Effect of cavity design on tooth

surface strain
Jefferson Ricardo Pereira, DDS, MSc, PhD,a
Ailbhe McDonald, BDentSc, MSc, PhD,b Aviva Petrie, MSc, PhD,c
and Jonathan Campbell Knowles, DDS, MSc, PhDd
UCL Eastman Dental Institute and School of Dentistry, University of
Southern Santa Catarina (UNISUL), Tubaro, Brazil; Unit of Biosta-
tistics, UCL Eastman Dental Institute, London, England; Dankook
University Graduate School, Gyeonggi-do, South Korea

Statement of problem. The loss of tooth structure can increase cuspal exure, thereby reducing the fracture resistance of the
tooth, or open the tooth-restoration interface, leading to microleakage.

Purpose. The purpose of this study was to evaluate tooth strain in teeth with different cavity preparations after loading and
unloading.

Material and methods. Ten intact human maxillary premolars were selected and embedded in epoxy resin molds. Constantan
strain gauges were used and tested as an intact tooth (group I), occlusal cavity (group O), mesio-occlusal cavity (group MO),
and nally mesio-occluso-distal cavity (group MOD). All teeth were subjected to gradual nondestructive occlusal loading and
unloading (50 N, 70 N, 90 N, 110 N, 130 N, 50 N, 0 N) in a servohydraulic testing machine. All data were analyzed
statistically by performing a repeated measures ANOVA with load and cavity as factors to compare the relevant mean strains,
and a Bonferroni post hoc test was performed for multiple comparisons (a.05).

Results. The repeated measures ANOVA did not provide any evidence of an interaction between load and cavity but indicated
a signicant difference in the mean strains both between the loads (P<.001) and between the cavity groups (P<.001).

Conclusions. MOD cavities presented statistically signicantly higher values of strain than MO, O, or intact teeth, and a
signicant increase in the values of mean strain for all cavities was observed, even with intact teeth, when nondestructive
occlusal loading was increased. (J Prosthet Dent 2013;110:369-375)

Clinical implications
In restorative dentistry, the deformation of teeth by occlusal load is
important. The increased loss of tooth structure can increase cuspal
exure, thereby reducing the fracture resistance of the tooth, or open the
restoration-tooth interface, leading to microleakage and ultimately to
recurrent caries.

Traditional operative dentistry has modern cavity shape is dictated by the requirements. The tooth preparation
involved the removal of carious tissue carious lesion, the removal of tooth is followed by placement of restorative
and the restoration of the cavity. The structure at risk of fracture, and esthetic materials to achieve a functional,

a
Senior Lecturer, Division of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute and School of Dentistry, University of
Southern Santa Catarina-UNISUL.
b
Senior Lecturer, Unit of Prosthodontics, UCL Eastman Dental Institute.
c
Senior Lecturer, Unit of Biostatistics, UCL Eastman Dental Institute.
d
Professor, Division of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute and Department of Nanobiomedical Science &
WCU Research Center, Dankook University Graduate School.

