Fatigue behavior of dental resin composites: Flexural fatigue in vitro versus 6 years in vivo

Objectives: To evaluate fatigue behavior of direct resin composite restorations (Tetric Ceram vs. Grandio) in vitro and in vivo over an observation period of 6 years. Methods: For the in vitro part, Young's moduli (YM) were calculated and both initial (FS: flexural strength) and fatigue flexural strength (FFL: flexural fatigue limit) were evaluated in a four-point bending setup (n 15) in distilled water at 37 degrees C. For the in vivo part, 30 patients received 68 direct resin composite restorations of the same materials (Grandio bonded with Solobond M; Tetric Ceram bonded with Syntac). Patients revealed a minimum of two different class II restorations in different quadrants. Epoxy replicas of restored teeth were analyzed under a scanning electron microscope (SEM) at 30x magnification for fatigue characteristics, and 11 selected restorations per group were assessed for marginal fatigue characteristics at 200x. Results: In vitro, YM was 15.7 GPa (Grandio) and 8.7 GPa (Tetric Ceram; p < 0.05), FS was 115.0 MPa (Grandio) versus 101.5 MPa (Tetric Ceram; p > 0.05), and FFL was 63.0 MPa (Grandio) versus 44.3 MPa (Tetric Ceram; p < 0.05). In vivo, no significant difference in fatigue behavior (cracks, chippings) was evaluated for the different materials under investigation. However, marginal breakdown was more pronounced under the SEM for Tetric Ceram (7.9% vs. 4.8% for Grandio; p < 0.05), but without being clinically relevant. SEM analysis exhibited distinct wear patterns after 6 years with no significant differences among materials as well. Significances: Despite higher in vitro values for YM, FS, and FFL for Grandio, clinical outcome for both resin composite materials over 6 years of clinical service was similar. Higher FFLs in vitro seem to be related to less marginal composite fractures in vivo but without any influence on clinical outcome until the 6 years recall. (C) 2012 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 100B: 903-910, 2012.