text: The influence of cavity preparation design on fracture strength and mode of fracture of laboratory-processed composite resin restorations.
  Removal of large amounts of sound tooth structure may result in a weakened restored tooth. Nevertheless, removal of tooth structure for cuspal coverage has been recommended to protect teeth restored with laboratory-processed composite resin (LPCR) from fracture. The purpose of this study was to evaluate the influence of different cavity preparation designs on fracture strength and modes of fracture of teeth restored with LPCR. Ninety anatomically similar human third mandibular molars were selected. There were 2 experimental factors, occlusal isthmus width (narrow versus wide) and cuspal coverage (inlay, 1-cusp onlay, 2-cusp onlay, and all-cusp onlay), and 1 control group that received no treatment, resulting in 9 groups (n=10). Indirect composite resin (SR Adoro) restorations were manufactured and adhesively cemented with Adper Single Bond 2 and Rely-X ARC. A compressive loading test (0.5 mm/min) was performed. The modes of fracture were classified according to 4 categories. One-way and 2-way ANOVA followed by Tukey-HSD test were used to statistically analyze the fracture load data (alpha =.05). The statistical analysis failed to show significant differences among restored groups but showed differences between these groups and the control group (P = .001). Two-way ANOVA failed to show any difference when considering the occlusal isthmus width alone (P = .98), cuspal coverage (P = .273), or the interaction between these factors (P = .972). Several teeth had fractures affecting a great amount of both restoration and tooth structure. This in vitro study showed restored teeth having similar fracture strength and fracture modes, suggesting that with the tested preparation designs, there is no advantage of cuspal coverage to protect LPCR restored teeth from fracture.