Pereira et al
370
biologic, and esthetic outcome.
Restorative materials should be of
appropriate width and pulpal depth to
ensure sufcient strength. An important
consideration when restoring a tooth is
the quantity and quality of the
remaining dentin, which, together with
occlusal forces, may determine the
subsequent potential for fracture.1-5
Cusps deect when stressed because
of the interocclusal relationships and
anatomy of posterior teeth. Although
healthy teeth normally withstand
masticatory loads and rarely fail, cuspal
fracture may occur in teeth that have
been weakened by cavity preparation
and caries.1-6 Several studies have
shown that as the cavity width and
depth increases during cavity prepara-
tion, the tooth strength decreases.2,7-11
Others8,12-18 have observed a correla-
tion between the cuspal fracture of the
restored teeth, tooth morphology, and
cavity parameters. The loss of tooth
tissue reduces the force required to
strain and subsequently fracture the
teeth in vitro, with the pattern of loss
inuencing the magnitude of the
induced strain.2,4,19
The resistance to fracture of restored
teeth is lower than sound teeth.4 One
study showed that 92% of fractured teeth
had previously undergone restoration.20
The presence of wide and/or deep res-
torations may confer the highest risk of
tooth fracture.21 In addition, even if
fracture does not occur, the deection of
a weakened or compromised cusp may
open the interface between the tooth
and restoration and lead to micro-
leakage and eventually to recurrent
caries. This may in turn predispose the
tooth to fracture.22-24
In an unrestored tooth, the stresses
are mainly compressive in response to
an axially applied compressive load, but
in a model with a deep and wide cavity
preparation, tensile stresses occur at
the pulpal wall.25 This change in the
stress type, from compression to ten-
sion, could increase the risk of fracture
in teeth with deep and wide cavity
preparations.8,12-18,25,26
Severely compromised teeth that
have been restored without cuspal
The Journal of Prosthetic Dentistry
protection are at a higher risk of frac-
turing than those with cuspal coverage,
frequently with unpredictable conse-
quences.2,5 The inuence of marginal
ridge removal and the depth and
width of cavities continues to be under
debate, but the anatomy of the
tooth probably plays an important
role.24,27-29 This is of particular impor-
tance for teeth in the posterior region
(for example, maxillary premolars)
because their anatomy favors deection
of the cusp and fracture under masti-
catory forces.2,7
The purpose of this study was to
evaluate tooth strain in teeth with
different cavity preparations after
cyclical loading. The null hypothesis
was that no difference would be found
in mean strain in teeth of different
cavity size and design.
MATERIAL AND METHODS
The research project was reviewed
and approved by the research ethics
committee, NRES Committee, Ben-
tham, London (REC reference 11/LO/
0939). Consent was obtained from
patients undergoing routine tooth ex-
tractions for orthodontic and peri-
odontal reasons. Ten intact human
maxillary premolars with approximately
the same coronal dimensions (8 mm in
height, 7 mm in mesiodistal width, and
9 mm in buccopalatal width) were
selected from 23 recently extracted
premolars. Each tooth was microscop-
ically examined to ensure the absence
of microfractures, cracks, or carious
lesions. The teeth were planed with
periodontal curettes (Gracey Curette;
Hu-Friedy Mfg) and intermittent water
irrigation and were stored in distilled
water at a temperature of 37 C until
use. The sample size of 10 premolars in
each group was based on a power
analysis. The sample size provided an
80% power at the 5% level of signi-
cance to detect a difference of 1120 me
between the intact tooth and the
mesio-occluso-distal (MOD) cavity at a
load of 130 N with a 2-sample t test
and assuming a standard deviation of
800 in each group.
Volume 110 Issue 5
All specimens were embedded in
clear epoxy resin (Specix-20; Struers
Ltd) and handled according to the
manufacturers recommendations.
Three millimeters of the roots was left
exposed below the cement-enamel
junction, simulating the alveolar bone
level. The teeth were embedded in
molds (2.5 cm in height), ensuring that
each root was positioned centrally with
the long axis of the tooth aligned par-
allel to the mold walls. The acrylic resin
was allowed to polymerize for 24 hours
at room temperature, the mold was
opened, and the acrylic resin trimmed
such that its base was orthogonal to
the long axis and parallel to a small
attened area on the occlusal surface of
the tooth. These areas were attened
with a cylindrical, round-edged, coarse
diamond rotary instrument (Two
Striper, Abrasive Technology; Myerson
Ltd), and then a ne grit diamond ro-
tary instrument (no. 585.8VF KS-2, ISO
shape 146 with a grit size of 45 mm;
Myerson Ltd), both with water spray.
The mounted teeth were kept in a
hydrated state throughout.
Strain gauges (Constantan; Mea-
surements Group UK Ltd) were used
with attached copper leads, a resistance
of 120U (type EA-06-062AP-120, op-
tion LE), and a gauge factor of 2.05.
The polyimide backing of the gauges
was trimmed to a 1-mm border around
the gauges to optimize positioning on
