Digital planning protocol for functional and esthetic prosthetic treatment.

AIM: The aim of the present study was to present the different stages of prosthetic treatment planning involved in the design of an esthetic smile and the improvement of masticatory function using CAD/CAM technology. MATERIALS AND METHODS: The patient underwent the following tests and procedures: CBCT (CS 9300; Carestream), intraoral scans and occlusal detection (CS 3600; Carestream), a photographic portrait session (Nikon D610; Nikon), a face scan (Bellus 3D FaceApp; iPhone XS, Apple), and registration of individual temporomandibular joint (TMJ) angles and mandibular movements with a Zebris for Ceramill device (Amman Girrbach). All the data were transferred to Ceramill Mind software (Amman Girrbach) where they were integrated. The face scan and photographs were superimposed on the CBCT scans. Scans of the dental arches were combined with the CBCT scans. On this CBCT base, the position of the condyles in the articular fossae was determined. A Virtual Artex CR virtual articulator (Amann Girrbach) was attached to the 3D object. Individual TMJ angles and mandibular movements were then introduced. RESULTS: A virtual patient was created in the Ceramill Mind software. The optimal shape and position of each tooth were designed into the program. The wax-up was printed using a 3D printer and a temporary mock-up, and final restorations were made for the patient. At the same time, the esthetics of the smile was improved, and a harmonious central occlusion and articulation were obtained on virtual models and in the patient's oral cavity. CONCLUSION: The presented digital planning protocol allows the working out of an optimal solution in complicated patient cases from both the functional and esthetic points of view. (Int J Comput Dent 2023;26(1):61-0; doi: 10.3290/j.ijcd.b2599445).

[Influence of primers ' chemical composition on shear bond strength of resin cement to zirconia ceramic]. / Wplyw skladu primerów na wytrzymalosc polaczenia tlenku cyrkonu z cementami kompozytowymi.

BACKGROUND: Resin cements establish a strong durable bond between zirconia ceramic and hard tissues of teeth. It is essential to use primers with proper chemical composition before cementation. OBJECTIVES: The aim of this study was to assess the influence of primer's chemical composition on the shear bond strength of zirconia ceramic to resin cements. MATERIAL AND METHODS: 132 zirconia specimens were randomly assigned to four groups. There were four resin systems used. They included resin cement and respective primer, dedicated to zirconia: Clearfil Ceramic Primer/Panavia F2.0, Monobond Plus/Multilink Automix, AZ - Primer/ResiCem, Z - Prime Plus/Duo-Link. In each group the protocol of cementation was as follows: application of primer to the zirconia surface and application of the respective resin cement in cylindric mold (dimensions: 3.0 mm height and 3.0 mm diameter). Then, the shear bond strength was evaluated and the failure type was assessed in lupes (×2.5 magnification), also random specimens under SEM. The Wilcoxon test was used to analyze the data, the level of significance was α = 0.05. Finally, the known chemical composition of each primer was analysed in reference to probable chemical bonds, which may occure between primers and zirconia. RESULTS: The mean shear bond strength between resin cements and zirconia was the highest for Z-Prime Plus/Duo-Link (8.24 ± 3,21 MPa) and lowest for Clearfil Ceramic Primer/Panavia F 2.0 (4.60 ± 2.21 MPa). The analysis revealed significant difference between all groups, except pair Clearfil Ceramic Primer/Panavia F 2.0 and AZ-Primer/ResiCem. The failure type in groups of Clearfil Ceramic Primer/Panavia F 2.0 and AZ-Primer/ResiCem was mainly adhesive, in groups Monobond Plus/ /Multilink Automix and Z-Prime Plus/Duo-Link mainly mixed. The chemical composition of primers affects different bond mechanisms between resin cements and zirconia. CONCLUSIONS: The highest shear bond strength of resin cement to zirconia can be obtained for the primer composed of 10-Methacryloyloxydecyl dihydrogen phosphate (MDP) and carboxylic monomer - Biphenyl dimethacrylate (BPDM).

