DOI: 10.14744/JPD.2023.
10_147
J Pediatr Dent 2024;10(1):21-26
Original Article
Comparative Evaluation of Fracture Resistance of
GC Fuji Type IX GIC, Composite Z-350, Cention N,
and Zirconomer Restorations in Class II MOD Cavity:
An In-Vitro Study
Kavita Kavita1 Kamal Kishor Gupta1 Vasundhara Pathania1 Amit Kumar Sharma1 Vinay Bal Singh Thakur1
Ishant Sood1
1
Department of Pedodontics and Preventive Dentistry, Himachal Den- Address for correspondence: Kavita Kavita, MDS, Department of
tal College, Sunder Nagar, India Pedodontics and Preventive Dentistry, Himachal Dental College,
Sunder Nagar, India
E-mail: kvardhan95@gmail.com
Abstract
Objective: An in vitro study was designed to evaluate the fracture resistance of premolars with class II MOD cavities restored
with GC Fuji Type IX GIC, Composite Z-350, Cention N, and Zirconomer restorations in comparison with intact teeth and unre-
stored teeth.
Materials and Methods: Sixty freshly extracted premolars were randomly divided into six groups: two control groups and four
experimental groups of 10 teeth each. Group I: Positive Control Group; Group II: Negative Control Group; Group III: Class II MOD
cavity restored with GC Fuji Type IX GIC; Group IV: Class II MOD cavity restored with Composite Z-350; Group V: Class II MOD
cavity restored with Cention N; and Group VI: Class II MOD cavity restored with Zirconomer. Fracture resistance was tested in a
Universal Testing Machine with a cross-head speed of about 1mm/min. The data were statistically analyzed.
Results: Maximum fracture resistance was recorded for the intact tooth (2299.3±64.1 N) followed by Cention N (1797.8±81.1
N), GC Fuji IX GIC (1508.4±79.2 N), Zirconomer (1399.2±38.1 N), Composite Z-350 (1157.8±55.9 N), and least in the Unrestored
tooth (311.1±38.8 N).
Conclusion: Among the experimental groups, Cention N showed the highest fracture resistance. Cention N is the material of
choice for posterior restorations.
Keywords: Cention N, composite Z-350, GC Fuji Type IX GIC, universal testing machine, zirconomer
Introduction clusal section of preparation.[3] According to Geistfeld,
an occlusal cavity preparation reduces tooth strength by
Removal of tooth structure by cavity preparation can 14–44% and a MOD cavity by 20–63%.[4] Depending on
cause the weakening of the tooth and increased suscepti- the extent of the cavity, restorative treatment is a predis-
bility to fracture.[1,2] It has been claimed that the posing factor for an incomplete or complete tooth frac-
strength of a tooth decreases in proportion to the amount ture.[5] Teeth weakened by restorative procedures
of tooth tissue removed, particularly the width of the oc- should be reinforced by restorative materials to strength-
How to cite this article: Kavita K, Gupta KK, Pathania V, Sharma AK, Singh Thakur VB, Sood I. Comparative Evaluation of Fracture Resistance of GC
Fuji Type IX GIC, Composite Z-350, Cention N, and Zirconomer Restorations in Class II MOD Cavity: An In-Vitro Study. J Pediatr Dent 2024;10(1):21-26
OPEN ACCESS This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
22 J Pediatr Dent 2024;10(1):21-26
en the remaining tooth structure.[3] The ideal restorative for 15 seconds, which was then rinsed off with water
material should have good compressive strength, tensile and gently air-dried. 3M ESPE Single Bond Universal
strength, shear bond strength, and the least microleakage bonding agent was applied and cured for 20 seconds.
for the success and longevity of a restoration.[6] When a Composite Z-350 was placed by incremental technique
restorative material tends to have lower compressive and cured for 20 seconds.
strength than the tooth material, most often it will lead to
fracture and failure of the restoration.[7,8] Hence, a ma- Group V: Class II MOD cavity restored with Cention
N: Class II MOD cavities were prepared. A matrix
terial needs to exhibit good compressive strength.[9]
band and retainer were tightly adapted to the tooth
This study evaluated and compared the fracture resis-
and then the teeth were restored with Cention N (Ivo-
tance of GC Fuji Type IX, Composite Z-350, Cention N,
clar Vivadent).
and Zirconomer restorations in class II MOD cavities.
