fuji II LC (GC Corporation, Tokyo, Japan), Biodentin (Septodont, France)(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) was applied to a total thickness of 4 mm. All layers were polymerized by applying light for 40 seconds. Then, the upper layer of the cavity was restored with Filtek One Bulk-Fill Restorative (3M ESPE, Seedfeld, Germany)(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)and polymerized with light for 40 seconds. Group 8 was restored entirely with Filtek One Bulk-Fill Restorative (in 4 mm increments) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Groups 9\u0026ndash;13, a lower layer of G-aenial UI, EverX, SDR Plus, Fuji II LC, Biodentin (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) was applied to a total thickness of 4 mm, and all layers were polymerized by applying light for 40 seconds. Then, the upper layer of the cavity was restored with Tetric N-Ceram (Ivoclar Vivadent, Schaan, Liechtenstein)(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) and polymerized with light for 40 seconds. Group 14 was entirely restored with Tetric N-Ceram (in 2 mm increments) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eMeasurement of Cusp Deflection\u003c/h3\u003e\n\u003cp\u003eStereo microscopy was used at five minutes, 24 hours, and 48 hours post-restoration to measure tubercle movements resulting from polymerization shrinkage after restoration in the experimental groups. ImageJ software was used for measurements.\u003c/p\u003e\n\u003ch3\u003eMeasurement of Fracture Resistance\u003c/h3\u003e\n\u003cp\u003eA universal testing machine (Instron, Lloyd, UK) was used to measure fracture resistance. A steel spherical tip with a diameter of 6 mm was placed perpendicular to the long axis of the tooth, and force was applied at a rate of 1 mm/min. The force at which the restoration or tooth fractured was recorded in Newtons (N). The fracture types of the broken samples were examined under a light microscope (Leica, Germany) at 20x magnification and classified as follows:\u003c/p\u003e \u003cp\u003eType 1: Minimum loss of tooth and restoration material\u003c/p\u003e \u003cp\u003eType 2: Minimal loss of a tubercle, intact restoration\u003c/p\u003e \u003cp\u003eType 3: Loss of at least one tubercle up to halfway through the restoration\u003c/p\u003e \u003cp\u003eType 4: Loss of at least one tubercle encompassing more than halfway through the restoration\u003c/p\u003e \u003cp\u003eType 5: Loss of more than halfway through the restoration, with tubercle fracture below the cement-enamel junction\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS 22.0 software (SPSS; Chicago, IL, USA). Two-way ANOVA analysis was used for repeated measurements of deflection values, comparison of fracture values using General Linear Models, and comparison of positive and negative control groups with other studies.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents the groups\u0026apos; deflection values at five minutes, 24 hours, and 48 hours post-restoration.\u003c/p\u003e\n\u003cp\u003eWhen the deflection values of each sub-layer within each upper layer were compared across measurement times, significant differences in tubercle movement change values were found among the groups at 5 minutes, 24 hours, and 48 hours (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cp\u003eIn intergroup comparisons, significant differences were found in tubercle movement change at each time interval in Groups 4 and 10, where EverX was used as the lower layer (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In contrast, no statistically significant difference was observed among the other groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cp\u003eWhen the deflection values at each measurement time were compared with the sub-layers, statistically significant differences were found among the time intervals in groups using Filtek One (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In contrast, no significant difference was observed in groups using Tetric N-Ceram (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cp\u003eThe fracture resistance values of the groups are presented in Tables \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eIn groups where Filtek One was used as the upper layer, no significant difference in fracture resistance was observed among Groups 3\u0026ndash;5 (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Still, the fracture resistance of these groups was significantly higher than that of the other groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cp\u003eIn groups where Tetric N-Ceram was used as the upper layer, no significant difference in fracture resistance was observed among Groups 9\u0026ndash;11 and 14 (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Still, the fracture resistance of these groups was significantly higher than that of the other groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cp\u003eWhen comparing fracture resistance among groups, significant differences were observed between groups using EverX and SDR Plus as the lower layer (p\u0026thinsp;\u0026lt;\u0026thinsp;0.005). In contrast, no significant difference was found among the other groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cp\u003eThe fracture values of the negative control group were significantly lower than those of all other groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The fracture values of the positive control group were similar to those of Groups 4 and 5 (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) but were statistically higher than those of all other groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cp\u003eFracture types according to groups is presented in Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eOne hundred thirty-one teeth (78%) exhibited MOD 4 and MOD 5 fracture types, indicating fractures that could not be repaired below the cement-enamel junction. Thirty-seven teeth (22%) exhibited repairable fractures above the cement-enamel junction (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur study aimed to measure cuspal deflection due to polymerization shrinkage at specific intervals and test fracture resistance by restoring endodontically treated MOD cavitated maxillary premolar teeth using varied materials and combinations. The results of our study accepted our null hypothesis.\u003c/p\u003e \u003cp\u003eCuspal deflection is a biomechanical event in teeth restored with composite resin. It occurs due to the interaction between the materials' polymerization stress and the remaining tooth structure's adaptation post-preparation [29]. Cuspal deflection may cause changes in occlusion points, postoperative pain, enamel cracking, and tooth fracture [30, 31].\u003c/p\u003e \u003cp\u003eExtracted teeth are commonly used in cuspal deflection measurement studies as they eliminate the compatibility issue between the test system and supporting structures. This study used maxillary first premolar teeth to ensure uniformity in size, shape, and form. The crown shape of maxillary premolars make it easier cusp fractures under occlusal forces [32, 33]. Additionally, cuspal deflection is more commonly observed in maxillary premolars than in other posterior teeth. Crown volume/shape, and crown/root ratio may contribute to this complication [34]. For these reasons, extracted upper first premolar teeth were used in this study.\u003c/p\u003e \u003cp\u003eThere is a clear relationship between cuspal deflection and structural loss of the tooth. The literature has reported that teeth with large cavity preparations show more deflection than teeth with smaller cavities [35]. Increasing the width of marginal ridges and isthmus areas reduces tooth hardness and increases tooth flexibility [36]. MOD cavity preparation was performed in this study to weaken the tooth structure and allow for tooth deflection.