Heat Transfer and Thermal Stress Analysis of a Mandibular Molar Tooth Restored by Different Indirect Restorations Using a Three-Dimensional Finite Element Method

Multi-response optimisation analysis of material properties in dental restorative composites under the influence of thermal and thermomechanical stimuli - A 3D finite element study

OBJECTIVES

Restored teeth undergo more damage than intact teeth. Therefore, the scientific investigation of their mechanical and physical behaviour under varying oral conditions is vital. The current study is to numerically investigate the stresses on a class-II mesio-occluso-distal (MOD) restored molar due to thermal and thermomechanical stimuli with varying input properties such as coefficient of thermal expansion and elastic properties. This is performed to optimise the dental restoration material, thereby reducing the stresses and failure of the restoration.

METHODS

An upper molar was scanned using μ-CT for segmenting and modelling the enamel and dentine. A class-II MOD cavity was then prepared on the model, after which non-manifold meshing was generated. The coefficient of thermal expansion (CTE) and elastic modulus (E) properties of the restoration were varied from 20 × 10-6 °C-1 to 55 × 10-6 °C-1 and 5 GPa-20 GPa, respectively. After the material properties and boundary conditions were set for the finite element (FE) analysis, the thermal and thermomechanical loading analyses were performed to demonstrate the influence of input parameters on the stress. The maximum values of principal stresses on the restoration-enamel junction and the restoration were evaluated. The results were statistically processed using analysis of variance, response surface methodology (RSM) and optimisation analysis to estimate the most optimum inputs for minimising principal stresses.

RESULTS

The study reveals that the location of principal stress occurs at the restoration-enamel junction (REJ) and the restoration changes based on the composite material value of E and CTE due to thermal and thermomechanical stimuli. The REJ showed higher principal stress than restoration during the application of both thermal and thermomechanical stimuli, making it more vulnerable to fracture and failure. Moreover, the study showed non-linear variations in the values and locations of principal stresses due to thermal and thermomechanical stimuli with the change in the property of the restoration composite used. Finally, this study derived an optimised restorative value for CTE and E due to the application of thermal and simultaneous thermal and mechanical stimuli.

CONCLUSION

This study highlights the importance of choosing the suitable material properties of the restoration composite by dental clinicians to repair a large class MOD cavity. The findings from this study also suggest that the difference in the values of E and CTE in a dental restoration composite when compared with the enamel causes a lack of uniformity in mechanical and thermal properties, thereby forming stress concentrations at the interfaces. The study establishes two optimised CTE and E values for the MOD restoration composite as 25 × 10-6 °C-1 and 20 GPa and 37 × 10-6 °C-1 and 5 GPa, respectively.

Development and validation of risk of bias tool for the use of finite element analysis in dentistry (ROBFEAD)

There has been a systematic review of studies that used FEA in dental sciences, but no adequate risk of bias (RoB) analysis technique has been developed. Therefore, the development and validation process of RoB in studies using the finite element analysis in dentistry (ROBFEAD) tool is described. In the first phase of development, the scope of the tool and possible modifications were covered, and validation was done in the second phase. The developed tool comprised 6 domains and a total of 22 guiding questions in these domains. This article proposes the development and validation of ROBFEAD, a tool for measuring RoB in finite element research in dentistry.

