RESEARCH AND EDUCATION

Mechanical properties, fracture resistance, and fatigue limits

of short fiber reinforced dental composite resin
Jasmina Bijelic-Donova, CTD, DDS,a Sufyan Garoushi, DDS, PhD,b Pekka K. Vallittu, CDT, DDS, PhD,c and
Lippo V. J. Lassila, DDS, MsC Engd

Restorative materials in the oral ABSTRACT

cavity are subjected to slow and Statement of problem. Cycling masticatory loads decrease the strength of particulate filler
repetitive cycling loading, which composites (PFCs) and initiate the failure process by fatigue. The life expectancy of a composite
emphasizes the importance of resin restoration under stress remains difficult to predict.
fatigue studies. When subjected
Purpose. The purpose of this study was to determine the fracture resistance and the compressive
to masticatory-like cycles fatigue limits (CFL) of anterior crown restorations made of a short-fiber reinforced composite resin
(loading and unloading cycles), (SFC), to investigate selected mechanical properties of the material following standard test
the material may fail because of methods, and to observe their correlation with the CFL.
fatigue at stresses below the ul-
Material and methods. Specimens (n=10) were fabricated either from SFC (everX Posterior, GC
timate tensile strength. Upon Corp) or PFC (G-ænial anterior, GC Corp). The properties investigated were flexural strength (FS),
cycling, cracks at the material compression strength (CS), diametral-tensile strength (DTS), and single-edge-notched-bend
surface or within the material fracture toughness (FT) following ISO standards. Fracture resistance was determined by static
gradually grow, leading to fail- load (n=10) and the CFL at 10 000 cycles was determined using a staircase approach (n=20),
ure. Fatigue as a low stress
1 both on anterior composite resin crowns. The results were analyzed with 1-way ANOVA (a=.05)
condition depends on the stress or 2-way ANOVA (a=.05) followed by a Tukey B post hoc test and the Pearson-correlation analysis.
range and the subcritical crack Results. The SFC crowns had higher fracture resistance (954 ±121 N) than the PFC crowns
growth2 and influences different (415 ±75 N) (P<.001) and higher CFL (267 ±23 N) than the PFC crowns (135 ±64 N) (P<.001). SFC
materials differently. Fatigue
3 revealed also higher FT (2.6 ±0.6 MPa$m1/2) than the PFC (1.0 ±0.2 MPa$m1/2) (F=69.313, P<.001). A
significant correlation was observed only between the FT and the CFL (r2=0.899; P<.001).
cycling decreases the strength of
particulate filler composite Conclusions. SFC crowns showed good performance under static and fatigue loading. FT
resins (PFCs) ; higher filler
4 was the only in vitro test method that filtered as a clinically relevant parameter. (J Prosthet
loaded materials4 and materials Dent 2016;115:95-102)
with smaller filler particles5 are
more fatigue resistant. Exposure to water and other fluids higher stress levels, the materials with higher fracture
will further weaken the resin matrix and accelerate crack toughness values perform better.3
growth.6-8 However, when stresses are high, the importance The mechanical properties of conventional PFCs are
of high fracture toughness values becomes significant; at improved by including short fibers in the reinforcing

A part of this study is based on a presentation at the 91st General Session of the IADR/AADR/CADR (International Association of Dental Research/American
Association of Dental Research/Canadian Association of Dental Research), March 2013, Seattle, Wash, (Lassila L, Garoushi S, Bijelic J. Vallittu P. Mechanical
characterization of short fiber reinforced composite-Xenius. J Dent Res 92 (Spec Iss A): 1562, 2013) and is part of the BioCity Turku Biomaterials Research Program.
a
Doctoral student, Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku, Turku, Finland.
b
Adjunct Professor in Dental Materials Science, Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University
of Turku, Turku, Finland; and Department of Restorative Dentistry and Periodontology, Institute of Dentistry, Libyan International Medical University, Benghazi, Libya.
c
Professor and Chair of Biomaterials Science, Director of Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku, Turku, Finland, and City
of Turku Welfare Division, Oral Health Care, Turku, Finland.
d
Laboratory Head, Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku, Turku, Finland.

