Effect of Restorative Cavity Designs and Restoration Techniques on Fracture Resistance and Fracture Patterns in Simulated Immature Teeth: An In Vitro Study

Merve Sarı; Şule Pekuz; Pelin Tufenkci

doi:10.7126/cumudj.1805743

Research Article

Effect of Restorative Cavity Designs and Restoration Techniques on Fracture Resistance and Fracture Patterns in Simulated Immature Teeth: An In Vitro Study

Year 2026, Volume: 29 Issue: 1, 129 - 137, 27.03.2026

Merve Sarı , Şule Pekuz , Pelin Tufenkci

https://doi.org/10.7126/cumudj.1805743

https://izlik.org/JA36TM67AD

Abstract

Objectives: This study evaluated the effects of different restorative techniques—direct composite, fiber post, and the Bioblock technique—on the fracture resistance and fracture patterns of simulated immature teeth with mesio-occlusal (MO) and single buccal cusp (SBC) cavity designs.
Materials and Methods: Seventy single-rooted mandibular premolars were selected. Ten teeth served as the control group, while the remaining specimens were randomly allocated into six experimental groups (n=10) according to cavity design (MO or SBC) and restorative technique (direct composite, fiber post, or Bioblock). To simulate immature apices, root canals were enlarged using Gates Glidden drills, followed by apexification with a 3-mm-thick MTA layer. All specimens then underwent fracture resistance testing. Fracture resistance data were analyzed using one-way analysis of variance (ANOVA), while fracture pattern data were evaluated with the chi-square test. The level of statistical significance was set at α = 0.05.
Results: The lowest fracture resistance was observed in the SBC fiber post group, while the control group exhibited the highest values. All MO subgroups demonstrated significantly higher fracture resistance than the SBC subgroups (p<0.01). No significant difference was found between the direct composite and Bioblock groups (p>0.05); however, both exhibited significantly greater fracture resistance than the fiber post groups (p<0.01). No significant differences were observed in fracture patterns among the groups (p>0.05).
Conclusion: MO cavity designs provided greater fracture resistance compared with SBC designs. Fiber post restorations yielded the lowest resistance values, whereas direct composite and Bioblock techniques performed significantly better.

Keywords

Dental Restoration , Endodontically-Treated , Failures , Mineral Trioxide Aggregate.

Ethical Statement

This study was approved by the ... University, Non-Interventional Research Ethics Committee (Protocol Number: 06/05/2021-26). The authors certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. As this study did not involve human participants, Hatay Mustafa Kemal University Non-Interventional Research Ethics Committee determined that informed consent was not required.

Supporting Institution

This study was funded by the Hatay Mustafa Kemal University Scientific Research Projects (Project No: 22.DHU.008).

