Dental Materials (2004) 20, 554–564

http://www.intl.elsevierhealth.com/journals/dema

Residual shrinkage stress distributions

in molars after composite restoration
Antheunis Versluisa,*, Daranee Tantbirojnb, Maria R. Pintadoa,
Ralph DeLonga, William H. Douglasa

a
Department of Oral Science, Minnesota Dental Research Center for Biomaterials and Biomechanics,
University of Minnesota, 16-212 Moos Tower, 515 Delaware Street SE, Minneapolis, MN 55455, USA
b
Department of Operative Dentistry, Chulalongkorn University, Bangkok, Thailand

Received 3 December 2002; received in revised form 16 May 2003; accepted 29 May 2003

KEYWORDS Summary Objective. Experimental measurements on various restoration configur-

Restorative composite;
Polymerization
shrinkage; Strain gauge;
Microhardness; Post-gel
shrinkage; Composite
restoration; Shrinkage
stress; Residual stress;
Deformation
ations have shown that restored teeth deform under the influence of polymerization
shrinkage, but actual residual stresses could not be determined. The purpose of this
study was to calculate and validate shrinkage stresses associated with the reported
tooth deformations.
Methods. Three different restoration configurations were applied in a finite element
model of a molar. The composite properties were based on experimentally determined
composite behavior during polymerization. The occlusal deformation pattern and the
residual stress states of the tooth, restoration, and tooth-restoration interface were
calculated using a polymerization model based on the post-gel shrinkage concept.
Reported strain gauge measurements and occlusal deformation patterns were used for
validation.
Results. The shrinkage stresses depended on the configuration and size of the
restorations. The tooth’s resistance against polymerization shrinkage diminished with
loss of dental hard tissue. Larger restorations resulted in lower stress levels in the
restoration and tooth-restoration interface, but increased stresses in the tooth. The
maximum stress values found for different configurations were not decisively
different.
Significance. The validated model indicated that shrinkage stress cannot be based on
composite properties or restoration configuration alone, but has to be approached as a
distributed pattern that depends on the location and on the properties of tooth and
restoration, geometry, constraints, and restoration procedures. Tooth deformation
was indicative of stresses in the tooth rather than in the restoration or across the
tooth-restoration interface.
Q 2003 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Introduction

*Corresponding author. Tel.: þ1-612-625-0950; fax: þ 1-612- It is widely accepted that polymerization shrinkage
626-1484. of current restorative composites cause residual
E-mail address: antheun@umn.edu stresses in restored teeth. These stresses are called

