Occlusal Stress Distribution on the Mandibular First Premolar - FEM Analysis.

OBJECTIVE: The aim of this paper was to analyze the distribution of stress and deformation on the mandibular first premolar under two types of loading (axial and para-axial load of 200 N) using the FEM computer method. MATERIALS AND METHOD: For this research a µCT scan of the first mandibular premolar was used, and the method used in this research was FEM analysis under two types of loading. RESULTS: The values of the von Mises stress measured in the cervical part of an intact tooth under axial load were up to 12 MPa, and under paraaxial load over 50 MPa. The values of the stress measured on the bottom of the noncarious lesion are very high ≈ 240 Mpa. Stress values in the cervical part of the intact tooth are higher in the zone of the sub-surface enamel. The deformation values of the tooth under para-axial loading were ≈ 10 times higher than the value of the deformation under axial load. The greatest deformations were seen in the area of the tooth crown. CONCLUSIONS: Occlusal loading leads to significant stress in the cervical part of teeth. The values of the measured stress are greater under the action of paraxial load. The values of stress in abfraction lesions measured under a paraxial load are extremely high. Exposing the lesion to further stress will lead to its deepening. The total deformation of the entire tooth under paraxial load was ≈ 10 times higher compared to the deformation value of the tooth under axial load.

Understanding external cervical resorption patterns in endodontically treated teeth.

AIM: To understand the patterns of external cervical resorption (ECR) in endodontically treated teeth. To compare characteristics and mechanisms of ECR in root filled teeth with those established in teeth with vital pulps. METHODOLOGY: Seven cases of endodontically treated permanent teeth displaying ECR were investigated. ECR diagnosis was based on clinical findings and radiographic examination with cone-beam computed tomography. The extracted teeth were further analysed by a nano-focus computed tomographic (nano-CT) system, hard-tissue histology and scanning electron microscopy (SEM). To make a comparison with teeth with vital pulps, representative cases with ECR were also included. RESULTS: All endodontically treated teeth had a similar ECR pattern. This pattern reflected many similarities to that seen in teeth with vital pulps; that is, three stages were observed namely initiation, resorption and repair. In particular, during the initiation stage (1st stage), the resorption started below the gingival epithelial attachment, at the level of cementum. In the resorption stage (2nd stage), ECR spreads towards the treated pulp space and in a coronal-apical direction, creating multiple resorption channels. The pulp and the pericanalar resorption resistant sheet (PRRS) had been removed during root canal treatment and thus offered no retarding or defence mechanism towards ECR. In the reparative stage (3rd stage), reparative hard-tissue formation occurred at a localized scale. CONCLUSIONS: Similar ECR patterns were observed in all examined teeth. These patterns consisted of an initiation, a resorption and a reparative stage. Some differences were noticed between endodontically treated and teeth with vital pulps, mainly in the resorption and reparative stages. The resorption stage in root filled teeth was more intense than the repair stage, as many clastic cells and abundant granulation tissue were observed in all samples. This is possibly due to the absence of the pulp and protective PRRS layer and/or to the altered chemical composition of the root dentine after root canal treatment. Furthermore, at the repair stage, formation of reparative bonelike tissue took place to a lesser extent in root filled teeth.

Effects of non-carious cervical lesion size, occlusal loading and restoration on biomechanical behaviour of premolar teeth.

BACKGROUND: Information on fracture biomechanics has implications in materials research and clinical practice. The aim of this study was to analyse the influence of non-carious cervical lesion (NCCL) size, restorative status and direction of occlusal loading on the biomechanical behaviour of mandibular premolars, using finite element analysis (FEA), strain gauge tests and fracture resistance tests. METHODS: Ten buccal cusps were loaded on the outer and inner slopes to calculate the strain generated cervically. Data were collected for healthy teeth at baseline and progressively at three lesion depths (0.5 mm, 1.0 mm and 1.5 mm), followed by restoration with resin composite. The magnitude and distribution of von Mises stress and maximum principal stress were simulated at all stages using FEA, and fracture strength was also determined (n = 7 per group). RESULTS: There were significant effects of the lesion size and loading directions on stress, strain and fracture resistance (p < 0.05). Fracture resistance values decreased with increase in lesion size, but returned to baseline with restorations. CONCLUSIONS: Combined assessment of computer-based and experimental techniques provide an holistic approach to characterize the biomechanical behaviour of teeth with both unrestored and restored NCCLs.