the tooth surface. The gauges were then
bonded to the cervicobuccal tooth
surface with a thin layer of cyanoacry-
late adhesive (M-Bond 200 Adhesive;
Measurements Group UK Ltd) so that
the top edge of the backing was
approximately 1 mm below the at-
tened area of the occlusal surface and
vertically aligned along the long axis of
the tooth. A control tooth received a
dummy gauge and was subjected to the
same environmental conditions but
without loading.
The teeth were wrapped in damp
gauze within a sealed polyethylene bag
until ready for testing. Before the test, a
length of shielded twin cable (RS
Components Ltd) was soldered to
the copper leads on an electronics
Pereira et al
November 2013
prototyping board (Double Side PHT;
Veroboard), and to ensure function-
ality, the gauge resistance was checked.
The bridge circuit was balanced to a
baseline value and output logging
commenced; 20 seconds after this, the
calibration resistor was switched into
the circuit for a further period of 20
seconds, and the transducer was
adjusted to record a second baseline
value. After this, the loading test began.
The periods of time used were selected
to enable adequate sampling.
The block of acrylic resin containing
the test specimen was kept in a brass
receptacle within a servohydraulic
testing machine (Dartec Ltd) with a 1.0
kN load cell in the loading ram. The
force was applied to the center of the
access preparation with a 2.5-mm-
diameter ball bearing. The brass
receptacle position was adjusted to
place the loading ram over the center of
the cavity preparation and remained in
this same position during all testing
procedures.
The tooth was mounted in the ser-
vohydraulic testing machine and tested
as an intact tooth, and without removal
from the servohydraulic testing ma-
chine, the occlusal cavity was then
prepared and the tooth tested again;
this sequence was repeated for the
mesio-occlusal (MO) cavity and nally
the MOD cavity. This sequential exten-
sion of the cavity was carried out in
each of the 10 teeth. There was a 30-
minute delay between the testing of
each specimen after each new cavity
preparation. Central loading was
veried before each episode of testing.
All specimens were prepared with
diamond rotary instruments (Two
Striper; Myerson Ltd) in a speed-
increasing electric handpiece (MF-
Tectorque; W&H Dentalwerk) with
continuous water spray coolant. A new
rotary instrument was used to prepare
the cavity in each tooth. Tooth struc-
ture was progressively removed to
produce 4 cavities in each of the teeth.
Groups were as follows: group I, intact
teeth; group O, class I cavities
(occlusal cavities); group MO, class II
cavity; and group MOD, class VI. For
Pereira et al
371
group O, the dimensions of cavities
were 3 mm in height for mesial, distal,
palatal, and buccal walls, 3.5 mm in A
width for buccopalatal walls, and 3 C
mm in length for mesiodistal walls B
(Fig. 1). The dimensions of MO cav-
ities and MOD cavities (groups MO
and MOD) were the same for the
occlusal cavities except for a 4.5-mm
height of the buccopalatal walls in
the box (Figs. 2, 3). The gingival oor
was kept above the cementoenamel
junction.
All teeth were subjected to gradual
nondestructive occlusal loading and
then unloading30 (50 N, 70 N, 90 N,
110 N, 130 N, 50 N, 0 N). Each period
of load consisted of 3 stages: loading
from 0 N to 50 N (the preload) (50
1 Occlusal cavity (A3.0 mm,
before); increasing loading from 50 N,
B3.5 mm, C3.0 mm).
70 N, 90 N, 110 N and 130 N,
unloading down to 50 N (50 after); and
unloading from 50 N to 0 N (after).
The duration of each loading cycle was
25 seconds. The preload was set at the B
start of each period of loading by pro-
gramming the test machine; the subse- C
quent loading phase was controlled by
the testing machines software (Work- A
shop 96, Dartec HC10; Zwick Ltd),
programmed with the appropriate pa-
rameters. The data were recorded at the
end of the loading period. 2 MO cavity (A3.0 mm,
The results were converted from text B3.0 mm, C4.5 mm).
to Microsoft Excel les (Microsoft
Corp). Shunting the calibration resistor
into the circuit produced a simulated
strain, which could be calculated from
B
the resistances of the calibration
resistor and also the bridge completion
C
resistors in the completed circuit. The
subsequent peak output voltage from
the strain gauge on loading the tooth A
could be directly compared to the
calibration output voltage; knowing the
strain value corresponding to the cali-
bration output, the peak strain value 3 MOD cavity (A3.0 mm,
could be deduced from a simple ratio. B3.0 mm, C4.5 mm).
The peak strain corresponding to the
output voltage (and loading cycle) of measures over teeth. If a statistically
each peak was deciphered. signicant effect in the ANOVA was
All data were statistically analyzed noted, after adjusting the P values for
by performing a 2-way analysis of multiple comparisons, a Bonferroni
variance (ANOVA) with load and cav- post hoc test was performed to
ity as factors and with repeated establish which load was statistically
372 Volume 110 Issue 5
different from the others. The as-
sumptions underlying the ANOVA were 2500 load (N)
tested by a study of the residuals and 50 before 130
were found to be satisfactory. A sig- 70 50 after
2000
90 after

