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 Table of Contents  
Year : 2022  |  Volume : 12  |  Issue : 2  |  Page : 120-126

Recent advances in direct reinforced restorations for vital teeth

1 Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Dr. D. Y. Patil Vidyapeeth, Dr. D. Y. Patil Dental College, Pune, Maharashtra, India
2 Department of Orthodontics, Faculty of Dentistry, Dr. D. Y. Patil Vidyapeeth, Dr. D. Y. Patil Dental College, Pune, Maharashtra, India
3 Department of Oral Medicine and Radiology, Faculty of Dentistry, Dr. D. Y. Patil Vidyapeeth, Dr. D. Y. Patil Dental College, Pune, Maharashtra, India
4 Department of Prosthodontics, Faculty of Dentistry, Rural Dental College, Loni, Maharashtra, India
5 Department of Prosthodontics, Bharati Vidyapeeth (Deemed to be) University Dental College and Hospital, CBD Belapur, Navi Mumbai, India

Date of Submission12-Jul-2021
Date of Decision31-Mar-2022
Date of Acceptance30-Apr-2022
Date of Web Publication13-May-2022

Correspondence Address:
Santosh Kumar Mastud
Department of Oral Medicine and Radiology, Faculty of Dentistry, Dr. D. Y. Patil Vidyapeeth, Dr. D. Y. Patil Dental College, Pimpri, Pune, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aihb.aihb_104_21

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The conservative option depends mainly on the ability of the bonded restoration to strengthen the enamel in the same way that dentine gives strength and supports the enamel. In order for a dental material to reinforce the vital tooth, it must bond to dentine. As such, an essential attribute of a good dentine adhesive system is the ability of the adhesive to wet and infiltrate the dentine. In restorative dentistry, numerous studies have demonstrated coronal reinforcement of the vital tooth through bonded restorations. Six bonded amalgams and resin composites have all been shown to reinforce the remaining vital tooth structure by bonding to dentine and enamel.

Keywords: Bonded amalgam, reinforced composites, restorative materials

How to cite this article:
Bhargava K, Mastud C, Mastud SK, Vikhe DM, Newase P, Mhaske PN. Recent advances in direct reinforced restorations for vital teeth. Adv Hum Biol 2022;12:120-6

How to cite this URL:
Bhargava K, Mastud C, Mastud SK, Vikhe DM, Newase P, Mhaske PN. Recent advances in direct reinforced restorations for vital teeth. Adv Hum Biol [serial online] 2022 [cited 2022 Aug 11];12:120-6. Available from: https://www.aihbonline.com/text.asp?2022/12/2/120/345202

  Introduction Top

Traditionally, more extensive restorations on vital teeth were performed using non-adhesive techniques. The materials of choice were gold, porcelain and metallic ceramics. These were placed either intra- or extra-coronally and relied on the preparation having near-parallel walls, assisted by a luting cement to fill the marginal gap and help with the retention process. With the development of new materials and techniques for bonding to the vital tooth, there has been a blurring of the methods used, and often restorations rely on a multitude of factors for retention, which incorporates both mechanical and adhesive principles.[1]

Loss of dentine, including anatomic structures such as cusps, ridges and arched roof of the pulp chamber, may result in tooth tissue fracture after the final restoration. Therefore, intra-coronal strengthening of teeth to protect them against fracture is important, particularly in posterior teeth, where stresses generated by forces of occlusion can lead to fracture of unprotected cusps.[2],[3],[4],[5]

  Replacement of Lost Coronal Tooth Structure Top

Indirect restorations are frequently placed on teeth that have lost substantial amounts of vital tooth structure. Retention and resistance forms are lost as the height of the tooth preparation is reduced in relation to the intended occlusal surface position of the final restoration.[6],[7] A foundation or core build-up restoration may be required to supplement retention and resistance form. The strength required of a foundation restoration will vary, depending on the location of the vital tooth in the dental arch, as well as on the design of the surrounding tooth preparation.[8],[9],[10]

Apart from acting as a transitional restoration in the management of a damaged tooth, a core build-up restoration must withstand crown preparation and impression taking and contribute to the retention and support of a provisional crown before the definitive crown restoration is placed. When retention and resistance depend significantly on the core build-up, the strength of the foundation restoration and its retention to the underlying tooth tissue can directly influence the survival of the restoration.[11] Some core materials lack sufficient strength and/or adhesion to vital tooth tissues to serve this function. Posterior vital teeth are exposed to greater forces than anterior vital teeth, and the direction of load differs.[12],[13]

Vital teeth that have to serve as abutments for fixed or removable prostheses are subject to increased stress. Almost one-quarter of all posterior crowns were provided with a pin- or post-retained core. The restoration of severely broken down vital teeth is an increasing problem for the restorative dentist, as more patients retain their natural teeth into older age.[14],[15],[16],[17],[18] Clinical studies demonstrate an increased incidence of vital tooth fractures in teeth with large restorations compared with sound or minimally restored teeth. Whilst advances in adhesive restorative materials and techniques may result in more predictable retention of restorations with compromised retention, the success of these techniques is still to be confirmed by clinical trials.[19],[20]

