ID Design Press, Skopje, Republic of Macedonia

Open Access Macedonian Journal of Medical Sciences. 2019 Dec 15; 7(23):4089-4093.
https://doi.org/10.3889/oamjms.2019.853
eISSN: 1857-9655
Dental Sciences

Comparison of Enamel Preparations - Bevel, Chamfer and Stair

Step Chamfer on Fracture Resistance of Nano Filled Resin
Composites Using Bulk Pack Technique - An In Vitro Study

1 2* 3 4
Jyothi Bommanagoudar , Shashidhar Chandrashekhar , Shilpa Sharma , Hiten Jain

1
Department of Pedodontics and Preventive Dentistry, SMBT Dental College and Hospital, Sanagmner, Maharashtra
2
422608, India; Conservative Dentistry and Endodontics, SMBT Dental College and Hospital, PAHER University Rajasthan,
3
Sangamner, Maharashtra, India; Department of Oral Medicine and Radiology, SMBT Dental College and Hospital,
4
Sanagmner, Maharashtra 422608, India; Department of Public Health Dentistry, SMBT Dental College and Hospital,
Sanagmner, Maharashtra 422608, India

Abstract
Citation: Bommanagoudar J, Chandrashekhar S, AIM: To evaluate and compare the effect of enamel preparation designs bevel, chamfer and stair-step chamfer on
Sharma S, Jain H. Comparison of Enamel Preparations -
Bevel, Chamfer and Stair Step Chamfer on Fracture
the fracture resistance of nanocomposite.
Resistance of Nano Filled Resin Composites Using Bulk
Pack Technique - An In Vitro Study. Open Access Maced METHODS: The sample group of this study consisted of 72 non-carious permanent maxillary central incisors. The
J Med Sci. 2019 Dec 15; 7(23):4089-4093. sample is divided into four groups of 18 each. Group, I control Group II bevel preparation, Group III chamfer
https://doi.org/10.3889/oamjms.2019.853
preparation, group IV stair step chamfer preparation. After the specific preparation, each tooth is filled with
Keywords: Bevel; Bulk pack; Chamfer; Nanocomposite;
Stair step chamfer nanocomposite using bulk pack technique. The teeth were subjected to fracture resistance test under Universal
*Correspondence: Shashidhar Chandrashekhar.
testing machine and then were examined under a stereomicroscope to evaluate the type of bond failure. The
Conservative Dentistry and Endodontics, SMBT Dental results were subjected to statistical analysis.
College and Hospital, PAHER University Rajasthan,
Sangamner, Maharashtra, India. E-mail: RESULTS: Results of the One-Way ANOVA revealed a significant difference in the mean peak failure load values
shashiendo6@gmail.com
of the four different groups. (P < 0.001) Tukey’s Post-Hoc comparison test revealed that there was a significant
Received: 13-Oct-2019; Revised: 04-Nov-2019;
Accepted: 05-Nov-2020; Online first: 10-Dec-2019 difference in the mean peak failure load values of the bevel and chamfer preparation. But there was no significant
Copyright: © 2019 Jyothi Bommanagoudar, Shashidhar
difference between chamfer and stair-step chamfer preparation designs.
Chandrashekhar, Shilpa Sharma, Hiten Jain. This is an
open-access article distributed under the terms of the CONCLUSION: Stair-step chamfer preparation demonstrated comparable values to Chamfer preparation but also
Creative Commons Attribution-NonCommercial 4.0 involved the removal of less amount of tooth structure adjacent to the fractured edge and good esthetic technique.
International License (CC BY-NC 4.0)
Funding: This research did not receive any financial
support
Competing Interests: The authors have declared that no
competing interests exist

Introduction depends upon the severity of fracture of hard tissue.

