BIOMECHANICAL BEHAVIOR

Reference
Cumulative Effects of Successive Restorative Procedures on Anterior Crown Flexure:
Intact Versus Veneered Incisors
Magne P, Douglas WHo

Quintessence In! 2000;31:5-18.

Figure 3-22: Figure 3-23:

Mean (s.d.) Fracture

Table 11-19: Hard Tissue Removal from Incisors Strength
_ NA _ _ ._ _
'" 2 .2 1.7 T - - __ -

1.~ ·~ =====----=====­
~ 2 :!!'" -
lob I . ---
~ 1.5

1.I--------- -=- =
Q.

E
o

------=.~---I· -==-=
v

~
OJ
g 14 '"
'w
't; 1.2 '--­
1 ~
0;

Intact Proximal Facial CL·1I1 ENDO Facial Facial

'"
Enamel Enamel cavitie s acce ss Ename I Ename'
G-';~
~~
~$ ~<f>
'<: ~§
rP
1/3 2/3 3/3
'"
("...:

Conclusion
• Each subsequent reduction in tooth structure resulted in a substantial increase in crown
flexibility, even after restoration.
• Endodontic procedures were responsible for most of the loss in crown stiffness.
• Extensive proximal cutting and restorations seemed to minimally affect crown flexure .
• Porcelain veneers showed perfect biomimetic behavior, because cumulated restoration
procedures had the same effect on natural and veneered incisors.

<::»

69
 Anterior Preparation Designs

ADHESIVELY RETAINED

o , ~2m m
Facial Veneer / Prepless
• Feldspathic

O'6m-..:..~
/ .\ Facial Veneer / Incisal Reduction Butt Joint
0 .3 m m \ • Feldspathic
I \
\ • EMAX

~2m m Facial Veneer / Incisal Reduction

Lingual Chamfer
• Feldspathic
• EMAX
"r.-, - ,
o .6 m~ / 1-.t 2m m
Full Veneer Preparation

D 0.3 mm
, I
,
I
h
~:-
.~
"
• Feldspathic
• EMAX
~
o
~ 0
~

----------------------- O- ~-
o m
COHESIVELY RETAINED (j')

Full Coverage Conservative Preparation

• EMAX only

2mm Full Coverage Conventional Preparation

• EMAX
• Zirconia
• Metal Ceramic

Full Coverage Agressive Preparation

• EMAX
• Zirconia
• Metal Ceramic

91
T O OTH PREPARATION CONCERNS - ANTERIOR

Adhesively Retained
Reference
Fracture Load and Mode of Failure of Ceramic Veneers with Different Preparations
Castelnuovo 1, Tjan AHI, Phillips K, Nicholls JI, Kois ic.

J Prosthet Dent 2000;83 :171-180.

Mean [s.d.] Fracture Strength

40 , - - - - - - - - - - - - - - - - - - : = _ _ _ _ _
19 35 + - - - - - - , - - - - - - - - - - - 1
.; 30 - f - - - - - . . , . - - - - t - - - - - - - ­
~ 25 +--+- ­
t
V>
20
'" 15
:5 10
~
~ 5
o
1 2 3 4 5

Veneer Design

Conclusion
Ceramic veneers with 2.0 rnm of unsupported incisal ceramic and butt joint and ceramic

veneers with feathered incisal edge were the strongest and remained intact.

A palatal chamfer did not provide increased strength for ceramic veneers.

• On the basis of this in vitro investigation, fractured teeth with up to 4.0 rnm of missing
tooth structure can be restored with leucite-reinforced ceramic veneers.
The fracture load values recorded were comparable to more conservative designs in
relation to the amount of unsupported incisal ceramic.
Ceramic veneers with incisal butt joint offered several clinical advantages such as tooth
preparation, ceramic veneer fabrication, manipulation, and insertion.

92
 TOOTH PREl'ARATION C O NCE R N S - ANTERIOR

Reference
Influence of Preparation Design and Existing Condition of Tooth Structure on Load to
Failure of Ceramic Laminate Veneers
Schm idt KK, Chi ayabutr Y, Phillips KM, Kois Jc.

J Prosth et Dent 20 II ,. 105:3 74-82.