THE JOURNAL OF PROSTHETIC DENTISTRY 95

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Clinical Implications
Predictions of the durability of composite
restorations should be based on the material’s
toughness properties. As a result, the selection of
the restorative material should be based on its
fracture toughness value. SFC should be used in
high-stress-bearing areas to yield enhanced
toughness and make the restorations more resistant
to fracture.
phase.9-12 This has resulted in formulations with in-
creased resistance to fracture.10-12 A new type of short
fiber composite resin (SFC) (everX Posterior; GC Corp)
consists of a combination of a resin matrix, discontinuous
E (electrical) glass fibers, and inorganic particulate fillers.
The resin matrix comprises cross-linked monomers,
bisphenol-A-glycidyl dimethacrylate (bis-GMA), and tri-
ethylene glycol dimethacrylate (TEGDMA), accompanied
by linear polymethylmethacrylate (PMMA). This combi-
nation of resins enables the formation of the semi-
interpenetrating polymer network (semi-IPN) during
the polymerization of the material, which increases the
good bonding properties and toughness of the composite
resin.9,10 The short, randomly orientated fibers, however,
provide an isotropic reinforcing effect, which means
that the strength of the material is independent of the
fracture load direction and is the same in all directions.
The purpose of the present study was first to inves-
tigate the correlation between the parameters evaluated
with mechanical tests following ISO standards and the
compressive fatigue limits (CFL) of the composite resin
material in simulated service and second to determine
the static load bearing capacity (the fracture resistance) of
anterior single crown restorations. Therefore, the present
study included a fatigue and a static test on a model
closely simulating a clinical service condition in a high
stress bearing area (the single anterior crown) and a
series of laboratory tests that evaluated several me-
chanical properties. The fatigue test used here is known
as a “staircase” approach method and is used to deter-
mine the compressive5,8,13 or flexural2,4,7,14 fatigue limits
of the restorative material. The selected properties were
flexural strength (FS), flexural modulus (FM), compres-
sion strength (CS), diametral tensile strength (DTS), and
fracture toughness (FT). The static test used to evaluate
the fracture resistance of the crown restorations is known
as the load-to-failure test or “crunch-the-crown” test.
This test has been strongly criticized,15 but a positive
correlation with the fatigue test would help predict fa-
tigue performance based on the compressive static
strength of the material. However, observation of the
possible correlation between the mechanical properties
THE JOURNAL OF PROSTHETIC DENTISTRY
Volume 115 Issue 1
following standard test methods and the fatigue test will
help predict the durability of the restoration in function
based on the investigated parameters. The null hypoth-
esis was that no such correlation exists and that SFC
restorations cannot sustain the compressive static and
fatigue loads required for single anterior crowns.
MATERIAL AND METHODS
One SFC and one particulate filler composite resin (PFC)
resin were used in this study. The SFC composite resin
(everX Posterior; GC Corp) contained short E-glass fiber
fillers with an average diameter of 17 mm and a length
ranging from 1.3 to 2 mm10 and particulate barium glass
fillers as the reinforcing phase of the material. The total
inorganic phase was 74.2 wt%. The resin matrix of the
SFC contained Bis-GMA, TEGDMA, and PMMA. A
commercial PFC with 45 to 50 wt% of particulate fillers
(shade A3) (G-ænial anterior; GC Corp) was used as a
control material. The reinforcing phase of this PFC
combined 2 types of pre-polymerized resin fillers (fillers
containing silica, as well as strontium and lanthanoid
fluoride), silica particles, and fumed silica fillers. The resin
matrix of the PFC contained a mixture of urethane
dimethacrylate and dimethacrylate co-monomers. FS,
FM, FT, DTS, and CS were evaluated for each composite
resin (n=10). The specimens were dry-stored at 37! C for
48 hours before testing. In addition, anterior composite
resin crowns were fabricated on a zirconia model to test
the fracture resistance in compressive static (n=10) and
fatigue load (n=20) of the materials.
FS and FM were determined according to ISO 4049,16
by conducting a 3-point bending test on bar-shaped
specimens prepared in a half-split stainless steel mold
(2×2×25 mm). The specimens were photopolymerized for
20 seconds each in 5 separate overlapping portions on
both sides, with a handheld light-polymerizing unit
(Elipar S10; 3M ESPE) having an output intensity of 1600
mW/cm2 and a wavelength range between 430 and 480
nm. A 3-point bend test was then conducted with a
universal material testing machine (Lloyd model LRX;
Lloyd Instruments), and the load deflection curves were
recorded with analysis software (Nexygen 4.0; Lloyd In-
struments). The FS was calculated automatically by the
software by measuring the force during bending as a
function of the deflection of the specimen. The FM was
determined from the slope of the linear region of the
load-deflection curve.
DTS and CS were determined on cylindrical specimens
(4 mm in diameter and 6 mm in height) that were prepared
in the same way according to ISO 4104.17 For the DTS,
each specimen was placed with its longitudinal side be-
tween the platens of the testing machine. The specimens
were loaded in compression until failure at a crosshead
speed of 1 mm/min. The length and the diameter of each
Bijelic-Donova et al
January 2016 97

