Effect of Cavity Design On Tooth Surface Strain - Jefferson Ricardo

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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 Volume 110 Issue 5
biologic, and esthetic outcome. protection are at a higher risk of frac- All specimens were embedded in
Restorative materials should be of turing than those with cuspal coverage, clear epoxy resin (Specix-20; Struers
appropriate width and pulpal depth to frequently with unpredictable conse- Ltd) and handled according to the
ensure sufcient strength. An important quences.2,5 The inuence of marginal manufacturers recommendations.
consideration when restoring a tooth is ridge removal and the depth and Three millimeters of the roots was left
the quantity and quality of the width of cavities continues to be under exposed below the cement-enamel
remaining dentin, which, together with debate, but the anatomy of the junction, simulating the alveolar bone
occlusal forces, may determine the tooth probably plays an important level. The teeth were embedded in
subsequent potential for fracture.1-5 role.24,27-29 This is of particular impor- molds (2.5 cm in height), ensuring that
Cusps deect when stressed because tance for teeth in the posterior region each root was positioned centrally with
of the interocclusal relationships and (for example, maxillary premolars) the long axis of the tooth aligned par-
anatomy of posterior teeth. Although because their anatomy favors deection allel to the mold walls. The acrylic resin
healthy teeth normally withstand of the cusp and fracture under masti- was allowed to polymerize for 24 hours
masticatory loads and rarely fail, cuspal catory forces.2,7 at room temperature, the mold was
fracture may occur in teeth that have The purpose of this study was to opened, and the acrylic resin trimmed
been weakened by cavity preparation evaluate tooth strain in teeth with such that its base was orthogonal to
and caries.1-6 Several studies have different cavity preparations after the long axis and parallel to a small
shown that as the cavity width and cyclical loading. The null hypothesis attened area on the occlusal surface of
depth increases during cavity prepara- was that no difference would be found the tooth. These areas were attened
tion, the tooth strength decreases.2,7-11 in mean strain in teeth of different with a cylindrical, round-edged, coarse
Others8,12-18 have observed a correla- cavity size and design. diamond rotary instrument (Two
tion between the cuspal fracture of the Striper, Abrasive Technology; Myerson
restored teeth, tooth morphology, and MATERIAL AND METHODS Ltd), and then a ne grit diamond ro-
cavity parameters. The loss of tooth tary instrument (no. 585.8VF KS-2, ISO
tissue reduces the force required to The research project was reviewed shape 146 with a grit size of 45 mm;
strain and subsequently fracture the and approved by the research ethics Myerson Ltd), both with water spray.
teeth in vitro, with the pattern of loss committee, NRES Committee, Ben- The mounted teeth were kept in a
inuencing the magnitude of the tham, London (REC reference 11/LO/ hydrated state throughout.
induced strain.2,4,19 0939). Consent was obtained from Strain gauges (Constantan; Mea-
The resistance to fracture of restored patients undergoing routine tooth ex- surements Group UK Ltd) were used
teeth is lower than sound teeth.4 One tractions for orthodontic and peri- with attached copper leads, a resistance
study showed that 92% of fractured teeth odontal reasons. Ten intact human of 120U (type EA-06-062AP-120, op-
had previously undergone restoration.20 maxillary premolars with approximately tion LE), and a gauge factor of 2.05.
The presence of wide and/or deep res- the same coronal dimensions (8 mm in The polyimide backing of the gauges
torations may confer the highest risk of height, 7 mm in mesiodistal width, and was trimmed to a 1-mm border around
tooth fracture.21 In addition, even if 9 mm in buccopalatal width) were the gauges to optimize positioning on
fracture does not occur, the deection of selected from 23 recently extracted the tooth surface. The gauges were then
a weakened or compromised cusp may premolars. Each tooth was microscop- bonded to the cervicobuccal tooth
open the interface between the tooth ically examined to ensure the absence surface with a thin layer of cyanoacry-
and restoration and lead to micro- of microfractures, cracks, or carious late adhesive (M-Bond 200 Adhesive;
leakage and eventually to recurrent lesions. The teeth were planed with Measurements Group UK Ltd) so that
caries. This may in turn predispose the periodontal curettes (Gracey Curette; the top edge of the backing was
tooth to fracture.22-24 Hu-Friedy Mfg) and intermittent water approximately 1 mm below the at-
In an unrestored tooth, the stresses irrigation and were stored in distilled tened area of the occlusal surface and
are mainly compressive in response to water at a temperature of 37 C until vertically aligned along the long axis of
an axially applied compressive load, but use. The sample size of 10 premolars in the tooth. A control tooth received a
in a model with a deep and wide cavity each group was based on a power dummy gauge and was subjected to the
preparation, tensile stresses occur at analysis. The sample size provided an same environmental conditions but
the pulpal wall.25 This change in the 80% power at the 5% level of signi- without loading.