\u003c/p\u003e \u003cp\u003eInter-cuspal measurements were conducted using a digital microscope. This method facilitates the storage of deflection data and repeat measurements without damaging the samples. Unlike other methods of measuring inter-cuspal distance, such as traditional calipers, this method measures deflection without touching the tooth, allowing cusps to move freely [37].\u003c/p\u003e \u003cp\u003eCuspal deflection values ranging from 6 to 47 \u0026micro;m have been reported in the literature, depending on restoration size, cavity design, composite rigidity, flowability, placement technique, applied adhesive system, and intensity and mode of light curing [38\u0026ndash;42]. In our study, this range was found to be 22.8\u0026ndash;53.3.\u003c/p\u003e \u003cp\u003eIn some studies investigating cuspal deflection, baseline measurements were taken before procedures began, and measurements were taken at specific times after the completion of the restoration. According to the results, the interval with the highest level of cuspal movement was reported to be between completion of the restoration and measurements were taken at five minutes thereafter [330, 43]. This peak in cuspal movement during this time interval is attributed to large cavity sizes and dehydration of the tooth [41]. Consistent with the findings of these studies, our study also observed that intra-group comparisons revealed the highest cuspal movement at 5 minutes, with a gradual decrease in cuspal movement at 24 and 48 hours.\u003c/p\u003e \u003cp\u003eIn the inter-group comparisons of this study, significant differences were observed only between Group 4 and Group 10, where EverX Posterior was used as the base layer in all measurement time intervals. In contrast, no significant differences were observed among other groups. The deflection values were significantly higher in the group where Tetric N-Ceram was used as the top layer. Considering that the base layer was the same, this difference may be attributed to the selection of the top layer. Ilie et al. [44], El-Damanhoury et al. [45], Tsujimoto et al. [46], and Garcia et al. [47] reported in their studies investigating the effects of bulk-fill and traditional composite resins on polymerization shrinkage and cuspal movements that, regardless of the technique used for measurement, bulk-fill composite resins caused less cuspal movement compared to conventional composite resins. This may be attributed to the structure of Filtek One, which contains the AUDMA monomer balancing volumetric shrinkage-induced stress and polymer matrix rigidity, and the AFM monomer facilitating stress reduction by simplifying the monomer structure.\u003c/p\u003e \u003cp\u003eIn this study, when Ever-X was used as the base layer in both groups where both Filtek One and Tetric N-Ceram were used, numerically higher deflection values were observed after 48 hours. Fronza et al. [48], in their study, evaluated conversion degree, Knoop microhardness, internal adaptation, and polymerization shrinkage stress of four bulk-fill (Surefill SDR, Filtek Bulk Fill Posterior, Tetric Evo Ceram Bulk Fill, EverX Posterior), and one conventional composite (Herculite Classic). Similar to our study, they reported that the EverX Posterior group showed the highest polymerization shrinkage. In this study and our study, EverX Posterior shows higher shrinkage than other materials, possibly due to its high elastic modulus, elevated levels of inorganic filler content and being more affected by stress at the gingival base.\u003c/p\u003e \u003cp\u003eUnrestored vital teeth and teeth that have undergone endodontic treatment are structurally different [49]. Teeth undergoing endodontic treatment are more prone to fracture due to structural hard tissue loss and dentin dehydration [50]. Advances in adhesive technology allow for the restoration of endodontically treated posterior teeth with different restorative materials and composite resins [51]. Therefore, the materials used to restore endodontically treated posterior teeth have become essential in terms of fracture resistance, tensile and stress resistance, and modulus of elasticity.\u003c/p\u003e \u003cp\u003eCompared with the positive control group, Group 4 (EverX Posterior\u0026thinsp;+\u0026thinsp;Filtek Bulk-fill Posterior) and Group 5 (SDR Plus\u0026thinsp;+\u0026thinsp;Filtek One) had fracture resistance similar to the positive control group. In contrast, other groups' fracture resistance was statistically lower than the positive control group. Similarly to our study, Garoushi et al. [16] compared the fracture resistance of fiber-reinforced composite resin with bulk-fill and conventional composite resin, showing that fiber-reinforced composite resin had higher fracture resistance than other materials. The effect of fiber-containing composite resins Based on the stress transfer from the polymer matrix to the fibers and the crack arresting tendency of the fibers.\u003c/p\u003e \u003cp\u003eAtiyah et al. [52] stated in a study that, similar to our study, there was no significant difference in the fracture resistance of premolar teeth restored with SDR bulk fill compared to sound teeth. These results may have been seen due to the elastic buffering effect of the low viscosity flowable composite, SDR's low polymerization shrinkage stress, and low elasticity modulus.\u003c/p\u003e \u003cp\u003eIn our study, when the fracture resistance of groups was compared according to the base-top layer, G-aenial UI, EverX Posterior, and SDR Plus showed similar values. G-aenial UI provides high fracture and wear resistance by containing ultrafine strontium glass particles that reduce the risk of restoration fracture during chewing forces and by increasing the filler monomer content from 20\u0026ndash;25\u0026ndash;69% compared to traditional flowable composites [53, 54].\u003c/p\u003e \u003cp\u003eThe continued hardening and development of Biodentine until it reaches a fracture resistance similar to natural dentin is a specific characteristic. Butt et al. [55] reported in a study examining the physical properties of Biodentine that it exhibited a fracture resistance of 170 MPa at 24 hours, and this value significantly increased to 304 MPa by day 28. This value was reported to be close to the fracture resistance of human dentin (297\u0026thinsp;\u0026plusmn;\u0026thinsp;24 MPa). The numerically lowest fracture resistance values observed in the groups where Biodentine was applied in our study may be because our fracture resistance test was conducted at the end of 48 hours without completing maturation.\u003c/p\u003e \u003cp\u003eIn this study, regardless of the restoration type, it was observed that most fractures were of MOD 4 and MOD 5, which were below the enamel-dentine junction and at an irreparable level. Our findings, contradict the results of Atalay et al. [28], who used the same fracture mode classification system while being consistent with the studies by Yasa et al. [56] and Toz et al. [57], which reported that the majority of fractures in endodontically treated teeth were irreparable. Although the systems classifying fracture types in these studies differed, the results were similar. In the studies mentioned, fractures were classified as repairable or irreparable when they were above the CEJ or within 1 mm apical to the CEJ (including vertical root fractures). However, this study used a more detailed fracture classification system.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eWithin the limitations of this current study, it was concluded that:\u003c/p\u003e\n\u003cp\u003e1. The highest cuspal deflection value was seen at the fifth minute in each group\u003c/p\u003e\n\u003cp\u003e2. While there was a significant difference in cuspal deflection values between the groups at each time point in the Filtek One groups, there was no significant difference in the Tetric N-Ceram groups.