Antheunis Versluis

Does an incremental filling technique reduce polymerization shrinkage stresses

It is widely accepted that volumetric contraction and solidification during the polymerization process of restorative composites in combination with bonding to the hard tissue result in stress transfer and inward deformation of the cavity walls of the restored tooth. Deformation of the walls decreases the size of the cavity during the filling process. This fact has a profound influence on the assumption-raised and discussed in this paper-that an incremental filling technique reduces the stress effect of composite shrinkage on the tooth. Developing stress fields for different incremental filling techniques are simulated in a numerical analysis. The analysis shows that, in a restoration with a well-established bond to the tooth-as is generally desired-incremental filling techniques increase the deformation of the restored tooth. The increase is caused by the incremental deformation of the preparation, which effectively decreases the total amount of composite needed to fill the cavity. This leads to a higher-stressed tooth-composite structure. The study also shows that the assessment of intercuspal distance measurements as well as simplifications based on generalization of the shrinkage stress state cannot be sufficient to characterize the effect of polymerization shrinkage in a tooth-restoration complex. Incremental filling methods may need to be retained for reasons such as densification, adaptation, thoroughness of cure, and bond formation. However, it is very difficult to prove that incrementalization needs to be retained because of the abatement of shrinkage effects.

Do Dental Composites Always Shrink Toward the Light

Many of the current light-curing composite restorative techniques are rationalized in compliance with the theory that composite shrinks toward the light. Shrinkage directed toward the margins is believed to be responsible for the observed improved marginal properties. However, the dental literature does not consistently support this theory. Experimental determination of contraction patterns is very difficult. In this study, a finite element technique is used to analyze the direction of composite shrinkage as it cures. The process of polymerization can be characterized by pre- and post-gel phases. The stress developed in a restoration can be relieved quickly by the flow of material still in the pre-gel phase. Residual stresses arise after gelation. Both auto- as well as photo-curing composites were analyzed. In photo-curing composites, the gel-point varies throughout the material with the intensity of the light. Experimentally determined light transmittance data for different materials were used in the simulation. Degree of cure and time-dependent shrinkage properties were also included from experimental measurements. The analysis showed that the shrinkage direction was not significantly affected by the orientation of the incoming curing light, but instead was mostly determined by the bonding of the restoration to the tooth and by the free surfaces. Consequently, differences between the contraction patterns of auto- and photo-cure were minimal. It was concluded that composite does not shrink toward the light, but that the direction is predominantly determined by cavity shape and bond quality. Improved marginal properties should be pursued by the optimization of other factors, such as the polymerization process, the curing procedure, and the bond quality. The direction of shrinkage vectors in response to light position does not seem to be an appropriate criterion for the optimization of marginal quality.

Can Fiber Posts Increase Root Stresses and Reduce Fracture

The clinical success of fiber posts has been attributed to their lower elastic modulus. The tested hypothesis was that fiber posts could lead to lower risk of post debonding and lower risk of root fracture, despite an increase in root stresses. Stress analyses were carried out with a 3D finite element model of a premolar restored with a metallic or a fiber post. Bonded and non-bonded post/cement interface conditions were simulated. We calculated risk-of-fracture indices by determining the highest principal stress values divided by the tensile strength. Shear stresses along the post/cement interface were analyzed for the bonded models. Compared with the premolar restored with a metallic post, the fiber post generated lower stresses along the interface and higher stresses in the root. However, with the fiber post, fracture was less likely to occur in the root, since its core and post fracture indices were higher.

Potential Relationship between Design of Nickel-Titanium Rotary Instruments and Vertical Root Fracture

INTRODUCTION Nickel-titanium (NiTi) rotary files can produce cleanly tapered canal shapes with low tendency of transporting the canal lumen. Because NiTi instruments are generally perceived to have high fracture risk during use, new designs have been marketed to lower fracture risks. However, these design variations may also alter the forces on a root during instrumentation and increase dentinal defects that predispose a root to fracture. This study compared the stress conditions during rotary instrumentation in a curved root for three NiTi file designs. METHODS Stresses were calculated using finite element (FE) analysis. FE models of ProFile (Dentsply Maillefer, Ballaigues, Switzerland; U-shaped cross-section and constant 6% tapered shaft), ProTaper Universal (Dentsply; convex triangular cross-section with notch and progressive taper shaft), and LightSpeed LSX (Lightspeed Technology, Inc, San Antonio, TX; noncutting round shaft) were rotated within a curved root canal. The stress and strain conditions resulting from the simulated shaping action were evaluated in the apical root dentin. RESULTS ProTaper Universal induced the highest von Mises stress concentration in the root dentin and had the highest tensile and compressive principal strain components at the external root surface. The calculated stress values from ProTaper Universal, which had the biggest taper shaft, approached the strength properties of dentin. LightSpeed generated the lowest stresses. CONCLUSION The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal, which raises the risk of dentinal defects that may lead to apical root cracking. Thus, stress levels during shaping and fracture susceptibility after shaping vary with instrument design.

