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Endodontic Topics 2012, 20, 30–51 2012 © John Wiley & Sons A/S
All rights reserved ENDODONTIC TOPICS 2012
1601-1538

Microstructure and mechanical

behavior of radicular and
coronal dentin
DWAYNE AROLA, JULIANA IVANCIK, HESSAM MAJD, ASHRAF FOUAD,
DEVENDRA BAJAJ, XIU-YIN ZHANG & NAOMI EIDELMAN

Fracture of root-filled teeth is not uncommon and appears to be a complex function of both the treatment and
the patient’s oral regimen. However, there have been few studies aimed at understanding the intrinsic mechanical
behavior of dentin and its relevance to the incidence of these fractures. In addition, there has been some
controversy over whether the fracture of root-filled teeth is attributed primarily to loss of tooth structure or if there
are other contributing factors. A comprehensive understanding of the structure and mechanical behavior of dentin
is of substantial importance to the success of endodontic therapy. Specifically, the importance of fatigue on tooth
fractures and the resistance of tissues to both the initiation and propagation of cracks have received scant attention.
As well, regional variations in these properties and the contribution of changes in microstructure to the fatigue and
fracture behavior are not well understood. This article reviews the importance of microstructure on the mechanical
behavior of dentin and compares the mechanical properties of tissue from the root and crown. Also, the changes
in microstructure with aging are discussed as well as their importance to the incidence of tooth fracture.

Received 29 July 2010; accepted 10 August 2011.

Introduction attention. In comparison to the interest in endodontic

Cracked teeth and vertical root fractures are major
clinical problems that may lead to tooth loss. Teeth
with a history of endodontic treatment are prone to
subgingival fractures, especially vertical root fractures
(VRF) (1). While this mode of failure has been
reported to be limited to less than 1% of endodonti-
cally treated teeth that could be followed (2), the exact
number is unknown as many patients with VRF do not
report back to the endodontic provider and eventually
have the tooth extracted elsewhere. In response to this
problem, substantial efforts have been made to evalu-
ate the changes in the structural behavior of pulpless
teeth. For example, the importance of preserving
tooth structure (3,4), the changes in stiffness and/or
strength associated with bonding and different restora-
tive materials (5,6,7), and the benefits of different post
and core systems (8,9) have received considerable
techniques and materials and their effects on the integ-
rity of the remaining tooth structure, very limited
emphasis has been placed on understanding the impor-
tance of regional variations and/or changes in the
mechanical behavior of dentin itself with respect to the
incidence of fractures.
The failure of root-filled teeth by fracture depends
primarily on two factors, namely (a) the magnitude of
stress experienced by the tooth, which is directly
related to the remaining tooth structure and the
patient’s oral function, and (b) the inherent mechani-
cal properties of the remaining tissue responsible for
resisting fracture. Endodontically treated teeth have
generally been considered to be more susceptible to
fracture than unrestored or conservatively restored
teeth because of loss of tooth structure and the corre-
sponding increase in stress. Indeed, there is evidence
that the probability of root fracture increases as

30
 Mechanical behavior of radicular dentin

the dentin thickness decreases via instrumentation a

(10,11). Laboratory studies have established the
importance of the instrumentation process and the
loss of tooth structure on tooth stability. For example,
Lang et al. (12) noted that all endodontic treatment
involving the removal of hard tissue from the canal
increased the deformability of the root and caused a
reduction in the stability of the tooth. Post prepara-
tions resulted in the most substantial reductions in
stability (i.e. increases in deformability), in particular
those requiring shaping of the canal for parallel-sided
posts. For teeth requiring endodontic treatment that
may also warrant the placement of a direct restoration, b
the degree of cuspal deflection and tooth strain has
been found to increase significantly with the loss of
axial dentin (13). One nearly universal outcome of
these studies is the recommendation for conservative
endodontic access [e.g. (14,15)]. However, there are
convincing results from a finite element study that,
while loss of tooth structure may result in lower sta-
bility, the removal of dentin does not always cause an
increased susceptibility to root fracture (16). These
important but essentially conflicting findings suggest
that there could be other contributing factors related
to the incidence of tooth fracture following endodon- Fig. 1. Examples of vertical root fractures in a bucco-
tic treatment. lingual orientation. Both teeth were loaded vertically by
an increasing force applied within the canal space
Experimental and clinical studies have both revealed
through a spreader tip. Note the faint evidence of scle-
that vertical root fractures occur predominantly in the rosis near the root surfaces in (a), and prominent evi-
bucco-lingual direction (17–20) where the dentin dence in (b). Fractures developed in the bucco-lingual
thickness is greatest. Figure 1 shows two examples of orientation despite the greater dentin thickness in this
root fractures with this characteristic. Due to the larger direction. (a) Cross-section of a mandibular incisor
(5 mm from the root apex). Reproduced with permis-
degree of “reinforcement” in regions of higher thick- sion from Lertchirakarn et al. (21). (b) Cross-section of
ness, this behavior seems counterintuitive. Yet con- a maxillary central incisor (4 mm from the root apex).
sidering canal shape, external root morphology, and Reproduced with permission from Lertchirakarn et al.
dentin thickness, finite element analyses of the stress (22). Scale rule at the bottom in each photo is in
millimeters.
distribution in root canals have demonstrated that the
magnitude of tensile stress induced by equi-distributed
internal canal pressure is largest in the bucco-lingual
direction (21,22). Finite element based investigations on the canal wall. Flaws of this type can facilitate
have proven useful in understanding the structural fracture under fatigue and/or as a result of cyclic crack
behavior of root-filled teeth and in performing para- growth. These components of mechanical behavior are
metric studies. However, one important limitation of relevant to the success of endodontic therapy and
past numerical studies (and numerical studies in warrant discussion.
general) is that they ignore the contribution of flaws There is an additional topic of relevance that has
introduced during the restorative process to the initia- largely been overlooked. Advancements in medicine
tion and growth of cracks in root-filled teeth under and an overall increase in the quality of life have
cyclic loading. Masticatory forces (23), mechanical resulted in far more healthy seniors in society today
instrumentation (11), obturation of the root canal than in the past (26). Oral health is of critical impor-
(24), or post placement (25) can produce craze lines tance to senior patients who wish to maintain a high