specimen were measured before testing with a digital

caliper, and the DTS was calculated based on specimen
length, diameter, and peak load.
For the CS, the same testing performances were used,
with the specimen being placed with the flat end on the
supporting plate. The flat ends were fixed between the
platens of the testing machine. In this case, a compres-
sive load was applied axially until failure. The CS was
determined using the peak load at fracture and the
diameter of the specimen.
Single-edge-notched-beam specimens (2.5x5x25 mm)
according to the adapted ISO 20795-1 standard
method18 were prepared to determine the FT.
A custom-made stainless steel split mold was used,
which enabled the removal of the specimen without
force. The restorative material was inserted into the
mold placed over a Mylar-strip-covered glass slide in 2 Figure 1. Position of crown and load direction during testing. Line de-
increments. Each increment (of approximately 2.5 mm scribes anatomically flat surface enabling stable load during fractural
thickness) was photopolymerized for 20 seconds in 5 assessment.
separate overlapping portions. Before photopolymerizing
the second layer, a sharp and centrally located crack
Table 1. Method for analyzing staircase test data
was produced by inserting a straight edged razor blade
G-ænial Anterior
into the prefabricated slot. This enabled standardization P P P
Load Stress Level Failures N= ni A= i$ni B= i2$ ni
of the crack length, which penetrated to approximately L i ni i$ ni i2$ ni
half the width of the specimen. The upper side of the 110 0 2 0 0
mold was covered with a Mylar strip and glass slide 130 1 2 2 2
from both sides of the blade before being exposed to 150 2 1 2 4
the photopolymerization light. Upon the removal from 170 3 2 6 18
the mold, each specimen was also photopolymerized on 190 4 1 4 16
N=8 A=14 B=40
the opposite side. The specimens were tested in 3-point
bend mode with a universal material testing machine at everX Posterior
a crosshead speed of 1.0 mm/min. Upon testing, the Load Stress Level
P
Failures N= ni
P
A= i$ni
P
B= i2$ ni
crack length (a) was determined as the average of 3 L i ni i$ ni i2$ ni
measurements of the distance below the notch (W-a) 250 0 2 0 0
with a light microscope (Leica; Leica Microsystems). The 270 1 2 2 2

FT was calculated by using the equation 290 2 5 10 20

N=9 A=12 B=22
h i
KIC = P L=B W3=2 fðxÞ; (1) L, load value in newtons at which restoration was tested; i, stress level starting from lowest
designated as 0 (i=0) or 1,2, and so on for every next (i=1; i=2 and so on); ni, number of
failures at given stress level; N, sum of all failures for all stress levels together (N=Sni); A, sum
where f(x) = 3/2x1/2 [1.99-x (1-x) (2.15-3.93x+2.7x2)]/ of all i$ni (A=Si$ni); B, sum of all i2$ ni (B= Si2$ ni).

