RESIN-BONDEDPROSTHESES

16. Cheung GS, Dimmer A, Mellor R, Gale M. A clinical evaluation of con- Reprint requests to:
ventional bridgework. J Oral Rehabil 1990;17:131-6. DR. FLEMMINC ISIDOR
17. Freilich MA, Niekrash CE, Katz RV, Simonsen RJ. The effects of res- DEPARTMENT OF PROSTHETIC DENTISTRY AND STOMATOGNATHIC PHYSIOL
in-bonded and conventional fixed partial dentures on the periodontium: OGY
restoration type evaluated. J Am Dent Assoc 1990;121:265-9. ROYAL DENTAL COLLEGE
18. Isidor F, Budtz-J$rgensen E. Periodontal conditions following treat- VENNELYST BOULEVARD
ment with distally extending cantilever bridges or removable partial DK-8000, AARHUS C
dentures in elderly patients. A 5-year study. J Periodontol1990;61:21-6. DENMARK

Three-dimensional finite element stress analysis of a

cantilever fixed partial denture
Hania A. Awadalla, BDS, MDS,a Mohsen Azarbal, DMD, MDS,b
Yahia H. Ismail, DMD, PhD,C and Wael El-Ibiari, BSd
University of Pittsburgh, School of Dental Medicine, Pittsburgh, Pa.

A three-dimensional mathematical model was generated, representing a three-unit

cantilever fixed partial denture and its supporting mandibular structures. First and
second premolars were used as abutments with one posterior cantilever pontic. A 5
lb vertical load was applied to the pontic. Vertical and horizontal stresses were
analyzed by means of a three-dimensional finite element stress analysis technique.
The results showed that a cantilever pontic creates considerable compressive
stress on the abutment nearest to the pontic and produces tensile stress on the
abutment farthest from the pontic. (J PROSTHET DENT 1992;68:243-8.)

R eplacement of missingposterior teeth in the ab- MATERIAL AND METHODS

senceof distal abutments can be achieved by one of the In this study the finite elementstressanalysistechnique
following ways: (1) with removable partial dentures with wasusedto evaluate the stressesin a mandibular posterior
distal extensionbases,(2) with fixed partial denturesusing cantilever fixed partial denture. Two- and three-dimen-
implants as distal abutments, and (3) with fixed partial sional finite element stressanalyseshave beenusedexten-
dentures with cantilever pontics. sively in dentistry. 2-gA three-dimensional stressanalysis
Conflicting opmionsexist regarding the useof cantilever technique is preferred over a two-dimensionalone because
fixed partial denturesto restore edentulousspaceswithout it is an actual representation of the stressbehavior in the
a distal abutment. The decision to use a cantilever fixed supporting bone.7
partial denture should be basedon a sound periodontal A three-dimensionalmathematical model of the mandi-
condition, good alveolar bone support, favorable tooth- ble was used in this study, representing the mandibular
to-tooth and arch-to-arch relationships, favorable root canine, first premolar, secondpremolar, and their support-
shape, a good crown-to-root ratio, and clinical experi- ing structures with a cantilever pontic and 7 mm of the
ence.l edentulous ridge distal to the secondpremolar. A three-
This study evaluated stress distribution in the abut- unit cantilever fixed partial denture was designedusing
ment teeth and their supporting alveolar bone in a man- first and secondpremolarsasabutments and a first molar
dibular posterior cantilever fixed partial denture using a as a pontic. In making the finite element model, the ana-
three-dimensional finite element stress analysis tech- tomic form and dimensions,the modulusof elasticity, and
nique. Poisson’sratios equivalent to those structures being simu-
lated were entered into the computer program. Compo-
nents of the dental model were mandibular bone, perio-
aGraduate Resident.
dontal ligaments,natural teeth, type 3 gold crowns,and full
bAssistant Professor, Department of Prosthodontics.
CProfessor and Chairman, Department of Prosthodoutics. gold pontics. Both abutment teeth were restored with cast
dEngineering Consultant. crowns, using type 3 gold with one cast gold cantilever
10/l/37744 pontic replacing the first molar.