Group VI: Class II MOD cavity restored with Zircono-
Materials and Methods mer: Class II MOD cavities were prepared. A matrix
band and retainer were tightly adapted to the tooth and
Important properties of the materials used in the study then the teeth were restored with Zirconomer (Shofu).
are like this (Table 1). All specimens were stored in distilled water for 24 hours
Sixty extracted teeth were washed under running water before testing. All the samples were positioned individ-
ually on a universal testing machine (G50KS Tinus Ol-
and any soft tissue was scraped from the root surfaces
sen) with the help of a rectangular gauge (Fig. 3), cross-
using an ultrasonic scaler, after which they were auto-
head speed of 1mm/minute till the restorations were
claved for infection control and stored in a 10% buff-
fractured (Fig. 4). The load at which the restorations
ered formalin solution. Samples were checked for any
fractured was recorded and expressed in Newton (N).
signs of fracture lines. The teeth were divided into 2
control groups (Group I; Group II) and 4 experimental
groups (Group III; Group IV; Group V, and Group VI) Results
with 10 teeth each. Class II MOD cavities were prepared
The statistical analysis was done using SPSS (Statistical
with standardized dimensions using a high-speed hand-
Package for the Social Sciences, SPSS Inc., v.16). The
piece and a No. 330 bur with continuous water cooling
descriptive statistics were calculated as mean and stan-
and verified using William’s periodontal probe. The oc-
dard deviation. The fracture resistance among the study
clusal preparation was 2 mm deep, with a width of one-
groups was compared using Analysis of Variance
third the intercuspal distance (Fig. 1). The proximal
(ANOVA), followed by post hoc Tukey’s test for multi-
boxes were prepared at a width of one-third the bucco-
ple comparisons. The level of significance for the pres-
lingual distance and a depth of 1.5 mm axially with a
ent study was fixed at a P-value of less than 0.05. The
cavosurface angle of 90° (Fig. 2).
maximum value of mean fracture resistance was re-
The teeth were randomly divided into 6 groups: corded for the intact tooth (2299.3±64.1 N) and the
least for the unrestored tooth (311.1±38.8 N). Among
Group I: Intact teeth (+ve control group): Sound teeth the experimental groups, Cention N (1797.8±81.1 N)
without restorations. showed the highest fracture resistance followed by GC
Fuji IX GIC (1508.4±79.2 N), Zirconomer (1399.2±38.1
Group II: Unrestored teeth (-ve control group): Class II
N), composite Z-350 (1157.8±55.9 N) (Fig. 5).
MOD cavities were prepared and left unrestored.
Group III: Class II MOD cavity restored with GC FUJI Discussion
Type IX: Class II MOD cavities were prepared. The pre-
pared cavities were restored with GC Fuji Type IX GIC A fracture is a complete or incomplete break in a mate-
using the Tofflemire matrix system for creating the rial resulting from the application of excessive force. It
proximal contours. is an important property directly related to cracking.[5]
Fracture resistance is a material’s inherent property by
Group IV: Class II MOD cavity restored with Compos- which it resists plastic deformation under a particular
ite Z-350: Class II MOD cavities were prepared. A ma- load. Masticatory forces on restored or unrestored teeth
trix band and retainer were tightly adapted to the tooth. tend to deflect the cusps under stress.[18] In the present
Acid etching was done with 37% phosphoric acid gel study, sixty single-rooted human-extracted premolar
Kavita et al. Comparative Evaluation of Fracture Resistance of Different Restorative Materials in Class II MOD Cavity 23
Table 1. Properties of the materials used in the study
GC Fuji Type IX Composite Z-350 Cention N Zirconomer
The new restorative materials Composite Z-350 is a visible Cention N is an “alkasite” Zirconomer is a new class of
need to have physical and light-activated composite restorative material which is restorative GIC that claims to
chemical properties that are designed for use in anterior essentially a subgroup of the have the strength and dura-
superior to our gold standard and posterior restorations. composite material class. [12] bility of amalgam and elimi-
conventional GIC to be nate mercury hazards as well
accepted as a permanent It has excellent polish, a wide It is a tooth-colored, basic fill- as issues related to polymer-
restorative material, espe- range of shades and opacities ing material for direct restora- ization shrinkage. [15]
cially in pediatric dentistry improved fluorescence tions as it is self-curing with
GIC type IX.[10] unique nanofiller technology. the additional option of light Its structural integrity has
curing.[13] been attributed to the inclu-
Nanofillers allow increased sion of zirconia fillers in the
filler volume and reduce poly- It also includes a special glass component thereby
