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Original Article

Mechanical Performance of a Newly Developed Glass Hybrid

Restorative in the Restoration of Large MO Class 2 Cavities
ZB Kutuk, C Ozturk, FY Cakir, S Gurgan

Department of Restorative Objective: To evaluate the mechanical properties of a glass hybrid  (GH)

Abstract
Dentistry, School of
Dentistry, Hacettepe
restorative system  (EQUIA Forte/GC) and compare it with a microhybrid
University, Ankara, Turkey composite  (G‑aenial Posterior/GC) by compressive strength  (CS) and fracture
resistance  (FR) tests. Materials and Methods: Cylindrical specimens were
subjected to a CS test  (n  =  12). There were about 48 mandibular molars were
used for a FR test and divided into four groups: Group  1  (positive control),
sound teeth; Group  2  (negative control), extended size Class  2 cavities prepared
on the mesial surfaces of teeth; Group  3, extended size Class  2 cavities restored
with a composite; and Group  4, extended size Class  2 cavities restored with
GH. Specimens were subjected to loading until a fracture occurred. Data were
analyzed statistically  (α = 0.05). Results: The fracture modes were examined by
scanning electron microscope  (SEM). The CS values of the composite and GH
were 278.20  ±  17.34 MPa and 164.62  ±  25.72 MPa, respectively  (P  <  0.05).
No differences were observed between the FR of restored groups  (P  >  0.05).
Conclusions: The GH exhibited sufficient mechanical properties as a restorative
material, and could be preferred for extensive caries lesions on posterior teeth.

Date of Acceptance: Keywords: Composite resin, compressive strength, fracture resistance,

23-Feb-2019 glass hybrid

Introduction and occlusal forces. The compressive strength and

T he primary cause of tooth damage is dental caries
or cavities. Conservatively, in recent years the
treatment of primary or secondary caries has involved
the use of composite resins for the placement of posterior
permanent tooth restorations particularly because of its
better esthetic properties and the general concerns about
the limitations of amalgam.[1,2]
Since tooth tissue loss is an irreversible process, the
least invasive technique should be considered as the
first therapeutic choice. The life span of a restoration,
known as service life or length of service, defines the
longevity of the restored tooth unit and is multifactorial.
It depends on the patient, operator (dentist), and material
related properties.[3‑6] The amount of residual tooth tissue
is also of paramount importance.[6‑8]
The posterior direct tooth‑colored restorative materials
should have adequate strength to resist masticatory
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fracture resistance are considered to be good indicators
for simulating the masticatory forces encountered in
the mouth. The compressive test aims to evaluate the
material’s resistance to vertical stresses as well as the
occlusal forces during function, and would be a more
important property for understanding the durability
of posterior restorations which encounter higher
masticatory loads.[9] However, fracture resistance is
also an essential factor that affects cracking of the
restorations under heavy loading. The experimental and
theoretical efforts have been made to relate the strength
of a material to its fracture resistance in addition to the
structural parameters.[10]
Address for correspondence: Dr. ZB Kutuk,
Department of Restorative Dentistry, School of Dentistry,
Hacettepe University, Ankara ‑ 06100, Turkey.
E‑mail: zeynepbilge.kutuk@hacettepe.edu.tr
This is an open access journal, and articles are distributed under the terms of the
Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows
others to remix, tweak, and build upon the work non‑commercially, as long as
appropriate credit is given and the new creations are licensed under the identical
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For reprints contact: reprints@medknow.com

DOI: 10.4103/njcp.njcp_628_18
How to cite this article: Kutuk ZB, Ozturk C, Cakir FY, Gurgan S.
Mechanical performance of a newly developed glass hybrid restorative
PMID: ******* in the restoration of large MO Class 2 cavities. Niger J Clin Pract
2019;22:833-41.

