Modelling of stress distribution and fracture in dental occlusal fissures

Modeling fracture in multilayered teeth using the finite volume-based phase field method

The present work, utilizing the finite volume-based phase field method (FV-based PFM), aims to investigate the initiation and propagation of cracks in the second molar of the left mandible under occlusal loading. By reconstructing cone beam computed tomography scans of the patient, the true morphology and internal mesostructure of the entire tooth are implemented into numerical simulations, including both 2D slice models and a realistic 3D model. Weibull functions are introduced to represent the tooth's heterogeneity, enabling the stochastic distribution characteristics of mechanical parameters. The results indicate that stronger heterogeneity leads to greater crack tortuosity, uneven damage distribution, and lower fracture stress. Additionally, different cusp angles (50° and 70°) and pre-existing fissure morphologies (i.e., U-shape, V-shape, IK-shape, I-shape, and IY-shape) also significantly affect the mechanical performance of the tooth. The study reveals that different cusp angles affect the location of crack initiation. Overall, this work demonstrates the utility of the FV-based PFM framework in capturing the complex fracture behavior of teeth, which can contribute to improved clinical treatment and prevention of tooth fractures. The insights gained from this study can inform the design of dental crown restorations and the optimization of cusp inclination and contact during clinical occlusal adjustments.

Effects of fissure length and angle on the fracture modes of 3D printed teeth model: Insights from DIC-based fracture tests and meshless numerical simulations

To investigate the influences of teeth fissure properties on their failure modes, 3D Printing technology is used to prepare the teeth models. The strain distributions of the teeth model surfaces at each moment of the loading processes are obtained by the DIC technique. And the progressive failure processes as well as the stress distributions of the teeth models are simulated by the improved Smoothed Particle Hydrodynamics (SPH) Method. Experimental results show that under the action of the steel ball, the teeth models mainly produce two types of cracks: The tensile cracks along the pre-existing fissures and the shear cracks along both sides of the teeth model. The existence of prefabricated fissures greatly reduces the peak strength of the teeth models. Compared with the circumstances containing no pre-existing fissures, the peak strength of d = 1 cm, d = 2 cm and d = 3 cm decreases by 22.33%, 31.79% and 18.94%, respectively, and the peak strength of θ = 30°, θ = 45°, θ = 60° decreases by 10.78%, 44.01% and 34.3%, respectively. Numerical results show that the initiations of tensile cracks are induced by the high tensile stress concentrations at the pre-existing fissure tips, while the shear cracks are caused by the high tensile stress concentrations in the low tensile stress concentration areas after the initiation of tensile cracks. The research results can provide some references for the understandings of teeth failure mechanisms as well as the applications of SPH method into teeth crack propagation simulations.

Stress Analysis on Mesiolingual Cavity of Endodontically Treated Molar Restored Using Bidirectional Fiber-Reinforced Composite (Wallpapering Technique)

Introduction

Endodontically treated teeth (ETT) undergo extensive structure change and experience high stress during biomechanical function. Stress distribution is influenced by the restoration material and the type of bond between material and tooth structure. The selection of materials that can distribute stress will affect the resistance and retention of ETT to mastication forces, thus biomechanical functions were achieved. Composite has mechanical properties similar to dentin, it can transmit and distribute stresses throughout the tooth surface. The disadvantage of composites in large cavities is their lack of toughness. The addition of fiber to composites can increase their toughness.

Purpose

This research is to determine the stress distribution of a fiber-reinforced composite made of polyethylene and e-glass on the mesiolingual cavity of ETT.

Materials and Methods

A three-dimensional model of the mandibular molar was prepared for cavity preparation and the formation of restorations using SolidWorks 2021. The models were analyzed with Abaqus 2020 to determine stress concentrations after given vertical and oblique loading.

Results

The maximum and minimum principal stress data were obtained to assess material resistance and interfacial damage criterion. Polyethylene fiber shows a more homogeneous stress distribution because the modulus of elasticity is close to the dentin and has a thickness that can reduce the volume of the composite. The E-glass shows the stress concentration on the circumferential fiber and cavity floor.