Thanks

None

References

1. Aksoy D, Kocak S. Management strategies for teeth with open apex: from apexification to regenerative endodontics. Cumhuriyet Dent J 2025;28:462-468.
2. Annamalai S, Mungara J. Efficacy of mineral trioxide aggregate as an apical plug in non-vital young permanent teeth: preliminary results. J Clin Pediatr Dent 2010;35:149-155.
3. Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures. J Endod 1989;15:512-516.
4. Hülsmann M, Heckendorff M, Schäfers F. Comparative in-vitro evaluation of three chelator pastes. Int Endod J 2002;35:668-679.
5. Sáry T, Garoushi S, Braunitzer G, Alleman D, Volom A, Fráter M. Fracture behaviour of MOD restorations reinforced by various fibre-reinforced techniques - an in vitro study. J Mech Behav Biomed Mater 2019;98:348-356.
6. Goracci C, Ferrari M. Current perspectives on post systems: a literature review. Aust Dent J 2011;56 Suppl 1:77-83.
7. Lassila LV, Tezvergil A, Lahdenperä M, Alander P, Shinya A, Shinya A, et al. Evaluation of some properties of two fiber-reinforced composite materials. Acta Odontol Scand 2005;63:196-204.
8. Thomas RM, Kelly A, Tagiyeva N, Kanagasingam S. Comparing endocrown restorations on permanent molars and premolars: a systematic review and meta-analysis. Br Dent J 2020.
9. Beji Vijayakumar J, Varadan P, Balaji L, Rajan M, Kalaiselvam R, Saeralaathan S, et al. Fracture resistance of resin based and lithium disilicate endocrowns. Which is better? - A systematic review of in-vitro studies. Biomater Investig Dent 2021;8:104-111.
10. Al-Nuaimi N, Ciapryna S, Chia M, Patel S, Mannocci F. A prospective study on the effect of coronal tooth structure loss on the 4-year clinical survival of root canal retreated teeth and retrospective validation of the Dental Practicality Index. Int Endod J 2020;53:1040-1049.
11. Ferrari M, Vichi A, Fadda GM, Cagidiaco MC, Tay FR, Breschi L, et al. A randomized controlled trial of endodontically treated and restored premolars. J Dent Res 2012;91:72s-78s.
12. Garoushi S, Vallittu PK, Lassila LV. Short glass fiber reinforced restorative composite resin with semi-inter penetrating polymer network matrix. Dent Mater 2007;23:1356-1362.
13. Fráter M, Sáry T, Néma V, Braunitzer G, Vallittu P, Lassila L, et al. Fatigue failure load of immature anterior teeth: influence of different fiber post-core systems. Odontology 2021;109:222-230.
14. Scotti N, Coero Borga FA, Alovisi M, Rota R, Pasqualini D, Berutti E. Is fracture resistance of endodontically treated mandibular molars restored with indirect onlay composite restorations influenced by fibre post insertion? J Dent 2012;40:814-820.
15. Tanalp J, Dikbas I, Malkondu O, Ersev H, Güngör T, Bayırlı G. Comparison of the fracture resistance of simulated immature permanent teeth using various canal filling materials and fiber posts. Dent Traumatol 2012;28:457-464.
16. Balkaya MC, Birdal IS. Effect of resin-based materials on fracture resistance of endodontically treated thin-walled teeth. J Prosthet Dent 2013;109:296-303.
17. Soares PV, Santos-Filho PC, Martins LR, Soares CJ. Influence of restorative technique on the biomechanical behavior of endodontically treated maxillary premolars. Part I: fracture resistance and fracture mode. J Prosthet Dent 2008;99:30-37.
18. Stappert CF, Att W, Gerds T, Strub JR. Fracture resistance of different partial-coverage ceramic molar restorations: an in vitro investigation. J Am Dent Assoc 2006;137:514-522.
19. Bayram E, Bayram HM. Effect of intracanal medicament on dentin penetration ability of root canal sealers: a confocal study. BMC Oral Health 2025;25(1):1253.
20. Balkaya H, Topçuoğlu HS, Demirbuga S, Kafdağ Ö, Topçuoğlu G. Effect of different coronal restorations on the fracture resistance of teeth with simulated regenerative endodontic treatment: an in vitro study. Aust Endod J 2022;48:331-337.
21. Assif D, Gorfil C. Biomechanical considerations in restoring endodontically treated teeth. J Prosthet Dent 1994;71:565-567.
22. Lin CL, Chang CH, Ko CC. Multifactorial analysis of an MOD restored human premolar using auto-mesh finite element approach. J Oral Rehabil 2001;28:576-585.
23. Taha NA, Palamara JE, Messer HH. Cuspal deflection, strain and microleakage of endodontically treated premolar teeth restored with direct resin composites. J Dent 2009;37:724-730.
24. El-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.
25. Seow LL, Toh CG, Wilson NH. Strain measurements and fracture resistance of endodontically treated premolars restored with all-ceramic restorations. J Dent 2015;43:126-132.
26. Linsuwanont P, Kulvitit S, Santiwong B. Reinforcement of simulated immature permanent teeth after mineral trioxide aggregate apexification. J Endod 2018;44:163-167.
27. Ree MH, Schwartz RS. Long-term success of nonvital, immature permanent incisors treated with a mineral trioxide aggregate plug and adhesive restorations: a case series from a private endodontic practice. J Endod 2017;43:1370-1377.
28. Jamshidi D, Homayouni H, Moradi Majd N, Shahabi S, Arvin A, Ranjbar Omidi B. Impact and fracture strength of simulated immature teeth treated with mineral trioxide aggregate apical plug and fiber post versus revascularization. J Endod 2018;44:1878-1882.