\u003c/p\u003e\n\u003cp\u003e3. EverX - Filtek One and SDR Plus - Filtek One applied teeth showed similar fracture strength to healthy teeth.\u003c/p\u003e\n\u003cp\u003e4. In both upper layers, G-aenial, EverX and SDR Plus applied groups showed the best fracture strength compared to the other lower layers.\u003c/p\u003e\n\u003cp\u003e5. MOD 4-5 fracture type was seen in 78% of the teeth.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the\u0026nbsp;Proofreading \u0026amp; Editing Office\u0026nbsp;of the Dean for Research at Erciyes University for copyediting and proofreading service for this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComplIance wIth EthIcal Standards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki. This study was approved by the Erciyes University Health Sciences Research Ethics Committee with protocol number 2020/594.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no financial or non-financial interests in the companies whose materials are included in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Erciyes University Research Unit (TDH-2021-10820).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBK ve SA contributed to study design, data collection and evaluation. BK and SA reviewed and approved the manuscript. All authors critically revised the manuscript and approved it for publication.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTorabzadeh H, Ghassemi A, Sanei M, Razmavar S, Sheikh-Al-Eslamian SM (2014). The influence of composite thickness with or without fibers on fracture resistance of direct restorations in endodontically treated teeth. Iran Endod J 9:215. https://doi.org/ 10.22037/iej.v9i3.4800\u003c/li\u003e\n\u003cli\u003eBurke FJ. (1992) Tooth fracture in vivo and in vitro J Dent 20: 131-139. https://doi.org/10.1016/0300-5712(92)90124-u\u003c/li\u003e\n\u003cli\u003eMergulh\u0026atilde;o V, de Mendon\u0026ccedil;a L, de Albuquerque M, Braz R (2019) Fracture resistance of endodontically treated maxillary premolars restored with different methods. 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J Appl Oral Sci 17:364-369. https://doi.org/10.1590/s1678-77572009000500003\u003c/li\u003e\n\u003cli\u003eMcCabe JF (1998) Resin-modified glass-ionomers. Biomaterials 19:521-527. https://doi.org/10.1016/S0142-9612(98)00132-X\u003c/li\u003e\n\u003cli\u003eRahman TSA, Mohamad D, Hasan H, Osman H (2021). Physical Properties of Newly Developed Resin Modified Glass Ionomer Cement with Synthesised Coumarin Derivatives. Sains Malaysiana 50: 2433-2444. https://doi.org/10.17576/jsm-2021-5008-24\u003c/li\u003e\n\u003cli\u003eTaha NA, Palamara JE, Messer HH (2011) Fracture strength and fracture patterns of root filled teeth restored with direct resin restorations. J Dent 39:527‐35. https://doi.org/10.1016/j.jdent.2011.05.003\u003c/li\u003e\n\u003cli\u003eTaha NA, Palamara JE, Messer HH (2009) Cuspal deflection, strain and microleakage of endodontically treated premolar teeth restored with direct resin composites. J Dent 37:724‐730. https://doi.org/10.1016/j.jdent.2009.05.027\u003c/li\u003e\n\u003cli\u003eJefferies SR (2014) Bioactive and biomimetic restorative materials:a comprehensive rewiev. Part I. J Esthet Rest Dent 26:14-26. https://doi.org/10.1111/jerd.12069\u003c/li\u003e\n\u003cli\u003eElnaghy AM, Elsaka SE (2016) Fracture resistance of simulated immature teeth filled with biodentine and white mineral trioxide aggregate - an in vitro study. Dent Traumatol 32:116\u0026ndash;120. https://doi.org/10.1111/edt.12224\u003c/li\u003e\n\u003cli\u003eEL-Ma AM, Qualtrough AJ, Watts DC (2014) Resistance to vertical fracture of MTA-filled roots. Dent Traumatol 30:36\u0026ndash;42. https://doi.org/10.1111/edt.12025\u003c/li\u003e\n\u003cli\u003eLabella R, Lambrechts P, Van Meerbek B, Vanhelle G (1999) Polimerization shringe and elasticity of flowable composites and filled adhesived. Dent Mater 15:301-308. https://doi.org/10.1016/s0109-5641(99)00022-6\u003c/li\u003e\n\u003cli\u003eTorres CRG, Rego HMC, Perote LCCC, Santos LF, Kamozaki MB, Gutierrez NC, et al. (2014) A split-mouth randomized clinical trial of conventional and heavy flowable composites in class II restorations. J Dent 42:793-9. https://doi.org/10.1016/j.jdent.2014.04.009\u003c/li\u003e\n\u003cli\u003eAtalay C, Yazici A, Horuztepe A, Nagas E, Ertan A, Ozgunaltay G (2016) Fracture resistance of endodontically treated teeth restored with bulk fill, bulk fill flowable, fiber-reinforced, and conventional resin composite. Oper Dent. 41: E131-E40. https://doi.org/10.2341/15-320-L\u003c/li\u003e\n\u003cli\u003eOskoee SS, Oskoee PA, Navimipour EJ, Ajami AA, Zonuz GA, Bahari M, et al. (2012) The effect of composite fiber insertion along with low-shrinking composite resin on cuspal deflection of root-filled maxillary premolars. J Contemp Dent Pract 13:595-601. https://doi.org/10.5005/jp-journals-10024-1193\u003c/li\u003e\n\u003cli\u003eLee MR, Cho BH, Son HH, Chung MU, Lee B (2007) Influence of cavity dimension and restoration methods on the cusp deflection of premolars in composite restoration dental materials. Dent Mater. 2007;23(3):288\u0026ndash;95. https://doi.org/10.1016/j.dental.2006.01.025\u003c/li\u003e\n\u003cli\u003eJafarpour S, El-Badrawy W, Jazi HS, McComb D (2012) Effect of composite insertion technique on cuspal deflection using an in vitro simulation model. Oper Dent 37:299-305. https://doi.org/10.2341/11-086-L\u003c/li\u003e\n\u003cli\u003eMcHugh LEJ, Politi I, Al-Fodeh RS, Fleming GJP (2017) Implications of resin-based composite (RBC) restoration on cuspal deflection and microleakage score in molar teeth: Placement protocol and restorative material. Dent Mater 33: e329-e335. https://doi.org/10.1016/j.dental.2017.06.001\u003c/li\u003e\n\u003cli\u003eSalem H, Elhefnawy S, Moharam M (2018) Effect of different restoration techniques and cavity designs on cuspal deflection of posterior teeth restored with resin composite inlays. Future Dent J 4:146-149. https://doi.org/10.1016/j.fdj.2018.09.004\u003c/li\u003e\n\u003cli\u003eTamse A, Fuss Z, Lustig J, Kaplavi J (1999) An evaluation of endodontically treated vertically fractured teeth. J Endod 25:506-508. https://doi.org/10.1016/S0099-2399(99)80292-1\u003c/li\u003e\n\u003cli\u003eSuliman AA, Boyer DB, Lakes RS (1993) Cusp movement in premolars resul ting from composite polymerization shrinkage. Dent Mater 9:6-10. https://doi.org/10.1016/0109-5641(93)90096-9\u003c/li\u003e\n\u003cli\u003ePearson GJ, Hegarty SM (1989) Cusp movement of molar teeth with com posite filling materials in conventional and modified MOD cavities. Br Dent J 166:162-5. https://doi.org/10.1038/sj.bdj.4806750\u003c/li\u003e\n\u003cli\u003eShabayek N, Hassan F, Mobarak E (2013) Effect of using silorane based resin composite for restoring conservative cavities on the changes in cuspal deflection. Oper Dent 38: E42-E9. https://doi.org/10.1038/sj.bdj.4806750\u003c/li\u003e\n\u003cli\u003eCara RR, Fleming GJ, Palin WM, Walmsley AD, Burke FJ. Cuspal deflection and microleakage in premolar teeth restored with resin-based composites with and without an intermediary flowable layer. J Dent. 2007;35(6):482\u0026ndash;489. https://doi.org/10.1016/j.jdent.2007.01.005\u003c/li\u003e\n\u003cli\u003eMeredith N, Setchell DJ (1997) In vitro measurement of cuspal strain and displacement in composite restored teeth. J Dent 25:331-337. https://doi.org/10.1016/s0300-5712(96)00047-4\u003c/li\u003e\n\u003cli\u003eVersluis A, Tantbirojn D, Pintado MR, et al. (2004) Residual shrinkage stress distributions in molars after composite restoration. Dent Mater 20:554-564. https://doi.org/10.1016/j.dental.2003.05.007\u003c/li\u003e\n\u003cli\u003eSuliman AA, Boyer DB, Lakes RS (1993) Cusp movement in premolars resulting from composite polymerization