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A comparative analysis of restorative materials used in abfraction lesions in

tooth with and without occlusal restoration: Three-dimensional finite element
analysis

Article  in  Journal of Conservative Dentistry · March 2013

DOI: 10.4103/0972-0707.108200 · Source: PubMed

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Original Article

A comparative analysis of restorative materials used in

abfraction lesions in tooth with and without occlusal
restoration: Three-dimensional finite element analysis
Srirekha A, Kusum Bashetty
Department of Conservative Dentistry and Endodontics, The Oxford Dental College, Hospital and Research Centre, Bangalore,
Karnataka, India

Abstract
Objectives The present comparative analysis aimed at evaluating the mechanical behavior of various restorative materials in
Objectives:
abfraction lesion in the presence and absence of occlusal restoration.
Materials and Methods
Methods: A three-dimensional finite-element analysis was performed. Six experimental models of mandibular
first premolar were generated and divided into two groups (groups A and B) of three each. All the groups had cervical
abfraction lesion restored with materials and in addition group A had class I occlusal restoration. A load of 90 N, 200 N, and
400 N were applied at 45° loading angle on the buccal inclines of buccal cusp and Von Mises stresses was chosen for analysis.
Results In all the models, the values of stress recorded at the cervical margin of the restorations were at their maxima.
Results:
Irrespective of the occlusal restoration, all the materials performed well at 90 N and 200 N. At 400 N, only low-shrink
composite showed stresses lesser than its tensile strength indicating its success even at higher load.
Conclusion Irrespective of occlusal restoration, restorative materials with low modulus of elasticity are successful in abfraction
Conclusion:
lesions at moderate tensile stresses; whereas materials with higher modulus of elasticity and mechanical properties can support
higher loads and resist wear.
Significance The model allows comparison of different restorative materials for restoration of abfraction lesions in the presence
Significance:
and absence of occlusal restoration. The model can be used to validate more sophisticated computational models as well as
to conduct various optimization studies.
Keywords: Abfraction lesion; finite-element analysis; low-shrink composite; nano-filled restorative materials; resin-modified
glass-ionomer; stress distribution

INTRODUCTION modified resin-based composites (compomers) and

Abfraction lesions present primarily at the cervical region
of the dentition and are typically wedge-shaped, with a
sharp internal and external line angles.[1,2] Studies have
shown that it is multi-factorial in etiology. Recently, the
finite-element analysis (FEA) has been extensively used in
dentistry because it shows the tooth mechanical behavior
in detail. This method is extremely useful for indicating
mechanical aspects of biomaterials and human tissues that
can hardly be measured in-vivo.[3]
Currently, materials indicated to be used for restoring
the cervical lesions include: Glass-ionomer cements (GIC),
resin-modified glass-ionomer cements (RMGIC), poly-acid
composite resins.[4] Stress concentration at the cervical
region is responsible not only for the development of
cervical lesion but for restoration retention failure as well.
Combining chemical adhesion and restorative materials of
appropriate elastic properties show promise of long-term
success.[5]
In this study, nano-filled RMGIC, micro-hybrid low-shrink
resin composites were evaluated. Tyas,[6] recommended
that RMGIC should be the first preference for restoration
of non-carious cervical lesions (NCCLs) and RMGIC/GIC
liner base be laminated with resin composite; hence,
layering technique was also considered. So, the purpose of
this study was two fold. First, to evaluate the mechanical

Address for correspondence: Access this article online

Dr. Srirekha A, Department of Conservative Dentistry and Quick Response Code:
Endodontics, The Oxford Dental College, Hospital and Research Website:
www.jcd.org.in
Centre, Bangalore, Karnataka, India.
E-mail: drsrirekha.a@gmail.com
Date of submission : 22.05.2012 DOI:
Review completed : 21.09.2012 10.4103/0972-0707.108200
Date of acceptance : 03.12.2012

Journal of Conservative Dentistry | Mar-Apr 2013 | Vol 16 | Issue 2 157

Srirekha and Bashetty: Restorative materials in abfraction lesion

a b
Figure 1: Finite element model of tooth, (a) Details of abfraction
lesion, (b) Direction and location of applied force on tooth
Figure 2: Stress distribution in low-shrink micro-hybrid
composite with occlusal restoration at different loads.
The value at the lower right hand side (red color) is the
maximum stress and left hand side (blue color) is the least
stress