An Analysis of the Stress Induced in the Periodontal Ligament during Extrusion and Rotation Movements: A Finite Element Method Linear Study Part I.

BACKGROUND: Orthodontic tooth movement occurs due to various biomechanical changes in the periodontium. Forces within the optimal range yield maximum tooth movement with minimum deleterious effects. Among various types of tooth movements, extrusion and rotational movements are seen to be associated with the least amount of root resorption and have not been studied in detail. Therefore in this study, the stress patterns in the periodontal ligament (PDL) were evaluated with extrusion and rotational movements using the finite element method FEM. MATERIALS AND METHODS: A three-dimensional (3D) FEM model of the maxillary incisors was generated using SOLIDWORKS modeling software. Stresses in the PDL were evaluated with extrusive and rotational movements by a 3D FEM using ANSYS software with linear material properties. RESULTS: It was observed that with the application of extrusive load, the tensile stresses were seen at the apex, whereas the compressive stress was distributed at the cervical margin. With the application of rotational movements, maximum compressive stress was distributed at the apex and cervical third, whereas the tensile stress was distributed on cervical third of the PDL on the lingual surface. CONCLUSION: For extrusive movements, stress values over the periodontal ligament was within the range of optimal stress value as proposed by Lee, with a given force system by Profitt as optimum forces for orthodontic tooth movement using linear properties. During rotation there are stresses concentrated at the apex, hence due to the concentration of the compressive forces at the apex a clinician must avoid placing heavy stresses during tooth movement.

Finite element method analysis of the periodontal ligament in mandibular canine movement with transparent tooth correction treatment.

BACKGROUND: This study used the 3D finite element method to investigate canine's displacements and stresses in the canine's periodontal ligament (PDL) during canine's translation, inclination, and rotation with transparent tooth correction treatment. METHODS: Finite element models were developed to simulate dynamic orthodontic treatments of the translation, inclination, and rotation of the left mandibular canine with transparent tooth correction system. Piecewise static simulations were performed to replicate the dynamic process of orthodontic treatments. The distribution and change trends of canine's displacements and stresses in the canine's PDL during the three types of tooth movements were obtained. RESULTS: Maximum displacements were observed at the crown and middle part in the translation case, at the crown in the inclination case, and at the crown and root part in the rotation case. The relative maximum von Mises and principal stresses were mainly found at the cervix of the PDL in the translation and inclination cases. In the translation case, tensile stress was mainly observed on the mesial and distal surfaces near the lingual side and compressive stress was located at the bottom of the labial surface. In the inclination case, tensile stress was mainly observed at the labial cervix and lingual apex and compressive stress was located at the lingual cervix and labial apex. In the rotation case, von Mises stress was mainly located at the cervix and inside the lingual surface, tensile stress was located on the distal surface, and compressive stress was detected on the mesial surface. The stress and displacement value rapidly decreased in the first few steps and then reached a plateau. CONCLUSIONS: Canine's movement type significantly influences the distribution of canine's displacement and stresses in the canine's PDL. Changes in canine's displacement and stresses in the canine's PDL were exponential in transparent tooth correction treatment.

Extreme root resorption associated with induced tooth movement: A protocol for clinical management

Cases in which teeth have only the cervical third remaining from orthodontically induced external root resorption, cast the following doubts: 1) What care should be taken to keep these teeth in mouth with the least risk possible? 2) What care should be taken with regards to reading of imaging exams, particularly in terms of accurately determining cervical root and bone loss? 3) Why is not endodontic treatment recommended in these cases? The present study aims at shedding light on the aforementioned topics so as to induce new insights into the theme.

