Effect of restorative protocol on cuspal strain and residual stress in endodontically treated molars

R. A.S. Pereira, A. A. Bicalho, S. D. Franco, D. Tantbirojn, A. Versluis, C. J. Soares

Research output: Contribution to journalArticle

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Abstract

Objectives: To evaluate the effect of the restorative protocol on cuspal strain, fracture resistance, residual stress, and mechanical properties of restorative materials in endodontically treated molars. Methods: Forty-five molars received mesioocclusal-distal (MOD) Class II preparations and endodontic treatment followed by direct restorations using three restorative protocols: composite resin (CR) only (Filtek Supreme, 3M-ESPE), resin modified glass ionomer cement in combination with CR (Vitremer, 3MESPE in pulp chamber and Filtek Supreme in MOD cavity), conventional glass ionomer cement in combination with composite resin (CGI-CR) (Ketac Fil, 3M-ESPE in pulp chamber and Filtek Supreme in MOD cavity). Cuspal strain was measured using strain gauges, and fracture resistance was tested with an occlusal load. Elastic modulus (EM) and Vickers hardness (VH) of the restorative materials were determined at different depths using dynamic microhardness indentation. Curing shrinkage was measured using the strain gauge technique. The restorative protocols were also simulated in finite element analysis (FEA). The shrinkage strain, cuspal strain, EM, VH, and fracture resistance data were statistically analyzed using split-plot analysis of variance and Tukey test (p=0.05). Residual shrinkage stresses were expressed in modified von Mises equivalent stresses. Results: Shrinkage strain values (in volume %) were Ketac Fil (0.0860.01) , Vitremer (0.1860.01) , Filtek Supreme (0.5460.03). Cuspal strain was higher and fracture resistance was lower when using CR only compared with the techniques that used glass ionomer. The EM and VH of the materials in the pulp chamber were significantly lower for glass ionomer. The FEA showed that using CR only resulted in higher residual stresses in enamel and root dentin close to the pulp chamber than the combinations with glass ionomers (RMGICR and CGI-CR). Conclusions: The choice of restorative protocol significantly affected the biomechanical behavior of endodontically treated molars. Using glass ionomer to fill the pulp chamber is recommended when endodontically treated molars receive direct composite restorations because it reduces cuspal strain and increases fracture resistance.

Original languageEnglish (US)
Pages (from-to)23-33
Number of pages11
JournalOperative dentistry
Volume41
Issue number1
DOIs
StatePublished - Jan 1 2016

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Composite Resins
Dental Pulp Cavity
Elastic Modulus
Hardness
Glass Ionomer Cements
Finite Element Analysis
Mechanical Stress
Endodontics
Dentin
Dental Enamel
Analysis of Variance
glass ionomer
Filtek Supreme

All Science Journal Classification (ASJC) codes

  • Dentistry(all)

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Effect of restorative protocol on cuspal strain and residual stress in endodontically treated molars. / Pereira, R. A.S.; Bicalho, A. A.; Franco, S. D.; Tantbirojn, D.; Versluis, A.; Soares, C. J.

In: Operative dentistry, Vol. 41, No. 1, 01.01.2016, p. 23-33.

Research output: Contribution to journalArticle

Pereira, R. A.S. ; Bicalho, A. A. ; Franco, S. D. ; Tantbirojn, D. ; Versluis, A. ; Soares, C. J. / Effect of restorative protocol on cuspal strain and residual stress in endodontically treated molars. In: Operative dentistry. 2016 ; Vol. 41, No. 1. pp. 23-33.
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AU - Pereira, R. A.S.

AU - Bicalho, A. A.

AU - Franco, S. D.

AU - Tantbirojn, D.

AU - Versluis, A.

AU - Soares, C. J.

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N2 - Objectives: To evaluate the effect of the restorative protocol on cuspal strain, fracture resistance, residual stress, and mechanical properties of restorative materials in endodontically treated molars. Methods: Forty-five molars received mesioocclusal-distal (MOD) Class II preparations and endodontic treatment followed by direct restorations using three restorative protocols: composite resin (CR) only (Filtek Supreme, 3M-ESPE), resin modified glass ionomer cement in combination with CR (Vitremer, 3MESPE in pulp chamber and Filtek Supreme in MOD cavity), conventional glass ionomer cement in combination with composite resin (CGI-CR) (Ketac Fil, 3M-ESPE in pulp chamber and Filtek Supreme in MOD cavity). Cuspal strain was measured using strain gauges, and fracture resistance was tested with an occlusal load. Elastic modulus (EM) and Vickers hardness (VH) of the restorative materials were determined at different depths using dynamic microhardness indentation. Curing shrinkage was measured using the strain gauge technique. The restorative protocols were also simulated in finite element analysis (FEA). The shrinkage strain, cuspal strain, EM, VH, and fracture resistance data were statistically analyzed using split-plot analysis of variance and Tukey test (p=0.05). Residual shrinkage stresses were expressed in modified von Mises equivalent stresses. Results: Shrinkage strain values (in volume %) were Ketac Fil (0.0860.01) , Vitremer (0.1860.01) , Filtek Supreme (0.5460.03). Cuspal strain was higher and fracture resistance was lower when using CR only compared with the techniques that used glass ionomer. The EM and VH of the materials in the pulp chamber were significantly lower for glass ionomer. The FEA showed that using CR only resulted in higher residual stresses in enamel and root dentin close to the pulp chamber than the combinations with glass ionomers (RMGICR and CGI-CR). Conclusions: The choice of restorative protocol significantly affected the biomechanical behavior of endodontically treated molars. Using glass ionomer to fill the pulp chamber is recommended when endodontically treated molars receive direct composite restorations because it reduces cuspal strain and increases fracture resistance.

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