Such techniques may be operator sensitive as the success of an indirect restoration depends on the ability of the cement or resin lute to prevent dislodgement of the restoration from the tooth preparation; the latter must possess adequate retention and resistance form. While resistance form is considered more critical than retention form, and it is impossible to separate these two features.[21] Retention will prevent dislodgement of the restoration along a direction parallel to its path of insertion, whilst resistance prevents dislodgement in any other direction. Minimal taper and maximum preparation heights are critical features for good retention. The fit of the restoration, any surface treatments which facilitate adhesion and the nature of the cement lute are also important variables. If adequate retention and resistance form can be developed from natural tooth structure, the strength of any core or foundation restoration is less critical and minor depressions or undercuts in the vital tooth preparation can be restored with adhesive restorative materials.[22],[24],[25],[26]

  Choice of Core Material Top

Clinically, there are times when the remaining tooth structure is so reduced that the margins of the crown must be placed at or just below the core. It is under these conditions that the choice of core material may be critical. Core build-up materials for direct placement include:

  • Dental amalgam
  • Resin composite
  • Reinforced glass-ionomer cement
  • Resin-modified glass ionomers/compomers (polyacid-modified resin composites).[27]

Gold alloys and ceramics have been used as indirect core build-up materials. Each candidate core material has advantages and disadvantages.

Desirable properties for a restorative material to be used in complex restorations:

  • Compressive strength to resist intraoral forces
  • Flexural strength to prevent core dislodgement during function
  • Biocompatibility with surrounding tissues
  • Ease of manipulation
  • Ability to bond to tooth structure, pins and posts
  • Capacity for bonding with luting cement or having additions made to it
  • Coefficient of thermal expansion conductivity similar to dentine
  • Dimensional stability
  • Minimal water absorption
  • Short setting time to allow tooth preparation and co-replacement to be carried out during the same visit
  • No adverse reaction with temporary crown materials or luting cement
  • Cariostatic potential
  • Low cost
  • Contrasting colour to tooth tissue unless being used for anterior cores.[28]

Dental treatment procedures are increasingly governed by factors such as biocompatibility of restorative materials, patients' demands for aesthetics and a conservative approach to minimise loss of vital tooth structure.[29],[30] Following the traditional Black's principles for cavity preparation, all undermined enamel should be removed even for marginal ridges composed of healthy, sound and caries-free undermined enamel.[31] This could be attributed to the brittle nature of the undermined enamel and the inability of the conventional cast inlays and amalgam restorations to strengthen the remaining tooth structure.[32],[33],[34]

However, the increased use of resin composites in posterior teeth violates these principles. Restoring vital teeth with minimal sacrifice of sound tooth structure depends mainly on adhesives that provide strong and durable bonding to the remaining sound enamel and dentine. Laboratory reports have proven that modern adhesives do effectively bond to tooth tissue in the short term. However, clinically, marginal deterioration of composite restorations remains problematic in the long term and still forms the major reason to replace adhesive restorations.[35]

When resin composite is bonded to tooth structure using adhesives, the initial and residual polymerisation stresses that are present along the cavity walls may result in gap formation, leakage, recurrent caries and pulp irritation. The detrimental effect of marginal gap formation cannot be offset even with the use of fluoride-releasing adhesives or restorative materials that prevent demineralisation along cavity margins. Thus, only the hermetic sealing of restorations guarantees clinical success. The purpose of restorative material is not only to restore the decayed or defective tooth and provide an effective seal between the restoration and the tooth but also to strengthen the tooth.[36]

Studies showed that strength of the vital teeth was significantly reduced after cavity preparation; others, however, report no significant difference between fracture resistance of intact teeth and the teeth that were prepared but unrestored. Morin showed that the mean relative deformation and stiffness values for acid-etched bonded teeth resemble the mean relative deformation and stiffness values for sound teeth. Simonsen showed that teeth restored with resin composite were stronger than those restored with amalgam when tested at cusp inclines. An important clinical controversial condition is the presence of undermined marginal ridge of the full thickness of enamel after cavity preparation. The clinician either leaves the undermined marginal ridge and restores the tooth or removes the thin enamel preparing Class II and restores the tooth.[37],[38],[39]

The conservative option depends mainly on the ability of the bonded restoration to strengthen the enamel in the same way that dentine gives strength and supports the enamel. In order for a dental material to reinforce the vital tooth, it must bond to dentine. As such, an essential attribute of a good dentine adhesive system is the ability of the adhesive to wet and infiltrate the dentine. In restorative dentistry, numerous studies have demonstrated coronal reinforcement of the vital tooth through bonded restorations. Six bonded amalgams and resin composites have all been shown to reinforce the remaining vital tooth structure by bonding to dentine and enamel.