(1+2x) (1-x)3/2 and 0<x<1 with x=a/W, P is the maximum

load in kilonewtons (kN), L is the span length (2 cm), B is
the specimen thickness in centimeters (cm), W is the
specimen width (depth) in cm, x is a geometric function
dependent on a/W, and a is the crack length in cm.
A zirconia abutment model of a maxillary central
incisor was milled following the computer-aided design
(5-TEC; Zirkonzahn) and then sintered in a furnace
(Zirkonofen 600/V2; Zirkonzahn) following the manu-
facturer’s instructions. The complete crown was waxed
using a pattern wax (Kronenwachs; Bego) on the zir-
conia model to obtain the exact anatomic shape of
a maxillary central incisor with a flat surface in order
to adapt the loading cell during the test setup. A
transparent polyvinyl siloxane impression (Memosil 2;
Heraeus Kulzer AG) was made to aid standardized
crown fabrication. The composite resin materials were
packed into the transparent mold and placed on the
model under light finger pressure. After removing the
excess material, the crown was photopolymerized from
2 sides for 20 seconds outside the mold. Upon removal
from the mold, the crown was further photo-
polymerized for another 40 seconds (20 seconds per
side). All crowns were finished and polished with dia-
mond rotary instruments and a polishing cup under
water cooling.
Compressive static fracture load was determined on
composite resin crowns (n=10/material) immediately

Bijelic-Donova et al THE JOURNAL OF PROSTHETIC DENTISTRY

98 Volume 115 Issue 1

Diametral Tensile Strength (MPa)

140 350 60

Compressive Strength (MPa)

107 47
247
Flexural Strength (MPa)

120 300 244

50
39
100 87 250
40
80 200
30
60 150
20
40 100

20 50 10

0 0 0
PFC SFC PFC SFC PFC SFC

Material Type A Material Type B Material Type C

Fracture Toughness (MPa . m1/2)

3.5 350

Compressive Fatigue Limit (N)

2.60
3.0 300 268

2.5 250

2.0 200 144

1.5 1.03 150

1.0 100

0.5 50

0.0 0
PFC SFC PFC SFC

Material Type D Material Type E

Figure 2. Graphs showing mechanical properties investigated for both materials. A, Flexural strength. B, Compressive strength. C, Diametral tensile
strength. D, Fracture toughness. E, Compressive fatigue limit. PFC, G-ænial anterior; SFC, everX posterior.

Table 2. Two-way ANOVA (P<.05)

Variables SS df MS F P was based on the failure versus nonfailure events.
Material type (PFC, SFC) 2405373.911 1 2405373.911 113.530 <.001 Equations 2 and 3 were used to calculate the CFL and its
Type of fracture load 279646.464 2 139823.232 6.599 .003 standard deviation S5,8,13:
[Initial (IF), final (FF), fatigue
(CFL) or postfatigue (PF) CFL=Xo +d ðA=N±1=2Þ (2)
fracture load]
Material type x type of 102098.566 2 51049.283 2.409 .099
fracture load
! " #
SS, sum of squares; MS, mean squares; PFC, G-ænial anterior; SFC, everX posterior. S=1:62 x d NB−A2 N2 +0:029 (3)

In equations 2 and 3, the CFL is the compressive fa-

upon their fabrication at room temperature 23 ±1! C. A tigue limit, Xo is the lowest load level considered in the
static load until fracture was applied to the crowns on the analysis, d is the fixed load increment (20 N) used in the
palatal side at a 45-degree angle using a universal testing sequential test, and S is the standard deviation. A, N, and
machine at a cross head speed of 1 mm/min. (Fig. 1). The B are explained in Table 1. A positive sign (+) in equation 2
specimens were loaded until fracture, with load values was used in the case of nonfailures and a negative sign (-)
measured in newtons (N). in the case of failures.5,8,13 The 11 SFC and 12 PFC crowns,
Compressive fatigue limits (CFL) at 10 000 cycles were which survived the 10 000 cycles, were statically loaded to
determined for the composite resin crowns (n=20/mate- evaluate the fracture resistance after fatigue testing,
rial) immediately upon their fabrication, according to the named here as postfatigue (PF) fracture resistance.
staircase approach. The test was performed in a water The data of all investigated properties were statisti-
bath at 37! C and a frequency of 1 Hz. The load was cally analyzed with software (SPSS v19; IBM Corp) using
applied on the palatal side of the crowns at a 45-degree analysis of variance (ANOVA) followed by a Tukey B post
angle as presented in Figure 1. In this “up and down” hoc test and Pearson correlation. Equality of variance was
method, specimens were sequentially tested so that the validated by the Levene test (P=.05). One-way ANOVA
first specimen was tested at the initial stress level (a=.05) was used to analyze the dependence between the
determined from preliminary data. The stress level for material (SFC, PFC) and the investigated mechanical
the next specimen was increased or decreased depending properties following standard test methods (FS, FT, DTS,
on the survival or the failure of the first specimen. The CS). Two-way ANOVA (a=.05) was calculated to deter-
magnitude by which the level was changed was fixed, mine whether the fracture resistance was different for
which, in the present study, was 20 N. Data analysis the materials investigated in this study (SFC, PFC) and