THE JOURNAL OF PROSTHETIC DENTISTRY 243


i ‘4 I ing around the apex and in the crest of the alveolar bone.
- first premolar were low and tensile, occurring around the
1 ing bone. Vertical stressesin this area were moderate and
Fig. 1, Mathematical model illustrating seven faciolin-
gual planes of reference.
The mathematical model was completed and the finite
element model was developed by dividing the model into
1216 elements connected at 1614 points known as nodes.
All other required data were entered into the computer us-
ing the GTSTRUDL (GTICES Systems Laboratory, “GT-
STRUDL User Manual,” Georgia Institute of Technology,
version 83.02) program. Five pounds of vertical occlusal
load was applied to the occlusal surface of the pontic. Gen-
erated stresses were calculated rrumerically and plotted
graphically in seven specific faciolingual cross sections of
the model (Fig. 1). Principal vertical and horizontal stresses
(both compressive and tensile) were considered in this
study.
RESULTS
Vertical and horizontal stress values and contours are
presented in the form of compressive and tensile stresses
in seven specific faciolingual planes of reference (Fig. 1).
Table I summarizes quantity of the stresses. At planes 1
and 2, which represent the canine tooth and surrounding
bone, vertical stresses were low and tensile horizontal
stresses were low and compressive.
Vertical stresses in the bone between the canine and first
premolar (plane 3) were low and tensile, and horizontal
stresses were primarily low and compressive. Plane 4 rep-
resents the first premolar and its surrounding bone. Verti-
cal stresses in the bone were low and tensile in nature, and
were concentrated around the apex and middle third of the
root (Fig. 2, right panel ). Vertical stresses inside the root
of the first premolar were high and tensile, and were
decreased in cervical and apical directions (Fig. 2, left
panel). Horizontal stresses in bone surrounding the root of
the first premolar were low and tensile in nature, appear-
244
AWADALLA ET AL
These stressescontinued to decrease,both anteriorly and
laterally, until they changedto compressivestresses(Fig.
3, right panel). Horizontal stressesinside the root of the
apex and decreasedcervically until they reached a zero
value. They then changedto compressivestressat the cer-
vical surface (Fig. 3, left panel). In the bone between the
first and secondpremolar (plane 5), vertical stresseswere
low and compressiveand wereobservedin the middle third
of the section. Horizontal stresseswere low and tensile in
nature, and were present in the upper third of the section.
Plane6 representsthe secondpremolar and its surround-
compressivein nature, and decreasedgradually both later-
ally and anteriorly (Fig. 4, right panel). Vertical stresses
inside the root of the secondpremolar were high and com-
pressive in nature at the apical third of the root. These
stressesdecreasedcervically until they reached a zero
value, then they changed to tensile stresses(Fig. 4, left
pane2). Horizontal stressesin the bone around the root of
the secondpremolar were low and compressive,and were
recorded around the entire root length. These stresses
changed to low and tensile in a lateral direction (Fig. 5,
right panel). Horizontal stressesinside the root of the sec-
ond premolar were high and compressiveand were concen-
trated at the apical third of the root (Fig. 5, left panel). At
plane 7, which representsbone under pontic, vertical low
compressive stresses were observed while horizontal
stresseswere low and tensile in nature.
DISCUSSION
Among the different methods of stress analysis, the
three-dimensional finite element stress analysis was se-
lected. This method allows closesimulation of the compo-
nents of the dental m.odelunder investigation. The amount
of biting force decreasesfrom the molar region to the inci-
sor region. The averagebiting force in the molar region is
127 lb, and in premolar, canine, and incisor regions,is 65,
47, and 35 lb, respectively. The chewing force in the first
molar, which wasrestored with the fixed partial denture,
was37% of the natural dentition, or an averageof 55 lb.rO
There is a linear relationship betweenthe applied load and
the internal stressgenerated.i1 This means,for example, if
a load of 5 lb produced a maximum of 124psi stress,a load
of 55 lb will generatea maximum stressof 124 X 11 = 1364
psi.
The highest value of tensile stressin the entire model
(145.7psi) wasrecorded inside the root of the first premo-
lar at the center. The highest value of all compressive
stresses(125 psi) was recorded inside the root of the sec-
ond premolar at the apical third.
In bone, the most significant values of vertical tensile
stresswere 14 and 14.5 psi, recorded between the canine
and the first premolar, and around the first premolar, re-
spectively.
AUGUST 1992 VOLUME 68 NUMBER 2
3-D STRESS ANALYSIS OF FPD

Fig. 2. Vertical stress contours inside root of first premolar and surrounding bone.