  Recent Advances Top


Ormocers, a word originally derived from organically modified ceramic, were originally developed for science and technology (e.g. for special surfaces such as protective coatings, non-stick surfaces, anti-static coatings and non-reflective coatings). In contrast to conventional composites, the ormocer matrix is not only organic but also inorganic. Therefore, monomers are better embedded in the matrix, which reduces the release of monomers.[40]

Ormocers basically consist of three components – organic and inorganic portions and polysiloxanes. The proportions of those components can affect the mechanical, thermal and optical qualities of the material:

  1. The organic polymers influence the polarity, the ability to crosslink, hardness and optical behaviour
  2. The glass and ceramic components (inorganic constituents) are responsible for thermal expansion and chemical stability
  3. The polysiloxanes influence the elasticity, interface properties and processing
  4. The inorganic components are bound to the organic polymers by multifunctional silane molecules.

After polymerisation, the organic portion of the methacrylate groups forms a three-dimensional network.[41] In spite of all efforts to create a better restorative material using ormocers, their performance (cervical and occlusal marginal adaptation) was significantly worse when compared to today's hybrid composites after cyclical loading in a laboratory test. However, no significant differences were found in a 5-year clinical comparison of AdmiraR (ormocer) and TetricCeramR (hybrid composite).[42]

At the same filler content, ormocers have a reduced polymerisation shrinkage compared to hybrid composites, or at a lower filler content of the ormocer, the polymerisation shrinkage is equal to that of a conventional composite.[43]

Ramsey PH et al. investigated the 'in vivo' quality of ormocer restorations in a clinical trial over 1 and 2 years. The clinical application was acceptable, but there were concerns about the marginal adaptation and the indication for Class V restorations due to poor adhesion. In contrast, another study found no difference in the longevity of restorations between ormocers and Bis-GMA-based systems. However, the 5-year control showed a much stronger tendency to discolouration with one of the two ormocer materials compared to the other materials.[44] Another 1-year study found that an ormocer (DefiniteR) failed to meet the requirements for restoration longevity compared to a conventional composite resin for Class II restorations. Numerous restorations had to be replaced within the 1st year.

Hayashi M et al. examined the cytotoxicity of three different filling materials and their flowables (AdmiraR, Z250R, TetricCeramR). The ormocer material (AdmiraR) had the highest cytotoxicity in the standard composites but the lowest regarding flowables. This has been rejected by another study, which showed that an ormocer (CeramXR) released significantly less monomers such as Bis-GMA, TEGDMA or UDMA compared to either a nanohybrid composite (Filtek Supreme XTR) or a self-curing composite (ClearfilCoreR).[45] With respect to microhardness, the ormocers are comparable with hybrid composites, but their wear resistance is lower. This contradicts other studies, which have shown less wear for ormocers.[46]


The word 'compomer' comes from composite and glass ionomer. The material itself is a polyacrylic/polycarboxylic acid-modified composite. Compomers are composed of composite and glass-ionomer components. It is an attempt to take advantage of the desirable qualities of both materials: The fluoride release and ease of use of the glass ionomer is one advantage and other one is the superior material qualities and aesthetics of the composites. In addition to the various polymerisable monomers (e.g. UDMA), the material also contains dicarboxylic acids, which in contrast to those composite and glass -ionomers, in traditional glass ionomers that have polymerisable double bonds.[47]

The reactive fluoro-aluminium silicate glasses from the glass-ionomer technology are found in compomers. The particle size of fillers in these products varies from 0.2 μm up to 10 μm. Compomer restorations have been shown to have insufficient retention without pre-treatment of the dental hard tissue with an adhesive system.

The composition and properties of these adhesives do not differ fundamentally from adhesives used for composites. The setting reaction of the compomer is based primarily on the polymerisation of acidic monomers.[48] The acid-base reaction, which starts only after water absorption, is limited to the superficial layers. Although, for a narrow range of indications, certain coloured compomer materials (Comp naturR) may be of interest for use in adults, compomers are most suitable for restorations in the deciduous dentition due to their low abrasion resistance.[49]

In cervical restorations, compomer restorations performed better than resin-modified glass ionomers but not as well as hybrid composites. The fluoride release of compomers increased quickly initially (24 h) but decreased equally quickly. The ability of compomer to be recharged with fluoride from its environment resulting in long-lasting caries prevention has been discussed.[50] An in situ experiment showed that caries development next to compomer restorations (DyracteXtraR) was lower than next to composite restorations (Spectrum TPHR). The fluoride release over 28 days had an inhibitory effect on caries development in the adjacent tooth. It has also been shown that fluoride release into saliva was less for young permanent teeth than for deciduous teeth. It is assumed, therefore, that young permanent teeth can store more ions in the enamel. However, a clinical study showed no difference in new caries development in children who received compomer restorations compared to those who had amalgam restorations. The fluoride regeneration is mainly determined by the glass component and the hydrogel layer.[51]