© 2019 Nigerian Journal of Clinical Practice | Published by Wolters Kluwer ‑ Medknow 833

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Kutuk, et al.: Comparison of mechanical properties of glass hybrid with composite
Hybrid composite resins are considered to be the
“gold standard,” and three‑step or two‑step agents are
recommended as gold standard adhesives.[7] The Academy
of Operative Dentistry‑European Section  (AODES)
also suggests the use of microhybrid or nanohybrid
composite resins with a minimum of 60% filler load by
volume to restore the lost tooth structure.[11]
In contrast to composite resins, conventional glass
ionomers  (GIs), have traditionally been considered
inferior restorative materials. While GIs traditionally
have been tagged as temporary materials not suitable
for permanent restorations, and have mainly been
placed temporarily over residual lesions since their
limited flexural strength does not allow for their
use to permanently restore extended cavities, recent
meta‑analytical findings have emphasized that highly
viscous GIs are not obviously inferior to the current gold
standard (amalgam).[2] Highly viscous GIs are constantly
being enhanced to improve their clinical handling,
and performance in order to be increasingly used in
restorative dentistry as a permanent restorative.[12]
The recent advances in this material class, however,
have widened the indication spectrum of GIs, and one
very recent development was the introduction of glass
hybrid  (GH)  (EQUIA Forte), which is a bulk‑fill highly
viscous GI reinforced with ultrafine, reactive glass
particles forming a GH restorative, and has been promoted
as amalgam alternative.[13] This reinforced GI contains
a second smaller and more reactive silicate particle
and higher‑molecular‑weight acrylic acid molecules
which supposedly increase matrix cross‑linking. This,
in turn, is thought to improve the material’s flexural
strength. Covering these restorations with a resin layer is
supposed to further improve wear resistance and esthetic
appearance.[14] Although the long‑term successful
performance of restorative GI systems in the restoration
of Class 1 and conservative (small size) Class 2 cavities
was demonstrated by clinical studies,[15,16] it remains
unclear if GH may truly be used to restore large size
Class  2 cavities, since the fracture resistance of teeth
restored with GH is unknown.
Therefore, the present in vitro study aimed to assess the
compressive strength and fracture resistance of a GH
restorative system and a microhybrid composite resin
and to compare the mechanical performance of these
materials in large Class  2 cavities on molar teeth. The
first hypothesis was that the GH restorative material
would have significantly lower compressive strength
than the microhybrid composite resin, and the second
hypothesis was that GH restorative material would
not adequately ensure fracture resistance in large size
Class 2 cavities of molar teeth.
834 Nigerian Journal of Clinical Practice  ¦  Volume 22  ¦  Issue 6  ¦  June 2019
Materials and Methods
The Human Research Ethics Committee of the university
approved this study with process no: GO 17/406‑06.
Materials selected for this study included a microhybrid
composite resin  (G‑ænial Posterior/GP) and a GH
restorative system  (EQUIA Forte/EF). The GH
restorative system was assessed with a nanofilled resin
coating  (EQUIA Forte Coat). Details of the materials
used in this study are shown in Table 1.
Compressive Strength Test: Specimens for compressive
strength  (CS) test were prepared using a customized
Teflon mold 8 mm in height and 4 mm in diameter. The
Teflon mold was placed on a glass plate, and the bottom
surface was covered with a Mylar strip  (S.S. White
Limited, Middx, England).
A G‑ænial Posterior composite resin was placed with
2 mm layers in a Teflon mold in four steps, and each layer
was polymerized using a light emitting diode  (LED)
light device  (1400  mW/cm2)  (Starlight S, Mectron
SpA, Carasco, Italy) for a 20s curing time. The upper
surface of the last layer was covered with a Mylar strip
to prevent the formation of an oxygen inhibition layer,
and constant pressure was applied with a 1 mm thick
microscope glass. Then, the pieces of the mold were
carefully removed, and cylindrical specimens  (4  mm Ø,
8 mm height, n = 12) were obtained.
EQUIA Forte specimens for CS test were prepared
according to the manufacturer’s instructions. The capsule
was tapped on its side on a hard surface to loosen the
powder; then, to activate the capsule, the plunger was
pushed until it was flush with the main body, and the
capsule was immediately placed into a capsule applier
and the lever was clicked once. The capsule was mixed
with an automixer  (Coxo Medical Instrument Co., Ltd,
Guangdong, China), and then applied to the Teflon
mold. The upper surface was covered with a Mylar strip,
and constant finger pressure was applied for the duration
of the setting process  (2  min, 30s). When the setting
was completed, the EQUIA Forte Coat was applied to
the top surfaces of the GH specimens using micro‑tip
applicators without air blowing and light cured for 20s.
The CS of tested materials were evaluated in ambient
air (23 ± 1°C) according to ISO 9917‑1:2007.[17] The test
was carried after 24h water storage at 37°C. The CS was
determined by loading in using a universal mechanical
testing machine  (Universal Testing Machine, Mod
Dental, Ankara, Turkey) at a crosshead speed of 1  mm/
min until specimen failure. The fracture load was noted
for each sample. The CS was calculated according to
equation[18] CS = 4 F/(π D2)