Recent Advances in the Diagnosis of Enamel Cracks: A Narrative Review

Cracked teeth can pose a diagnostic dilemma for a clinician as they can mimic several other conditions. The constant physiological stress along with any pathological strain like trauma or iatrogenic causes can lead to the development of microcracks in the teeth. Constant exposure to immense stress can cause the progression of these often-undiagnosed tooth cracks to cause tooth fractures. This review aims to outline the etiology of tooth cracks, their classification, and recent advances in the diagnosis of enamel cracks. Diagnosing a cracked tooth can be an arduous task as symptoms differ according to the location and extension of the incomplete fracture. Early detection is critical because restorative treatment can prevent fracture propagation, microleakage, pulpal or periodontal tissue involvement, and catastrophic cusp failure. Older methods of crack detection are not sensitive or specific. They include clinical examination, visual inspection, exploratory excavation, and percussion test. The dye test used blue or gentian violet stains to highlight fracture lines. Modern methods include transillumination, optical coherence tomography Swept-Source Optical Coherence Tomography (SSOCT), near-infrared imaging, ultrasonic system, infrared thermography, and near-infrared laser. These methods appear to be more efficacious than traditional clinical dental imaging techniques in detecting longitudinal tooth cracks. Clinically distinguishing between the various types of cracks can be difficult with patient-reported signs and symptoms varying according to the location and extension of the incomplete fracture. Cracks are more common in restored teeth. Technological advances such as transillumination allow for early detection and enhanced prognosis.

Mechanical and Thermal Stress Analysis of Cervical Resin Composite Restorations Containing Different Ratios of Zinc Oxide Nanoparticles: A 3D Finite Element Study

Due to an increase in prevalence of cervical lesions, it is important to use appropriate restorative materials to reduce the incidence of secondary lesions. Owing to having antibacterial properties, cervical composite restorations containing different ratios of Zinc Oxide nanoparticles (ZnO NPs) have been analyzed using the Finite Element method to determine the optimal incorporation ratio from mechanical and thermal perspectives. A numerical simulation is conducted for a mandibular first premolar with a cervical lesion (1.5 × 2 × 3 mm³) restored with composites containing 0 to 5% wt. ZnO NPs. Subsequently, the samples are exposed to different thermo-mechanical boundary conditions, and stress distributions at different margins are examined. The accumulated stress in the restoration part increases for the 1% wt. sample, whereas the higher percentage of ZnO NPs leads to the reduction of stress values. In terms of different loading conditions, the least and most stress values in the restoration part are observed in central loading and lingually oblique force, respectively. The change in the surface temperature is inversely correlated with the ratio of ZnO NPs. In conclusion, the composite containing 5% wt. ZnO NPs showed the most proper thermo-mechanical behavior among all samples.

Influence of thermal and thermomechanical stimuli on a molar tooth treated with resin-based restorative dental composites

OBJECTIVES

In-vivo experimental techniques to understand the biomechanical behavior of a restored tooth, under varying oral conditions, is very limited because of the invasive nature of the study and complex tooth geometry structure. Therefore, 3D-Finite element analyses are used to understand the behavior of a restored tooth under varying oral conditions. In this study, the distribution of maximum principal stress (MaxPS) and the location of MaxPS on a restored tooth using six different commercially available dental resin composites under the influence of thermal and thermomechanical stimuli are performed.

METHODS

An intact tooth was scanned using µ-CT and segmented to obtain separate geometric models of the tooth, including enamel and dentine. Then, a class II mesial-occlusal-distal (MOD) cavity was constructed for the tooth model. The restored tooth model was further meshed and imported to the commercial Finite Element (FE) software ANSYS. Thermal hot and cold stimuli at 50 °C and 2 °C, respectively, were applied on the occlusal and lingual surface of the tooth model with the tooth's ambient temperature set at 37 °C. A uniform loading of 400 N was applied on the occlusal surface of the tooth to imitate the masticatory forces during the cyclic thermal stimuli.

RESULTS

The results of this study showed that the restorative materials with higher thermal conductivity showed a lower temperature gradient between the restoration and enamel, during the application of thermal stimuli, leading to a higher value of MaxPS on the restoration. Moreover, on applying thermal stimuli, the location of MaxPS at the restoration-enamel junction (REJ) changes based on the value of the coefficient of thermal expansion (CTE). The MaxPS distribution on the application of simultaneous thermal and mechanical stimuli was not only dependent on the elastic modulus of restorative materials but also their thermal properties such as the CTE and thermal conductivity. The weakest part of the restoration was at the REJ, as it experienced the peak stress level during the application of thermomechanical stimuli.

