Professional Documents
Culture Documents
CONTENTS
INTRODUCTION
FORCE
FORCE ON DENTAL STRUCTURE
STRESS
TYPES OF STRESS
MECHANICAL PROPERTIES OF MATERIAL
BIOMECHANICS FOR RESTORATIVE DENTISTRY
STRESS ANALYSIS AND DESIGN OF DENTAL STRUCTURES
a) FINITE ELEMENT STRESS ANALYSIS
b) PHOTOELASTICITY
STRESS IN THE PERIODONTAL MEMBRANE
STRESS PATTERNS OF TEETH
ON ANTERIOR TEETH
ON POSTERIOR TEETH
OCCLUSAL CONSIDERATIONS IN RESTORING TEETH
FORCES EXERTED DURING OCCLUSION / MASTICATION AND
THEIR RESOLUTION
FORCES ACTING ON AMALGAM RESTORATIONS
CLASS I
CLASS II
FORCES ACTING ON INLAY RESTORATION
FORCES ACTING ON COMPOSITE RESTORATION
FORCES ACTING ON POSTS
FORCES
ACTING
RESTORATIONS
ON
CAST
METAL
AND
PORCELAIN
CONCLUSIONS
FORCE
The general concept of force is gained through the muscular action of
pushing or pulling on an object. When there is a tendency to change the
position of rest as the motion of a mass, it is said that a force is applied.
A force always has a direction and the direction is often characteristic of the
type of force.
If the body to which the force is applied remains at rest, the force causes the
body to deform.
Units of force are the pound or the kilogram or Newton.
FORCES ON DENTAL STRUCTURES :
One of the most important applications of physics in dentistry is in the
study of forces applied to teeth and dental restorations. There are numerous
reports in the dental literature that describe the measurement of biting forces on
teeth. The maximum forces reported have ranged form 200 to 2440 N (45 to
550 lb).
Numerous instruments have been used to make this measurements,
including strain gauges and telemetric devices small enough to be incorporated
into dental restorations.
NORMAL BITING FORCES :
Experiments conducted on adults have shown that the biting force
decreases form the molar region to the incisors. Studies have revealed that four
patients developed biting forces on the first and second molars that varied form
390 to 800 N (88 to 198 lb), with the average being 565 N (127 lb). The
average force on the bicuspids, cupids and incisors was 288, 208 and 155 N
(65, 47 and 35 lb) respectively.
In a similar investigations of the biting forces in children, 783 boys and
girls were studied. Children form 6 to 17 years of age were included, and it
was observed that there was an increase in force form 235 to 494 N (53 to 111
lb) as age increased, with the average yearly increase being in the order of 22.2
N (5 lb).
The average biting forces in persons with normal and modified
occlusion were measured. Data indicate that the when the bite was raised
0.5 mm, the measured forces were generally higher, approaching twice the
values obtained with normal occlusion. This observation may be explained by
the fact that the force on teeth are determined by muscular effort, and this effort
is controlled by the nervous system. Thus some force regulating mechanism
was operating and it probably exists in case of malocclusion. The maximum
force measured will depend on the type of food.
FORCES ACTING ON THE TEETH :
FORCES AND RESPONSES :
The forces which act on the teeth and cause them to move within their
periodontal tissues vary in magnitude, duration, frequency and direction.
The responses by the teeth to the forces depend on such factors as the shape
and length of the roots the characteristics of the fluid content of the
periodontal space, the composition and orientation of the periodontal fibres
and the extent of the alveolar bone.
The responses by the teeth will also depend on the consistency of the bolus
being chewed and the muscular forces being used to crush it. This will also
apply to parafunctional clenching and chewing with or without a foreign
body between the teeth. It is, therefore, difficult to assess what is a normal
response to a force on a tooth and what is potentially harmful. As a result
of these forces, a tooth can be displaced in one of six directions : - apically,
mesiodistally or buccolingually, and each one producing a rotation or a
translation.
The result is likely to be a combination of all directions leading to an
omnidirectional movement. The same principle of movement will apply to
the opposing tooth involved.
