Fracture Resistance of Endodontically Treated Teeth with Class II Restorations Restored with New Short Fiber-reinforced Composite: An in-vitro study
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Abstract This study aimed to evaluate the fracture resistance of endodontically treated teeth restored with new short fiber-reinforced composite (SFRC) restorations and compared it with flowable bulk-fill composite when used in the same way. Forty extracted first maxillary premolars were collected and distributed randomly into four groups (n = 10). Root Canal Treatments and MOD coronal preparations were done in three groups since group 1 had solid teeth. Two groups were restored with one of the study materials, group 3 was restored with Ever X Flow composite, and group 4 was restored with tetric n-flow bulk fill, whereas group 2 was left without canal obturation or coronal restoration. Composites were applied in a 4 mm layer, and a conventional composite layer was applied in a 2 mm thickness as an enamel replacement. Compression load test was done for all groups, and then data were analyzed with one-way ANOVA and Bonferroni tests. Results showed that the Ever X Flow group had the highest mean of the compression load test, significantly different from group 2, and not significantly different from the other two groups (p > 0.05). The use of flowable SFRC as a restorative material without using fiber posts or other cores may achieve a good result and enhance the fracture resistance of treated teeth.
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Fracture Resistance of Endodontically Treated Teeth with Class II Restorations Restored with New Short Fiber-reinforced Composite: An in-vitro study | 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 Article Fracture Resistance of Endodontically Treated Teeth with Class II Restorations Restored with New Short Fiber-reinforced Composite: An in-vitro study Bashar sairafi, Alaa Farran This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4584220/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This study aimed to evaluate the fracture resistance of endodontically treated teeth restored with new short fiber-reinforced composite (SFRC) restorations and compared it with flowable bulk-fill composite when used in the same way. Forty extracted first maxillary premolars were collected and distributed randomly into four groups (n = 10). Root Canal Treatments and MOD coronal preparations were done in three groups since group 1 had solid teeth. Two groups were restored with one of the study materials, group 3 was restored with Ever X Flow composite, and group 4 was restored with tetric n-flow bulk fill, whereas group 2 was left without canal obturation or coronal restoration. Composites were applied in a 4 mm layer, and a conventional composite layer was applied in a 2 mm thickness as an enamel replacement. Compression load test was done for all groups, and then data were analyzed with one-way ANOVA and Bonferroni tests. Results showed that the Ever X Flow group had the highest mean of the compression load test, significantly different from group 2, and not significantly different from the other two groups (p > 0.05). The use of flowable SFRC as a restorative material without using fiber posts or other cores may achieve a good result and enhance the fracture resistance of treated teeth. Health sciences/Health care Health sciences/Medical research Physical sciences/Materials science Endodontically Treated Teeth MOD cavities Ever X Flow Flowable Bulk Fill Composite Short Fiber-Reinforced Composite. Figures Figure 1 Figure 2 Figure 3 1. Introduction The incidence rate of fracture of teeth restored by class II composite restorations is greater than that of those restored by class I composite restorations, ]1[. In class II cavities, the marginal ridges are lost and the remaining tooth structure has significantly decreased. Therefore, the tooth strength is significantly decreased [ 2 ]. On the other hand, the tooth's strength is known to reduce significantly after the root canal treatment. This decrease in loss of strength is due to many reasons, including caries, trauma, loss of tooth structure, cusps, ridges, and the arching roof of the pulp chamber and radicular mechanical preparation; moreover, the chemical preparation of root canal system and medicaments applied to it influence the fracture of those teeth ]3[. Many techniques suggested to restore endodontically treated teeth, amalgam restorations, endocrowns, crowns, onlayes, fiber posts, and adhesive restorations ]4[. Bonded composites can increase the fracture resistance of endodontically treated teeth and recently, fiber-reinforced resin composite was an introduced as alternative to dentine because of its structure which resembles the structure of natural dentine, which is rich with fibers ]5[. This study aimed to evaluate the fracture resistance of endodontically treated teeth restored with new short fiber-reinforced composite (SFRC) restorations and compare it with flowable bulk-fill composite when used in the same way when used in Upper Premolars. 2. Materials and Methods Sample Criteria : This is an in-vitro study that depends on a mechanical test (compression load test). Forty mature upper first premolars free of any cracks, defects, caries, or restorations, extracted by undergraduate students at orthodontics department at Arab Private University of Science and Technology (AUST) because of orthodontic reasons, were selected after the approved of ethics committee at AUST depending on checking the ethical standards of scientific research, as well as the informed consent was obtained from all participants or their legal guardians. Teeth were stored in saline and then divided randomly into four equal groups (n = 10). Methods : A total of 40 premolars were scaled and then stored in a saline solution for 24 hours. After that, the samples were divided randomly into 4 equal groups (n = 10) and fixed in acrylic cubes (2×2×2 cm): Group 1: Sound Upper First Premolars without any restorations or Root canal treatment. Group 2: Class II (MOD) cavity preparations and endodontically treated Upper First Premolars without canal obturation or coronal restorations. Group 3: Class II (MOD) cavity restored with Ever X Flow composite and endodontically treated Upper First Premolars. Group 4: Class II (MOD) cavity restored with Tetric-N Flow Bulkfill composite and endodontically treated Upper First Premolars. The cavity design of class II preparations was based on traditional preparation technique with equal dimensions; the depth from the gingival floor to the occlusal surface was 6 mm and the buccal-palatal width was 2 mm. On the other hand, root canal treatment depended on one cone technique with ADSEAL® sealer and the used gutta- percha cones was 4% tapered with a size of 25#. Details of restoration materials used in this study are given in Table 1 : Table 1 Restorations Materials used in the study Product Name Type Manufacturer Components Lot Number Shade Ever X Flow Short-Fiber Reinforced Composite for Dentin Replacement GC Corporation Tokyo, Japan Bis-MEPP, TEGDMA, UDMA, E-glass Fiber, Barium Glass, Silicon Dioxide 2209161 B Tetric® N- Flow Bulkfill Flowable Bulkfill Composite for Dentin Replacement Ivocalr Vivadent Schaan, Liechtenstein Bis-GMA, UDMA, barium glass fillers, YbF3, mixed oxides, silicon dioxide Z04XLY Iv A Tetric® N-Ceram Composite for Anterior and Posterior Restorations Ivocalr Vivadent Schaan, Liechtenstein Bis-GMA, urethane dimythacrylate, TEGDMA, barium glass, ytterbium trifluoride, Silicon Dioxide, mixed oxide, initiators, stabilizers, pigments Z03D8P B2 Tetric® N-Bond Universal Light curing single-component dental adhesive Ivocalr Vivadent Schaan, Liechtenstein Methacrylate, ethanol, water, silicon dioxide, initiators and stabilizers Z0591C ــــ N- Etch Etching acid Ivocalr Vivadent Schaan, Liechtenstein Phosphoric acid 37% Z05W0S ــــ Bis-GMA, bisphenylglycidyl dimethacrylate; UDMA, diurethane dimethacrylate; TEGDMA, triethylene glycol dumethacrylate; Outline form design of MOD class II cavities was made using pencil on the tooth, gingival depth is 6 mm in the box cavity, access cavity was prepared with cylindrical diamond burs size 2# changed after each of five prepared cavities, the steps of root canal treatment (RCT) were done under the same conditions, RCTs and restorations were done by same operator, and then teeth were restored by the one of type of composite used in this study after applying Resin Modified Glass Ionomer (RMGI) as a base and barrier between Root Canal Obturation and Composite restorations. To restore teeth, manufacturer instructions were applied. The Selective etch technique was chosen to apply etching acid for 30 seconds on the enamel. After rinsing the acid for 20 seconds and drying the water gently, the first layer of self-bond was applied by a bond brush with massaging movement for 20 seconds and drying gently for 5 seconds. After that, the second layer was applied in the same steps and light curing for 30 seconds. Ever X Flow was applied by the syringe at a depth of 4 mm and light-cured for 40 seconds. The same