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7 AUTHORS, INCLUDING:
Roberto Sorrentino
Raffaella Aversa
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Marco Ferrari
Antonio Apicella
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d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 983993
available at www.sciencedirect.com
DISPAMA, Material Laboratory, Second University of Naples, Borgo S. Lorenzo, Aversa (Caserta), Italy
Department of Restorative Dentistry and Dental Materials, University of Siena, Siena, Italy
c Dental School, Second University of Naples, Naples, Italy
d Dental School, University of Naples Federico II, Naples, Italy
b
a r t i c l e
i n f o
a b s t r a c t
Article history:
restorative materials resulted in the most homogeneous stress and strain distributions.
Methods. A three-dimensional nite element analysis was performed. All the nodes on the
external surface of the root were constrained in all directions. Eighteen experimental models
with different material properties and congurations were simulated. An arbitrary load of
Keywords:
10 N was applied at 60 angle with tooth longitudinal axis on the palatal surface of the crown.
Stress
Results. In all the models the values of both strain and stress recorded at the middle third of
Strain
the buccal aspect of the root surface were at their maxima. On the contrary, the minimum
values were noticed at level of both the apical portion of the post and the root apex.
Post
The maximum stresses were evidenced at level of the cementoenamel junction (CEJ)
Core
on both the buccal and palatal aspects of root cement and dentin. Stress progressively
Crown
decreased from the outer to the inner part of the root and from the CEJ towards the incisal
Composite resin
Dental materials
Signicance. The results of the present study would allow clinicians to make an informed
Adhesion
1.
Introduction
Restoration of endodontically treated teeth is a common problem in restorative dentistry, related to the fractures occurring
in such teeth [1,2]. Posts are used to maintain the core material particulary in posterior teeth, where masticatory loads
are essentially compressive [3]. However, when loaded transversely, as in the case of incisors, the exural behaviour of
posts should be carefully considered [4]. The magnitude and
the angle of incisal load greatly inuence the long-term success of restorative systems involving central incisors [5]. In the
complex systems of post restorations, the stress distribution
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The present study compared the stress and strain distribution patterns of a sound maxillary central incisor with those of
endodontically treated teeth restored with different post, core
and crown direct and indirect materials within the restorative
materials and at the adhesive interfaces as well.
The aim of the present comparative analysis was to estimate which combination of restorative materials resulted in
the most homogeneous stress and strain distributions, so that
to obtain the most similar conguration to that of a sound
tooth.
Two different null hypotheses were tested:
- there is no association between the mechanical properties
of core and crown materials on stress and strain concentration areas along the dentin/cement/post interfaces;
- there is no association between the mechanical properties
of core and crown materials on stress and strain levels along
the dentin/cement/post interfaces.
As to clinical signicance, the results of the present study
would allow clinicians to make an informed choice from
among available materials to restore endodontically treated
teeth.
2.
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d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 983993
Crown
Abutment
Post/cement
Natural tooth
Feldsp.
Feldsp.
Feldsp.
Feldsp.
Feldsp.
GFR
GFR
GFR
GFR
GFR
Gradia
Gradia
Gradia
Gradia
Gradia
Natural tooth
GDA
GDA + GFL
GFL
Unil core
GDA
GDA + GFL
GFL
Unil core
GDA
GDA + GFL
GFL
Unil core
GDA
GDP
Elastic modulus
(GPa)
Poissons
ratio
Dentin
Enamel
Feldspathic ceramics
Composite
Gradia direct anterior
Gradia ow
Gradia Forte
Gradia direct posterior
Unil core
18.6
84.1
69
16
5.2
7.4
13
6.7
13
0.32
0.33
0.3
0.3
0.22
0.22
0.22
0.22
0.22
986
d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 983993
37
9.5
9.5
0.27
0.34
0.27
3.10
3.50
3.10
A linear static structural analysis was performed to calculate the strain and stress distributions in different restoring
congurations. An arbitrary load of 10 N was applied at 60
angle with tooth longitudinal axis on the palatal surface of
the crown to simulate tearing function (Fig. 2). The static load
of 10 N was dened to compare the systems in the eld of low
deformation where a linear static analysis can be performed
with reliable results. Results of a static linear analysis are lineary proportional with the applied load.
In order to identify areas of strain and stress concentration
where possible fatigue failures are more expected to occur,
the choice of the pertinent stress representation criterion was
based on the evaluation of failure predictive potential of the
analysis performed. Von Mises (equivalent stresses) energetic
criterion was then chosen. Under fatigue loading, in fact, the
calculated stresses should relate to fracture probability and,
therefore, to the assumption that different stress states having
the same effect are equivalent when determining the system
failure at critical stress values (failure criterion). In such cases,
accurate predictions were observed [2123].
The following assumptions were made:
- dentin was assumed as an elastic and isotropic material
[28,29];
3.
Results
3.1.
Strain analysis
In all the models the values of strain recorded at the middle third of the buccal aspect of the root surface were at their
maxima. On the contrary, the minimum values were noticed
at level of both the apical portion of the post and the root apex.