Conclusion

The stress distribution of fiber-reinforced composite on the buccolingual cavity of ETT using the finite element method did not show structural failure in the polyethylene group because the maximum and minimum principal stresses were lower than the strength of the material. Interfacial bond failure occurs at the enamel portion. The maximum and minimum principal values of e-glass indicate structural failure in the circumferential fiber and the base fiber because the stress exceeds the strength of the material. Interfacial bond failure occurred on the circumferential and the cavity floor.

The Stresses and Deformations in the Abfraction Lesions of the Lower Premolars Studied by the Finite Element Analyses: Case Report and Review of Literature

BACKGROUND

The purpose of the study was to investigate the behavior of hard dental structures of the teeth with abfraction lesions when experimental occlusal loads were applied.

METHODS

A 65-year-old patient came to the dentist because she had painful sensitivity in the temporomandibular joints and the lower right premolars. The patient was examined, and cone-beam computed tomography (CBCT) of the orofacial area was indicated. The data provided from the CBCT were processed with Mimics Innovation Suite 17 software to create the desired anatomical area in 3D format. Then, the structural calculation module was used in order to perform a finite element analysis of the lower right premolar teeth. A focused review of articles published between 2014 and 2023 from specialty literature regarding the FEA of premolars with abfraction lesions was also conducted.

RESULTS

The parcel area and the cervical third of the analyzed premolars proved to be the most vulnerable areas under the inclined direction of occlusal loads. The inclined application of experimental loads induced 3-4 times higher maximum shears, stresses, and deformations than the axial application of the same forces.

CONCLUSIONS

FEA can be used to identify structural deficiencies in teeth with abfractions, a fact that is particularly important during dental treatments to correct occlusal imbalances.

Tooth morphology, internal fit, occlusion and proximal contacts of dental crowns designed by deep learning-based dental software: A comparative study

OBJECTIVES

This study compared the tooth morphology, internal fit, occlusion, and proximal contacts of dental crowns automatically generated via two deep learning (DL)-based dental software systems with those manually designed by an experienced dental technician using conventional software.

METHODS

Thirty partial arch scans of prepared posterior teeth were used. The crowns were designed using two DL-based methods (AA and AD) and a technician-based method (NC). The crown design outcomes were three-dimensionally compared, focusing on tooth morphology, internal fit, occlusion, and proximal contacts, by calculating the geometric relationship. Statistical analysis utilized the independent t-test, Mann-Whitney test, one-way ANOVA, and Kruskal-Wallis test with post hoc pairwise comparisons (α = 0.05).

RESULTS

The AA and AD groups, with the NC group as a reference, exhibited no significant tooth morphology discrepancies across entire external or occlusal surfaces. The AD group exhibited higher root mean square and positive average values on the axial surface (P < .05). The AD and NC groups exhibited a better internal fit than the AA group (P < .001). The cusp angles were similar across all groups (P = .065). The NC group yielded more occlusal contact points than the AD group (P = .006). Occlusal and proximal contact intensities varied among the groups (both P < .001).

CONCLUSIONS

Crowns designed by using both DL-based software programs exhibited similar morphologies on the occlusal and axial surfaces; however, they differed in internal fit, occlusion, and proximal contacts. Their overall performance was clinically comparable to that of the technician-based method in terms of the internal fit and number of occlusal contact points.

CLINICAL SIGNIFICANCE

DL-based dental software for crown design can streamline the digital workflow in restorative dentistry, ensuring clinically-acceptable outcomes on tooth morphology, internal fit, occlusion, and proximal contacts. It can minimize the necessity of additional design optimization by dental technician.

Effects on different full-coverage designs and materials of crack propagation in first mandibular molar: an extended finite element method study

Objectives: 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. Materials and Methods: 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. Results: 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. Conclusion: 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.