shrinkage. Dent Mater 9:6-10. https://doi.org/10.1016/0109-5641(93)90096-9\u003c/li\u003e\n\u003cli\u003ePearson GJ, Hegarty SM (1989) Cusp movement of molar teeth with composite filling materials in conventional and modified MOD cavities. Br Dent J 166:162-165. https://doi.org/10.1038/sj.bdj.4806750\u003c/li\u003e\n\u003cli\u003eKaraman\u003csup\u003e \u003c/sup\u003eE, Ozgunaltay G (2013) Cuspal deflection in premolar teeth restored using current composite resins with and without resin-modified glass ionomer liner. Oper Dent 38:282-289. https://doi.org/10.2341/11-400-L\u003c/li\u003e\n\u003cli\u003eIlie N, Hickel R (2011) Investigations on a methacrylate-based flowable composite based on the SDR\u0026trade; technology. Dent Mater 27:348-55. https://doi.org/10.1016/j.dental.2010.11.014\u003c/li\u003e\n\u003cli\u003eEl-Damanhoury H, Platt J (2014) Polymerization shrinkage stress kinetics and relate properties of bulk-fill resin composites. Oper Dent 39:374-82. https://doi.org/10.2341/13-017-L\u003c/li\u003e\n\u003cli\u003eTsujimoto A, Nagura Y, Barkmeier WW, Watanabe H, Johnson WW, Takamizawa T, et al. (2018) Simulated cuspal deflection and flexural properties of high viscosity bulk-fill and conventional resin composites. J Mech Behav Biomed Mater 87:111-118. https://doi.org/10.1016/j.jmbbm.2018.07.013\u003c/li\u003e\n\u003cli\u003eGarcia D, Yaman P, Dennison J, Neiva G (2014) Polymerization shrinkage and depth of cure of bulk fill flowable composite resins. Oper Dent 39:441-448. https://doi.org/10.2341/12-484-L\u003c/li\u003e\n\u003cli\u003eFronza BM, Rueggeberg FA, Braga RR, Mogilevych B, Soares LE, Martin AA, et al. (2015) Monomer conversion, microhardness, internal marginal adaptation, and shrinkage stress of bulk-fill resin composites. Dent Mater 31:1542-1551. https://doi.org/10.1016/j.dental.2015.10.001\u003c/li\u003e\n\u003cli\u003eOskoee PA, Ajami AA, Navimipour EJ, Oskoee SS, Sadjadi J (2009) The effect of three composite fiber insertion techniques on fracture resistance of root-filled teeth. J Endod 35:413-416. https://doi.org/10.1016/j.joen.2008.11.027\u003c/li\u003e\n\u003cli\u003eHshad M, Dalkılı\u0026ccedil; E, Ozturk G, Dogruer I, Koray F (2018) Influence of different restoration techniques on fracture resistance of root-filled teeth: in vitro investigation. Oper Dent 43:162-169. https://doi.org/10.2341/17-040-L\u003c/li\u003e\n\u003cli\u003eBelli S, Erdemir A, Yildirim C (2006) Reinforcement effect of polyethylene fibre in root‐filled teeth: comparison of two restoration techniques. Int Endod J 39:136-142. https://doi.org/10.1111/j.1365-2591.2006.01057.x\u003c/li\u003e\n\u003cli\u003eAtiyah AH, Baban LM (2014) Fracture resistance of endodontically treated premolars with extensive MOD cavities restored with different composite restorations (An In vitro study). J Bagh Coll Dent 15:7-15. https://doi.org/10.12816/0015139\u003c/li\u003e\n\u003cli\u003eShaalan OO, Abou-Auf E, El Zoghby AF (2017) Clinical evaluation of flowable resin composite versus conventional resin composite in carious and noncarious lesions: Systematic review and meta-analysis. J Conserv Dent 20:380. https://doi.org/10.4103/JCD.JCD_226_17\u003c/li\u003e\n\u003cli\u003eHaugen HJ, Marovic D, Par M, Thieu MKL, Reseland JE, Johnsen GF (2020) Bulk fill composites have similar performance to conventional dental composites. Int J Mol Sci 21:5136. https://doi.org/10.3390/ijms21145136\u003c/li\u003e\n\u003cli\u003eButt N, Talwar S, Chaudhry S, Nawal RR, Nawal RR, Yadav S, Bali A (2014) Comparison of physical and mechanical properties of mineral trioxide aggregate and Biodentine. Indian J Dent Res 25:692. https://doi.org/10.4103/0970-9290.152163\u003c/li\u003e\n\u003cli\u003ePlasmans P, Creugers N, Mulder J (1998) Long-term survival of extensive amalgam restorations. J Dent Res 77:453-460. https://doi.org/10.1177/00220345980770030401\u003c/li\u003e\n\u003cli\u003eEklund SA (2010) Trends in dental treatment, 1992 to 2007. J Am Dent Assoc 141:391-399. https://doi.org/10.14219/jada.archive.2010.0191\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Materials Used in the Study\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"665\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaterials\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eContent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTetric N-Ceram\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(Ivoclar Vivadent, Schaan, Liechtenstein)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eNanohybrid composite resin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eBis-GMA, UDMA, TEGDMA\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eBis-EMA, Barium glass,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYtterbium Trifluoride, Mixed oxide\u003c/p\u003e\n \u003cp\u003eSilicon dioxide, Prepolymers\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFiltek One Bulk-Fill Restorative\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(3M ESPE, Seefeld, Germany)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eHigh-viscosity bulk-fill composite resin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eUDMA, 1,12-DDMA, AFM, AUDMA (CQ), 20 nm silica, 4\u0026ndash;11 nm zirconia, ytterbium trifluoride filler consisting of agglomerate 100 nm particles\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;SDR Plus Bulk Fill Flowable\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(Dentsply, Milford, DE, USA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eLow-viscosity bulk-fill composite resin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eTEGDMA, EBADMA, UDMA\u003c/p\u003e\n \u003cp\u003eEBPADMA, Barium\u003c/p\u003e\n \u003cp\u003eStrontium aluminofluorosilicate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEver-X Posterior\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(GC, Leuven, Belgium)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eFiber-reinforced high-viscosity bulk-fill composite resin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eBis-GMA, PMMA, TEGDMA\u003c/p\u003e\n \u003cp\u003eShort E-type glass fiber filler\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Barium glass\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eG-aenial Universal Injectable\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(GC Corporation, Tokyo, Japan)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eHigh viscosity flowable composite resin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eUDMA, Bis-MEPP, TEGDMA\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSilicon dioxide, Strontium glass\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFuji II LC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(GC Corporation, Tokyo, Japan)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eResin-modified glass ionomer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003ePowder: Fluoroalumino silicate glass\u003cbr\u003eLiquid: Polyacrylic acid, Maleic acid, HEMA, Water, CQ.