31
Arola et al.
quality of life (27). As a result, there is presently a
larger group of senior patients seeking oral health care.
That raises some important questions. How does
aging contribute to the mechanical properties of
dentin and the potential for tooth fracture in this
cohort of patients? Furthermore, are there age-related
differences in the degree of change between tissues of
the root and crown?
Here we review the mechanical behavior of dentin
and examine the mechanical properties of this tissue
that are relevant to fracture resistance. We review
studies on the behavior of coronal and radicular
dentin, concentrate on potential differences related to
the microstructure, and then address how aging con-
tributes to the mechanical properties and the poten-
tial for VRF. It is not the intent of this review to
focus on the changes in structural properties of teeth
following dental procedures. Rather, the primary
focus is on the contribution of either changes or vari-
ations in the microstructure of dentin to these struc-
tural properties.
Structure of dentin
Dentin is comprised of both organic and inorganic
components and is approximately 45% mineral, 33%
organic material (primarily type I collagen), and 22%
water by volume (28); this distribution is approximately
70% mineral, 20% organic material, and 10% water by
weight. On a microscopic scale, the most distinct
feature is the dentin tubules, which are a network of
microscopic tubules that extend almost radially
outward from the pulp toward the dentin–enamel junc-
tion (DEJ) and cementum–dentin junction (CDJ).
Each tubule is surrounded by a highly mineralized cuff
of apatite crystals known as the peritubular dentin (28).
The intertubular dentin occupies the region between
the tubules and consists of a collagen fibril mesh ori-
ented essentially perpendicular to the tubules and
bound by apatite crystallites (29,30). The collagen
fibrils have diameter of 50 to 100 nm whereas the
apatite crystals are approximately 5 nm thick and their
remaining dimensions are dependent on distance from
the pulp (needle-like at the pulp and plate-like at the
DEJ) (31). In recognition of this broad range of dimen-
sional scales, dentin is often described as exhibiting a
complex hierarchical structure (29).
Many characteristics of the tubules are important to
the structural behavior of dentin, its permeability, and
32
in achieving strong adhesive bonds. Of primary impor-
tance are the tubule density, tubule diameter, and
spatial variations in these measurements. In the crown,
the average density ranges from approximately 15,000
to 65,000 tubules to per mm2 (32–34). The tubule
diameter decreases from approximately 2.5 mm (near
the pulp) to less than 1 mm at the DEJ (e.g. Fig. 2a).
Mjör & Nordahl (35) compared the tubule density
and degree of branching within the crown and root of
human teeth. The mean density ranged from approxi-
mately 8,000 to 58,000 tubules/mm2 and the crown
exhibited significantly greater tubule density than the
root. Also, the number of fine tubule branches (0.3 to
0.7 mm diameter) was highest in the root, particularly
near the apices and in regions of low primary density.
In studies involving both bovine and human teeth,
both Schilke et al. (36) and Camargo et al. (37) inde-
pendently observed that radicular dentin exhibited
larger diameter tubules than the crown, but had a
lower density as evident in Figure 2b. Indeed, Koma-
bayashi et al. (38) reported a density of 14,000 to
32,000 tubules/mm2 1–2 mm below the cemento–
enamel junction of human canines, which is much
lower than equivalent measures in the crown; the
density effectively doubled from the outer wall (near
the periodontal ligament) to the region adjacent to the
pulp. Camargo et al. (37) divided the roots into cer-
vical, middle, and apical thirds and concluded that the
density decreased with increasing depth from the
cervix to the apices. Also distinct is the smaller peritu-
bular cuff thickness in radicular dentin when compared
to the dimensions in the crown. The lower tubule
density and smaller peritubular cuff thickness in the
root give rise to a higher percentage of intertubular
dentin per unit volume of tissue and a larger volume
fraction of matrix (39). Of perhaps equal importance,
the collagen fibrils of radicular dentin have a larger
diameter (39) as well as a different primary orientation
and degree of biaxiality than those in the crown (40).
With the mineral and collagen respectively regarded as
the elements most responsible for the hardness and
toughness of dentin (30), these spatial variations in
structure are relevant to the mechanical behavior and
potential variations in properties.
Mechanical properties of dentin
One of the aims of this review was to describe the
importance of the mechanical properties of both

Fig. 2. Micrographs highlighting variations in the microstructure of dentin from a premolar of a 25-year-old female.
Note the differences in tubule dimensions and density with distance from the pulp and from the root apex. (a) Coronal
dentin. (b) Radicular dentin.
radicular and coronal dentin to the success of endo-
dontic practices and the survival of treated teeth. As
such, this review discusses the strength of dentin,
the response of this tissue to cyclic loading (i.e. the
fatigue properties), and its fracture toughness, all of
which can play a role in the incidence of tooth fracture.
It does not address the properties of teeth resulting
from indentation methods (e.g. micro- and nano-
indentation). For readers interested in that topic,
Angker & Swain (41) have reviewed nano-indentation
evaluation of dental hard tissues.
Strength
The strength of coronal and radicular dentin has been
studied in detail, and in these investigations the influ-
ence of tubule orientation and tubule density has
Mechanical behavior of radicular dentin
received the most scrutiny. Although studies adopting
indentation have found that the hardness (42) and
elastic properties (43) of dentin are essentially iso-
tropic, strength measures show a substantial depend-
ence on the tubule orientation. Of particular note,
tissues of the tooth experience a combination of
tensile, compressive, and shear stresses. Tensile stresses
are nearly always considered the most detrimental due
to evidence that the majority of failures occur under
this mode of stress. Under this mode of loading, the
“strength” is the maximum stress that the tissue can
withstand and is regarded as the Ultimate Tensile
Strength (UTS). Lertchirakarn et al. (44) evaluated
the UTS of coronal (cervical third) and radicular (mid-
root) dentin by direct tension and diametral testing
over a range of tubule orientations. The results of that
study are summarized in Figure 3a. Although there
33
Arola et al.
a was no difference in the strength of equivalent speci-
b
Fig. 3. The ultimate tensile strength (UTS) of radicular
dentin and the importance of tubule orientation. (a)
Tensile strength of human radicular dentin determined
from tension (T) tests and diametral (D) testing. The
orientation defines the angle from the direction of
maximum tensile stress to the tubules. In both schematic
diagrams, “q” designates the orientation (angle) of
tubules from the direction of maximum tensile stress. In
the diametral testing, the direction of maximum tensile
stress is perpendicular to the loading axis. Columns with
different letters represent a significant difference. Results
presented here are from Lertchirakarn et al. (44). (b)
The importance of tubule orientation on the strength of
dentin from bovine incisors. Results presented here
compare data from Inoue et al. (59) and Liu et al. (60).
The orientations (1, 2, and 3) indicate the specimen
orientation and axis of loading. The 1, 2, and 3 direc-
tions are often regarded as the circumferential, radial,
and axial orientations, respectively. Samples aligned with
the 1 and 3 axes will have tubules in the ⬜ orientation,
whereas those along the 2 axis will have // tubule
orientations. Note the similar strength of specimens
aligned with the 1 and 2 axes despite having orientations
of ⬜ and //, respectively.
34
mens from the root and crown, those with tubules
oriented parallel to the direction of maximum ten-
sile stress exhibited significantly lower strength. Here
the angle theta (q) designates the orientation of
the tubules with respect to the orientation of the
maximum principal stress. For example, if the tubules
are aligned with the direction of loading, then the
tubules are parallel to the direction of maximum
tensile stress. Loading in this manner causes fracture
perpendicular to the tubules and some papers refer to
this orientation differently. Here we avoid using angles
for simplicity and to achieve consistency between pub-
lished studies. If the degree of anisotropy (or differ-
ence in properties in different directions) is defined by
the ratio of UTS in the perpendicular (⬜) and parallel
(//) orientations [AR = UTS(⬜)/UTS(//)], then
the AR is 1.64 and 1.45 for the coronal and radicular
dentin, respectively. Anisotropy was thought to origi-
nate from contributions of the dentinal matrix, which
results in the largest UTS when the collagen fibrils are
arranged in planes parallel to the loading direction.
Carvalho et al. (45) and Inoue et al. (46) reported
similar findings for coronal dentin, i.e. the perpendicu-
lar orientation exhibited significantly higher strength
than that in other orientations. The degree of aniso-
tropy evident from the results of these two groups
(AR = 1.40 and 1.27 ⱕ AR ⱕ 1.46, respectively) is
consistent; however, the UTS is not. For the parallel
orientation, the average strengths were approximately
40 MPa (44), 58 MPa (45), and 65 MPa (46)—a very
wide range. This difference appears to originate from
the specimen geometry, as the cross-sectional areas
were 1.13 mm2, 0.5 mm2, and 0.25 mm2 in these
three studies, respectively. Specimen geometry and
size are important issues that can influence the appar-
ent strength of materials due to the flaw population
(number of internal defects) and its contribution to
failures. This issue is critically important in character-
izing the properties of dental materials and is most
evident in the evaluation of bond strength. Recent
reviews of this topic in application to dental adhesives
were presented by Armstrong et al. (47) and Braga
et al. (48). Thus, it is imperative to maintain consist-
ency in the sample dimensions when comparing
reported properties of the root and crown dentin. A
recommended or “standard” specimen dimension
would be valuable for future studies due to its con-
tributions to the measured mechanical properties.