merization shrinkage. [11] patented filler (isofiller) which imparting better strength.[16]
acts as a shrinkage stress
reliever.[14] The high flexural modulus
and compressive strength.[17]
Figure 1. Occlusal box preparation Figure 2. Proximal box preparation
teeth were selected. Premolars are prone to masticatory tooth structure but also increase the fracture resistance
loading, more due to their position in the arch, and the of the tooth and promote effective marginal sealing.[25]
anatomy of premolars with deep cuspal inclination Ideally, any material that is used to restore the missing
makes them more susceptible to fracture.[19,20] They tooth structure should reinforce the tooth and mini-
are more susceptible to compressive and shear stresses, mize the risk of cuspal fracture.[17]
thus making them ideal candidates for testing fracture
resistance under load.[21] The present in vitro study In the present study, when the fracture resistance of
was conducted to compare and evaluate the fracture re- intact teeth was compared with all other groups of
sistance of GC Fuji Type IX GIC, Composite Z-350, teeth, it was found that the fracture resistance of intact
Cention N, and Zirconomer in Class II MOD cavities. teeth was significantly higher than that of teeth re-
According to Mondelli and others, teeth with large stored with any of the filling materials. The fracture
MOD cavities are severely weakened due to the loss of resistance of unrestored teeth was found to be signifi-
reinforcing structures and become more susceptible to cantly lower than any of the restored teeth and intact
fractures.[22,23] Reeh et al[24] reported MOD prepara- teeth. Similar results were found in the study done by
tion results in a loss of 63% relative cusp rigidity. Thus, Hood (1991),[25] Assif D. and Gorfil C. (1994),[26]
the restorative material used must not only replace the Cobankara et al[27] (2008), Rajaraman et al[28] (2022)
24 J Pediatr Dent 2024;10(1):21-26
Figure 3. Sample loaded on universal testing machine
Figure 4. Sample after fracture
who analyzed the biomechanics of the intact, pre-
pared, and restored teeth and concluded that the de-
gree of cuspal deflection increases with an increase in
the depth of the preparation. Soares and colleagues
(2008)[29] also claimed that the application of a load
on unrestored teeth produces a wedge effect between
buccal and palatal/lingual cusps, leading to reduced
fracture resistance and a more catastrophic fracture of
the teeth. Teeth with a MOD cavity suffer a significant
reduction in fracture resistance due to the loss of the
marginal ridge and the occurrence of micro-fractures
caused by occlusal forces. Occlusal load tends to force
the cusps in opposite directions, causing cuspal frac-
ture from fatigue. Thus, the restorative material used Figure 5. Fracture resistance (in Newton)
must not only replace the tooth structure but also in-
crease the fracture resistance of the tooth and promote Jhamb A, and Bhatra D (2019)[32] also concluded in
effective marginal sealing. their study that the compressive strength of alkasite
was significantly higher than that of GC Fuji Type IX
In our study, when the fracture resistance of Cention GIC. The reason for the higher compressive strength
N and GC Fuji Type IX GIC was compared, the frac- of Cention N can be attributed to a special patented
ture resistance of Alkasite was significantly higher isofiller (partially functionalized by silanes) which is
than that of High Strength GIC. Similar results were also used in Tetric N-Ceram Bulk Fill. This acts as a
found in the studies performed by Naz T, Singh DJ, shrinkage stress reliever that minimizes shrinkage
Somani R, and Jaidka S (2019),[10] and Balagopal S, force. In contrast, the organic/inorganic ratio as well
Nekkanti S, and Kaur K (2021),[30] and Adsul SP, as the monomer composition of the material is re-
Dhawan P, Tuli A, Khanduri N, Singh A (2022).[31] sponsible for the low volumetric shrinkage.
They concluded that the compressive strength and
flexural strength of Cention were higher because of When the fracture resistance of High Strength GIC was
the presence of UDMA particles in the monomer ma- compared with zirconia-reinforced GIC, it was found
trix which is less elastic and provides stiffness to the that High Strength GIC had a higher fracture resistance
matrix, thus becoming highly resistant to stresses gen- than that of zirconia-reinforced GIC. Similar results
erated in the oral cavity. The cyclic aliphatic structure were found in the studies performed by Patel et al[33]
of aromatic aliphatic UDMA ensures stability and in- (2018), Dheeraj M, Johar S, Jandial T, Sahi H, and Ver-
creased mechanical strength. Kaur M, Mann NS, ma S (2019).[34] They found that High-strength GIC
Kavita et al. Comparative Evaluation of Fracture Resistance of Different Restorative Materials in Class II MOD Cavity 25
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