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Kutuk, et al.: Comparison of mechanical properties of glass hybrid with composite
where CS is the compressive strength; F is the maximum
applied load in Newton  (N), and D is the diameter of
the specimen in mm.
Fracture Resistance Test: There were about 48
extracted human lower first molars for periodontal or
orthodontic reasons were selected according to their
mesial‑distal  (mean  ±  SD  =  11.27  ±  0.13  mm) and
buccal‑lingual width  (mean  ±  SD  =  10.11  ±  0.14  mm),
with a maximum deviation of 0.2  mm from the means
in each dimension set as the limit. Teeth were cleaned
in 5.25% NaOCl for five min and examined for defects.
The root surface of each tooth was coated with a
layer of liquid latex separating material  (Rubber‑Sep,
Kerr, Orange, CA) prior to embedding to mimic
the periodontal ligament, and then the specimens
were embedded in methacrylate resin  (SC, Imicryl,
Konya, Turkey) at 2.0  mm from the cementoenamel
junction (CEJ) using a gauge to simulate the bone level.
The teeth were divided randomly into four
groups  (n  =  12): Group  1: positive control, intact,
unprepared, and unrestored teeth; Group  2:
mesio‑occlusal  (MO) cavities, prepared and unrestored;
Group  3: MO cavities prepared and restored with
microhybrid composite resin  (G‑Premio Bond/G‑ænial
Posterior); and Group  4: MO cavities prepared and
restored with GH restorative system (EQUIA Forte).
Standardized large size Class  2 MO cavities were
prepared by the same trained operator to eliminate
inter‑operator differences under water cooling.
A high‑speed handpiece with a flat end cylinder diamond
bur  (10‑4  mm, #835, Diatech, Coltène/Whaledent AG,
Altstätten, Switzerland) was used to prepare cavities in
Group 2, 3, and 4.
As recommended by the manufacturer of EQUIA Forte,
the proximal cavity boundaries were placed 1.0‑1.5  mm
distance from the cusp peaks [Figure 1]. The isthmus
width was larger than 1/3 of the intercuspal space, and
the occlusal portion cavity depth was 2.5 mm. The axial
wall in the mesial proximal box was prepared to a depth
of 2  mm, and the gingival margin was placed 1.5  mm
above the CEJ. The cavosurface margins were prepared
at 90°, and all the internal lines and point angles were
rounded. The depth and width of the cavities were
checked using a scaled periodontal probe  (instrument
number 23/UNC 15; Hu Friedy, Chicago, IL, USA). The
cavity design with dimensions is shown in Figure 2.
The prepared cavities in Group  3 were rinsed with
water and air‑dried with an air/water syringe. After
application of a contoured matrix band (Hawe Tofflemire
Contoured Matrices, Kerr, Bioggio, Switzerland), the
enamel surfaces were acid‑etched selectively with 35%
Nigerian Journal of Clinical Practice  ¦  Volume 22  ¦  Issue 6  ¦  June 2019
phosphoric acid gel  (GLUMA Etch 35 Gel, Heraeus
Kulzer, Hanau, Germany) for 15s, rinsed with water,
and gently air‑dried. The universal adhesive G‑Premio
Bond  (GC Corp., Tokyo, Japan) was applied to the
cavity walls for 10s and then spread with maximum
compressed air for 5s. The adhesive layer was light‑cured
for 10s. Microhybrid composite resin (G‑ænial Posterior)
was placed in several consecutive 2 mm‑thick oblique
increments. Each increment was light cured from the
occlusal surface for 20s. After removal of the matrix,
the restorations were finished with a series of Soflex
discs (Optidisc, Kerr, Bioggio, Switzerland).
The prepared cavities in Group 4 were rinsed with water
and air‑dried with an air/water syringe. After application
of a contoured matrix band, the cavity surfaces were
treated with 20% polyacrylic acid  (Cavity Conditioner,
GC Corp.) for 10s, rinsed with water, and air‑dried.
The GH restorative system was prepared the same as
the CS test and applied to the cavities. The restorations
were finished as in Group  3, and then the coating
agent (EQUIA Forte Coat, GC Corp.) was applied using
the micro‑tip applicators without air blowing and light
cured for 20s.
The specimens were stored in distilled water for 24h and
thermo‑cycled  (Thermo‑cycle Machine, Mod Dental)
for 10.000  cycles at 5°C and 55°C with each cycle
corresponding to a 20s bath at each temperature with
a 5s dwell time. Afterwards, all prepared specimens
were tested for fracture resistance, using a universal
loading device  (Universal Testing Machine, Mod
Dental).[19] Each test was performed at a cross‑head
speed of 1 mm/min, and load was applied using a
5  mm diameter stainless‑steel ball‑shaped stylus. The
ball‑shaped stylus should contact the inclined planes
of the buccal and lingual cusps beyond the margins
of the restorations. A Mylar strip was placed between
the specimen and the stylus to avoid local stress
concentration by dispersing the load. The peak load to
fracture was recorded in N for each specimen, and the
mean was calculated for each group.
The fracture types seen in the specimens were
evaluated under a stereomicroscope  (Leica MZ 16A,
Leica Microsystems, Switzerland), and classified in
two forms. The first classification was made according
to repairability: (1) a restorable fracture above the
CEJ means that, in case of fracture, the tooth can be
re‑restored by restoration;  (2) a non‑restorable fracture
extends below the CEJ and the tooth is likely to be
extracted.[20] The second classification is based on
the surface of the fracture:  (1) adhesive  +  cohesive in
restoration, the type of fracture in which the restoration
breaks and separates from the dental tissue;  (2)
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Kutuk, et al.: Comparison of mechanical properties of glass hybrid with composite