Nos casos em que os dentes têm apenas o terço cervical remanescente de uma reabsorção radicular externa induzida ortodonticamente: 1) Quais seriam os cuidados para que permaneçam na boca, com o menor risco possível de perda? 2) Quais seriam os cuidados na interpretação imaginológica desses casos, quanto à determinação precisa da perda radicular e óssea cervical? 3) Por que o tratamento endodôntico não estaria indicado? No presente trabalho, procura-se esclarecer esses pontos e respondendo os questionamentos, para induzir novos insights sobre o assunto.

The effects of ageing on the biomechanical properties of root dentine and fracture.

OBJECTIVES: Knowledge of the mechanical behaviour of root dentine can facilitate better understanding of spontaneous vertical root fracture (VRF), an age-related disease initiated mainly at the root apex. We tested the hypothesis that the biomechanical properties of root dentine change with ageing. METHODS: Sixteen human premolars were divided into "old" (17-30 years) and "young" (50-80 years) groups. The elastic modulus, nano-hardness, micro-hardness, elemental contents, tubular density/area of root dentine in cervical, middle and apical root regions were evaluated using atomic force microscopy-based nano-indentation, Knoop indentation, scanning electron microscopy and energy dispersive X-ray spectroscopy, respectively. RESULTS: The apical dentine showed a lower nano-hardness, a lower elastic modulus, a lower calcium content, a lower calcium-to-phosphorus ratio and a smaller tubular density/area than the cervical dentine in both age groups, whereas spatial differences in micro-hardness were observed only in old roots. Compared with young dentine, old dentine showed a greater hardness, a higher elastic modulus, a greater mineral content and a smaller tubular size in the cervical portion, whereas the age-induced changes in tubular density were insignificant. Finite element analysis revealed that due to its higher elastic modulus, old apical dentine has a higher stress level than young dentine. CONCLUSIONS: The intrinsic material properties of root dentine have spatial variations, and they are altered by ageing. The higher stress level in old apical dentine may be one reason, if not the most important one, why spontaneous VRFs are more likely to occur in the elderly population.

Eruptive and functional changes in periodontal ligament fibroblast orientation in CD44 wild-type vs. knockout mice.

BACKGROUND AND OBJECTIVE: Periodontal ligament (PDL) fibroblasts establish principal fibers of the ligament during tooth eruption, and maintain these fibers during occlusion. PDL development and occlusal adaptation includes changes in the orientation of PDL fibroblasts; however, the mechanism for these changes in orientation is unclear. The objective of this study was to compare PDL fibroblast orientation in different stages corresponding with first molar eruption and occlusion in CD44 wild-type (WT) and knockout (KO) mice. MATERIAL AND METHODS: CD44 WT and KO mice were raised to six postnatal stages corresponding with first molar (M1 ) eruption (postnatal day 8, 11, 14 and 18) and occlusion (postnatal day 26 and 41). Coronal sections of the first mandibular molar (M1 ) were prepared and the orientation of fibroblasts in the cervical root region was measured. Angle measurements were compared across developmental stages and between strains using Watson-Williams F-test (oriana software) and ANCOVA. RESULTS: PDL fibroblast orientation increased significantly in CD44 WT (9-87°) and KO mice (14-93°; p ≤ 0.05) between intraosseous eruption (day 11), mucosal penetration (day 14) and preocclusal eruption (day 18); however, the PDL fibroblast orientation did not change significantly with the onset of occlusion (day 26) or continued function (day 41). Within each strain, the variance in fibroblast orientation during preocclusal eruption (day 18) was significantly higher than the variance of all other time points (p < 0.0005). CD44 WT and KO mice showed a similar pattern of PDL development and eruption with a significant difference in CD44 WT vs. KO fibroblast orientations only during early function (day 26, 92° vs 116°; p = 0.05). CONCLUSIONS: The development of PDL fibroblast orientation is highly similar between CD44 WT and KO mice. Between early (day 11) and late (day 18) eruptive stages PDL fibroblast orientation increases, corresponding with the upward movement of M1 . The PDL fibroblast orientation established in preocclusal eruption (day 18) is maintained during early (day 26) and late (day 41) stages of occlusal function, suggesting that PDL cells adapt to mechanical loads in the oral cavity before M1 occlusion.

