Recent Advances in Applied & Biomedical Informatics and Computational Engineering in Systems Applications

Stress Distribution in Premolars with MOD Cast Metal Restorations

LILIANA SANDU, FLORIN TOPAL, SORIN POROJAN School of Dentistry V. Babe University of Medicine and Pharmacy 9 Revolutiei 1989 Blv., 300072 Timioara ROMANIA lilianasandu@gmail.com
Abstract: Little information is available on the stress analysis of cast metallic inlays and onlays. Modern design and valuation in order to obtain an adequate framework strength involves numerical simulations. The aim of the paper was to evaluate, the effect of MOD cavity design for cast metal inlays and onlays on stress distribution in teeth structures and restorations. The study was performed on an upper first premolar, using a finite element analysis. The first step of the study was to achieve 3D models in order to design and analyze teeth and cast metal MOD inlays and onlays. Eleven 3D models of maxillary first premolars, prepared for MOD inlays and onlays with different tapers were generated. The mesh structure of the solid 3D model was created using the computational simulation of Ansys finite element analysis software. An occlusal load of 200 N was conducted, and stresses occurring in the inlays, onlays and teeth structures were calculated. For all cavity designs, stresses in the restoration, enamel, and dentin were evaluated separately. The highest stress values were exhibited in the restoration in the most cases. Stresses in the enamel were significantly lower in the teeth prepared for onlays, compared to the teeth prepared for inlays. The MOD restoration on premolars has to distribute the load over a wide surface. Covering the occlusal surface with the restoration, using an MOD onlay, may prevent failure and produce a lower stress values than an MOD inlay. Key-Words: premolar, MOD cavity design, cast metal restoration, inlay, onlay, 3D model, stress analysis.

1 Introduction
Large restorations have been considered the principal factors to predispose a tooth to fracture, and adequate preparation guidelines are important. Irrespective of the cavity preparation design, preparations weaken teeth. To reduce loss of tooth tissue and to improve biomechanical results, inlay and onlays restorations are good treatment choices for extensive cavities in posterior teeth [1, 2]. Inlays restore central cavities in teeth. Onlays restore one or more cusps and may completely cover the occlusal surfaces, resulting in a favorable distribution of stresses in teeth and a decreased risk of fractures. However, preparation for onlays requires additional tooth reduction relative to inlay restorations [3,4]. Cast metal inlays and onlays can be used on premolars requiring a MOD restoration instead amalgam and offer a durable alternative. Because it is known that MOD inlays may increase the susceptibility to fracture, it is important to ensure optimal performance in selection of the adequate preparation design to reduce stresses in teeth structures and also in the restorations [3]. Finite element analysis (FEA) has been widely employed in many researches to investigate the impact and effect of dental materials and restorative

techniques on stress distribution. FEA is deemed as an effective tool to evaluate the biomechanical characteristics of these dental restorative materials and systems, whereby the results carry significant clinical implications [5,6]. Little information is available on the stress analysis of cast metallic inlays and onlays. Modern design and valuation in order to obtain an adequate framework strength involves numerical simulations. Analyses in this field continuously advance both in three-dimensional modeling, computer aided design and structural analyses simulation methods.

2 Purpose
The aim of the paper was to evaluate, by means of three-dimensional finite element analysis, the effect of MOD cavity design for cast metal inlays and onlays on stress distribution in teeth structures and restorations.

3 Materials and Method

Sophisticated three-dimensional models are required to better understand the mechanical behavior of teeth structures and prosthetic dental restorations.

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Recent Advances in Applied & Biomedical Informatics and Computational Engineering in Systems Applications

The first step of the study was to achieve 3D models in order to develop applications for basic research use, to design and analyze teeth and cast metal MOD inlays and onlays. The study was performed on an upper first premolar, using a finite element analysis. Surfaces were modeled according with anatomical dimensions. The nonparametric modeling software (Blender 2.57b) was used in order to obtain the shape of root, enamel, dentin and pulp structures (Fig. 1).

the preparation. Inlay and onlay cavities designs were created using literature data.

