Support of Occlusal Enamel Provided by Bonded Restorations

In this in vitro study, the resistance to fracture of occlusal enamel supported by a bonded tooth-colored restorative material was compared to unsupported enamel and enamel supported by sound dentin. Eighty extracted human lower molars were sorted into five groups of 16 teeth each. Lingual cusps were removed. In Groups 2-5, dentin was removed from the facial cusps, leaving a shell of enamel. In Group 1, dentin was not removed. Group 2 remained unrestored. The groups in which a restorative material was inserted to replace missing dentin were as follows: Group 3-bonded resin composite (Scotchbond MP/Filtek Z250 [A2] in capsules, 3M); Group 4-resin-modified glass-ionomer (Fuji II LC [A2] in capsules, GC); Group 5-conventional ionomer (Fuji IX [A2] in capsules, GC). Specimens were thermocycled (1500 cycles, 6°-60°C, dwell 30 seconds), then mounted in die stone with lingual inclines of facial cusps approximately horizontal. The cusp ridges of the lingual inclines were flattened slightly using a horizontally mounted separating disk. Specimens were loaded evenly on flattened inclines in an Instron with a flat rectangular rod at a crosshead speed of 5 mm/minute. Data analysis was with one-way ANOVA and Student-Newman-Keul's test (F=50.30, p<0.0001). The bonded restorations provided significantly less enamel support than natural dentin and significantly more than when the enamel was left without support by dentin or a restorative material. There was no difference in support provided by the three restorative materials.