SIGNIFICANCE

The findings from this study suggest that restorative materials with lower values of elastic modulus, lower coefficient of thermal expansion and higher values of thermal conductivity result in lower stresses on the restoration. The outcomes from this study also suggest that the thermal and mechanical properties of a restorative material can have a considerable effect on the selection of restorative materials by dental clinicians over conventional restorative materials.

Thermal Load and Heat Transfer in Dental Titanium Implants: An Ex Vivo-Based Exact Analytical/Numerical Solution to the ‘Heat Equation’

Introduction: Heat is a kinetic process whereby energy flows from between two systems, hot-to-cold objects. In oro-dental implantology, conductive heat transfer/(or thermal stress) is a complex physical phenomenon to analyze and consider in treatment planning. Hence, ample research has attempted to measure heat-production to avoid over-heating during bone-cutting and drilling for titanium (Ti) implant-site preparation and insertion, thereby preventing/minimizing early (as well as delayed) implant-related complications and failure. Objective: Given the low bone–thermal conductivity whereby heat generated by osteotomies is not effectively dissipated and tends to remain within the surrounding tissue (peri-implant), increasing the possibility of thermal-injury, this work attempts to obtain an exact analytical solution of the heat equation under exponential thermal-stress, modeling transient heat transfer and temperature changes in Ti implants (fixtures) upon hot-liquid oral intake. Materials and Methods: We, via an ex vivo-based model, investigated the impact of the (a) material, (b) location point along implant length, and (c) exposure time of the thermal load on localized temperature changes. Results: Despite its simplicity, the presented solution contains all the physics and reproduces the key features obtained in previous numerical analyses studies. To the best of our knowledge, this is the first introduction of the intrinsic time, a “proper” time that characterizes the geometry of the dental implant fixture, where we show, mathematically and graphically, how the interplay between “proper” time and exposure time influences temperature changes in Ti implants, under the suitable initial and boundary conditions. This fills the current gap in the literature by obtaining a simplified yet exact analytical solution, assuming an exponential thermal load model relevant to cold/hot beverage or food intake. Conclusions: This work aspires to accurately complement the overall clinical diagnostic and treatment plan for enhanced bone–implant interface, implant stability, and success rates, whether for immediate or delayed loading strategies.

Adipokines in dental pulp: physiological, pathological, and potential therapeutic roles

BACKGROUND

Hundreds of adipokines have been identified, and their extensive range of endocrine functions-regulating distant organs such as oral tissues-and local autocrine/paracrine roles have been studied. In dentistry, however, adipokines are poorly known proteins in the dental pulp; few of them have been studied despite their large number. This study reviews recent advances in the investigation of dental-pulp adipokines, with an emphasis on their roles in inflammatory processes and their potential therapeutic applications.

HIGHLIGHTS

The most recently identified adipokines in dental pulp include leptin, adiponectin, resistin, ghrelin, oncostatin, chemerin, and visfatin. They have numerous physiological and pathological functions in the pulp tissue: they are closely related to pulp inflammatory mechanisms and actively participate in cell differentiation, mineralization, angiogenesis, and immune-system modulation.

CONCLUSION

Adipokines have potential clinical applications in regenerative endodontics and as biomarkers or targets for the pharmacological management of inflammatory and degenerative processes in dental pulp. A promising direction for the development of new therapies may be the use of agonists/antagonists to modulate the expression of the most studied adipokines.

Temperature Rise at the Pulp-Dentin Junction for a Multi-Layered Composite Restoration using the Finite Element Method

Objectives:

During the light-curing process of composite restoration, excessive heat can be produced, which can potentially lead to pulp necrosis (death). In this study, we aimed, based on the Finite Element Method (FEM), to assess the risk of pulp damage during the light-curing process by investigating the influence of light-curing devices, under various irradiation regimes, on the temperature increase at the pulp-dentin junction, during a one-layer or multi-layered deep composite restoration.