stress type, from compression to ten- cance to detect a difference of 1120 me The teeth were wrapped in damp
sion, could increase the risk of fracture between the intact tooth and the gauze within a sealed polyethylene bag
in teeth with deep and wide cavity mesio-occluso-distal (MOD) cavity at a until ready for testing. Before the test, a
preparations.8,12-18,25,26 load of 130 N with a 2-sample t test length of shielded twin cable (RS
Severely compromised teeth that and assuming a standard deviation of Components Ltd) was soldered to
have been restored without cuspal 800 in each group. the copper leads on an electronics
The Journal of Prosthetic Dentistry Pereira et al
November 2013 371
prototyping board (Double Side PHT; group O, the dimensions of cavities
Veroboard), and to ensure function- were 3 mm in height for mesial, distal,
ality, the gauge resistance was checked. palatal, and buccal walls, 3.5 mm in A
The bridge circuit was balanced to a width for buccopalatal walls, and 3 C
baseline value and output logging mm in length for mesiodistal walls B
commenced; 20 seconds after this, the (Fig. 1). The dimensions of MO cav-
calibration resistor was switched into ities and MOD cavities (groups MO
the circuit for a further period of 20 and MOD) were the same for the
seconds, and the transducer was occlusal cavities except for a 4.5-mm
adjusted to record a second baseline height of the buccopalatal walls in
value. After this, the loading test began. the box (Figs. 2, 3). The gingival oor
The periods of time used were selected was kept above the cementoenamel
to enable adequate sampling. junction.
The block of acrylic resin containing All teeth were subjected to gradual
the test specimen was kept in a brass nondestructive occlusal loading and
receptacle within a servohydraulic then unloading30 (50 N, 70 N, 90 N,
testing machine (Dartec Ltd) with a 1.0 110 N, 130 N, 50 N, 0 N). Each period
kN load cell in the loading ram. The of load consisted of 3 stages: loading
force was applied to the center of the from 0 N to 50 N (the preload) (50
1 Occlusal cavity (A3.0 mm,
access preparation with a 2.5-mm- before); increasing loading from 50 N,
B3.5 mm, C3.0 mm).
diameter ball bearing. The brass 70 N, 90 N, 110 N and 130 N,
receptacle position was adjusted to unloading down to 50 N (50 after); and
place the loading ram over the center of unloading from 50 N to 0 N (after).
the cavity preparation and remained in The duration of each loading cycle was
this same position during all testing 25 seconds. The preload was set at the B
procedures. start of each period of loading by pro-
The tooth was mounted in the ser- gramming the test machine; the subse- C
vohydraulic testing machine and tested quent loading phase was controlled by
as an intact tooth, and without removal the testing machines software (Work- A
from the servohydraulic testing ma- shop 96, Dartec HC10; Zwick Ltd),
chine, the occlusal cavity was then programmed with the appropriate pa-
prepared and the tooth tested again; rameters. The data were recorded at the
this sequence was repeated for the end of the loading period. 2 MO cavity (A3.0 mm,
mesio-occlusal (MO) cavity and nally The results were converted from text B3.0 mm, C4.5 mm).
the MOD cavity. This sequential exten- to Microsoft Excel les (Microsoft
sion of the cavity was carried out in Corp). Shunting the calibration resistor
each of the 10 teeth. There was a 30- into the circuit produced a simulated
minute delay between the testing of strain, which could be calculated from
B
each specimen after each new cavity the resistances of the calibration
preparation. Central loading was resistor and also the bridge completion
C
veried before each episode of testing. resistors in the completed circuit. The
All specimens were prepared with subsequent peak output voltage from
diamond rotary instruments (Two the strain gauge on loading the tooth A
Striper; Myerson Ltd) in a speed- could be directly compared to the
increasing electric handpiece (MF- calibration output voltage; knowing the
Tectorque; W&H Dentalwerk) with strain value corresponding to the cali-
continuous water spray coolant. A new bration output, the peak strain value 3 MOD cavity (A3.0 mm,
rotary instrument was used to prepare could be deduced from a simple ratio. B3.0 mm, C4.5 mm).