Estimated Marginal Means

nicance level of .05 was used 110
throughout. A statistical package was
1500
used (IBM SPSS Statistics for Win-
dows, v21.0; IBM Corp).
1000
RESULTS
500
The estimated mean strain values
and their associated standard errors for
0
all the groups are shown Figure 4.
The 2-way repeated measures anal-
ysis of variance was based on a 3-way 500
table (tooth, cavity, load) that does
Intact Occlusal MO MOD
not have replication in its cells. There-
4 Estimated marginal means of strain.
fore, determining the 3-way interaction
is impossible, and the 2-way interaction
Table I. Multiple comparisons among groups with different forces applied on
(for example, of cavityload) took as
each tooth
its replication the 10 teeth, ignoring the
dependencies in the data. For this Condence Interval
reason, the interaction between cavity for Difference in
and tooth was assessed by plotting the Means
strain against the cavity, producing the Difference in
mean load for each cavity and linking (I) Load (J) Load Means (I-J) Lower Upper P
the means for each load, as shown
50 before 70 -172.95 -417.52 -71.62 .065
below. The Mauchley sphericity test
produced a signicant result for both 90 -355.40 -599.97 -110.83 .001
load (P<.001) and cavity (P.002). 110 -517.65 -762.22 -273.08 .001
Therefore, the Greenhouse-Geisser cor- 130 -682.10 -926.67 -437.53 .001
rections were applied to the degrees of 50 after -286.60 -531.17 -42.03 .008
freedom, and adjusted P values were After 787.65 543.08 1032.22 .001
obtained.
Two-way repeated measures ANOVA 70 90 -182.45 -427.02 62.12 .481
did not provide any evidence of an 110 -344.70 -589.27 -100.13 .001
interaction between load and cavity and 130 -509.15 -753.72 -264.58 .001
indicated a statistically signicant dif- 50 after -113.65 -358.22 130.92 .999
ference in the mean strains both be- After 960.60 716.03 1205.17 <.001
tween the loads (P<.001) and between
the cavity groups (P<.001). Tables I and 90 110 -162.25 -406.82 82.32 .889
II show the results of the Bonferroni 130 -326.70 -571.27 -82.13 .001
multiple comparison tests for the com- 50 after 68.80 -175.77 313.37 .999
parison of the mean strain with different After 1143.05 898.48 1387.62 .001
loads and cavity groups. Table II shows
110 130 1143.05 -409.02 80.12 .842
the statistical differences found when the
types of cavity preparations were 50 after 231.05 -13.52 475.62 .085
compared (P<.05). After 1305.30 1060.73 1549.87 .001

130 50 after 395.50 150.93 640.07 .001

DISCUSSION After 1469.75 1225.18 1714.32 .001

The null research hypothesis that no 50 after After 1074.25 -1318.82 -829.68 .001
difference would be noted in the mean Difference is signicant for P<.05. (I) load (initial load) and (J) (load applied) were used to measure
strain in teeth with different cavity size difference in mean strain between both these loads.

