Journal of Biomechanics 34 (2001) 12691277

3D-nite element analyses of cusp movements in a human upper

premolar, restored with adhesive resin-based composites
P. Ausielloa,*, A. Apicellab, C.L. Davidsonc, S. Rengoa
a
School of Dentistry, University of Naples, Federico II, Policlinico Edicio 14, Via Pansini 5, 80131 Naples, Italy
b
Department of Material & Production Engineering, University of Naples, Federico II, Italy
c
Department of Dental Materials Sciences. ACTA, University of Amsterdam, The Netherlands
Accepted 30 May 2001

Abstract

The combination of diverse materials and complex geometry makes stress distribution analysis in teeth very complicated.
Simulation in a computerized model might enable a study of the simultaneous interaction of the many variables. A 3D solid model
of a human maxillary premolar was prepared and exported into a 3D-nite element model (FEM). Additionally, a generic class II
MOD cavity preparation and restoration was simulated in the FEM model by a proper choice of the mesh volumes. A validation
procedure of the FEM model was executed based on a comparison of theoretical calculations and experimental data. Dierent
rigidities were assigned to the adhesive system and restorative materials. Two dierent stress conditions were simulated: (a) stresses
arising from the polymerization shrinkage and (b) stresses resulting from shrinkage stress in combination with vertical occlusal
loading. Three dierent cases were analyzed: a sound tooth, a tooth with a class II MOD cavity, adhesively restored with a high (25
GPa) and one with a low (12.5 GPa) elastic modulus composite. The cusp movements induced by polymerization stress and (over)-
functional occlusal loading were evaluated. While cusp displacement was higher for the more rigid composites due to the pre-
stressing from polymerization shrinkage, cusp movements turned out to be lower for the more exible composites in case the
restored tooth which was stressed by the occlusal loading.
This preliminary study by 3D FEA on adhesively restored teeth with a class II MOD cavity indicated that Youngs modulus
values of the restorative materials play an essential role in the success of the restoration. Premature failure due to stresses arising
from polymerization shrinkage and occlusal loading can be prevented by proper selection and combination of materials. r 2001
Published by Elsevier Science Ltd.

Keywords: 3D FEA; Adhesive tooth restorations; Resin-based composites; Polymerization shrinkage; Occlusal loading; Stress distribution

1. Introduction (mastication, temperature uctuations). Modifying both

Resin-based materials are being employed to a large
extent in contemporary restorative dentistry. A promi-
nent advantage is the possibility of bonding the
restoration to tooth structure. Signicant disadvantages
of these materials are the polymerization contraction
and the mismatch in mechanical characteristics with
tooth structures (Davidson, 2000). During hardening,
polymerization shrinkage stresses the adhesively placed
restoration, while the mechanical mismatch leads to
interfacial stress concentrations during functioning
*Corresponding author. Tel.: +39-081-7462089; fax: +39-081-
7462197.
E-mail address: pietausi@unina.it (P. Ausiello).
material characteristics by adding inorganic ller
particles to the resin, results in shrinkage reduction
and strength and stiness (E-modulus) increase. Un-
fortunately, increase of modulus is associated with
higher polymerization shrinkage stresses. Stress control
in resin-based composite restorations is a major problem
in operative dentistry.
Clinical studies have shown that fractures in teeth
with class II MOD restorations are mainly related to
insucient residual hard tooth structure, restorative
procedures and material selection (Wendt et al., 1987).
Occlusal loading of teeth, adhesively restored with a
variety of materials (amalgam, resin-based composites
and combinations of glass-ionomers with resin-based
composites), did not lead to equal fracture resistance

0021-9290/01/$ - see front matter r 2001 Published by Elsevier Science Ltd.