The hydrogel layer is, in turn, dependent on the acid-base reaction. Therefore, both the fluoride release and the fluoride re-uptake are greatest in glass ionomers followed by compomers and then by composites. The increased water absorption of the compomer compared to conventional composite results in marginal discolouration interfering with aesthetics, particularly in the anterior teeth. Compomers are also contraindicated for large core build-ups due to their poor abrasion resistance.[52]


The name of this material class refers to its chemical composition from siloxanes and oxiranes. This product class aims to have lower shrinkage, longer resistance to fading and less marginal discolouration. The silorane monomer ring differs obviously from the chain monomers of hybrid composites.

The hydrophobic properties of the material are caused by siloxanes. Exogenous discolouration and water absorption are reduced. The oxirane rings are responsible for the physical properties and the low shrinkage. Siloranes are polymerised by a cationic reaction in contrast to methacrylates, which crosslink via radicals.[53] The photoinitiator system is based on three components: light-absorbing camphor, an electron donor (e.g. amine) and an iodonium salt. The camphor Chinon is excited and reacts with the electron donor, which reduces the iodonium salt to an acidic cation in the process. This starts the opening process of the oxirane ring. The opening of the oxirane rings during the polymerisation process compensates to some degree for the polymerisation shrinkage. The fillers in FiltekSiloraneR, the only silorane material on the market at the moment, consist of 0.1–2.0 μm quartz particles and radiopaque yttrium fluoride.[54]

A comprehensive study of FiltekSiloraneR was carried out by Heyman HO et al.: it confirms the low shrinkage (<1%) and found that the light stability of the silorane was seven times longer than for methacrylates. The silorane low shrinkage leads to lower contraction stress. The silorane-based filling material was shown to have both low water absorption and water solubility. The adhesion of streptococci observed on the surface of silorane restorations was low, maybe because of its hydrophobic properties. Siloranes have been shown to have good storage stability in various media, and compared to conventional composites, they are less susceptible to changes if stored in ethanol. FiltekSiloraneR has good polishing characteristics. The material showed little colour change after artificial ageing, and the surface gloss was retained.[55],[56],[57]

The clinical application of these materials is limited to the posterior teeth because few low translucent colours are available.

Because of the hydrophobic properties, the appropriate adhesive system must be used for silorane restorations. Dentists both value and recognise the challenge of the relatively high viscosity. At the moment, the weak radiopacity is a disadvantage since the limitations of the restoration are difficult to recognise on radiographs.[58]

  Ceromer Top

Due to the increasing patient demand for aesthetic, biocompatible restorations, materials that exhibit a natural appearance, strength and durability have been developed. Researchers have explored several alternatives for achieving this objective, including the use of inlay or onlay restorations fabricated of direct composites in ceramic and ceramic optimised polymer (ceromer) materials. The advancements associated with computer-aided design/computer-aided manufacturing and milled restorations have further increased the clinician's ability to deliver predictably durable restorations.[39],[34] Whilst direct Class II composite restorations can provide clinical advantages with regard to aesthetics, reduced patient expense and efficiency, clinicians must simultaneously address several materialistic and procedural limitations (e.g. polymerisation shrinkage, microleakage and post-operative sensitivity). Although conventional ceramic or ceromer inlays and onlays are clinically superior to direct composite restorations, these modalities increase treatment expense and require multiple visits to facilitate placement.

The use of direct inlays or glass insert restorations was introduced in the early 1980s in the form of Beta Quartz glass inserts. After utilising this technology, sites prepared for direct composite resin restorations were mega filled with pre-polymerised glass inserts to reduce polymerisation shrinkage and impart strength to the definitive restorations. Sites treated in this manner have exhibited a sevenfold lower coefficient of thermal expansion as compared to amalgam and have demonstrated the ability to reduce polymerisation shrinkage by 50%–70%. The use of the inserts is intended to improve the wear characteristics of composite restorations by providing a solid surface for contact against the opposing dentition and also permits them to function as acceptable megafiller for composite resin.[39] The glass inserts, however, are also characterised by clinical deficiencies that include the poor aesthetic blending of the insert and composite materials and marginal failure due to the gap that often forms between the insert and the restorative margins.

