Introduction
Treatment of the root canal can be seen as an additional problem for restoring the fracture-prone posterior teeth because of the reduced structural structure integrity due to the treatment. Successful root canal treatment is a double-edged sword. It initially heals infections and does not impair the tooth’s function. However, the tooth becomes weaker for some time to resist biomechanical stresses. However, this choice is critical in the vertebra because of its role in reinforcing the tooth structure and preventing cracks.
The forthcoming literature review is expected to give a comparative analysis of fracture outcomes of the various direct restorations done in the posterior teeth with post-endodontic treatment. Clinicians need to be aware of the factors and elements that determine the fracture resistance and effectiveness of different restorative materials to make deliberate decisions when planning the treatment and picking the materials.
The review opens with a description of the present endodontically treated teeth. It specifies the difficulties in restoration with this type and the relationship between that and the long-term term success of the structure. Then, the discussion shifts from an overview of the direct restorations utilized in these cavity teeth, such as cementum resin, amalgam, and resin-modified glass ionomer materials. Biomaterials’ characteristics, properties, advantages, and disadvantages are described to mention an appraisal of relevant research papers that evaluate them according to their fracture resistance.
Moreover, the article also investigates the attributes that rule fracture resistance, such as material traits, cavity creation, bonding methods, occlusal forces, and how clinicians handle them. The role of substance abuse and family and social networks is vital. This section of the paper aims to integrate and clarify the peculiarities of the interconnections between these factors and recommendations for clinical practice.
This Literature review aims to provide in-depth knowledge about Fracture resistance in the posterior teeth posts-endo and, therefore, help select materials that bring the best clinical results. Tonight, developing an evidence-based approach to restorative dentistry will be discussed. This process involves critically reviewing the existing evidence and identifying the weak areas for future research.
Endodontically Treated Teeth: Overview and Challenges
Endodontically treated teeth represent a unique subset in restorative dentistry, characterized by the need for root canal therapy to address pulpal pathology while preserving tooth structure and function. Despite successful endodontic treatment, these teeth often face challenges related to compromised structural integrity, which can lead to fractures and subsequent treatment complexities.
Structural Integrity and Fracture Susceptibility
Endodontic treatment starts with the removal of pulpal infection or death of tissues to prevent canal system reinforcement. It may be the case that strengthening the tooth could affect its structural strength, making it more vulnerable to damage, namely vertical root fractures (VRFs). RRFs are fractures of longitudinally oriented roots, not seldom with subclinical and radiographic presentation, making it harder to distinguish from other injuries/pathologies.
Diagnostic Challenges: Diagnosing VRFs in the teeth after root canal treatments may be difficult because the symptoms, such as pain and swelling, can be similar to the problems of the teeth with apical periodontitis or failed root canal treatments. The expected clinical signs are yellowish-white to yellow morsels of inflammatory debris emanating from deep crater-like lesions. However, they may not be specific enough to indicate VRF. Radiographs such as periapical radiographs and CBCT are imperative in formulating a precise diagnosis, although some instances require further investigation to acquire a definitive diagnosis.
Prevalence and Demography
For instance, articles in dental journals have found different levels of post-endodontic therapy failures, ranging from 3.69% to 25%. Demographically, VRF tends to lead to the deconditioning of patients in the range between 30 years and 69 years, with no particular gender predilection (Sıla et al. et al., 2022). Crestal or vertical atrophy, including resorption of marginal and interdental bone, is another type of ridge resorption associated with teeth and roots that tend to be thinner, such as some maxillary premolars and mandibular molars with a shallow, oval or flattened cross-section.
Treatment Considerations
Besides introducing the troubles of treating VRLs in endodontically treated teeth, it is imperative to recognize that these fractures may ruin the tooth’s teeth structure, thus forcing patients to remove the teeth if they are not appropriately addressed. Hybrid therapy suggests using nontherapeutic measures such as plastic bonding and replacement of crowns to stabilize the tooth; however, the success of long-term durability of these strategies is not sure. Surgical treatments such as endodontics (root resection or extraction) may be done for the cases where they are more severe.
Literature Review
Types of Direct Restorations for Post-Endodontic Posterior Teeth
Dental Materials
Posterior teeth undergoing endodontic treatment require robust and durable restorations to withstand occlusal forces and maintain functionality. Various direct restorations are available for these teeth, each with advantages, limitations, and indications. This section provides an in-depth exploration of the different kinds of direct restorations commonly used for post-endodontic posterior teeth, including amalgam, composite resin, glass ionomer cement (GIC), resin-modified glass ionomer cement (RMGIC), and bulk-fill composites (Shafiei et al., 2021).