PII: S 0 0 2 1 - 9 2 9 0 ( 0 1 ) 0 0 0 9 8 - 7
1270 P. Ausiello et al. / Journal of Biomechanics 34 (2001) 12691277
values nor comparable fracture patterns (Ausiello et al.,
1997). Resin-based composite restored teeth often show
mesial-distal crown fractures with the composite materi-
al fracture located at the critical tooth-resin interface.
This behavior has been attributed to the stresses arising
from the polymerization shrinkage (Davidson and De
Gee, 1984), which results in stress build-up in the
restored tooth and cusp displacements (Pearson and
Hegarty, 1987). Repeated functional loading will cause
fatiguing of the restored tooth and will ultimately result
in failure. Ausiello et al. (1999a, b) investigated in vitro
the performance of adhesively restored large and deep
cavities in maxillary premolars under cyclic loading.
That fatiguing process showed that, when polymeriza-
tion shrinkage pre-stressing conditions are present, the
adhesive restoration-cavity wall interface initially de-
bonds at the weakest bonded areas between the dentin
and the restorative material. As reported in several
previous studies (Koike et al., 1990), polymerization
shrinkage stress of adhesive composite restorations
depends on several factors such as restoration size,
cavity shape, incremental or bulk placement technique,
water sorption, composite creep and cusp movements
(Feilzer et al., 1990). Moreover, it has been shown that
increased exibility (reduced E-modulus) of the restora-
tion reduces the polymerization stress (Kemp-Scholte
and Davidson, 1990). Suliman et al. (1993) investigated
in vitro the cusps deection in adhesively restored
natural teeth under dierent polymerization compensat-
ing eects by using a microscope with a micrometer.
According to that study, cusps deection dierences
depend on cavity size, wet and dry storage conditions
and lling material rigidity. Apparently, there are a
variety of factors that are simultaneously active. Some
enlarge each other, whilst other mechanisms counteract
each other. Proper understanding of the physical
phenomena occurring in the adhesively restored tooth
during the placement and setting of the materials and
throughout it is functioning is crucial in the determina-
tion of the proper placement procedures and material
selection. Structural analyses of the integral process may
oer an essential tool for the assessment and reduction
of fracture risks, ensuring optimal performance in
selection of the restorative material combinations and
material application protocols. Since stress distribution
investigation of teeth, in particular after restoration, is
very complicated due to the complex geometry, 3D-
Finite Element Analysis might be a powerful tool to
visualize the problems.
The aim of this study was to provide FEA engineering
tools for the understanding of the inuence of the
shrinkage characteristics and composite rigidity on the
extent of cusps displacement and localization of critical
sites in a given restored tooth under (over) functional
loading. Moreover, validation of the proposed proce-
dure of the Finite Element Model (FEM) was investi-
gated by a comparison of calculated theory and
mechanical experimental data.
2. Materials and methods
3D-nite element approach consists in dividing a
geometric model into a nite number of elements in
which the variables of interest are approximated with
some mathematical functions. Biomedical applications
of this method are already known in some elds of
medicine (Apicella et al., 1994; Dalstra et al., 1995;
Apicella et al., 1998).
In our study, a 3D FEM model of a rst upper
premolar was realized. The rst step was the solid
model generation in which the shapes of dentin, pulp
and enamel were obtained. The space for the class
II MOD cavity preparation was also dened. Then
the solid model was lled with elements, creating the
mesh, and the material properties of dentin and enamel
were assigned to the elements, which lled the corre-
sponding regions. Thus the sound tooth FEM model
was obtained. Subsequently, the FEM model of the
restored tooth was realized by changing element
material properties in the central zone of cavity
preparation. At the end loads and geometric conditions
were applied.
2.1. Tooth solid model generation
Tooth solid model was generated using literature
data on the tooth morphology for the denition of the
dentine and enamel volumes (Wheeler, 1974) and a
plaster model (Thanaka model, Japan, 1978) for the
external shape denition. Crown and roots were
constructed in two dierent phases and assembled
afterwards. The crown was realized by digitizing an
upper premolar tooth plaster model on the scale of
one to ve by a Cyberware laser scanner. Over two
hundred proles were generated at 0,33 mm incre-
ments by laser scanning in two dierent directions: a
vertical and a horizontal one. Among all the proles,
only 34 were collected, 17 vertical and 17 horizontal
at 2 mm increments, and were assembled in a 3D
wire-frame structure (Fig. 1) by means of a 3D CAD
(Autocad 12, Autodesk, Inc., Neuchatel, Swiss, 1992).
The wire-frame curves were exported in Pro-Engineer
16.0 (Parametric Technology Co., Waltham, MA, USA,
1994), where a solid model was generated tting
the horizontal and vertical proles. The model was
cut in the cervical area in order to obtain the nal
crown (Fig. 2).
The roots were modelled by means of their mesial-
distal and buccal-lingual representations taken from the
literature (Braden, 1976). The two representations were
scanned and 8 vertical proles were generated imitating
 P. Ausiello et al. / Journal of Biomechanics 34 (2001) 12691277 1271