OMNIDIRECTIONAL AND UNIDIRECTIONAL RESPONSES :
These omnidirectional tilting and rotations of teeth will reach a limit
when an equal and opposite resistance is reached and the periodontal receptors
cause a reflex arrest of the muscle force. When the force is removed, the teeth
will recover their positions due to the elastic recovery of the compressed
periodontal tissues. This is referred to as replacement of the teeth.
ii)
iii)
The opposing
forces are then equal to the moving forces. Thus, maxillary incisors with
poor periodontal support and incompetent lips will drift forwards. This
forward drift will continue until the teeth are shortened or are prevented
from moving further by an appliance and by treatment of the periodontal
breakdown.
STRESS
When a force acts on a body, tending to produce deformation, a resistance
is developed to this external force application.
Stress is the internal reaction to the external force.
Both the applied force and stress are distributed over a given area of the
body, and so the stress in a structure is designated as the force per unit area.
Force
Stress = --------Area
Area over which the force acts is an important factor of consideration
especially in dental restorations in which areas over which the force applied
often are extremely small. Since stress at a constant force is inversely
proportional to the area, the smaller the area, the larger the stress. And vice
versa.
Technically, stress is the internal resistance of the body in terms of force per
unit area and is equal and opposite in direction to the force (external)
applied. This external force is also known as load.
TYPES OF STRESSES :
Depending upon the nature of the force, all stresses can be divided into 3
basic types which are recognized as ;
i.
Tension
ii.
Compression and
iii.
Shear
F
2) Compression : Results when the body is subjected to 2 sets of forces in the
same straight lien and directed to each other.
F
F
3) Shear : Is a result of 2 forces directly parallel to each other.
Tensile Stress :
-
The molecules making up the body must resist being pulled apart.
Compressive Stress :
-
Shear Stress :
-
Complex Stresses :
Whenever force is applied over a body, complex as multiple stresses are
produced. They may be a combination of tensile, shear or compressive stress.
These multiple stresses are called complex stresses.
MECHANICAL PROPERTIES OF A MATERIAL :
The mechanical properties of a material describe its response to loading.
It is common to simply describe the external load in terms of a single
dimension (direction) as compression, tension, or shear combination of these
can produce Torsion (Twisting) or Flexion (transverse bending).
When a load is applied, the structure undergoes deformation as it bonds
are compressed, stretched, or sheared. The load deformation characteristics are
only useful information if the absolute size and geometry of the structure
involved are known. Therefore, it is typical to normalize load and deformation
as stress and strain.
10
At first this
However,
11
An
12
Biomechanical Unit :
The standard biomechanical unit involves the
1. Restorative material
2. Tooth structure, and
3. Interface between the restoration and tooth
The importance of considering three structures in the biomechanical unit
is to detect stresses that may cause unwanted fractures or debonding. The
restorative material may be strong enough to resist fracture, but the interface or
tooth structure may not be.
STRESS TRANSFER :
Normal tooth structure transfers external biting loads through enamel
into dentin as compression. The concentrated external loads are distributed
over a large internal volume of tooth structure and the local stresses are lower.
During this process a small amount of dentin deformation may occur which
results in tooth flexure.
A restored tooth tends to transfer stress differently than an intact tooth.
Any force on the restoration produces compression, tension, or shear along the
tooth restoration interface. Once enamel is no longer continuous, its resistance
is much lower. Therefore, most restorations are designed to distribute stresses
onto sound dentin, rather than to enamel. The process of stress transfer to
dentin becomes more complicated when the amount of remaining dentin is thin
13
and the restoration must bridge a significant distance to seat onto thicker dentin
(Liners or bases).
TOOTH FLEXURE :
Tooth flexure has been described as either a lateral bending or an axial
bending of a tooth during occlusal loading. This flexure produces the maximal
strain in the cervical region, and the strain appears to be resolved in tension or
compression within local regions, causing the loss of bonded class V
restorations in preparations with no relative grooves. Moreover, one current
hypothesis is that tensile or compressive strains produce microfractures (called
ABFRACTIONS) in the thinnest region of enamel at the CEJ. Such fractures
predispose enamel to loss when subjects to tooth brush abrasion and/or
chemical erosion. This process may be key in the formation of Class V defects.
PRINCIPLES OF BIOMECHANICS :
Stress transfer and the resulting deformations of structures are
principally governed by :
1. The elastic limit of the materials
2. The ratio of the elastic moduli involved
3. Thickness of the structures
Materials with a high elastic modulus transfer stresses without much
strain. Lower modulus materials undergo dangerous strains where stresses are
concentrated, unless there is adequate thickness.