However, the community has not yet addressed this
issue formally.
In addition to orientation, tubule density has been
shown to contribute to spatial variations in strength.
Deep dentin of the crown is weaker than superficial
dentin and the difference is attributed to tubule
density (45,46,49). Similarly, deep dentin of the
crown exhibits lower shear strength when compared to
locations near the DEJ (50–53). An interesting study
reported by Jainaen et al. (54,55) using micro-punch
shear tests attempted to improve the shear strength of
radicular dentin in regions of high tubule density and
large diameter by filling the lumens. However, neither
canal preparation nor obturation using epoxy- or
UDMA-based resins as sealer cements substantially
improved the fracture properties.
Some of the regional variations in properties of the
crown may not be solely attributable to the tubule
density. In an evaluation of the UTS of tissue from the
cervical, cuspal, and occlusal regions of third molars
using micro-tensile tests, the strength ranged from 34
to 114 MPa (56). There was a significant difference in
the median strength of inner (44 MPa) and outer
(98 MPa) dentin, which would be expected from the
differences in tubule density in these two regions.
However, using Weibull probability statistics, it was
noted that regional variations in the strength might be
attributed to spatial variations in the population of
intrinsic defects (56). That concept becomes increas-
ingly relevant if flaws are introduced around the
periphery of the canal during instrumentation. Inner
dentin exhibits comparatively high tubule density and
diameter (38), qualities that appear to result in greater
flaw sensitivity and lower strength (57).
A number of investigations on the tensile strength of
dentin have been performed with bovine teeth to gain
further understanding of the importance of micro-
structure. In a study involving both human and bovine
teeth, Sano et al. (58) found that the tensile strength
of radicular dentin was greater than that of the crown.
Inoue et al. (59) reported similar findings but noted
that samples with axial and circumferential orienta-
tions of the root exhibited significantly different
strengths despite having nearly identical tubule orien-
tation (Fig. 3b). Their results were supported by a
discussion of the dentin matrix, hypothesizing that the
highest strength in the axial direction of the root
(which is a perpendicular tubule orientation) stemmed
from the preferential orientation of collagen fibers in
Mechanical behavior of radicular dentin
that direction (42). Liu et al. (60) also compared the
UTS of tissues from the cervical, middle, and apical
thirds of the root. While there were no significant
differences in strength between specimens from the
three regions, those with axial orientations had signifi-
cantly (p ⱕ 0.01) greater (more than double) strength
than those in the other two orientations (Fig. 3b).
Note that uniaxial tensile samples aligned with the “1”
direction (Fig. 3b) have a perpendicular tubule orien-
tation, but the UTS is nearly equivalent to that of
samples with a parallel tubule orientation. Using the
UTS of samples aligned with the “3” axis for the
parallel orientation, the AR of root dentin exceeds 3!
Sano et al. (58) reported similar values of tensile
strength for dentin samples with axial alignment from
bovine (ave. 91 to 129 MPa) or human (ave. 94 to
106 MPa) teeth. Fully demineralized samples with this
orientation had a UTS of approximately 30 MPa,
which is less than one-third that of mineralized tissue
but nearly equivalent to the fully mineralized strength
of samples with a parallel tubule orientation (Fig. 3).
Thus, radicular dentin exhibits a greater degree of
anisotropy than coronal dentin, which has been attrib-
uted to characteristics of the matrix. Radicular dentin
appears to have a larger UTS than coronal dentin as
well, but this statement is dependent on the tubule
orientation being evaluated.
Relevant clinical factors
Patient demographics
In a discussion of the UTS of dentin, there are relevant
factors other than tubule orientation and density that
should be considered. For example, in a study com-
paring regional variations in the UTS of dentin by
Mannocci et al. (61), the mid-apical third (i.e. mid-
root) specimens exhibited significantly higher strength
than those from the coronal third. The UTS reported
by this group was at least 40% lower than that reported
by Lertchirakarn et al. (44) despite having the same
tubule orientation (i.e. samples with axial alignment
and tubules with a perpendicular orientation) and an
identical cross-sectional area. The primary difference
appears to be patient demographics. Mannocci et al.
(61) reported that the teeth were from patients 45 to
51 years old (average = 48). Lertchirakarn et al. (44)
did not control for age but micrographs of the fracture
surfaces suggest that the teeth were obtained from
35
Arola et al.
younger patients. This is evidence that age-related
microstructural changes could cause a reduction in the
UTS of radicular dentin.
Interference or shrinkage stress
Another consideration is the rate of the applied load
and its influence on fracture resistance. There are a
number of conditions that can cause the development
of stress within a tooth which are not associated with
masticatory load (e.g. polymerization shrinkage stress).
Experimental studies of root dentin have shown that
the tissue undergoes time-dependent deformation and
exhibits linear-viscoelastic behavior over a range of
stress rates (62). This behavior is also exhibited by
coronal dentin (29) and implies that there will be a
reduction of stress under displacement control loads
due to progressive deformation (and strain). There is
also a reduction in the elastic modulus of dentin with a
decrease in the load rate that is attributed to the same
mechanism (63). Under conditions that pose a static
load within dentin that is under displacement control
(such as that in the press-fit of a post within the canal),
time-dependent relaxation would promote a reduction
in interfacial stress and “retentive force.” However, the
loading rate is also important to strength; a study on the
strength of coronal dentin showed that there is a sig-
nificant decrease in strength with a decreasing rate of
loading (63). In addition, fully hydrated dentin behaves
in an increasingly brittle manner at low stress rates while
dehydrating dentin causes it to exhibit the opposite
behavior.
Pulpectomy
Based on clinical observations, there has been some
belief that pulpless teeth are more brittle (64).
Removal of the pulp is often considered to contribute
to dehydration and embrittlement, and there is evi-
dence that dehydration causes a reduction in the
“work of fracture” (65), an engineering term that is
used to describe the area under the load–displacement
diagram that is obtained from a flexure test. However,
there is reportedly no difference between vital and
endodontically restored teeth in terms of moisture
content (66). Huang et al. (67) compared the com-
pressive and tensile strengths of dentin from vital and
pulpless teeth and found that the strength and stiffness
of dentin of the two groups were not significantly
36
different in either mode of loading. Sedgley & Messer
(68) studied the properties of dentin from pulpless
teeth using punch shear tests in terms of toughness
and load to fracture. They concluded that teeth do not
become more brittle as a result of endodontic treat-
ment. However, Zheng et al. (69) compared the
tensile strength and compressive strength of dentin
from vital and pulpless teeth and found that the dentin
in the latter group was significantly weaker (p ⱕ 0.05).
The conflicting findings of the aforementioned studies
could be associated with two important factors that are
often disregarded. In the evaluation of endodontically
restored teeth, the period of time following pulp
removal is often relatively short, or in cases where the
teeth have received treatment in situ and are removed
later, the duration of time after pulp removal is
unknown. Also, the age of the patient at the time of
extraction is either not controlled or unknown. The
importance of the later factor will be addressed below.
Effects of intracanal agents
It is necessary to acknowledge that there has been
substantial interest in the effects of irrigation on
chemical degradation of dentin and its influence on
mechanical properties. Although it has been a substan-
tial concern for decades, it remains a relatively contro-
versial issue. A thorough review of the literature in this
area was recently presented by Pascon et al. (70).
According to that review and independent contribu-
tions by Marending et al. (71) and Soares et al. (72),
the mechanical properties of dentin may undergo det-
rimental changes as a result of irrigation with sodium
hypochlorite and that it is attributed to degradation in
the dentin matrix. Moreover, intracanal medicaments
have been found to affect the apparent strength of
teeth. So while calcium hydroxide has been shown to
decrease the ultimate strength of teeth (73), mineral
trioxide aggregate (74) and micro- or nano-particulate
SiO2-Na2O-CaO-P2O5 bioactive glass (75) did not
appear to negatively impact the flexural strength of
root dentin. The degree of change (involving loss of
elastic modulus and/or strength) is clearly a function
of both concentration as well as duration of exposure
time. Work in this area is ongoing.
Loading conditions
Although teeth are subjected to repeating or cyclic
loads and often fail as a result of “fatigue,” in most
 Mechanical behavior of radicular dentin