0109-5641/$ - see front matter Q 2003 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.dental.2003.05.007
Residual shrinkage stress distributions in molars after composite restoration
residual because after curing a restored tooth is
left under stress even when there is no functional
loading. The presence of residual stresses results in
a changed behavior of the restored tooth, which
may become evident in its clinical performance.
Clinical symptoms associated with residual shrink-
age stresses are inadequate adaptation, microcrack
propagation, marginal loss, post-operative sensi-
tivity, microleakage, and secondary caries.1 – 5
Stress is not a material property, but a local
physical state that is derived from the combination
of material properties, geometry, boundary con-
ditions, and history. Since residual shrinkage stress
is not a straightforward property that can be
measured directly, its quantification in restorations
remains a source of controversy. Various methods
have been used to estimate residual shrinkage
stresses, ranging from extrapolated shrinkage or
load measurements in vitro to stress analyses in
tooth shaped anatomies using photoelastic or finite
element methods.6,7 Calculation of shrinkage stres-
ses in a tooth-restoration complex is not trivial. One
challenge is the description of the sequence of
changes that take place in composite during
polymerization. Another challenge is that stress
depends on the geometry and mechanical proper-
ties of surrounding tissues.
Many intricacies of the biomechanical manifes-
tations of polymerization processes are still not
well understood. As a result the development of a
residual shrinkage stress model (i.e. the expression
of our understanding of the event) is an interactive
Figure 1 Cuspal deformation patterns (mm) for a molar determined in in vitro experiments for four consecutive
restorations (Class I, small Class II OM, large Class II OM, and Class II MOD) using Cumulus software.8
555
process with experimental observations. Defor-
mation patterns of occlusal surfaces for restored
molars due to shrinkage stresses have been deter-
mined and observed in a series of experiments.8
While deformation could be measured experimen-
tally, the stress distribution must still be calculated
using transient composite properties determined
from another series of experiments.9 The purpose
of this study was to develop and validate a
polymerization model for the calculation of
residual shrinkage stress distributions associated
with the reported deformations, using the deter-
mined transient properties distributions. The vali-
dated model can consequently be used to
investigate the shrinkage stresses in restored
teeth, and study factors that affect them.
Material and methods
Deformations of occlusal surfaces have been
reported for a successive range of cavity prep-
arations in extracted human molars:8 Class I, small
Class II OM, large Class II OM, and Class II MOD. The
deformation due to polymerization shrinkage was
quantified by comparing the digitized occlusal
surfaces before and after restoration (Fig. 1). To
calculate corresponding residual stresses in the
tooth, a finite element simulation was carried out
for a similar combination of geometry, boundary
conditions, material properties, and restoration
procedures (history).
556
Figure 2 Finite element model of molar, indicating four simulated restorations (Class I, small Class II OM, large Class II
OM, and Class II MOD), increments, and the direction of light curing (black arrows).
Four consecutive restorations were applied in a
finite element model of a molar: Class I, small Class
II OM, large Class II OM, and Class II MOD (Fig. 2).
Additionally, a large Class I and small Class II MOD
were created. The external molar shape was
digitized using a contact stylus profilometer,10
while the internal enamel – dentin and pulp surfaces
were estimated based on general anatomy. The
molar root was fixed, simulating the embedded
specimens of the corresponding experimental
design.8
Orthotropic elastic properties were modeled for
the enamel. The elastic moduli were 84 GPa
(principal direction, perpendicular to the pulp
surface) and 42 GPa, with a Poisson’s ratio of
0.30. The dentin elastic modulus was 18 GPa, with
a Poisson’s ratio of 0.23. The composite properties
used were based on experimental data9 obtained
for Z100 Incisal shade (Lot 6BN, 3M ESPE, St Paul,
MN, USA), the same as used for the companion
study.8 Z100 is a commercially available universal
restorative composite, containing bisGMA and
TEGDMA resins with zirconia/silica fillers (66%
inorganic filler loading by volume, particle size
range of 3.5 – 0.01 mm). The relatively translucent
composite was chosen to obtain good light pen-
etration in the large restorations. The maximum
elastic modulus and Poisson’s ratio for a fully cured
composite were 20 GPa and 0.24, respectively.
In this study a linear-elastic approach was
validated for the simulation of residual shrinkage
A. Versluis et al.
stress development. A linear elastic approach
allows a significant reduction of the stress calcu-
lation time, while the required properties that have
to be determined are reduced to the elastic
modulus and post-gel shrinkage. Both properties
depend on the curing light intensity, exposure time,