After the advent of a sonically driven preparation system (e.g. SONICSYS, Ivoclar Vivadent, Amherst, NY; KaVo, Lake Zurich, IL), many of the original limitations of insert technology have been resolved. This sonic system consists of single-sided, diamond-coated tips (40 μm–50 μm coating) that facilitate conservative preparation of mesial and distal surfaces without causing damage to adjacent teeth. The tips – designed for three Class II preparation sizes – attach to an oscillating air scaler unit.[59]

The appropriate tip should be selected based on the size of the preparation required for complete decay removal and finishing of the inlay restoration. The system also contains ceramic inserts – fabricated from a leucite-reinforced glass-ceramic material similar to that of a pressed ceramic (i.e., IPS Empress, Ivoclar Vivadent, Amherst, NY) – that are precisely shaped to correspond to the assorted preparation tips. The objective of the technique is to establish a preparation of predictable size and shape to one of the three inserts, thus achieving an 'inlay' type restoration in the interproximal region of the tooth. The definitive result is a prefabricated ceramic inlay with marginal tolerance of 81 μm–108 μm in the interproximal area, and 12 μm–21 μm in the gingival bevel areas, which significantly reduces the deficiencies (e.g. microleakage and post-operative sensitivity) of conventional direct composite restorations that are typically associated with polymerisation shrinkage. The gingival inclination of the sonically driven preparation instrument is 45°, which is optimal for the acid-etch technique in cervical enamel.[60]

If the proximal preparation margin extends into the dentine, the preparation is completed as soon as the dentinal gingival margin is smooth. Bevelling the gingival margin in the dentine does not provide decisive strength advantages for bonding strength. This article demonstrates a clinical protocol that features the preparation and ceramic insert technology utilised to perform direct inlay restorations in the posterior segment.

Clinical protocol

Following proper case selection, diagnosis and treatment planning for direct inlay restorations, a strict clinical protocol should be followed in order to achieve predictable results. Preparation design utilising sonic technology and predictable cavity size contributes to the success of the restoration with the ceramic insert. When selecting the design of the inlay or onlay preparation, the 'One-Half Rule' can be applied by the clinician. 1 Instances in which the width of the isthmus is equal to or greater than one half of the buccolingual intercuspal distance, or in which the preparation finish line falls on or above the halfway point of the cuspal incline ridge, are indicated for an onlay restoration. Additional parameters (e.g. occlusal function, the position of the tooth in the arch and degree of enamel support) should also be considered. The smallest preparation instrument that covers the marginal regions and provides axial wall bevelling should be selected.[61]

Sonic technology, which cuts less aggressively than rotary instruments, is ideal for finishing and standardisation of the proximal box to ensure proper fit of the ceramic inlay. Upon completion of the milled and precise interproximal preparation site, the appropriately sized ceramic insert is selected. Accepted isolation protocols should be followed to eliminate moisture, which may compromise the conventional bonding procedures employed for direct resin restorations. The ceramic insert is subsequently placed into the interproximal preparation and luted with flowable and conventional microhybrid ceromers (e.g. Tetric Flow; Tetric Ceram, Ivoclar Vivadent, Amherst, NY).[62] The inserts increase the depth of cure by conducting the curing light within the composite material, and their light transmission produces cohesive stress that is directed towards the insert rather than the surface of the restoration. Once complete curing of the dentine layer has been performed, pit and fissure stains are incrementally applied to the surface along with an enamel layer of a reinforced microfill composite resin. Final occlusal adjustments, finishing and polishing are accomplished in order to complete the aesthetic and functional direct resin/composite inlay restoration.[63]

Whisker composites

Ceramic whiskers were used as fillers in dental resins. Nanometre-sized silica particles were fused onto the whiskers to facilitate silanization is the covering of a surface with organofunctional alkoxysilane molecules. mineral components like glass and metal oxide surface can all be silanized, minimise whisker entanglement and enhance whisker retention in the resin matrix by roughening the whisker surfaces. These whisker composites demonstrated flexural strength and fracture toughness values nearly twofold those of currently available dental composites.[64] They showed superior performance in thermal cycling between 5°C and 60°C water baths up to 105 cycles, long-term water ageing for 2 years and three-body wear. An in vitro biocompatibility study showed that the whisker composites were non-cytotoxic and supported cell attachment and proliferation.

The most promising work in composites with modified fillers for both enhanced mechanical properties and remineralising potential by virtue of calcium and phosphate release has been the work with fused silica whiskers and dicalcium or tetracalcium phosphate nanoparticles. These composites may be stronger and tougher, but the optical properties are not ideal, and their opacity requires them to be self-cured or heat-processed at this point.[65]

The reinforcement mechanisms for the whisker composites are said to be whiskers pinning and bridging the cracks. The whiskers have a tensile strength of about 50 GPa, compared with 2.6 GPa of glass fibres. The fracture toughness of silicon carbide is also higher than glass. Therefore, compared with the conventional glass fillers, the whiskers are more effective in resisting the cracks and less likely to be cut through by the cracks. The whiskers increased the elastic modulus of the monocalcium phosphate monohydrate–whisker composite to more closely mimic the elastic modulus of natural dentine.