the cavity in each tooth. Tooth struc- The peak strain corresponding to the
ture was progressively removed to output voltage (and loading cycle) of measures over teeth. If a statistically
produce 4 cavities in each of the teeth. each peak was deciphered. signicant effect in the ANOVA was
Groups were as follows: group I, intact All data were statistically analyzed noted, after adjusting the P values for
teeth; group O, class I cavities by performing a 2-way analysis of multiple comparisons, a Bonferroni
(occlusal cavities); group MO, class II variance (ANOVA) with load and cav- post hoc test was performed to
cavity; and group MOD, class VI. For ity as factors and with repeated establish which load was statistically
Pereira et al
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 373
Table II. Multiple comparisons comparing mean strain for different cavities mean strain for all cavities, even intact
teeth. Hood22 used linear voltage dif-
Condence ferential transducers to demonstrate
Interval for that the removal of remaining tooth
Difference in structure when preparing intracoronal
Means cavities promoted increased cusp
Difference in
deection. Hood noted that after a
(I) Cavity (J) Cavity Means (I-J) Lower Upper P cavity preparation, the weakened
cusps behave like cantilever beams
Intact Occlusal -105.94 -266.14 54.25 .479
when they undergo occlusal loading.
MO -271.11 -431.31 -110.92 .001
The axial wall of the cavity preparation
MOD -792.86 -953.05 -632.66 .001 serves as the fulcrum for the cusp
Occlusal MO -165.17 -325.37 -4.98 .039 bending. With cavity preparations
MOD -686.91 -847.11 -526.72 .001 becoming deeper, the beam length
(cusp) increases, and its deection in-
MO MOD -521.74 -681.94 -361.55 .001
creases according to the cube of its
MO, mesio-occlusal; MOD, mesio-occluso-distal. length. Clearly, the cavity designs and
Difference is signicant for P<.05. the cusp morphology are more com-
plex than a simple cantilever beam, but
and design was rejected. The results Increased loss of tooth structure the concept of a cantilever beam has
showed a signicantly different mean causes increased cuspal exure, and in been generally successful in predicting
strain when teeth with different cavity this study, MOD cavities presented cuspal exure with increasing cavity
geometries were submitted to nonde- statistically signicantly higher values preparation depth.
structive occlusal loading. Teeth may of strain than MO, O, and intact teeth. When loads are applied to a tooth,
vary considerably in their stiffness and This could be due to the loss of both stresses causing structural strain may
coronal morphology. Cavity prepara- marginal ridges in MOD cavities and be generated, but if these stresses
tions may also be subject to individual reduced bracing of the cusps. The become excessive and exceed the
characteristics in spite of attempts to presence of the cusps with intact mesial elastic limit, teeth can fail. The stress
achieve standardization. Thus, varia- and distal marginal ridges in the distribution mode and strain values
tions among different teeth in different palatal and buccal regions can form a were directly inuenced by the type of
studies can be considerable, making it continuous circle of remaining tooth restorative material used and the
difcult to show statistically signicant structure, thereby maintaining and quantity of tooth structure removed.23
effects of different treatments. Mea- reinforcing the tooth integrity. This is in Concentrated stress can result in the
surement techniques may also vary in accordance with Reeh et al,27 who formation of crack formations and
their sensitivity and in their reproduc- found that endodontic access to intact subsequent propagation, which can
ibility to changes in test conditions. To teeth reduced fracture resistance by lead to fracture and eventual structural
reduce these limitations, researchers only about 5%; however, when this was failure.23 In this study, the recovery of
have used nondestructive testing, combined with MOD cavity prepara- the relative strain decreased as the
which allows measurements to be per- tions, the reduction was 69%. Magne28 cavity size increased. Similarly,
formed sequentially on the same tooth showed that in endodontically treated increasing the size of the cavity prepa-
and which can further minimize the teeth, the stress concentration was rations produced a tooth that was
effects of variation among different higher for teeth with cavity prepara- signicantly less rigid than the healthy
teeth.30 tions in which both of the proximal tooth, as suggested by Morin et al.6
In this study, teeth were subjected to marginal ridges were lost. Cavity prep- With a 3-dimensional measurement
4 sets of gradual nondestructive arations made with an occlusal open- technique, Lang et al26 showed that
occlusal loading to 130 N and then ing and the removal of the marginal teeth with large cavities exhibited both
unloading. Cavity preparations were ridge raised strain values, supporting buccolingual outward bending of the
enlarged progressively before each set the theory that teeth can be weakened cusps and torsion of the whole crown.