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiodentine\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(Septodont, France)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eCalcium silicate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eTricalcium silicate, Calcium oxide, Calcium carbonate, Zirconium oxide, Iron oxide, Water, Calcium chloride\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClearfil SE Bond\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003c/strong\u003eKuraray, Tokyo, Japan)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e2-step Self-etch Adhesive System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003ePrimer: Water, MDP, HEMA, CQ, DET, Hydrophilic DMA\u003c/p\u003e\n \u003cp\u003eBond: MDP, BisGMA, HEMA, Hydrophilic DMA, CQ, DET, Silanized Colloidal Silica\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eDeflection values of the groups at 5 minutes, 24 hours, and 48 hours post-restoration\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"575\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLOWER LAYER\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMEASUREMENT TIMES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUPPER LAYER\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 128px;\"\u003e\n \u003cp\u003eTest Statistics\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003eFiltek One\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003eTetric N-Ceram\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cem\u003ese\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cem\u003esh\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eG-aenial UI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eDk5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e51,8\u003cem\u003e\u003csup\u003ea,xy\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e1,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e48,7\u003cem\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e1,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,814\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eS24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e35,0\u003cem\u003e\u003csup\u003eb,xy\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e34,3\u003cem\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,831\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eS48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e26,0\u003cem\u003e\u003csup\u003ec,xy\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e26,7\u003cem\u003e\u003csup\u003ec\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cem\u003eTest Statistics\u003c/em\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e=1008,3; \u003cem\u003ep\u003c/em\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e=976,7; \u003cem\u003ep\u003c/em\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEverX\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eDk5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e49,4\u003cem\u003e\u003csup\u003ea,x\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e1,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e52,2\u003cem\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e1,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5,124\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,025\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eS24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e34,9\u003cem\u003e\u003csup\u003eb,x\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e38,3\u003cem\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5,146\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,025\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eS48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e27,2\u003cem\u003e\u003csup\u003ec,x\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e29,8\u003cem\u003e\u003csup\u003ec\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5,129\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,025\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cem\u003eTest Statistics\u003c/em\u003e\u003csup\u003e\u0026nbsp;\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e=1011,9; \u003cem\u003ep\u003c/em\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e=1192,5; \u003cem\u003ep\u003c/em\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;SDR Plus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eDk5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e48,6\u003csup\u003ea,y\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e1,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e49,5\u003cem\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e1,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1,587\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eS24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e31,7\u003csup\u003eb,y\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e33,4\u003cem\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1,569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,213\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eS48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e23,7\u003cem\u003e\u003csup\u003ec,y\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e24,9\u003cem\u003e\u003csup\u003ec\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1,582\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,211\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cem\u003eTest Statistics\u003c/em\u003e\u003csup\u003e\u0026nbsp;\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e=855,2; \u003cem\u003ep\u003c/em\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e=922,1; \u003cem\u003ep\u003c/em\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFuji II LC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eDk5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e51,6\u003cem\u003e\u003csup\u003ea,y\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e1,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e52,3\u003cem\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e1,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1,071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,303\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eS24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e33,3\u003cem\u003e\u003csup\u003eb,y\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e34,0\u003cem\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1,069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,303\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eS48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e23,8\u003cem\u003e\u003csup\u003ec,y\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e25,1\u003cem\u003e\u003csup\u003ec\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1,061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,305\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cem\u003eTest Statistics\u003c/em\u003e\u003csup\u003e\u0026nbsp;\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e=921,4; \u003cem\u003ep\u003c/em\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e=976,9; \u003cem\u003ep\u003c/em\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiodentine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eDk5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e49,6\u003cem\u003e\u003csup\u003eb,xy\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e1,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e49,7\u003cem\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e1,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e3,307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eS24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e32,0\u003cem\u003e\u003csup\u003ec,xy\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e32,2\u003cem\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e3,309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eS48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e22,9\u003cem\u003e\u003csup\u003ed,xy\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e23,2\u003cem\u003e\u003csup\u003ec\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e3,318\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cem\u003eTest Statistics\u003c/em\u003e\u003csup\u003e\u0026nbsp;\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e=853,9; \u003cem\u003ep\u003c/em\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e=863,2; \u003cem\u003ep\u003c/em\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFiltek One / Tetric \u0026nbsp; \u0026nbsp; \u0026nbsp; N-Ceram\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eDk5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e51,8\u003cem\u003e\u003csup\u003ea,xy\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e1,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e53,3\u003cem\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e1,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,963\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,328\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eS24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e32,2\u003cem\u003e\u003csup\u003eb,xy\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e34,8\u003cem\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,982\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,324\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eS48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e22,8\u003cem\u003e\u003csup\u003ec,xy\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e25,8\u003cem\u003e\u003csup\u003ec\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,989\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0,322\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cem\u003eTest Statistics\u003c/em\u003e\u003csup\u003e\u0026nbsp;\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e=893,3; \u003cem\u003ep\u003c/em\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e=1022,8; \u003cem\u003ep\u003c/em\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cem\u003eTest İstatistikleri\u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003csub\u003eDk5\u003c/sub\u003e\u003c/em\u003e=5,224; \u003cem\u003ep\u003c/em\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003csub\u003eDk5\u003c/sub\u003e\u003c/em\u003e=1,864; \u003cem\u003ep\u003c/em\u003e=0,105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003csub\u003eS24\u003c/sub\u003e\u003c/em\u003e=5,158; \u003cem\u003ep\u003c/em\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003csub\u003eS24\u003c/sub\u003e\u003c/em\u003e=1,808; \u003cem\u003ep\u003c/em\u003e=0,116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003csub\u003eS48\u003c/sub\u003e\u003c/em\u003e=5,148; \u003cem\u003ep\u003c/em\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003csub\u003eS48\u003c/sub\u003e\u003c/em\u003e=1,796; \u003cem\u003ep\u003c/em\u003e=0,118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cimg width=\"8\" height=\"24\" src=\"data:image/png;base64,R0lGODlhCAAYAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAIAAgAGABIAhAAAAAAAAAAAOgAAZgA6ZgA6kABmtjoAADoAOmYAOmY6OmZmkJA6AJA6ZpBmkJDb25Db/7ZmALb//9uQOtvbkNvbttv////bkP/btv//tv//2wECAwECAwECAwECAwECAwUpIABoTDCIaKqubOu+7HUUVqY5VfI0IklAqIkBdVHQAJgFBfGIECQkQQgAOw==\" alt=\"image\"\u003e: Mean, \u003cem\u003ese\u003c/em\u003e: Standard error\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e: Comparison of deflection values in the lower layers with respect to the upper layers at each measurement time,\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e: Comparison of deflection values of each lower layer within each upper layer according to measurement times,\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u0026amp;\u003c/sup\u003e: Comparison of deflection values at each measurement time within each upper layer with respect to the lower layers,\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eF\u003csub\u003eDk5\u003c/sub\u003e\u003c/em\u003e: 5th Minute, \u003cem\u003eF\u003csub\u003eS24\u003c/sub\u003e\u003c/em\u003e: 24th Hours, \u003cem\u003eF\u003csub\u003eS48\u003c/sub\u003e\u003c/em\u003e: 48th Hours.\u003c/p\u003e\n\u003cp\u003eSuperscripts \u003cem\u003ea, b,\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;c\u003c/em\u003e indicate the difference between each measurement time in each upper layer for each lower layer. Superscripts \u003cem\u003ex\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;y\u003c/em\u003e indicate differences between lower layers at each measurement time within each upper layer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eComparison of the Fracture Strengths of Positive and Negative Control Groups with Other Study Groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"469\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eFracture Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eTest Statistics \u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cimg width=\"7\" height=\"23\" src=\"data:image/png;base64,R0lGODlhBwAXAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAIAAgAFABEAhAAAAAAAAAA6kABmkDoAOjqQ22Zmtma2/5A6AJBmZpCQ25Db/7ZmANuQOtu2Ztv///+2Zv/bkP//tv//2wECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwUhIDAhQQGcaKqubOuuTnBMktIMyRkRi84DEQOjwBA8IIEQADs=\" alt=\"image\"\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003ese\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 1\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(Pozitive Control)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e951,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e37,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"14\" style=\"width: 85px;\"\u003e\n \u003cp\u003e17,785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"14\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 2\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(Negative Control)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e325,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e16,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 3\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(G-aenial UI + Filtek One)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e813,6\u003csup\u003e\u0026dagger;*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e34,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 4\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(EverX + Filtek One)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e886,3\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e44,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 5\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(SDR Plus + \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Filtek One)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e834,2\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e33,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 6\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(Fuji II LC + \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Filtek One)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e528,7\u003csup\u003e\u0026dagger;*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e36,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 7\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(Biodentin + Filtek One)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e501,6\u003csup\u003e\u0026dagger;*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e36,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 8\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFiltek One + Filtek One)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e675,1\u003csup\u003e\u0026dagger;*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e32,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 9\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(G-aenial UI + Tetric N-Ceram)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e703,5\u003csup\u003e\u0026dagger;*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e56,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 10\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(EverX+Tetric N-Ceram)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e685,0\u003csup\u003e\u0026dagger;*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e59,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 11\u003c/strong\u003e (SDR Plus + Tetric N-Ceram)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e667,2\u003csup\u003e\u0026dagger;*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e24,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 