Fig. 1. 3D Solid upper premolar model and nite element model generation.

Fig. 2. On-o experimental test with FEM simulation.

the scanned images. The roots were constructed, tting The crown and the roots with the pulp chamber
the vertical proles (Fig. 1). The pulp region was were assembled in the nal model (Fig. 1). Dening
obtained in an analogous way and subtracted from parametric cutting plane, it is also possible to
the roots. easily realize dierent cavities and MOD preparations.
1272 P. Ausiello et al. / Journal of Biomechanics 34 (2001) 12691277
In Fig. 5, a MOD II cavity is shown with 3.5 mm
occlusal width.
2.2. FEM model generation
The solid model was exported into ANSYS rel. 5.3
(Ansys Inc, Houston, USA, 1994), using the IGES
format. The volumes were redened and meshed with
8-node brick and 4-node tetrahedral elements, result-
ing in an 11165-element and 7340-node structure.
Dierent material properties were assigned to the
elements according to the volume denition. Three
dierent models were realized. The rst model
(Mod. A) is the sound tooth; the second model
(Mod. B) is a restored tooth with a more rigid
composite; the third model is a restored tooth with a
less rigid composite (Mod. C). Material properties are
listed in Table 1.
Some assumptions were made in order to simplify the
calculations. Absolute bonding was considered among
enamel, dentin and composite. The pulp chamber was
modeled as a void because of its negligible stiness and
strength. Despite their intrinsic anisotropic nature,
dentin and enamel can be assumed homogeneous and
isotropic (Darendeliler et al., 1998; Versluis et al., 1996)
because their anisotropy belongs to a microscopic
scale whereas the tooth model is macroscopic. Further-
more, all materials were considered elastic through-
out the entire deformation, which is a reasonable
assumption for brittle materials in non-failure
conditions (Rees et al., 1995).
2.3. Model experimental validation
In order to validate the FEM model, a compression
test was performed on a class II MOD restored human
upper premolar. The resin-based composite Prodigy
(Kerr, USA), with a Youngs modulus of 12.5 GPa and
polymerization shrinkage of 2.7370.31% by volume in
combination with Optibond FL adhesive (Kerr, USA)
was used for the restoration. The tooth was inserted
until the cementum-enamel junction in a steel cylindrical
ring with the apical root area in contact with the steel
ring oor. Subsequently, it was lled with resin
Table 1
Youngs modulus (GPa) Poissons ratio
Dentin 18a
0.23b
Enamel 48a 0.3b
More rigid composite (B) 25 0.3
Less rigid composite (C) 12.5 0.3
a
Wheeler (1974).
b
Verluis (1996).
composite material, so it was possible to record only
the material deformation within the tooth. The cylinder
was clamped to the test machine and the load was
applied vertically by means of a 6 mm diameter steel
cylinder with the axis normal to the tooth axis in order
to simulate one main important force which develops
during occlusion (Mc Neil, 1997). A 1 mm/min constant
rate was imposed on the loading cylinder and the
vertical displacement and the axial load were acquired
until the restored tooth fractured (experimental curve in
Fig. 3). The same test has been simulated using the FE
analysis and the results are compared. The comparison
test loading cylinder was modelled with the 3D elastic
beams (Fig. 3). The beams have one end in common and
the other one on a cusp. End rotations have not
constrained. The common end was displaced in the
central position of the loading cylinder section in the
experimental test. The load is applied on the tooth at
two points (Fig. 3), namely the beams elements (blue
lines) and on the cusps (red areas). The resulting force F
crossing the central position of the loading cylinder
section is 400 N (Fig. 3, red arrow). The beam elastic
properties were thought to be innitely rigid compared
to the tooth. Resin support was not modelled and it was
considered to be rigid as the loading system. Other
studies (Darendeliler et al., 1998) also assumed the
supporting alveolar bone rigidity.
2.4. Numerical simulations
Three dierent situations were simulated: a compres-
sion test with a 400 N occlusal load, composite
polymerization shrinkage and the combination of
occlusal loading and shrinkage. In these simulations,
the tooth model had to be constrained apically to the
enamel-dentin junction. This fact permitted to eliminate