studies the mechanical behavior of dentin has been a

characterized through the application of an increasing
quasi-static load to fracture. Bedran-de-Castro et al.
(76) considered the potential contribution of cyclic
loading on the apparent tensile strength of dentin.
Conventional tension specimens of dentin were pre-
pared from either the root or crown of bovine incisors
with orientations parallel or perpendicular to the
dentin tubules. Selected samples were obtained from
teeth that had been subjected to cyclic loading (up to
1 million cycles). Samples obtained from the roots
with tubules oriented perpendicular to the axis of
applied tension (i.e. perpendicular orientation) exhib- b
ited significantly greater tensile strength. The authors
attributed these differences to the relative organic and
inorganic content as well as the composition of the
dentin matrix. However, there was no significant
reduction in strength imposed by cyclic loading of the
teeth. This is an important statement, but one that
requires a greater understanding of the contribution
cyclic loading has on dentin.

Fatigue properties
Fatigue describes the progressive degradation in struc-
tural integrity of a material as a result of cyclic loading
and the consequent reduction in “load-carrying capac-
ity” that results from the accumulation of internal
damage. The fatigue “life” of a material or structure
represents the number of cycles that it can endure at a
particular cyclic stress without failure. It is comprised
of the initiation and progression of damage. Those
two components are regarded as the “initiation life”
(also known as the “stress-life”) and the “propagation
life,” respectively. For a material or structure that is
free from major flaws (i.e. cracks), the fatigue life is
primarily comprised of the number of cycles required
for the initiation of damage, and thus is largely a
function of the magnitude of cyclic stress.
The fatigue properties of dentin have been reviewed
by Kruzic & Ritchie (77) and by Arola et al. (78).
Human dentin exhibits a traditional fatigue life behav-
ior similar to that of common engineering metals
(77,79–81). Fatigue life diagrams for coronal dentin
with three different tubule orientations are shown
in Figure 4a. They demonstrate the characteristic
decrease in the number of cycles to fracture with an
increase in the cyclic stress amplitude. Of particular
note, dentin exhibits an apparent endurance limit
Fig. 4. Fatigue life diagrams for human dentin. Data
points with arrows represent specimens that did not fail,
for which the test was discontinued. All of the specimens
were obtained from the molars of young patients
(age ⱕ 35). (a) The influence of tubule orientation on
the fatigue life of human dentin. Results presented here
are used with permission from Arola & Reprogel (83).
(b) A comparison of the fatigue life of dentin obtained
from unrestored and restored molars (unpublished
results). All of these specimens have tubules oriented
perpendicular (⬜) to the direction of maximum principal
stress.
ranging from approximately 20 to 50 MPa that varies
according to the mean stress (82) and the tubule
orientation (83). The endurance limit represents a
limiting stress. Below that magnitude of cyclic stress,
the material is capable of withstanding cyclic loading
without undergoing fatigue failure. Nalla et al. (82)
found that dentin undergoes a significant reduction in
fatigue life when the loading conditions result in a
tensile mean stress; the mean stress is the mathematical
average of the values of maximum stress (␴max) and
minimum stress (␴min) of a fatigue cycle and it exists
when the cyclic conditions do not result in fully