adhesive + cohesive in restoration + cohesive in the
tooth, the type of fracture in which fracture of the tooth
is seen when the restoration is broken and separated
from the dental tissue;  (3) cohesive in tooth, the type
of fracture that can only be seen in the teeth; and  (4)
cohesive in restoration, the type of fracture that can only
be seen in restoration.[21]
Scanning Electron Microscope  (SEM)  (JSM‑6400
Scanning Electron Microscope, Jeol Ltd, Tokyo, Japan)
images were taken of selected specimens from each
group, and their fracture types were investigated at 15×,
50×, and 200×. Surface characteristics of the tested
materials in the study were also investigated under SEM
at 250×, 500×, and 1000×.
All statistical calculations were performed using the
SPSS software program  (SPSS 20.0 for Windows/
SPSS Inc., Chicago, IL, USA) at a α = 0.05 confidence
interval. Since, the Kolmogorov‑Simirnov test indicated
that the compressive strength data did not follow normal
distribution in any of the groups, the non‑parametric
Mann‑Whitney U test was utilized for the comparison.
The differences between the groups were evaluated by
the Kruskal Wallis test, and pair‑wise comparisons were
performed using the Tukey HSD  (honestly significant
difference) test in the analysis of fracture resistance
values.
The fracture resistance values for the four groups
are presented in Table  3. There was a statistically
significant difference among the groups according to
the Kruskal‑Wallis test  (P  <  0.05). The highest mean
fracture resistance value was seen in the positive
control group  (977.99  ±  92.79 N). This value was
significantly higher than the mean fracture resistance
value of the negative control  (418.48  ±  36.91 N)
and the EQUIA Forte restored  (841.88  ±  74.57 N)
groups (P < 0.05). The lowest mean fracture resistance value
was found in the negative control group  (418.48  ±  36.91
N), which was statistically lower than the positive
control group  (977.99  ±  92.79 N) and G‑ænial Posterior
restored (961.87 ± 46.04 N) groups (P < 0.05).
Pair‑wise comparison of the test groups with the Tukey
HSD test are shown in Table 4. There is no statistically
significant difference between the mean values of the
fracture resistance of the groups restored using G‑ænial
Posterior and EQUIA Forte (P = 0.239).
Fracture types and their percentage distributions of
the specimens in the groups subjected to restoration
after the fracture resistance test are given in Figure  3.
Different fracture types of teeth restored with