technique for Tetric N-Flow Bulkfill. The last layer from the composite was Tetric N-Ceram for two groups, and it was applied as a replacement for enamel. All methods were performed in accordance with the relevant guidelines and Helsinki declaration. Mechanical Test : For the fracture resistance test, the compression load test which is used to demonstrate how a material will respond to compression was done for all 40 samples by Tinius Olsen H50KS testing machine, the machine has been operated at a speed of 1 mm/min with a load cell 5 K after fixing the samples on the machine by securing screws Fig. 1 . Results were recorded in Newton (N) when the sample fractured (tooth structure or restorative material) and this has been the failure mode point. Statistical Analysis : The Data were statistically analyzed with SPSS version 25 (SPSS, IBM Corp.) using analysis of variance (one-way ANOVA) at p < 0.05 significance level by a Bonferroni test to determine the differences between the groups. Results The results of all tested samples were summarized in Table 2 : Sample number Group 1 Normal Teeth (N) Group 2 RCT Teeth (N) Group 3 Ever X Flow (N) Group 4 Tetric N Flow (N) 1 437.3 153.3 378.8 534 2 778 178.4 788 1256 3 1478 251 947 269.2 4 910 147.7 595 927 5 479.5 149 945 658 6 855 247.7 867 697 7 338 269.7 1138 1283 8 622 148.3 1072 417.5 9 541 148.7 911 251.3 10 626 202 455 313 Table 2: The results of the compression load test for all samples (Newton) The mean value of the compression load test with standard deviation (SD) was summarized in Table 3 . Groups Mean (N) N SD (N) Minimum (N) Maximum (N) Group 1 ( Normal Teeth) 706.4800 10 327.37841 338.00 1478.00 Group 2 (RCT Teeth) 189.5800 10 49.37491 147.70 269.70 Group 3 (Ever X Flow) 809.6800 10 255.02471 378.80 1138.00 Group 4 (Tetric-N Flow Bulkfill) 660.6000 10 384.54229 251.30 1283.00 Total 591.5850 40 364.23780 147.70 1478.00 Table 3: The Mean values and standard deviation of study groups A one-way ANOVA test showed a significant difference among the groups (p= 0.000). The Bonferroni test was used to determine the difference between the two groups. Table 4 summarizes the results of the Bonferroni test. Fig 2 illustrates the Mean values and standard deviation of study groups and shows the result of the Bonferroni test. Multiple Comparisons Groups (I) Groups (J) Mean Difference (I-J) (N) Std. Error P Value 95% Confidence Interval Lower Bound Upper Bound Normal Teeth RCT Teeth 516.90000 * 126.98915 .001 162.3499 871.4501 Ever X FLow -103.20000- 126.98915 1.000 -457.7501- 251.3501 Tetric-N Flow Bulkfill 45.88000 126.98915 1.000 -308.6701- 400.4301 RCT Teeth Normal Teeth -516.90000- * 126.98915 .001 -871.4501- -162.3499- Ever X FLow -620.10000- * 126.98915 .000 -974.6501- -265.5499- Tetric-N Flow Bulkfill -471.02000- * 126.98915 .004 -825.5701- -116.4699- Ever X FLow Normal Teeth 103.20000 126.98915 1.000 -251.3501- 457.7501 RCT Teeth 620.10000 * 126.98915 .000 265.5499 974.6501 Tetric-N Flow Bulkfill 149.08000 126.98915 1.000 -205.4701- 503.6301 Tetric-N Flow Bulkfill Normal Teeth -45.88000- 126.98915 1.000 -400.4301- 308.6701 RCT Teeth 471.02000 * 126.98915 .004 116.4699 825.5701 Ever X FLow -149.08000- 126.98915 1.000 -503.6301- 205.4701 *. The mean difference is significant at the 0.05 level. Table 4: Bonferroni test results to compare each couple of groups The Bonferroni test showed that there is a significant difference between the RCT Group and all other groups; on the other hand, there is no significant difference among the other three groups (Group 1, Group 3, and Group 4). The Ever X Flow group had the highest mean compression load test, with significantly different from the RCT Teeth group; and without significantly different other two groups (Group 1 and Group 4), whereas, the Tetric- N Flow Bulkfill Group had the lowest mean of compression load test, with a significantly different with RCT Teeth group, and without significant difference other two groups (Group 1 and Group 3). Discussion Root Canal Treatment causes stress concentration along the root and weakens its structure ] 6 [ , especially, when rotary instrumentations are used because of its high rotation ] 7 [ . In addition, studies show better longevity for endodontically treated teeth when they have more walls, a study illustrates superior survival for teeth with loss of 1–3 surfaces when compared with those with more than 3 lost surfaces ] 8 [ . Moreover, the restorations of these teeth must achieve retention without promoting damage to the remaining dental tissue, and they must prevent bacterial microleakage and possible root or crown fractures ] 9 [ , many authors suggest that using fiber posts in maxillary premolars is indicated because of many factors, as the small volume of its pulp chamber, small diameter of its roots, and because of the mixture of forces exposed these teeth as shear and compressive forces ] 10 [ , this study did not used fiber post to restore endodontically treated teeth, instead of that it evaluated the Ever X Flow when used in the same cases. On the other hand, Class II Cavities design effect on the strength of tooth, Bonilla et al. study has investigated that one of the primary causes of failure of class II resin composite restorations are tooth fracture or restoration fracture ] 11 [ , obviously, when the isthmus width increase from 1/4 to 1/3 intercuspal distance, there is a significant weakening of the prepared tooth ] 12 [ , besides, studies suggest that MOD cavity preparation in upper premolars leads to a 63% mean loss relative cuspal stiffness ] 13 [ , whereas the loss of only one marginal ridge cause mean loss of 46%, therefore, the restoration material should show similar physicochemical properties to the replaced dental tissues and boost the dental structure and enhance the strength of prepared tooth, especially the modulus of elasticity ] 12 [ ] 14 [ , resin composite can used as a restorative material for these kind of cavities, composite restorations suffer from polymerization shrinkage stress as a main cause of failure, therefore, many approaches have investigated to solve this problem, one of them is using bulk-fill composite instead of traditional composite in deep cavities ] 15 [ . Short fiber-reinforced composite (SFRC) materials are a new approach to restoring endodontically treated teeth, and it seems that they can enhance the strength of treated teeth and solve the problem of lack of the toughness of traditional direct composite restorations ] 16 [ . SFRC materials are made of a polymer matrix charged with fibers that, on the one hand, rummage the stress throughout the restoration, and on the other hand, fibers act as a crack stopper or stress breaker that improves the structural material and enhances the strength of teeth ] 17 [ . This study has been designed to evaluate the effect of Ever X Flow composite, which is one of the new types of SFRC when used as restoration material in endodontically treated teeth with MOD cavities, and compare it with traditional bulk-fill flowable composite when used in the same cases. Moreover, this study has been conducted on the first upper Premolar, because of its anatomical shape and because of the easiness of getting it, and this matches many studies ] 18 [ ] 19 [ ] 20 [ . Compression load test, which was used in this study to evaluate the Ever X Flow effect when used as restoration material in endodontically treated teeth with MOD cavities and compare it with bulk-fill flow composite, was used in many studies ] 5 [ ] 20 [ ] 21 [ ] 22 [ . A compression test is a mechanical test used to determine the behavior of materials when subjected to compressive loads and give helpful insights into the mechanical properties of materials ] 23 [ . The results of this study showed that the group of Ever X Flow had highest fracture resistance with no significant difference when compared with packable flowable composite group, this result approved many other studies ] 19 [ ] 21 [ , on contrary, many studies showed significant difference between reinforced composite -which had the highest fracture resistance- and other types of composites ] 5 [ ] 18 [ , these difference with this study can be substantiated, on one hand, of the variation of restoration materials used in various studies, for example, farhanny et al. study had three groups two of them used conventional bulk-fill composite and the third one was Ever X Posterior, whereas this study used Ever X Flow composite and compared it with one type of bulk-fill flowable composite, on the other hand, of the difference coronal cavities design, lassila et al. study evaluate the fracture behavior of direct composite restorations made with two different composite core materials, whereas, MOD traditional preparation cavities used in this study. The highest fracture resistance value of Ever X Flow can be attributed to its specific composition, especially the integration among the resin matrix, the organic fillers, and the short e-glass fibers. Since, these fibers decrease the polymerization shrinkage stress of composites, and thus reduce the cuspal tension. In addition, these fibers can stop the cracks through the material