Effects on Different Full-coverage Designs and Materials of Crack Propagation in First Mandibular Molar: an Extended Finite Element Method Study

Overview

Journal Front Bioeng Biotechnol

Date 2023 Aug 31

PMID 37650043

Authors

Jianzhao Ni

Liang Xu

Yunzhi Lin

Danlin Lai

Xiaohong Huang

Affiliations

Soon will be listed here.

Abstract

This study aims to investigate the biomechanical properties of fracture resistance in cracked teeth using five different full-coverage restorations made of three different materials. A 3D model of a mandibular first molar was created to design five different full-coverage repair models: crown, crown with composite resin filling inside, occlusal veneer, occlusal veneer with composite resin filling inside and onlay. These repair models were fabricated using three different materials, namely, zirconia, lithium disilicate (LDS), and a hybrid polymer-infiltrated ceramic network material (PIC). In total, 15 repair models were tested using the extended finite element method (XFEM), with an occlusal load of 5000 N applied slowly to the occlusal surface of the restoration. The analysis of stress distribution in the restoration and dentin crack line was conducted to measure and record the crack initial load on the restoration and dentin. The results showed that restorations on the occlusal surface significantly improved crack resistance, with zirconia exhibiting superior fracture resistance among the materials tested. Restorations of crown with composite resin filling inside demonstrated the highest resistance to fracture, while occlusal veneers showed the lowest. MPS concentration was observed at the interface between the restoration and dentin and at the root bifurcation, with the highest values at the top of crack development. Dentin covered by oxidized restorations had the highest displacement, while PIC restorations exhibited the lowest. Pulp analysis revealed selective MPS concentration and strain patterns in models with zirconia restorations and onlay, with pronounced pulp displacement in zirconia restorations and onlay. Enamel analysis indicated larger MPS values and displacements in zirconia restoration models and onlay, with higher strain in onlay. Restoration played a crucial role in protecting the tooth, with crack propagation initial loads in dentin surpassing restorations in experimental groups. This study confirms that full-coverage restorations significantly increased the fracture resistance of cracked teeth, with zirconia restorations significantly protecting the underlying cracked tooth. Elimination of fracture lines in the restoration design can improve fracture resistance in cracked teeth. The findings have implications for dental prosthetic design and clinical practice.

References

Yamaguchi S, Kani R, Kawakami K, Tsuji M, Inoue S, Lee C . Fatigue behavior and crack initiation of CAD/CAM resin composite molar crowns. Dent Mater. 2018; 34(10):1578-1584. DOI: 10.1016/j.dental.2018.07.002. View

Kanamaru J, Tsujimoto M, Yamada S, Hayashi Y . The clinical findings and managements in 44 cases of cracked vital molars. J Dent Sci. 2019; 12(3):291-295. PMC: 6399997. DOI: 10.1016/j.jds.2017.04.002. View

Griffin Jr J . Efficient, conservative treatment of symptomatic cracked teeth. Compend Contin Educ Dent. 2006; 27(2):93-102. View

Li W, Swain M, Li Q, Ironside J, Steven G . Fibre reinforced composite dental bridge. Part II: Numerical investigation. Biomaterials. 2004; 25(20):4995-5001. DOI: 10.1016/j.biomaterials.2004.01.011. View

Opdam N, Roeters J . The effectiveness of bonded composite restorations in the treatment of painful, cracked teeth: six-month clinical evaluation. Oper Dent. 2003; 28(4):327-33. View

Waldecker M, Rues S, Rammelsberg P, Bomicke W . Validation of in-vitro tests of zirconia-ceramic inlay-retained fixed partial dentures: A finite element analysis. Dent Mater. 2019; 35(3):e53-e62. DOI: 10.1016/j.dental.2019.01.017. View

Emamian A, Aghajani F, Safshekan F, Tafazzoli-Shadpour M . Nonlinear viscoelastic properties of human dentin under uniaxial tension. Dent Mater. 2020; 37(2):e59-e68. DOI: 10.1016/j.dental.2020.10.025. View

Turp J, Gobetti J . The cracked tooth syndrome: an elusive diagnosis. J Am Dent Assoc. 1996; 127(10):1502-7. DOI: 10.14219/jada.archive.1996.0060. View

Peskersoy C, Sahan H . Finite element analysis and nanomechanical properties of composite and ceramic dental onlays. Comput Methods Biomech Biomed Engin. 2022; 25(14):1649-1661. DOI: 10.1080/10255842.2022.2032004. View

10.

Chen Y, Hsu T, Liu H, Chogle S . Factors Related to the Outcomes of Cracked Teeth after Endodontic Treatment. J Endod. 2020; 47(2):215-220. DOI: 10.1016/j.joen.2020.11.024. View

11.

Duanmu Z, Liu L, Deng Q, Ren Y, Wang M . Development of a biomechanical model for dynamic occlusal stress analysis. Int J Oral Sci. 2021; 13(1):29. PMC: 8423745. DOI: 10.1038/s41368-021-00133-5. View

12.

Zhang Z, Zheng K, Li E, Li W, Li Q, Swain M . Mechanical benefits of conservative restoration for dental fissure caries. J Mech Behav Biomed Mater. 2015; 53:11-20. DOI: 10.1016/j.jmbbm.2015.08.010. View

13.

Abulhamael A, Tandon R, Alzamzami Z, Alsofi L, Roges R, Rotstein I . Treatment Decision-making of Cracked Teeth: Survey of American Endodontists. J Contemp Dent Pract. 2019; 20(5):543-547. View

14.

Wang Y, Wang Q, Chen H, Sun J, He L . Comparative Study on Crack Initiation and Propagation of Glass under Thermal Loading. Materials (Basel). 2017; 9(10). PMC: 5456625. DOI: 10.3390/ma9100794. View

15.

Wu S, Lew H, Chen N . Incidence of Pulpal Complications after Diagnosis of Vital Cracked Teeth. J Endod. 2019; 45(5):521-525. DOI: 10.1016/j.joen.2019.02.003. View

16.

Krell K, Rivera E . A six year evaluation of cracked teeth diagnosed with reversible pulpitis: treatment and prognosis. J Endod. 2007; 33(12):1405-7. DOI: 10.1016/j.joen.2007.08.015. View

17.

Berman L, Kuttler S . Fracture necrosis: diagnosis, prognosis assessment, and treatment recommendations. J Endod. 2010; 36(3):442-6. DOI: 10.1016/j.joen.2009.12.018. View

18.

Signore A, Benedicenti S, Covani U, Ravera G . A 4- to 6-year retrospective clinical study of cracked teeth restored with bonded indirect resin composite onlays. Int J Prosthodont. 2007; 20(6):609-16. View

19.

Sulaiman T, Abdulmajeed A, Delgado A, Donovan T . Fracture rate of 188695 lithium disilicate and zirconia ceramic restorations after up to 7.5 years of clinical service: A dental laboratory survey. J Prosthet Dent. 2019; 123(6):807-810. DOI: 10.1016/j.prosdent.2019.06.011. View

20.

Ito K, Nanba K, Akashi T, Murai S . Incomplete fractures in intact bilateral maxillary first molars: a case report. Quintessence Int. 1998; 29(4):243-8. View