and storage time. In order to apply the properties in
the finite element analysis, they have to be
expressed in mathematical forms. The local light
intensity I in the restoration was approximated
using the light intensity of the curing light source,
the effect on the light intensity due to the distance
between the restoration and light guide, and the
exponential relationship for light attenuation in the
composite9
I ¼ I0 exp½2ðw=10Þ3 exp½21:19d 0:72  ð1Þ
where I0 is the light intensity of the curing light
source (mW/cm2); w is the distance from light-
guide to the restoration surface (mm); d is the
depth in the composite (mm). In each composite
element integration point (where stresses are
determined by the finite element software) local
properties were calculated as a function of local
light intensity and time (light exposure and dark
cure time). The reported correlation between
Knoop microhardness and elastic modulus11 can be
employed to calculate the local elastic modulus of
the composite as a function of light energy and
time. Local light energy density Y (mJ/cm2) is
Residual shrinkage stress distributions in molars after composite restoration
defined as12,13
Y ¼ Itc ð2Þ
where tc is the curing light exposure time (s). The
empirical relationship found for the microhardness
KMH is9
KMH¼ð66211exp½2t=3000Þð12exp½2ðY=2500Þ1:1 Þ
ð3Þ
where t is the total time since the start of curing (s).
The first term describes how the microhardness
values increase during the storage time t after light
cure. The second term describes the exponential
relationship between microhardness and light energy.
The local elastic modulus E can be obtained by
E ¼Emax KMH=KMHmax ð4Þ
where Emax is the maximum attainable elastic
modulus value (Emax ¼20 GPa), and KMHmax is the
maximum microhardness value used to normalize
KMH in Eq. (3) ðKMHmax ¼66Þ:
Post-gel shrinkage values were obtained by the
strain gauge method.9 Unlike microhardness, post-
gel shrinkage cannot be fully described by the
applied light energy because it depends on the light
intensity at which the polymerization reaction was
initiated. The maximum value for the post-gel
shrinkage amax can be expressed by the empirical
relationship ðR . 0:999Þ
amax ¼ 5000ð1 2 exp½2ðI0 =500Þ0:22 Þ ð5Þ
where I0 is the intensity of the light source with
which the polymerization was initially initiated
(mW/cm2). The polymerization process can be
divided into two periods: light exposure and dark
cure (after the light cure). Post-gel shrinkage
during ðalight Þ and after ðadark Þ light exposure can
be expressed by ðR . 0:97Þ
alight ¼ amax ð1 2 exp½2Y00:7 =ð450 þ 0:35I0 ÞÞ ð6Þ
adark ¼ amax ð8 þ 0:06I0 Þexp½2ðY0 =1:161Þ0:186 
 ð1 2 exp½2{Y0 =ð858 þ 4:1I0 Þ}1:5 Þ ð7Þ
where I0 is the light intensity of the light source at
which the composite polymerization is initiated
(mW/cm2), and Y0 is the applied light energy ðI0 tc Þ:
Note the difference between applied and local light
intensity or energy. The applied values are the output
of the curing light source. The post-gel shrinkage
value a determined by the strain gauge becomes:
a ¼ alight þ adark ð8Þ
Unlike the microhardness data, which were deter-
mined as local properties (Eq. (3)), the post-gel
shrinkage results were determined as bulk properties
557
(Eqs. (6) and (7)), using the intensity output of the
curing light source rather than local intensity levels.
A bulk property means that the acquired strain gauge
data represents the response of the whole sample.
Since post-gel shrinkage depends on the light
intensity and light intensity is location dependent,
the post-gel shrinkage also depends on the location.
Therefore, the bulk value for post-gel shrinkage
cannot be used in the finite element analysis.
Considering that the strain gauge records the local
deformation at the gauge surface, the post-gel
shrinkage results (Eqs. (6) and (7)) can be easily
adjusted by correction of the terms that contain the
light intensity
I0 ¼ FI ð9Þ
Y0 ¼ FItc ¼ FY ð10Þ
where F is the correction factor for the actual light
intensity at the gauge surface. Using the light
attenuation Eq. (1) the correction factor F is 6.1
(w ¼ 3 mm, d ¼ 1:75 mm). To validate the derived
elastic modulus and post-gel shrinkage formulations
the strain gauge design was also simulated in a finite
element analysis. The strain gauge configuration was
modeled by a 1.75 mm high composite sample placed
on an 80 mm thick strain gauge (elastic modulus 6 GPa
and Poisson’s ratio 0.3, manufacturer’s data) (Fig. 3).
Light curing from above (light guide positioned 3 mm
above composite sample) was simulated for the four
curing light intensities used in the experimental
setup9 (I0 ¼ 100; 300, 500, and 700 mW/cm2). The
plane strain in a 1 mm2 area at the center of the strain
gauge was recorded for validation with the exper-
imental shrinkage strain results.
In the restoration models, light cure was applied
occlusally to the composite restorations (188 off for
the proximal boxes) for 60 s per increment at
650 mW/cm2, mimicking the experimental study.8
The diameter of the simulated light guide was
12 mm. The Class II OM cavities were filled in two
increments, the Class II MOD in three (Fig. 2).
Figure 3 Finite element model of the strain gauge
experiment,9 showing the element distribution for the
quarter mesh.
558 A. Versluis et al.