In silico fatigue performance of molars restored with full crowns under alternating cyclic loadings

OBJECTIVE

In this study, a preclinical approach was used to analyze and directly compare the fatigue performance (fatigue life and damage percentage) and maximum principal stresses (Max. Ps) of prepared models treated with different materials and geometric parameters.

METHODS

Four groups of preparative parameters (crown width, crown length, degree of polymerization and material) were selected, each with five variables. An alternating cyclic occlusal load with an amplitude of 300 N was applied to the ball part along the longitudinal axis. The fatigue properties of the preparations and Max.Ps were analyzed.

RESULTS

A shoulder width of 0.8 mm, a shoulder height offset of 0.2 mm, a degree of polymerization of 5°, and a crown material of ZC resulted in the smallest percentage of damage. In contrast, the effect of different modulus of elasticity (MOE) on Max.Ps was not significant (p = 0.609).

CONCLUSION

The results suggest that the selection of larger modulus of elasticity MOE and larger Poisson's ratio material's, preparation of larger shoulder widths within safety, reasonable increase in crown length, and selection of larger degree of polymerization are favorable methods to protect the preparation.

Morphology and mechanical performance of dental crown designed by 3D-DCGAN

OBJECTIVES

This study utilised an Artificial Intelligence (AI) method, namely 3D-Deep Convolutional Generative Adversarial Network (3D-DCGAN), which is one of the true 3D machine learning methods, as an automatic algorithm to design a dental crown.

METHODS

Six hundred sets of digital casts containing mandibular second premolars and their adjacent and antagonist teeth obtained from healthy personnel were machine-learned using 3D-DCGAN. Additional 12 sets of data were used as the test dataset, whereas the natural second premolars in the test dataset were compared with the designs in (1) 3D-DCGAN, (2) CEREC Biogeneric, and (3) CAD for morphological parameters of 3D similarity, cusp angle, occlusal contact point number and area, and in silico fatigue simulations with finite element (FE) using lithium disilicate material.

RESULTS

The 3D-DCGAN design and natural teeth had the lowest discrepancy in morphology compared with the other groups (root mean square value = 0.3611). The Biogeneric design showed a significantly (p < 0.05) higher cusp angle (67.11°) than that of the 3D-DCGAN design (49.43°) and natural tooth (54.05°). No significant difference was observed in the number and area of occlusal contact points among the four groups. FE analysis showed that the 3D-DCGAN design had the best match to the natural tooth regarding the stress distribution in the crown. The 3D-DCGAN design was subjected to 26.73 MPa and the natural tooth was subjected to 23.97 MPa stress at the central fossa area under physiological occlusal force (300 N); the two groups showed similar fatigue lifetimes (F-N curve) under simulated cyclic loading of 100-400 N. Designs with Biogeneric or technician would yield respectively higher or lower fatigue lifetime than natural teeth.

SIGNIFICANCE

This study demonstrated that 3D-DCGAN could be utilised to design personalised dental crowns with high accuracy that can mimic both the morphology and biomechanics of natural teeth.

Mathematical tools for recovery of the load on the fissure according to the micro-CT results

In the present paper X-ray microtomographic research of a molar tooth was conducted. The study revealed regions with a reduced mineral density in the vicinity of the fissure tip. The basic assumption investigated is that corrosion induced enamel mineral density decrease is enhanced by high tensile stresses generated by mechanical load on the occlusal surface of the tooth during crushing of food. Magnitude and location of tensile stress concentration occurs at the fissure tip and may be determined by solving the problem of the stress-strain state of the tooth crown enamel with a wedge-shaped notch. The study of stresses in the vicinity of fissure tip make it possible to construct the boundaries of enhanced enamel virtual fracture. Comparison of the sizes and locations of areas with a reduced enamel mineral density with the sizes and locations of areas of virtual enamel fracture made it possible to establish their approximate congruence. This circumstance made it possible to recreate by mathematical means the nature and magnitude of the force load on the lateral surface of the fissure. Degree of influence of the main parameters of the fissure on the geometrical characteristics of the virtual fracture, such as its area and diameters, were determined.