37
Arola et al.
reversed loading (i.e. when ␴max ⫽ − ␴min). The obser-
vations reported by Nalla et al. (82) indicate that
endodontic treatments promoting a static component
of tensile stress (e.g. due to expansion mismatch at
bonded interfaces or in the case of press-fit posts) will
lower the resistance to fatigue failure of dentin and
cause a reduction in the endurance limit.
Similar to the measures of UTS and shear strength,
the fatigue strength of dentin is also dependent on the
tubule orientation. In a study of coronal dentin from
the crowns of third molars, it was found that the
fatigue life decreases with the amplitude of cyclic stress
regardless of the tubule orientation (83). Dentin
exhibits the lowest fatigue strength and endurance
limit (24 MPa) when the tubules are aligned with the
direction of maximum tensile stress as evident in
Figure 4a. Using results from quasi-static and cyclic
loading, the ratio of the endurance limit to the flexure
strength for parallel and perpendicular orientations
was 0.28 and 0.41, respectively. This disparity high-
lights the importance of the organic matrix in the
fatigue of dentin as the collagen fibrils are oriented
approximately perpendicular to the tubules in coronal
dentin, thereby promoting greater durability for the
perpendicular orientation. Furthermore, using the
ratio of apparent endurance limits for the parallel and
perpendicular orientations, the AR is approximately 2,
which is much greater than that observed for the UTS
of dentin determined by quasi-static loading to failure.
Because of the influence of tubule orientation on the
monotonic properties of radicular dentin, the fatigue
strength would be expected to exhibit a similar
dependence. The fatigue strength of bovine radicular
dentin was recently evaluated (84) in a perpendicular
orientation and found to be approximately 44 MPa at
a life of 105 cycles. Using the value of tensile strength
reported in that study, the AR for radicular dentin is
approximately 2. However, if the matrix undergoes
degradation as a result of irrigation during endodontic
therapy, the fatigue strength of pulpless teeth could be
substantially diminished regardless of orientation.
Future studies should explore this important issue.
The fatigue strength of structural materials can be
degraded by the volume and size of intrinsic defects. Of
importance here is the observation that restorative
processes, which involve enamel or dentin removal,
have the propensity to introduce flaws to the remaining
tooth structure (85). All of the reported studies to date
have been conducted using tissue from unrestored
38
human and bovine teeth. To address this concern, the
authors recently conducted a preliminary study to
compare the fatigue behavior of coronal dentin from
caries-free unrestored and restored molars obtained
from young patients (18 ⱕ age ⱕ 35). Specimens of
the restored molars were obtained adjacent to (just
beneath) the restoration. The results for specimens
with a perpendicular tubule orientation are shown in
Figure 4b. Although the number of cycles (or years of
function) elapsed after placement of the restoration
was not available, the results suggest that a substantial
reduction in the fatigue strength occurs in dentin
which is adjacent to the placed restoration. It is
unknown whether the reduction in fatigue strength
occurs due to the presence of structural damage or a
change in the chemical composition of dentin adjacent
to the restorative material. It has been shown that
dentin underneath carious lesions (and presumably
under restorations placed to treat caries) is less perme-
able than normal dentin (86). This was believed to
result from occlusion of dentinal tubules and develop-
ment of sclerotic dentin underneath the carious lesion,
as a means of natural defense against the advancement
of the carious lesion. Studies are presently underway to
address the potential differences between sclerotic
dentin developed via “defense mechanisms” and that
occurring as a result of natural aging.
Fatigue crack growth
The propagation life of a material or structure is com-
prised of the number of loading cycles required to
propagate an existing crack to a critical length that
facilitates bulk fracture. Cyclic extension of the crack
occurs by a process called fatigue crack growth.
Because of the relevance of this issue in tooth fractures
(81,87,88), the fatigue crack growth resistance of
human dentin has been studied in some detail. Dentin
is susceptible to fatigue crack growth (81,89,90);
typical responses are shown in Figure 5a. The history
of cyclic extension is generally examined in terms of
the incremental fatigue crack growth rate and the cor-
responding stress intensity range (DK) in which cyclic
extension takes place. The incremental fatigue crack
growth rate is quantified by the ratio of incremental
crack extension (Da) to the number of cycles associated
with that period of growth (DN), whereas the stress
intensity range represents the difference in maximum
stress intensity and minimum stress intensity that is

a initiate fatigue crack growth from an existing crack,
b tensile stress promoting cyclic crack growth was
Fig. 5. Fatigue crack growth in human dentin. (a) A
typical fatigue crack growth response for cyclic extension
in the same plane as the tubules and perpendicular to the
tubules. The responses presented here are for coronal
dentin from the third molars of a 25-year-old female and
an 18-year-old male, respectively. (b) A comparison of
the fatigue crack growth resistance of coronal dentin
from the inner, central, and peripheral regions (92).
Crack growth in these specimens was in the same plane
as the tubules. The results presented in this figure are for
young dentin from 18 ⱕ age ⱕ 35.
active on the crack over the fatigue cycle (DK = Kmax
-Kmin) (91). Two quantities used in characterizing the
growth responses are (a) the stress intensity threshold
(DKth), which defines the minimum DK required to
Mechanical behavior of radicular dentin
and (b) the increase in growth rate with increasing
stress intensity; the latter is generally defined by the
exponent of the Paris Law. These quantities are high-
lighted in the responses presented in Figure 5a and
help to quantify the relative difference in fatigue crack
growth resistance behavior with tubule orientation. In
an examination of cracks emanating from the line
angles of restored teeth (88), it was noted that fatigue
crack growth primarily occurred perpendicular to the
dentin. The responses from the experiments in
Figure 5a demonstrate that dentin exhibits the lowest
resistance to fatigue crack growth when the tubules are
aligned with the direction of cyclic loading and per-
pendicular to the orientation of the crack. Fracture
surface markings have been used to determine that the
DK contributing to fatigue crack growth in vivo ranged
from 0.7 to 0.9 MPa•m0.5 (88) and that the average
approximately 12 MPa. While that level of DK would
enable fatigue crack growth to occur perpendicular to
the tubules (Fig. 5a), it is not sufficient to cause
fatigue crack growth parallel to the tubules as evident
in this figure. The lower fatigue crack growth resist-
ance of dentin that occurs when the tubules are
aligned parallel to the direction of cyclic stress empha-
sizes the preference for cracks to grow perpendicular
to the tubules in restored teeth.
Recent work by the author’s group has begun to
address the importance of tubule density on the fatigue
crack growth behavior of coronal dentin (92). A com-
parison of the incremental fatigue crack growth
responses for deep, middle, and superficial dentin of the
crown is shown in Figure 5b. As evident from the
distribution in these responses, deep dentin is less
resistant to fatigue crack growth than middle or super-
ficial dentin. Most importantly, because of the lower
DKth, fatigue crack growth initiates in deep dentin from
existing cracks at comparatively lower driving forces
than in the middle or superficial regions. These results
are in agreement with the trends reported in the UTS
and shear strength, and are expected to arise due to a
reduction in the organic matrix with increasing depth
from the DEJ. Fatigue crack growth studies have not
been conducted with radicular dentin. However,
according to the findings by Ivancik et al. in 2011 (92)
and distribution of tubule densities in the root, the
fatigue crack growth resistance of radicular dentin
would be expected to be lowest in the cervical third.
39
Arola et al.
One interesting aspect of fatigue behavior is the
transition between the initiation and propagation of
damage. Kruzic & Ritchie (93) proposed using the
so-called Kitagawa-Takahashi diagram, which is a
graphical method of combining the initiation life and
propagation life behavior of a material and examining
the inter-relationships. They constructed the diagram
for fatigue of dentin with the tubules oriented par-
allel to the maximum cyclic tensile stress and detailed
the critical flaw size at the boundary of finite and
infinite life. The Kitagawa-Takahashi diagram has also
been used to examine anisotropy in the fatigue
behavior of dentin (89). Based on a comparison of
the transition behavior in the fatigue of human
dentin for all tubule orientations, it was found that
dentin is susceptible to fatigue failure at the lowest
cyclic stress when the tubules are aligned with the
cyclic stress (in a parallel orientation). It was also
found that dentin exhibits the largest degree of ani-
sotropy in the initiation life regime (AR = 2) com-
pared to that corresponding to fatigue crack growth
(AR = 1.2). The results of this evaluation showed
that fatigue failure of coronal dentin is most likely to
occur when cyclic stresses are oriented parallel to the
tubules. However, after initiation of a flaw, the level
of anisotropy decreases and cyclic crack extension is
largely directed by the magnitude of cyclic stress;
tubule orientation becomes less important. This
applies to coronal dentin but may not be applicable
to the root. Because of the larger degree of aniso-
tropy in the UTS of radicular dentin (Fig. 3b), there
may be unique trends in the resistance to fatigue
crack initiation and growth that account for the eti-
ology of vertical root fracture and fracture patterns.
Future work on this topic is warranted.
Fracture toughness
Fracture toughness is a property describing the ability
of a material to resist fracture caused by the extension
of an existing crack. If a crack is introduced in dentin
during the restorative process or as a result of cyclic
loading, then tooth fracture is possible in a single load
cycle provided that the load and flaw length combined
exceed the fracture toughness (Kc) of the tissue.
According to linear elastic fracture mechanics, fracture
occurs when the stress intensity (K), which is defined
in terms of the flaw length and stress, is equivalent to
the fracture toughness of the material (Kc) (94). The
40
fracture properties of dentin were recently discussed in
a review by Ruse (95). As shown in other properties of
human dentin, the resistance to fracture is dependent
on the tubule orientation (96) and depth (i.e. the
tubule density) (97). In coronal dentin, the greatest
toughness is realized for stresses applied perpendicular
to the tubules, which results in crack growth parallel to
the tubules (98). A complete review of the studies on
fracture toughness of dentin is not possible here, but
one investigation comparing the fracture behavior of
coronal and radicular dentin warrants discussion (99).
In that study, specimens of dentin with a machined
notch were prepared from bovine incisors and a crack
was introduced by fatigue. The specimens were loaded
to fracture and the load-deflection curves were docu-
mented (Fig. 6a). In comparison to the substantial
non-linearity evident in the root responses, the coronal
dentin exhibited relatively brittle behavior. Using the
critical load and crack length, the estimated fracture
toughness of coronal and radicular dentin was 2.1 and
4.8 MPa•m0.5, respectively. The regional differences in
Kc were attributed to microstructural contributions. In
radicular dentin, the collagen fibrils are oriented axially
(98) and acted to reinforce the cracked specimen. The
authors also noted that the incremental lines served as
weak fault lines and specimens of radicular dentin were
prepared such that the crack was forced to extend
perpendicular to these lines (Fig. 6b). Lastly, as cracks
initiate in the peritubular dentin, the absence of cuffs
in the root (e.g. Fig. 2b) resulted in a greater resist-
ance to the initiation and propagation of cracks.
Therefore, it appears that the fracture toughness of
radicular dentin is greater than that in the crown,
provided that the crack grows perpendicular to the
incremental lines. However, in vertical root fracture,
the crack is aligned with the direction of the incremen-
tal lines, suggesting that the toughness in that direc-
tion may be substantially lower. Also, aging of the root
may cause more substantial changes in the fracture
behavior of the root due to the deposition of minerals
in the tubules, thereby increasing the cuff thickness
and the relative mineral content.
A summary of the reported mechanical properties for
young dentin is shown in Table 1, which provides a
simple comparison of values for tissues from the crown
and root. As previously highlighted, differences in the
choice of specimen size and location in tension testing
(e.g. distance from the DEJ or distance from the root
apex) have resulted in a broad range of apparent
 Mechanical behavior of radicular dentin