12\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(Fuji II LC + Tetric N-Ceram)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e517,7\u003csup\u003e\u0026dagger;*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e57,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 13\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(Biodentin + Tetric N-Ceram)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e482,1\u003csup\u003e\u0026dagger;*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e50,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 14\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(Tetric N-Ceram +Tetric N-Ceram)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e634,0\u003csup\u003e\u0026dagger;*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e36,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cimg width=\"8\" height=\"24\" src=\"data:image/png;base64,R0lGODlhCAAYAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAIAAgAGABIAhAAAAAAAAAAAOgAAZgA6ZgA6kABmtjoAADoAOmYAOmY6OmZmkJA6AJA6ZpBmkJDb25Db/7ZmALb//9uQOtvbkNvbttv////bkP/btv//tv//2wECAwECAwECAwECAwECAwUpIABoTDCIaKqubOu+7HUUVqY5VfI0IklAqIkBdVHQAJgFBfGIECQkQQgAOw==\" alt=\"image\"\u003e: Mean, se: Standard error, \u0026amp;: One-Way Analysis of Variance, \u003csup\u003e\u0026dagger;\u003c/sup\u003e: Groups different from the negative control, *Groups different from the positive control\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eComparison of the Fracture Strength of Groups According to the Lower and Upper Layers\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"527\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLOWER LAYER\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUPPER LAYER\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003eTest Statistics\u003csup\u003e\u0026nbsp;\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003eFiltek One\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003eTetric N-Ceram\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cimg width=\"8\" height=\"24\" src=\"data:image/png;base64,R0lGODlhCAAYAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAIAAgAGABIAhAAAAAAAAAAAOgAAZgA6ZgA6kABmtjoAADoAOmYAOmY6OmZmkJA6AJA6ZpBmkJDb25Db/7ZmALb//9uQOtvbkNvbttv////bkP/btv//tv//2wECAwECAwECAwECAwECAwUpIABoTDCIaKqubOu+7HUUVqY5VfI0IklAqIkBdVHQAJgFBfGIECQkQQgAOw==\" alt=\"image\"\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cem\u003ese\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cimg width=\"8\" height=\"24\" src=\"data:image/png;base64,R0lGODlhCAAYAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAIAAgAGABIAhAAAAAAAAAAAOgAAZgA6ZgA6kABmtjoAADoAOmYAOmY6OmZmkJA6AJA6ZpBmkJDb25Db/7ZmALb//9uQOtvbkNvbttv////bkP/btv//tv//2wECAwECAwECAwECAwECAwUpIABoTDCIaKqubOu+7HUUVqY5VfI0IklAqIkBdVHQAJgFBfGIECQkQQgAOw==\" alt=\"image\"\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cem\u003ese\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eG-aenial UI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e813,6\u003cem\u003e\u003csup\u003ex\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e43,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e703,5\u003cem\u003e\u003csup\u003ex\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e43,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e3,235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0,074\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eEverX\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e886,3\u003cem\u003e\u003csup\u003ex\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e43,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e685,0\u003cem\u003e\u003csup\u003ex\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e43,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e10,796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eSDR Plus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e834,2\u003cem\u003e\u003csup\u003ex\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e43,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e667,2\u003cem\u003e\u003csup\u003ex\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e43,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e7,427\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eFuji II LC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e528,7\u003cem\u003e\u003csup\u003ey\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e43,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e517,7\u003cem\u003e\u003csup\u003eyz\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e43,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0,032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0,858\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eBiodentin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e501,6\u003cem\u003e\u003csup\u003ey\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e43,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e482,1\u003cem\u003e\u003csup\u003ez\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e43,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0,101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0,751\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eFiltek One/Tetric N-Ceram\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e675,1\u003cem\u003e\u003csup\u003ez\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e43,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e634,0\u003cem\u003e\u003csup\u003exy\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e43,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0,449\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0,504\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cem\u003eTest Statistics\u0026nbsp;\u003c/em\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e=14,354; \u003cem\u003ep\u003c/em\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e=4,575; \u003cem\u003ep=\u003c/em\u003e\u003cstrong\u003e0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cimg width=\"8\" height=\"24\" src=\"data:image/png;base64,R0lGODlhCAAYAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAIAAgAGABIAhAAAAAAAAAAAOgAAZgA6ZgA6kABmtjoAADoAOmYAOmY6OmZmkJA6AJA6ZpBmkJDb25Db/7ZmALb//9uQOtvbkNvbttv////bkP/btv//tv//2wECAwECAwECAwECAwECAwUpIABoTDCIaKqubOu+7HUUVqY5VfI0IklAqIkBdVHQAJgFBfGIECQkQQgAOw==\" alt=\"image\"\u003e: Mean, sh: Standard error \u003csup\u003e\u0026dagger;\u003c/sup\u003e: Comparison of upper layers within each lower layer, \u003csup\u003e\u0026Dagger;\u003c/sup\u003e: Comparison of lower layers within each upper layer, superscripts \u003cem\u003ex\u003c/em\u003e, \u003cem\u003ey\u003c/em\u003e ve \u003cem\u003ez\u003c/em\u003e indicate comparisons of lower layers within each upper layer. Lower layers with the same letters are statistically similar.