An improved Smoothed Particle Hydrodynamics (SPH) method for modelling the cracking processes of teeth and its applications

The present work aims to propose a meshless method to establish the tooth meso-structures and model the tooth fracturing processes as well as investigate the influencing factors that affect the dental mechanical properties. To this end, the traditional kernel function in the SPH method has been improved by introducing a fracture mark ξ to realize the progressive failure processes of teeth; The "Particle Searching Method" has been proposed, which can realize the establishments of microstructures of teeth such as enamel, dentine, pulp, PDL and alvedar bones. The Weibull function is introduced to represent the heterogeneity of teeth, which can realize the random distribution characteristics of dental mechanical parameters. The simulation results of homogeneous and heterogeneous teeth show that the failure mode changes from tensile splitting (homogeneous) to shear failure (heterogeneous). Meanwhile, the fracture networks become more complex, and the failure stress decreases sharply. The cuspal angles also have a great impact on the teeth fracture characteristics. The failure modes changes from tensile splitting of the enamel tip to the cracking from the contact points between the enamel and the rigid ball; Different fssural morphologies have little influences on the teeth failure characteristics. The research results can provide some references for the applications of SPH method into biomechanical simulations such as teeth failure. Meanwhile, it can also provide some guidance for the understandings of the internal mechanisms of teeth fracture processes, the diagnosis and treatments of clinical diseased teeth as well as the design of bionic teeth materials.

Biomechanical Modelling for Tooth Survival Studies: Mechanical Properties, Loads and Boundary Conditions-A Narrative Review

Recent biomechanical studies have focused on studying the response of teeth before and after different treatments under functional and parafunctional loads. These studies often involve experimental and/or finite element analysis (FEA). Current loading and boundary conditions may not entirely represent the real condition of the tooth in clinical situations. The importance of homogenizing both sample characterization and boundary conditions definition for future dental biomechanical studies is highlighted. The mechanical properties of dental structural tissues are presented, along with the effect of functional and parafunctional loads and other environmental and biological parameters that may influence tooth survival. A range of values for Young's modulus, Poisson ratio, compressive strength, threshold stress intensity factor and fracture toughness are provided for enamel and dentin; as well as Young's modulus and Poisson ratio for the PDL, trabecular and cortical bone. Angles, loading magnitude and frequency are provided for functional and parafunctional loads. The environmental and physiological conditions (age, gender, tooth, humidity, etc.), that may influence tooth survival are also discussed. Oversimplifications of biomechanical models could end up in results that divert from the natural behavior of teeth. Experimental validation models with close-to-reality boundary conditions should be developed to compare the validity of simplified models.

Interaction of rod decussation and crack growth in enamel

Enamel possesses ingenious hierarchical structure that gives rise to superior fracture resistance. Despite considerable efforts devoted to characterization of fracture behavior of enamel, the role of rod decussation in fracture of enamel is largely unknown. In this study, the features of rod decussation in the inner enamel are experimentally identified, and analyses of crack growth in enamel are carried out using a micromechanical model of enamel, in which the structural features of the outer enamel and rod decussation of the inner enamel are incorporated. We carry out calculations within a framework based on the extended finite element method, and the crack growth and crack path selection are natural outcomes of imposed loading. We show that crack deflection in enamel is controlled by rod decussation. For crack growth in the parazone, the crack path is oriented along the axis of enamel rods, leading to gross crack deflection. The microstructure of inner enamel with intermediate inclination angle enables multiple crack deflections, giving rise to enhanced toughness. For crack growth in the diazone, the transition in orientation of crack deflection occurs as inclination angle increases. The relatively straight crack path emerges in the case of the microstructure of enamel with intermediate inclination angle, leading to weak fracture resistance. It is further found that compared with the diazone, the gross crack deflection in the parazone provides greater contribution to fracture resistance of enamel. The findings of this study provide a good mechanistic understanding of the role of rod decussation in enamel.