Table 1: Material properties

Materials Elastic Poisson’s Tensile
modulus (MPa) ratio strength (MPa)
Enamel 80,000 0.30
Dentin 15,000 0.31
Pulp 2.07 0.45
Cancellous bone 3.45 0.31
Compact bone 13,800 0.26
Periodontal ligament 50 0.49
Low-shrink composite 9000 0.23 123
Nano-RMGIC 4000 0.44 55
Adhesive layer 1000 0.3
Z250 11,000 0.28
Figure 3: Stress distribution in nano-ionomer with occlusal RMGIC 10,800 0.3 Layered technique-45
restoration at different loads RMGIC: Resin-modified glass-ionomer cements

Figure 4: Stress distribution Figure 5: Stress distribution Figure 6: Stress distribution Figure 7: Stress distribution
in layering technique with in low-shrink micro-hybrid in nano-ionomer without in layering technique without
occlusal restoration at composite without occlusal occlusal restoration at occlusal restoration at
different loads restoration at different loads different loads different loads

behavior of various restorative materials in abfraction MATERIALS AND METHODS

lesion and secondly, stresses generated in the tooth and
cervical restoration in the presence and absence of occlusal A three-dimensional (3D) finite-element model (FEM) of a
restoration. mandibular first premolar was created in the FEA software

158 Journal of Conservative Dentistry | Mar-Apr 2013 | Vol 16 | Issue 2

 Srirekha and Bashetty: Restorative materials in abfraction lesion

Table 2: Von Mises stresses in tooth (MPa) with occlusal cavity (group A)
Groups 90 N 200 N 400 N
Overall tooth Cervical restoration Overall tooth Cervical restoration Overall tooth Cervical restoration
Low-shrink composite 46.6 14.9 103.6 33 207.3 66.1
Nano-RMGIC 52.5 14.9 116.8 33 233.5 66.1
Layered technique 54.6 Comp-16.0 121.3 Comp-35.7 242.5 Comp-71.3
RMGIC-15.2 RMGIC-33.8 RMGIC-67.5
RMGIC: Resin-modified glass-ionomer cements

Table 3: Von Mises stresses in tooth (MPa) without occlusal cavity (group B)
Groups 90 N 200 N 400 N
Overall tooth Cervical restoration Overall tooth Cervical restoration Overall tooth Cervical restoration
Low-shrink composite 89.4 19.1 198.7 42.4 397.3 84.9
Nano-RMGIC 89.3 17.2 198.7 38.2 397.3 76.3
Layered technique 80 Comp-18.9 177.8 Comp-42.1 355.3 Comp-84.1
RMGIC-16.9 RMGIC-37.6 RMGIC-75.3
RMGIC: Resin-modified glass-ionomer cements

preprocessor ANSYS rel 9.0 FEM software (ANSYS Inc.,
Houston, USA). As judged by direct vision and radiography
the reconstruction was done with comparison of literature
data[7] on tooth morphology. According to Coolidge,[8] the
periodontal ligament is of varying thickness in-vivo and has
been applied in this study to make the model more precise
and realistic. The alveolar bone (cancellous and compact)
that supports the tooth was reconstructed with the upper
line of the bone 3 mm below the cervical line of the tooth
simulating an actual anatomic situation.
First order tetrahedral elements with 3 degree of freedom per
node were used for meshing the models which resulted in
67,278 nodes and 357,333 elements of approximately 0.3 mm
size. The exterior nodes of the alveolar bone were fixed in all
directions as the boundary conditions. Modulus of elasticity
and Poisson’s ratio were assigned to the elements [Table 1].
Six experimental models were generated and an abfraction
wedge shaped lesion was created on the buccal cervical
margin of 1.5 mm deep and 2 mm in occluso-cervical
direction. The angle of the wedge-shaped defect was
45° [Figure 1a]. Models were divided into groups A and B
(n3). Group A models had an additional class-I shaped
volume with cavity depth of 2 mm and was given the
properties of micro-hybrid composite (Filtek Z250, 3M
ESPE Seefeld, Germany). The adhesive layer was modeled
in the cervical lesion and the occlusal cavity (group A) for
composite resin restorations as a shell layer of 50 m wide.
resin-modified glass-ionomer cement (Fuji II LC, GC,
Tokyo, Japan) of 0.5 mm thickness veneered by 1 mm
thickness of low shrink composite.
Polymerization shrinkage was modeled in the materials
using uniform volumetric contraction. Polymerization
contraction of micro-hybrid composite in the occlusal cavity
was modeled as 2% (group A) and low shrink composite in
the abfraction lesion was modeled as 1%.
A load of 90 N, 200 N, and 400 N were applied on the
buccal inclines of the buccal cusp and oriented in 45°
oblique direction toward the buccal from the long axis of
the tooth [Figure 1b]. This yielded three distinctive loading
cases for each of the material under each group. Only static
loading was considered and the occlusal load of typical
magnitude was resolved into vertical (y-axis) and horizontal
(x-axis) components and applied on the tooth [Figure 1b].
The failure was decided by the fact that a higher Von Mises
stress value will be an indication of a greater possibility of
failure and the resultant stresses were compared with the
materials’ tensile strength.
In this study, the following assumptions were made:
 Enamel, dentin, and the restorative materials were
assumed to be homogeneous and isotropic.
 The polymerization of the restoration results in
uniform volume shrinkage.