THE JOURNAL OF PROSTHETIC DENTISTRY Bijelic-Donova et al

January 2016
for the type of the load (static [IF, FF], fatigue [PF, CFL])
encountered by the crown restorations. Finally, a
Pearson correlation coefficient was calculated to examine
the relationship between the investigated mechanical
properties of the materials following standard test
methods, the fracture resistance of the crowns, and the
fatigue performance of the crowns.
RESULTS
The results of the investigated mechanical properties are
reported in Figure 2. One-way ANOVA revealed that
SFC had statistically higher FT (2.6 ±0.6 MPa$m1/2) than
the PFC (1.0 ±0.2 MPa$m1/2) (F=69.313, P<.001).
A statistically significant difference (F=14.727, P=.001)
between the materials was also observed for the FS
(107 ±14 MPa for the SFC and 87 ±9 MPa for the PFC),
but not for the CS or for the DTS (P>.001). The PFC had
higher (15 ±2 GPa) FM values than the SFC (10 ±1 GPa)
(F=62.375, P<.001).
Two-way ANOVA showed that both the material
type and the type of applied fracture load affected the
fracture resistance of the crowns (Table 2). The crowns
made of SFC had significantly higher initial (931 ±100 N)
(P<.001) and final fractural load (954 ±121 N) (P<.001)
than the PFC crowns (415 ±75 N), which had the same
initial and final fracture load. Figure 3 presents the values
of the static versus the postfatigue fracture load of the
crowns, which passed the preassigned life of 10 000 cy-
cles. The decrease in the strength of the materials was
calculated from the initial fracture (IF), final fracture (FF),
and the postfatigue fracture (PF) load values (Fig. 3) and
herein is called fracture resistance loss or endurance loss.
The fracture resistance loss after fatigue loading was less
for the SFC (4 to 7%, average 5%) than for the PFC
(11%). The PF fracture load of the crowns differed
significantly between the materials (651 ±161 N for the
SFC and 370 ±109 N for the PFC) (P<.001), but the PF
difference from the IF and FF fracture load was significant
only for the SFC (P<.001). The fatigue limit (CFL) values
are given to inform the observation that the compressive
static strength (the fracture resistance) values of those
crowns that survived the fatigue test (PF values) were
higher than the fatigue values of CFL.
Figure 4 shows the results of the fatigue investigation.
The mean load exerted on the SFC crowns during fatigue
(CFL) was 268 ±23 N and 144 ±64 N on the PFC crowns
(Fig. 4). The difference between the materials was sta-
tistically significant (P<.001). The ratio between the fa-
tigue limit and the static load was 0.3 ±0.03.
The results showed a strong correlation between the
FT and the CFL (r2=0.899, P<.001) for both investigated
materials. DTS showed a moderate correlation with the
CFL (r2=0.662, P=.001). A strong correlation was also
observed between the compressive static strength of the
Bijelic-Donova et al
99
a a
1200
954
Fracture Resistance Loss (N)
Fracture Resistance versus
931
1000 b
651
800
600 415 415 370
i
400 i 268
144
200
0
IF FF PF CFL IF FF PF CFL
PFC SFC
Figure 3. Fracture resistance versus fracture resistance loss of materials
investigated. PFC, G-ænial anterior; SFC, everX posterior; IF, initial failure;
FF, final failure; PF, postfatigue failure; CFL, fatigue limit. IF and FF were
obtained from compressive static fracture load test, whereas PF was
obtained from crowns that survived 10 000 cycles. CFL was mean frac-
ture load used in fatigue test. Horizontal line and same superscript let-
ters above columns indicate groups that were not statistically different
(P<.05), and i indicates informative values.
crowns and the fatigue limits (CFL) of the crowns
(r2=0.821, P<.001) (Table 3).
As seen in Figure 5, visual inspection revealed 2 types
of fracture patterns: brittle fracture for the PFC crowns
and ductile fracture for the SFC crowns.
DISCUSSION
The data suggested the rejection of the null hypothesis.
One of the ISO tests showed a strong correlation with the
fatigue performance and the SFC successfully sustained the
loads in both the compressive static and the fatigue load.
Firstly, an increase in the fracture resistance of
the crowns, which survived the preassigned cycle life
(PF versus CFL values in Figure 3), was observed in
this study. Secondly, the compressive static strength
of the crowns in the present investigation was signif-
icantly correlated with their fatigue limits (Table 3).
This indicates that the static load-bearing capacity
values can be used as a parameter for estimating
fatigue limits. Furthermore, this study revealed that
subjecting a composite resin crown restoration to fa-
tigue stresses surpassing an average amplitude of 30%
of the material’s compressive static strength will