structure ] 19 [ ] 24 [ . In addition, studies ensure that short fibers added to reinforced composites increase its flexural properties ] 25 [ , the length of Ever X Flow composite fibers is 200–300 µm and a diameter of 6 µm and these let Ever X Flow to mimic a dentine in a natural tooth ] 21 [ , Fig 3 shows Ever X Flow Composite substratum. According to the results of this study, the new flowable SFRC (Ever X Flow) may be used efficiently as a restorative material for endodontically treated teeth, and it can give treated teeth the same fracture resistance as intact teeth, this result should be followed by many other laboratory studies or clinical ones. Conclusion Within the limits of this study, it can be concluded that Ever X Flow improved fracture resistance in endodontically treated teeth as a bulk-fill flowable composite, and as solid teeth, this could suggest using Ever X Flow on posterior endodontically treated teeth instead of fiber posts and traditional cores. Declarations Author Contribution The two authors of this manuscript designed the way of study and did the lab procedures together, the main author is Bashar Sairafi who analyzed the data and wrote the manuscript , the co-autor mr Alaa Farran reviewed it with the main author. Data Avaibality: The data that support the findings of this study can be made available from the corresponding author, Bashar Sairafi, upon reasonable request. References Demarco FF, Corrêa MB, Cenci MS, Moraes RR, Opdam NJ. Longevity of posterior composite restorations: not only a matter of materials. Dent Mater. 2012. January; 28(1): 87– 101. López SG, Chinesta MVS, García LC, de HaroGasquet F, Rodríguez MPG. Influence of cavity type and size of composite restorations on cuspal flexure. Med Oral Patol Oral Cir Bucal. 2006. November 1; 11 (6): E536– 40. [PubMed] [Google Scholar] SelvarajH, KrithikadattaJ, ShrivastavaD, Al Onazi MA et al. Systematic review fracture resistance of endodontically treated posterior teeth restored with fiber reinforced composites- a systematic review. BMC Oral Health.2023. August; 23: 566. Bassir MM, Labibzadeh A and Mollaverdi F. The effect of amount of lost tooth structure and restorative technique on fracture resistance of endodontically treated premolars. J Conserv Dent. 2013 Sep-Oct; 16(5): 413–417. Gamal, W., Abdou, A. & Salem, G.A. Fracture resistance and flexural strength of endodontically treated teeth restored by different short fiber resin composites: a preclinical study. Bull Natl Res Cent 46, 276 (2022). Rippe MP, Santini MF, Bier CAS, Baldissara B, Valandro LF. Effect of root canal preparation, type of endodontic post and mechanical cycling on root fracture strength. J Appl Oral Sci. 2014;22(3):165-73. Bier CA, Shemesh H, Tanomaru-Filho M, Wesselink PR, Wu MK. The ability of different nickel-titanium rotary instruments to induce dentinal damage during canal preparation. J Endod. 2009; 35:236-8. Dammaschke T, Nykiel K, Sagheri D, Schafer E. Influence of coronal restorations on the fracture resistance of root canal-treated premolar and molar teeth: a retrospective study. 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Influence of resin-based composite restoration technique and endodontic access on cuspal deflection and cervical microleakage scores. J. Dent. 2013, 41; 216- 222. Conserva, E.; Consolo, U.; Gimenez, A.; Foschi, F.; Paolone, G.; Giovarrusscio, M.; Sauro, S. Stress distribution in carbon-post applied with different composite core materials: A three-dimensional finite element analysis. J. Adhes. Sci. Technol. 2017, 1, 2435–2444. Ferracane JL. Resin Composite state of the art. Dental materials. 2011; 27(1) 29- 38. Sáry T, Garoushi S, Braunitzer G, Alleman D, Volom A, Fráter M. Fracture behavior of MOD restorations reinforced by various fiber-reinforced techniques—An in vitro study. J. Mech. Behav. Biomed. Mater. 2019: 98; 348–356. Ilday N, Seven N. The influence of different fiber-reinforced composites on shear bond strengths when bonded to enamel and dentin structures. Journal of Dental Sciences. 2011: 6(2); 107-115. Kaur B, Gupta S, Grover R, Sadana G, Gupta T, Mehra M. Comparative Evaluation of Fracture Resistance of Endodontically Treated Teeth Restored with Different Core Build-up Materials: An In Vitro Study. Int J Clin Pediatr Dent. 2021 Jan-Feb;14(1):51-58. Farahanny W, Dennis D, Sihombing D. Fracture Resistance of Various Bulk-fill Composite Resins in Class II MOD Cavity on Premolars: An In Vitro Study. World journal of dentistry. 2019; 10(3): 166- 169. Guo YB, Bai W, Liang YH. Fracture resistance of endodontically treated teeth with cervical defects using different restorative treatments. J Dent Sci. 2022 Apr;17(2):842-847. Lassila L, Säilynoja E, Prinssi R, Vallittu P, Garoushi S. Characterization of a new fiber-reinforced flowable composite. Odontology. 2019 Jul;107(3):342-352. Atalay C, Yazici AR, Horuztepe A, Nagas E, Artan A, Ozgunaltay G. Fracture Resistance of Endodontically Treated Teeth Restored With Bulk Fill, Bulk Fill Flowable, Fiber-reinforced, and Conventional Resin Composite. Oper Dent (2016) 41 (5): E131–E140. Yanıkoğlu UD, Sakarya RE. Test methods used in the evaluation of the structure features of the restorative materials: a literature review. Journal of Materials Research and Technology.2020; 9(5): 9720-9734. Abouelleil H, Pradelle N, Villat C, Attik N, Colon P, Grosgogeat B. Comparison of mechanical properties of a new fiber reinforced composite and bulk filling composites. Restor Dent Endod. 2015 Nov;40(4):262-70. Benkhelladi A, Laouici H, Bouchoucha A. Tensile and flexural properties of polymer composites reinforced by flax, jute, and sisal fibres. J Adv Manuf Technol 2020; 108(3):895–916. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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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-4584220","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":321688343,"identity":"91482af8-8f97-4ce7-aaa2-f749acdf9590","order_by":0,"name":"Bashar sairafi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYBACAwYGNjADRH5IqACSzMwNRGthnJFwBqSFkUgtDCAtjG1gGr8Wc/bjzx783FMnzyd9+GHDw3m10fztQC0/Krbh1GLZk2Nu2PPssGEbX5phQ+K247kzDjM2MPacuY3bYQdy2CR4DhxgbONhMH+QuO1YbgNQCzNjGx4t558/k/xzoM6+jYf9Y0PinGO58wlquZFgJs1zgDmxjYcH6LCGmtwNhLRYznhjJi1z4HAyUEthQ8KxA7kbgVoO4vOLOX/6M8k3B+ps5/ewb2z8UVOXO+/84YMPflTg1oIODoPJA0SrB4I6UhSPglEwCkbBCAEAjcpeFkFnA40AAAAASUVORK5CYII=","orcid":"","institution":"Arab Private University for Science \u0026 Technology","correspondingAuthor":true,"prefix":"","firstName":"Bashar","middleName":"","lastName":"sairafi","suffix":""},{"id":321688344,"identity":"58efb963-fa78-4fe8-ba9a-85dd0553f071","order_by":1,"name":"Alaa Farran","email":"","orcid":"","institution":"Arab Private University for Science \u0026 Technology","correspondingAuthor":false,"prefix":"","firstName":"Alaa","middleName":"","lastName":"Farran","suffix":""}],"badges":[],"createdAt":"2024-06-14 22:38:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4584220/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4584220/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59903353,"identity":"2b767a23-98f5-4ad2-8711-d78c396590ae","added_by":"auto","created_at":"2024-07-09 06:17:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":169089,"visible":true,"origin":"","legend":"\u003cp\u003eCompression Load Test applied on a sample\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4584220/v1/c5d24a58b5593a3d2535dd1c.png"},{"id":59903352,"identity":"e318ad4a-6498-44ca-973c-738cf80062e5","added_by":"auto","created_at":"2024-07-09 06:17:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":18093,"visible":true,"origin":"","legend":"\u003cp\u003eBar graph illustrating the Mean values and standard deviation of study groups and showing the result of the Bonferroni test\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4584220/v1/bdce5da67675b945667c9f6b.png"},{"id":59903355,"identity":"63cf6bf5-7ab0-4ced-9800-4bb4c2a09395","added_by":"auto","created_at":"2024-07-09 06:17:45","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":104867,"visible":true,"origin":"","legend":"\u003cp\u003eEver X Flow Composite\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4584220/v1/ab94a9e264d854f0274241e6.png"},{"id":60044985,"identity":"e519a43d-8c28-4cd2-872e-6189058eb83a","added_by":"auto","created_at":"2024-07-11 04:16:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":699530,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4584220/v1/161cdfe5-cca8-4b36-8664-b2be3379ff3b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Fracture Resistance of Endodontically Treated Teeth with Class II Restorations Restored with New Short Fiber-reinforced Composite: An in-vitro study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe incidence rate of fracture of teeth restored by class II composite restorations is greater than that of those restored by class I composite restorations, ]1[. In class II cavities, the marginal ridges are lost and the remaining tooth structure has significantly decreased. Therefore, the tooth strength is significantly decreased [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOn the other hand, the tooth's strength is known to reduce significantly after the root canal treatment. This decrease in loss of strength is due to many reasons, including caries, trauma, loss of tooth structure, cusps, ridges, and the arching roof of the pulp chamber and radicular mechanical preparation; moreover, the chemical preparation of root canal system and medicaments applied to it influence the fracture of those teeth ]3[.