Extreme root resorption associated with induced tooth movement: a protocol for clinical management.

Cases in which teeth have only the cervical third remaining from orthodontically induced external root resorption, cast the following doubts: 1) What care should be taken to keep these teeth in mouth with the least risk possible? 2) What care should be taken with regards to reading of imaging exams, particularly in terms of accurately determining cervical root and bone loss? 3) Why is not endodontic treatment recommended in these cases? The present study aims at shedding light on the aforementioned topics so as to induce new insights into the theme.

Influence of periodontal ligament simulation and splints on strains developing at the cervical area of a tooth crown.

Many in vitro tooth models do not incorporate periodontal ligament (PDL) simulation. This study presents the influence of physiologically loaded occlusal splints on cervical strains in a model incorporating roots and PDL. Four sets (N = 10) of occlusal splints differing in material (hard/soft) and location (upper/lower) were prepared for first maxillary and mandibular anatomic molars. Two strain gauges were bonded to the buccal and lingual aspects of the lower molar. Teeth were embedded in acrylic resin with/without a PDL-simulating material. Force vs. strain data were acquired during loading and the maximal strains at 500 N were analyzed. When PDL was incorporated into the model without splints, buccal compressive strains were significantly decreased. Usage of a soft splint resulted in compressive strains on both tooth aspects. Usage of a hard splint on the lower tooth resulted in higher compressive strains on the lingual side compared with the buccal side, whereas usage of this splint on the upper tooth resulted in tensile strains on the lingual side. Bending towards the buccal side occurred when the splints were located on the upper tooth. Soft splints reduce buccal bending, but do not reduce cervical strains. Periodontal ligament stimulation materials should therefore be incorporated in models involving teeth.

A three-dimensional finite element analysis of the effects of restorative materials and post geometry on stress distribution in mandibular molar tooth restored with post-core crown.

This study investigated the effects of crown material, post material, and post geometry on stress distribution in molar tooth restored with post-core crown. A three-dimensional solid model consisting of the mandibular second molar tooth, periodontal ligament, cortical bone, and spongy bone was generated. Finite element analysis results showed that prefabricated posts with a composite resin core increased stress concentration at the cementoenamel junction (CEJ), while cast posts induced high stress at post-dentin interface. Increase in the elastic modulus of crown material also increased the stress concentration, especially at CEJ.

Appropriate electrode placement site for electric pulp testing of anterior teeth in Nigerian adults: a clinical study.

Electric pulp testing is one of the pulp vitality tests which aid dentists in diagnosis of the pulp status. This test is technique sensitive and hence may elicit false responses. There are some concerns regarding the optimal placement of the probe tip. The threshold value (the lowest electric current at which sensation is perceived) is reached when an adequate number of nerve fibers are stimulated, so the sensation would be greatest where the density of neural distribution is the highest. The purpose of this study was to identify the optimum site for electrode placement in anterior teeth of adults, the threshold values of these teeth using an electric pulp test, and to determine the influence of sex, age, and arch on the outcome. The optimum electrode placement sites and threshold values varied with type of tooth and arch. The maxillary teeth, canines, male gender and increasing age required higher electric current to evoke a sensation, while incisal edges required lower current to evoke a sensation.

Structure, chemical composition and mechanical properties of coronal cementum in human deciduous molars.