Effects of composite resin core level and periodontal pocket depth on crack propagation in endodontically treated teeth: An extended finite element method study

STATEMENT OF PROBLEM

Preserving teeth with radicular cracks with or without a periodontal pocket is an alternative to extraction. However, an effective protocol for the restoration of radicular cracks is lacking.

PURPOSE

The purpose of this study was to examine the composite resin core level and periodontal pocket depth effects on stress distribution, maximum von Mises stress, and crack propagation in endodontically treated teeth by using the extended finite element (FE) method.

MATERIAL AND METHODS

Four 3-dimensional models of a cracked endodontically treated mandibular first molar were constructed: PP2C2 (periodontal pocket depth, 2 mm; composite resin core level, 2 mm below the canal orifice level); PP2C4 (periodontal pocket depth, 2 mm; composite resin core level, 2 mm below the crack level); PP4C2 (periodontal pocket depth, 4 mm; composite resin core level, 2 mm below the canal orifice level); and PP4C4 (periodontal pocket depth, 4 mm; composite resin core level, 2 mm below the crack level). The crack initiation was at the same level in all models. A static 700-N load was applied to the models in a vertical direction.

RESULTS

The highest stress in dentin was observed in PP2C2, whereas PP2C4 exhibited the lowest stress and least crack propagation. Stress was high in the dentin and supporting bone. No reduction in crack propagation was observed in the PP4 models, regardless of the composite resin core level.

CONCLUSIONS

The periodontal pocket depth (2 mm and 4 mm) and composite resin core level (2 mm below the crack level and 2 mm below the canal orifice level) affected stress concentration in dentin, resulting in different patterns of crack propagation in the FE models.

Effect of occlusal anatomy of CAD/CAM feldspathic posterior crowns in the stress concentration and fracture load

OBJECTIVES

This study evaluated the effect of restoration occlusal design on the maximum fracture load and stress distribution of a feldspathic ceramic crown.

MATERIALS AND METHODS

Twenty dentin analogues were used to simulate a full-crown preparation. Next, 20 feldspathic crowns were milled according to the occlusal design parameter available in the CAD database (Young or Adult). The crowns were cemented with dual cure resin-cement and loaded until fracture at 1 mm/min crosshead speed. Data were analyzed by using one-way ANOVA and Tukey tests (p < 0.05). The same geometry and experimental setup was modeled and exported to the computer aided engineering software and tensile stress concentration was calculated using the finite element method with 300 N occlusal load simulation.

RESULTS

The occlusal anatomy significantly influenced the load-to-fracture (p < 0.05). Adult design showed higher mean values (1149 ± 201 N) than Young design (454 ± 77 N). The maximum principal stress criteria showed similar stress pattern for both designs, however, the highest stress concentration was calculated for Young design (91 MPa) in the occlusal surface.

CONCLUSIONS

An anatomy design with reduced cusp angulation and less evident occlusal sulcus can reduce the stress concentration and increase the fracture load for feldspathic CAD/CAM posterior crowns.

Mechanical failure of posterior teeth due to caries and occlusal wear- A modelling study

OBJECTIVES

The purpose of the present work is to explore the effect of occlusal wear and different types and degrees of caries on the mechanical performance and structural integrity of posterior teeth.

METHODS

Three-dimensional (3D) computational models with different combinations of caries parameters (caries location, caries size and caries induced pulp shrinkage) and occlusal wear factors (enamel thickness, marginal ridge height and cuspal slope) were developed and analyzed using the extended finite element method (XFEM) to identify the stress distribution, crack initiation load and ultimate fracture load values. The effect of a non-drilling conservative treatment using resin infiltration on the recovery of mechanical properties of carious molar teeth was also investigated.