Fig. 1. Premolar surfaces modelled according to the anatomical dimensions. The collected data were used to construct three dimensional models using Rhinoceros (McNeel North America) NURBS (Nonuniform Rational BSplines) modeling program. These points were used to extrapolate the shape of the object, a process called reconstruction (Fig. 2). Reconstruction involves finding and connecting adjacent points in order to create continuous surfaces. Nonuniform rational B-spline (NURBS) is a mathematical model commonly used in computer aided design, manufacturing and engineering. CAD is mainly used for detailed 3D models but it is also used throughout the manufacturing process, from conceptual design, through strength and dynamic simulation analyses.

b Fig. 3. Volume of the prepared and restored premolar: a. with inlay, b. with onlay. The mesh structure of the solid 3D model was created using the computational simulation of Ansys finite element analysis software (Fig. 4).

Fig. 2. Volume of the premolar. Twenty-two 3D models of maxillary first premolars, prepared for MOD inlays and onlays with different tapers (between 0 and 10 degree from the cavity base to the surface) were generated (Fig. 3). In the onlay cavity, cusps were reduced and included in b Fig. 4. Mesh structure of the restored premolar: a. with inlay, b. with onlay.

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Recent Advances in Applied & Biomedical Informatics and Computational Engineering in Systems Applications

An occlusal load of 200 N was conducted, and stresses occurring in the inlays, onlays and teeth structures were calculated. An oblique loading of 200 N was applied in 5 points: to the mesial and distal marginal ridge, and buccal cusp (3 points). At each selected loading point, an oblique loading of 50 N was applied (Fig. 5).

Table 2. Von Mises equivalent stress values in the restoration and in the inlay and onlay restored premolars.
Sample 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Taper [degree] 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Von Mises equivalent stress [Pa] Restoration Enamel Dentin 5.65E+08 4.57E+08 2.72E+07 4.93E+08 5.03E+08 3.71E+07 4.85E+08 4.98E+08 3.80E+07 4.98E+08 4.30E+08 3.83E+07 6.40E+08 5.29E+08 2.55E+07 5.06E+08 5.23E+08 1.89E+07 5.31E+08 4.34E+08 2.72E+07 4.53E+08 4.95E+08 3.52E+07 5.55E+08 4.62E+08 2.66E+07 5.50E+08 5.50E+08 2.59E+07 4.96E+08 4.69E+08 3.64E+07 5.93E+08 3.75E+07 3.56E+07 5.90E+08 3.83E+07 2.63E+07 5.96E+08 3.91E+07 2.76E+07 5.52E+08 3.80E+07 2.82E+07 5.75E+08 3.84E+07 2.86E+07 5.40E+08 4.00E+07 2.46E+07 5.41E+08 3.97E+07 2.55E+07 5.44E+08 4.16E+07 2.60E+07 6.22E+08 3.60E+07 2.83E+07 5.76E+08 3.64E+07 2.47E+07 5.89E+08 3.88E+07 2.71E+07

b Fig. 5. Points selected for loading on the restored premolar: a. with inlay, b. with onlay. In making the finite element models, the characteristics of a tooth structures and gold alloy used for the cast restoration were entered into the computer program (Table 1). Table 1. materials. Elastic properties of the isotropic
Elastic modulus [GPa] 18.6 84.1 70 Poissons ratio 0.32 0.33 0.30

Material/component Dentin Enamel Gold

3 Results and Discussions

To analyze stress distribution and location, all the created structures were isolated from the rest of the model. For all cavity designs (sample 1-11 for inlays, sample 12-22 for onlays), stresses in the restoration, enamel, and dentin were evaluated separately (Table 2, Fig. 6). b Fig. 6. Von Mises equivalent stress values in the restored premolar: a. with inlay, b. with onlay.