Fibre or whisker reinforcement has produced very significant enhancements in toughness, but not to the range of high toughness ceramics or casting alloys, and this may be what is required to render the materials essentially fracture-resistant under all oral conditions.[66]

  Conclusion Top

From this information obtained during the patient evaluation, the operator must envision the restoration replacing lost tooth structure being subjected to functional loading and then try to plan the best tooth preparation to both retain this restoration and make it resistant to these loads.[67]

Complex restorations are clinically rewarding, but they do require careful treatment planning to ensure their longevity in the mouth. This aspect of restorative dentistry ensures that the patient has a vital functional restoration that is mechanically sound but also biologically compatible. Many factors need to be considered, including the aesthetic desires of the patient, functional requirements of the material, tooth colour, core or abutment being restored, condition of the tooth, whether the restoration is anterior or posterior and whether the dentist prefers cementing or bonding the definitive restoration.

Optimal functional capacity and stability of occlusal relationships are major considerations in every phase of restorative dentistry.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Ayad MF, Rosenstiel SF, Farag AM. A pilot study of lactic acid as an enamel and dentin conditioner for dentin-bonding agent development. J Prosthet Dent 1996;76:254-9.  Back to cited text no. 1
Black GV. G.V. Black's Classification of dental caries. 7th ed. Chicago: Medico-Dental Publishing; 1936. p. 137-65.  Back to cited text no. 2
Eakle WS. Fracture resistance of teeth restored with class II bonded composite resin. J Dent Res 1986;65:149-53.  Back to cited text no. 3
Eakle WS, Staninec M. Effect of bonded gold inlays on fracture resistance of teeth. Quintessence Int 1992;23:421-5.  Back to cited text no. 4
Lacy AM. Conservative restoration of fractured cusps with posterior composite resin. 1985;16:807-811.  Back to cited text no. 5
Abu-Hanna AA, Mjör IA. Resin composite reinforcement of undermined enamel. Oper Dent 2004;29:234-7.  Back to cited text no. 6
De Munck J, Van Meerbeek B, Satoshi I, Vargas M, Yoshida Y, Armstrong S, et al. Microtensile bond strengths of one- and two-step self-etch adhesives to bur-cut enamel and dentin. Am J Dent 2003;16:414-20.  Back to cited text no. 7
Collins CJ, Bryant RW, Hodge KL. A clinical evaluation of posterior composite resin restorations: 8-year findings. J Dent 1998;26:311-7.  Back to cited text no. 8
Hayashi M, Wilson NH. Marginal deterioration as a predictor of failure of a posterior composite. Eur J Oral Sci 2003;111:155-62.  Back to cited text no. 9
Krämer N, Reinelt C, Richter G, Petschelt A, Frankenberger R. Nanohybrid & fine hybrid composite in class II cavities: Clinical results and marginal analysis after four years. Dent Mater 2009;25:750-9.  Back to cited text no. 10
Fabianelli A, Kugel G, Ferrari N. Efficency of self-etching primer on sealing margins of class II restorations. Am J Dent 2003;16:37-41.  Back to cited text no. 11
Savarino L, Saponara Teutonico A, Tarabusi C, Breschi L, Prati C. Enamel microhardness after in vitro demineralization and role of different restorative materials. J Biomater Sci Polym Ed 2002;13:349-57.  Back to cited text no. 12
Tay FR, Pashley DH, Suh BI, Carvalho RM, Itthagarun A. Single-step adhesives are permeable membranes. J Dent 2002;30:371-82.  Back to cited text no. 13
Joynt RB, Wieczkowski G Jr., Klockowski R, Davis EL. Effects of composite restorations on resistance to cuspal fracture in posterior teeth. J Prosthet Dent 1987;57:431-5.  Back to cited text no. 14
Belli S, Erdemir A, Yildirim C. Reinforcement effect of polyethylene fibre in root-filled teeth: Comparison of two restoration techniques. Int Endod J 2006;39:136-42.  Back to cited text no. 15
Re GJ, Draheim RN, Norling BK. Fracture resistance of mandibular molars with occlusal class I amalgam preparations. J Am Dent Assoc 1981;103:580-3.  Back to cited text no. 16
Blaser PK, Lund MR, Cochran MA, Potter RH. Effects of designs of class 2 preparations on resistance of teeth to fracture. Oper Dent 1983;8:6-10.  Back to cited text no. 17
Morin D, DeLong R, Douglas WH. Cusp reinforcement by the acid-etch technique. J Dent Res 1984;63:1075-8.  Back to cited text no. 18