Evaluation of Hardness and Wear of Conventional and Transparent Zirconia Ceramics, Feldspathic Ceramic, Glaze, and Enamel.

The aim of the study was to compare the hardness, coefficient of friction, and wear experienced by four different ceramic samples: 3Y-TZP zirconium oxide ceramics-Zi-Ceramill Zi (Amman Girrbach), 5Y-PSZ transparent zirconium oxide ceramics-Zol-Ceramill Zolid (Amman Girrbach), Sak-feldspathic ceramics-Sakura Interaction (Elephant), and Glaze (Amman Girrbach). The Vickers hardness of the samples was measured. Friction tests ball-on-disc were performed between the discs of four ceramics and a zirconia ceramic ball, then a premolar tooth as a counter-sample. The mass loss and the friction coefficients of the ceramic samples were determined. The tooth counter-samples were 3D scanned, and enamel attrition depths and mass were measured. The following hardness values (HV1) were obtained: 1454 ± 46 HV1 for Zi, 1439 ± 62 HV1 for Zol, 491 ± 16 HV1 for Sak, 593 ± 16 HV1 for Glaze, and 372 ± 41 HV1 for enamel. The mass losses of the teeth in contact with ceramics were 0.1 mg for Zi, 0.1 mg for Zol, 5.5 mg for Sak, and 4 mg for Glaze. Conventional and transparent zirconium oxide ceramics are four times harder than enamel and three times harder than veneering ceramics. Zirconia ceramics exhibit lower wear and a more homogenous, smoother surface than the other ceramics. Tooth tissues are subject to greater attrition in contact with veneering ceramics than with polished zirconium oxide ceramics.

Mechanism of enamel damage in the grooves of molars during mastication.

BACKGROUND: During mastication, molars are subjected to heavy stress. However, a full explanation of the effects of physiological loads on tooth structures is lacking. OBJECTIVES: The study aimed to determine stress in molars and identify the mechanism of enamel damage in the grooves of the teeth during computer-simulated mastication. MATERIAL AND METHODS: The study was carried out using the finite element method (FEM). A three-dimensional (3D) model of the first mandibular molar and of the crown of the opposing maxillary tooth was created. A food bite was introduced between the antagonistic teeth. The mastication cycle of the bolus was computer-simulated. The equivalent stress in the enamel and dentin of the mandibular molar was calculated according to the modified von Mises (mvM) criterion. RESULTS: During the simulated chewing activity, the highest equivalent mvM stress and tensile stress concentrated on the molar enamel around the central groove and the foramen cecum. The value of the equivalent mvM stress was close to the tensile strength of the enamel. According to the mvM criterion, the enamel in these areas was exposed to destruction, which coincided with the occurrence of class I caries. CONCLUSIONS: During mastication, significant tensile and mvM stress concentrates on the mandibular molar enamel around the central groove and the foramen cecum. High stress in these areas may cause prism microfractures and facilitate the bacterial penetration of the enamel.

The Influence of Alumina Airborne-Particle Abrasion with Various Sizes of Alumina Particles on the Phase Transformation and Fracture Resistance of Zirconia-Based Dental Ceramics.

The surface of zirconia-based dental ceramic restorations require preparation prior to adhesive cementation. The purpose of this study was to assess the influence of airborne-particle abrasion with different sizes of alumina particles (50 µm, 110 µm, or 250 µm) on the mechanical strength of zirconia-based ceramics' frameworks and on the extent of phase transformations. A fracture resistance test was performed. The central surface of the frameworks was subjected to a load [N]. The identification and quantitative determination of the crystalline phase present in the zirconia specimens was assessed using X-ray diffraction. The Kruskal-Wallis one-way analysis of variance was used to establish significance (α = 0.05). The fracture resistance of zirconia-based frameworks significantly increases with an increase in the size of alumina particles used for air abrasion: 715.5 N for 250 µm alumina particles, 661.1 N for 110 µm, 608.7 N for 50 µm and the lowest for the untreated specimens (364.2 N). The X-ray diffraction analysis showed an increase in the monoclinic phase content after air abrasion: 50 µm alumina particles-26%, 110 µm-40%, 250 µm-56%, and no treatment-none. Air abrasion of the zirconia-based dental ceramics' surface with alumina particles increases the fracture resistance of zirconia copings and the monoclinic phase volume. This increase is strongly related to the alumina particle size.