Such options end up with the removal of healthy tooth
tissue to gain adequate mechanical retention [3] but
The overall seriousness of traumatic injuries also are time consuming and expensive. They are
to the anterior teeth often focuses on the aesthetic also contraindicated in the adolescents because of the
implications of the injury. It is estimated that 1 out of large pulp chambers and continuous migration of the
every 4 persons under the age of 18 years sustains a epithelial attachment [4]. Fragment reattachment of
traumatic dental injury in the form of an anterior crown the crown is a widely accepted procedure in young
fracture [1]. Eighty percent of the traumatised teeth adolescents, but it is seldom the parents or child
were maxillary central incisors. The most common realises the importance of retrieving fractured
type of injury was a crown fracture involving both fragment, which is lost [5].
enamel and dentin (45.7%) [2]. To achieve esthetics, fracture resistance and
The treatment of crown fractures of anterior durability poses great difficulty in restoring class IV
teeth ranges from simple composite restorations to cavity of anterior teeth in the young patient.
intracoronal gold inlay restoration. Ultimate treatment Shortcomings of restorative techniques developed
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until now are retention and esthetics [6]. From the bacteriostatic/bactericidal solution for one week.
discovery of acid etching technique to till the recent Following which, they were stored in distilled water at
development in adhesive dentistry, the emphasis is a temperature of 4°C [11]. To reduce deterioration, the
mainly given on bonding to the enamel which storage medium was replaced each fortnightly. All
reestablishes the integrity and strength to the teeth selected for testing were used within one month
restorative tooth complex [7]. of procurement. An ethical committee approval was
obtained to use extracted human teeth for the study.
Nano filled composite may represent an
important milestone in this development which shows All samples were mounted similarly for
easy adaptation, high fracture resistance; excellent standardisation. PVC pipe tubes measuring the length
handling properties, outstanding polishability, long of 2.5 cm, with a diameter of 2 cm were used to mount
term colour stability and highly aesthetic properties the teeth. During the mounting procedure, the cervical
make them use both anterior and posterior line of each tooth was made to coincide with the level
restorations [8]. of acrylic resin or upper edge of the tube to achieve
parallelism and standard inclination of the incisal
Preparations techniques like featheredge
edges. The tooth should be at 90° to the upper edge
were used earlier to prevent insult to the injured tooth,
of the tube. The roots of mounted teeth were
but they were weak, un-aesthetic due to over
subsequently embedded in cold-cure acrylic resin by
contoured margins. They were prone to marginal
dough method.
leakage and easy dislodgement. As a result, enamel
reduction was considered necessary not only to Individual custom-made strip crowns were
accommodate the bulk of resin but also to increase fabricated on type III dental stone models using
®
the enamel surface area available for acid etching. Biostar machine (Essix technologies).
The degree of retention varies directly with the
amount of enamel available for acid etching. Enamel The specimens were divided into six groups
preparation also resulted in grinding of the superficial of twelve samples each and colour-coded with
aprismatic layer by exposing the prismatic subsurface coloured adhesive tapes and numbered. A
enamel before acid etching and thus has been standardised mesio-incisal fracture was created which
strongly recommended [9]. coincides with 5 mm gingivally and 5 mm distally
along the incisal edge. Then they were joined to form
In 1996, Albers introduced the stair-step a base of an imaginary triangle with apex
chamfer preparation for class IV restorations he corresponding to mesio-incisal line angle.
describes this preparation design as a chamfer that
follows the vertical and horizontal anatomical Experimental fractures were made using low-
contours, making the preparation look like stair steps speed diamond disc (JUNWEI, China) at a constant
at the same time masking margins by placing them speed of 150 RPM. Using a standard diamond rotary
within natural developmental grooves in the enamel of bur (Mani Inc. Diamond bur TC-S21, ISO NO.
10 160/014), a 45° bevel extending 2 mm beyond the
anterior teeth. Such technique achieves high degree
esthetics along with exposure of reactive enamel. fractured incisal edge and through the entire enamel
thickness, was given on the cavosurface margin of the
The purpose of this study is to determine the tooth. Similarly with a standard diamond rotary bur
influence of enamel preparation designs namely (Mani Inc. Diamond bur SO-20, ISO NO. 288/012), a
bevel, chamfer and newly introduced stair-step chamfer preparation and stair-step chamfer
chamfer on fracture resistance of nanocomposite preparation was placed on the labial surface of teeth
resin (Filtek TM Supreme XT) restoration of in their respective groups (Figure 1).
standardised simulated incisal angle fracture in
anterior teeth and the strength of interface between
composite and tooth structure with the null hypothesis
that there is no significant difference among the
enamel preparation designs on fracture resistance of
nanocomposite resin restoration of anterior teeth.