14
The
inlays. Light field isochromatic fringes for rounded shoulder and shoulderless
models under a 445 N load were analyzed. The load was applied at 3 other
locations :
i)
ii)
On the cusp
iii)
the restoration, two in the tooth and five at the junction of the restoration and
the tooth.
The study showed that the chamfer and rounded type of preparations are
the optimum designs in proximo-occlusal posterior restorations, since they
demonstrated the lowest stress when loaded vertically. The maximum fringe
order for the rounded shoulder was 10 whereas that for the shoulderless
preparation was 17. It was also shown that rounding the axiogingival line
angle in the shoulder geometry reduced the stress concentration factor by upto
50%. The gingival area of the proximal shoulder was the area of high stress,
and extra retentive features such as pins or grooves should not be placed in this
area.
FINITE ELEMENT STRESS ANALYSIS :
The finite element is a newer method than photoelasticity and offers
considerable advantages. In this method a finite number of discrete structural
elements are interconnected at a finite number of points or nodal points. These
17
finite elements are formed when the original structure is divided into a number
of appropriately shaped sections, with the sections retaining the actual
properties of the real materials.
The information needed to calculate the stresses and displacement in the
model is
1) The total number of nodal points and elements.
2) A numbering system for identifying each nodal point and element.
3) The elastic modulus and Poissons ratio for the materials associated with
each element.
4) The coordinates of each nodal point
5) The type of boundary constraints
6) The evaluation of the forces applied to the external nodes.
A first molar with an amalgam restoration was idealized by an
axisymmetrical model and analyzed by the two-dimensional finite element
method.
The smaller
triangles are located in areas of greater interest. The ability of various types
and thickness of cement bass to support the amalgam was studied. The plots of
maximum tensile stress start at the centre of the cavity and extend toward the
cavity wall.
The stress induced in the amalgam restoration was from four to five
times higher when the amalgam was supported by 2 mm Zinc Oxide Eugenol
cement base, as compared with an equal thickness of zinc phosphate cement
18
base. When the stresses induced in the amalgam by a zinc phosphate base of 2
mm are considered in relation to those induced by a dentin floor alone one can
see that replacement of dentin by zinc phosphate to a depth of 2 mm does not
result in any significant increase in the tensile stress induced in the amalgam.
The zinc oxide eugenol cement base unlike the zinc phosphate cement bar,
does not function as rigid material and induces a larger displacement.
In comparison with zinc phosphate cement base the zinc oxide eugenol
material does not have adequate mechanical properties to support a restoration.
Even thin layers (0.5 mm) of zinc oxide eugenol cement caused significant
changes in the stress induced n the amalgam. Therefore the study indicates that
the fracture of amalgam is influenced more by the modulus of elasticity
(Stiffness) of the base material than by the compressive strength of the base.
An ideal situation would be to have a cement base with a modulus of elasticity
equal to that of the restorative material. Also, a subsequent study found that
tensile and shear stresses occurring in the cement base were of sufficient
magnitude to exceed the strength of some cements.
The stress distribution in porcelain fused to metal and porcelain jacket
crowns was conducted using a finite element method. Design parameters of
rounding of shoulders, avoidance of sharp notches, minimum thickness of
metal copings, and minimum labial bulk of porcelain were incorporated into
the model of an upper central incisors.
19
A load of 444 N was applied at the incisal third of the lingual surface
and at the middle third of the lingual surface.
Vertical loading and loading 30 degrees to the vertical were used.
Since fracture is probably initiated by tensile failure at the periphery, the
tensile stress at the boundary is of special importance.
With vertical loading at the incisal third, the highest tensile stresses were
found tat the labial third and on the lingual surface near the load, decreasing
toward the incisal edge. Low stresses wee observed at the margin and on
the lingual surface below the load. The surface stress was nearly the same
whether a gold or Ni-Cr base alloy was used; the use of Ni-Cr caused a
slight decrease in surface stress.
When the direction of the loading was changed to 30 degrees from the
vertical, high tensile stresses were observed near the lingual margin that
would be of sufficient magnitude to fracture the cement in this area.
STRESS IN THE PERIODONTAL MEMBRANES :
Although limited measurements have been made on the periodontal
membrane of animals, the actual stress in the membrane has not been
determined experimentally.
calculated. In one case, it was assumed that the periodontal membrane was
incompressible, whereas in another it was assumed to be approximately that of
water. In both cases the root of the tooth was assumed to be a cone and the
elastic modulus of the membrane was taken as 1.45 MN/m2.