Gelb MN, Barouch E, Simonsen RJ. Resistance to cusp fracture in class II prepared and restored premolars. J Prosthet Dent 1986;55:184-5.  Back to cited text no. 19
Purk JH, Eick JD, DeSchepper EJ, Chappell RP, Tira DE. Fracture strength of Class I versus Class II restored premolars tested at the marginal ridge. I. Standard preparations. Quintessence Int 1990;21:545-51.  Back to cited text no. 20
Macpherson LC, Smith BG. Reinforcement of weakened cusps by adhesive restorative materials: An in-vitro study. Br Dent J 1995;178:341-4.  Back to cited text no. 21
Bader JD, Shugars DA, Martin JA. Risk indicators for posterior tooth fracture. J Am Dent Assoc 2004;135:883-92.  Back to cited text no. 22
Jagadish S, Yogesh B. Fracture resistance of teeth with Class II silver amalgams, posterior composites, and glass cement restorations. Oper Dent 1990;15:42-7.  Back to cited text no. 23
Boyer DB, Roth L. Fracture resistance of teeth with bonded amalgams. Am J Dent 1994;7:91-4.  Back to cited text no. 24
Alander P, Lassila LV, Tezvergil A, Vallittu PK. Acoustic emission analysis of fiber-reinforced composite in flexural testing. Dent Mater 2004;20:305-12.  Back to cited text no. 25
Vallittu PK. The effect of glass fiber reinforcement on the fracture resistance of a provisional fixed partial denture. J Prosthet Dent 1998;79:125-30.  Back to cited text no. 26
Heyman Ho, Roberson TM, Sockwell CL. Direct tooth colored restorations for class II, IV, and V cavity preparations. In: Sturdevant JR, editor. Art and Science of Operative Dentistry. 3rd ed. St. Louis: Mosby; 1995. p. 134-465.  Back to cited text no. 27
Freilich MA, Meisers JC, Duncan JP, Goldberg AJ. Advance care of Endodontics. Chicago: Quintessence Publishing; 2000. p. 4-6.  Back to cited text no. 28
Rosentritt M, Behr M, Lang R, Handel G. Experimental design of FPD made of all-ceramics and fiber-reinforced composite. Dent Mater 2000;16:159-65.  Back to cited text no. 29
Rudo DN, Karbhari VM. Physical behaviors of fiber reinforcement as applied to tooth stabilization. Dent Clin North Am 1999;43:7-35.  Back to cited text no. 30
Behr M, Rosentritt M, Lang R, Handel G. Glass fiber-reinforced abutments for dental implants. A pilot study. Clin Oral Implants Res 2001;12:174-8.  Back to cited text no. 31
Göhring TN, Mörmann WH, Lutz F. Clinical and scanning electron microscopic evaluation of fiber-reinforced inlay fixed partial dentures: Preliminary results after one year. J Prosthet Dent 1999;82:662-8.  Back to cited text no. 32
Altieri JV, Burstone CJ, Goldberg AJ, Patel AP. Longitudinal clinical evaluation of fiber-reinforced composite fixed partial dentures: A pilot study. J Prosthet Dent 1994;71:16-22.  Back to cited text no. 33
Ramsey P.H. Power of univariate pairwise multiple comparison procedures. Psychological Bulletin 1981;90:352–66.  Back to cited text no. 34
Van Meerbeek B, Perdigão J, Lambrechts P, Vanherle G. The clinical performance of adhesives. J Dent 1998;26:1-20.  Back to cited text no. 35
Vallittu PK. Flexural properties of acrylic resin polymers reinforced with unidirectional and woven glass fibers. J Prosthet Dent 1999;81:318-26.  Back to cited text no. 36
Finnis WM, Tezvergil A, Kuijs RH, Lassila LV, Kreulen CM, Creugers NH, et al. In vitro fracture resistance of fiber reinforced cuspreplacing composite restorations. Dent Mater 2005;21:565-72.  Back to cited text no. 37
Purk JH, Eick JD, DeSchepper EJ, Chappel RP, Tira DE. Fracture strength of class I class II restored premolars tested at the marginal ridge. I. Standard preparations. Quintessence Int 1990;21:545-51.  Back to cited text no. 38
Watts DC, el Mowafy OM, Grant AA. Fracture resistance of lower molars with Class 1 composite and amalgam restorations. Dent Mater 1987;3:261-4.  Back to cited text no. 39
Bergmann P, Noack MJ, Roulet JF. Marginal adaptation with glass-ceramic inlays adhesively luted with glycerine gel. Quintessence Int 1991;22:739-44.  Back to cited text no. 40
Al-Hiyasat AS, Darmani H, Milhem MM. Cytotoxicity evaluation of dental resin composites and their flowable derivatives. Clin Oral Investig 2005;9:21-5.  Back to cited text no. 41
Asmussen E, Peutzfeldt A. Long-term fluoride release from a glass ionomer cement, a compomer, and from experimental resin composites. Acta Odontol Scand 2002;60:93-7.  Back to cited text no. 42
Asmussen E, Peutzfeldt A. Influence of UEDMA, BisGMA and TEGDMA on selected mechanical properties experimental resin composites. Dent Mater 1998;14:51-6.  Back to cited text no. 43