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Recent Advances in Applied & Biomedical Informatics and Computational Engineering in Systems Applications

The highest stress values were exhibited in the restoration in the most cases, excepted for the tooth prepared for inlay with a taper of 7 degree. In this case the maximal stress was located in the enamel. Stresses in the enamel were significantly lower in the teeth prepared for onlays, compared to the teeth prepared for inlays. Even if the distribution of the stresses is more extended for the teeth prepared for onlays, the values 10 times lower do not affect the strength of the tooth structures. Occlusal load on an MOD restored tooth produces stress surrounding the contact areas in the restorations (Fig. 7).

b Fig. 8. Von Mises equivalent stress in the enamel of the restored tooth: a. with inlay, b. with onlay. a

b Fig. 7. Von Mises equivalent stress in the restoration: a. inlay, b. onlay. In the enamel stresses are located around the contact areas for inlays prepared teeth and distributed in the functional cusp and around the buccal cervical area for the onlays prepared teeth (Fig. 8). For onlays restotred teeth the variations for different tapers were smaller than for inlays restored teeth. Regarding the distribution of stresses in dentin, they are located in the cervical areas, oral for inlays prepared teeth and around the teeth for onlays prepared teeth (Fig. 9). In enamel the stresses were significant lower in all cases when an onlay was used for the MOD restoration compared to those when an inlay was used.

b Fig. 9. Von Mises equivalent stress in the dentin of the restored tooth: a. with inlay, b. with onlay.

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Recent Advances in Applied & Biomedical Informatics and Computational Engineering in Systems Applications

4 Conclusion
Within the limitations of this study, the following conclusions were drawn: 1. Cast metal inlays transferred more functional stress to the teeth structures if they are prepared for inlays. 2. The taper of the preparation has no significant influence on the stress values for all the studied cases. 3. The MOD restoration on premolars has to distribute the load over a wide surface. Covering the occlusal surface with the restoration, using an MOD onlay, may prevent failure and produce a lower stress values than an MOD inlay.

diferent post, core and crown materials. Dental Materials 2007, 23:98393. [8] Lanza A, Aversa R, Rengo S, Apicella D, Apicella A. 3D FEA of cemented steel, glass and carbon posts in a maxillary incisor. Dent Mater 2005;21:70915.

4 Acknowledgements
This work was supported by CNCSIS-UEFISCSU, project number PN II-RU TE_217/2010. References: [1] Fonseca RB, Fernandes-Neto AJ, CorrerSobrinho L, Soares CJ. The influence of cavity preparation design on fracture strength and mode of fracture of laboratory-processed composite resin restorations. J Prosthet Dent 2007;98:277-284. [2] Dejak B, Mlotkowski A, Romanowicz M. Finite element analysis of stresses in molars during clenching and mastication. J Prosthet Dent 2003;90:591-7. [3] Shillingburg HT. Fundamentals of fixed prosthodontics. 3rd ed. Chicago: Quintessence;1997. p.171-9. [4] B. Dejak, A. Mlotkowski, M. Romanowicz. Strength estimation of different designs of ceramic inlays and onlays in molars based on the Tsai-Wu failure criterion. J Prosthet Dent 2007;98: 89-100. [5] Yamanel K, Caglar A, Gulsahi K, Ozden UA. Effects of different ceramic and composite materials on stress distribution in inlay and onlay cavities: 3-D finite element analysis. Dental Materials Journal 2009; 28(6): 661 670. [6] Dejak B, Mlotkowski A. Three-dimensional finite element analysis of strength and adhesion of composite resin versus ceramic inlays in molars. J Prosthet Dent 2008; 99: 131-140. [7] Sorrentino R, Aversa R, Ferro V, Auriemma T, Zarone F, Ferrari M, Apicella A. Threedimensional finite element analysis of strain and stress distributions in endodontically treated maxillary central incisors restored with

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