\u003c/p\u003e \u003cp\u003eMany techniques suggested to restore endodontically treated teeth, amalgam restorations, endocrowns, crowns, onlayes, fiber posts, and adhesive restorations ]4[. Bonded composites can increase the fracture resistance of endodontically treated teeth and recently, fiber-reinforced resin composite was an introduced as alternative to dentine because of its structure which resembles the structure of natural dentine, which is rich with fibers ]5[.\u003c/p\u003e \u003cp\u003eThis study aimed to evaluate the fracture resistance of endodontically treated teeth restored with new short fiber-reinforced composite (SFRC) restorations and compare it with flowable bulk-fill composite when used in the same way when used in Upper Premolars.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003e \u003cb\u003eSample Criteria\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eThis is an in-vitro study that depends on a mechanical test (compression load test). Forty mature upper first premolars free of any cracks, defects, caries, or restorations, extracted by undergraduate students at orthodontics department at Arab Private University of Science and Technology (AUST) because of orthodontic reasons, were selected after the approved of ethics committee at AUST depending on checking the ethical standards of scientific research, as well as the informed consent was obtained from all participants or their legal guardians. Teeth were stored in saline and then divided randomly into four equal groups (n\u0026thinsp;=\u0026thinsp;10).\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethods\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eA total of 40 premolars were scaled and then stored in a saline solution for 24 hours. After that, the samples were divided randomly into 4 equal groups (n\u0026thinsp;=\u0026thinsp;10) and fixed in acrylic cubes (2\u0026times;2\u0026times;2 cm):\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eGroup 1: Sound Upper First Premolars without any restorations or Root canal treatment.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eGroup 2: Class II (MOD) cavity preparations and endodontically treated Upper First Premolars without canal obturation or coronal restorations.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eGroup 3: Class II (MOD) cavity restored with \u003cb\u003eEver X Flow\u003c/b\u003e composite and endodontically treated Upper First Premolars.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eGroup 4: Class II (MOD) cavity restored with \u003cb\u003eTetric-N Flow Bulkfill\u003c/b\u003e composite and endodontically treated Upper First Premolars.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe cavity design of class II preparations was based on traditional preparation technique with equal dimensions; the depth from the gingival floor to the occlusal surface was 6 mm and the buccal-palatal width was 2 mm. On the other hand, root canal treatment depended on one cone technique with ADSEAL\u0026reg; sealer and the used gutta- percha cones was 4% tapered with a size of 25#.\u003c/p\u003e \u003cp\u003eDetails of restoration materials used in this study are given in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRestorations Materials used in the study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProduct Name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eManufacturer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eComponents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLot Number\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eShade\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEver X Flow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShort-Fiber Reinforced Composite for Dentin Replacement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGC Corporation\u003c/p\u003e \u003cp\u003eTokyo, Japan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBis-MEPP, TEGDMA, UDMA, E-glass Fiber, Barium Glass, Silicon Dioxide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2209161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTetric\u0026reg; N- Flow Bulkfill\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFlowable Bulkfill Composite for Dentin Replacement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIvocalr Vivadent Schaan, Liechtenstein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBis-GMA, UDMA, barium glass fillers, YbF3, mixed oxides, silicon dioxide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eZ04XLY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIv A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTetric\u0026reg; N-Ceram\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComposite for Anterior and Posterior Restorations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIvocalr Vivadent Schaan, Liechtenstein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBis-GMA, urethane dimythacrylate, TEGDMA, barium glass, ytterbium trifluoride, Silicon Dioxide, mixed oxide, initiators, stabilizers, pigments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eZ03D8P\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eB2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTetric\u0026reg; N-Bond Universal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLight curing single-component dental adhesive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIvocalr Vivadent Schaan, Liechtenstein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMethacrylate, ethanol, water, silicon dioxide, initiators and stabilizers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eZ0591C\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eــــ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN- Etch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEtching acid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIvocalr Vivadent Schaan, Liechtenstein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePhosphoric acid 37%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eZ05W0S\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eــــ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eBis-GMA, bisphenylglycidyl dimethacrylate; UDMA, diurethane dimethacrylate; TEGDMA, triethylene glycol dumethacrylate;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOutline form design of MOD class II cavities was made using pencil on the tooth, gingival depth is 6 mm in the box cavity, access cavity was prepared with cylindrical diamond burs size 2# changed after each of five prepared cavities, the steps of root canal treatment (RCT) were done under the same conditions, RCTs and restorations were done by same operator, and then teeth were restored by the one of type of composite used in this study after applying Resin Modified Glass Ionomer (RMGI) as a base and barrier between Root Canal Obturation and Composite restorations.\u003c/p\u003e \u003cp\u003eTo restore teeth, manufacturer instructions were applied. The Selective etch technique was chosen to apply etching acid for 30 seconds on the enamel. After rinsing the acid for 20 seconds and drying the water gently, the first layer of self-bond was applied by a bond brush with massaging movement for 20 seconds and drying gently for 5 seconds. After that, the second layer was applied in the same steps and light curing for 30 seconds.\u003c/p\u003e \u003cp\u003eEver X Flow was applied by the syringe at a depth of 4 mm and light-cured for 40 seconds. The same technique for Tetric N-Flow Bulkfill. The last layer from the composite was Tetric N-Ceram for two groups, and it was applied as a replacement for enamel.\u003c/p\u003e \u003cp\u003e All methods were performed in accordance with the relevant guidelines and Helsinki declaration.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMechanical Test\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eFor the fracture resistance test, the compression load test which is used to demonstrate how a material will respond to compression was done for all 40 samples by Tinius Olsen H50KS testing machine, the machine has been operated at a speed of 1 mm/min with a load cell 5 K after fixing the samples on the machine by securing screws Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eResults were recorded in Newton (N) when the sample fractured (tooth structure or restorative material) and this has been the failure mode point.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eStatistical Analysis\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eThe Data were statistically analyzed with SPSS version 25 (SPSS, IBM Corp.) using analysis of variance (one-way ANOVA) at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 significance level by a Bonferroni test to determine the differences between the groups.