A.A. Bicalho

Mechanical properties, shrinkage stress, cuspal strain and fracture resistance of molars restored with bulk-fill composites and incremental filling technique

OBJECTIVES To compare bulk-fill with incremental filling techniques for restoring large mesio-occlusal-distal (MOD) restorations. METHODS Seventy-five molars with MOD preparations were divided into five groups: Z350XT, incrementally filled with Filtek Z350XT and four bulk-fills-FBF/Z350XT, Filtek Bulk Fill/Filtek Z350XT; VBF/CHA, Venus Bulk Fill/Charisma Diamond; SDR/EST-X, SDR/Esthet-X HD; TEC, TetricEvoCeram Bulk Fill. Cuspal strains were measured using strain-gauges (n=10): CSt-Re, during restorative procedure; CSt-100N, during 100N occlusal loading; CSt-Fr, at fracture load. Before fracture load, teeth were load-cycled. Fracture resistance, fracture mode, and enamel cracks were recorded. The other five teeth were used for Elastic modulus (E) and Vickers hardness (VH). Post-gel shrinkage (Shr), diametral tensile strength (DTS) and compressive strength (CS) were determined (n=10). Shrinkage stresses were analyzed using finite element analysis. RESULTS SDR had similar CS values as TEC, lower than all other composites. CHA had similar DTS values as Z350XT, higher than all other composites. Z350XT had the highest mean Shr and SDR the lowest Shr. New enamel cracks and propagation was observed after the restoration, regardless of filling technique. Z350XT had lower fracture resistance than bulk-fill composite techniques. No significant differences in failure modes were found. E and VH were constant through the depth for all techniques. Bulk-filling techniques had lower stresses compared to Z350XT. CONCLUSIONS Flowable bulk-fill composites had lower mechanical properties than paste bulk-fill and conventional composites. All bulk-fill composites had lower post-gel shrinkage than conventional composite. Bulk-fill filling techniques resulted in lower cusp strain, shrinkage stress and higher fracture resistance. CLINICAL SIGNIFICANCE Using bulk-fill composites cause lower CSt wich indicates lower stress in restored tooth. Furthermore, bulk-fill composites have a higher fracture resistance. Therefore, clinicians may choose the bulk-fill composite to decrease undesirable effects of restoration while simplifying filling procedure.

Polymerization shrinkage stresses in a premolar restored with different composite resins and different incremental techniques.

PURPOSE To investigate how the incremental filling technique, elastic modulus, and post-gel shrinkage of different dental composite resins affect residual shrinkage stress in a restored premolar. MATERIALS AND METHODS Sixteen composites indicated for restoring posterior teeth were tested. Elastic modulus and Knoop hardness were measured using Knoop indentation tests (n = 10). A strain gauge test was used to measure the post-gel shrinkage (n = 10). Two incremental techniques, horizontal or oblique, were applied in a finite element model of a premolar in combination with the experimentally determined properties to assess the stress conditions along the interface of the restoration and within the material structures. Linear regressions were determined between residual shrinkage stress and the elastic modulus and post-gel shrinkage values. RESULTS The mechanical properties and the post-gel shrinkage varied significantly among the composites tested. The calculated shrinkage stress showed a strong correlation with post-gel shrinkage and a weaker correlation with elastic modulus. The oblique incremental filling technique resulted in lower residual shrinkage stress in the enamel and dentin and along the enamel/composite interface compared to the horizontal technique. CONCLUSION Residual stress varied significantly among the contemporary dental composites indicated for restoring posterior teeth. Shrinkage stress in a restored tooth correlated with post-gel shrinkage. In general, oblique incremental filling resulted in lower residual stresses than did horizontal increments.

Effect of temperature and humidity on post-gel shrinkage, cusp deformation, bond strength and shrinkage stress - Construction of a chamber to simulate the oral environment