20
When the force was applied to the center o the tooth axis, the stress
distribution was uniform with respect to the longitudinal axis of the tooth and
the pressure was greatest at the apex.
If the loading was transverse, the maximum stress occurred near the
apical third of the root on the same side as the compression force.
21
The junction between the clinical crown and clinical root bears
shear components of stress, together with tension on the loading
side and compression at the non-loading side, during excursive
mandibular movements.
ii)
The incisal angles, especially if they are square, are subject t tensile
and shear stress in normal occlusion. Massive compressive stresses
will be present in edge-to-edge occlusion, and if the incisal angles
22
iii)
The axial angles and lingual marginal ridges will bear concentration
shear stresses. In addition, on the loading side, tensile stresses are
present, and on the nonloading side, compressive stresses are found.
iv)
23
v)
vi)
24
vii)
25
ii)
iii)
Axial angles bear tensile and shear stresses on the non-functional side,
and compressive and shear stresses on the functional side.
iv)
The junction between the clinical root and the clinical crown during
function (especially lateral excursion) bears tremendous shear stresses,
in addition to compression on the occluding contacting side and tension
on the non-contracting side.
26
v)
ii)
27
iii)
iv)
v)
28
29
7. When the dentin loses its vitality, there is a drop of almost 40-60% in its
strength properties.
VALE EXPERIMENT :
The original experiment involved preparation of occlusoproximal
cavities with different crossing dimensions at the marginal and crossing ridges
with a standard depth. The teeth were then subjected to measured occlusal
loads. The load that split the tooth was recorded and compared to the control,
which was the load that split a round tooth. Later, the same experiment was
repeated by several investigators using more sophisticated equipment than that
used by vale. The results were consistent.
A summary of their findings brought to the closest round figures is as follows :
i)
ii)
iii)
iv)
v)
30
vi)
vii)
viii)
ix)
31
Thus from the above figures, it is possible to deduce that the inverted
truncated cone shapes will have a higher resistance to loading than the box
shapes, and the box shapes will have a higher resistance than the cone shapes.
Therefore, if conditions and requirements allow, cavity preparations should be
prepared in an inverted truncated cone shape.
4) Definite floors, walls and surfaces with line and point angles are essential to
prevent micromovements of restorations, with concomitant shear stresses
on remaining tooth structures.
Load A
10 stress units/mm3
1 stress unit / mm3
6) Designing the outline form with minimal exposure of the restoration surface
to occlusal loading will definitely minimize stresses and the possibility of
mechanical fracture in the restoration.
32
33
way
we
occlude
teeth
affects
the
periodontium,
the
34
35
i) AMALGAM RESTORATIONS :
Sufficient bulk of amalgam is mandatory when restoring a cavity with
amalgam so as to withstand the load of occlusion.
Adequate thickness of amalgam should be provided at the marginal ridges
in order to support the opposing supporting cusps.
Amalgam restorations are carved following the cuspal inclines.
In case of large restorations, where there are no cuspal planes to guide
carving, the operator should follow a cautious approach :
Buccal and lingual cusp tips should be placed in lines joining those of
adjacent teeth.
The level of central fossa and the marginal ridge should be carved
similar to that of adjacent teeth.
The bucco-lingual width of the occlusal surface is kept narrower than
the original buccolingual width of the tooth.
In case both the working cusps on more than 2 cusps are restored,
preferably the occlusal table is kept narrowed.
This narrower occlusal table leads to :
Reduction of force : When the occlusal table is made narrower, lesser force
is applied over the same to undergo masticatory functions.
Force is
transmitted to all structures underlying the occlusal table, which include the
restoration, the tooth structure and the periodontium.
Reduction of the effect of force : The direction in which the applied force is
transmitted is governed by muscular activities and the area on which the
36
37
ANTERIOR RESTORATIONS :
The resin composites and the glass ionomer cements are mainly used in
anterior restorations.
40
F
Surface
F
Surface
Thus, the reaction force no longer opposes the applied force in direction
nor is equal to its magnitude. Hence the forces are not in equilibrium when
applied on inclined planes.
The equilibrium can be maintained if more than one force is exerted on
tooth or the forces are resolved in both directions.
Forces acting on inclined planes.