lead to failure at levels lower than the preassigned
cycle life. Consequently, the fatigue stress limits must
be lower than this for the composite to withstand
a longer cycle life.
The SFC survived higher loads at a smaller cycling
range (230 to 290 N) than the PFC (110 to 210 N). The
scatter in the cycling loading range is important because
the smaller it is, the more uniform is the distribution
among the specimens. In terms of withstanding the
THE JOURNAL OF PROSTHETIC DENTISTRY
100
350
Fatigue Limits according to Staircase
300
250
Approach (N)
200
150
100
50
0
1 2
Figure 4. Graph showing fatigue load performance of investigated materials in accordance with staircase approach. PFC, G-ænial anterior; SFC, everX
posterior.
Table 3. Pearson correlation (r2) of some mechanical properties evalu-
ated on specimens prepared following standard test methods and
compressive static strength of crowns with fatigue performance (CFL) of
crowns
Compressive Fatigue LimitsdCFL
Pearson Correlation
Variables
Fracture toughnessdFT
Flexural strengthdFS
Diametral tensile strengthdDTS
Compressive strengthdCS
Compressive static strength
fatigue load, the PFC in this study behaved unpredictably
and tended toward unfavorable fractures, which could
explain the inconsistency in the scatter. The SFC yielded
better fatigue resistance than the PFC, as seen in the
lower fracture resistance loss after fatigue testing. This
endurance loss represents how much the strength of the
material decreased as a result of the mechanical fatigue
and is a relevant parameter showing more clearly the
fatigue resistance of the material than the fatigue test
itself.4,19 As a result, it may reliably estimate the long-
term mechanical properties and endurance limits of the
material. The enhanced fatigue resistance of the SFC
crowns in this study is supported by the failure mode
analysis. As shown in Figure 5, the SFC crowns preserved
their integrity, and only cracking or partial fracturing of
the material was observed with the SFC crowns. The PFC
crowns, however, fractured catastrophically, and their
typical mode of failure was splitting of the PFC crown
(Fig. 5).
Various indicators such as the Young modulus2,19 and
FT 3,19
are used to predict the sensitivity of the material in
THE JOURNAL OF PROSTHETIC DENTISTRY
Volume 115 Issue 1
PFC SFC
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Crown Reference
fatigue. A strong correlation between the FT and the
fatigue performance for both material types was
observed in the present investigation. This finding sup-
ports earlier suggestions for using the FT value to predict
the clinical performance of the composite resins.2,3,20,21
r2 P By using a 4-point bend test, Belli et al19 showed that
.899 <.001 FT and FS were both poorly correlated with fatigue
.391 .059 resistance. The testing methodology used might explain
.662 .001 the differences between this19 and other studies.2,3,20,21
-.210 .375
However our study also showed that FS is not an accu-
.821 <.001
rate predictor of fatigue behavior.
The FT of the short fiber composite resins is
generally higher than that of conventional composite
resins.10-12 In the case of the presently investigated
SFC, this property is ascribed to the millimeter-scale
short fibers, which exceed the critical fiber length.22
This enables the stress transfer from the matrix to the
fibers. Furthermore, the linear PMMA polymer chain
and the cross-linked polymer matrix of BisGMA and
TEGDMA present as a combined phase in this SFC,
contributing to the toughening of the composite resin.10
Our study demonstrated improved inherent properties
of the SFC, which is in a good agreement with the
literature findings.10,23,24 The present study also agrees
that the material choice influences the fracture resis-
tance of restorations.25 Although the properties of the
composite resins can be tailored by selectively
combining the components of the resinous phase,26 the
organic phase alone is not a predominant factor in the
response of the material to stressing conditions.
Instead, the type and stiffness of the fiber reinforcement
are dominant over the properties of the organic ma-
trix27; the importance of the high fiber fraction is also
observed clinically.28
Bijelic-Donova et al
January 2016
Figure 5. Brittle and ductile fracture of anterior PFC and SFC crown restoration. A, Brittle fracture (splitting of crown) seen with PFC:G-ænial anterior.
B, Ductile fracture (cracking) seen with SFC everX posterior composite resin. Arrows indicate cracking line.
The use of crowns prepared and tested on a zirconia
model and the use of only 2 materials could be
considered limitations of this study. A zirconia model
was used because it enables standardization of the