All the models were grouped and sub-grouped as follows: RESULTS

 Group A: Model with abfraction lesion and occlusal
restoration
 Group B: Model with abfraction lesion and without
occlusal restoration
 A1 and B1: Low shrink composite (Filtek LS, 3M ESPE,
Seefeld, Germany)
 A2 and B2: Nano-RMGIC (Ketac N100, 3M ESPE, Seefeld,
Germany)
 A3 and B3: A layered technique with use of conventional
The results are presented in terms of Von Mises stress
values in MPa.
It was noticed that the Von Mises stress levels increased in
direct proportion with increased loading in all the groups.
Irrespective of the materials used, maximum stresses occurred
at the cervical margin of the restoration [Tables 2 and 3]. The
stresses in overall tooth show that, in group A [Figures 2-4],

Journal of Conservative Dentistry | Mar-Apr 2013 | Vol 16 | Issue 2 159

Srirekha and Bashetty: Restorative materials in abfraction lesion
irrespective of loading condition low-shrink composite
showed least stress followed by nano-RMGIC and layering
technique. In group B [Figures 5-7], low-shrink composite
and nano-RMGIC showed similar stresses, which were
comparatively more than layering technique.
The stresses in cervical restoration show that, in group A,
both low-shrink composite and nano-RMGIC resulted same
stresses which were recorded to be marginally lower than
layered restoration. In group B, nano-RMGIC revealed the
least stress followed by low-shrink composite and layered
restoration.
It was observed that the resultant maximum stresses in
overall tooth and in the cervical region were higher in
group B than in group A.
DISCUSSION
The scope of this study was to evaluate the mechanical
behavior of various restorative materials known to be
recommended or used in abfraction lesions under different
loading characteristics. The possible changes in the tooth
structure because of occlusal restoration, the utilized
restorative material and their consequences were studied
in detail.
The tooth modeled for this analysis was a mandibular
first premolar. Literature review reveals highest incidence
of abfraction lesions in mandibular bicuspids. The lingual
orientation of mandibular bicuspids renders them more
susceptible to the concentration of tensile stresses at the
cervical region, the anatomically smaller cervical cross
section may also contribute to the weakness of the teeth.[9]
In this study, 3D-FEA was used, which produces more
accurate results compared to 2D-FEA modeling. 3D-FEA
is preferred to obtain an optical realistic analysis with
detailed tooth anatomy and computational process. In
this study, the periodontal ligament and alveolar bone was
modeled mimicking clinical situation. Modulus of elasticity
of periodontal ligament is low; as a result, it allows the
tooth to bottom out allowing tooth movement. Modeling
periodontal ligament is important for realistic results.[10]
Cementum is a very thin layer and has the same physical
properties as dentin; therefore, it seemed unnecessary to
define it as a separate layer from the dentin.
Our analysis reveals that, all the tooth models restored
with different materials showed high resultant stresses
concentrated at the cervical margin. Hence, this area is the
most likely potential failure site of the restoration. This is
in accordance with clinical surveys which showed a higher
percentage of marginal defects in restorations of the NCCL
occurring on the cervical area of the restoration.[11] From an
analytical point of view, this study used different loads like
400 N, which was assumed to represent bruxism, 200 N
160 Journal of Conservative Dentistry | Mar-Apr 2013 | Vol 16 | Issue 2
vaguely represents the traumatic load and 90 N load was
relatively modest in clinical terms.[12,13]
When a low-shrink composite was taken into consideration,
in group A it showed least stresses compared to other
materials. This could be attributed to the presence of
adhesive layer. The necessity of stress buffering was
acknowledged by Kemp-Scholte and Davidson[14,15] in the
case of shrinkage stress reduction. However, this principle
can be extrapolated to other functional load cases as shown
by Ausiello et al.[16] The results of this study agree with the
findings of Kemp-Scholte and Davidson, who reported an
improvement of surface marginal integrity when a layer of
adhesive resin was used in a class V composite restoration.
This was attributed to an increase in strain capacity of the
adhesive resin so that the restoration could deform under
the loading of polymerization shrinkage.
When nano-RMGIC was taken into consideration, it
developed least stresses in the cervical region of tooth
with and without occlusal restoration. This may be due
to the deformation and flexing of the material because of
its low modulus, which absorbed the induced stresses and
thus reduced the resultant stresses in the tooth. This is in
accordance with Van Meerbeek et al.[17] who confirmed the
correlation of improved clinical results with lower moduli
of elasticity. The restorations with lower modulus of
elasticity allow the restoration to flex with the tooth rather
than debond.[13] On the contrary, a study[18] showed that
class V lesions restored with materials of higher modulus
of elasticity enabled better stress distribution. However,
many studies[19] found no significant difference between
materials with different elastic moduli.
When layered restoration was considered, in group A the
stresses were more with this technique when compared
with other two materials. But, in group B stresses were
equivalent to low-shrink composite. A thick layer of
RMGIC in the layered restoration acts as a stress breaker
compared to the bulk filled technique.[14] In the layering
technique a thin layer of a flexible material would fail in
the cervical region, mainly because, its limited thickness
cannot provide sufficient reduction in stress. In the case of
thick layer, failure does not occur but the marginal tensile
stresses are close to the failure limit.[20]
The occlusal restoration weakens the integrity of the
tooth and allows greater flexing of the cusp under occlusal
load.[21,22] On the contrary, in this study, teeth without
occlusal restoration resulted in marginally higher stresses.
For the tooth with occlusal restoration, the limited cuspal
flexure may be explained by the perfect simulation of
the bond between tooth and restoration, and such cusp
reinforcement is achieved by the bonding agent.[23]
Failure to consider occlusion will likely lead to restorative
failure as clearly demonstrated by previous studies.[22,24]