Evaluation of Fracture Resistance of Occlusal Veneers Made of Different Types of Materials Depending on Their Thickness.

Pathological tooth wear is an escalating social problem. Occlusal veneers can be an alternative to traditional prosthetic restorations such as crowns, inlays, and onlays. BACKGROUND: The aim of this study is to assess the fracture resistance of occlusal veneers made of various materials depending on their thickness. METHODS: In total, 120 occlusal veneers were examined. The restorations were made of four ceramics: leucite LC (IPS Empress Esthetic), hybrid HC (Vita Enamic), lithium disilicate LDC (IPS e.max Press), and zirconium oxide ZOC (Ceramill Zolid HT). A total of 30 veneers were made of each material, 10 for each of the three thicknesses: 1 mm, 1.5 mm, 2 mm. The restorations were cemented on identical abutments duplicated from the developed phantom tooth 35 (KaVo) with composite cement (All Bond Universal). The samples prepared in this way were subjected to a compressive strength test in a universal testing machine. Statistical analysis of the results was performed. RESULTS: The average fracture resistance of occlusal veneers made of zirconium oxide ceramic was 1086-1640 N, of lithium disilicate ceramics 456-1044 N, of hybrid ceramics 449-576 N, and of leucite ceramics 257-499 N. CONCLUSIONS: Occlusal veneers made of ceramics, zirconium oxide and lithium disilicate, had the highest resistance to fractures. Restorations made of leucite ceramics turned out to be the least resistant to forces. The greater the thickness of the ceramic occlusal veneers, the greater their fracture resistance.

Finite element analysis of strength and adhesion of cast posts compared to glass fiber-reinforced composite resin posts in anterior teeth.

STATEMENT OF PROBLEM: Previous studies on the strength of teeth restored with posts have not resolved the controversy as to which post systems provide the greatest strength and longevity. PURPOSE: The purpose of this study was to compare the strength of teeth restored using cast posts with those restored using glass fiber-reinforced composite resin posts and to evaluate the bond strength of the posts to dentin. MATERIAL AND METHODS: The investigation was conducted by using finite element analysis, combined with the application of contact elements. Three-dimensional (3-D) models of the maxillary central incisors were generated: IT, an intact tooth; CC, a tooth with a ceramic crown; FP, a tooth restored with an FRC (glass fiber-reinforced composite resin) post; CPAu, a tooth restored with a gold alloy cast post; and CPNi, a tooth restored with an NiCr (nickel chromium alloy) cast post. Each model was subjected to vertical and oblique loads with a force of 100 N. To evaluate the strength of the restored tooth, ceramics, and composite resin, the modified von Mises failure criterion was used, the Tsai-Wu criterion for FRC, and the von Mises criterion for gold and NiCr alloy. The equivalent stresses found in the tested models were compared with the tensile strength of the respective materials. Contact stresses in the luting cement-dentin interface were calculated. RESULTS: The maximum mvM (modified von Mises failure criterion) stresses in the dentin of the teeth restored with FRC posts were reduced by 21%, and in those restored with cast NiCr posts, stresses were reduced by 25% when compared to the stresses in the intact tooth. The equivalent stresses in metal posts were several times higher than in FRC posts, but did not exceed the tensile strength of the materials. The highest mvM stress in the luting resin cement around the FRC post was 55% higher than in the luting resin cement around the metal post, under an oblique load. In the ceramic crown, which covered the composite resin post and core, the highest mvM stress was 30.7 MPa, whereas with the metal post and core, it was 23 MPa. CONCLUSIONS: Cast metal posts resulted in lower stresses in the dentin of the restored teeth than did FRC posts. Irrespective of the material, the equivalent stresses in the posts did not exceed their tensile strength. Lower stresses were present in the luting cement and the cement-dentin interface around cast posts than around FRC posts. In the ceramic crown supported by a metal post and core, the stresses were lower than those observed in the crown supported by a composite resin core foundation.