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe results of all tested samples were summarized in \u003cstrong\u003eTable 2\u003c/strong\u003e:\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"416\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003eSample number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003eGroup 1\u003c/p\u003e\n \u003cp\u003eNormal Teeth (N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003eGroup 2\u003c/p\u003e\n \u003cp\u003eRCT Teeth (N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003eGroup 3\u003c/p\u003e\n \u003cp\u003eEver X Flow (N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003eGroup 4\u003c/p\u003e\n \u003cp\u003eTetric N Flow (N)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e437.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e153.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e378.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e534\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e178.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e788\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e1256\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e1478\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e947\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e269.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e910\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e147.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e595\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e927\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e479.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e945\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e658\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e855\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e247.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e697\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e269.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e1138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e1283\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e622\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e148.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e1072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e417.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e541\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e148.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e251.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e626\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"top\"\u003e\n \u003cp\u003e313\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2: The results of the compression load test for all samples (Newton)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe mean value of the compression load test with standard deviation (SD) was summarized in \u003cstrong\u003eTable 3\u003c/strong\u003e.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.46031746031746%\" valign=\"bottom\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.80952380952381%\" valign=\"bottom\"\u003e\n \u003cp\u003eMean (N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.015873015873016%\" valign=\"bottom\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.253968253968253%\" valign=\"bottom\"\u003e\n \u003cp\u003eSD (N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.492063492063492%\" valign=\"bottom\"\u003e\n \u003cp\u003eMinimum (N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.968253968253968%\" valign=\"bottom\"\u003e\n \u003cp\u003eMaximum (N)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.46031746031746%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eGroup 1 (\u003c/span\u003e\u003cspan dir=\"LTR\"\u003eNormal Teeth)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.80952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e706.4800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.015873015873016%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.253968253968253%\" valign=\"top\"\u003e\n \u003cp\u003e327.37841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.492063492063492%\" valign=\"top\"\u003e\n \u003cp\u003e338.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.968253968253968%\" valign=\"top\"\u003e\n \u003cp\u003e1478.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.46031746031746%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eGroup 2 (RCT Teeth)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.80952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e189.5800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.015873015873016%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.253968253968253%\" valign=\"top\"\u003e\n \u003cp\u003e49.37491\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.492063492063492%\" valign=\"top\"\u003e\n \u003cp\u003e147.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.968253968253968%\" valign=\"top\"\u003e\n \u003cp\u003e269.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.46031746031746%\" valign=\"top\"\u003e\n \u003cp\u003eGroup 3 (Ever X Flow)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.80952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e809.6800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.015873015873016%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.253968253968253%\" valign=\"top\"\u003e\n \u003cp\u003e255.02471\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.492063492063492%\" valign=\"top\"\u003e\n \u003cp\u003e378.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.968253968253968%\" valign=\"top\"\u003e\n \u003cp\u003e1138.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.46031746031746%\" valign=\"top\"\u003e\n \u003cp\u003eGroup 4 (Tetric-N Flow Bulkfill)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.80952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e660.6000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.015873015873016%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.253968253968253%\" valign=\"top\"\u003e\n \u003cp\u003e384.54229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.492063492063492%\" valign=\"top\"\u003e\n \u003cp\u003e251.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.968253968253968%\" valign=\"top\"\u003e\n \u003cp\u003e1283.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.46031746031746%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.80952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e591.5850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.015873015873016%\" valign=\"top\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.253968253968253%\" valign=\"top\"\u003e\n \u003cp\u003e364.23780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.492063492063492%\" valign=\"top\"\u003e\n \u003cp\u003e147.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.968253968253968%\" valign=\"top\"\u003e\n \u003cp\u003e1478.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3: The Mean values and standard deviation of study groups\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA one-way ANOVA test showed a significant difference among the groups (p= 0.000). The Bonferroni test was used to determine the difference between the two groups. \u003cstrong\u003eTable 4\u003c/strong\u003e summarizes the results of the Bonferroni test. \u003cstrong\u003eFig 2\u003c/strong\u003e illustrates the Mean values and standard deviation of study groups and shows the result of the Bonferroni test.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"724\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultiple Comparisons\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.948824343015215%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eGroups (I)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.948824343015215%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eGroups (J)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.96957123098202%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eMean Difference (I-J) (N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.341632088520056%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eStd. Error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.820193637621024%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eP Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.970954356846473%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e95% Confidence Interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"bottom\"\u003e\n \u003cp\u003eLower Bound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"bottom\"\u003e\n \u003cp\u003eUpper Bound\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.975069252077564%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eNormal Teeth\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.975069252077564%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eRCT Teeth\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.988919667590027%\" valign=\"top\"\u003e\n \u003cp\u003e516.90000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.357340720221607%\" valign=\"top\"\u003e\n \u003cp\u003e126.98915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.833795013850416%\" valign=\"top\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.434903047091412%\" valign=\"top\"\u003e\n \u003cp\u003e162.3499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.434903047091412%\" valign=\"top\"\u003e\n \u003cp\u003e871.4501\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.418803418803417%\" valign=\"top\"\u003e\n \u003cp\u003eEver X FLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.264957264957264%\" valign=\"top\"\u003e\n \u003cp\u003e-103.20000-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.017094017094017%\" valign=\"top\"\u003e\n \u003cp\u003e126.98915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.136752136752136%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.581196581196583%\" valign=\"top\"\u003e\n \u003cp\u003e-457.7501-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.581196581196583%\" valign=\"top\"\u003e\n \u003cp\u003e251.3501\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.418803418803417%\" valign=\"top\"\u003e\n \u003cp\u003eTetric-N Flow Bulkfill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.264957264957264%\" valign=\"top\"\u003e\n \u003cp\u003e45.88000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.017094017094017%\" valign=\"top\"\u003e\n \u003cp\u003e126.98915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.136752136752136%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.581196581196583%\" valign=\"top\"\u003e\n \u003cp\u003e-308.6701-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.581196581196583%\" valign=\"top\"\u003e\n \u003cp\u003e400.4301\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.975069252077564%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eRCT Teeth\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.975069252077564%\" valign=\"top\"\u003e\n \u003cp\u003eNormal Teeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.988919667590027%\" valign=\"top\"\u003e\n \u003cp\u003e-516.90000-\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.357340720221607%\" valign=\"top\"\u003e\n \u003cp\u003e126.98915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.833795013850416%\" valign=\"top\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.434903047091412%\" valign=\"top\"\u003e\n \u003cp\u003e-871.4501-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.434903047091412%\" valign=\"top\"\u003e\n \u003cp\u003e-162.3499-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.418803418803417%\" valign=\"top\"\u003e\n \u003cp\u003eEver X FLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.264957264957264%\" valign=\"top\"\u003e\n \u003cp\u003e-620.10000-\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.017094017094017%\" valign=\"top\"\u003e\n \u003cp\u003e126.98915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.136752136752136%\" valign=\"top\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.581196581196583%\" valign=\"top\"\u003e\n \u003cp\u003e-974.6501-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.581196581196583%\" valign=\"top\"\u003e\n \u003cp\u003e-265.5499-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.418803418803417%\" valign=\"top\"\u003e\n \u003cp\u003eTetric-N Flow Bulkfill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.264957264957264%\" valign=\"top\"\u003e\n \u003cp\u003e-471.02000-\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.017094017094017%\" valign=\"top\"\u003e\n \u003cp\u003e126.98915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.136752136752136%\" valign=\"top\"\u003e\n \u003cp\u003e.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.581196581196583%\" valign=\"top\"\u003e\n \u003cp\u003e-825.5701-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.581196581196583%\" valign=\"top\"\u003e\n \u003cp\u003e-116.4699-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.975069252077564%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eEver X FLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.975069252077564%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eNormal Teeth\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.988919667590027%\" valign=\"top\"\u003e\n \u003cp\u003e103.20000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.357340720221607%\" valign=\"top\"\u003e\n \u003cp\u003e126.98915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.833795013850416%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.434903047091412%\" valign=\"top\"\u003e\n \u003cp\u003e-251.3501-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.434903047091412%\" valign=\"top\"\u003e\n \u003cp\u003e457.7501\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.418803418803417%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eRCT Teeth\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.264957264957264%\" valign=\"top\"\u003e\n \u003cp\u003e620.10000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.017094017094017%\" valign=\"top\"\u003e\n \u003cp\u003e126.98915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.136752136752136%\" valign=\"top\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.581196581196583%\" valign=\"top\"\u003e\n \u003cp\u003e265.5499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.581196581196583%\" valign=\"top\"\u003e\n \u003cp\u003e974.6501\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.418803418803417%\" valign=\"top\"\u003e\n \u003cp\u003eTetric-N Flow Bulkfill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.264957264957264%\" valign=\"top\"\u003e\n \u003cp\u003e149.08000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.017094017094017%\" valign=\"top\"\u003e\n \u003cp\u003e126.98915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.136752136752136%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.581196581196583%\" valign=\"top\"\u003e\n \u003cp\u003e-205.4701-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.581196581196583%\" valign=\"top\"\u003e\n \u003cp\u003e503.6301\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.975069252077564%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eTetric-N Flow Bulkfill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.975069252077564%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eNormal Teeth\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.988919667590027%\" valign=\"top\"\u003e\n \u003cp\u003e-45.88000-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.357340720221607%\" valign=\"top\"\u003e\n \u003cp\u003e126.98915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.833795013850416%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.434903047091412%\" valign=\"top\"\u003e\n \u003cp\u003e-400.4301-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.434903047091412%\" valign=\"top\"\u003e\n \u003cp\u003e308.6701\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.418803418803417%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eRCT Teeth\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.264957264957264%\" valign=\"top\"\u003e\n \u003cp\u003e471.02000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.017094017094017%\" valign=\"top\"\u003e\n \u003cp\u003e126.98915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.136752136752136%\" valign=\"top\"\u003e\n \u003cp\u003e.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.581196581196583%\" valign=\"top\"\u003e\n \u003cp\u003e116.4699\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.581196581196583%\" valign=\"top\"\u003e\n \u003cp\u003e825.5701\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.418803418803417%\" valign=\"top\"\u003e\n \u003cp\u003eEver X FLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.264957264957264%\" valign=\"top\"\u003e\n \u003cp\u003e-149.08000-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.017094017094017%\" valign=\"top\"\u003e\n \u003cp\u003e126.98915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.136752136752136%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.581196581196583%\" valign=\"top\"\u003e\n \u003cp\u003e-503.6301-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.581196581196583%\" valign=\"top\"\u003e\n \u003cp\u003e205.4701\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003e*. The mean difference is significant at the 0.05 level.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4: Bonferroni test results to compare each couple of groups\u003c/p\u003e\n\u003cp\u003eThe Bonferroni test showed that there is a significant difference between the RCT Group and all other groups; on the other hand, there is no significant difference among the other three groups (Group 1, Group 3, and Group 4).