OBJECTIVES: It was hypothesized that the coronal cementum containing collagen forms a weak junction with enamel unlike the well integrated DEJ and CDJ. METHODS: The hypothesis was investigated in two parts: (1) evaluate the structure, chemical composition and mechanical properties of coronal cementum and its junction with enamel using scanning electron microscopy, micro-X-ray computed tomography, and atomic force microscopy. The chemical composition and mechanical properties were determined by evaluating the spatial variations of inorganic (PO(4)(3-)nu(1) mode at 960 cm(-1)) and organic (C-H deformation at 1452 cm(-1); C-H stretch at 2940 cm(-1)) contents using Raman microspectroscopy and elastic modulus and hardness values using nanoindentation. (2) Estimate the strength and evaluate the microstructure of coronal cementum interface with enamel using SEM and MicroXCT. RESULTS AND CONCLUSIONS: Coronal cementum is heterogeneous because it is a combination of laminar acellular afibrillar cementum and acellular extrinsic fiber cementum with relatively higher organic content. It integrates micromechanically via a scallop-like weak interface with enamel unlike the biomechanically efficient DEJ and CDJ and is continuous with primary root cementum. A single tooth could exhibit all three types of cementum enamel junctions; an overlap, butt and a gap depending on the sectioning plane. The elastic modulus of coronal cementum (11.0+/-5.8 GPa) is significantly lower (p<0.05; Student's t-test with 95% confidence interval) than primary cementum (15.8+/-5.3 GPa).

Multiscale analysis of stress distribution in teeth under applied forces.

OBJECTIVES: The present study aimed to clarify stress distribution in teeth under an external applied load using microindentation and multiscale simulation. METHODS: Anisotropic material properties of enamel and dentin were measured using a microindentation method with a dynamic ultra microhardness tester. The numerical model was constructed using the finite element mesh superposition method with a microscale (enamel rods), mesoscale (teeth), and macroscale (bone). Multiscale simulation was used to analyze different scale structures. A concentrated load (10 N) was applied to the labial surface of the central incisor. RESULTS: The results revealed stresses of 5 MPa (normal stress) and 6.5 MPa (shear stress) in the enamel sheath at the center of the labial region compared to 1.4 MPa (normal stress) and 21.4 MPa (shear stress) in the cervical region. SIGNIFICANCE: These results suggest that shear stresses in the enamel sheath may play significant roles in stress transmission.

Evaluation of the cervical integrity during occlusal loading of Class II restorations.

There are many concerns regarding the clinical behavior of packable composite restorations in Class II cavities, particularly when those restorations are subjected to axial mechanical loads. This study evaluated microleakage in vitro in proximal vertical "slot"-type cavities with walls located in enamel and dentin, filled with packable composite, associated or not associated with a flowable composite, a reinforced light-curing glass-ionomer or a compomer, after being submitted to occlusal load cycling. These preparations were subjected to either occlusal load cycling or no occlusal load cycling. Eighty human molars with enamel and dentin margins were treated with standardized cavity preparations (proximal vertical "slot" preparations). After completing the filling process using a packable composite (Filtek P60) with or without a cervical increment of flowable composite (Filtek flow), light-curing glass-ionomer (Vitremer) or compomer (Dyract AP), the molars were separated into two groups: control (without occlusal loading) and test, in which 4,000 one-second cycles of 150 N occlusal loading were applied. All 80 teeth were submitted to a microleakage test, then evaluated utilizing silver nitrate dye penetration. Significant statistical differences (Wilcoxon test, p<0.05) in the amount of leakage in enamel and dentin were found in both the control and test groups. After a paired comparison of the control and test groups, a significant statistical difference was found at the enamel level (Mann-Whitney test, p<0.05). In dentin, the only statistically significant difference found was the relation to the flow material. The Kruskal-Wallis test did not detect any statistically significant difference in the amount of leakage among the four materials studied, with a 5% level of significance for both enamel and dentin. Based on this data, it was concluded that restorations with margins located in dentin had greater microleakage than those restorations with margins located in enamel. When the samples were submitted to occlusal loading, they were negatively influenced, which increased microleakage values in enamel and dentin. There was no statistically significant difference among the four tested materials, when comparing their performance.

Three-dimensional finite element analysis of stress in the periodontium.