A comparison of mvM stress of inlays, onlays and endocrowns made from various materials and their bonding with molars in a computer simulation of mastication - FEA.

OBJECTIVES: The purpose of the study was to compare the mvM stresses occurring in inlays, onlays and endocrowns made from different materials and their bonding with molars in a computer simulation of mastication. METHODS: The study was conducted using the finite elements method with contact elements. Sixteen 3D first molar models were created of a intact tooth - T; a tooth with a ceramic inlay - IN; a tooth with an onlay - ON; and a tooth with an endocrown - EN. The restorations were made of: Comp - resin nanoceramic; Hc - hybrid ceramic; Le - leucite ceramic; Dlit - lithium disilicate; and Zr - zirconia. Computer simulations of mastication were performed. The equivalent stresses according to the modified von Mises criterion (mvM) were calculated in model materials and contact stresses at the interface cement-dental tissue around the examined restorations. RESULTS: The highest equivalent mvM stresses were concentrated in buccal margins of inlays. The mvM stresses recorded in onlays were 1.6-5 times lower than those found in inlays, while in endocrowns they were 2.3-6.5 times lower. Around the onlays and endocrowns, in tooth structures and luting cement, mvM stresses were significantly lower compared to teeth restored with inlays. The tensile and shear contact stresses between inlays and teeth were several times lower than under another restorations. The highest stresses (58.5MPa) occurred in the zirconia inlay. The stresses observed in the enamel of a tooth restored with an INZr inlay were half those noted in INComp, and a third of those observed in cement. Tensile contact stresses at the interface between the INZr inlay and dental tissue were 4.5 times lower than in the INComp, and the shear stresses were more than 7 times lower. SIGNIFICANCE: The highest values and unfavorable of stress levels occurred in teeth restored with inlays. Cavities MOD in molars should be reconstructed with cusp-covering restorations. The endocrown in molars should withstand physiological loading. The higher the modulus of elasticity of the restoration material, the higher the stresses in the restorations, while the lower stresses were observed in the tooth structures, luting cement and at the interface between the restoration and the dental tissue. Ceramic restorations should provide better protection and marginal seal of the reconstructed tooth than composite ones.

Strength comparison of anterior teeth restored with ceramic endocrowns vs custom-made post and cores.

PURPOSE: The aim of the study was to compare strength of the anterior teeth restored with ceramic endocrowns versus custom-made post and core. METHODS: The investigation used the finite element analysis. Three 3-D models of maxillary central incisor were created: model A-tooth restored with metal post and core with ceramic crown; model B-tooth with leucite ceramic endocrown; model C-tooth with lithium disilicate ceramic endocrown. Each model was subjected to a 100N force applied at a distance of 5mm from the incisal edge, at the angle of 130° to the long axis of the tooth. The modified von Mises failure criterion was used to evaluate the strength of the dentin, ceramic and resin cement, and Huber-Mises-Hencky failure criterion for cast alloy. Contact stresses in the cement-tissue adhesive interface were calculated. RESULTS: The lowest stresses occurred in the anterior tooth restored with custom post and core (model A). The mvM stress of 47.5MPa concentrated in leucite ceramic endocrown (model B) and its value was close to the tensile strength of this material. The maximal mvM stresses in the lithium disilicate ceramic endocrown (model C) were 4 times lower than tensile strength of this material. In all cases contact stresses in the adhesive interface under restorations did not exceed the resin cement bond strength to dentin. CONCLUSIONS: Leucite ceramic endocrowns in incisors may fracture during physiological loading. Endocrowns made of lithium disilicate ceramic are resistant to failure. Posts and prosthetic crowns are still recommended for anterior teeth restorations.

A comparison of stresses in molar teeth restored with inlays and direct restorations, including polymerization shrinkage of composite resin and tooth loading during mastication.