Additionally, a large Class I and a small Class II MOD
were modeled. The time between increments was
60 s. It is important that the successive filling
increments are not part of the analysis before they
are placed. Eight-node isoparametric arbitrary
hexahedral reduced integration elements were
used. A custom program calculated and applied the
material property relationships for enamel and
composite, performed the restorative actions of
filling and light cure, defined and submitted the
restoration models to a finite element solver for
calculation of stresses (MSC.Marc, MSC Software
Co., Los Angeles, CA, USA), processed the results
and created a convenient output format. The
analyses were performed on a Compaq AlphaServer
ES40 (Compaq, Houston, TX, USA).
Modified von Mises equivalent stresses were used
to express the stress conditions. The advantage of
using equivalent von Mises stress is that a multi-
dimensional stress distribution (e.g. six Cartesian
stress components or three principal stresses) is
expressed into one value, which eases the interpret-
ation of the overall stress condition. The used
equivalent stress is based on the well-known von
Mises formulation, modified to take into account the
difference between compressive and tensile
strength for enamel, dentin, and the composite.14
Since cuspal deflection is often reported for in vitro
studies, the inter-cuspal distance change were
determined for the mesial and distal cusp pairs.
The calculated occlusal deformations were com-
pared with the experimentally determined occlusal
deformation8 (Fig. 1), using a locally developed new
generation software package (Cumulus, copyright
Regents of the University of Minnesota). Surface
changes in Cumulus are determined perpendicular to
the baseline surface taken before restoration. In
order to import the finite element geometry in
Cumulus, the before and after surfaces were
isolated, refined and converted to object file format
(Alias Wavefront Object Files). From the dense
surface point-clouds, Cumulus created rendered
surfaces. Differences between the before and after
occlusal enamel surfaces were determined and
visualized using a linear color scale. The quantitative
color patterns were used to compare the experimen-
tal and finite element results. Cusp displacements
(bucco-lingual direction) were determined to be
compared with values reported in the literature.
Results
To validate the polymerization modeling pro-
cedures, deformation was calculated in two finite
element simulations (strain gauge simulation and
occlusal deformation of a tooth crown), using the
equations for light intensity, elastic modulus, and
post-gel shrinkage derived from experimental data.
The response of the strain gauge is not solely
caused by post-gel shrinkage, but also by develop-
ment of elastic modulus and distribution of
properties due to the light attenuation in the
composite. Results (microstrain) of the experimen-
tal data9 were compared with the results obtained by
the finite element simulation (Table 1). The table