LOAD

Shoulder Palatal Shoulder Palatal

Finish Une Chamfer Finish Line Chamfer

Non-Worn Tooth Worn Tooth

Table 4-1: Mean (SD) of Load to Failure and Remaining Enamel Thickness on Incise­
dcclusal Surface. For Mode of Failure: Type I: Cohesive Failure with Veneer Fracture ; Type
I~: l"1ixed Failure; Type III: Adhesive Failure; Type IV: Root Fracture

Remaining Enamel Mode of Failure

Group Load to Failure (N)
Thickness (mm) I II III IV
Shoulder Fini sh Line
0 .6 8 ( 0. 18 )a 131.84 (18.88)b 62.5 25 .0 0 12.5
( Non-wor n Tooth)

p:alatal Chamfer

0.60 ( 0.08 )a 166.67 (2 8 .89 )a 87 .5 0 0 12 .5

( ~ on -worn tooth)

Shoulder Fini sh Line

0.49 (0 .05)b 90 .56 (9 .32 )c 37 . 5 37 . 5 25.0 0

(Wear tooth )
I
Pplatal Chamfer
0.44 (0.04)b 119 .56 (23.88)b 37 .5 50.0 12.5 0
(}Nea r tooth)

Valu es with same lowe rcase letter are not signifi cant ly different at P< .05

I .

Conclusion
I

Preparation design and the amount of existing tooth structure had a 'significant effect on
I

load to failure for ceramic veneers. This study revealed that using a palatal chamfe r margin
desig n significantly increased the load to failure compa red to a shoulder fi nish line.

93
 CRACKED TOOTH SYNDROME

Reference
Assessment of the Resistance to Fracture of Endodontically Treated Molars Restored
with Amalgam
AssifD, Missan 1, Gafni Y, Gordon M

J Prosthet Dent 2003;89:462-465.

The choice of an appropriate restorative material to be used as the foundation

restoration for an endodontically treated tooth has become more complex. The
structural concerns ofthe remaining tooth structure must be caref ully evaluated and
weigh ed against the esthetic needs ofthe patient.

Conclusion
Endodontically treated molars with a conservative endodontic acce ss, or after removal of all
cusps restored to origin al contour with amalgam , presented the highest resistance to fracture
under a simulated occlusal load.

83
 CRACKED TOOTH SYNDROM E

Cuspal Deflection
Reference
Effect of Prepared Cavities on the Strength of Teeth
Larson TD, Douglas WH, Geistfe ld RE.

Operative Dentistry 198 1;6:2-5.

Table 3-5: Load Required to Fracture Teeth

Group Load
Mean ~ [) \ SD
No Cavity 530 lq: If'~ ~ ) 119.3
(238 .5) 1 (53 .7)
1/4 rCD / MOD 33 4 115 .6

1/ 4 rCD / OCC

1/3 rCD / MOD

(1 50 .3)
333
(1 49 .9)
2 16
(52)
112.4
(5 0 .6 )
62.8
}
1/3 rCD / OCC

} Joins Pairs that are not significa ntly diff erent .

(97 .2)
2 13
(95 .9 )
(28. 3)
66
(30)
}

Figure 3-25: Text Goe s Here

Conclusion

The width of the occlusal portion of a preparation affects the strength.

77
CRACKED TOOTH SYNDROME

Reference
Premolar Cuspal Flexure as a Function of Restorative Material and Occlusal Contact
Location
Magne P, Oganesyan T

Quintessence Int 200 9;40:363-370.

Figure 3~27: Congruent STL parts of enamel and enti n res ultin g fr om Boole an intersecti on s
and subt ract ions between the ori gi nal enamel/dentin STLs and different CAD inserts . The
finai model of the to oth is an assembly of 4 different parts . Different material properties can
be attributed to the dent in an d ena mel inserts, resulting in 3 possible models, ie, the natu ral
t oot h (NAT), MOD porcelain restoration (CER), and MOD composite re sin restoration (CPR).

Figure 3-29: : Possib le ball Figure 3-30: Load protoco an configu ration as
contacts during loading. (E) seen in Mentat, ie, a nonlinear contact an alysi s
Enamel contacts with la rge, between a r igid body ( sphe re moving al ong
Figure 3-28: Cusp widening 9,S -mm ball ; ( M) contacts at
Z-axi s against the tooth) and a deformable tooth.
re sults. Force generated by the r est oration marg in with the
The widening of the cusp s (IN) was calculated
load sphere in newtons versus medium, 6 .S-mm ball; ® cont act s
from the output values of di splacement along the
cuspal widening in millimeters for in resto rati ve material with small ,
each exp erimental de sign. 4 .S-mm bail.
Y-axts for selected nodes near the cusp tip.

Figure 3-31: Buccolingual cross-section views of the first pr incipai stress di stribution in 5 of the 9 models studied
(load in crement close t to 100 N) .

Conclusion
These models revealed high cuspal strains associated with mesio-occlusodistal preparations
and restorations compared to individual two-surface preparations. Whenever possible during
removal of interdental decay, an intact marginal ridge should be maintained to avoid three­
surface preparations such as the mesio-occlusodistal.

78
 Reference
A Compariso of Various Preparation Designs for Adhesively Retained Posterior
Ceramic onl,lys .
Kois DE. .

Presented in part at the Annual SCientific Meeting ofthe Am erican Academy ofRest orative Dentistry.