42
43
44
45
Tooth B has no marginal ridge. Force 1 and 2 are acting on tooth a and B
respectively. The horizontal component of 2, H2 is missing in the tooth B,
because force 2 is mainly directed towards tooth A.
Horizontal component H2 will drift the tooth A apart and the vertical
component V1 and V2 of both the forces 1 and 2 will help the food impact
vertically. The vertical force V 2 will be more than required, there may
46
47
ii)
The force or the load is applied at different areas at a time and the stress
distribution depends upon various factors.
a) If the cross section of that area is constant, stress distribution is
practically uniform.
b) If there is variation in cross-section (such areas are normally termed as
prisms); here stress varies form point to point, being inversely
proportional to area.
c) If change of cross-section area is abrupt; greater concentration of stress
occurs at that point.
In vertical loading, there will be shearing stresses in prism in any plane.
This haring stress increases to a maximum at 45o and then decreases to zero
at 90o. Therefore, materials that are weaker in shear than in compression or
tension replace in planes at 45o to the axis.
The modulus of elasticity of the material is an important property and
should be taken care of. If a cavity is restored with gold inlay or porcelain,
48
the modulus of elasticity varies between the tooth and the restorative
material. With the vertical force exerting on both, the compression will be
the same for the restoration and the tooth, but since gold/porcelain is much
stiffer, they will be highly stressed, since S = dE.
S (Stress) = S (Unit strain) x E (Modulus of elasticity)
When the force is applied perpendicular to the prism axis, the resultant
resolution is known as beam. Beam can be supported form both the ends
(simple beam) and may be supported form one end (cantilever beam).
Example of simple beam : MOD preparation
Example of Cantilever beam : MO / DO preparation
The retention of the restoration depends upon these beams, although the
strength and the deflection of the material also play part.
Moment of Force = Force x Perpendicular Distance
The bonding moment is at the axiopulpal line angle, which tends to rotate
the restoration out of the cavity.
Gingival retention with a moment equal to F x L is required to counteract
this moment. The total retentive force (R) is equal to F x L / l
Where l is the depth of the axial wall.
If we take depth of gingival wall (d) into account, then R and d will be in
the same direction, so their moment of force is zero. Therefore, the depth
of the gingival wall does not take part in retention.
49
In MOD Preparation :
In MOD preparation, the force (F) is divided equally on both the sides.
The mesio distal distance (L) is also divided into two. The moment of force at
the midpoint is :
F / 2 x L / 2 = FL / 4
If this moment of force is divided into two (because it is actually acting on both
the ends) then the moment of force :
FL
1
FL
----- x ----- = ----4
2
8
Since the beam forces a concave downward curvature between the load and the
fixed end, therefore, by sign convention, this end moment is taken as negative.
By equation R x l = FL / 8
So R = FL / 8 l
The negative sign is used only in vector form and in magnitude only
positive sign is used.
If we take depth of gingival wall (d) into account, then R and d will be in
the same direction, so their moment of force remains zero.
50
It is presumed in MOD preparations that the length of the axial wall (l) is
kept equal on booth the ends. If there is marked discrepancy between the
two ends, the end result may not be the same as is described earlier.
Therefore, preferably the length of the two axial walls should be the same.
In Cervical / Gingival Restorations :
It has been established that certain forces act on the cervical reign, which
could destabilize the restoration and even lead to cracks at the cementoenamel junction.
The forces acting on inclined planes of the occluding cusps consequently
lead to transverse stresses. These transverse stresses try to bend the tooth
gingivo-occlusally. Since the teeth are firmly held in alveolar socket, these
rotations are minimum and counteracted.
In cases where a cavity is cut on the cervical surfaces, depending upon the
height of the axial wall, the deflective force is increased. If the restorative
materials are not adhesive in nature, a gap can be created at the cervical
surface of the restoration on buccal side and occlusal surface on the lingual
side.
51
52
2) Class II restoration
Stresses which tend to rotate the restoration, mostly act on marginal
ridges.
Stresses also is more at axiopulpal line angle, hence, this axiopulpal line
angle should be well rounded, thereby decreasing stress concentration
and increasing the bulk of the material at this point.
In MOD restorations, bending of the occlusal portion is caused by the
difference between the total masticatory force and the support given by
the pulpal floor of the cavity.
Gingival retention and rounding of the axiopulpal line angles are
required as in MO and DO cavity.