Table 1 Comparison of shrinkage strains measured by the strain gauge experiments9 (mean and standard deviation; n ¼ 5) and
calculated by the numerical polymerization simulation of the strain gauge setup.

Light intensity, I0 (mW/cm2) Exposure time, tc (s) Light energy, Y0 (mJ/cm2) Shrinkage strain (mstrain)

Experimental Finite element analysis

100 10 1000 451(89) 865

100 20 2000 1227(31) 1315
100 40 4000 1703(16) 1693
100 60 6000 1844(40) 1926
300 10 3000 1825(60) 1962
300 20 6000 2280(65) 2283
300 40 12,000 2560(75) 2606
300 60 18,000 2641(49) 2777
500 10 5000 2224(95) 2433
500 20 10,000 2664(69) 2665
500 40 20,000 2849(68) 2941
500 60 30,000 2907(73) 3077
700 10 7000 2602(80) 2684
700 20 14,000 2889(86) 2868
700 40 28,000 3060(44) 3122
700 60 42,000 3136(81) 3241

The results were determined 2 min after polymerization for different combinations of light intensities ðI0 Þ and light exposure times ðtc Þ:
Residual shrinkage stress distributions in molars after composite restoration
Figure 4 Cuspal deformation patterns (mm) for the simulated molar for four restorations (Class I, small Class II OM,
large Class II OM, and Class II MOD) using the numerical polymerization model and Cumulus software.
shows a good agreement between the experimental
and finite element data.
Applying the material relationships to a tooth
model, the occlusal deformations were calculated
and visualized by color coding (Fig. 4) for compari-
son with the experimental results (Fig. 1) using the
Cumulus software. Positive values are defined as
higher surfaces, and negative values indicate lower
surfaces compared to the baseline. The defor-
mation pattern and values were similar in magni-
tude and distribution to the results found by the
experimental method. The finite element analysis
calculated occlusal deformation lower than 10 mm
for the smallest restoration (Class I), and increased
deformation with increasing restoration size, up to
20 mm for the Class II MOD.
The calculated inter-cuspal distance changes
(mean value of mesial and distal cusp pairs) were
5.3, 27.1 (10.1 distal), 46.8 (16.0 distal), and
45.5 mm for the Class I, Class II OM (small), Class II
OM (large), and Class II MOD restorations, respect-
ively. Note that in the OM-configurations the values
for the distal cusps are given separately because
the inter-cuspal distance changes were much
smaller between the distal cusps compared with
the mesial cusps. The cuspal deflections for the
large Class I and small Class II MOD were 10.8 and
25.5 mm, respectively.
Residual stress distributions (modified von Mises
equivalent stresses) at the tooth surfaces were
visualized for four configurations using a linear
559
color scale to indicate their intensity (Fig. 5).
The restorations were rendered invisible to view
the tooth-restoration interface. Note that the
shown interfacial stresses are extrapolated across
the tooth-restoration interface. The distributions
show areas of high stress concentrations (yellow)
and low stress areas (blue). The color patterns
illustrate that stress values were local conditions.
In general, the Class I restoration showed a larger
area of high stresses at the tooth-restoration
interface than the Class IIs. However, the Class II
MOD showed higher stresses in the enamel surfaces
than the other restorations.
The residual stresses inside the tooth, compo-
site, and along the tooth-composite interface were
also plotted in distribution graphs that visualize all
stresses (Fig. 6). These graphs plot the total range
of internal stresses (modified von Mises equivalent
stresses), ranked in ascending order, for all restor-
ation variations. Note that the graphs do not
contain information about local stress patterns.
The ratio between bonded and free surfaces are
also indicated in the figure. The graphs show that in
general the stress level in the tooth (enamel and
dentin) is the highest for the Class II MODs, followed
by the Class II OMs, while the lowest overall stress
level in the tooth was found for the Class I
restoration (Fig. 6A). The order is reversed if
general stress levels in the restoration or along
the tooth-restoration interface are considered
(Fig. 6B and C).
560 A. Versluis et al.

Figure 5 Residual shrinkage stress distributions (modified von Mises equivalent stresses) for the four restorations
(Class I, small Class II OM, large Class II OM, and Class II MOD) calculated by the numerical polymerization model. To show
the tooth-restoration interface, the restoration was rendered invisible.

Discussion symptoms such as microfracture, microleakage and

The large number of publications about polymeriz-
ation shrinkage of restorative composites indicates
that it is still considered a serious clinical concern.
Shrinkage stress has been associated with clinical
post-operative sensitivity. None of these symp-
toms, however, are direct measures of shrinkage
stress. The alleged presence of shrinkage stresses is
thus only known through indirect manifestations.
One of them, tooth deformation, is often not