29. Naumann M, Koelpin M, Beuer F, Meyer-Lueckel H. 10-year survival evaluation for glass-fiber-supported postendodontic restoration: a prospective observational clinical study. J Endod 2012;38:432-435.
30. Ambica K, Mahendran K, Talwar S, Verma M, Padmini G, Periasamy R. Comparative evaluation of fracture resistance under static and fatigue loading of endodontically treated teeth restored with carbon fiber posts, glass fiber posts, and an experimental dentin post system: an in vitro study. J Endod 2013;39:96-100.
31. Junqueira RB, de Carvalho RF, Marinho CC, Valera MC, Carvalho CAT. Influence of glass fibre post length and remaining dentine thickness on the fracture resistance of root filled teeth. Int Endod J 2017;50:569-577.
32. Crozet A, Aubeux D, Pérez F, Gaudin A. Fracture resistance of simulated immature maxillary anterior teeth restored with various canal filling materials, with micro-posts or with a fiber post. Dent Mater J 2023;42:368-374.
33. Schmoldt SJ, Kirkpatrick TC, Rutledge RE, Yaccino JM. Reinforcement of simulated immature roots restored with composite resin, mineral trioxide aggregate, gutta-percha, or a fiber post after thermocycling. J Endod 2011;37:1390-1393.
34. Aurélio IL, Fraga S, Rippe MP, Valandro LF. Are posts necessary for the restoration of root filled teeth with limited tissue loss? A structured review of laboratory and clinical studies. Int Endod J 2016;49:827-835.
35. Fráter M, Forster A, Jantyik Á, Braunitzer G, Nagy K, Grandini S. In vitro fracture resistance of premolar teeth restored with fibre-reinforced composite posts using a single or a multi-post technique. Aust Endod J 2017;43:16-22.
36. Le Bell-Rönnlöf AM, Lassila LV, Kangasniemi I, Vallittu PK. Load-bearing capacity of human incisor restored with various fiber-reinforced composite posts. Dent Mater 2011;27:e107-115.
37. Hou QQ, Gao YM, Sun L. Influence of fiber posts on the fracture resistance of endodontically treated premolars with different dental defects. Int J Oral Sci 2013;5:167-171.
38. Mangold JT, Kern M. Influence of glass-fiber posts on the fracture resistance and failure pattern of endodontically treated premolars with varying substance loss: an in vitro study. J Prosthet Dent 2011;105:387-393.
39. Fráter M, Lassila L, Braunitzer G, Vallittu PK, Garoushi S. Fracture resistance and marginal gap formation of post-core restorations: influence of different fiber-reinforced composites. Clin Oral Investig 2020;24:265-276.
40. Forster A, Sáry T, Braunitzer G, Fráter M. In vitro fracture resistance of endodontically treated premolar teeth restored with a direct layered fiber-reinforced composite post and core. J Adhes Sci Technol 2017;31:1454-1466.
41. Lassila L, Keulemans F, Säilynoja E, Vallittu PK, Garoushi S. Mechanical properties and fracture behavior of flowable fiber reinforced composite restorations. Dent Mater 2018;34:598-606.
42. Ayad MF, Maghrabi AA, García-Godoy F. Resin composite polyethylene fiber reinforcement: effect on fracture resistance of weakened marginal ridges. Am J Dent 2010;23:133-136.
43. Eapen AM, Amirtharaj LV, Sanjeev K, Mahalaxmi S. Fracture resistance of endodontically treated teeth restored with 2 different fiber-reinforced composite and 2 conventional composite resin core buildup materials: an in vitro study. J Endod 2017;43:1499-1504.
44. Vallittu PK. High-aspect ratio fillers: fiber-reinforced composites and their anisotropic properties. Dent Mater 2015;31:1-7.
45. Garoushi S, Gargoum A, Vallittu PK, Lassila L. Short fiber-reinforced composite restorations: a review of the current literature. J Investig Clin Dent 2018;9:e12330.
46. Garoushi S, Säilynoja E, Vallittu PK, Lassila L. Physical properties and depth of cure of a new short fiber reinforced composite. Dent Mater 2013;29:835-841.
47. Fráter M, Sáry T, Jókai B, Braunitzer G, Säilynoja E, Vallittu PK, Lassila L, Garoushi S. Fatigue behavior of endodontically treated premolars restored with different fiber-reinforced designs. Dent Mater 2021;37:391-402.
48. Rocca GT, Saratti CM, Cattani-Lorente M, Feilzer AJ, Scherrer S, Krejci I. The effect of a fiber reinforced cavity configuration on load bearing capacity and failure mode of endodontically treated molars restored with CAD/CAM resin composite overlay restorations. J Dent 2015;43:1106-1115.
49. Omran TA, Garoushi S, Abdulmajeed AA, Lassila LV, Vallittu PK. Influence of increment thickness on dentin bond strength and light transmission of composite base materials. Clin Oral Investig 2017;21:1717-1724.
50. Taha NA, Palamara JE, Messer HH. Fracture strength and fracture patterns of root filled teeth restored with direct resin restorations. J Dent 2011;39:527-535.
51. Eakle WS. Effect of thermal cycling on fracture strength and microleakage in teeth restored with a bonded composite resin. Dent Mater 1986;2:114-117.
52. Garoushi S, Sungur S, Boz Y, Ozkan P, Vallittu PK, Uctasli S, Lassila L. Influence of short-fiber composite base on fracture behavior of direct and indirect restorations. Clin Oral Investig 2021;25:4543-4552.
53. Soares CJ, Pizi EC, Fonseca RB, Martins LR. Influence of root embedment material and periodontal ligament simulation on fracture resistance tests. Braz Oral Res 2005;19:11-16.