Results
Table  2 summarizes the CS values for the tested
materials. According to the Mann‑Whitney U test
results following the Kolmogorov‑Smirnov test, the CS
values of the materials were found to be statistically a
different. The microhybrid composite resin  (G‑ænial
Posterior)  (278.20  ±  17.34 MPa) showed significantly
higher mean CS values than the GH  (EQUIA
Forte) (164.62 ± 25.72 MPa) (P < 0.001).

b c

Figure 1: The schematic view of the extended size MO Class 2 cavity
d e
Figure 2: Standardized large size Class 2 MO cavity preparation and
corresponding measurements. (a) General view of the cavity from occlusal
side. (b) The gingival margin was placed 1.5 mm above to the CEJ. (c) The
axial wall height was approx. 2.5 mm. (d) The occlusal portion cavity
depth was 2.5 mm. (e) The axial wall in the mesial proximal box was
prepared to a depth of 2 mm

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Kutuk, et al.: Comparison of mechanical properties of glass hybrid with composite

a b
Figure 3: Percentage distributions of fracture types of the specimens
according to 2 classified forms (repairability and fracture surface)

c d
Figure 4: Examples of different fracture types on teeth restored
a b c with G‑ænial Posterior:  (a) adhesive  +  cohesive in restoration,  (b)
Figure 5: Examples of different fracture types on teeth restored with EQUIA adhesive  +  cohesive in restoration  +  cohesive in tooth  (can be
Forte (a) adhesive + cohesive in restoration, (b) adhesive + cohesive in re‑restored), (c) cohesive in tooth, (d) cohesive in restoration
restoration + cohesive in tooth (can be re‑restored), (c) adhesive + cohesive
in restoration + cohesive in tooth (cannot be re‑restored)

a b

a b

c d
Figure 7: SEM images of an ‘adhesive + cohesive in restoration’ fracture
type of a specimen in tooth restored with EQUIA Forte. (a) The photograph
of the tooth before SEM evaluation, (b) 15×, (c) 50×, (d) 200×. (D: Dentin;
EF: EQUIA Forte)
c d
Figure 6: SEM images of an ‘adhesive  +  cohesive in restoration’
fracture type of a specimen in tooth restored with G‑ænial Posterior.
(a) The photograph of the tooth before SEM evaluation,  (b) 15×,
(c) 50×, (d) 200×. (E: Enamel; D: Dentin; GP: G‑ænial Posterior)

G‑ænial Posterior and EQUIA Forte are shown in

Figures  4 and 5. The most common type of fracture in
both groups was adhesive + cohesive in the restoration
a b c
fracture where the restoration was broken and separated
from the tooth. All of the fracture types seen in the
group restored with G‑ænial Posterior were restorable,
whereas two  (16.66%) specimens in the group restored
with EQUIA Forte exhibited non‑restorable fractures. d e f
In Figure 6 it provides representative SEM images of Figure 8: SEM images of the surface appearance of the materials at
an adhesive + cohesive in a restoration fracture type different magnifications; G‑ænial Posterior: (a) 250×, (b) 500×, (c) 1000×;
of a specimen in the G‑ænial Posterior restored group. EQUIA Forte: (d) 250×, (e) 500×, (f) 1000×
SEM images of an adhesive + cohesive in a restoration
fracture type of a specimen in the EQUIA Forte restored smooth surface appearance of the composite resin and
group is in Figure 7. The SEM observations of the tested glass fillers of the GH restorative material with different
materials for surface analysis are shown in Figure 8. The sizes were clearly seen.

