Background: The present in-vitro study was undertaken to evaluate and compare fracture resistance of weakened endodontically treated premolars with class II MOD cavities restored with different bulk fill composite restorations (EverX posterior, Alert, Tetric EvoCeram Bulk Fill, and SDR). The type and mode of fracture were also assessed for all the experimental groups. Materials and Method: Forty-eight human adult maxillary premolar teeth were selected for this study. Standardized extensive class II MOD cavities with endodontic treatment were prepared for all teeth, except those that were saved as intact control. The teeth were divided into six groups of eight teeth each (n=8): (Group 1) intact control group, (Group 2) unrestored teeth with endodontic treatment, (Group 3) restored with (TetricEvoCeram Bulk Fill), (Group 4) restored with SDR bulk-fill flowable composite, (Group 5) restored with EverX Posterior composite and (Group 6) restored with Alert composite. . All specimens were subjected to compressive axial loading until fracture in a universal testing machine. The data were statistically analyzed using one-way ANOVA test and LSD test. Macroscopic fracture type were observed and classified into favorable and unfavorable. Specimens in groups 3, 4, 5 and 6 were examined by stereomicroscope at a magnification of 20× to evaluate the mode of failure into adhesive, cohesive or mixed. Results: The mean fracture load was (1.2505Kn) for group 1, (0.371Kn) for group 2, (0.512 Kn) for group 3, (0.6435 Kn) for group 4, (0.608 Kn) for group 5, and (0.8315) for group 6. Using one way ANOVA test a highly significant difference (P < 0.01) were found among all groups. The use of Alert composite (which contain micro glass fiber) improved the fracture resistance significantly in comparison to other groups. SDR bulk-fill flowable composite showed better improvement in fracture resistance but with no significant differences in comparison to EverX composite restoration (which contain Short E-glass fiber filler). The type of failure was unfavorable for all the restored groups. Conclusion: All experimental composite restorations showed significant improvement in the resistance to cuspal fracture in comparison to unrestored one (group 2). However, under the conditions of this study, direct composite restorations should be considered as a valid interim restoration for weakened endodontically treated teeth before cuspal coverage can be provided.