Restoratif Kavite Tasarımlarının ve Restorasyon Tekniklerinin Simüle Edilmiş İmmatür Dişlerde Kırılma Direnci ve Kırılma Paternleri Üzerine Etkisi: İn Vitro Çalışma

Year 2026, Volume: 29 Issue: 1, 129 - 137, 27.03.2026

Merve Sarı , Şule Pekuz , Pelin Tufenkci

https://doi.org/10.7126/cumudj.1805743

https://izlik.org/JA36TM67AD

Abstract

Amaç: Bu çalışma, farklı restoratif tekniklerin—direkt kompozit, fiber post ve Bioblock tekniği—mezio-okal (MO) ve tek bukkal kusp (SBC) kaviteli simüle immatür dişlerde kırılma direnci ve kırılma paternleri üzerindeki etkilerini değerlendirmiştir.
Gereç ve Yöntemler: Yetmiş tek köklü mandibular premolar diş seçilmiştir. On diş kontrol grubu olarak ayrılmış, kalan örnekler ise kavite tasarımı (MO veya SBC) ve restoratif teknik (direkt kompozit, fiber post veya Bioblock) esas alınarak rastgele altı deney grubuna (n=10) dağıtılmıştır. İmmatür apeksleri simüle etmek için kök kanalları Gates Glidden frezleriyle genişletilmiş ve ardından 3 mm kalınlığında MTA tabakası ile apeksifikasyon yapılmıştır. Tüm örneklerde kırılma direnci testi uygulanmıştır. Kırılma direnci verileri tek yönlü varyans analizi (ANOVA) ile, kırılma paterni verileri ise ki-kare testi ile değerlendirilmiştir. İstatistiksel anlamlılık düzeyi α = 0,05 olarak belirlenmiştir.
Bulgular: En düşük kırılma direnci SBC fiber post grubunda gözlenirken, en yüksek değerler kontrol grubunda bulunmuştur. Tüm MO alt grupları, SBC alt gruplarına göre anlamlı derecede daha yüksek kırılma direnci göstermiştir (p<0,01). Direkt kompozit ve Bioblock grupları arasında anlamlı fark bulunmamıştır (p>0,05); ancak her ikisi de fiber post gruplarına kıyasla anlamlı derecede daha yüksek kırılma direnci sergilemiştir (p<0,01). Gruplar arasında kırılma paternleri açısından anlamlı farklılık gözlenmemiştir (p>0,05).
Sonuçlar: MO kavite tasarımları, SBC tasarımlarına kıyasla daha yüksek kırılma direnci sağlamıştır. Fiber post restorasyonlar en düşük direnç değerlerini verirken, direkt kompozit ve Bioblock teknikleri anlamlı derecede daha iyi performans göstermiştir.

Keywords

Başarısızlıklar , Diş Restorasyonu , Endodontik Tedavili Dişler , Mineral Trioksit Agregat.

Ethical Statement

Bu çalışma, ... Üniversitesi Girişimsel Olmayan Araştırmalar Etik Kurulu tarafından onaylanmıştır (Protokol Numarası: 06/05/2021-26). Yazarlar, çalışmanın 1964 Helsinki Bildirgesi’nde belirtilen etik standartlara ve sonraki değişikliklerine veya benzeri etik standartlara uygun olarak yürütüldüğünü beyan ederler. Bu çalışma insan katılımcıları içermediğinden, Hatay Mustafa Kemal Üniversitesi Girişimsel Olmayan Araştırmalar Etik Kurulu bilgilendirilmiş onamın gerekli olmadığına karar vermiştir.