In Mod.1 (control) the maximum deformations were evidenced at level of the cementoenamel junction (CEJ) on both
the buccal and palatal aspects of root cement and dentin.
Strains progressively decreased from the outer to the inner
part of the root and from the CEJ towards the incisal margin
of the crown as well (Fig. 3).
In Mod.2 the maximum strains were evident at level of the
root side of the CEJ next to the prosthetic margin and progressively decreased from the outer to the inner part of the root.
The crown showed minimum strains at the cervical region,
whereas the middle and incisal thirds were almost free of
deformations (Fig. 3).
In Mod.3, Mod.4, Mod.5 and Mod.6 strain distributions quite
similar to those described for Mod.2 were evident but the prosthetic crown appeared even less defromed at the cervical third.
The glass ber post was interested by minimal strains on the
buccal aspect (Fig. 3).
In Mod.7 the maximum strains were evident at level of the
root side of the CEJ next to the prosthetic margin and progressively decreased from the outer to the inner part of the root
and from the cervical third towards the incisal margin of the
crown as well (Fig. 4).
In Mod.8, Mod.9, Mod.10 and Mod.11 the maximum strains
were evident at level of the root side of the CEJ next to the
prosthetic margin and progressively decreased from the outer
to the inner part of the root and from the cervical third
towards the incisal margin of the crown as well. Deformations
concentrated on the palatal aspect of either the prosthetic
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Table 4 Strain values expressed in (CI, combined crown interface; RI, root interface)
Model
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Maximum
Crown
55167
55167
55167
55167
55167
55330
55440
55330
55440
55440
55500
55500
55500
55500
55500
55500
55500
Abutment
Post/cement
55330
55110
110330
110330
55167
55167
55220
167500
167500
167389
110278
110440
167500
167500
167440
110330
167500
167500
Root
55440
55500
55110
55167
55167
55167
55500
55500
55500
55500
55440
55167
55167
55167
55167
55440
55440
55440
55440
55440
55167
55167
55167
55167
55220
55167
55440
55440
55440
55440
55440
55440
CI
RI
55330
55330
55167
55167
110389
110440
110330
110222
167500
167500
110389
110167
167500
110440
55167
55167
55167
55167
55167
55167
55167
55167
55330
55330
55167
55167
55220
55220
3.2.
Stress analysis
In all the models the values of stress recorded at the middle third of the buccal aspect of the root surface were at their
maxima. On the contrary, the minimum values were noticed
at level of both the apical portion of the post and the root
apex.
In Mod.1 (control), the maximum stresses were evidenced
at level of the cementoenamel junction on both the buccal
and palatal aspects of root cement and dentin. Stress progressively decreased from the outer to the inner part of the root
Table 5 Stress values expressed in MPa (CI, combined crown interface; RI, root interface)
Model
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Maximum
Crown
1.18.9
1.18.9
1.110
1.110
1.110
1.15.5
1.16.7
1.16.7
1.16.7
1.16.7
1.13.3
1.13.3
1.13.3
1.13.3
1.13.3
1.13.3
1.13.3
Abutment
1.16.7
1.12.2
1.12.2
1.12.2
1.12.2
1.12.2
1.14.4
1.12.2
1.12.2
1.12.2
1.13.3
1.16.7
1.13.3
1.13.3
1.13.3
1.16.7
1.13.3
1.13.3
Post/cement
Root
1.17.8
1.18.9
1.17.8
1.17.8
1.17.8
1.17.8
1.18.9
1.18.9
1.18.9
1.18.9
1.17.8
1.110
1.110
1.18.9
1.17.8
1.17.8
1.17.8
1.17.8
1.17.8
1.17.8
1.110
1.110
1.110
1.110
1.110
1.110
1.17.8
1.17.8
1.17.8
1.17.8
1.17.8
1.17.8
CI
RI
1.15.5
1.15.5
1.15.5
2.25.5
2.210
2.210
2.28.9
2.27.8
2.210
2.210
2.210
3.310
2.210
2.210
1.17.8
1.17.8
1.17.8
1.17.8
1.17.8
1.17.8
1.17.8
1.17.8
1.110
1.110
1.110
1.110
1.110
1.110
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d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 983993
and from the CEJ towards the incisal margin of the crown as
well (Fig. 6).
In Mod.2 stress distributions quite similar to those
described for Mod.1 were noticed. Stress concentrated at level
of the root side of the CEJ buccally whereas it mainly interested
d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 983993
989
and from the cervical third towards the incisal margin of the
crown as well (Fig. 7).
In Mod.8, Mod.9, Mod.10 and Mod.11 lower stresses than
in Mod.36 were recorded in the cervical area of the restorative systems. On the contrary, higher stresses interested the
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d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 983993
4.
Discussion
According to the results of the present study, the mechanical properties of the crown and core material inuenced both
the position of concentration areas and the level of stress and
strain along the dentin/cement/post interfaces; consequently,
both the null hypotheses tested were rejected.
Stress concentrates where not homogeneous material distributions are present just like interfaces. Interfaces of materials with different moduli of elasticity represent the weak
link of restorative systems, as the toughness/stiffness mismatch inuences the stress distribution [3032]. In the oral
enviroment, restorative systems are subjected to fatigue
stress, namely the repeated application of lower loads than
the yield strenght of the restorative materials. Nevertheless, such a cycling load application might produce microcracks causing the failure of the restorative system [13].
