title: Strain measurements and fracture resistance of endodontically treated premolars restored with all-ceramic restorations.
abstract: OBJECTIVE
  The aim of this study was to investigate the recovery of cuspal stiffness and fracture resistance in endodontically treated maxillary premolars restored with bonded ceramic inlays and onlays of various designs.
  
  
  METHODS
  Seventy intact premolars were selected for this study; six cavity designs were investigated: (i) mesio-occlusal-distal (MOD) inlay (I), (ii) MOD inlay with palatal cusp coverage (IPC), (iii) MOD onlay (O), (iv) MOD inlay with pulp chamber extension (IPE), (v) MOD inlay with palatal cusp coverage and pulp chamber extension (IPCPE), and (vi) MOD onlay with pulp chamber extension (OPE). Intact teeth acted as control. Strain gauges were attached to the buccal and palatal surfaces of the teeth to measure cuspal stiffness under static loading. All specimens were eventually subjected to compressive load to failure. Cuspal stiffness and fracture resistance data were analyzed using ANOVA and Tukey test.
  
  
  RESULTS
  The I and IPE restorations restored cuspal stiffness to 75% of the sound tooth value. The O and OPE restored teeth had stiffness values greater than that of a sound tooth. The I, IPC, O, IPE, IPCPE and OPE restored teeth demonstrated fracture strength values of 938N±113 N (s.d.), 1073N±176 N and 1317N±219 N, 893N±129 N, 1062N±153 N and 1347N±191 N respectively.
  
  
  CONCLUSIONS
  Within the limitations of this study, it was concluded that the all-ceramic onlay or inlay with palatal cusp coverage provided best biomechanical advantage in restoring an endodontically treated maxillary premolar tooth.
  
  
  CONCLUSIONS
  The onlay approach which is more conservative compared to full coverage restoration is considered an appropriate approach to the restoration of endodontically treated maxillary premolars. The addition of a pulpal extension to the all-ceramic restorations, apart from being technically challenging, was not found to offer any biomechanical advantage to the restored teeth.
authors.affiliation: School of Dentistry, International Medical University, 126, Jalan Jalil Perkasa 19, 57000 Kuala Lumpur, Malaysia. Electronic address: lianglin_seow@imu.edu.my.
authors.forename: Liang Lin
authors.initials: LL
authors.lastname: Seow
authors.affiliation: School of Dentistry, International Medical University, 126, Jalan Jalil Perkasa 19, 57000 Kuala Lumpur, Malaysia.
authors.forename: Chooi Gait
authors.initials: CG
authors.lastname: Toh
authors.affiliation: King's College London Dental Institute, Guy's Hospital, London SE1 9RT, England, United Kingdom.
authors.forename: Nairn H F
authors.initials: NH
authors.lastname: Wilson
mesh_terms: D001641:Bicuspid / Q000502:physiology / Q000601:surgery*; D002516:Ceramics / Q000627:therapeutic use; D003737:Dental Cavity Preparation; D003776:Dental Porcelain / Q000627:therapeutic use; D003793:Dental Restoration, Permanent; D017220:Dentin-Bonding Agents / Q000627:therapeutic use*; D006801:Humans; D007284:Inlays / Q000379:methods; D012390:Root Canal Therapy; D019228:Tooth Crown / Q000601:surgery; D014082:Tooth Fractures / Q000473:pathology / Q000601:surgery*; D019553:Tooth, Nonvital / Q000473:pathology / Q000601:surgery
chemical_list: D017220:Dentin-Bonding Agents; D003776:Dental Porcelain
keywords: Endodontically treated teeth; Fracture strengths; Inlay; Onlay; Pulp chamber extension; Strains