OBJECTIVES Evaluate the effect of environment on post-gel shrinkage (Shr), cuspal strains (CS), microtensile bond strength (μTBS), elastic modulus (E) and shrinkage stress in molars with large class II restorations. METHODS Sixty human molars received standardized Class II mesio-oclusal-distal cavity preparations. Restorations were made with two composites (CHA, Charisma Diamond, Heraus Kulzer and IPS Empress Direct, Ivoclar-Vivadent) using three environment conditions (22°C/50% humidity, 37°C/50% humidity and 37°C/90% humidity) simulated in custom developed chamber. Shr was measured using the strain gauge technique (n=10). CS was measured using strain gauges. Half of the teeth (n=5) were used to assess the elastic modulus (E) and Knoop hardness (KHN) at different depths using microhardness indentation. The other half (n=5) was used to measure the μTBS. The composites and environment conditions were simulated in a two-dimensional finite element analysis of a tooth restoration. Polymerization shrinkage was modeled using Shr data. The Shr, CS, μTBS, KHN and E data were statistically analyzed using two-way ANOVA and Tukey test (significance level: 0.05). RESULTS Both composites had similar Shr, CS, μTBS and shrinkage stress. CHA had higher elastic modulus than IPS. Increasing temperature and humidity significantly increased Shr, CS and shrinkage stress. μTBS were similar for groups with lower humidity, irrespective of temperature, and higher with higher humidity. E and KHN were constant through the depth for CHA. E and KHN values were affected by environment only for IPS, mainly deeper in the cavity. Shrinkage stress at dentin/composite interface had high inverse correlation with μTBS. Shrinkage stress in enamel had high correlation with CS. CONCLUSIONS Increasing temperature and humidity caused higher post-gel shrinkage and cusp deformation with higher shrinkage stresses in the tooth structure and tooth/restoration interface for both composites tested. The chamber developed for simulating the oral environment conditions will improve the realism of in vitro studies. Clinical significance Simulating oral temperature and humidity is important to better determine the biomechanical behavior of composite resin restoration. Avoiding high humidity during restorative procedures using rubber dam isolation may reduce cuspal deformation and shrinkage stress and improve the bonding strength of posterior composite restorations.

Root Dentin Strain and Temperature Rise During Endodontic Treatment and Post Rehabilitation

This study investigated the effects of endodontic treatment procedures and different post systems rehabilitation steps on the strain and temperature rise on apical and cervical root dentin regions. Twenty-one extracted human canine teeth had two strain gages attached to the distal root surface and two thermocouples attached to the mesial root surface (cervical and apical). The strain and temperature rise were recorded during the following procedures: root canal preparation, final rinse and drying, root canal filling and canal relief. Then the teeth were divided into three groups (n=7), according to the type of post system: CPC, cast post and core; FGP, fiberglass post; and PSP, prefabricated steel post. Data continued to be recorded during the post space preparation, post modeling (only for CPC), post trying and post cementation. Data were subjected to a two-way ANOVA followed by Tukeys test (α=0.05). The post-space preparation caused the highest temperature rise (4.0-14.9 °C) and the highest strain in the apical region during irrespective of post type. The resin cement light-activation resulted in significant temperature increases in the cervical region for all of the groups. The canal relief and the post-space preparation produced highest temperature rises. The CPC post modeling resulted in higher root strain level similarly the level of post preparation. The PSP resulted in highest strain during post trying and post cementation.

Effect of Resin Cement Porosity on Retention of Glass-Fiber Posts to Root Dentin: An Experimental and Finite Element Analysis

The aim of this study was to evaluate the effect of porosity of self-adhesive resin on the stress distribution, post retention and failure mode of fiber post cemented to human root dentin. Ten human central upper incisors with circular root canal were selected. They were sectioned with 15 mm and were endodontically filled. The roots were scanned using micro-CT after post space preparation for root filling remaining evaluation. Fiber posts were cemented using self-adhesive resin cement (Rely X U200, 3M-ESPE). Two 1-mm-thick slices from the cervical, medium and apical thirds were scanned for resin cement bubbles volume measurements and submitted to a push-out test (PBS). Three operators using stereomicroscopy and confocal laser microscopy classified the failure mode. Stress distributions during the push-out test were analyzed using 3D finite element analysis. PBS values (MPa) were submitted to one-way ANOVA and Tukeys post hoc tests and the failure modes using the Kappa coefficient to assess inter-operator agreement. Chi-square test was used to determine significant differences between the methods ( = 0.05). Push-out bond strength was significantly affected by the bubbles presence in all root depth (p<0.05). The stress concentration was higher when the bubbles were present. Adhesive dentin/resin cement interface failure was the most frequent type of failure. Confocal microscopy was better than stereomicroscopy for failure analysis. Bubbles generated during resin cement insertion into the root canal negatively affect the stress distribution and the bond strength. The use of confocal microscopy is recommended for failure analysis.