Thermal expansion coefficient of dental composites measured with strain gauges.

OBJECTIVES A simple test method was developed to determine the coefficient of thermal expansion of prevailing restorative resin composites and to study the transient behavior as a function of temperature and repeated thermocycles. METHODS Strain gauges were used to determine the thermal expansion for seven commonly used restorative resin composites by measuring the instantaneous strain along with temperature change. The temperature was measured by means of a thermocouple, the tip of which was embedded in the composite. The differences among the test groups were analyzed using ANOVA, followed by Scheffés multiple comparisons test. RESULTS The coefficient of thermal expansion determined for the composites tested was: 22.5 +/- 1.4 x 10(-6)/degree C (Z-100), 23.5 +/- 1.4 x 10(-6)/degree C (P-50), 32.6 +/- 1.6 x 10(-6)/degree C (Herculite XR), 34.1 +/- 1.8 x 10(-6)/degree C (APH), 35.4 +/- 1.4 x 10(-6)/degree C (Conquest), 41.6 +/- 1.5 x 10(-6)/degree C (Silux Plus), 44.7 +/- 1.2 x 10(-6)/degree C (Heliomolar). The coefficient was almost linear in the considered temperature range (26-75 degrees C) for all composites (r > 0.99) and decreased with each consecutive thermocycle (p < 0.1). SIGNIFICANCE Thermally induced loads, introduced into restored teeth by the mismatch of the coefficient of thermal expansion of the tooth and the restorative material, may be related to microleakage and wear problems. A highly filled hybrid composite such as Z-100 had a coefficient of thermal expansion closest to that of the tooth crown, confirming other studies which demonstrated the benefits of high filler loading in matching the properties of the dental hard tissues.

Mechanical response of nickel–titanium instruments with different cross-sectional designs during shaping of simulated curved canals

AIM To evaluate how different cross-sectional designs affect stress distribution in nickel-titanium (NiTi) instruments during bending, torsion and simulated shaping of a curved canal. METHODOLOGY Four NiTi rotary instruments with different cross-sectional geometries were selected: ProFile and HeroShaper systems with a common triangle-based cross section, Mtwo with an S-shaped rectangle-based design and NRT with a modified rectangle-based design. The geometries of the selected files were scanned in a micro-CT and three-dimensional finite-element models were created for each system. Stiffness characteristics for each file system were determined in a series of bending and torsional conditions. Canal shaping was simulated by inserting models of the rotating file into a 45 degrees curved canal model. Stress distribution in the instruments was recorded during simulated shaping. After the instruments were retracted from the canal, residual stresses and permanent bending of their tips due to plastic deformation were determined. RESULTS The greatest bending and torsional stiffness occurred in the NRT file. During simulated shaping, the instruments with triangle-based cross-sectional geometry had more even stress distributions along their length and had lower stress concentrations than the instruments with rectangle-based cross sections. Higher residual stresses and plastic deformations were found in the Mtwo and NRT with rectangle-based cross-sectional geometries. CONCLUSIONS Nickel-titanium instruments with rectangle-based cross-sectional designs created higher stress differentials during simulated canal shaping and may encounter higher residual stress and plastic deformation than instruments with triangle-based cross sections.

The influence of cavity design and glass fiber posts on biomechanical behavior of endodontically treated premolars.

The aim of this study was to evaluate the effect of cavity design and glass fiber posts on stress distributions and fracture resistance of endodontically treated premolars. Fifty extracted intact mandibular premolars were divided into 5 groups (n = 10): ST, sound teeth (control); MOD, mesio-occlusal-distal preparation + endodontic treatment (ET) + composite resin restoration (CR); MODP, mesio-occlusal-distal + ET + glass fiber post + CR; MOD2/3, mesio-occlusal-distal + two thirds occlusal-cervical cusp loss + ET + CR; and MODP2/3, mesio-occlusal-distal + two thirds cusp loss + ET + glass fiber post + CR. The specimens were loaded on a cusp slope until fracture. Fracture patterns were classified according to four failure types. Stress distributions were evaluated for each group in a two-dimensional finite element analysis. The fracture resistance of the MODP, MOD2/3, and MODP2/3 groups was significantly lower than the ST and MOD groups (p < 0.05). The loss of dental structure and the presence of fiber post restoration reduced fracture resistance and created higher stress concentrations in the tooth-restoration complex. However, when there was a large loss of dental structure (MODP2/3), the post reduced the incidence of catastrophic fracture types.