a b

Fig. 6. Characteristics of fracture in root and crown dentin. (a) A comparison of the load-deflection behavior of
dentin from the root and crown of bovine incisors. The graph is reproduced with permission from Wang (99). (b)
Crack morphology in a specimen of root dentin. The arrowhead indicates the crack along the incremental line
(indicated by dashed line). The arrow on the right shows the pre-crack generated by fatigue loading. The dentin
tubules extend from the top to the bottom of this figure in a nearly uniform vertical direction. This figure is
reproduced with permission from Wang (99).

Table 1: A comparison of the reported range in mechanical properties for young coronal and radicular dentin
Property Coronal Dentin* Radicular Dentin*

Elastic Modulus (GPa)a 12 to 20 12 to 20

Tensile Strength (MPa)b 35 to 110 30 to 120

Fracture Toughness (MPa•m0.5)c 1.5 to 1.8 (//) and 1.5 to 2.5 (⬜) 1.6 (//) and 4.8 (⬜)

Endurance Strength (MPa)d 24 (//) and 44 (⬜) 44 (⬜)

m (power law exponent)e 10 to 15 (//) and 20 to 27 (⬜) N/A

DKth (MPa•m0.5)e 0.6 to 1.0 (//) and 0.7 to 1.3 (⬜) N/A

* Note that the symbol (//) indicates that the direction of maximum tensile stress is parallel to the tubules, which is consistent
with the definition used for tension testing. This causes fracture perpendicular to the tubules and often this direction is quoted
in the literature as the perpendicular orientation. Similarly, (⬜) indicates that the direction of maximum tensile stress is
perpendicular to the tubules. Fracture in this loading condition will occur parallel or in the same plane as the tubules.
a
Elastic modulus responses are highly dependent on the loading rate (29).
b
Effects of orientation are not distinguished due to the compounding effects of specimen size and dentin depth on the
reported results.
c
Limited to estimates using sharp pre-cracks. Values for radicular dentin are estimates based on two sources (99,122).
d
Zero to tension (flexure) identified at 106 cycles. The value for radicular dentin was determined for 105 cycles (84).
e
Tubule density variations with depth result in spatial variations in the fatigue crack parameters (92).

strength, making it nearly impossible to determine
which is strongest. Both the crown and root exhibit
anisotropy and, regardless of orientation, regions of
low tubule density are stronger. Nevertheless, the
largest strength overall has been reported for radicular
dentin. While the number of studies reporting on the
fracture behavior of radicular dentin is very low, the
results presented thus far suggest that the root may also
exhibit the largest fracture toughness. At present it is
not possible to compare the fatigue behavior of human
dentin above and below the crown because no study has
conducted a fatigue analysis of specimens limited to
human radicular dentin. This is a topic of importance
and should be pursued in future studies of dentin.

41
Arola et al.

Fig. 7. Changes in the microstructure of dentin with aging. (a) Examples of the lumen dimensions from scanning
electron micrographs of coronal dentin within the third molars of young (left; age = 20) and old (right; age = 67)
patients. These micrographs are reproduced with permission from Arola & Reprogel (79). (b) The change in average
lumen dimensions in adult human third molars. This figure is reproduced with permission from Arola (119).

Aging of dentin Microstructure

Aging is accompanied by an increase in dentin thick-
ness in both the crown and root. According to a study
of odontometric changes in teeth, the increases in root
thickness are significantly greater than those in the
crown (100). While there is an overall decrease in the
density of pulpal cells with aging, the density is signifi-
cantly lower in the root. These changes are undoubt-
edly important to the success of endodontic therapy.
However, there are additional concerns related to
the microstructure and consequent changes in the
mechanical behavior that could be important to the
incidence of tooth fracture.
In dentin, there is a reduction in tubule diameter with
increasing age due to the deposition of minerals within
the lumens. Micrographs of coronal dentin from two
patients and a measure of the lumen dimensions in
coronal dentin of human teeth are shown in Figures 7a
and b, respectively. This process begins in the third
decade of life and results in an increase in mineralization
(28). After an adequate number of lumens have been
filled, the tissue appears transparent and dentin that has
undergone this change is known as “sclerotic.” Histo-
logical evaluations have shown that sclerosis begins in
the root and progresses to the crown (101–104).