\u003c/p\u003e\n\u003cp\u003eThe Ever X Flow group had the highest mean compression load test, with significantly different from the RCT Teeth group; and without significantly different other two groups (Group 1 and Group 4), whereas, the Tetric- N Flow Bulkfill Group had the lowest mean of compression load test, with a significantly different with RCT Teeth group, and without significant difference other two groups (Group 1 and Group 3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eRoot Canal Treatment causes stress concentration along the root and weakens its structure \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e6\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e, especially, when rotary instrumentations are used because of its high rotation \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e7\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e. In addition, studies show better longevity for endodontically treated teeth when they have more walls, a study illustrates\u0026nbsp;superior survival for teeth with loss of 1\u0026ndash;3 surfaces when compared with those with more than 3 lost surfaces\u0026nbsp;\u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e8\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e. Moreover, the restorations of these teeth must achieve retention without promoting damage to the remaining dental tissue, and they must prevent bacterial microleakage and possible root or crown fractures \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e9\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e, many authors suggest that using fiber posts in maxillary premolars is indicated because of many factors, as the small volume of its pulp chamber, small diameter of its roots, and because of the mixture of forces exposed these teeth as shear and compressive forces \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e10\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e, this study did not used fiber post to restore endodontically treated teeth, instead of that it evaluated the Ever X Flow when used in the same cases.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOn the other hand, Class II Cavities design effect on the strength of tooth, Bonilla et al. study has investigated that one of the primary causes of failure of class II resin composite restorations are tooth fracture or restoration fracture\u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e11\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e, obviously, when\u0026nbsp;the isthmus width increase from 1/4 to 1/3 intercuspal distance, there is a significant weakening of the prepared tooth\u0026nbsp;\u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e12\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e, besides, \u0026nbsp;studies suggest that MOD cavity preparation in upper premolars leads to a 63% mean loss relative cuspal stiffness \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e13\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e, whereas the loss of only one marginal ridge cause mean loss of 46%, \u0026nbsp; therefore, the restoration material should\u0026nbsp;show similar physicochemical properties to the replaced dental tissues and boost the dental structure and enhance the strength of prepared tooth, especially the modulus of elasticity\u0026nbsp;\u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e12\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e14\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e, resin composite can used as a restorative material for these kind of cavities, composite restorations suffer from polymerization shrinkage stress as a main cause of failure, therefore, many approaches have investigated to solve this problem, one of them is using bulk-fill composite instead of traditional composite in deep cavities \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e15\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eShort fiber-reinforced composite (SFRC) materials are a new approach to restoring endodontically treated teeth, and it seems that they can enhance the strength of treated teeth and solve the problem of lack of the toughness of traditional direct composite restorations \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e16\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e. SFRC materials are made of a polymer matrix charged with fibers that, on the one hand,\u0026nbsp;rummage the stress throughout the restoration, and on the other hand,\u0026nbsp;fibers act as a crack stopper or stress breaker that improves the structural material and enhances the strength of teeth\u0026nbsp;\u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e17\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study has been designed to evaluate the effect of Ever X Flow composite, which is one of the new types of SFRC when used as restoration material in endodontically treated teeth with MOD cavities, and compare it with traditional bulk-fill flowable composite when used in the same cases. Moreover, this study has been conducted on the first upper Premolar, because of its anatomical shape and because of the easiness of getting it, and this matches many studies \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e18\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e19\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e20\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eCompression load test, which was used in this study to evaluate the Ever X Flow effect when used as restoration material in\u0026nbsp;endodontically treated teeth with MOD cavities and compare it with bulk-fill flow composite, was used in many studies \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e5\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e20\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e21\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e22\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e. A\u0026nbsp;compression test is a mechanical test used to determine the behavior of materials when subjected to compressive loads and give helpful insights into the mechanical properties of materials\u0026nbsp;\u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e23\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eThe results of this study showed that the group of Ever X Flow had highest fracture resistance with no significant difference when compared with packable flowable composite group, this result approved many other studies \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e19\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e21\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e, on contrary, many studies showed significant difference between reinforced composite -which had the highest fracture resistance- and other types of composites \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e5\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e18\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e, these difference with this study can be substantiated, on one hand, of the variation of restoration materials used in various studies, for example, farhanny et al. study had three groups two of them used conventional bulk-fill composite and the third one was Ever X Posterior, whereas this study used Ever X Flow composite and compared it with one type of bulk-fill flowable composite, on the other hand, of the difference coronal cavities design, lassila et al. study evaluate the fracture behavior of direct composite restorations made with two different composite core materials, whereas, MOD traditional preparation cavities used in this study.\u003c/p\u003e\n\u003cp\u003eThe highest fracture resistance value of Ever X Flow can be attributed to its specific composition, especially the integration among the resin matrix, the organic fillers, and the short e-glass fibers. Since, these fibers decrease the polymerization shrinkage stress of composites, and thus reduce the cuspal tension. In addition, these fibers can stop the cracks through the material structure \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e19\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e24\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e. In addition, studies ensure that short fibers added to reinforced composites increase its flexural properties \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e25\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e, the length of Ever X Flow composite fibers is 200\u0026ndash;300 \u0026micro;m and a diameter of 6 \u0026micro;m and these let Ever X Flow to mimic a dentine in a natural tooth \u003cspan dir=\"RTL\"\u003e]\u003c/span\u003e21\u003cspan dir=\"RTL\"\u003e[\u003c/span\u003e, \u003cstrong\u003eFig 3\u003c/strong\u003e shows Ever X Flow Composite substratum.\u003c/p\u003e\n\u003cp\u003eAccording to the results of this study, the new flowable SFRC (Ever X Flow) may be used efficiently as a restorative material for endodontically treated teeth, and it can give treated teeth the same fracture resistance as intact teeth, this result should be followed by many other laboratory studies or clinical ones.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWithin the limits of this study, it can be concluded that Ever X Flow improved fracture resistance in endodontically treated teeth as a bulk-fill flowable composite, and as solid teeth, this could suggest using Ever X Flow on posterior endodontically treated teeth instead of fiber posts and traditional cores.