Figure 6 Stress distribution plots representing all internal stresses (modified von Mises equivalent stresses) ranked in
ascending order in: (A) the tooth, (B) the restoration, and (C) the tooth-restoration interface. The stresses are displayed
for two restoration sizes (small and large) of three configurations (Class I, Class II OM, and Class II MOD). The ratios
between bonded and free restoration surfaces are listed.
Residual shrinkage stress distributions in molars after composite restoration
specified among the clinical concerns, possibly
because it is too small to be perceived under
normal clinical conditions. It is well accepted,
however, that teeth deform under loads.15 Among
all clinical symptoms, deformation offers the
closest relationship with shrinkage stresses. Fur-
thermore, deformation can be quantified, unlike
many of the other symptoms that remain substan-
tially subjective. Deformation in teeth is often
quantified by measuring the flexure of cusps.16 – 20
Cusp flexure indicates the deformation at particular
locations on the tooth crown. It has been shown,
however, that cusp flexure may not be a reliable
indication of actual shrinkage stress levels.21 As
part of this study the complete pattern of occlusal
tooth deformations were measured and visualized
(Fig. 1)8 The deformation patterns registered how a
total crown deforms for different restoration
configurations. However, the expectation fueled
by dental literature that Class I configurations have
higher stresses than Class IIs seems to be reversed if
residual stresses are correlated directly with the
tooth deformation.
Obviously, there is more to the assessment of
residual shrinkage stresses in restored teeth than
simply measuring deformation on a restored tooth
(let alone extrapolation of stress conditions from
simplified laboratory specimens). Stress is a physi-
cal condition which depends on the combination of
all material properties involved, geometry, and
boundary conditions. The interactions between
them obey universal mechanical laws. Unfortu-
nately, shrinkage stress considerations have thus
become much more complicated because they must
involve comprehensive computations. Residual
stresses can be studied using finite element
analysis, which is a widely used contemporary
computational technique.22 Finite element analysis
provides the framework to combine material
properties, with geometry and boundary conditions
according to universal mechanical laws. Using
computational techniques is not merely an option,
but has become inevitable to express and test our
current insight of dental materials behavior. This
contemporary modeling approach also has conse-
quences for the design of experimental studies.
Supporting experiments can be divided into two
categories (as demonstrated by the design of this
study): experimental determination of basic prop-
erties9 and experimental simulation for model
validation.8 Basic property experiments are used
to obtain material behavior relationships required
in a computational model, such as elastic modulus
and post-gel shrinkage in the current study. They
often have to be determined as theoretical or
empirical functions of their controlling factors,
561
such as time. Simulation experiments do not
determine single properties but rather a bulk
response that incorporates the interaction between
various basic properties, such as the deformation of
a restored tooth which involves the interaction
between dental tissues and restorative properties,
anatomy, fixation, and restorative sequence.
One of the complexities for understanding (and
thus modeling) polymerization shrinkage is knowing
what exactly happens to the mechanical properties
during polymerization. The realization that not all
shrinkage contributes to shrinkage stresses is
fundamental. The concept of pre- and post-gel
shrinkage or time-dependent viscosity was noted by
Bowen in one of the earliest publications about
silica-reinforced polymer properties.23 Although
this concept has thus been known in restorative
dentistry since the first introduction of composites,
its consequences are only recently gaining more
recognition. This may be explained by the increas-
ing acceptance of polymerization stress modeling
and because of observations that polymerization
kinetics affect post-gel shrinkage and bulk stresses.
The post-gel concept is based on a division of the
total shrinkage into a component that does not
cause stress development due to relief by viscous
flow (pre-gel), and a component that causes stress
development due to elastic storage of contraction
deformation (post-gel). From a physical point of
view, polymerization is a process of simultaneous
resin densification and composite modulus change.
The time-dependent relationship between contrac-
tion on the one hand and the viscous (loss) and
elastic (storage) modulus on the other hand
determines the potential contribution of the com-
posite properties for the generation of residual
shrinkage stresses. For the tooth model used in this
study, the calculation using a time-dependent
viscoelastic model proved prohibitively time-con-