Amalgam Restorations
Amalgam has been the focal point of dentistry with restoration due to its durability, longevity, and affordability. Filling restoring posterior teeth after endodontic treatment with amalgam is one of the safe treatment options to date, especially in high-stress regions. Good compressive strength and wear resistance make it work well in prosthetic restorations of posterior teeth’ occlusal and proximal surfaces.
When it comes to post-root canal teeth, amalgam fillings enjoy many benefits. An excellent marginal seal and adaptation reduces the risk of microleakage and caries, i.e., repeated cavities. Amalgam also has low polymerization shrinkage in contrast to resin composite materials, and thus, the possibility of gap formation at the tooth-restoration interface is less. Additionally, the capability of amalgam to release fluoride ions can be a caries prevention impact.
Besides this, apprehensions about appearances and the possibility of microleakage at the tooth restoration interface may impact the diminishing usage of amalgam to tooth-coloured substitutes. Moreover, mechanically maintaining the tooth and removing healthy tissue to restore the tooth structure weakens the tooth structure. Besides that, amalgam, comprised of several materials, may undergo torn or wear and subsequent tooth decay in the long run.
Composite Resin Restorations
Composite resin restorations have dominated in past decades because of their excellent aesthetic qualities, bondability, and the match they can achieve in colour. Conservation, enhanced fracture resistance, and the ability to restore both the structure and function are among the many advantages composite resins have over metal crowns as used in certain posterior teeth in post-endodontic situations.
Comporting polymers are made from organic resin plastic, the structural unit, and the inorganic fillers. It gives the material physical and visual properties, which are very similar to the natural tooth structure. The relevance of its aesthetic advantage makes it the preferred way of restoring posterior teeth to be used in visually prominent areas, where appearance is the central matter.
The adhesive nature of composite resin is the characteristic feature of the material. It allows a dentist to leave a tooth less damaged than when amalgam restorations are used. It helps to fill the gaps in these teeth that are already compromised due to caries, trauma, or previous restoration processes and, thus, provides solid support to the tooth. Moreover, composite resin restorations display a small amount of microleakage, but they can be very well sealed by placing them correctly and bonding perfectly with the tooth.
Even though composite resin restorations have benefits, they, on the other hand, have limitations. Shrinkage via the curing phenomenon during the polymerization process may result in margin gaps and microleakage, which can further cause secondary caries and postoperative sensitivity. Apart from that, composite resins entail a higher difficulty requirement than amalgam. Hence, the dentist needs to implement precise isolation and bonding protocols for satisfactory results to be realized. Furthermore, the long-term lifespan of composite resin fillings may be affected by factors including occlusion, oral hygiene quality, and the dentist’s expertise.
Glass Ionomer Cement (GIC) Restorations
Glass ionomer cement (GICs) are an adaptable restorative material with exclusive advantages such as the ability to bond chemically with tooth structure, fluoride release, and good biocompatibility. Amidst the post-endo of posterior teeth, GIC also has excellent benefits, which makes it a nice option with proper indication.
GICs’ ability to bond with tooth enamel makes them ideally suited to post-restorative work, like fillings for non-load bearing teeth, e.g. cervical lesions, cavities in the roots, and small class V cavities. Adhering to the tooth structure and releasing fluoride are the two mechanisms that make them aim to rehydrate and promote remineralization to prevent recurrent decay situations. Notably, the polymerization shrinkage and the thermal expansion undergone therein are considerably low, which protects the restoration from marginal breakdown and recurrent caries.
One of the specific benefits, or features, of the GIC is its ability to produce fluoride ions, which can halt carious lesion damage and promote the remineralization of the tooth structure nearby. Such repairs are essential to patients at high risk of caries or those who struggle with oral hygiene. In addition, GIC has good biocompatibility with dental tissues, significantly reducing the risk of a postoperative appearance or pulpal discomfort.
It should be noted that GIC has its merits and demerits, and how fit they are for emergencies also plays a vital role. Less than satisfactory compressive and tensile properties occupy a shallow place in the hierarchical ranking complicated by multiple stress situations. Another disadvantage concerning GICs is that they are more vulnerable to the development of bullets and erosion, which is related to reduced durability densely loaded in posterior teeth exposed to large occlusal forces. Additionally, regarding aesthetics, GIC colours are unnatural, which is unfavourable for restorations in the visible area.