UNLABELLED: Polymerization shrinkage of composites is one of the main causes of leakage around dental restorations. Despite the large numbers of studies there is no consensus, what kind of teeth reconstruction--direct or indirect composite restorations are the most beneficial and the most durable. OBJECTIVE: The aim was to compare equivalent stresses and contact adhesive stresses in molar teeth with class II MOD cavities, which were restored with inlays and direct restorations (taking into account polymerization shrinkage of composite resin) during simulated mastication. METHOD: The study was conducted using the finite elements method with the application of contact elements. Three 3D models of first molars were created: model A was an intact tooth; model B--a tooth with a composite inlay, and model C--a tooth with a direct composite restoration. Polymerization linear shrinkage 0.7% of a direct composite restoration and resin luting cement was simulated (load 1). A computer simulation of mastication was performed (load 2). In these 2 situations, equivalent stresses according to the modified von Mises criterion (mvM) in the materials of mandibular first molar models with different restorations were calculated and compared. Contact stresses in the luting cement-tooth tissue adhesive interface around the restorations were also assessed and analyzed. RESULTS: Equivalent stresses in a tooth with a direct composite restoration (the entire volume of which was affected by polymerization shrinkage) were many times higher than in the tooth restored with a composite inlay (where shrinkage was present only in a thin layer of the luting cement). In dentin and enamel the stress values were 8-14 times higher, and were 13 times higher in the direct restoration than in the inlay. Likewise, contact stresses in the adhesive bond around the direct restoration were 6.5-7.7 times higher compared to an extraorally cured restoration. In the masticatory simulation, shear contact stresses in the adhesive bond around the direct composite restoration reached the highest values 32.8 MPa and significantly exceeded the shear strength of the connection between the resin luting cement and the tooth structure. SIGNIFICANCE: Equivalent stresses in the tooth structures restored with inlays and in the restoration material itself and contact stresses at the tooth-luting cement adhesive interface are many times lower compared to teeth with direct composite restorations. Teeth with indirect restorations are potentially less susceptible to damage compared to those with direct restorations. Composite inlays also ensure a better seal compared to direct restorations. Polymerization shrinkage determines stress levels in teeth with direct restorations, while its impact on adhesion in indirectly restored teeth is insignificant.

The influence of ferrule effect and length of cast and FRC posts on the stresses in anterior teeth.

OBJECTIVES: The purpose was to assess the influence of ferrule effect and length of cast post and cores, and FRC posts on the strength of anterior teeth. MATERIALS AND METHODS: The investigations were conducted by means of finite element analysis with the application of contact elements. Thirteen 3D models of maxillary first incisors were generated: model 1 was an intact tooth; 2A - a tooth with all-ceramic crown with ferrule effect, 2B-D a teeth restored with, ferrule and FRC posts of various lengths 13mm, 8mm, 4mm, 3A - a tooth with ceramic crown without, ferrule effect, 3B and C teeth without ferrule and 10mm, 5mm length FRC posts, 4B-D teeth with ferrule, restored by cast posts and cores of 13mm, 8mm, 4mm lengths and 5B and C teeth without ferrule, restored with cast posts and cores of 10mm, 5mm lengths. Each model was subject to a load with a total force of 100N uniformly distributed under the lingual cingulum, at an angle of 130°. To evaluate, the strength of tooth tissues, ceramics and composites, the modified von Mises failure criterion was used, for FRC the Tsai-Wu criterion and for cast NiCr alloy the von Mises criterion. Contact stresses were calculated at the luting cement-tissue interface. RESULTS: Ferrule effect in teeth reduces mvM stresses in dentin, in posts and in luting cement. The contact tensile stresses around posts in teeth with ferrule effect were 1.7-3.0 times smaller than in, teeth without ferrule. Lower mvM stresses occurred in teeth with cast posts in comparison with FRC posts. The mvM stresses in teeth with posts of various lengths were similar, irrespective of post material. SIGNIFICANCE: Ferrule effect in teeth with posts and cores has a critical influence on stress reduction. Using posts and cores made of rigid materials leads to stress reduction in teeth. Post length has a small, effect on stress values in tooth structures.