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Kutuk, et al.: Comparison of mechanical properties of glass hybrid with composite

Table 1: Materials used in this study

Material Manufacturer Type Composition Batch No.
G‑ænial Posterior GC Corp. (Tokyo, Japan) Microhybrid UDMA, DMA co‑monomer, Inorganic filler 1609052
composite resin >100 nm; Fluoroaluminosilicate, Inorganic filler
<100 nm; Fumed silica, Pre‑polymerized fillers
(16-17 μm); Strontium and lanthanoid fluoride
Filler (wt/vol %): 77/65
G‑Premio Bond GC Corp. Universal adhesive 10‑MDP, phosphoric acid ester monomer, 1607061
dimethacrylate, 4‑MET, MEPS, acetone,
silicondioxide, initiators
GLUMA Etch 35 Gel Heraeus Kulzer, Acid etch Phosphoric acid (35%) 405001
(Hanau, Germany)
EQUIA Forte GC Corp. Glass hybridFluoroaluminosilicate glass, polyacrylic acid 2684031
restorative powder, surface‑treated glass
EQUIA Forte Coat GC Corp. Nanofilled resin
Methyl methacrylate, colloidal silica, 2684031
camphorquinone, urethane methacrylate,
phosphoric ester monomer
Cavity Conditioner GC Corp. Cavity cleaning Polyacrylic acid 20%, aluminum chloride 3%, 1609061
agent distilled water
UDMA: Urethanedimethacrylate, DMA: Di‑methacrylate co‑monomer, 10‑MDP: 10 methacryloyloxydecyl dihydrogen phosphate,
4‑MET: 4 methacryloxyethyltrimellitate anhydride; MEPS: Methacryloyloxyalkyl thiophosphate

Table 2: The compressive strength (MPa) values (n=12)

Materials Mean Median Minimum Maximum SD
G‑aenial Posterior 278.20a 280.18 229.35 295.41 17.34
EQUIA Forte 164.62b 165.61 117.42 202.82 25.72
In the mean column, different superscript letters indicate statistically significant difference (P < 0.05)

Table 3: Fracture resistance (n) values (n=12)

Groups Mean Median Minimum Maximum SD
Group 1: Positive Control (Sound teeth) 977.99a 947.61 892.98 1216.10 92.79
Group 2: Negative Control (Teeth with cavity preparation) 418.48b 403.87 61.27 864.65 36.91
Group 3: Teeth restored with G‑aenial Posterior 961.87a,c 881.85 669.83 1185.09 46.04
Group 4: Teeth restored with EQUIA Forte 841.88c 883.87 632.24 985.10 74.57
In the mean column, different superscript letters indicate statistically significant difference (P < 0.05)

Table 4: Pair‑wise comparison of the fracture resistance values of groups according to the Tukey HSD test
Groups p
Group 1 (Sound teeth) - Group 2 (Teeth with cavity preparation) 0.000*
Group 1 (Sound teeth) - Group 3 (Teeth restored with G‑aenial Posterior) 1.000
Group 1 (Sound teeth) - Group 4 (Teeth restored with EQUIA Forte) 0.014*
Group 2 (Teeth with cavity preparation) - Group 3 (Teeth restored with G‑aenial Posterior) 0.002*
Group 2 (Teeth with cavity preparation) - Group 4 (Teeth restored with EQUIA Forte) 0.653
Group 3 (Teeth restored with G‑aenial Posterior) - Group 4 (Teeth restored with EQUIA Forte) 0.239
(*) Shows the significant differences between the groups according to Tukey HSD test (P < 0.05)