RESULTS

Presence of fissural caries, worn proximal marginal ridge and decreased enamel thickness due to occlusal wear, imparted a significant negative effect on the crack initiation load value of the lower molar models. Accordingly, models with intact and strong proximal marginal ridge, generally exhibited higher crack initiation loading, regardless of caries size and location. Presence of fissure caries drastically decreased (55%-70%) the crack initiation load compared to sound teeth. The depth of the fissural lesion and the presence of proximal caries did not have a major effect on crack initiation load values. However, increasing the caries size resulted in lower final fracture load values in most of the cases. Accordingly, the groups with combined and connected large fissural and proximal lesions experienced the largest drop in the fracture load values compared to sound tooth models. The worst condition consisted of two connected large proximal and fissural caries with no proximal marginal ridge, in which the fracture load dramatically decreased to only 25% of that for sound teeth with intact marginal ridge. On the other hand, decreased cuspal slope due to occlusal wear and shrinkage of the pulp due to caries appeared to have a protective role and a direct relation with the fracture resistance of the tooth. Following the application of resin infiltration on the carious models, the crack initiation load and the fracture load could recover up to 75% and 90% of the values for the corresponding sound tooth models, respectively.

SIGNIFICANCE

Presence of fissural caries, if not treated (either with remineralization, resin infiltration or restoration), can be a major risk factor in the initiation of tooth fracture. When combined with decreased enamel thickness and loss of proximal marginal ridge due to mechanical or chemical wear, the weakening effect of the caries will be amplified specially in teeth with steep cuspal slopes. The application of a conservative treatment with resin infiltration can be an effective approach in prevention of further mechanical failure of demineralized enamel. The findings of this study emphasize the importance of early interventions in the management of caries for the prevention of future cuspal or tooth fracture especially in subjects with higher risk factors for tooth fracture such as caries, wear and bruxism.

The effect of dental restoration geometry and material properties on biomechanical behaviour of a treated molar tooth: A 3D finite element analysis

OBJECTIVES

To test the hypothesis that restoration of class II mesio-occlusal-distal (MOD) cavities can be strengthened through judicious choice of restoration geometry and material properties.

METHODS

An intact extracted human maxillary molar tooth was digitized, segmented, reconstructed, and four 3D restored tooth models were developed with four different restoration geometries: one straight, one single-curved, and two double-curved. Stress analysis was conducted for representative loading using finite element analysis, and maximum principal stresses were determined at the dentine-enamel and restoration-enamel junctions. A range of restorative material elastic moduli (5-80 GPa) and Poisson's ratios (0.25-0.35) were studied. Vertical loads of 400 N were applied on occlusal points, while the roots of the molar teeth, below the crevices, were supported in all directions. All the materials were modelled as homogeneous, isotropic, and elastic.

RESULTS

The maximum principal stresses at the restoration-enamel junctions were strongly dependent on the MOD restoration geometries. Peak stresses occurred along the palatal surface of the restoration rather than the opposite buccal surface. Double-curved restorations showed the lowest peak stress at restoration-enamel junctions. Choice of the mechanical properties of restorative material in the range of 5-35 GPa further reduced stress concentrations on the enamel.

SIGNIFICANCE

Class II MOD restorations may be stronger if designed with double-curved marginal geometries that can reduce stress concentrations. Designs with convex and concave geometries were particularly effective because they reduced stress concentrations dramatically. Results suggest that relatively minor changes to the geometry of a restoration can have a substantial effect on stress at the restoration-enamel junction and motivate future experimental analysis.