The aim of this study is to calculate the stress produced in the periodontium at different bone levels under occlusal load. Four finite element models of maxillary incisors were designed consisting of the tooth, pulp, periodontal ligament and alveolar bone at various levels of bone height (25%, 50% and 75%). An occlusal load of 24 kg at an angle of 50 degrees to the long axis of the tooth was applied on the palatal surface, at the level of the middle third of the crown. All the models were assumed to be isotropic, linear and elastic and the analysis was performed on a Pentium IV computer using the NISA II Display III software. The results showed that maximum stress in the tooth was seen at the cervical region and to a greater extent at the apex for all the models. In periodontal ligament, maximum stress was seen at the alveolar crest in models with normal alveolar bone height and with reducing alveolar bone height maximum stress was at the apex. There was no significant stress distribution in alveolar bone, while no stress was seen on the pulp. The results of the study demonstrated a significant increase in stress concentration at the apex with loss of alveolar bone height.

The effects of dietary naringenin supplementation on physiological changes in molar crestal alveolar bone-cemento-enamel junction distance in young rats.

The objective of this study was to evaluate the influence of dietary naringenin (NAR) supplementation on physiological molar crestal alveolar bone (CAB)-cemento-enamel junction (CEJ) distances in young male albino rats. The effects of diets supplemented with 0.09%, 0.18%, 0.36%, and 0.72% NAR, at the expense of dextrose, were tested on 40 young rats, divided equally into five groups, for a period of 42 days. Rat skulls were defleshed, and CAB-CEJ distance was scored according to the modified method of Keyes and Gold. Data were analyzed using one-way analysis of variance, post hoc Tukey's test, and Spearman's (R(2)) correlation. P < .05 was used to reject the null hypothesis. NAR showed a statistically significant inverse dose-dependent relationship on CAB-lingual alveolar bone distance (P < .05). In all cases lingual CAB-CEJ distance was larger than buccal CAB-CEJ distance. Thus dietary NAR supplementation was shown to significantly reduce molar CAB-CEJ distance (P < .001-.05) during alveolar development in young male rats.

Dentin erosion simulation by cantilever beam fatigue and pH change.

Exposed root surfaces frequently exhibit non-carious notches representing material loss by abrasion, erosion, and/or abfraction. Although a contribution from mechanical stress is often mentioned, no definitive proof exists of a cause-effect relationship. To address this, we examined dimensional changes in dentin subjected to cyclic fatigue in two different pH environments. Human dentin cantilever-beams were fatigued under load control in pH = 6 (n = 13) or pH = 7 (n = 13) buffer, with a load ratio (R = minimum load/maximum load) of 0.1 and frequency of 2 Hz, and stresses between 5.5 and 55 MPa. Material loss was measured at high- and low-stress locations before and after cycling. Of the 23 beams, 7 withstood 1,000,000 cycles; others cracked earlier. Mean material loss in high-stress areas was greater than in low-stress areas, and losses were greater at pH = 6 than at pH = 7, suggesting that mechanical stress and lower pH both accelerate erosion of dentin surfaces.

Physical properties of human premolar cementum: hardness and elasticity.

AIMS: To determine if the cementum on the maxillary right and left first premolars has identical physical properties. METHODS: Ten normal maxillary first premolar teeth, extracted from five orthodontic patients with a mean age of 14.0 years, were used. The teeth had not been subjected to an orthodontic force. The hardness and elastic modulus of the cementum were measured on the buccal and lingual surfaces of the roots at three locations: cervical third, middle third and apical third. RESULTS: There were no significant side-to-side differences in cementum hardness (Mean side-to-side difference: 0.0063 GPa; SD: 0.0279; p = 0.525) or elastic modulus (Mean side-to-side difference: -0.027 GPa; SD: 0.111; p = 0.814). The hardness and elastic modulus of the cementum decreased from cervical to apical regions on both root surfaces. CONCLUSIONS: Similar physical properties of the cementum on the maxillary right and left first premolars suggest that intra-arch comparisons can be used to investigate root resorption caused by orthodontic forces.