the lower part of the mesh, reducing the model size to
7894 elements and 5812 nodes.
Numerical results were obtained for the three models
(A, B and C). Particularly, the vertical displacement of
the load application point in model C can be used as the
numerical datum for the model experimental validation.
For the evaluation of the stresses arising from the
composite polymerization shrinkage, a volumetric con-
traction has been applied to the composite. The
shrinkage data required for this study were obtained
by using a linometer (De Gee et al., 1993). The
shrinkage which determines cusp deections, however,
cannot be directly related to the amount measured in the
linometer free shrinkage tests. This is due to the
viscoelastic relaxation occurring in the material during
the passage from a viscous uid into an elastic solid. It
has to be noted that when a composite is adhesively
placed in the tooth cavity, only a part of the shrinkage
produces cusp deections and a part relaxes. In this
paper an on-o test is described: composites discs were
 P. Ausiello et al. / Journal of Biomechanics 34 (2001) 12691277
polymerized on a glass substrate. In that study, the
composite shrinkage stresses should overcome the silica
glass substrate strength at about 20 % of the value
measured in the linometer test: nonetheless, fracture
was observed in a few cases only when total shrinkage
was attained. This datum was arbitrarily used as
reference in this study. A 0.54% constrained volume
shrinkage (2.7% free volumetric shrinkage) was as-
sumed to occur during the inside cavity resin-based
composite polymerization.
Fig. 3. Occlusal vertical load and comparison between experimental
and numerical data.
Fig. 4. Von Mises stress distribution due to vertical loading (up) and displacement distribution (down).
1273
3. Results
All the analyses performed are linear static. The
comparison between the experimental curve and the
numerically determined one is shown in Fig. 3. Fig. 4
shows the Von Mises equivalent stress which was
evaluated for the three models under vertical (over)-
functional loading as well as total displacement. In
Fig. 5 the path traces are indicated with the two yellow
small circular points. Both the paths are normal to the
tooth axis, mesial-distally directed, little above the pulp
chamber and near the interface of models B and C
between composite and natural tooth. One path is on
the side of the composite restoration; the other path is
on the natural tooth side. Von Mises equivalent stress
was evaluated along these paths (Figs. 6 and 7).
A Von Mises equivalent stress map was also extracted
for models B and C under shrinkage condition (Fig. 8).
Two other paths were dened on these models,
following the buccal and lingual wall proles of the
tooth (Fig. 9). Along these paths normal displacement
to the tooth axis was determined. In Fig. 9 the cusp
displacements are plotted. Lingual cusp displacement is
considered negative towards the center of the tooth,
while buccal cusp displacement is considered positive
towards the center of the tooth.
1274 P. Ausiello et al. / Journal of Biomechanics 34 (2001) 12691277
Fig. 5. Paths dened in tooth.
Fig. 6. Von Mises stress path in cusp (natural tooth).
Fig. 7. Von Mises stress path in cavity region (composite).
In Fig. 10 the Von Mises equivalent stress maps for
models B and C under the vertical loading and
shrinkage combination and model A under vertical
loading only are shown.
4. Discussion
Endodontically treated teeth are easily subject to
fracture as a result of the modication of their natural
rigidity and to pre-stressing, generated by the restorative
procedures. Conventional conservative class II MOD
composite restorations may exhibit micro-cracking and
interfacial failure due to internal pre-stressing from
altered cusp movements as a result of resin-based
composite polymerization contraction and occlusal
loading. The study of the eects of restoration
techniques on endodontically treated teeth usually
encounters all the negative inuences associated with
the use of natural tooth samples. Teeth, in fact, dier
from each other for obvious reasons, patient age, sex,
etc., and they are usually responsible for large standard
deviations of the determined means values. Therefore,
dierent laboratory test results are dicult to compare.
Consequently, it is of paramount importance to rstly
exclude the anatomical sample dierences and statistical