Discussion The compressive strength of the microhybrid composite

While treating deep and large caries lesions, dentists
cope with managing the vitality of the pulp and restoring
the resulting extended cavity.[22] The present in vitro
study investigated an alternative appropriate restorative
material for these types of large cavities and assessed the
suitability of a new restorative material, GH restorative,
in terms of compressive strength, fracture resistance, and
reparability properties.
resin was found to be higher than the GH restorative
system. Thus, the first hypothesis was accepted.
These results suggested that the new GH restorative
system (EQUIA Forte) needs to improve its compressive
strength property. On the other hand, and perhaps more
relevantly, the two materials did not differ significantly
in their fracture resistance on molar teeth. Therefore, the
second hypothesis was rejected.

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Kutuk, et al.: Comparison of mechanical properties of glass hybrid with composite
The compressive strength test is one of the main
methods to assess the ability of a material to
withstand masticatory forces. Previous studies reported
compressive strength values for composite resins that
ranged from 250 to 390 MPa.[21,23,24] This reported
compressive strength for composite resin ensures
sufficient strength to be used for restoring all cavity
types.[25] In this study, the composite resin exhibited
significantly higher mean values of compressive
strength than the GH restorative system. This may
be explained by the different compositions of these
materials. GI based restoratives consist of basic
fluoroaluminosilicate glasses and acidic copolymers
that chemically set by acid‑base reactions. Water
is the reaction medium into which cement‑forming
cations are leached and transported to react with
polyacids. Water also serves to hydrate the cross‑link
matrix, increasing the cement strength. The final
set glass ionomer structure contains a substantial
amount of unreacted glass that acts as fillers for the
set cement.[26] New generations of GI restoratives
have coating agents; however, we still advocate for
improvement of their physicomechanical properties
and clinical longevity.[15,27] However, the results of the
study indicated that the coating application could not
be enough to increase the compressive strength of the
GH restorative system as much as the composite resin.
The mean value of the compressive strength of the GH
restorative system recorded in this study was closer
to the GI based restorative materials that have been
reported in the literature after 24 hours of setting time
using standardized cylindrical specimens.[21,28‑30]
In the present study, the specimens for the fracture
resistance test were stored in distilled water for 24  h
and thermo‑cycled for 10.000  cycles at 5°C and 55°C
to simulate a one‑year aging period.[31] There is a
wide variation in temperature amplitude as well as in
the number and duration of the elected cycles  (500‑5
million cycles) in several studies.[30,32,33] Some authors
reported degradation of the GI after the thermo‑cycle
while others did not find any degradation effects using
such experimental simulation method.[33‑35]
A fracture is a complete or incomplete breakage in
a material resulting from the application of extreme
strength. Fracture resistance is a substantial attribute
directly related to cracking. Theoretical and practical
experiments have been made concerning the strength of
a material in terms of its fracture resistance in addition
to the constructional parameters. Depending on the
stress status in direct restorative materials, fracture
resistance can increase or decrease according to the
strength changes.[10]
Nigerian Journal of Clinical Practice  ¦  Volume 22  ¦  Issue 6  ¦  June 2019
This study showed that the extended sized cavities
restored with the microhybrid composite resin
strengthened the remaining tooth structure. There is
no significant difference in the fracture resistance was
found between teeth restored with the microhybrid
composite resin and the unprepared teeth. This result
could be attributed to the improved characteristics
of posterior composite resins.[10] It was also found
that the cavity preparation weakened the teeth. On
the basis of the application of loading, the microhybrid
composite resin (G‑ænial Posterior) increased the
resistance to fracture similar to that of the intact,
unprepared teeth. Moreover, restoring the extended
sized cavities with the GH restorative system  (EQUIA
Forte) increased the fracture strength up to 66% of the
mean value exhibited by the intact teeth and up to 67%
of the mean value exhibited by the restored teeth with
microhybrid composite resin (G‑ænial Posterior).
The superior results for the fracture resistance of the GH
restorative system in the present study may be due to