In cases where the opposing cusps occlude in such a way that one
contact point is on a proximoocclusal restoration while the other is on
tooth structure, there is a tendency to wedge the two apart. To prevent
this wedging, the occlusal lock is used even though occlusal surface is
not involved by caries.
3) Class III and Class IV Restorations :
Since these lesions are not in direct contact with opposing teeth, only
transverse stresses play part in dislodging / rotating the restoration
In such restorations, there is tendency to rotate about an axial approximately
parallel to the long axis of the tooth. As incisal retention cannot be made
due to thin labiolingual size, so lingual lock, is placed on lingual surface. It
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54
The seat of the restoration is placed at a distinct right angle to the direction
of stresses.
B. When a caries cone penetrates deeply into dentin, removing undermined and
decayed tooth structures can lead to a conical (hemispherical in cross-section)
cavity preparation. Mechanically, two problems can occur if a restoration is
inserted into such a cavity preparation.
1. If the occlusal loading is applied centrically, the restoration may act as a
wedge, concentrating forces at the pulpal floor, and leading to dentin bridge
cracking, and an increased tendency for tooth splitting.
2. If the occlusal loading is applied eccentrically the restoration will have
tendency to rotate laterally, for there would be no lateral locking walls in
definite angulation with a floor. Although these lateral movements are
55
These
movements can also lead to fracture of marginal tooth structure, and even to
splitting of lateral walls.
To solve these problems, flatten the pulpal end of the cavity preparation.
However, if accomplishing this at a deep location incurs increased risk of
involving the pulp chamber, pulp horns, or recessional lines containing
remnants of pulp tissues, make the pulpal floor at more than one level. One
level will be the ideal depth level (1.5 mm) and the others will be the caries
cone(s) level(s), dictated by the pulpal extent of the decay. The shallow level
creates the flat portion of the pulpal floor at definite angles to the surrounding
walls, adequately resisting occlusal forces and laterally locking the restoration,
without impinging on pulp tissues. Reiterating, the other level(s) is (are) only
necessitated by the caries extent., creating one or more concavities or cones in
the pulpal floor.
C. When a cavity wall comes in contact with a marginal ridge, the wall should
be divergent pulpo-occlusally, making an obtuse angle with the pulpal floor.
This design allows for maximum bulk of tooth structure supporting the
marginal ridge and avoids undermining of the marginal ridge, creating more
mechanical and biological problems.
D. If cariogenic conditions do not dictate otherwise, the width of the cavity
should be limited to to 1/5 the intercuspal distance (not less than 1.5 mm).
This minimizes loss of tooth structure in this critical cross-section of the tooth.
This width will also facilitate easy carving of the restoration, and minimize the
possibilities of occlusal interferences.
E. All cavosurface angles should be right angled to create a butt-joint with the
marginal amalgam. This configuration allows marginal amalgam to withstand
stresses with the least possibility of failure.
56
F. All line and point angles, or any junction between different details in the
cavity preparation, should be rounded but definite. This design has all the
advantages of the mortise shape, while avoiding stress concentration in the
tooth structure and restorative materials that may occur from sharp angulations.
G.
intolerable tensile loading which may lead to amalgam failure if the amalgam is
in thin cross sections, i.e. acute angled marginal amalgam will fracture. B, If
marginal amalgam is right angled, it can be stand induced stresses from
occlusal loading with less possibility of failure, even if the stresses are tensile
in nature.
CLASS II AMALGAM RESTORATION
By definition Class II cavity preparation is proximal preparations of
molars and premolars.
Resistance Form :
The fundamental concept of resistance form is based on the reaction
within the restoration and the remaining tooth structure to occlusal loading.
The objective of a cavity preparation design is to establish the best
possible configuration that can cope with the distribution and magnitude
of the stresses in both structure and the restoration without failure. To
57
restoration and the tooth structure are periodically loaded both separately and
jointly. This brings about different stresses patterns depending on the actual
morphology
opposing contacting cuspal elements. For the purpose of this discussion, one
can classify these loading situations and their induced stress patterns in the
following way.
1) A small cusp contacts the fossa away from the restored proximal surface, in
a proximo occlusal restoration at centric closure.