crown substrate and the crown shape, allowing the ef-
fect of the material type to be the only variable factor.
Because of the extensive methodology used, only 2
materials were selected: the SFC as a material of interest
and the conventional PFC as a random blinded
selection.
The possible connection between fatigue behavior
and wear encourages laboratory studies on the predict-
ability of the clinical wear of SFC. Indeed, the wear of a
material is a process that weakens its strength, and both
fatigue and wear are obligatory tests before clinical
trials.14
CONCLUSIONS
The survival prognosis of a restoration in fatigue can be
made based on its static strength, regardless of the
composite resin type, particulate filler, or short fiber
composite. Within the limitations of this study, fracture
toughness appears to be a useful predictor of clinical
performance and consequently, the selection of the
restorative material should be based on its fracture
toughness value. Owing to the enhanced resistance to
fracture propagation, SFC should be used in high stress-
bearing areas to yield enhanced toughness.
REFERENCES
1. O’Brien WJ. Dental materials and their selection. 4th ed. Carol Stream:
Quintessence Publishing; 2008. p. 16.
2. Braem M, Lambrechts P, Vanherle G. Clinical relevance of laboratory fatigue
studies. J Dent 1994;22:97-102.
3. Goldman M. Fracture properties of composite and glass ionomer dental
restorative materials. J Biomed Mater Res 1985;19:771-83.
Bijelic-Donova et al
101
4. Lohbauer U, von der Horst T, Frankenberger R, Krämer N, Petschelt A.
Flexural fatigue behavior of resin composite dental restoratives. Dent Mater
2003;19:435-40.
5. Ornaghi BP, Meier MM, Lohbauer U, Braga RB. Fracture toughness and
cycling fatigue resistance of resin composites with different filler size distri-
butions. Dent Mater 2014;30:742-51.
6. Söderholm KJM, Roberts MJ. Influence of water exposure on the tensile
strength of composites. J Dent Res 1990;69:1812-6.
7. Braem MJA, Lambrechts P, Gladys S, Vanherle G. In vitro fatigue behavior of
restorative composites and glass ionomers. Dent Mater 1995;11:137-41.
8. Garoushi S, Lassila LVJ, Tezvergil A, Vallittu PK. Static and fatigue
compression test for particulate filler composite resin with fiber-reinforced
composite substructure. Dent Mater 2007;23:17-23.
9. Garoushi S, Vallittu PK, Lassila LVJ. Short glass fiber reinforced restorative
composite resin with semi-interpenetrating polymer network matrix. Dent
Mater 2007;23:1356-62.
10. 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:
835-41.
11. Manhart J, Kunzelmann KH, Chen HY, Hickel R. Mechanical properties of
new composite restorative materials. J Biomed Mater Res (Appl Biomater)
2000;53:353-61.
12. Drummond JL, Lin L, Miescke KJ. Evaluation of fracture toughness of a
fiber containing dental composite after flexural fatigue. Dent Mater
2004;20:591-9.
13. Draughn RA. Compressive fatigue limits of composite restorative materials.
J Dent Res 1979;58:1093-6.
14. Frankenberger R, Garcia-Godoy F, Lohbauer U, Petschelt A, Krämer N.
Evaluation of resin composite materials. Part I: In vitro investigations. Am J
Dent 2005;18:23-7.
15. Kelly JR, Benetti P, Rungruanganunt P, Della Bona A. The slippery slope-
Critical perspectives on in vitro research methodologies. Dent Mater 2012;28:
47-51.
16. International Organization for Standardisation. ISO 4049. Dentistryd
Polymer-based restorative materials. ISO, Geneva; 2009. Available at: http://
www.iso.org/iso/store.htm. Last accessed December 15, 2015.
17. International Organization for Standardisation. ISO 4104. Dental zinc poly-
carboxylate cements. ISO, Geneva; 1984.
18. International Organization for Standardisation. ISO 20795-1. DentistrydBase
polymersdPart 1: Denture base polymers. ISO, Geneva, 2013. Available at:
http://www.iso.org/iso/store.htm. Last accessed December 15, 2015.
19. Belli R, Petschelt A, Lohbauer U. Are linear elastic material properties rele-
vant predictors of the cyclic fatigue resistance of dental resin composites?
Dent Mater 2014;30:381-91.
20. Tyas MJ. Correlation between fracture properties and clinical perfor-
mance of composite resins in class IV cavities. Aust Dent J 1990;35:
46-9.
21. Bonilla ED, Mardirossian G, Caputo AA. Fracture toughness of posterior resin
composites. Quintessence Int 2001;32:206-10.
22. Vallittu PK. High-aspect ratio fillers: fiber-reinforced composites and their
anisotropic properties. Dent Mater 2015;31:1-7.
23. Leprince JG, Palin WM, Vanacker J, Sabbagh J, Devaux J, Leloup G. Physico-
mechanical characteristics of commercially available bulk-fill composites.
J Dent 2014;42:993-1000.
THE JOURNAL OF PROSTHETIC DENTISTRY
102 Volume 115 Issue 1