variability. In the present study, the mechanical
behavior of a bicuspid, subjected to polymerization
contraction and occlusal loading has been investigated
by means of a computer analysis and numerical results
were validated by laboratory experimental data. FEM
provides a powerful tool for analyzing the mechanical
behavior of complex structures. For this reason in the
last two decades FEM was widely used in studying
biological systems. In fact, a mathematical model
permits to evaluate natural systems response under
various loads or geometric conditions apart from the
high dispersion, which characterizes experimental data.
Obviously, FEM models need an experimental valida-
tion, which is purposely prepared and denitive. If
possible, suitable laboratory data for validation can also
be collected from literature in order to minimize time
and costs. After validation, the model can be extensively
used for a wide range of studies. Only signicant
changes in the FEM model require a new experimental
validation.
The system analysis procedures proposed in this study
create a feedback mechanism that helps in closing the
structures and material design loop with engineering
prediction of application stresses localization and
build-up coupled with a structural performance. In
the last two decades many works have shown how
the 2D nite elements analysis applied to dental
mechanics has become a popular numerical method to
investigate the critical aspects related to stress distribu-
tion in tooth (Sakaguchi et al., 1991) and in dental
restoratives (Farah and Craig, 1974) or to evaluate the
stress relief of shrinking resin-based materials (Versluis
et al., 1996).
The use of a more detailed 3D dental model to test the
inuence of elastic and shrinking properties of resin-
based restoring material commonly used in operative
dentistry (such as light curing resin-based composite),
seems to be of extreme interest to understand critical
problems related to the restorative material choice and
optimal application procedures denition.
 P. Ausiello et al. / Journal of Biomechanics 34 (2001) 12691277
Fig. 8. Von Mises stress distribution due to polymerization contraction.
Fig. 9. Displacement path in cavity region.
We focused our interest on the investigation of the
mechanical behavior of a critical system such as the rst
upper premolar restored by a class II MOD cavity
preparation (where a consistent amount of dentin and
enamel tissue is lost and the integrity of the structure is
seriously altered).
Methods for geometric data acquisition, geometric
model creation and modication (parametric modelling)
and nite element model generation though CAE
ambient are presented and discussed.
The FEM prediction is in good agreement with the
experimental data, as shown in Fig. 3. Comparison
underlines the great accuracy for the tooth model with
respect to a very complex simulation as a compressive
test of restored tooth. Our numerical data are also in
good agreement with experimental ones obtained by
Suliman et al., 1993 by means of a microscope with a
micrometer stage.
Considering, rstly, the occlusal loading eect alone,
the sound tooth exhibits a wider high stress area (red),
localized in correspondence of the occlusal enamel, than
the restored teeth (Fig. 5, upper left side). This is due to
the rigidity of the enamel. In particular, looking at
1275
models B and C, in which a dierent composite rigidity
was used, a wider high stress area was found in the
model with the more rigid composite (Mod. B). In fact,
a less rigid structure (Mod. C) releases stress in greater
deformation. In this way, Fig. 4 shows that the cusp
movements increase from model A to C. Even if high
stress areas are reduced in Mod. C compared to Mod. B,
it does not mean that its mechanical behavior is the best
one. In fact, this reduction occurs in the composite
restoration, which is less rigid, and its lower rigidity
allows greater cusp movements. So the average stress in
the entire structure is lower but the stress values in
buccal and lingual cusps are higher. These preliminary
considerations, however, do not take into account
setting composite shrinkage. Obviously, the best beha-
vior is relative to the sound tooth model with a very
large stress area in the central enamel region and low
cusp deections. This consideration is conrmed from
the Von Mises stress path into the natural tooth (Fig. 6).