As shown due to the elasticity of the dentin, (in young teeth) a restoration
will bevel at the axio-pulpal line angle (provided the proximal part of the
restoration is self-retained). This creates tensile stresses at the isthmus
portion of the restoration, shear stresses at the junction of the main bulk of
the proximal part of the restoration and self retained parts and compressive
stresses in the underlying dentin.
2) A large cusp contacts the fossa adjacent to the restored proximal surface in
a proximo-occlusal restorations at centric closure, either in the early stages
of moving out of centric or at the late stages of moving toward it.
As shown, the large cusps will tend to separate the proximal part of the
restoration from the occlusal part. This crates tensile stresses at the isthmus
portion of the restoration even fi the proximal portion is self retained.
This loading situation will deliver compressive forces in the remaining
tooth structure, apical to the restoration.
3) Occluding cuspal elements contact facial and lingual tooth structure
surrounding a proximo-occlusal or proximo-occluso-proximal restoration,
during centric and excursive movements.
58
59
The first
60
61
62
minimum stresses at the junction of one part with another, i.e. the isthmi.
This can be achieved in amalgam preparations by retentive grooves, internal
boxes, and undercuts.
6) Sixth, one should avoid, as much as possible, placing or leaving any surface
discontinuities, such as carved developmental grooves, scratches, etc at
these critical areas in the restoration. These can precipitate and accentuate
stresses leading to fatigue failure.
Finally, by checking occlusion to eliminate prematurities in the restoration,
immediate overloading and failure can be avoided.
2. Margins :
Amalgam has good compressive strength when it has sufficient bulk
(1.5 mm minimum). However, frail, feather edged margins of amalgam, which
will occur when the cavosurface angles of preparations are bevelled, will
fracture easily. Occluding forces will cause amalgam at the bevel to bend with
maximum tensile stresses, occurring as a result of elastic deformation of the
tooth structure beneath the bevel. Marginal excess of amalgam will similarly
fracture, leaving a ditch around the restoration that will enhance recurrence of
decay. So, for the margins of these p reparations, four design features should
be observed ; create butt joint amalgam tooth structure at the margins, leave no
frail enamel at the cavosurface margins, remove flashes of amalgam on tooth
surface adjacent to amalgam margins, and, as practically as possible, the
interface between amalgam and tooth structure should not be at an occluding
contact area with opposing teeth either in centric or excursive mandibular
movements.
3. Cuspal and Axial angles :
The following are the design features for these parts of a restoration.
a. Amalgam bulk in all three dimensions should be atleast 1.5 mm
b. Each portion of the amalgam should be completely immobilized with
retention modes.
c. Amalgam should be seated on a flat floor or table in these areas.
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If one were to consider the restoration as being L-shaped, with the long
arm of the L occlusally and the short arm proximally, when the long arm is
loaded by vertical force V, it will seat the restoration more into the tooth.
This is due to the elasticity of the dentin, especially in young teeth, wherein the
pulpal floor will change location from position 1 to position 2. However, since
metallic restorations are more rigid than the dentin, the short arm of the L will
move proximally, as shown in the figure. The fulcrum of this rotation is the
axio-pulpal line angle. In order to prevent such a displacement, proximal selfretention in the form of facial, lingual and/or gingival grooves are required.
However, shear stresses will be induced at the junction between the amalgam
of the main restoration and that in the grooves.
Therefore, it is to be
understood that these grooves are prepared only when there is complete
assurance that there will be sufficient dentinal bulk to accommodate them, and
that they will not impinge on the axial angle or on the pulp anatomy.
C. Lateral Rotation of the Restoration Around Hemispherical Floors (Pulpal
and Gingival)
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casting in the inclined planes of the cusps. This reduction should be 1.5 mm
for cast ceramics. The reduction of the occluding inclined planes should be cut
in a concave form, to accommodate maximal bulk of the casting where stresses
are at their maximum.
The internal parts of the cavity preparation should be mortised to
preserve the resistance and retention features of the preparation (and to assure
one path for the preparation). The internal boxed up portion should occupy the
maximum dimensions of the cavity preparation as practically as possible. This
will necessitate making the cavity wall in different planes. At least, the internal
planes are fixed in their angulation (almost right angle) with the adjacent floors
or walls.
Since the retention of an inlay and its resistance to displacement are
primarily mechanical problems, a group of the principles of retention is based
on understanding the forces of mastication and the analysis of strains which are
present in the restoration.