Risk Factors Associated with Cusp Fractures in Posterior Permanent Teeth—A Cross-Sectional Study

Objectives: This cross-sectional study aimed to evaluate the frequency and risk factors associated with cusp fractures in posterior permanent teeth. Methods: Patients presented cusp fractures on posterior permanent teeth, clinically assessed in up to 7 days after the event, and requesting dental treatment at two public services were included in this cross-sectional study. Fractured teeth already treated, with antagonist absence, or with prosthesis (total or removable) were excluded. Demographic and clinical data were collected to draw the patient profiles and establish how teeth were affected individually. Statistical analysis was performed by the Fisher exact test, and uni- and multivariate logistic regression (α = 0.05). Results: One hundred and seventy-seven (177) patients from 16 to 66 years old (±41.56), from 1998 to 2016, were included in this study. Non-functional and lingual cusps presented a higher fracture than functional and buccal cusps, respectively. Fractures were more common in teeth with isthmus wider than 1/3 of the intercuspid distance and/or more than three restored surfaces. Teeth with endodontic treatment presented a higher subgingival fracture. On lingual cusps, fracture type and location were significantly associated, being that total fractures were 3.2 times more likely to occur than partial fractures, and subgingival were 3.62 times more likely to occur than supragingival fractures. Conclusion: Indications of classic protection on functional cusps (LUBL) was refuted since, generally, nonfunctional cusps fractured more than the functional cusps. However, upper pre-molars showed more fractures in functional cusps and lower molars presented more fractures on the nonfunctional cusps. In general, lingual cusps were the most fractured and were associated with a higher prevalence of severe fractures (total fractures at the subgingival level). Fractures were more common in teeth where the restoration had an isthmus wider than 1/3 of the intercuspid distance and/or involved more than three restored surfaces. Most of the patients did not show previous symptoms and signs. Overall, teeth with endodontic treatment presented a higher subgingival fracture.

Acoustic emission and finite element study on the influence of cusp angles on zirconia dental crowns

OBJECTIVE

The effect of cusp angle on the load-carrying capacity and failure behaviour of BionZ Diamond zirconia crowns is carried out using experimental and numerical investigations.

METHODS

The experimental program using monolithic crowns were divided into three groups (n = 14) for three cusp angles, 60, 80 and 120 degrees and were tested to failure under the static load. A 2-channel acoustic emission (AE) system was used to monitor the failure process while the piezo sensors were attached to the rigid stainless-steel jig for recoding the AE events. Load-displacement and AE response were simultaneously monitored until failure of specimens. Parametric AE analysis was conducted for the factors such as amplitude, energy released, signal duration and cumulative counts, for each AE signal. Fast Fourier transform (FFT) was conducted to assess the frequency at failure. Linear finite element analysis (FEA) was carried out using commercial software Ansys Workbench 19.1 to present the stress distribution and failure modes. Post-failure surface morphology study was carried out using scanning electron microscopy (SEM) and statistical analysis was performed using Weibull analysis.

RESULTS

All the samples in three different groups have failed at the mid-line, splitting the zirconia crowns into two equal pieces. The load to failure was directly proportional to the cusp angle in crowns; 120° group had the highest load-carrying capacity of 2.93 ± 0.26 kN while 60 and 80° groups had a failure load of 2.46 ± 0.53 and 2.52 ± 0.16 kN, respectively. Parametric AE analysis revealed that the failure was instantaneous and 60-degree samples had higher AE signature. FE analysis showed the crack initiation at the occlusal surface of the crown which is in agreement with the SEM images. A close agreement of results for the load and stress distribution from FEA complemented with the experimental study.

SIGNIFICANCE

Optimisation of cusp-angle could help clinicians to accurately design the monolithic zirconia crown focussing on maximum load-carrying capacity, increasing the restoration life.