Supporting Institution

Bu çalışma, Hatay Mustafa Kemal Üniversitesi Bilimsel Araştırma Projeleri Koordinatörlüğü tarafından desteklenmiştir (Proje No: 22.DHU.008).

References

1. Aksoy D, Kocak S. Management strategies for teeth with open apex: from apexification to regenerative endodontics. Cumhuriyet Dent J 2025;28:462-468.
2. Annamalai S, Mungara J. Efficacy of mineral trioxide aggregate as an apical plug in non-vital young permanent teeth: preliminary results. J Clin Pediatr Dent 2010;35:149-155.
3. Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures. J Endod 1989;15:512-516.
4. Hülsmann M, Heckendorff M, Schäfers F. Comparative in-vitro evaluation of three chelator pastes. Int Endod J 2002;35:668-679.
5. Sáry T, Garoushi S, Braunitzer G, Alleman D, Volom A, Fráter M. Fracture behaviour of MOD restorations reinforced by various fibre-reinforced techniques - an in vitro study. J Mech Behav Biomed Mater 2019;98:348-356.
6. Goracci C, Ferrari M. Current perspectives on post systems: a literature review. Aust Dent J 2011;56 Suppl 1:77-83.
7. Lassila LV, Tezvergil A, Lahdenperä M, Alander P, Shinya A, Shinya A, et al. Evaluation of some properties of two fiber-reinforced composite materials. Acta Odontol Scand 2005;63:196-204.
8. Thomas RM, Kelly A, Tagiyeva N, Kanagasingam S. Comparing endocrown restorations on permanent molars and premolars: a systematic review and meta-analysis. Br Dent J 2020.
9. Beji Vijayakumar J, Varadan P, Balaji L, Rajan M, Kalaiselvam R, Saeralaathan S, et al. Fracture resistance of resin based and lithium disilicate endocrowns. Which is better? - A systematic review of in-vitro studies. Biomater Investig Dent 2021;8:104-111.
10. Al-Nuaimi N, Ciapryna S, Chia M, Patel S, Mannocci F. A prospective study on the effect of coronal tooth structure loss on the 4-year clinical survival of root canal retreated teeth and retrospective validation of the Dental Practicality Index. Int Endod J 2020;53:1040-1049.
11. Ferrari M, Vichi A, Fadda GM, Cagidiaco MC, Tay FR, Breschi L, et al. A randomized controlled trial of endodontically treated and restored premolars. J Dent Res 2012;91:72s-78s.
12. Garoushi S, Vallittu PK, Lassila LV. Short glass fiber reinforced restorative composite resin with semi-inter penetrating polymer network matrix. Dent Mater 2007;23:1356-1362.
13. Fráter M, Sáry T, Néma V, Braunitzer G, Vallittu P, Lassila L, et al. Fatigue failure load of immature anterior teeth: influence of different fiber post-core systems. Odontology 2021;109:222-230.
14. Scotti N, Coero Borga FA, Alovisi M, Rota R, Pasqualini D, Berutti E. Is fracture resistance of endodontically treated mandibular molars restored with indirect onlay composite restorations influenced by fibre post insertion? J Dent 2012;40:814-820.
15. Tanalp J, Dikbas I, Malkondu O, Ersev H, Güngör T, Bayırlı G. Comparison of the fracture resistance of simulated immature permanent teeth using various canal filling materials and fiber posts. Dent Traumatol 2012;28:457-464.
16. Balkaya MC, Birdal IS. Effect of resin-based materials on fracture resistance of endodontically treated thin-walled teeth. J Prosthet Dent 2013;109:296-303.
17. Soares PV, Santos-Filho PC, Martins LR, Soares CJ. Influence of restorative technique on the biomechanical behavior of endodontically treated maxillary premolars. Part I: fracture resistance and fracture mode. J Prosthet Dent 2008;99:30-37.
18. Stappert CF, Att W, Gerds T, Strub JR. Fracture resistance of different partial-coverage ceramic molar restorations: an in vitro investigation. J Am Dent Assoc 2006;137:514-522.
19. Bayram E, Bayram HM. Effect of intracanal medicament on dentin penetration ability of root canal sealers: a confocal study. BMC Oral Health 2025;25(1):1253.
20. Balkaya H, Topçuoğlu HS, Demirbuga S, Kafdağ Ö, Topçuoğlu G. Effect of different coronal restorations on the fracture resistance of teeth with simulated regenerative endodontic treatment: an in vitro study. Aust Endod J 2022;48:331-337.
21. Assif D, Gorfil C. Biomechanical considerations in restoring endodontically treated teeth. J Prosthet Dent 1994;71:565-567.
22. Lin CL, Chang CH, Ko CC. Multifactorial analysis of an MOD restored human premolar using auto-mesh finite element approach. J Oral Rehabil 2001;28:576-585.
23. Taha NA, Palamara JE, Messer HH. Cuspal deflection, strain and microleakage of endodontically treated premolar teeth restored with direct resin composites. J Dent 2009;37:724-730.
24. El-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.
25. Seow LL, Toh CG, Wilson NH. Strain measurements and fracture resistance of endodontically treated premolars restored with all-ceramic restorations. J Dent 2015;43:126-132.
26. Linsuwanont P, Kulvitit S, Santiwong B. Reinforcement of simulated immature permanent teeth after mineral trioxide aggregate apexification. J Endod 2018;44:163-167.
27. Ree MH, Schwartz RS. Long-term success of nonvital, immature permanent incisors treated with a mineral trioxide aggregate plug and adhesive restorations: a case series from a private endodontic practice. J Endod 2017;43:1370-1377.
28. Jamshidi D, Homayouni H, Moradi Majd N, Shahabi S, Arvin A, Ranjbar Omidi B. Impact and fracture strength of simulated immature teeth treated with mineral trioxide aggregate apical plug and fiber post versus revascularization. J Endod 2018;44:1878-1882.