Methods:

A Three-dimensional finite element method model of typical geometry and material properties, as commonly reported in the literature, was employed in COMSOL Multiphysics simulations in order to determine the temperature increase in the pulp. Various combinations of light intensities, durations, and irradiation regimes were investigated for the two cases, of shallow and deep multi-layered composite restoration.

Results:

Results of light-curing composite resins within enamel; indicate that the temperature rise during the curing process was within the safety margins. Results of light-curing composite resin restorations closer to the pulp with thin remaining dentin, indicate a temperature increase that could be sufficient to cause thermal injury in the pulp. Modulating the light output marginally, reduced the temperature rise while reducing the intensity and increasing the curing duration which was consistently more effective in this respect.

Conclusion:

The results clearly demonstrate that with currently adopted standard procedures, there exists a risk of thermal injury during multi-layered composite restorations with thin remaining dentin; it is thus important to establish appropriate curing regimes that would lead to minimal temperature increase during deep composite restorations and hence reduce the risk of thermal injury to the pulp.

Repair bond strength of resin composite to three aged CAD/CAM blocks using different repair systems

PURPOSE

The purpose of this study is to evaluate the repair bond strength of a nanohybrid resin composite to three CAD/CAM blocks using different intraoral ceramic repair systems.

MATERIALS AND METHODS

Three CAD/CAM blocks (Lava Ultimate, Cerasmart, and Vitablocks Mark II) were selected for the study. Thirty-two specimens were fabricated from each block. Specimens were randomly divided into eight groups for the following different intraoral repair systems: Group 1: control group (no treatment); Group 2: 34.5% phosphoric acid etching; Group 3: CoJet System; Group 4: Z-Prime Plus System; Group 5: GC Repair System; Group 6: Cimara System; Group 7: Porcelain Repair System; and Group 8: Clearfil Repair System. Then, nanohybrid resin composite (Tetric Evo Ceram) was packed onto treated blocks surfaces. The specimens were thermocycled before application of repair systems and after application of composite resin. After second thermal cycling, blocks were cut into bars (1 × 1 × 12 mm³) for microtensile bond strength tests. Data were analyzed using two-way ANOVA and Tukey's HSD test (α=.05).

RESULTS

Cimara System, Porcelain Repair, and Clearfil Repair systems significantly increased the bond strength of nanohybrid resin composite to all CAD/CAM blocks when compared with the other tested repair systems (P<.05). In terms of CAD/CAM blocks, the lowest values were observed in Vitablocks Mark II groups (P<.05).

CONCLUSION

All repair systems used in the study exhibited clinically acceptable bond strength and can be recommended for clinical use.

The Effect of Thermocycling and Surface Treatments on the Surface Roughness and Microhardness of Three Heat-Pressed Ceramics Systems

Dental ceramic restorations are widely used in restorative dentistry. However, these restorations can be affected once cemented in the oral cavity by several factors. How can conventional surface treatments, such as glazing and mechanical polishing, diminish the effects of aging? The purpose of this in vitro study was to evaluate the effect of thermocycling and conventional surface treatments on the surface roughness and microhardness of three types of glass-ceramics by using a profilometer, scanning electron microscopy (SEM), atomic force microscopy (AFM), and a microhardness tester. Three types of ceramic systems (zirconia reinforced lithium silicate glass-ceramic, lithium disilicate glass-ceramic, and feldspathic glass-ceramic) (n = 48) were prepared. The samples were subjected to thermocycling for 10,000 cycles. Surface roughness was evaluated numerically using a profilometer and visually by using SEM and AFM. Microhardness was performed using a microhardness tester. The data were interpreted using the ANOVA test, and the results were correlated using Pearson’s correlation formula (r). Significant differences were found before and after thermocycling for the Ra (p < 0.01) and Rz (p < 0.05) parameters. As well, differences between glazed and polished surfaces were significant before and after thermocycling for surface roughness and microhardness (p < 0.05). A correlation was made between average surface roughness and microhardness (r = −460) and for the maximum surface roughness and microhardness (r = −606). Aging increases the roughness and decreases in time the microhardness. The tested ceramic systems behaved differently to the aging and surface treatments. Surface treatments had a significant impact on the microhardness and surface characteristics. The glazed groups were reported with higher surface roughness and lower microhardness when compared to the polished groups before and after thermocycling. The measuring roughness techniques determine the scale-dependent values for the Ra (Sa) and Rz (Sq) parameters. Thermocycling almost doubled the surface roughness for all the tested samples. Microhardness decreased only for the Celtra glazed samples. Nano-roughness increased the values for Vita and slightly for Emax. Thermocycling had little effect on Emax ceramic and a more significant impact on Celtra Press ceramic.