Resin-Modified Glass Ionomer Cement (RMGIC) Restorations
Resin-modified glass ionomer cement (RMGIC) provides both durable mechanical qualities and better esthetics, like glass ionomer cement (GIC), in addition to the enhanced esthetics related to resin-based materials (Tanaka., 2020). In the RMGICs for endodontic treatment cases, the current GICs and composite resins must be substituted because RMGICs paint an excellent picture for long-term durability with perfect esthetics and the freedom for fluoride release.
These RMGICs develop their additional mechanical properties mainly due to resins that improve how they (RMGICs) bond together against more basic GICs. This resin component also boosts the restoration’s beauty by improving the properties of colour stability, making them perfect for filling in the back teeth in the visible areas. Similarly, RM-GICs possess outstanding wear resistance and a higher fracture toughness relative to conventional GICs, which contributes to the durability of these restorations under load-bearing occlusal conditions (Tekçe et al., 2021).
Regarding the analogue of RMGIC in GICs, this fluoride release has contributed to preventing second caries and reconstructing the nearby tooth structure. This feature is also attributed to conventional GICs. As such, using RMGICs will be beneficial, especially for patients most prone to caries attacks or compromised oral general body health. Moreover, there will be no disjunction between the adhesive and the tooth structure. Therefore, there will be an acceptable seal, and this will mitigate the common concern of microleakage and postoperative sensitivity.
Conversely, the existing pros may not be enough to rely on this technology entirely. The relatively high shrinkage of fillings comprised of the polymerization process in comparison with those consisting of the composite resins may lead to the occurrence of marginal gaps and microleakage, especially when extensive restorations or restorations with high occlusal force are involved (Carvalho et al., 2018). Besides, it significantly weakens or reduces these materials’ strength and impact resistance and makes them less appropriate for high-stress use in biting and chewing areas. Moreover, the behavioural properties of RMGICs, which are well established as stickiness and difficulty in getting the predefined outlines and anatomic properties, might challenge the clinicians in the positioning process.
Bulk-Fill Composites
Visually, the bulk-filled composites represent a big step forward in the field of restoration-dentistry, with the main advantage being the simplified placement techniques, alongside the added benefit of a deeper crosslinking of composite resin. Regarding the precise post-endodontics treatment of posterior teeth, bulk-fill composites provide a wide range of perks, such as fast chair time, good fit with the cavity walls, and enhanced mechanical properties (Shafiei et al., 2021).
A particular type of bulk-fill composite is mainly manufactured with a distinctive formulation, which enables placement of the restorations up to 4 mm in one step, bypassing the step-wise layering of the amalgam and thus decreasing the chance for voids and air entrapment. This lambaste physician location, consequently, reduces the chair time and increases the restorative procedure simpleness, which is especially good for releasing big cavities in the posterior penetration-achieved teeth.
The ultimate curing depth of the bulk-fill composites now allows the light/cure more easily through light penetration and polymerization through whole restoration so that all the monomers can be converted entirely, and there is less postoperative sensitivity. Moreover, bulk-fill composites are superior to conventional composites for they can adapt to the cavity’s walls and margins; hence, the risk of microleakage and secondary caries becomes less.
While bulk-filled composites come with some advantages, there are still some considerations to be taken into account that may affect the actual utilization of these materials in the clinic (Atalay et al., 2016). Even though their cryogens’ high viscosity and opacity can hinder complete contour and anatomy, the medical applications of these biomaterials can be successfully implemented in places with difficult access or visibility. Likewise, the mechanical properties of bulk-fill composites can change from one manufacturer and formulation to another. Hence, determining the mix that is well-adapted to the clinical situation and patient needs takes careful selection. Subsequently, clinical trials and longitudinal studies will investigate the steady-state clinical efficacy of bulk-fill composites in the post-endodontic recovery of posterior teeth at the most challenging stress points.
Factors Influencing Fracture Resistance
Various factors, including material properties, cavity preparation design, bonding techniques, and occlusal forces, influence fracture resistance of direct restorations in post-endodontic posterior teeth. Understanding these factors is crucial for selecting the most appropriate therapeutic approach and optimizing long-term clinical outcomes.