Validated Finite Element Models of Premolars: A Scoping Review

Finite element (FE) models are widely used to investigate the biomechanics of reconstructed premolars. However, parameter identification is a complex step because experimental validation cannot always be conducted. The aim of this study was to collect the experimentally validated FE models of premolars, extract their parameters, and discuss trends. A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Records were identified in three electronic databases (MEDLINE [PubMed], Scopus, The Cochrane Library) by two independent reviewers. Twenty-seven parameters dealing with failure criteria, model construction, material laws, boundary conditions, and model validation were extracted from the included articles. From 1306 records, 214 were selected for eligibility and entirely read. Among them, 19 studies were included. A heterogeneity was observed for several parameters associated with failure criteria and model construction. Elasticity, linearity, and isotropy were more often chosen for dental and periodontal tissues with a Young’s modulus mostly set at 18–18.6 GPa for dentine. Loading was mainly simulated by an axial force, and FE models were mostly validated by in vitro tests evaluating tooth strains, but different conditions about experiment type, sample size, and tooth status (intact or restored) were reported. In conclusion, material laws identified herein could be applied to future premolar FE models. However, further investigations such as sensitivity analysis are required for several parameters to clarify their indication.

Nature's design solutions in dental enamel: Uniting high strength and extreme damage resistance

The most important demand of today's high-performance materials is to unite high strength with extreme fracture toughness. The combination of withstanding large forces (strength) and resistance to fracture (toughness), especially preventing catastrophic material failure by cracking, is of utmost importance when it comes to structural applications of these materials. However, these two properties are commonly found to be mutually exclusive: strong materials are brittle and tough materials are soft. In dental enamel, nature has combined both properties with outstanding success - despite a limited number of available constituents. Made up of brittle mineral crystals arranged in a sophisticated hierarchical microstructure, enamel exhibits high stiffness and excellent toughness. Different species exhibit a variety of structural adaptations on varying scales in their dental enamel which optimise not only fracture toughness, but also hardness and abrasion behaviour. Nature's materials still outperform their synthetic counterparts due to these complex structure-property relationships that are not yet fully understood. By analysing structure variations and the underlying mechanical mechanisms systematically, design principles which are the key for the development of advanced synthetic materials uniting high strength and toughness can be formulated. STATEMENT OF SIGNIFICANCE: Dental enamel is a hard protective tissue that combines high strength with an exceptional resistance to catastrophic fracture, properties that in classical materials are commonly found to be mutually exclusive. The biological material is able to outperform its synthetic counterparts due to a sophisticated hierarchical microstructure. Between different species, microstructural adaptations can vary significantly. In this contribution, the different types of dental enamel present in different species are reviewed and connections between microstructure and (mechanical) properties are drawn. By consolidating available information for various species and reviewing it from a materials science point of view, design principles for the development of advanced biomimetic materials uniting high strength and toughness can be formulated.

A Systematic Review of Real-Time Medical Simulations with Soft-Tissue Deformation: Computational Approaches, Interaction Devices, System Architectures, and Clinical Validations

Simulating deformations of soft tissues is a complex engineering task, and it is even more difficult when facing the constraint between computation speed and system accuracy. However, literature lacks of a holistic review of all necessary aspects (computational approaches, interaction devices, system architectures, and clinical validations) for developing an effective system of soft-tissue simulations. This paper summarizes and analyses recent achievements of resolving these issues to estimate general trends and weakness for future developments. A systematic review process was conducted using the PRISMA protocol with three reliable scientific search engines (ScienceDirect, PubMed, and IEEE). Fifty-five relevant papers were finally selected and included into the review process, and a quality assessment procedure was also performed on them. The computational approaches were categorized into mesh, meshfree, and hybrid approaches. The interaction devices concerned about combination between virtual surgical instruments and force-feedback devices, 3D scanners, biomechanical sensors, human interface devices, 3D viewers, and 2D/3D optical cameras. System architectures were analysed based on the concepts of system execution schemes and system frameworks. In particular, system execution schemes included distribution-based, multithread-based, and multimodel-based executions. System frameworks are grouped into the input and output interaction frameworks, the graphic interaction frameworks, the modelling frameworks, and the hybrid frameworks. Clinical validation procedures are ordered as three levels: geometrical validation, model behavior validation, and user acceptability/safety validation. The present review paper provides useful information to characterize how real-time medical simulation systems with soft-tissue deformations have been developed. By clearly analysing advantages and drawbacks in each system development aspect, this review can be used as a reference guideline for developing systems of soft-tissue simulations.