of loading, and the nal MOD cavity by the removal of marginal ridges29 This led in turn to considerable
was exposed to 4 episodes of loading. and may need cuspal coverage when shearing movement at the tooth
Although loading was nondestructive, they lose either one or both marginal restoration interface. The shear stress
this may have led to some changes ridges. was not measured in this current study.
within the tooth structure. However, all In the present study, increasing Lang et al26 noted that the extent of
teeth were subjected to the same test nondestructive occlusal loading caused preparation was an important factor.
conditions. a signicant increase in the values of In teeth with small cavities, the strain
Pereira et al
374 Volume 110 Issue 5
was minimal; this effect is virtually in- cavity design optimization and for 10. Gelb MN, Barouch E, Simonsen RJ. Resistance
to cusp fracture in class II prepared and restored
dependent of the restorative material testing restorations. Two limitations of
premolars. J Prosthet Dent 1986;55:184-5.
that was used. In teeth of this type, the this study were that it was an in vitro 11. Stampalia LL, Nicholls JI, Brudvik JS,
remaining tooth structure was the investigation, which does not fully Jones DW. Fracture resistance of teeth with
main factor limiting tooth deformation replicate the oral environment, and that resin-bonded restorations. J Prosthet Dent
1986;55:694-8.
under chewing stress. In teeth with a single load was used to test tooth 12. Eakle WS, Maxwell EH, Braly BV. Fractures of
large cavities, on the other hand, strain. For more meaningful results, posterior teeth in adults. J Am Dent Assoc
deformation increased and differences future studies should incorporate ther- 1986;112:215-8.
13. Cavel WT, Kelsey WP, Blankenau RJ. An
emerged among the various restorative mal testing, fatigue cycling of the in vivo study of cuspal fracture. J Prosthet
materials. The consequence of this specimens, and holography to measure Dent 1985;53:38-42.
nding for clinical practice could be a strain. 14. Lagouvardos P, Sourai P, Douvitsas G. Cor-
onal fractures in posterior teeth. Oper Dent
greater incidence of tooth fractures,
1989;14:28-32.
whether they are loaded on tooth CONCLUSIONS 15. Mondelli J, Stengall L, Ishikirma A, Delima-
structure or restorative material, which Navarro MF, Socres FB. Fracture strength of
has been shown to translate within the Within the limitations of this human teeth with cavity preparations.
J Prosthet Dent 1980;43:419-22.
cavity. in vitro study, it was concluded that 16. Re GJ, Norling BK, Draheim RN. Fracture
Another consequence of the tooth MOD cavities presented statistically strength of molars containing three surface
strain observed in this current study signicantly higher strain values than amalgam restorations. J Prosthet Dent
1982;47:183-7.
could be that, clinically, restored MO, O, or intact teeth; and that a 17. Re GJ, Draheim RN, Norling BK. Fracture
maxillary premolars may undergo signicant increase in the values of resistance of mandibular molars with
buccal and palatal strain as a result of mean strain for all cavities was ob- occlusal class I amalgam preparations. J Am
Dent Assoc 1981;103:580-3.
applying an occlusal load, which may served, even with intact teeth, when
18. Larsen TD, Douglas WH, Geistfeld RE. Ef-
correlate with high levels of stress con- nondestructive occlusal loading was fects of prepared cavities on the strength of
centration within the tooth structure increased. teeth. Oper Dent 1981;6:2-5.
and restoration. Morin et al19 observed 19. Morin D, Delong R, Douglas WH. Cusp
reinforcement by the acid-etch technique.
that the removal of hard tissue left the REFERENCES J Dent Res 1984;63:1075-8.
remaining cusps exing outward to a 1. Hunter AR, Treasure ET, Hunter AJ. Increases 20. Gher ME, Dunlap RM, Anderson MH,
higher degree under a given force, as in cavity volume associated with the removal Kuhl LV. Clinical survey of fractured teeth.
reected in the greater strain values. of class 2 amalgam and composite restora- J Am Dent Assoc 1987;114:174-7.
tions. Oper Dent 1995;20:2-6. 21. Valdivia AD, Raposo LH, Simamoto-
This is important because depending 2. Larson TD, Douglas WH, Geistfeld RE. Effect Jnior PC, Novais VR, Soares CJ. The effect
on the bonding of the restoration of prepared cavities on the strength of teeth. of ber post presence and restorative
(nonbonded versus bonded), occlusal Oper Dent 1981;6:2-5. technique on the biomechanical behavior
3. Millar BJ, Robinson PB, Davies BR. Effects of of endodontically treated maxillary in-
loading may promote stresses at the cisors: an in vitro study. J Prosthet Dent
the removal of composite resin restorations on
interface of the tooth and restoration. class II cavities. Br Dent J 1992;173:210-2. 2012;108:147-57.