the additions of certain components to the material. The
coating agent (EQUIA Forte Coat) applied to the surface
of the GH restorative system contains a nanofilled resin
that may have contributed significantly to the increased
resistance of the material to mechanical forces. Other
studies have recommended that GI based restorative
surfaces, before being contaminated with water,
should be coated in order to optimize their mechanical
strength.[36,37] Additionally, the incorporation of ultrafine,
highly reactive glass particles in the GH restorative
system [Figure 8] could be the reason for having similar
fracture resistance to the microhybrid composite resin.
In a recent study, Ong et al.[13] compared the viscoelastic
properties of the same GH restorative system with
bulk‑fill reinforced highly viscous GI cements and
different composite resins. The authors reported that
EQUIA Forte was significantly more rigid and deformed
less than the other materials under functional stresses,
supporting its indication for posterior restorations.
A recent systematic review also reported a comparable
failure rate between highly viscous GIs and amalgam in
permanent posterior teeth.[38] So, the results of this study
were found to be compatible with these studies.
Although, composite resin is stronger than the GH
restorative system tested in the present study, its
fracture mode resulted within the material. This was
in contrast to the GH restorative system that showed
fracture lines within the material and the sacrificing of
the surrounding enamel and/or dentin, which was not a
characteristic of GI based restoratives.[39] In a clinical
situation, the former fracture mode is to be preferred to
the latter, as it permits easier repair. A direct restoration
839
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Kutuk, et al.: Comparison of mechanical properties of glass hybrid with composite
should recover the stress/strain conditions of the
original intact tooth.[40]
The present study has a number of limitations. First, the
cavities were prepared by the operator using high‑speed
hand instruments and standardized via measuring with a
periodontal probe, which increases variability between
samples and results in cavities that might be less
undermining and extended than real‑life deep cavities.[14]
Second, clinically, masticatory forces have a relatively
permanent magnitude and are applied over a longer
period of time. The variations in application speed, and
direction cause a different pattern of fractures. In vitro
studies are not an exact imitation of an ordinary chewing
blow because they apply a continuously increasing force
until the tooth fractures, but they represent an important
source of information on the structural integrity of the
tooth.[41] Third, the thermo‑cycle procedure was applied
to fracture resistance specimens whereas compressive
strength specimens were stored for 24  h in distilled
water and not subjected to the thermo‑cycle procedure
as defined by ISO 9917‑1:2007.[17,42]
The GH restorative system is obtained by the
development of GIs that are accepted as materials
for the future in restorative and minimally invasive
dentistry. Recent studies suggest that these materials are
promising as permanent restorative materials in large
Class  2 restorations.[15,43] These laboratory results cannot
be directly extrapolated to the clinical situation, but they
could give impressions regarding clinical performance
of new restorative materials. However, the mechanical
properties need to be further improved.
As a result, it may be preferable to use the GH
restorative system, which stands out because of its
favorable properties, such as its fast and easy application
and compatibility with dental tissue, as an alternative to
composite resins in the restoration of large caries lesions
in posterior teeth.
Conclusions
Within the limitation of this in vitro study, the following
conclusions may be drawn:
1) the compressive strength of the GH restorative
system (EQUIA Forte) was lower than the composite
resin (G‑ænial Posterior),
2) the fracture resistance of the GH restorative
system  (EQUIA Forte) was comparable to the
composite resin (G‑ænial Posterior),
3) the fracture resistance of the composite resin (G‑ænial
Posterior) was found to be similar to that of intact
teeth,
4) the most common fracture type was
adhesive + cohesive in restoration in the teeth
840 Nigerian Journal of Clinical Practice  ¦  Volume 22  ¦  Issue 6  ¦  June 2019
restored with composite resin (G‑ænial Posterior) and
the GH restorative system (EQUIA Forte), and
5) a small number of non‑restorable fractures
occurred in teeth restored with the GH restorative
system  (EQUIA Forte) while restorable fractures
occurred with respect to forces in all teeth restored
with composite resin (G‑ænial Posterior).
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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