suming for current hardware specifications because
of the large number of time-steps required to
manage the distributed time-dependent nonlinear
property changes. Using the post-gel concept,
however, allowed for shrinkage stresses and tooth
deformations to be approached in a linear elastic
analysis. A linear elastic analysis requires consider-
ably less time-steps, and thus a significantly
reduced solver time. The validity of the linear
elastic approach was supported by the good agree-
ment between numerical and experimental results.
The shrinkage stress model was experimentally
validated by the results of the strain gauge and the
restored molar. At first sight, the strain gauge
experiments9 may not seem an independent vali-
dation, since they also provided the data on which
the used post-gel shrinkage relationship was based.
562
However, the shrinkage model also contained light
attenuation and elastic modulus equations. These
were derived from different experiments, and were
combined with the post-gel shrinkage in the
numerical polymerization model. The very close
results of the measured and calculated strains not
only validated the numerical polymerization model,
they also indicated that the experimental strain
gauge data actually represented local strain values
at the gauge surface (Table 1). This is an important
observation because it supports the notion that,
when corrected for the local light intensity at the
gauge surface, the strain gauge measures post-gel
shrinkage as a local rather than a bulk value as was
initially presumed.
The calculated tooth deformations (Fig. 4) also
compared well in patterns and magnitudes with the
experimentally determined deformations (Fig. 1).
Deformation can be defined in different ways. In
order to ensure identical definition and measure-
ment for the numerical and experimental
approaches, the deformation for both was quanti-
fied using the same software (Cumulus). Addition-
ally, the calculated cuspal flexure data was in the
same range as has been reported in the literature
(16 – 45 mm).16 – 20 An important conclusion that can
be drawn from the positive validation of the
numerical polymerization model is that post-gel
shrinkage must be used to calculate residual
shrinkage stresses (and deformations) rather than
total shrinkage. Using total shrinkage values,
typically about five to ten times higher than post-
gel shrinkage, would have grossly overestimated
the stresses (and deformations).21 Consequently,
shrinkage stress cannot be approximated from
shrinkage that is determined by displaced volume
or weight methods. Since a correlation between
post-gel and total shrinkage is improbable (post-gel
shrinkage depends mainly on reaction kinetics),
total shrinkage values are unsuitable for qualitative
shrinkage stress estimations (e.g. in shrinkage
properties rankings). Note that it is not our
intention to nullify the value of total shrinkage
measurements. For example, total shrinkage plays
a decisive role in the direction of shrinkage;24
however, total shrinkage does not reflect shrinkage
stress expectations.
Strictly speaking, post-gel shrinkage cannot be
extrapolated to predict shrinkage stresses either.
As discussed before, stress is not a material
property. The stresses that were calculated by the
shrinkage model were the result of the combination
of all properties (tooth and restoration), the whole
anatomy (tooth and restoration), all boundary
conditions (root and interfaces), and the complete
restoration history (each incremental filling and
A. Versluis et al.
polymerization action). Considering that each of
these conditions affected the final stress and
deformation pattern, it is unrealistic to expect an
exact fit between the finite element model and the
experiments. For example, although in both cases a
mandibular molar was used, their shapes were not
exactly identical. Note that this is not a finite
element versus ‘reality’ issue, because the five
molars investigated in the experiments were not
exactly identical either. Other factors that could
have caused variations in the results were the
enamel and dentin distribution, the properties for
the dental tissues, the shape of the cavities, the
applied light intensity, the exact distance between
light guide and restoration during curing, etc.
Taking into consideration the inherent variation in
experiments, validation is successfully achieved
when a general similarity in deformation patterns
and deformation values is demonstrated.
The goal of polymerization shrinkage research is
to understand and predict the development of
residual shrinkage stresses. The calculated defor-
mation was caused by residual stresses predicted by
the numerical polymerization model. Having vali-
dated the deformation, the calculated stress
distributions associated with them can be con-
sidered validated too. It was found that the stress
levels in the tooth increased with increasing
restoration size, while stresses in the restoration
and along the tooth-restoration interface decrease
(Figs. 5 and 6). This result can be explained by the
increasing loss of dental hard tissues for increasing