3D-Finite element analysis of molars restored with endocrowns and posts during masticatory simulation.

OBJECTIVE: The objective was to compare equivalent stresses in molars restored with endocrowns as well as posts and cores during masticatory simulation using finite element analysis. METHODS: Four three-dimensional models of first mandibular molars were created: A - intact tooth; B - tooth restored by ceramic endocrown; C - tooth with FRC posts, composite core and ceramic crown; D - tooth with cast post and ceramic crown. The study was performed using finite element analysis, with contact elements. The computer simulations of mastication were conducted. The equivalent stresses of modified von Mises failure criterion (mvM) in models were calculated, Tsai-Wu index for FRC post was determinate. Maximal values of the stresses in the ceramic, cement and dentin were compared between models and to strength of the materials. Contact stresses in the cement-tissue adhesive interface around restorations were considered as well. RESULTS: During masticatory simulation, the lowest mvM stresses in dentin arisen in molar restored with endocrown (Model B). Maximal mvM stress values in structures of restored molar were 23% lower than in the intact tooth. The mvM stresses in the endocrown did not exceed the tensile strength of ceramic. In the molar with an FRC posts (Model C), equivalent stress values in dentin increased by 42% versus Model B. In ceramic crown of Model C the stresses were 31% higher and in the resin luting cement were 61% higher than in the tooth with endocrown. Tensile contact stresses in the adhesive cement-dentin interface around FRC posts achieved 4 times higher values than under endocrown and shear stresses increased twice. The contact stress values around the appliances were several time smaller than cement-dentin bond strength. SIGNIFICANCE: Teeth restored by endocrowns are potentially more resistant to failure than those with FRC posts. Under physiological loads, ceramic endocrowns ideally cemented in molars should not be demaged or debonded.

Three-dimensional finite element analysis of molars with thin-walled prosthetic crowns made of various materials.

OBJECTIVES: The aim of the study was to compare the strength of thin-walled molar crowns made of various materials under simulation of mastication. METHODS: Five 3D FE models of the first lower molar with the use of contact elements were created: intact tooth; tooth with a zirconia crown; tooth with a porcelain crown; tooth with a gold alloy crown and tooth with a composite crown. The computer simulations of mastication were conducted. For the models, equivalent stresseswere calculated using the modified von Mises failure criterion (mvM). Contact stresses at the adhesive interface between the cement and tooth structure under the crowns were analyzed. RESULTS: Equivalent stresses in the crowns, did not exceed the tensile strength of their material. The mvM stresses in resin cement under the zirconia crown were 1.3 MPa, and under the composite crown they increased over 6 times. The tensile and shear contact stressesunder the stiff crowns (ceramics and gold alloy), were several times lower than those under the composite one. The maximum mvM stresses in the tooth structure for the zirconia crown were only 2.8 MPa, whereas for the composite crown were 6.4 MPa. The higher elastic modulus the crown was, the lower the equivalent stresses occurred in the composite luting cement and in the tooth structures. Also contact stresses decreased with the increasing stiffness of the crowns. SIGNIFICANCE: Under physiological loads, the thin-walled crowns perfectly luted to molars, made of zirconia ceramic, gold alloys and composite resin are resistant to failure. Prosthetic crowns made of stiff materials are less prone to debonding than those made of composite resin. Prosthetic crowns made of a material with a higher elastic modulus than enamel will strengthen the dental structures of molar teeth.

Three-dimensional finite element analysis of strength and adhesion of composite resin versus ceramic inlays in molars.