Berg JH. The continuum of restorative materials in pediatric dentistry – A review for the clinician. Pediatr Dent 1998;20:93-100.  Back to cited text no. 44
Bottenberg P, Jacquet W, Alaerts M, Keulemans F. A prospective randomized clinical trial of one bis-GMA-based and two ormocer-based composite restorative systems in class II cavities: Five-year results. J Dent 2009;37:198-203.  Back to cited text no. 45
Bottenberg P, Alaerts M, Keulemans F. A prospective randomized clinical trial of one Bis-GMAbased and two ormocer-based composite restorative systems in class II cavities: Three-year results. J Dent 2007;35:163-71.  Back to cited text no. 46
Bouillaguet S, Gamba J, Forchelet J, Krejci I, Wataha JC. Dynamics of composite polymerizationmediates the development of cuspalstrain. Dent Mater 2006;22:896-902.  Back to cited text no. 47
Bowen RL. Properties of a silica-reinforced polymer for dental restorations. JADA 1963;66:57-64.  Back to cited text no. 48
Bürgers R, Schneider-Brachert W, Hahnel S, Rosentritt M, Handel G. Streptococcal adhesion to novel low-shrink silorane-based restorative. Dent Mater 2009;25:269-75.  Back to cited text no. 49
Bürgers R, Schneider-Brachert W, Rosentritt M, Handel G, Hahnel S. Candida albican adhesion to composite resin materials. Clin Oral Investig 2009;13:293-9.  Back to cited text no. 50
Cattani-Lorente M, Bouillaguet S, Godin CH, Meyer JM. Polymerization shrinkage of Ormocer based dental restorative composites. Eur Cell Mater 2001;1:25-6.  Back to cited text no. 51
Ernst CP, Meyer GR, Klöcker K, Willershausen B. Determination of polymerization shrinkage stress by means of a photoelastic investigation. Dent Mater 2004;20:313-21.  Back to cited text no. 52
Ernst CP, Brandenbusch M, Meyer G, Canbek K, Gottschalk F, Willershausen B. Two-year clinicalperformance of a nanofiller vs. a fine-particle hybrid resin composite. Clin Oral Investig 2006;10:119-25.  Back to cited text no. 53
Folwaczny M, Lohner C, Mehl A, Kunzelmann K H, Hickel R. Tooth-colored filling materials for therestoration of cervical lesions – A 24-monthfollow-up study. Oper Dent 2000;25:251-8.  Back to cited text no. 54
Folwaczny M, Loher C, Mehl A, Kunzelmann KH, Hickel R. Class V lesions restored with four differenttooth-colored materials-3-year results. Clin Oral Investig 2001;5:31-9.  Back to cited text no. 55
Folwaczny M, Mehl A, Kunzelmann KH, Hickel R. Clinical performance of a resin-modified glassionomer and a compomer in restoring noncarious cervical lesions. 5-year results. Am J Dent 2001;14:153-6.  Back to cited text no. 56
Furuse AY, Gordon K, Rodrigues FP, Silikas N, Watts DC. Colour-stability and gloss-retention of silorane and dimethacrylate composite with accelerated aging. J Dent 2008;36:945-52.  Back to cited text no. 57
Gjorgievska E, Nicholson JW, Gjorgovski I, Iljovska S. Aluminium and fluoride release into artificial saliva from dental restoratives placed in teeth. J Mater Sci Mater Med 2008;19:3163-7.  Back to cited text no. 58
Glasspole EA, Erickson RL, Davidson CL. A fluoride- releasing composite for dental applications. Dent Mater 2001;17:127-33.  Back to cited text no. 59
Gonçalves F, Pfeifer CS, Ferracane JL, Braga RR. Contraction stress determinants in dimethacrylate composites. J Dent Res 2008;87:367-71.  Back to cited text no. 60
Han L, Cv E, Li M, Niwano K, Ab N, Okamoto A, et al. Effect of fluoride mouthrinse on fluoride releasing and recharging from aesthetic dental materials. Dent Mater J 2002;21:285-95.  Back to cited text no. 61
Hickel R, Manhart J. Longevity of restorations in posterior teeth and reasons for failure. J Adhes Dent 2001;3:45-64.  Back to cited text no. 62
Hse KM, Wei SH. Clinical evaluation of compomer in primary teeth: 1-year results. J Am Dent Assoc 1997;128:1088-96.  Back to cited text no. 63
Ikejima I, Nomoto R, McCabe JF. Shear punch strength and flexural strength of model composites with varying filler volume fraction, filler size and silanization. Dent Mater 2003;19:206-11.  Back to cited text no. 64
Ilie N, Hickel R. Investigations on mechanical behavior of dental composites. Clin Oral Investig 2009;13:427-38.  Back to cited text no. 65
Ilie N, Hickel R. Macro-, micro- and nano-mechanical investigations on silorane and methacrylate- based composites. Dent Mater 2009;25:810-9.  Back to cited text no. 66
Ilie N, Jelen E, Clementino-Luedemann T, Hickel R. Low-shrinkage composite for dental application. Dent Mater J 2007;26:149-55.  Back to cited text no. 67


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