February 201@, Chicago, l/linois.

1. k ey Tooth Preparation Design Elements

Figure 6-57: A & B:

(Optiral) .

A & B: Mechani cal - Positive Seat.

A
B --
~' .

205
TOOTH PREPARATION ICONCERNS- POSTERIOR

Adhesively Retained

Figure 4-3: ~reparatio n design for MOD Figu re 4-4: Preparation desig n for MOD gold
gold onlay : occtusat View . onlay: Proximal View.
I

Figure 4-5: Prreparation design for 2mm TI. Figure 4-6: TPreparatio n design for 2mm TIl VNR.
I

jFig u r e 4-7 : Preparat ion des ign for 4mm TT tigure 4 -8: Preparat ion desig n for 4mm TTl VNR.

100 10{l
c­ o
E g {) i. 80
t e
1;;
~~ 6{) III 60
(l,[Y) -~
III[Y)
o!
00 U o!
-.0. 40 00 4Q
-.0.
j! ~ J! ~:J
g, ::J 20 20
U
u= ::;a­
oLf u­
L.

lJ
0
0-
.
-r'f.
o
lJ
IJ

E f::o.->
E
::J
z (? :J
Z

prJ!paration Design Pre paration Design

Figure 4-9: Mean and 5 Iof pr eli mi nary failure cycle Figure 4 -10: Mean and SD of catas trophic failure cyc le
coun ts xl 03). counts ( xl 03) .

96
 T O OTH PREPARATION C O NC ER NS- POSTERIOR

E
.s 1.5
~
'c"
~
u
~ 1.0
no
c
Q2
a;
E 0.5
'"c
I.IJ

0.0
2mmTT 2mmTT/V NR 4m mTT 4mmTT/VNR

Preparation Design

Figure 4-11: Enamel ring thickness in relation to

preparati on design distributed by statistical categ ories.
Different letters represent significant differen ces identified
by Tukey test for enamel ring th ickness (P<.05).

Conclusion
1. Preparation design had a significant (P <.05) effect on number of cycles to preliminary
and complete failure for posterior adhesively retained ceramic onlays.
~.

2. The 4 mm occlusal reduction experimental onlays (4 mmTT, 4 mmTT/ VNR) displayed

a statistically significant lower number of cycles to failure than all other groups.

3. In all ceramic onlay groups, the buccal veneer component made no statistically significant
difference.

4. Catastrophic (ceramic fracture) failures occurred only in the 4 mm vertical reduction

experimental groups (4 mmTT, 4 mmTT/VNR).

5. A significant (P < .05) difference in enamel ring thickness was revealed between 2 nun
and 4 mm occlusal reductions.

Clinical Implications
When vertical posterior tooth preparation depth minimizes enamel ring thickness « 1 mm)
and involves compromised dentin structure, adhesively retained restorative solutions are not
recommended. t

t
" ~
.c. I) fL P,
', - ~ IU
~,I lr
U <. '

97
 TOOTH PREPARATION CONCER s- POSTERIOR

Reference
Marginal Quality and Fracture Strength of Root-Canal Treated Mandibular Molars with
Overlay Restorations after Thermocycling and Mechanical Loading
Dere M, Ozcan M, Gohring TN.

J Adhes Dent 2010; 12:287-94.

Group n Initial Crack Loads to Failure (N) Total Failure Failure Characteristics .
Mean ± Mean ±
so Significance* Sp Significance* Minimum Maximum Reparable Catastrophic

1362 ± 304 '8 ±

UTR 8 DE 1859 4298 8
821 B 905
I
RCT- 8 1942 ± AB 2770 ±
CD 2264 3648 8
COM 699 457

RCT-FRC 8 2~;62 ± A 3651~ ± E 2964 4598 4 4

RCT-CER 8 1800 ± AB 203 k ± AC 1597 2630 8

277 3 ~9
*No statistical significant differences were found in' groups with the same letters ( P < 0.05).

RCT.Cl!R
Fn ",tu te Mode~ Mod e I n

Mo~ 1
!'lll PO;" ~CI,,1 (:< j ~ r;-:;-";lpl n a :z Q

Mode :z
C¢mpla: n ll ~ fl-"..h'" p l n G :z 0

MoDe J
~'~rti :;;, 1 actUle alurlQ the
tl)c:...-r O ~ t.;' R ~ I"'-' mrfne\,
.. --- WJ 1c

Conclusion
Composite resin restorations (Class ]1 cavities) with and without glass-fiber reinforcement
performed similar to intact teeth. FAilure types, however, varied between the restorative
materials. While intact teeth failed dXclusivelY in reparable modes, all other restorations
(except for half of the fiber reinforcedI composite group) failed in a catastrophic maimer.
I

99