Consequently, the marginal integrity 4. Mondelli J, Steagall L, Ishikiriama A, de Lima 22. Hood JA. Biomechanics of the intact,
Navarro MF, Soares FB. Fracture strength prepared and restored tooth: some clinical
may be at risk and debonding a liabil-
of human teeth with cavity preparations. implications. Int Dent J 1991;41:25-32.
ity. Frequent tooth structure deforma- J Prosthet Dent 1980;43:419-22. 23. Soares PV, Santos-Filho PC, Gomide HA,
tion at high loads may result in the 5. Mondelli RF, Barbosa WF, Mondelli J, Araujo CA, Martins LR, Soares CJ. Inuence
failure of high-stiffness structures, Franco EB, Carvalho RM. Fracture strength of restorative technique on the biomechan-
of weakened human premolars restored with ical behavior of endodontically treated
resulting in fatigue failure.23 However, if
amalgam with and without cusp coverage. maxillary premolars. Part II: strain measure-
the strain values are above the resis- Am J Dent 1998;11:181-4. ment and stress distribution. J Prosthet Dent
tance capacity of the tooth structure, 6. Morin DL, Douglas WH, Cross M, DeLong R. 2008;99:114-22.
Biophysical stress analysis of restored teeth: 24. Boaro LCC, Xavier TA, Brandt WC,
then the restoration may be mechani-
experimental strain measurement. Dent Braga RR. How cavity dimension inuences
cally compromised. In addition, a gap Mater 1988;4:41-8. in the composite deformation during poly-
formation may occur at the adhesive 7. Jagadish S, Yogesh BG. Fracture resistance of merization shrinkage. J Res Dent 2013;2:
interface, leading to crack formation, teeth with class 2 silver amalgam, posterior 127-33.
composite, and glass cermet restorations. 25. Khera SC, Gael VK, Chen RCS, Gurusami SA.
microleakage, and eventually fracture.24 Oper Dent 1990;15:42-7. A three-dimensional nite element model.
The interocclusal relationships of pos- 8. Blaser PK, Lund MR, Cochran MA, Oper Dent 1988;13:128-37.
terior teeth and anatomy result in a Potter RH. Effect of designs of class 2 prep- 26. Lang H, Rampado M, Mllejans R,
arations on resistance of teeth to fracture. Raab WH. Determination of the dynamics
tendency for the cusps to deect under Oper Dent 1983;8:6-10. of restored teeth by 3D electronic speckle
stress. This may predispose the tooth to 9. Soares PV, Milito GA, Pereira FA, Zola LF, pattern interferometry. Lasers Surg Med
fracture. Naves ML, Faria VLG, et al. Inuence of 2004;34:300-9.
geometrical conguration of the cavity in 27. Reeh ES, Messer HH, Douglas WH. Reduc-
Measuring the occlusal load defor-
the stress distribution of restored premolars tion in tooth stiffness as a result of end-
mation of teeth is important in restor- with composite resin. J Res Dent 2013;1: odontic and restorative procedures. J Endod
ative dentistry and serves as the basis of 72-82. 1989;15:512-6.

The Journal of Prosthetic Dentistry Pereira et al


November 2013 375
28. Magne P. Efcient 3D nite element analysis 30. Jantarat J, Panitvisai P, Palamara JE, Corresponding author:
of dental restorative procedures using micro- Messer HH. Comparison of Dr Jefferson Ricardo Pereira
CT data. Dent Mater 2007;23:539-48. methods for measuring cuspal Rua Recife 200, apto 601
29. Schwartz RS, Robbins JW. Post placement and deformation in teeth. J Dent 2001; Bairro Recife-Tubaro/SC 88701-420
restoration of endodontically treated teeth: a 29:75-82. BRAZIL
literature review. J Endod 2004;30:289-301. E-mail: jeffripe@rocketmail.com

Copyright 2013 by the Editorial Council for


The Journal of Prosthetic Dentistry.

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