restoration sizes. Removal of dental hard tissue
decreases the stiffness of the tooth. Residual
shrinkage stresses are caused by the resistance of
the tooth structure to shrinkage deformation of the
bonded restoration. Therefore, a decreased stiff-
ness of the supporting tooth structure decreases
residual stresses in the restoration and tooth-
restoration interface. However, it also results in
more tooth deformation and consequently higher
stresses in the tooth. Deformation measurements of
the tooth crown are therefore more indicative of
residual stresses in the tooth structure than
of shrinkage stresses in the composite restoration
or across their interfaces. Note that the stresses at
the enamel surfaces and the stresses across the
tooth-restoration interface should not be compared
with each other in absolute terms, since they
involve different materials. Furthermore, the inter-
facial stress values were extrapolated across the
tooth-restoration interface. Since the bonding layer
has not been modeled separately, the interfacial
stresses should only be viewed as a qualitative
indication of an interfacial stress distribution that a
bonding layer would encounter.
Residual shrinkage stress distributions in molars after composite restoration
Areas of high stresses are at a higher risk for
failure. Although the overall stress level along the
tooth-restoration interface was generally higher for
the Class I configuration, the maximum stresses of
the other configurations approached or met the
maximum stress values of the Class I (Fig. 6). When
composites were introduced, Bowen25 predicted
that restoration type will affect the resulting stress
levels. He noted that cavities with a large free
surface in proportion to bonded cavity walls would
develop stresses of lower magnitudes. The current
study confirms Bowen’s early observation as a
general rule-of-thumb for the stress state in the
composite and the tooth-restoration interface.
However, extrapolation of the ratio between
bonded and free surfaces as a prediction for
shrinkage stresses, as has been proposed by others,
cannot hold, even for stress levels in the restoration
and across the interface. Fig. 6 shows that the ratio
between bonded and free surface areas does not
consistently predict the stress levels. For example
(Fig. 6C), the small versus large Class I restorations
with almost identical ratios show large differences in
the interfacial stress levels. Moreover, the bonded-
free surface ratio of the large Class I is much higher
than the ratio for the Class II OM, but their interfacial
stress levels are similar. A last example is the large
Class II OM, which although it has a higher bonded-
free surface ratio than the small Class II MOD, seems
to have higher overall interfacial stress levels.
The validated residual shrinkage stress distri-
butions that were determined in this study confirm
that stress is a local property, which within one
restored tooth may have high values in one location
and low values in another. Shrinkage stresses cannot
be captured by single values, such as cusp flexure or
restoration configuration, but must be studied as a
location dependent distribution that takes the
whole restored tooth into consideration. In the
introduction, various clinical symptoms were listed
that have been associated with shrinkage stresses.
Those symptoms also involve all aspects of the
restored tooth, i.e. the restoration (marginal loss),
the interface (adaptation, microleakage, secondary
caries), and the tooth structure (propagation of
enamel microcracks, post-operative sensitivity).
Any discussion of residual shrinkage stresses should,
therefore, involve the whole tooth, not just the
composite restoration or composite properties.
Conclusions
This study used deformation patterns—measured
experimentally—to validate a biomechanical
563
shrinkage model that was based on experimental
polymerization data. Although more has to be done
to unravel remaining less-understood polymeriz-
ation sequences, the current study confirmed the
validity of a linear elastic approach based on the
post-gel shrinkage concept for the calculation of
residual stresses in a restored tooth. It was shown
that tooth deformation indicated the stress levels in
the tooth, rather than in the restoration. Shrinkage
stress could not be expressed into a single average
value based on composite properties or restoration
configuration alone, but had to be approached as a
distribution that depended on the location and
properties of the tooth and restoration, tooth and
restoration geometry, tooth and restoration fix-
ture, and the consecutive restorative procedures.
Acknowledgements
Based in part on abstract No. 498, presented at the
80th IADR meeting in San Diego, March 6 –9, 2002.
The authors thank Iryna B. Olson for her assistance
with the Cumulus analysis. This study was supported
by the Minnesota Dental Research Center for
Biomaterials and Biomechanics, a Faculty Develop-
ment Grant from Chulalongkorn University, and
NIH/NIDR Grant R01-DE12225.
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