Finite Element Analysis in Dentistry - Improving the Quality of Oral Health Care

The primary function of the human dentition is preparation and processing of food through a biomechanical process of biting and chewing. This process is based on the transfer of masticatory forces, mediated through the teeth (Versluis & Tantbirojn, 2011). The intraoral environment is a complex biomechanical system. Because of this complexity and limited access, most biomechanical research of the oral environment such as restorative, prosthetic, root canal, orthodontic and implant procedures has been performed in vitro (Assuncao et al., 2009). In the in vitro biomechanical analysis of tooth structures and restorative materials, destructive mechanical tests for determination of fracture resistance and mechanical properties are important means of analyzing tooth behavior. These tests, however, are limited with regard to obtaining information about the internal behavior of the structures studied. Furthermore, biomechanics are not only of interest at the limits of fracture or failure, but biomechanics are also important during normal function, for understanding property-structure relationships, and for tissue response to stress and strain. For a more precise interrogation of oral biomechanical systems, analysis by means of computational techniques is desirable.

The effect of antagonist tooth contact on the biomechanical response of custom‐fitted mouthguards

BACKGROUND/AIM Custom-fitted mouthguards are devices used to prevent dental injuries. The aim of this study was to verify the influence of the antagonist contact on the stresses and strains of the anterior teeth, shock absorption and displacement of EVA custom-fitted mouthguards during a horizontal impact. MATERIALS AND METHODS Finite element models of human maxillary central incisors with and without a mouthguard for different occlusion conditions (with and without antagonist contact) were created based on tomography. A nonlinear dynamic impact analysis using the single-step Houbolt method was performed in which a rigid object hit the model at 1 m s-1 . Strain and stress were evaluated by means of Von Mises and Critical modified Von Mises criterion and shock absorption during impact were calculated as well as the mouthguard displacement. RESULTS The model without mouthguard and without antagonist contact showed the highest stress and strain values at the enamel and dentin in the tooth crown on impact compared to the model without mouthguard and with antagonist contact. Mouthguard presence reduced the stress and strain values regardless of the occlusion condition. The mouthguard displacement decreased with the mandibular antagonist contact. CONCLUSIONS Mouthguards are efficient at decreasing the stress and strain values on the tooth in front of an impact reaching more than 90% of shock absorption. A mouthguard with balanced occlusion and maximum number of contacts with mandibular anterior teeth should be considered because it reduces mouthguard displacement.

Molar cusp deformation evaluated by micro-CT and enamel crack formation to compare incremental and bulk-filling techniques

OBJECTIVES To describe a method of measuring the molar cusp deformation using micro-computed tomography (micro-CT), the propagation of enamel cracks using transillumination, and the effects of hygroscopic expansion after incremental and bulk-filling resin composite restorations. METHODS Twenty human molars received standardized Class II mesio-occlusal-distal cavity preparations. They were restored with either a bulk-fill resin composite, X-tra fil (XTRA), or a conventional resin composite, Filtek Z100 (Z100). The resin composites were tested for post-gel shrinkage using a strain gauge method. Cusp deformation (CD) was evaluated using the images obtained using a micro-CT protocol and using a strain-gauge method. Enamel cracks were detected using transillumination. RESULTS The post-gel shrinkage of Z100 was higher than XTRA (P < 0.001). The amount of cusp deformation produced using Z100 was higher compared to XTRA, irrespective of the measurement method used (P < 0.001). The thinner lingual cusp always had a higher CD than the buccal cusp, irrespective of the measurement method (P < 0.001). A positive correlation (r = 0.78) was found between cusp deformation measured by micro-CT or by the strain-gauge method. After hygroscopic expansion of the resin composite, the cusp displacement recovered around 85% (P < 0.001). After restoration, Z100 produced more cracks than XTRA (P = 0.012). CONCLUSIONS Micro-CT was an effective method for evaluating the cusp deformation. Transillumination was effective for detecting enamel cracks. There were fewer negative effects of polymerization shrinkage in bulk-fill resin restorations using XTRA than for the conventional incremental filling technique using conventional composite resin Z100. CLINICAL SIGNIFICANCE Shrinkage and cusp deformation are directly related to the formation of enamel cracks. Cusp deformation and crack propagation may increase the risk of tooth fracture.

Effect of Light Activation of Pulp-Capping Materials and Resin Composite on Dentin Deformation and the Pulp Temperature Change.

