Fracture resistance and 3D finite element analysis of machined ceramic crowns bonded to endodontically treated molars with two planes versus flat occlusal preparation designs: an in vitro study

Background: The flat occlusal preparation design (FOD) of posterior teeth offers promising results of fracture resistance and stress distribution, but its application in vital teeth is limited as there may be a danger of pulp injury. Although this danger is omitted in endodontically treated teeth, there is no research work assessing the impact of FOD on the fracture resistance and distribution of stresses among these teeth. The aim of this study was to assess the impact of FOD of endodontically treated molars on the fracture resistance and distribution of stresses among a ceramic crown-molar structure when compared to the two planes occlusal preparation design (TOD). Methods: 20 human mandibular molars were endodontically treated and distributed equally to two groups: Group I (TOD) and Group II (FOD). Ceramic CAD/CAM milled lithium disilicate (IPS e.max CAD) crowns were produced for all preparations and adhered using self-adhesive resin cement. Using a universal testing machine, the fracture resistance test was performed. The fractured samples were examined using a stereomicroscope and scanning electron microscope to determine modes of failure. Stress distribution was evaluated by 3D finite element analysis, which was performed on digital models of endodontically treated mandibular molars (one model for each design). Results: Group II recorded statistically non-significant higher fracture resistance mean values (3107.2± 604.9 N) than Group I mean values (2962.6 ±524.27 N) as indicated by Student’s t-test (t=0.55, p= 0.57). Also, Group II resulted in more favorable failure mode as compared to Group I. Both preparation designs yielded low von-Mises stresses within the factor of safety. However, the stress distribution among different layers of the model differed. Conclusions: FOD having comparable fracture strength to TOD and a more favorable fracture behavior can be used for the preparation of endodontically treated molars.