Table I. Highest stress values recorded in model (in pounds per square inch)
Vertical stresses Horizontal stresses

Planes Components Compressive Tensile Compressive Tensile

Piane 1 Bone only 2.2 5.2 4.1 1.0

Bone 0 a.2 2.0 2.0
Plane 2
Root 1.0 3.0 2.7 0
Plane 3 Bone only 0 14.0 0 3.8
Bone 0 14.5 0 9.0
Plane 4 Root 0 145.7 2.7 34.0
Plane 5 Bone only 13.0 0 5.6 8.5
Bone 46.0 6.5 25.3 18.2
Plane 6
Root 125.0 21.7 101.6 2.5
Plane 7 Bone only 15.6 0 3.4 13.7

The most significant values of horizontal tensile stress of vertical occlusal load. Since this magnitude of force is 11
were 9 and 18.2 psi, recorded around the root of t.he first and times less than the average biting force on a restored side,1°
second premolars. these resultant stresses should be multiplied by a factor of
The most significant values of vertical compressive stress 11 for a more accurate calculation of stresses generated by
were 13,15, and 46 psi, recorded between the first and sec- a cantilever fixed partial denture and of its effect on the
ond premolars, in the pontic area, and around the root of supporting bone.
the second premolar, respectively. By evaluating different kinds of stresses and their mag-
Finally, the most significant value of horizontal com- nitude, it is evident that the abutment nearest the edentu-
pressive stress in the bone was 25.3 psi and was recorded lous space and its supporting bone receives compressive
around the root of the second premolar. stresses, and the abutment farthest from the pontic space
These stresses were generated as a result of applying 5 lb and its bone support is under tensile stress.

THE JOURNAL OF PROSTHETIC DENTISTRY 245

 AWADALLA ET AL

Fig. 3. Horizontal stress contours inside root of first premolar and surrounding bone.

r------“-----i
-200
-300
-460
-500
-----$-O0
‘eoa
3
G

Fig. 4. Vertical stress contours inside root of second premolar and surrounding bone.

AUGUST 1992 VQLWME t38 NUMBER 2

3-D STRESS ANALYSIS OF FPD

Fig. 5. Horizontal stress contours inside root of second premolar and surrounding bone.

The effect of the stress on the bone has been discussed 3. The abutment farthest away from the pontic assumes
by many investigators. 2a12,13 Although bone is influenced tensile forces. These forces generate tensile stress of 34
by many systemic and local factors, most investigators to 145.7 psi in the root and 9 to 14.5 psi in surrounding
studying bone tissue have accepted the concept that bone.
biomechanical forces represent the principal factor that 4. To achieve the actual value of these stresses, which are
regulates the course of bone remodeling through life. the result of a 5 lb vertical load, they were multiplied by 11
“Nothing is known about the magnitude of stress that is times, because the average biting force on a posterior fixed
capable of initiating bone resorption and apposition. Clin- partial denture is 55 lb.
ically, however, it is known that relatively small force mag-
nitudes are capable of tipping teeth (10 gm or less) on REFERENCES
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partial dentures. J PROSTHET DENT 197&39:274-7.
mation than its quantity. I5 Further study is needed to 3. Gupta KK, Knoell AC, Grenoble DE. Mathematical modeling and
clarify the limit of bone tolerance to stresses without structural analysis of the mandible [Abstract]. J Biomat Med 1973;1:469.
resorption. 4. Hadeed GJ, Ismail YH, Garrana H, Pahountis LN. Three-dimension-
al finite element stress analysis of Nobelpharma and Core-Vent im-
SUMMARY AND CONCLUSIONS plants and their supporting structures [Abstract]. J Dent Res 1988;
67:286.
The study of vertical forces in a cantilever fixed partial 5. Ismail YH, Michel MC, Hadeed GJ, Pahountis LN. A three-dimensional
finite element stress analysis of a Bladevent implant. J Dent Res
denture analyzed by means of a three-dimensional finite 1986;65:304.
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1. Vertical forces applied to abutment tooth through a finite element stress analysis of TPS implant. J Dent Res 1986;65:304.
7. Ismail YH, Pahountis LN, Fleming JF. Comparison of two-dimensional
cantilever pontic are resisted both vertically and horizon- and three-dimensional finite element analysis of a blade implant. Int J
tally. Oral Implant 1987;4:25-31.
2. The abutment nearest to the pontic receives more 8. Tesk JA, Widera 0. Stress distribution in bone arising from loading on
endosteal dental implant. J Biomed Mater Res Sym 1973;4:251-61.
than 50% of the forces. These forces, which are mainly 9. Takahashi N, Kitagami T, Kimoro T. Behavior of teeth under various
compressive, generate 101.6 to 125 psi compressive stress loading conditions with finite element method. J Oral Rehabil
in the root and 25.3 to 46 psi in surrounding bone. 1980:7:453-61.