The Journal of Prosthetic Dentistry Pereira et al

November 2013
Table II. Multiple comparisons comparing mean strain for different cavities
Difference in
(I) Cavity (J) Cavity Means (I-J)
Intact Occlusal -105.94
MO -271.11
MOD -792.86
Occlusal MO -165.17
MOD -686.91
MO MOD -521.74
MO, mesio-occlusal; MOD, mesio-occluso-distal.
Difference is signicant for P<.05.
and design was rejected. The results
showed a signicantly different mean
strain when teeth with different cavity
geometries were submitted to nonde-
structive occlusal loading. Teeth may
vary considerably in their stiffness and
coronal morphology. Cavity prepara-
tions may also be subject to individual
characteristics in spite of attempts to
achieve standardization. Thus, varia-
tions among different teeth in different
studies can be considerable, making it
difcult to show statistically signicant
effects of different treatments. Mea-
surement techniques may also vary in
their sensitivity and in their reproduc-
ibility to changes in test conditions. To
reduce these limitations, researchers
have used nondestructive testing,
which allows measurements to be per-
formed sequentially on the same tooth
and which can further minimize the
effects of variation among different
teeth.30
In this study, teeth were subjected to
4 sets of gradual nondestructive
occlusal loading to 130 N and then
unloading. Cavity preparations were
enlarged progressively before each set
of loading, and the nal MOD cavity
was exposed to 4 episodes of loading.
Although loading was nondestructive,
this may have led to some changes
within the tooth structure. However, all
teeth were subjected to the same test
conditions.
Pereira et al
Condence
Interval for
Difference in
Means
Lower Upper P cavity preparation, the weakened
-266.14 54.25 .479
-431.31 -110.92 .001
-953.05 -632.66 .001
-325.37 -4.98 .039
-847.11 -526.72 .001
-681.94 -361.55 .001
Increased loss of tooth structure
causes increased cuspal exure, and in
this study, MOD cavities presented
statistically signicantly higher values
of strain than MO, O, and intact teeth.
This could be due to the loss of both
marginal ridges in MOD cavities and
reduced bracing of the cusps. The
presence of the cusps with intact mesial
and distal marginal ridges in the
palatal and buccal regions can form a
continuous circle of remaining tooth
structure, thereby maintaining and
reinforcing the tooth integrity. This is in
accordance with Reeh et al,27 who
found that endodontic access to intact
teeth reduced fracture resistance by
only about 5%; however, when this was
combined with MOD cavity prepara-
tions, the reduction was 69%. Magne28
showed that in endodontically treated
teeth, the stress concentration was
higher for teeth with cavity prepara-
tions in which both of the proximal
marginal ridges were lost. Cavity prep-
arations made with an occlusal open-
ing and the removal of the marginal
ridge raised strain values, supporting
the theory that teeth can be weakened
by the removal of marginal ridges29
and may need cuspal coverage when
they lose either one or both marginal
ridges.
In the present study, increasing
nondestructive occlusal loading caused
a signicant increase in the values of
373
mean strain for all cavities, even intact
teeth. Hood22 used linear voltage dif-
ferential transducers to demonstrate
that the removal of remaining tooth
structure when preparing intracoronal
cavities promoted increased cusp
deection. Hood noted that after a
cusps behave like cantilever beams
when they undergo occlusal loading.
The axial wall of the cavity preparation
serves as the fulcrum for the cusp
bending. With cavity preparations
becoming deeper, the beam length
(cusp) increases, and its deection in-
creases according to the cube of its
length. Clearly, the cavity designs and
the cusp morphology are more com-
plex than a simple cantilever beam, but
the concept of a cantilever beam has
been generally successful in predicting
cuspal exure with increasing cavity
preparation depth.
When loads are applied to a tooth,
stresses causing structural strain may
be generated, but if these stresses
become excessive and exceed the
elastic limit, teeth can fail. The stress
distribution mode and strain values
were directly inuenced by the type of
restorative material used and the
quantity of tooth structure removed.23
Concentrated stress can result in the
formation of crack formations and
subsequent propagation, which can
lead to fracture and eventual structural
failure.23 In this study, the recovery of
the relative strain decreased as the