STATEMENT OF PROBLEM: Previous studies on strength of teeth reconstructed with ceramic or composite resin inlays have not resolved which restoration material provides the highest strength and marginal integrity. PURPOSE: The purpose of this study was to compare strength of mandibular molars restored with composite resin inlays to those restored with ceramic inlays, according to the Mohr-Coulomb failure criterion, and to analyze contact stresses in cement-tooth adhesive interfaces of these inlays. MATERIAL AND METHODS: The investigation used a 3-dimensional (3-D) finite element analysis with the use of contact elements. Seven 3-D models of first molars of the same shape and size were created: IT, intact tooth; UT, unrestored tooth with an MOD cavity preparation; CRIT, tooth restored with composite resin inlays (True Vitality) with an elastic modulus equal to 5.4 GPa; CRIH, tooth restored with composite resin inlays (Herculite XRV) (9.5 GPa); CRIC, tooth restored with composite resin inlays (Charisma) (14.5 GPa); CRIZ, tooth restored with composite resin inlays (Z100) (21 GPa); and CI, tooth restored with a ceramic (IPS Empress) inlay with an elastic modulus equal to 65 GPa. Each model was subjected to a force of 200 N directed to the occlusal surface. The stresses occurring in the tested inlays, composite resin cement layer, and tooth tissues were calculated. To evaluate the strength of materials, the Mohr-Coulomb failure criterion was used. Contact stresses in the cement-tissue adhesive interface were calculated and compared to tensile and shear bond strength of the luting cement to enamel and dentin. RESULTS: In the teeth restored with composite resin and ceramic inlays, the values of the Mohr-Coulomb failure criterion were lower than in the unrestored tooth with a preparation (UT), but still 2.5 times higher than in the intact tooth (IT). For the ceramic inlay (CI), the values of the Mohr-Coulomb failure criterion were nearly 3 times higher than in the composite resin inlays. For the luting agent for the ceramic inlay model, these values were 2-4 times lower than for the luting agents for the composite resin inlay models. At the adhesive interface between the cement and tooth around the ceramic inlays, contact tensile and shear stresses were lower than around the composite resin inlays. In the cervical enamel surrounding the proximal surface of the inlays, the stresses exceeded the tissue strength. CONCLUSIONS: Adhesively bonded composite resin and ceramic inlays reinforce the structure of prepared teeth, but do not restore their original strength. The proximal enamel surrounding inlays is prone to failure. The value of the Mohr-Coulomb failure criterion for ceramic inlays was higher than for composite resin inlays. With an increase in the elastic modulus of inlay materials, the values of the Mohr-Coulomb failure criterion decrease in the luting cement. Contact tensile and shear stresses on the cement-tissue adhesive interface decrease as well.

Strength estimation of different designs of ceramic inlays and onlays in molars based on the Tsai-Wu failure criterion.

STATEMENT OF PROBLEM: Successful restoration of large molar defects is a serious clinical problem. Studies on the strength of teeth restored with ceramic restorations of various designs have provided conflicting results. PURPOSE: The purpose of this study was to determine the shapes of large MOD ceramic restorations in molars most likely to prevent failure and to produce a favorable distribution of contact stresses between the cement and teeth during mastication. MATERIAL AND METHODS: The study was performed using a finite element analysis with contact elements. Eight 2-dimensional models of mandibular first molars with the following designs of MOD ceramic restorations were created: an inlay with a butt joint margin, an inlay with a beveled margin, an onlay with a butt joint margin, and an onlay with a rounded shoulder margin. The restorations had 3-mm or 5-mm isthmus widths. Models of opposing maxillary crowns were also developed. Computational simulation of mastication of boluses in the frontal plane was conducted, during which the stresses occurring in the ceramic restorations, cement, and tooth structure were calculated. The Tsai-Wu failure criterion was used to evaluate the strength of the materials. Contact stresses at the adhesive interface between the tooth structure and resin cement around these restorations were analyzed. RESULTS: According to the Tsai-Wu failure criterion, the margin of the beveled inlay and the surrounding tissue could be damaged during masticatory simulation. At the junction of the butt joint margin inlay and enamel, contact tensile stresses appeared. The lowest inverse of the Tsai-Wu strength ratio index appeared in the onlay with a rounded shoulder margin. At the adhesive interfaces around margins of large onlays, compressive contact stresses occurred. CONCLUSIONS: For the large molar MOD ceramic restorations tested, the lowest values of the inverse of the Tsai-Wu strength ratio index and a favorable distribution of contact stresses between restoration and tissues appeared in the onlay with a rounded shoulder margin.