OBJECTIVES To analyze the effect of pulp-capping materials and resin composite light activation on strain and temperature development in the pulp and on the interfacial integrity at the pulpal floor/pulp-capping materials in large molar class II cavities. METHODS Forty extracted molars received large mesio-occlusal-distal (MOD) cavity bur preparation with 1.0 mm of dentin remaining at the pulp floor. Four pulp-capping materials (self-etching adhesive system, Clearfil SE Bond [CLE], Kuraray), two light-curing calcium hydroxide cements (BioCal [BIO], Biodinâmica, and Ultra-Blend Plus [ULT], Ultradent), and a resin-modified glass ionomer cement- (Vitrebond [VIT], 3M ESPE) were applied on the pulpal floor. The cavities were incrementally restored with resin composite (Filtek Z350 XT, 3M ESPE). Thermocouple (n=10) and strain gauge (n=10) were placed inside the pulp chamber in contact with the top of the pulpal floor to detect temperature changes and dentin strain during light curing of the pulp-capping materials and during resin composite restoration. Exotherm was calculated by subtracting postcure from polymerization temperature (n=10). Interface integrity at the pulpal floor was investigated using micro-CT (SkyScan 1272, Bruker). The degree of cure of capping materials was calculated using the Fourier transform infrared and attenuated total reflectance cell. Data were analyzed using one-way analysis of variance followed by the Tukey test (α=0.05). RESULTS Pulpal dentin strains (μs) during light curing of CLE were higher than for other pulp-capping materials ( p<0.001). During resin composite light activation, the pulpal dentin strain increased for ULT, VIT, and CLE and decreased for BIO. The pulpal dentin strain was significantly higher during pulp-capping light activation. The temperature inside the pulp chamber increased approximately 3.5°C after light curing the pulp-capping materials and approximately 2.1°C after final restoration. Pulp-capping material type had no influence temperature increase. The micro-CT showed perfect interfacial integrity after restoration for CLE and ULT; however, gaps were found between BIO and pulpal floor in all specimens. BIO had a significantly lower degree of conversion than ULT, VIT, and CLE. CONCLUSIONS Light curing of pulp-capping materials caused deformation of pulpal dentin and increased pulpal temperature in large MOD cavities. Shrinkage of the resin composite restoration caused debonding of BIO from the pulpal floor.

Effect of cavity preparation design and ceramic type on the stress distribution, strain and fracture resistance of CAD/CAM onlays in molars

Abstract Objective This study aimed to evaluate the effect of the cavity preparation and ceramic type on the stress distribution, tooth strain, fracture resistance and fracture mode of human molar teeth restored with onlays. Material and Methods Forty-eight molars were divided into four groups (n=12) with assorted combinations of two study factors: BL- conventional onlay preparation with boxes made from leucite ceramic (IPS-Empress CAD, Ivoclar Vivadent); NBL- conservative onlay preparation without boxes made from leucite ceramic; BD- conventional onlay preparation with boxes made from lithium disilicate glass ceramic (IPS e.max CAD, Ivoclar Vivadent); NBL- conservative onlay preparation with boxes made from lithium disilicate glass ceramic cuspal deformation (µS) was measured at 100 N and at maximum fracture load using strain gauge. Fracture resistance (N) was measured using a compression test, and the fracture mode was recorded. Finite element analysis was used to evaluate the stress distribution by modified von Mises stress criteria. The tooth strain and fracture resistance data were analyzed using the Tukey test and two-way ANOVA, and the fracture mode was analyzed by the chi-square test (α=0.05). Results The leucite ceramic resulted in higher tooth deformation at 100 N and lower tooth deformation at the maximum fracture load than the lithium disilicate ceramic (P<0.001). The lithium disilicate ceramic exhibited higher fracture resistance than the leucite ceramic (P<0.001). The conservative onlay resulted in higher fracture strength for lithium disilicate ceramic. Finite element analysis results showed the conventional cavity preparation resulted in higher stress concentration in the ceramic restoration and remaining tooth than the conservative onlay preparation. The conservative onlays exhibited increased fracture resistance, reduced stress concentration and more favorable fracture modes. Conclusion Molars restored with lithium disilicate CAD-CAM ceramic onlays exhibited higher fracture resistance than molars restored with leucite CAD-CAM ceramic onlays.