Such micro-cracks nucleate at locations of highest stress
and lowest local strenght. Systems investigated either in
static and fatigue loading conditions show underposable highest stress concentration areas and similar failure patterns
[3335].
Static linear analyses can be successfully applied to extrapolate reliable information about the relative susceptibility
of systems to fatigue loading conditions. On this basis, the
assumption that systems showing homogeneous stress disributions in a static analysis would show a lower fatigue sensitivity in clinical applications can be state.
The present study compared the stress distributions of different restorative systems to identify areas of high stress concentration, where eventual fatigue failures are more expected
to occur.
When the loading of a sound tooth (Mod.1, control) was
simulated, the stress was almost uniformely distributed in
tooth strucure. Nevertheless, the stress concentrated at the
cervical region, where the cementoenamel junction creates
a physiological discontinuity of the tissue mechanical properties.
Due to its increased rigidity (E = 69 GPa), the feldspathic
crown luted on a natural tooth abutment (Mod.2) transmitted
lower deformations to coronal dentin concentrating the strain
on root dentin next to the CEJ. Similarly, when the feldspathic
crown was luted on composite cores (Mod.3, Mod.4, Mod.5 and
Mod.6), the ceramic produced a stress and strain shielding
effect on the core materials: as a consequence, deformations
991
concentrated on root dentin next to the prosthetic crown interface. One one side, root dentin absorbed part of the strain but,
on the other side, it conveyed limited deformations to the glass
post. Stress arose at the RI due to the difference in mechanical
resistance between the post and the dentin. Stress and strain
values recorded in Mod.3, Mod.4, Mod.5 and Mod.6 were limited because of the good deformation absorbing capability of
the dentin. Moreover, when a relatively rigid material just like
feldspathic ceramic was used to build a prosthetic crown, the
mechanical properties of the more elastic composite materials
did not signicantly inuence the stress and strain concentrations within the core.
On the contrary, when a prosthetic crown made up of a high
modulus composite material (e.g. Gradia Forte, E = 13.7 GPa)
was simulated and luted on composite abutments (Mod.7,
Mod.8, Mod.9, Mod.10 and Mod.11), the lower resistance to
deformation of the composite crown produced higher deformation values in the core structure than those recorded simulating the presence of a feldspathic crown (Mod.3, Mod.4,
Mod.5 and Mod.6). The deformations occurring in the core
structure were transferred to the coronal part of the glass post.
As a consequence, the discontinuity in the mechanical properties of the core materials, the cement, the post and the dentin
caused a stress concentration at the CI. Differently than the
restorative systems provided with a feldspathic crown, in case
of a high modulus composite crown the mechanical characteristics of the core materials signicantly inuenced the stress
arising at the CI. Cores with lower elastic modulus transferred
higher deformations to the glass post, increasing the material
properties discontinuity and producing higher stress values
at the CI. Conversely, higher elastic modulus cores reduced
the strain of the glass post and decreased the mechanical
properties mismatch, leading to lower stress arising at the
CI.
When a low modulus composite (e.g. Gradia, E = 6.4 GPa)
crown was simulated on a natural tooth abutment (Mod.12),
the stress and strain distributions in tooth tissues remained
basically unchanged. Due to the low resistance to deformation
of the composite material, most strains arose at the cervical
third of the crown. When a low modulus composite crown
was luted on composites cores (Mod.13, Mod.14, Mod.15 and
Mod.16), the deformation transferring phenomenon previously described for Mod.8, Mod.9, Mod.10 and Mod.11 was signicantly emphasized. Perhaps, the values of stress concentrating at the CI were signicantly higher than those recorded
in both the feldspathic crown and high modulus composite
crown systems. In Mod.16 the higher modulus of the core
material signicantly reduced the stress arising at the CI when
compared to Mod.13, Mod.14 and Mod.15.
Mod.17 and Mod.18 simulated direct restorations of glass
post-reinforced teeth by means of a low modulus direct composite (e.g. Gradia direct anterior, E = 5.2 GPa) and a high modulus direct composite (e.g. Gradia direct posterior, E = 6.7 GPa),
respectively. Due to the lower rigidity, Mod.17 conguration
transferred higher deformations to the coronal part of the
glass post and increased stress arising at the CI. On the contrary, the higher resistance to deformation of the high modulus direct composite material reduced strains of the glass
post, leading the restorative system to undergo lower stress
and strain values at the CI.
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5.
d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 983993
Conclusions
In FEA, assumptions related to material properties of simulated structures are not usually absolute representations of
the structure. In reality the structures modeled are much
more dynamic. Moreover, the physical characteristics of tissues vary from site to site and from individual to individual. The dimensions of natural restored teeth may deviate
from those selected for the study and the mechanical constants involved may vary as well. In spite of these limitations,
the present study may be considered to provide relative values that are meaningful representations of qualitative clinical
trends.
Within the limitations of the present theoretical study, the
following conclusions can be drawn:
references
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