Finite element analysis of mechanism of cervical lesion formation in simulated molars during mastication and parafunction.

STATEMENT OF PROBLEM: The mechanical theory of cervical lesion formation is popular; however, the mechanism of formation of these lesions is not fully explained. PURPOSE: The aim of this study was calculation of the stresses and Tsai-Wu strength ratio in the cervical area of the mandibular molar during grinding, clenching, and mastication, as well as theoretical investigation of the mechanism of cervical lesion formation in teeth. MATERIAL AND METHODS: A 2-dimensional finite element model of the mandibular first molar and crown of the opposing maxillary molar in the frontal section was developed. Computational simulation of mastication of a bolus with high elastic modulus, including grinding and clenching, was performed. Pairs of contact elements were used between the bolus and occlusal surfaces of the teeth. The analysis was nonlinear. During these simulations, the pressure exerted on the occlusal surface and the state of stresses in the mandibular molar were calculated. To evaluate the strength of anisotropic tooth tissues, the Tsai-Wu failure criterion was applied. This criterion considers the difference in strength of materials due to tensile, compressive, and shear stresses. RESULTS: Significant pressures were exerted on lingual cusps of the mandibular molar model during computer simulations of physiological and pathological load. In enamel elements close to the buccal cemento-enamel junction (CEJ) of the studied tooth, tensile stresses were observed which exceeded the strength of the enamel. In this area, the Tsai-Wu strength ratio reached values higher than 1. According to the Tsai-Wu criterion, these elements were damaged and, thus, were removed from the computer tooth model. During subsequent modeling of the tooth with the initiated cervical lesion, the Tsai-Wu ratio exceeded 1 along the dentino-enamel junction (DEJ), creating an overhang of enamel in the cervical area. Application of minimal horizontal force caused a fracture of this fragile, unsupported enamel fragment. CONCLUSIONS: Overloading of theoretical teeth by computer simulation resulted in enamel damage at the CEJ and led to initiation of a cervical lesion. Subsequent overloading resulted in enamel destruction along the DEJ. The overhanging enamel fragment may easily be chipped. This process was repeated during subsequent tooth overloading and caused enlarging of the lesion.

Finite element analysis of stresses in molars during clenching and mastication.

STATEMENT OF PROBLEM: During physiological functions of the masticatory system such as swallowing and chewing, teeth are subjected to variations in force application. Most in vitro analyses of stress have not analyzed the combined forces acting on teeth. PURPOSE: The purpose of this study was to analyze the stresses induced in a mandibular molar during clenching and chewing of morsels with various elastic moduli. MATERIALS AND METHODS: The investigation was performed by means of finite element analysis with the use of contact elements. Two-dimensional models of the mandibular first molar and the crown of the opposing maxillary molar were created. The computerized simulation evaluated the clenching and chewing of 4 morsels with different elastic moduli (similar to hard gum, tough meat, bone, and combination of hard gum and bone). The movement of the studied teeth was simulated in the frontal plane. Teeth models crushed morsels and closed into the maximal intercuspation position. The values of stresses in the mandibular molar were calculated during these situations. RESULTS: The study revealed that clenching of molars and chewing morsels of high elastic moduli resulted in maximal equivalent stresses within occlusal enamel. During mastication of morsels of low elastic moduli the stress concentration was located in the cervical region of the lingual side of the mandibular molar. Masticating a low-elasticity morsel containing a fragment of bone caused the highest equivalent stresses in the lingual wall and high tensile stresses in enamel near the central intercuspal fissure of the tooth studied. CONCLUSION: During mastication of various morsels, maximal equivalent stresses occurred in occlusal enamel and in the cervical region of the lingual wall of the first mandibular molar. The more unfavorable and highest stresses were exerted during mastication of nonhomogeneous morsels.