29. Naumann M, Koelpin M, Beuer F, Meyer-Lueckel H. 10-year survival evaluation for glass-fiber-supported postendodontic restoration: a prospective observational clinical study. J Endod 2012;38:432-435.
30. Ambica K, Mahendran K, Talwar S, Verma M, Padmini G, Periasamy R. Comparative evaluation of fracture resistance under static and fatigue loading of endodontically treated teeth restored with carbon fiber posts, glass fiber posts, and an experimental dentin post system: an in vitro study. J Endod 2013;39:96-100.
31. Junqueira RB, de Carvalho RF, Marinho CC, Valera MC, Carvalho CAT. Influence of glass fibre post length and remaining dentine thickness on the fracture resistance of root filled teeth. Int Endod J 2017;50:569-577.
32. Crozet A, Aubeux D, Pérez F, Gaudin A. Fracture resistance of simulated immature maxillary anterior teeth restored with various canal filling materials, with micro-posts or with a fiber post. Dent Mater J 2023;42:368-374.
33. Schmoldt SJ, Kirkpatrick TC, Rutledge RE, Yaccino JM. Reinforcement of simulated immature roots restored with composite resin, mineral trioxide aggregate, gutta-percha, or a fiber post after thermocycling. J Endod 2011;37:1390-1393.
34. Aurélio IL, Fraga S, Rippe MP, Valandro LF. Are posts necessary for the restoration of root filled teeth with limited tissue loss? A structured review of laboratory and clinical studies. Int Endod J 2016;49:827-835.
35. Fráter M, Forster A, Jantyik Á, Braunitzer G, Nagy K, Grandini S. In vitro fracture resistance of premolar teeth restored with fibre-reinforced composite posts using a single or a multi-post technique. Aust Endod J 2017;43:16-22.
36. Le Bell-Rönnlöf AM, Lassila LV, Kangasniemi I, Vallittu PK. Load-bearing capacity of human incisor restored with various fiber-reinforced composite posts. Dent Mater 2011;27:e107-115.
37. Hou QQ, Gao YM, Sun L. Influence of fiber posts on the fracture resistance of endodontically treated premolars with different dental defects. Int J Oral Sci 2013;5:167-171.
38. Mangold JT, Kern M. Influence of glass-fiber posts on the fracture resistance and failure pattern of endodontically treated premolars with varying substance loss: an in vitro study. J Prosthet Dent 2011;105:387-393.
39. Fráter M, Lassila L, Braunitzer G, Vallittu PK, Garoushi S. Fracture resistance and marginal gap formation of post-core restorations: influence of different fiber-reinforced composites. Clin Oral Investig 2020;24:265-276.
40. Forster A, Sáry T, Braunitzer G, Fráter M. In vitro fracture resistance of endodontically treated premolar teeth restored with a direct layered fiber-reinforced composite post and core. J Adhes Sci Technol 2017;31:1454-1466.
41. Lassila L, Keulemans F, Säilynoja E, Vallittu PK, Garoushi S. Mechanical properties and fracture behavior of flowable fiber reinforced composite restorations. Dent Mater 2018;34:598-606.
42. Ayad MF, Maghrabi AA, García-Godoy F. Resin composite polyethylene fiber reinforcement: effect on fracture resistance of weakened marginal ridges. Am J Dent 2010;23:133-136.
43. Eapen AM, Amirtharaj LV, Sanjeev K, Mahalaxmi S. Fracture resistance of endodontically treated teeth restored with 2 different fiber-reinforced composite and 2 conventional composite resin core buildup materials: an in vitro study. J Endod 2017;43:1499-1504.
44. Vallittu PK. High-aspect ratio fillers: fiber-reinforced composites and their anisotropic properties. Dent Mater 2015;31:1-7.
45. Garoushi S, Gargoum A, Vallittu PK, Lassila L. Short fiber-reinforced composite restorations: a review of the current literature. J Investig Clin Dent 2018;9:e12330.
46. Garoushi S, Säilynoja E, Vallittu PK, Lassila L. Physical properties and depth of cure of a new short fiber reinforced composite. Dent Mater 2013;29:835-841.
47. Fráter M, Sáry T, Jókai B, Braunitzer G, Säilynoja E, Vallittu PK, Lassila L, Garoushi S. Fatigue behavior of endodontically treated premolars restored with different fiber-reinforced designs. Dent Mater 2021;37:391-402.
48. Rocca GT, Saratti CM, Cattani-Lorente M, Feilzer AJ, Scherrer S, Krejci I. The effect of a fiber reinforced cavity configuration on load bearing capacity and failure mode of endodontically treated molars restored with CAD/CAM resin composite overlay restorations. J Dent 2015;43:1106-1115.
49. Omran TA, Garoushi S, Abdulmajeed AA, Lassila LV, Vallittu PK. Influence of increment thickness on dentin bond strength and light transmission of composite base materials. Clin Oral Investig 2017;21:1717-1724.
50. Taha NA, Palamara JE, Messer HH. Fracture strength and fracture patterns of root filled teeth restored with direct resin restorations. J Dent 2011;39:527-535.
51. Eakle WS. Effect of thermal cycling on fracture strength and microleakage in teeth restored with a bonded composite resin. Dent Mater 1986;2:114-117.
52. Garoushi S, Sungur S, Boz Y, Ozkan P, Vallittu PK, Uctasli S, Lassila L. Influence of short-fiber composite base on fracture behavior of direct and indirect restorations. Clin Oral Investig 2021;25:4543-4552.
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There are 53 citations in total.