Methods

Seventy-two human, non-carious permanent Figure 1: Different enamel preparation designs (Bevel, Stairstep
maxillary central incisors were collected and stored in Chamfer, Chamfer) on a typodont
distilled water; the adherent blood and soft tissue
were removed immediately after procurement. Then
they were stored in 0.5% Chloramine-T The chamfer and stair-step chamfer included
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 Bommanagoudar et al. Comparison of Enamel Preparations-Bevel, Chamfer and Stair Step Chamfer on Fracture Resistance of Nanofilled Resin Composites
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approximately half the thickness of the enamel and failure.

extended 2 mm cervically beyond the edge of the
The actual mode of failure was recorded
fractured surface. Stair-step chamfer was produced
according to the following criteria:
under the technique described by Harry F. Albers [10].
Lingually all preparations were restricted to an inclined Adhesive (A): Failure at the tooth resin
bevel extending 2 mm cervically from the fractured interface;
edge. The enamel margins were acid etched with 35%
phosphoric acid gel for 15 seconds, then thoroughly Cohesive (C): Complete failure within the
resin restoration;
rinsed with water for 15 seconds.
Mixed (M): Partial fractures of resin
Adper Single bond 2 Adhesive (3M ESPE,
restoration and partial adhesive failure at the interface
USA), a total-etch adhesive was applied on the
prepared surface using adhesive applicator according
to manufacturer’s instruction and light-cured for 10 s
using a quartz-tungsten-halogen light-curing unit
(Optilux 501, Demetron; Danbury, CT, USA) with an Results
2
irradiance of 500 mW/cm . All the preparations were
restored with nano filled composite using custom strip
crowns in ‘bulk pack‘ technique (Figure 2). The null hypothesis states that there is no
significant difference among the tested specimen

Table 1: Descriptive statistics of peak failure load (Newtons)

for various groups – mean, SD, SE
Groups Mean Standard Deviation Standard Error
GROUP I (CONTROL) 610.63 37.55 11.87
GROUP II (BEVEL) 253.6 64.59 14.44
GROUP III (CHAMFER) 324.5 73.16 16.36
GROUP IV (STAIR
311.2 82.67 18.48
‘STEP CHAMFER)

All the obtained data were subjected to

statistical tests one way ANOVA test, Tukey’s Post
Hoc test and independent samples‘t-test. The mean
peak failure load for control, bevel, chamfer & stair
step chamfer preparations along with standard
deviations values were observed as 610.63 ± 37.55,
Figure 2: Completed restoration 253.6 ± 64.59, 324.5 ± 73.16 and 311.2 ± 82.67 in N
respectively (Table 1) (Figure 3).