cavity size increased. Similarly,
increasing the size of the cavity prepa-
rations produced a tooth that was
signicantly less rigid than the healthy
tooth, as suggested by Morin et al.6
With a 3-dimensional measurement
technique, Lang et al26 showed that
teeth with large cavities exhibited both
buccolingual outward bending of the
cusps and torsion of the whole crown.
This led in turn to considerable
shearing movement at the tooth
restoration interface. The shear stress
was not measured in this current study.
Lang et al26 noted that the extent of
preparation was an important factor.
In teeth with small cavities, the strain
374
was minimal; this effect is virtually in-
dependent of the restorative material
that was used. In teeth of this type, the
remaining tooth structure was the
main factor limiting tooth deformation
under chewing stress. In teeth with
large cavities, on the other hand,
deformation increased and differences
emerged among the various restorative
materials. The consequence of this
nding for clinical practice could be a
greater incidence of tooth fractures,
whether they are loaded on tooth
structure or restorative material, which
has been shown to translate within the
cavity.
Another consequence of the tooth
strain observed in this current study
could be that, clinically, restored
maxillary premolars may undergo
buccal and palatal strain as a result of
applying an occlusal load, which may
correlate with high levels of stress con-
centration within the tooth structure
and restoration. Morin et al19 observed
that the removal of hard tissue left the
remaining cusps exing outward to a
higher degree under a given force, as
reected in the greater strain values.
This is important because depending
on the bonding of the restoration
(nonbonded versus bonded), occlusal
loading may promote stresses at the
interface of the tooth and restoration.
Consequently, the marginal integrity
may be at risk and debonding a liabil-
ity. Frequent tooth structure deforma-
tion at high loads may result in the
failure of high-stiffness structures,
resulting in fatigue failure.23 However, if
the strain values are above the resis-
tance capacity of the tooth structure,
then the restoration may be mechani-
cally compromised. In addition, a gap
formation may occur at the adhesive
interface, leading to crack formation,
microleakage, and eventually fracture.24
The interocclusal relationships of pos-
terior teeth and anatomy result in a
tendency for the cusps to deect under
stress. This may predispose the tooth to
fracture.
Measuring the occlusal load defor-
mation of teeth is important in restor-
ative dentistry and serves as the basis of
The Journal of Prosthetic Dentistry
cavity design optimization and for
testing restorations. Two limitations of
this study were that it was an in vitro
investigation, which does not fully
replicate the oral environment, and that
a single load was used to test tooth
strain. For more meaningful results,
future studies should incorporate ther-
mal testing, fatigue cycling of the
specimens, and holography to measure
strain.
CONCLUSIONS
Within the limitations of this
in vitro study, it was concluded that
MOD cavities presented statistically
signicantly higher strain values than
MO, O, or intact teeth; and that a
signicant increase in the values of
mean strain for all cavities was ob-
served, even with intact teeth, when
nondestructive occlusal loading was
increased.
REFERENCES
1. Hunter AR, Treasure ET, Hunter AJ. Increases
in cavity volume associated with the removal
of class 2 amalgam and composite restora-
tions. Oper Dent 1995;20:2-6.
2. Larson TD, Douglas WH, Geistfeld RE. Effect
of prepared cavities on the strength of teeth.
Oper Dent 1981;6:2-5.
3. Millar BJ, Robinson PB, Davies BR. Effects of
the removal of composite resin restorations on
class II cavities. Br Dent J 1992;173:210-2.
4. Mondelli J, Steagall L, Ishikiriama A, de Lima
Navarro MF, Soares FB. Fracture strength
of human teeth with cavity preparations.
J Prosthet Dent 1980;43:419-22.
5. Mondelli RF, Barbosa WF, Mondelli J,
Franco EB, Carvalho RM. Fracture strength
of weakened human premolars restored with
amalgam with and without cusp coverage.
Am J Dent 1998;11:181-4.
6. Morin DL, Douglas WH, Cross M, DeLong R.
Biophysical stress analysis of restored teeth:
experimental strain measurement. Dent
Mater 1988;4:41-8.
7. Jagadish S, Yogesh BG. Fracture resistance of
teeth with class 2 silver amalgam, posterior
composite, and glass cermet restorations.
Oper Dent 1990;15:42-7.
8. Blaser PK, Lund MR, Cochran MA,