Nominal shear or fracture mechanics in the assessment of composite-dentin adhesion?

This study addresses the anticipated problem of discriminating among high-performing dentin adhesives. The simplicity of the nominal shear bond test, despite being heavily criticized, has made it a routine procedure for the determination of bonding efficacy. A fracture mechanics approach has been suggested as a better assessment of bonding efficacy (Versluis et al., 1997). However, experimental complexity is a major limitation. It is hypothesized that a new, simplified interfacial fracture toughness test (Lin, 1994) will evaluate bonding agents differently if compared with the traditional shear bond test. Therefore, the objective of this study was to compare the performances of six dentin bonding agents subjected to the interfacial fracture toughness test (critical plane strain energy release rate) or to the nominal shear bond test (shear bond strength). Their performances were also characterized by scanning electron micrography of the fracture surfaces for evidence of dentin cohesive failure. Statistical analyses showed only marginal differences between these determinants of the two tests. However, when the analysis was applied only to the materials that had 100% frequency of dentin cohesive failure in shear testing, which also had high bonding efficacy, the difference in adhesive strengths between the two tests became significant. The reliability of the nominal shear test is questioned when dentin cohesive failure occurs, which usually is associated with high bonding efficacy. Since it is expected that bonding efficacy will increase further, the interfacial fracture toughness test is the preferred methodology to distinguish among high-performing dentin adhesives.

The effect of post, core, crown type, and ferrule presence on the biomechanical behavior of endodontically treated bovine anterior teeth

STATEMENT OF PROBLEM Unresolved controversy exists concerning the remaining coronal tooth structure of anterior endodontically treated teeth and the best treatment option for restoring them. PURPOSE The purpose of this study was to evaluate the effect of post, core, crown type, and ferrule presence on the deformation, fracture resistance, and fracture mode of endodontically treated bovine incisors. MATERIAL AND METHODS One hundred and eighty bovine incisors were selected and divided into 12 treatment groups (n=15). The treatment variations were: with or without ferrule, restored with cast post and core, glass fiber post with composite resin core, or glass fiber post with fiber-reinforced core, and metal- or alumina-reinforced ceramic crown (n=15). The restored incisors were loaded at a 135-degree angle, and the deformation was measured using strain gauges placed on the buccal and proximal root surfaces. Specimens were subsequently loaded to the point of fracture. Strain and fracture resistance results were analyzed by 3-way ANOVA and Tukey HSD tests (α=.05). RESULTS Ferrule presence did not significantly influence the buccal strain and fracture resistance for the ceramic crown groups, irrespective of core and crown type. Ferrule presence resulted in lower strains and higher fracture resistance in the metal crown groups, irrespective of core. The cast post and core showed lower strain values than groups with glass fiber posts when restored with metal crowns. CONCLUSIONS Core type did not affect the deformation and fracture resistance of endodontically treated incisors restored with alumina-reinforced ceramic crowns. The presence of a ferrule improved the mechanical behavior of teeth restored with metal crowns, irrespective of core type.

Forces and moments generated at the dental incisors during forceful biting in humans

A miniature load sensor capable of measuring all forces and all moments simultaneously at a single location in space was used to assess the magnitude and direction of loads that affect the dental incisors during forceful, static biting. While prior approaches have not measured all necessary six degrees of freedom during biting, the complete set of loads is needed to serve as realistic boundary conditions for analytical or computational models of mandibular mechanics. Four subjects were asked to perform controlled and repetitive edge-to-edge incisal biting activities. Customized devices were used to rigidly hold the load sensor in place at pre-specified tooth separations of less than 1 mm. The results yielded force resultants with a magnitude range of 24.5 to 28.4 N. This range was intentionally limited in magnitude to avoid damage to the internal strain gauge assembly of the sensor. In all cases, the highest force component was oriented upwards. An additional simultaneous moment resultant (range: 8.9-17.0 N cm) with a main moment component oriented backwards and downwards towards the oral cavity was also detected. These data suggest that in order for the biting loads to be composed of six DOF, the remaining forces acting on the mandibular force system (i.e. muscular and/or articular) may indeed be non-coplanar and non-concurrent. Although useful for static biting activities, the bulk of the sensor would probably preclude meaningful measurements during dynamic events such as chewing or swallowing.