Lambrechts et al.[25] pointed out that if the occlusion is
not corrected, it results in premature loss of the cervical
restoration. Elimination of non-axial forces can be achieved
by simple occlusal equilibration, which will result in
reduction or elimination of stress on the restoration. In this
study, the resultants of the 90 N force can be compared to
the stress obtained on occlusal correction.
The extent of the role of compressive stress versus tensile stress
in the retentive failure in-vivo remains uncertain.[26] Finally any
conclusions drawn by considering a single stress component
will not reflect the true behavior of the tooth and hence will
be far from accurate. The magnitude of stresses reported in
this study are likely to be higher, since the polymerization
shrinkage was assumed to be applied instantaneously where
as, in reality, the shrinkage increases gradually, which may
allow an opportunity for stress reduction, which cannot
be simulated and calculated with computer. Small areas of
de-bonding and composite flow during polymerization also
may reduce the amount of stress on the tooth, in reality.[27]
Studies have proven the anisotropic property of enamel and
dentin and intraoral environment gives rise to nonlinearities
in the periodontal ligament, residual stresses in restorative
materials and inter facial stresses.[28] Such nonlinear
simulations of the analysis were not carried out in this study,
which will provide more realistic results. Further studies need
to be carried out keeping into consideration all these factors
accompanied by long-term clinical experiments.
CONCLUSION
Within the limitations of this study:
 Restorative materials with low modulus of elasticity
(nano-RMGIC restorative material) are successful
in abfraction lesions at moderate tensile stresses
whereas a higher modulus of elasticity and mechanical
properties (low-shrink composites) can support higher
loads and resist wear
 Irrespective of occlusal restoration, low-shrink micro-
hybrid composites showed good results at all the loading
conditions without crossing its tensile strength limits
 Irrespective of occlusal restoration, both nano-ionomer
and layered technique performed well at 90 N and
200 N, but both failed at 400 N because of the resultant
stresses produced beyond their tensile strength.
ACKNOWLEDGMENT
We would like to acknowledge Mr. Pawan Kumar, CAE Engineer,
Bangalore, Karnataka, India.
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How to cite this article: Srirekha A, Bashetty K. A comparative
analysis of restorative materials used in abfraction lesions in tooth
with and without occlusal restoration: Three-dimensional finite
element analysis. J Conserv Dent 2013;16:157-61.
Source of Support: Nil, Conflict of Interest: None declared.
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