Potter RH. Effect of designs of class 2 prep-
arations on resistance of teeth to fracture.
Oper Dent 1983;8:6-10.
9. Soares PV, Milito GA, Pereira FA, Zola LF,
Naves ML, Faria VLG, et al. Inuence of
geometrical conguration of the cavity in
the stress distribution of restored premolars
with composite resin. J Res Dent 2013;1:
72-82.
Volume 110 Issue 5
10. Gelb MN, Barouch E, Simonsen RJ. Resistance
to cusp fracture in class II prepared and restored
premolars. J Prosthet Dent 1986;55:184-5.
11. Stampalia LL, Nicholls JI, Brudvik JS,
Jones DW. Fracture resistance of teeth with
resin-bonded restorations. J Prosthet Dent
1986;55:694-8.
12. Eakle WS, Maxwell EH, Braly BV. Fractures of
posterior teeth in adults. J Am Dent Assoc
1986;112:215-8.
13. Cavel WT, Kelsey WP, Blankenau RJ. An
in vivo study of cuspal fracture. J Prosthet
Dent 1985;53:38-42.
14. Lagouvardos P, Sourai P, Douvitsas G. Cor-
onal fractures in posterior teeth. Oper Dent
1989;14:28-32.
15. Mondelli J, Stengall L, Ishikirma A, Delima-
Navarro MF, Socres FB. Fracture strength of
human teeth with cavity preparations.
J Prosthet Dent 1980;43:419-22.
16. Re GJ, Norling BK, Draheim RN. Fracture
strength of molars containing three surface
amalgam restorations. J Prosthet Dent
1982;47:183-7.
17. Re GJ, Draheim RN, Norling BK. Fracture
resistance of mandibular molars with
occlusal class I amalgam preparations. J Am
Dent Assoc 1981;103:580-3.
18. Larsen TD, Douglas WH, Geistfeld RE. Ef-
fects of prepared cavities on the strength of
teeth. Oper Dent 1981;6:2-5.
19. Morin D, Delong R, Douglas WH. Cusp
reinforcement by the acid-etch technique.
J Dent Res 1984;63:1075-8.
20. Gher ME, Dunlap RM, Anderson MH,
Kuhl LV. Clinical survey of fractured teeth.
J Am Dent Assoc 1987;114:174-7.
21. Valdivia AD, Raposo LH, Simamoto-
Jnior PC, Novais VR, Soares CJ. The effect
of ber post presence and restorative
technique on the biomechanical behavior
of endodontically treated maxillary in-
cisors: an in vitro study. J Prosthet Dent
2012;108:147-57.
22. Hood JA. Biomechanics of the intact,
prepared and restored tooth: some clinical
implications. Int Dent J 1991;41:25-32.
23. Soares PV, Santos-Filho PC, Gomide HA,
Araujo CA, Martins LR, Soares CJ. Inuence
of restorative technique on the biomechan-
ical behavior of endodontically treated
maxillary premolars. Part II: strain measure-
ment and stress distribution. J Prosthet Dent
2008;99:114-22.
24. Boaro LCC, Xavier TA, Brandt WC,
Braga RR. How cavity dimension inuences
in the composite deformation during poly-
merization shrinkage. J Res Dent 2013;2:
127-33.
25. Khera SC, Gael VK, Chen RCS, Gurusami SA.
A three-dimensional nite element model.
Oper Dent 1988;13:128-37.
26. Lang H, Rampado M, Mllejans R,
Raab WH. Determination of the dynamics
of restored teeth by 3D electronic speckle
pattern interferometry. Lasers Surg Med
2004;34:300-9.
27. Reeh ES, Messer HH, Douglas WH. Reduc-
tion in tooth stiffness as a result of end-
odontic and restorative procedures. J Endod
1989;15:512-6.
Pereira et al
November 2013
28. Magne P. Efcient 3D nite element analysis
of dental restorative procedures using micro-
CT data. Dent Mater 2007;23:539-48.
29. Schwartz RS, Robbins JW. Post placement and
restoration of endodontically treated teeth: a
literature review. J Endod 2004;30:289-301.
30. Jantarat J, Panitvisai P, Palamara JE,
Messer HH. Comparison of
methods for measuring cuspal
deformation in teeth. J Dent 2001;
29:75-82.
375
Corresponding author:
Dr Jefferson Ricardo Pereira
Rua Recife 200, apto 601
Bairro Recife-Tubaro/SC 88701-420
BRAZIL
E-mail: jeffripe@rocketmail.com

Copyright 2013 by the Editorial Council for

The Journal of Prosthetic Dentistry.

Receive Tables of Contents by E-mail

To receive tables of contents by e-mail, sign up through our Web site at http://www.journals.elsevierhealth.com/peri-
odicals/ympr.
Instructions
Log on and click Register in the upper right-hand corner. After completing the registration process, click on My
Alerts, then Add Table of Contents Alert. Select the category Mosby or type The Journal of Prosthetic Dentistry in
the search field and click on the Journal title. The title will then appear, and having already completed the Registra-
tion process, you may add tables of contents alerts by accessing an issue of the Journal and clicking on the Add TOC
Alert link.
You will receive an e-mail message confirming that you have been added to the mailing list.

Note that tables of contents e-mails will be sent when a new issue is posted to the Web site.

Pereira et al