24. Goracci C, Cadenaro M, Fontanive L, Giangrosso G, Juloski J, Vichi A, et al. Corresponding author:
Polymerization efficiency and flexural strength of low-stress restorative Dr Jasmina Bijelic-Donova
composites. Dent Mater 2014;30:688-94. TCBC, Institute of Dentistry, University of Turku
25. Frater M, Forster A, Kereszturi M, Braunitzer G, Nagy K. In vitro fracture Itäinen Pitkäkatu 4 B, FI-20520 Turku
resistance of molar teeth restored with a short fibre-reinforced composite FINLAND
material. J Dent 2014;42:1143-50. Email: jabije@utu.fi
26. Asmussen E, Peutzfeldt A. Influence of UEDMA, BisGMA, and TEGDMA on
selected mechanical properties of experimental resin composites. Dent Mater Acknowledgments
1998;14:51-6. The authors thank Robert M. Badeau, PhD, of Aura Professional English
27. Narva KK, Lassila LV, Vallittu PK. The static strength and modulus of fiber Consulting, Ltd, for the English language editing of this manuscript, and the
reinforced denture base polymer. Dent Mater 2005;21:421-8. GC Corporation, Tokyo, Japan, for providing the materials used in this
28. Frese C, Schiller P, Staehle HJ, Wolff D. Fiber-reinforced composite fixed investigation.
dental prostheses in the anterior area: a 4.5-year follow-up. J Prosthet Dent
2014;112:143-9. Copyright © 2016 by the Editorial Council for The Journal of Prosthetic Dentistry.

Noteworthy Abstracts of the Current Literature

Evidence-based criteria for differential treatment planning of implant restorations

for the maxillary edentulous patient

Sadowsky SJ, Fitzpatrick B, Curtis DA

J Prosthodont 2015;24:433-446

Since the introduction of the endosseous concept to North America in 1982, there have been new permutations of the
original ad modum Branemark design to meet the unique demands of treating the edentulous maxilla with an implant
restoration. While there is a growing body of clinical evidence to assist the student, faculty, and private practitioner in
the algorithms for design selection, confusion persists because of difficulty in assessing the external and internal validity
of the relevant studies. The purpose of this article is to review clinician- and patient-mediated factors for implant
restoration of the edentulous maxilla in light of the hierarchical level of available evidence, with the aim of elucidating
the benefit/risk calculus of various treatment modalities.
Reprinted with permission of the American College of Prosthodontists.

THE JOURNAL OF PROSTHETIC DENTISTRY Bijelic-Donova et al