THE JOURNAL OF PROSTHETIC DENTISTRY 247

 AWADALLA ET AL

10. Craig RG, O’Brien NJ, Powers JM. Restorative dental Materials. 6th ed. 15. Akerman JL, Cohen MI. The effects of quantified pressure on bone. Am
St. Louis: CV Mosby Co, 1980. J Orthod 19665234-6.
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In vitro evaluation of dynamic fluid displacement in dentinal

tubules activated on pin placement
Thomas Hummer& DDS,” and David Kaiser, DDS, MSDb
University of Texas Health Science Center, Dental School, San Antonio, Tex.

The use of cemented, friction-lock, and self-threading pins for improving retention
has been essential for treatment in restorative dentistry, with the self-threading
pin considered to be the most retentive. Cavity varnish has been suggested to
prevent microleakage around pins. This study investigated the insertion of a
self-threading pin when the pinhole was filled with a liquid dye. The results showed
that pinholes filled with dye before pin placement had measurable dye displace-
ment. Pinholes without pins displayed no measurable dye displacement through the
dentin; this was also true when the dye fluid was removed before the pin place-
ment. However, the dye in pinholes was displaced toward the path of least resis-
tance, and fluid in a pinhole can contribute to crazing of the dentin during place-
ment. (J PROSTKET DENT 1992;68:248-55.)

he use of cemented, friction-lock, and self-thread-

ing pins for improving the retention of restorations has be-
come routine.lm5 Cemented pins were described explicitly
by Markley6, 7 in 1951 and 1958. Woehrlen8 also has pub-
lished a comprehensive literature review with clinical con-
siderations for using pins. The use of different cements and
varnishes to retain pins was also reported,g, lo and optimal
depths were evaluated. I1 I5 Friction-lock pins can cause
stress in the dentinI and are inferior to the retention of
self-threading pins. 11,17:l8 Self-threading pins are self-re-
tentive, require no cement, and are superior in retention to
cemented pins.lg
Hanson et aLzO demonstrated that a self-threading pin
0.24 inch (0.61 mm] in diameter, cemented with zinc phos-
phate in a pinhole 0.25 inch (0.63 mm) in diameter, was one Fig. 1. Occlusal view of sectioned pins and pinholes.
of the most retentive pins. CaOH21 has been recommended
for pulpal protection and/or cavity varnish9 in controlling
microleakage with pins. A fluid, such as cavity varnish,
CaOH, or a cement, that fills a pinhole during insertion of
a pin is subject to specific dynamic changes. The fluid will
aAssistant Clinical Professor, Department of Restorative Den- be displaced either through the open dentinal tubules with
tistry.
“Associate Professor, Department of Restorative Dentistry; In-
slight leakage at the access of the pinhole, or it can
terim Head, Department of Prosthodontics. traumatize the approximating thin dentin with eventual
10/l/36924 pulpal involvement. If the fluid does not escape at the same

248 AUGUST1992 VOLUME68 NUMBER2