42
 Mechanical behavior of radicular dentin

Fig. 8. Collagen and mineral to collagen ratio Fourier Transform Infrared (FTIR) maps and the matching visual map
of dentin from a premolar of a 57-year-old male. Red represents the highest and blue represents the lowest peak areas
in the FTIR maps. Note the lower collagen content (collagen map) and the higher mineral to collagen ratios (mineral
to collagen ratio map) in the coronal dentin compared to the radicular dentin. A gradient in the mineral to collagen
ratios is seen when moving from the crown toward the bottom of the root. These maps were obtained using FTIR
microspectroscopy with the reflectance mode (FTIR-RM) method (125).

Despite the initiation and progression of sclerosis from
the root, the lowest relative collagen content and
highest mineral to collagen ratios are found in deep
coronal dentin (Fig. 8). Within the root, sclerosis ini-
tiates in the tubule periphery (105,106) and progresses
toward the pulp. Furthermore, changes begin in the
mesial and distal aspects of the root and then spread to
the lingual and buccal regions. These regional varia-
tions could be due to the lower density of tubules in the
distal and mesial walls (107). Within the regions under-
going sclerosis, the number of remaining unobstructed
lumens continues to decrease with age (101,108,109).
At least two groups did not find significant differ-
ences in the number of open lumens with tooth age
(37,110). In the investigation of Tidmarsh & Arrow-
smith (110), 10 teeth were examined over a broad age
range (35–81 year-olds). The teeth were incisors,
canines, and premolars, which raises two issues. The
different tooth types could possess variations in dentin
thickness, corresponding tubule lengths, and degree of
apparent deposited mineral. However, there were also
potential differences in the onset and progression of
sclerosis based on tooth position in the oral cavity and
the unique tubule density (107). Camargo et al. (37)
limited the investigation to premolars, but performed
measurements along the pulpal wall, where sclerosis
develops last. In addition, removal of the pulp could
contribute to sclerosis. Thomas et al. (105) compared
the degree of apical translucency of vital and root-filled
teeth over an age range of 18 to 76 years; the mean
patient age of the two groups was 45 and 47 years,
respectively. They concluded that translucent dentin is
more prominent in root-filled teeth, regardless of age.
This is a fascinating finding, but one that raises ques-
tions as to the cause. The greater degree of sclerosis
could develop before endodontic treatment and result
from pulp pathosis and the related response of the
odontoblastic processes.
The decrease in lumen diameter that accompanies
aging reduces the depth of bacterial penetration
within the tubules (111). This suggests that infection of
the dentin tubules is less extensive in older patients with
pulpal infections. However, according to clinical
studies (112–114), vertical root fractures are signifi-
cantly more prevalent in older patients. Indeed, in teeth
requiring root canal treatment with posts, vertical root
fracture is more likely to occur in the teeth of older
patients (60+ years of age) (115). Because of the nature
of the deposited material filling the lumens, there is an
increase in mineral content (80,99,116,117). As

43
Arola et al.

mineral and collagen are regarded as the hard and a

tough components of the tissue (30), respectively, an
increase in brittleness and/or a reduction in fracture
resistance is to be expected with aging.

Mechanical behavior

Although the importance of aging on the mechanical

behavior of dentin was identified over a decade ago
(118), most of the studies addressing this topic have
only appeared in the last 5 years. A review of dentin
aging and its importance to the mechanical behavior of
dentin was recently published (119). Overall, coronal
dentin becomes more brittle with increasing patient b
age. This transition causes a significant reduction in
both the strength and energy required to fracture
(79). According to an evaluation of the flexural
strength of coronal dentin, there is a decrease in
strength of almost 20 MPa per decade of life that
begins shortly after reaching adulthood (Fig. 9a). If
the young and old groups are loosely defined as
age ⱕ 30 and age ⱖ 55, respectively, there is a 50%
reduction in strength and a 75% reduction in energy
required to fracture in old compared to young dentin.
Similar investigations have shown that there is also a
reduction in the fatigue strength of dentin with age.
Kinney et al. (80) found that transparent dentin (from
old patients) exhibited a lower fatigue strength over Fig. 9. Influence of age on the strength of coronal
the finite life regime, but no difference in the apparent dentin. (a) The distribution of flexure strength in
coronal dentin with respect to patient age. The average
endurance limit. In that study, the difference in fatigue reduction in strength over the adult age span is 20 MPa
properties between the young and old dentin speci- per decade. (b) The fatigue life distribution for coronal
mens was not limited to age; the young specimens dentin obtained from young and old patients. Data pre-
were mostly obtained from molars whereas the old sented is from Arola & Reprogel (79).
specimens were prepared from incisors and would
therefore contain a larger percentage of radicular
dentin. Differences would also be expected between experienced, the critical stress for static loading is the
these two groups of specimens in terms of the orien- UTS whereas the critical stress for cyclic loading is the
tation of the incremental lines and collagen fibrils. In endurance limit (a stress above this limit will result in
contrast, in a study limited to tissues from the crowns failure within a finite number of cycles). The ratio of
of third molars, the old dentin exhibited significantly these two critical stresses distinguishes the relative
lower fatigue life regardless of the magnitude of cyclic fatigue resistance of a material. Therefore, the smaller
stress (Fig. 9b) (79). The ratio of the apparent endur- ratio for old dentin emphasizes its lower resistance to
ance limit to the ultimate strength in flexure for young fatigue in comparison to young dentin. According to
and old dentin was 0.5 and 0.38, respectively. This the visible change in microstructure, it would appear
ratio is an important quantity and accounts for the that the reduction in strength of old dentin is attrib-
material performance in the two primary modes of utable to the increase in mineral content. However, it
functional loading, namely static and cyclic loading. If is presently not clear whether the changes are solely
one considers the critical stress that is associated with due to the filling of the lumens, or if they are caused by
“fracture” of the material in each mode of loading the dentin matrix as well. The changes in properties