Details

Primary Language	English
Subjects	Dental Materials and Equipment, Endodontics, Restorative Dentistry
Journal Section	Research Article
Authors	Merve Sarı 0000-0002-9432-3809 Şule Pekuz 0000-0002-6563-1327 Pelin Tufenkci 0000-0001-9881-5395
Submission Date	October 17, 2025
Acceptance Date	February 26, 2026
Publication Date	March 27, 2026
DOI	https://doi.org/10.7126/cumudj.1805743
IZ	https://izlik.org/JA36TM67AD
Published in Issue	Year 2026 Volume: 29 Issue: 1

Cite

EndNote	Sarı M, Pekuz Ş, Tufenkci P (March 1, 2026) Effect of Restorative Cavity Designs and Restoration Techniques on Fracture Resistance and Fracture Patterns in Simulated Immature Teeth: An In Vitro Study. Cumhuriyet Dental Journal 29 1 129–137.

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Cumhuriyet Dental Journal (Cumhuriyet Dent J, CDJ) is the official publication of Cumhuriyet University Faculty of Dentistry. CDJ is an international journal dedicated to the latest advancement of dentistry. The aim of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments in different areas of dentistry. First issue of the Journal of Cumhuriyet University Faculty of Dentistry was published in 1998. In 2010, journal's name was changed as Cumhuriyet Dental Journal. Journal’s publication language is English.

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