Critical considerations on load-to-failure test for monolithic zirconia molar crowns

Application of monolithic zirconia crowns (MZCs) with reduced thickness to the molar region has been proposed, but potential complications have yet to be fully evaluated in laboratory tests. The present study aimed to develop a clinically relevant load-to-failure test in combination with fatigue treatments involving thermal and mechanical cycling (TC and MC) to evaluate the fracture resistance of molar MZCs. MZCs with a minimal thickness of 0.5 mm were bonded to dies made of resin-based composite (RBC), epoxy resin (EP), or polyoxymethylene-copolymer (POM-C). The samples were either untreated (UT) or subjected to TC (5-55 °C for 1 × 10⁵ cycles) and MC (300 N for 2.4 × 10⁶ cycles). The stress generated by TC and MC was simulated by finite element modeling. The load-to-failure test was performed using an inverse V-shaped two-plane indenter and was followed by fractographic analysis. The median values of fracture load for MZC/RBC and MZC/EP in the TC group were significantly lower than those in the UT group. MC also decreased the median value of fracture load for MZC/RBC significantly, but not that for MZC/EP and MZC/POM-C. Fractography revealed that the fracture started in the cervical area in all groups, which is similar to clinically failed crowns. The simulation confirmed stress concentration at the cervical area in both TC and MC groups. The present study suggests that the load-to-failure test using a two-plane indenter could induce clinically relevant fracture of MZCs, the vulnerability of the MZCs depends largely on the die material employed, and MZCs are more likely to be damaged by thermal fatigue than mechanical fatigue.

Influence of microscale expansion and contraction caused by thermal and mechanical fatigue on retentive strength of CAD/CAM-generated resin-based composite crowns

CAD/CAM-generated resin-based composite crowns have been proposed as an inexpensive alternative to conventional crowns. However, concerns have been raised about crown loosening in clinical use. Therefore, the present in vitro study aimed to evaluate the influence of thermal and mechanical cycling (TC and MC) on retentive strength of CAD/CAM resin-based crowns in relation to microscale expansion and contraction caused by fatigue. Eighty standardized dies were produced using a resin-based composite material. Crowns were milled from resin-based composite (n = 40) and glass-ceramic blocks (n = 40; control) using a dental CAD/CAM system. The crowns bonded to the dies were subjected to TC (temperature: 5 and 55 °C, cycles: 50,000) and MC (load: 200 N, cycles: 1.2 million). After fatigue treatment, retentive strength of the crowns was evaluated by a crown pull-off test at a crosshead speed of 1 mm/min. Coefficient of thermal expansion (CTE) and modulus of elasticity (E-modulus) of each material were also analyzed to estimate the microscale expansion and contraction during TC and MC. TC and MC significantly reduced the retentive strength of the CAD/CAM resin-based crowns whereas that of the CAD/CAM ceramic crowns was only affected by TC. In addition, the resin-based crowns showed a higher number of crown loosening during TC than the ceramic crowns. Analyses of CTE and E-modulus indicated that the resin-based crowns would be more deformed during TC and MC than the ceramic crowns. The present study demonstrated that the resistance of crowns to microscale expansion and contraction caused by thermal and mechanical fatigue would play an important role in maintaining retentive strength.