After removing excess material, the resin

composites were light-cured through strip crowns from
labial and lingual sides. Strip crowns were removed
gently with BP blade no. 15.
Specimens were aged for 24 hrs in distilled
water at 37° degrees in an incubator and then
subjected to cantilever bending test using a universal
testing machine (Instron T-Series TINIUS OLSEN.
Instron Corp. England, UK) to determine the
resistance to fracture of composite restorations
(Figure 5). A loading force was applied on a specific
spot of lingual aspect of the specimen by 6-inch
stainless steel rod with a 2.5 mm radius at a constant
crosshead speed of 5mm per minute until the resin
Figure 3: Mean Peak failure load values of various groups
was dislodged or fractured. The readings were noted
to determine the peak force at failure in Kilograms
(Kg) then converted to Newtons (N).
One way ANOVA test revealed a significant
difference in the mean peak failure load values of 4
Fracture mode evaluation different groups with ‘an F‘ value of 61.389 was
found to be highly significant (P ˂ 0.001). Tukey’s
After the testing of preparations, the Post Hoc test tests mean of various groups. Pairwise
specimens were examined under a stereomicroscope comparisons with control & test groups showed highly
at 40 x magnification to evaluate the type of bond significant means. Multiple comparisons within test
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groups showed no significant differences in the mean fillers are loosely bound agglomerates of nano-sized
peak failure load values, but there is a significant particles [8]. The combination of nanomer sized
difference in the mean peak failure load between particles to the nanocluster formulations reduces the
bevel & chamfer group. interstitial spacing of the filler particles. This provides
for increased filler loading, better physical properties
Using Independent samples ‘t-test, the
and improved polish retention [12]. The resin consists
comparison of mean peak failure loads of bevel with
of three major components. TEGDMA is used in minor
chamfer & bevel with stair-step chamfer showed
amounts to adjust the viscosity. UDMA and Bis-EMA
significant difference with ‘t’ value of -3.248 (P ˂
resins are of higher molecular weight and therefore
0.001) & -2.455 (P ˂ 0.05) whereas no significant
have fewer double bonds per unit of weight. The
difference between mean peak failure load of chamfer
higher molecular weight of the resin results in less
& stair step chamfer with ‘t’ value 0.538 (P ˂ 0.05),
shrinkage reduced ageing and a slightly softer resin
(Table 2).
matrix.
Table 2: Descriptive statistics of peak failure load (Newtons) However longevity of class IV restoration is
for Preparation groups along with the results of independent not only dependent entirely on material, but cavity
samples–t-test
design is also utmost important for clinical success of
GROUPS MEAN (S.D) ‘t’ test p-value, Significance such restorations. Various enamel preparation
GROUP II (BEVEL)
GROUP III (CHAMFER)
253.6 (64.59)
324.5 (73.16)
-3.248
p < 0.001, highly
significant
techniques, like butt joint margins, feather edge
GROUP II (BEVEL) 253.6 (64.59)
-2.455
p = 0.019 significant margins, bevels, chamfer preparation, short bevel and
GROUP IV (STAIR STEP) 311.2 (82.67) difference
GROUP III (CHAMFER) 324.5 (73.16) p = 0.593, no long bevel, have been recommended to achieve
0.538
GROUP IV (STAIR STEP) 311.2 (82.67) significant difference retention and esthetics [13]. The bevel design, given
by Black, creates a gradual change of colour from the
Failure types examined under a tooth to the restoration, but it is not as durable as a
stereomicroscope at 40 x magnification (Figure 4). chamfer [10]. Jordan introduced chamfer preparation
which enhances acid etching and provides increased
The bevel group (Group II) showed maximum marginal bulk which increases fracture and leakage
mixed failure modes (50%) followed by adhesive resistance and higher retention of tooth structures
(35%) and cohesive (15%) failure modes. The [14]. Albers used the mamelons present on the labial
Chamfer group (Group III) showed a maximum of surface of incisors in stair-step design by giving
cohesive failure modes followed by mixed (35%) and horizontal and vertical grooves with chamfer
adhesive failure modes (5%). The stair-step chamfer cavosurface margin to achieve good esthetic result
group (Group IV) showed a maximum of cohesive [10]. As the strengths of restorative materials
failure modes (55%) followed by mixed (35%) and increases along with advances in adhesive systems,
adhesive failure modes (10%). appropriate preparation designs on enamel for
retention are persistently being evaluated.
Prevalence studies showed maxillary incisors
most commonly involved in both types fractures, i.e.
complicated and uncomplicated as well [15], [16].
Enamel preparation designs selected for this study
are based on more esthetic outcome [10], availability
of more reactive enamel surface to bond as there is
the removal of aprismatic enamel [17], increase the
bulk of restorative material [10].
Cantilever bending test was used to
determine the fracture resistance of composite
buildup.
Figure 4: Percentage-wise distribution of failure modes in enamel
preparation groups
Loading force was applied at a specific point
on the lingual side of the restoration to simulate oral
conditions.
In this study, obviously, the control group of
untreated teeth showed significantly higher mean
failure load values compared to the experimental
Discussion groups (Highly significant; P < 0.001) (Table 1). The
natural, intact teeth are more resistant to complex
forces than restored teeth. Similar observations were
Resin composites are the material of choice made by the studies of Eid H [18], and Eid H, George
for anterior esthetic restorations. The nanocomposite EW [19].
contains a unique combination of two types of Mean peak failure load for chamfer
nanofillers (5-75 nm) and nanoclusters. Nanocluster
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