Material Properties
The elasticity and strength associated with restorative material are the foremost determinants of its fracture resistance. The mechanical properties of various materials, such as strength, elasticity, and hardness, are distinct, which are factors in their resistance to occlusal forces and can cause a fracture.
Composite Resins: They are widely used with direct restorations because they give excellent esthetics and versatility. Although the fracture resistance of composite resins may vary due to filler content, particle size, and polymerization shrinkage, this aspect is essential in determining the success of overall restoration.
The composite resins with a large filler volume have higher fracture resistance since they have good mechanical properties and wear resistance (Osiewicz et al., 2022). On the contrary, there are composite resins with nanofillers or composite resin hybrid formulations that have enhanced strength and durability to repair load-bearing posterior surfaces of the molars after pulp extraction (post-endodontic treatment).
The contraction of the polymerization shrinkage process can generate stress at the margin and the interface of the restoration and the interface of the restoration and tooth, resulting in the crack of the restoration. Strategies like the staged polymerization process and extensive fillings placement have been proven to mitigate the shrinkage of polymers and produce stronger restorations with fewer defects.
Glass Ionomer Cements (GICs): These cement have shown superfluity by liberating fluoride, chemically bonding with dental structures, and being non-toxic to living tissues. Nevertheless, the low break resistance inherent in glass ionomer cement restricts them to the less stressful prosthetic zone following endodontic treatment in the posterior teeth.
Nowadays, common GICs can resist fractures resulting from incorporating resin into them. Such GICs are resin-modified glass ionomer cement (RMGICs) (Tanaka et al., 2020). RMGICs have combined advantages of EITE in flexural strength and low solubility of resin composite, preferable for restoration of posterior restorations.
Bulk-Fill Composites: Bulk-fill composite resins are purposely engineered in their properties. Bulk-fill composite resins simplify the procedure and improve film thickness through the extent of curing in contrast to traditional composites. The augmented development of adherence to the cavity walls and reduced shrinkage in the polymerizing process are the essential characteristics that guarantee the crown’s power to withstand the harsh masticatory forces in the posterior post-endodontic teeth.
Void- and gap-free dentistry is the advantage of bulk-fill composites as they function efficiently, and the light can penetrate and polymerize within the whole dent tissue without polymerization issues. It has a high resistance to occlusal forces and structural integrity, making it an ideal material for posterior teeth and for restoring a large cavity in most cases.
Cavity Preparation Design
The shape of the cavity preparation plays a crucial role in achieving the desired fracture resistance of direct restorations in the posterior teeth following root canal treatment. The preparation’s shape, depth, and extent influence the distribution of stress, load-carrying capacity, and restoration retention.
Conservative Preparation: Conservative cavity preparation conserves tooth structure by excising only the carious tissues and unsupported enamel. Minimal intervention techniques not only minimize the risk of cuspal deflection, fracture, and pulpal trauma but also facilitate long-term tooth survival.
Conservative measures aim to drill out only the diseased or failing parts of the tooth and then use sealant materials to reinstate the remaining parts of the tooth. Such an approach ensures decreased tooth structure removal and tooth biomechanical integrity preservation.
Cusp Coverage: Cusp coverage restorations are often used in clinical situations where cusps are weakened or compromised, as they ensure sufficient support and reinforcement, thus preventing cuspal fracture and excessive cuspal flexure. Techniques such as clay, overlay, or crown placement are examples of approaches designed to spread chewing pressure uniformly and thus protect the total thickness of the tooth from undue stress.
Also, cusp coverage restorations indirectly fabricate restorations using ceramic, metal, or composite resin materials. These restorations recreate the natural occlusal anatomy and function and reinforce the weaker part of the tooth structure, leading to teeth preservation.
Marginal Integrity: The restoration comprises the unimpeachable integrity that prevents access of bacteria, microleakage, and secondary decay around the restoration margins. Achieving integration of the restoration through preparation, contouring, and contact points minimizes the risk of giving space for the marginal discrepancies, open margins, and voids, which reduces the longevity cover the res
toration’s resistanceFor example, tilted angles, bevels, or chamfers for critical areas, as well as shoulder moulding, are used to enhance marginal adaptation and seal, thus guaranteeing a stable and durable restoration-tooth interface. Achieving the proper amount of marginal integrity leads to a long-term successful outcome and reduces the probability of restoration fracture and failure.