The peaks on the left- and on the right-hand side depend
on the enamel, which is more rigid than dentin. The
curves have the same shape for the three models but
there is higher stress for the less rigid structure. It is
interesting to note the dierence between this Von Mises
path and the Von Mises path in composite (Fig. 7).
Along the two dierent paths the sound tooth exhibits
an analogous behavior, with two peaks in enamel. These
two peaks disappear for the restored models in which
there is a single material: the composite. In Fig. 7, in
fact, Models B and C have similar curves but Mod. B
exhibits higher values. Mod. C behaves in the central
zone as the dentin of the sound tooth.
Applying contraction load in models B and C, the
high stress areas are concentrated near the composite-
tooth interface, where failure can occur (Fig. 8). Even if
failure does not occur during composite curing, a pre-
stress arises in the structure. Higher modulus restoration
exhibits higher stress values. In fact, a less rigid
restoration can relax the applied stress by means of a
1276 P. Ausiello et al. / Journal of Biomechanics 34 (2001) 12691277
Fig. 10. Von Mises stress distribution due to vertical loading for Mod. A and to shrinkage and vertical loading for Models B and C.
greater elastic deformation. This eect is also shown in
Fig. 9 where the displacements normal to the tooth axis
are plotted. The less rigid composite exhibits a greater
elastic deformation that is transferred to a lower
deformation of the cusps. Higher stress release depends
also on viscous ow of the composite during curing. But
this eect was not directly taken into account in these
models. Simply, the contraction load input in simula-
tions was signicantly reduced compared to the free
contraction.
At the end, occlusal loading and shrinkage were
combined for models B and C. A Von Mises stress map
is plotted in Fig. 10 together with that of the sound
tooth under occlusal loading. Models B and C exhibit a
similar behavior, even if Mod. B has higher stress in the
upper part of the restoration whereas Mod. C has higher
stress in the cusps. However, this eect is greatly
reduced compared to the single occlusal loading case.
The important dierence is between these two models
and the sound tooth because they show high stress
values at the composite-tooth interface, in a zone where
the sound tooth exhibits low stress.
This study was designed to investigate the correlation
between resin composite elastic properties and restored
tooth stiness. Findings indicate that more rigid
composites lead to lower cusp movements under
occlusal loading but exhibit higher pre-loading eect.
A good composite for restoration has to balance the two
opposite eects. In this way a low pre-load on the cusps
can be accepted in order to reach sucient restoration
rigidity.
5. Conclusions
FEM simulations supply information about mechan-
ical behavior of sound and restored teeth. The best
restoration is that which allows restored tooth to react
to external loads as the sound tooth does. For this, the
composite has to store a great quantity of energy,
limiting cusp movements. Furthermore, it does not have
to bend cusps as a consequence of its curing, otherwise
the pre-loading eect can be disastrous. The problem is
that rigid composites have low elastic release. In this
way the solution is in balancing the two eects,
accepting a low pre-loading eect in order to obtain
sucient rigidity.
A new point of view can be introduced considering
two aspects not contemplated in the present model. On
the one hand there is the viscous ow that can generate a
great stress release during composite curing. But viscous
ow needs time and actually the light curing composite
kinetics are too fast for this. On the other hand, there is
the adhesive interface, which can limit the cusp pre-
loading eect with its elastic deformation. By changing
the adhesive elastic modulus or by simply changing its
thickness it is possible to obtain dierent rigidity of the
interface region. In this direction the authors plan to
develop the actual study, making use again of FEM
simulations, which prove to be an ecient tool in
complex structure analysis.
Acknowledgements
Particular thanks to Eng. F. Quadrini and Eng. L. Di
Palma for their collaboration in the research on the
experimental model validation and numerical simula-
tions.
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