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u0026nbsp;\u003c/strong\u003eDistribution of Fracture Types among Groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"621\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eExperimental Groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMOD 1 \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMOD 2 \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMOD 3 \u0026nbsp; \u0026nbsp;N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMOD 4 \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMOD 5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 1\u0026nbsp;\u003c/strong\u003e (Positive Control Group)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e3 (25,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e4 (33,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e5 (41,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 2\u0026nbsp;\u003c/strong\u003e (Negative Control Group)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e3 (25,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e5 (41,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e4 (33,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 3\u003c/strong\u003e (G-aenial UI + Filtek One)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e3 (25,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e2 (16,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e7 (58,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 4\u003c/strong\u003e (Ever X + Filtek One)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1 (8,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1 (8,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1 (8,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (25,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e6 (50,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 5\u003c/strong\u003e (SDR Plus + Filtek One)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e2 (16,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1 (8,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n 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95px;\"\u003e\n \u003cp\u003e4 (33,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e6 (50,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 9\u003c/strong\u003e (G-aenial UI + Tetric N-Ceram)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e2 (16,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e2 (16,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e3 (25,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e5 (41,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 10\u003c/strong\u003e (EverX Posterior + Tetric N-Ceram)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e3 (25,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1 (8,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e2 (16,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e6 (50,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 11\u003c/strong\u003e (SDR Plus + Tetric N-Ceram)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1 (8,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e2 (16,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e9 (75,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 12\u003c/strong\u003e (Fuji II LC + Tetric N-Ceram)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1 (8,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1 (8,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e2 (16,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e8 (66,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 13\u003c/strong\u003e (Biodentin + Tetric N-Ceram)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1 (8,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e11 (91,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 14\u003c/strong\u003e (Tetric N-Ceram + Tetric N-Ceram)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1 (8,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1 (8,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (25,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e7 (58,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e15 (8,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e14 (8,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e8 (4,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e28 (16,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e103 (61,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Bulk fill composite resin, Cuspal deflection, Fiber-reinforced composite resin, Flowable composite, Fracture resistance, Glass ionomer","lastPublishedDoi":"10.21203/rs.3.rs-6189355/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6189355/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e This study evaluated the effects of restorations using varied materials and their combinations on cuspal deflection and fracture resistance of endodontically treated MOD cavitated maxillary premolars.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and methods: \u003c/strong\u003e168 premolar teeth were used in the study. MOD cavities were prepared, and endodontic treatments were performed. Subsequently, the teeth were divided into 14 groups. Group 1 was the positive control (healthy teeth), and Group 2 was the negative control (MOD cavity only). In Groups 3-7 and Groups 9-13, EverX Posterior, SDR Plus Bulk Fill Flowable, G-aenial Universal Injectable, Biodentine, and Fuji II LC were used as the base layer, respectively. In Groups 3-7, Filtek One Bulk-Fill Restorative was used as the top layer, while in Groups 9-13, Tetric N-Ceram was used. Group 8 was entirely restored with Filtek One Bulk-Fill Restorative and Group 14 with Tetric N-Ceram. Cusp deflection was measured. Fracture resistance testing was performed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Within each group, there was a statistically significant decrease in cusp deflection change values at all measured time points (p \u0026lt;0.05). In intergroup comparisons, significant differences were found in cusp deflection change values at all times only in groups where EverX Posterior was applied as the base layer (p \u0026lt;0.05). In the groups where Filtek One was used, differences were seen between the groups at all times (p\u0026lt;0.05).Groups 4 and 5 exhibited fracture resistance similar to the positive control group (p\u0026gt;0.05). In the comparison between groups, a significant difference was seen in terms of fracture strength only in the groups where EverX Posterior and SDR Plus Bulk Fill Flowable were used as the substrate (p \u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003eDifferent materials and combinations of these materials produced different fascial deflection and fracture strength endodontically treated teeth.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Relevance: \u003c/strong\u003eWhen performing coronal restoration of an endodontically treated tooth, it is recommended to select and use the appropriate restorative material, taking into account the position of the tooth in the mouth and the amount of material loss.\u003c/p\u003e","manuscriptTitle":"Evaluation of Cuspal Deflection and Fracture Strength of Endodontically Treated Teeth Restored with Different Restorative Material Combinations","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-21 17:22:59","doi":"10.21203/rs.3.rs-6189355/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-22T02:09:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-18T09:03:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-08T20:48:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"198218110434981621221491741210869304802","date":"2025-04-06T08:19:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"105655448155819282441827447310224766058","date":"2025-04-01T10:51:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-01T03:15:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-14T07:16:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-14T07:14:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"Clinical Oral Investigations","date":"2025-03-09T14:55:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"31a69a45-52f6-4b7f-bbe0-db20d7a3548a","owner":[],"postedDate":"April 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-14T16:02:24+00:00","versionOfRecord":{"articleIdentity":"rs-6189355","link":"https://doi.org/10.1007/s00784-025-06452-9","journal":{"identity":"clinical-oral-investigations","isVorOnly":false,"title":"Clinical Oral Investigations"},"publishedOn":"2025-07-09 15:57:32","publishedOnDateReadable":"July 9th, 2025"},"versionCreatedAt":"2025-04-21 17:22:59","video":"","vorDoi":"10.1007/s00784-025-06452-9","vorDoiUrl":"https://doi.org/10.1007/s00784-025-06452-9","workflowStages":[]},"version":"v1","identity":"rs-6189355","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6189355","identity":"rs-6189355","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}