Bonding Techniques
The bonding technique during restoration placement influences the fracture resistance and longevity of direct restorations in post-endodontic posterior teeth. Adequate adhesion to tooth structure enhances retention, marginal seal, and resistance to fracture, minimizing the risk of restoration debonding or failure.
Etch-and-Rinse Bonding: Etch-and-rinse bonding is a technique which involves the application of acid phosphate to enamel and dentin to create a space for the adhesive to penetrate and bond (Sato et al., 2021). This method helps to strengthen the hold and the leak-proofness of the restoration in particular. Therefore, it decreases microleakage incidence and carious lesions’ recurrence.
The tooth surface is subsequently washed and dried after an acid etching has been carried out. A bonding agent or adhesive resin is then applied. The adhesive resin penetrates the demineralized dentin structure by generating the resin tags that, stemming from the resin material, can blend with the restoration material to create a robust and durable bond.
Self-Etch Bonding: Self-etch bonding simplifies the process by etching and priming in one step. This technology facilitates insensitivity to technique and decreases sitting time and postoperative tenderness to enhance reliable adhesion and bonding strength.
Self-etch adhesives contain acidic monomers which etch and prime the tooth surface molecules and obtain a chemo-mechanical interaction. Hybrid resin forms a hybrid layer between demineralized tooth tissue and is placed into the cavity, improving bond strength and fracture resistance.
Universal Bonding Agents: Universal bonding agents are employed in restorative materials, substrates, and bonding techniques. These versatile products can be combined with different items (Perdigão et al., 2021). These multipurpose adhesives are tools used to carry out bonding jobs and avoid having numerous adhesive systems, thus streamlining clinical processes and making the job more effective.
Regardless of the bonding system, be it etch-and-rinse, self-etch or selective enamel etch technique, a bonding agent ensures the composite material has strong adhesion to both enamel and dentin surfaces. Their broad accessibility and steady predictability allow them to be used for a multitude of clinical applications, in particular, post-endocranial restorations of posterior teeth.
Occlusal Forces
The force acting on the posterior teeth from the occlusal movement caused by rumination, bruxism, and parafunctional habits profoundly impacts the fracture resistance of direct restoration in endodontically treated posterior teeth. Restoration failure, cuspal fracture, or tooth loss can result from emphasized unbalance occlusion, making occlusal analysis, equilibration, and occlusal splint therapy critical in eliminating occlusal factors that generate fracture efficiency.
Occlusal Analysis: During occlusal analysis, where the contribution of upper and lower teeth are evaluated, and the occlusal forces, which are distributed throughout different movements of the mandible and maxilla, are understood. A medical exam with anatomical models and diagnostic tools such as articulating paper and digital occlusal analysis systems allows visualizing dysfunctions of occlusion (biting) that may predispose molar and premolar that are post-op restored teeth to fracture.
Comprehensive occlusal analysis requires examining the joints in six different positions to determine the effects of the joints of the upper and lower teeth and the occlusal plane in the mandible. The detection of occlusal contacts will distribute loads correctly and consequently diminish the probability of restoration failure in the molar teeth that have been endodontic therapy.
Equilibration: The force acting on the posterior teeth from the occlusal movement caused by rumination, bruxism, and parafunctional habits profoundly impacts the fracture resistance of direct restoration in endodontically treated posterior teeth. Restoration failure, cuspal fracture, or tooth loss can result from emphasized unbalance occlusion, making occlusal analysis, equilibration, and occlusal splint therapy critical in eliminating occlusal factors that generate fracture efficiency.
The occlusal equilibration procedure consists of a selective dentition tooth surface levelling adjustment to get balanced occlusal contacts and interlocked or “harmoniously fitted” occlusal relationships. Thus, balanced occlusion aims to provide uniform force distribution across the dental arch. This helps in avoiding unnecessary overstressing of certain teeth and restorations.
Equilibration methods encompass differential grinding of occlusal high spots, occlusal modification, and occlusal plane adjustment procedures to aid in the efficient output and function of the system. Additionally, equilibration enables re-distributing past-timber contact force, which stops one’s restored teeth from being overloaded and allows the fracturing resistance of those teeth to grow in the long run.
Occlusal Splint Therapy: Occlusal splint therapy utilizes custom-fabricated removable appliances to stabilize occlusal relationships, reduce parafunctional habits, and protect teeth and restorations from excessive forces. Occlusal splints, or bite guards or night guards, are designed to provide a uniform occlusal contact pattern and protect the dentition during sleep or periods of bruxism.