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThe two authors of this manuscript designed the way of study and did the lab procedures together, the main author is Bashar Sairafi who analyzed the data and wrote the manuscript , the co-autor mr Alaa Farran reviewed it with the main author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Avaibality:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study can be made available from the corresponding author, Bashar Sairafi, upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDemarco FF, Corr\u0026ecirc;a MB, Cenci MS, Moraes RR, Opdam NJ. Longevity of posterior composite restorations: not only a matter of materials. Dent Mater. 2012. January; 28(1): 87\u0026ndash; 101. \u003c/li\u003e\n\u003cli\u003eL\u0026oacute;pez SG, Chinesta MVS, Garc\u0026iacute;a LC, de HaroGasquet F, Rodr\u0026iacute;guez MPG. Influence of cavity type and size of composite restorations on cuspal flexure. Med Oral Patol Oral Cir Bucal. 2006. November 1; 11 (6): E536\u0026ndash; 40. [PubMed] [Google Scholar]\u003c/li\u003e\n\u003cli\u003eSelvarajH, KrithikadattaJ, ShrivastavaD, Al Onazi MA et al. Systematic review fracture resistance of endodontically treated posterior teeth restored with fiber reinforced composites- a systematic review. BMC Oral Health.2023. August; 23: 566.\u003c/li\u003e\n\u003cli\u003eBassir MM, Labibzadeh A and Mollaverdi F. The effect of amount of lost tooth structure and restorative technique on fracture resistance of endodontically treated premolars. J Conserv Dent. 2013 Sep-Oct; 16(5): 413\u0026ndash;417.\u003c/li\u003e\n\u003cli\u003eGamal, W., Abdou, A. \u0026amp; Salem, G.A. Fracture resistance and flexural strength of endodontically treated teeth restored by different short fiber resin composites: a preclinical study. Bull Natl Res Cent 46, 276 (2022). \u003c/li\u003e\n\u003cli\u003eRippe MP, Santini MF, Bier CAS, Baldissara B, Valandro LF. Effect of root canal preparation, type of endodontic post and mechanical cycling on root fracture strength. J Appl Oral Sci. 2014;22(3):165-73.\u003c/li\u003e\n\u003cli\u003eBier CA, Shemesh H, Tanomaru-Filho M, Wesselink PR, Wu MK. The ability of different nickel-titanium rotary instruments to induce dentinal damage during canal preparation. J Endod. 2009; 35:236-8.\u003c/li\u003e\n\u003cli\u003eDammaschke T, Nykiel K, Sagheri D, Schafer E. Influence of coronal restorations on the fracture resistance of root canal-treated premolar and molar teeth: a retrospective study. Australian Endodontic Journal 2013: 39, 48\u0026ndash;56.\u003c/li\u003e\n\u003cli\u003eStricker EJ, G\u0026ouml;hring TN. Influence of different posts and cores on marginal adaptation, fracture resistance, and fracture mode of composite resin crowns on human mandibular premolars. An in vitro study. J Dent, 34 (2006), pp. 326-335.\u003c/li\u003e\n\u003cli\u003eZillich R, Yaman P. Effect of root curvature on post length in the restoration of endodontically treated premolars. Endod Dent Traumatol 1985; 1:135\u0026ndash;137.\u003c/li\u003e\n\u003cli\u003eBonilla ED, Hayashi M, Pameijer CH, Le NV, Morrow BR, Garcia-Godoy F. The effect of two composite placement techniques on fracture resistance of MOD restorations with various resin composites. Journal of Dentistry. 2020: 101.\u003c/li\u003e\n\u003cli\u003eV. Susila Anand, C. Kavitha, C. V. Subbarao. Effect of Cavity Design on the Strength of Direct Posterior Composite Restorations: An Empirical and FEM Analysis. International Journal of Dentistry. 2011. vol. 2011, Article ID 214751, 6 pages, 2011.\u003c/li\u003e\n\u003cli\u003eEL-Helali R, Dowling AH, McGinley EL, Duncan HF, Fleming GJ. Influence of resin-based composite restoration technique and endodontic access on cuspal deflection and cervical microleakage scores. J. Dent. 2013, 41; 216- 222.\u003c/li\u003e\n\u003cli\u003eConserva, E.; Consolo, U.; Gimenez, A.; Foschi, F.; Paolone, G.; Giovarrusscio, M.; Sauro, S. Stress distribution in carbon-post applied with different composite core materials: A three-dimensional finite element analysis. J. Adhes. Sci. Technol. 2017, 1, 2435\u0026ndash;2444.\u003c/li\u003e\n\u003cli\u003eFerracane JL. Resin Composite state of the art. Dental materials. 2011; 27(1) 29- 38.\u003c/li\u003e\n\u003cli\u003eS\u0026aacute;ry T, Garoushi S, Braunitzer G, Alleman D, Volom A, Fr\u0026aacute;ter M. Fracture behavior of MOD restorations reinforced by various fiber-reinforced techniques\u0026mdash;An in vitro study. J. Mech. Behav. Biomed. Mater. 2019: 98; 348\u0026ndash;356.\u003c/li\u003e\n\u003cli\u003eIlday N, Seven N. The influence of different fiber-reinforced composites on shear bond strengths when bonded to enamel and dentin structures. Journal of Dental Sciences. 2011: 6(2); 107-115.\u003c/li\u003e\n\u003cli\u003eKaur B, Gupta S, Grover R, Sadana G, Gupta T, Mehra M. Comparative Evaluation of Fracture Resistance of Endodontically Treated Teeth Restored with Different Core Build-up Materials: An In Vitro Study. Int J Clin Pediatr Dent. 2021 Jan-Feb;14(1):51-58.\u003c/li\u003e\n\u003cli\u003eFarahanny W, Dennis D, Sihombing D. Fracture Resistance of Various Bulk-fill Composite Resins in Class II MOD Cavity on Premolars: An In Vitro Study. World journal of dentistry. 2019; 10(3): 166- 169.\u003c/li\u003e\n\u003cli\u003eGuo YB, Bai W, Liang YH. Fracture resistance of endodontically treated teeth with cervical defects using different restorative treatments. J Dent Sci. 2022 Apr;17(2):842-847.\u003c/li\u003e\n\u003cli\u003eLassila L, S\u0026auml;ilynoja E, Prinssi R, Vallittu P, Garoushi S. Characterization of a new fiber-reinforced flowable composite. Odontology. 2019 Jul;107(3):342-352. \u003c/li\u003e\n\u003cli\u003eAtalay C, Yazici AR, Horuztepe A, Nagas E, Artan A, Ozgunaltay G. Fracture Resistance of Endodontically Treated Teeth Restored With Bulk Fill, Bulk Fill Flowable, Fiber-reinforced, and Conventional Resin Composite. \u003cem\u003eOper Dent\u003c/em\u003e (2016) 41 (5): E131\u0026ndash;E140.\u003c/li\u003e\n\u003cli\u003eYanıkoğlu UD, Sakarya RE. Test methods used in the evaluation of the structure features of the restorative materials: a literature review. Journal of Materials Research and Technology.2020; 9(5): 9720-9734.\u003c/li\u003e\n\u003cli\u003eAbouelleil H, Pradelle N, Villat C, Attik N, Colon P, Grosgogeat B. Comparison of mechanical properties of a new fiber reinforced composite and bulk filling composites. Restor Dent Endod. 2015 Nov;40(4):262-70. \u003c/li\u003e\n\u003cli\u003eBenkhelladi A, Laouici H, Bouchoucha A. Tensile and flexural properties of polymer composites reinforced by flax, jute, and sisal fibres. J Adv Manuf Technol 2020; 108(3):895\u0026ndash;916.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Endodontically Treated Teeth, MOD cavities, Ever X Flow, Flowable Bulk Fill Composite, Short Fiber-Reinforced Composite.","lastPublishedDoi":"10.21203/rs.3.rs-4584220/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4584220/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study aimed to evaluate the fracture resistance of endodontically treated teeth restored with new short fiber-reinforced composite (SFRC) restorations and compared it with flowable bulk-fill composite when used in the same way. Forty extracted first maxillary premolars were collected and distributed randomly into four groups (n\u0026thinsp;=\u0026thinsp;10). Root Canal Treatments and MOD coronal preparations were done in three groups since group 1 had solid teeth. Two groups were restored with one of the study materials, group 3 was restored with Ever X Flow composite, and group 4 was restored with tetric n-flow bulk fill, whereas group 2 was left without canal obturation or coronal restoration. Composites were applied in a 4 mm layer, and a conventional composite layer was applied in a 2 mm thickness as an enamel replacement. Compression load test was done for all groups, and then data were analyzed with one-way ANOVA and Bonferroni tests. Results showed that the Ever X Flow group had the highest mean of the compression load test, significantly different from group 2, and not significantly different from the other two groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The use of flowable SFRC as a restorative material without using fiber posts or other cores may achieve a good result and enhance the fracture resistance of treated teeth.\u003c/p\u003e","manuscriptTitle":"Fracture Resistance of Endodontically Treated Teeth with Class II Restorations Restored with New Short Fiber-reinforced Composite: An in-vitro study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-09 06:17:40","doi":"10.21203/rs.3.rs-4584220/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b66f73d2-453d-4ca0-a445-82a3b43bdfc4","owner":[],"postedDate":"July 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":34009522,"name":"Health sciences/Health care"},{"id":34009523,"name":"Health sciences/Medical research"},{"id":34009524,"name":"Physical sciences/Materials science"}],"tags":[],"updatedAt":"2024-07-11T04:08:11+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-09 06:17:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4584220","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4584220","identity":"rs-4584220","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}
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