44

Fig. 10. The reduction in fatigue crack growth resist-
ance of dentin with age. The young (age ⱕ 35) and old
(50 ⱕ age) groups consist of specimens prepared from
third molars. The direction of cyclic crack growth is
perpendicular to the tubules. Results presented are from
Bajaj et al. (90).
with age could potentially result from changes in
cross-linking of the collagen (120,121).
There is reduction in the fatigue crack growth resist-
ance of dentin with increasing age. A comparison of
the responses for coronal dentin from the third molars
of young and old patients is shown in Figure 10. The
average fatigue crack growth exponent for the old
dentin (m = 21.6) is significantly greater than that of
the young dentin (m = 13.3). However, the impor-
tance of age is most evident in the average rate of
fatigue crack growth. Over the range in stress intensity
that is active in vivo (0.7 to 0.9 MPa•m0.5) (87), the
average rate of fatigue crack growth in old tissue is
greater than 100 times that of young dentin. As such,
cracks introduced during instrumentation or another
aspect of the restorative process would be far more
likely to cause tooth fracture in senior patients. There
is preliminary evidence that the age-related changes in
mechanical behavior may be a function of the ethnic
background of the individual (23,78). It should also
be recognized that the degree and nature of tooth
function undoubtedly plays an important role in the
onset of crack propagation and tooth fracture. Factors
such as the type of tooth (incisor, canine, molar, etc.)
and the magnitude of occlusal forces, the presence of
an opposing tooth and whether or not the tooth was in
function, habitual bruxism or clenching by the patient,
and perhaps temporomandibular dysfunction may all
Mechanical behavior of radicular dentin
be important. Overall, age should be considered a
synergistic variable that has the potential to increase the
likelihood of tooth fracture due to these other factors.
As expected, detrimental changes in the fracture
toughness of dentin occur with increasing patient
age. Independent studies of crack extension parallel
(122,123) and perpendicular (124) to the dentin
tubules show that “old” dentin undergoes a reduction
in the crack growth resistance in both orientations.
However, there are some unique qualities of the
responses. For cracks extending parallel to the tubules,
there is a significant decrease in the crack growth
toughness (Kg) as a result of sclerosis. Most hard
tissues exhibit an increase in the resistance to crack
growth as the crack length increases, which is a result
of toughening induced by the complex microstructure
(77). The Kg quantifies the increase in toughness with
crack extension and represents the slope of the trend
between the critical stress intensity and crack length. It
is also regarded as the slope of the fracture resistance
curve (i.e. the R-curve). If the crack growth curves
reported in that study are used to interpret differences
in fracture toughness (Kc) (Fig. 11a), there is a reduc-
tion but it is not significant.
In the investigation of cracks extending perpendicular
to the tubules, there was a significant reduction in Kg
with patient age as well (124). However, there was also
a significant decrease (30%) in Kc as evident from the
results of the three age groups shown in Figure 11b.
Note that Kc for the middle and old groups (with
tubules aligned in the direction of tensile stress) were
significantly lower than those corresponding groups of
dentin with a perpendicular orientation. The results
from these two studies provide conclusive evidence that
there is a reduction in the degree of toughening in
dentin with aging and that it is associated with filling of
the lumens. However, it is not possible to conclude that
the differences are orientation dependent because the
specimens tested by Koester et al. (122) contained the
crown as well as the cervical and middle thirds of
the root. The microstructure was certainly different
amongst some of these specimens and, as emphasized
throughout this review, this could have a substantial
influence on the toughening behavior irrespective of
the tooth age and degree of sclerosis. Although a study
on the effects of aging on the fracture of radicular
dentin has not been conducted, it is expected that there
would be a significant reduction in Kc. The remaining
questions of primary importance concern the age at
45
Arola et al.
a implications in the choice of treatment and the prob-
b
Fig. 11. The fracture toughness of human dentin in the
two primary directions. Columns with letters represent
significant differences (p ⱕ 0.05). Differences in the Kc
between cracks extending parallel and perpendicular to
the tubules are significant for the middle (p ⱕ 0.05) and
old (p ⱕ 0.005) age groups. (a) Crack growth parallel
and/or oblique to the tubules. Data were extracted from
the study of Koester et al. (122) from the crowns of
molars as well as the cervical and middle thirds of the
root. * The middle and old age groups presented here are
interpretations of the “aged opaque” and “aged transpar-
ent” groups reported in that investigation. Both groups
included tissues from patients between 40 and 70 years of
age. (b) Crack growth perpendicular to the tubules. Data
were from Nazari et al. (124) and were obtained from the
crowns of third molars; young (aged 17–32), middle
(aged 40–45), and old (aged 55–83) age groups.
which the changes begin and the extent of the changes.
Because of regional variations in the progression of
sclerosis, the degradation in Kc of the root could begin
earlier and be more severe. This may have important
46
ability of its success.
Summary
In reviewing the literature, it is apparent that dentin
possesses a complex microstructure that plays an impor-
tant role in the mechanical behavior of this tissue. The
mechanical properties most important to tooth fracture
are a function of the tubule orientation and the tubule
density. Specifically, coronal dentin exhibits substantial
anisotropy with the tensile strength and fatigue
strength being significantly lower (up to 50%) when the
maximum tensile stress is applied parallel to the tubules.
Similarly, the resistance to fatigue crack growth and
fracture toughness of dentin are lowest when the crack
extends perpendicular to the tubules. Tubule density is
also important as the ultimate tensile strength and
fatigue crack growth resistance of coronal dentin
decrease with depth (i.e. in regions exhibiting large
tubule density and tubule diameter). The property
variations with tubule characteristics are a result of the
relative mineral content and primary orientation of the
collagen fibrils. However, it is important not to over-
look the degradation resulting from intrinsic defects, as
well as those that may be introduced during the course
of treatment. It is clear that the resistance to fracture is
largest in regions of high volume fraction of dentinal
matrix and in the direction of the collagen fibrils.
While a large number of studies have examined the
properties of coronal dentin, few have characterized the
mechanical properties of radicular dentin. Consistent
with the crown, root dentin exhibits substantial aniso-
tropy and regional variations in strength. The greatest
strength is obtained for loads applied parallel to the axis
of the root. In addition, based on the reduction in
tubule density from the cervical third to the apical third,
there is an expected increase in strength with proximity
to the apex. Comparisons of the mechanical behavior of
dentin from the crown and root suggest that root
dentin may possess the greatest strength and fracture
toughness overall, provided that the direction of
loading is aligned with the axis of the root. No studies
have been reported that characterize the fatigue
strength of radicular dentin or its resistance to fatigue
crack growth. While there is some evidence that remov-
al of the pulp may facilitate a reduction in strength, a
comprehensive study regarding the mechanical behav-
ior of dentin from pulpless teeth (including its resist-

ance to fatigue) has not been performed. New data on
the fatigue strength of dentin from restored teeth
suggests that there may be a substantial reduction in the
fatigue properties related to the restorative process,
which is not limited to the changes that arise due to
pulpectomy. Future research should be performed
to explore the potential changes in microstructure that
develop post-endodontic treatment and to identify
their importance in the resistance to tooth fracture.
Because of the changes in microstructure and mecha-
nical behavior, patient age should now be regarded as
an important consideration in the selection of treat-
ment. There is up to a 50% reduction in the tensile
strength and fatigue strength of coronal dentin from
seniors when compared to that of young adults. Of
equal importance, the fatigue crack growth resistance
of dentin decreases with increasing patient age and the
incremental rate of crack extension is up to 100 times
greater in seniors. There is also a significant reduction in
the fracture toughness. Evaluations addressing the age-
dependence of the mechanical behavior of dentin have
thus far been limited to coronal dentin. Although the
onset of sclerosis and filling of the lumens begins in the
root, no study has addressed the changes in properties
specific to radicular dentin nor identified the degree of
differences in the rate of aging between the root and
crown. Nevertheless, it is hoped that this review has
provided a better understanding of what is known, and
will serve as a potential guide in future studies aimed at
understanding the changes in microstructure of dentin
that are important to tooth fracture.
Acknowledgements
The authors acknowledge that this work was supported in
part by the National Institutes of Health, National Institute
of Dental and Craniofacial Research (grants R01-DE016904
and R01-DE017983). Special thanks are extended to Prof.
Harold H. Messer in the Melbourne Dental School at the
University of Melbourne and Prof. Rizhi Wang in the
Department of Materials Engineering at the University of
British Columbia for their contributions in content and
insightful comments.
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