Occlusal splints distribute occlusal forces over a larger surface area, preventing localized stress on individual teeth and restorations. They also promote muscle relaxation, temporomandibular joint (TMJ) stability, and symptom relief in patients with bruxism-related disorders. Incorporating occlusal splint therapy into the comprehensive treatment plan enhances direct restorations’ longevity and fracture resistance in post-endodontic posterior teeth.
Conclusion
Conclusively, the literature review provides essential details relating to the fracture of composite, ceramic, amalgam, and glass ionomers in posterior restoration after teeth endodontic treatment. Composite resins have higher polishing retention, reduce the risk of thermal damage, and provide better esthetics when compared to traditional materials; GIC and RMGIC have the advantages of biocompatibility, adhesion, and greater hydration. Decision-making in cavity preparation design, bonding methods, and occlusal load is the most crucial factor in expectations from the vital work and the patient’s clinical outcome. By blending evidence-based principles and tackling research inconsistencies, health providers will attain substantial treatment outcomes and increase patient satisfaction in therapeutic dentistry practice.
References
Atalay, C. A. N. S. U., Yazici, A. R., Horuztepe, A. Y. N. U. R., Nagas, E., Ertan, A. H. M. E. T., & Ozgunaltay, G. (2016). Fracture resistance of endodontically treated teeth restored with bulk fill, bulk fill flowable, fiber-reinforced, and conventional resin composite. Operative dentistry, 41(5), E131-E140. https://doi.org/10.2341/15-320-L
Carvalho, M. A. D., Lazari, P. C., Gresnigt, M., Del Bel Cury, A. A., & Magne, P. (2018). Current options concerning the endodontically-treated teeth restoration with the adhesive approach. Brazilian oral research, 32, e74. https://doi.org/10.1590/1807-3107bor-2018.vol32.0074
Isufi, A., Plotino, G., Grande, N. M., Ioppolo, P., Testarelli, L., Bedini, R., … & Gambarini, G. (2016). Fracture resistance of endodontically treated teeth restored with a bulkfill flowable material and a resin composite. Annali di stomatologia, 7(1-2), 4. https://doi.org/10.11138/ads/2016.7.1.004
Osiewicz, M. A., Werner, A., Roeters, F. J., & Kleverlaan, C. J. (2022). Wear of bulk-fill resin composites. Dental Materials, 38(3), 549-553. https://doi.org/10.1016/j.dental.2021.12.138
Perdigão, J., Araujo, E., Ramos, R. Q., Gomes, G., & Pizzolotto, L. (2021). Adhesive dentistry: Current concepts and clinical considerations. Journal of Esthetic and restorative Dentistry, 33(1), 51-68. https://doi.org/10.1111/jerd.12692
Sato, T., Takagaki, T., Hatayama, T., Nikaido, T., & Tagami, J. (2021). Update on enamel bonding strategies. Frontiers in Dental Medicine, 2, 666379. https://doi.org/10.3389/fdmed.2021.666379
Shafiei, F., Dehghanian, P., Ghaderi, N., & Doozandeh, M. (2021). Fracture resistance of endodontically treated premolars restored with bulk-fill composite resins: The effect of fiber reinforcement. Dental Research Journal, 18(1), 60.
Tanaka, C. B., Ershad, F., Ellakwa, A., & Kruzic, J. J. (2020). Fiber reinforcement of a resin modified glass ionomer cement. Dental Materials, 36(12), 1516-1523. https://doi.org/10.1016/j.dental.2020.09.00
Tekçe, N., Aydemir, S., Demirci, M., Tuncer, S., Bozkaya, S., Sevilay Yıldırım, E., & Akman, Ş. (2021). Evaluation of fracture strength and total void amount in composite restorations on endodontically treated teeth. Odovtos International Journal of Dental Sciences, 23(3), 75-86. http://dx.doi.org/10.15517/ijds.2021.45371
Toz, T., Tuncer, S., Öztürk Bozkurt, F., Kara Tuncer, A., & Gözükara Bağ, H. (2015). The effect of bulk-fill flowable composites on the fracture resistance and cuspal deflection of endodontically treated premolars. Journal of Adhesion Science and Technology, 29(15), 1581-1592. https://doi.org/10.1080/01694243.2015.1037381
write