It has been stated that when a force is applied at right angles to a surface
its effectiveness with the direction of force and that is proportional to its
magnitude likewise, the opposing forces are equal and opposite in direction.
Another law states that if the force is applied at an angle to the surface other
than right angle, the magnitude of which depends n the angle of application ad
that the reacting force is neither equal nor opposite in direction.
Lateral or tangential forces may cause displacement of the restoration
unless adequate resistance and retention have been incorporated in the
preparation.
Frictional retention can be achieved by the action of dentin and enamel
walls grasping the restoration (intracoronal retention).
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Now let us consider the forces applied at right angles to the flat surface
of a restoration.
Pulpal Floor and Gingival Seal :
1) A typical proximoocclusal cavity will have two such surfaces to vertical
forces the pulpal and gingival walls.
If the forces are perpendicular to these surfaces the opposing forces are
equal and opposite, then there is no tendency to displace the filling. Floors
positioned perpendicular to these lines of force absorbs the stress over a
broad area of tooth.
2) It is only when the pulpal wall is flat and the two vertical walls are parallel
to each other that the maximum retention form is obtained.
While these above illustration refer to simple box type cavity preparation,
the same principles hold good when the force is applied at right angles to
the occlusal surfaces of proximo occlusal inlay.
3) In a tooth weakened by extensive caries, the resistance form is obtained by
extracoronal extension of the preparation in the form of extra long reverse
bevel in capped cusps or by partial or complete coverage of facial or lingual
surfaces.
4) If the dentin of the pulpal wall is compressed elastically under vertical
forces, if the compression is conical then the gingival portion of the filling
would rotate out of the cavity with the axiopulpal line angle acting as the
fulcrum.
Because of the added retention obtained by the pulpal extension and if
the diagonal force is applied to the casting which is L shaped. It will have a
tendency to straighten out, so this causes the metal to move out laterally at the
gingival area. To resist this lateral spreading, at the gingival wall provision is
made for the depression of the wall and creating the gingival groove which
restores the retentive form to a certain extent.
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buccal and lingual proximal walls. Now whether they should flare
axioproximally or be parallel to each other (that is the part of the wall lying
within the dentin).
There are 3 different relationships of wall A to wall B in the
gingivoocclusal direction.
1) The walls are parallel to each other.
2) Walls are widely divergent.
3) Divergence not exceeding 5o from the vertical plane.
When forces are applied at an angle other than right angle, force is
resolved in 2 ways, one of which reacts in its effectiveness at right angle to the
surface. This force is not opposite in direction, nor is it equally magnitude to
the original force. The tendency in a tooth is for the cusp of the opposing tooth
to slide down the inclined plane or for an inlay to be pushed out of the cavity in
a horizontal plane.
When a vertical force is applied to a proximal extension the filling is
rotated occlusoproximally out of its cavity. The rotation point of fulcrum being
gingival marginal wall. These forces are always effective unless counteracted
by an opposing movement. This can be achieved by properly prepared occlusal
lock, by proper preparation of gingival wall, pulpal wall and lastly by the
proper contour and contact point.
Slice :
Slice preparation provides external support of weakened tooth or areas
subjected to high stresses during function. It increases the resistance and
retention form by exposing a larger amount of tooth structure to the frictional
grasp of the restoration.
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Occlusal Dove Tail : Tensile stresses developed by this is one of the strongest
means of resisting the displacement of an inlay. Clinical precaution demands
that by lingual inclined planes which extend into the isthmus of the occlusal
block be on sound cusps with a sufficient amount of supporting dentin. If these
are lacking, there is likelihood, of fracture of one or both the cusps whenever
inlay is subjected to horizontal forces.
Now the buccal and lingual axial walls, instead of flaring from the axial
line angles to the cavosurface margin in a continuous plane, are now changed
into two narrower but parallel planes and two smaller diverging planes. It is
evident that in this type of preparation, it is possible to retain the retentive form
of the preparation, even if the walls diverge in a continuous plane, when stress
is applied to the occlusal surface, the reaction of the opposite forces will tend to
dislodge the filling. So retention in this type of preparation is by placing a
gingival groove in the gingival wall and by adding an occlusal lock. Hence
effort is made to parallel at least part of the buccal and lingual proximal walls
that lie in dentin.
Second method of resisting horizontal displacing forces is by the proper
preparation of gingival walls. The properly prepared gingival groove assist in
preventing the lateral displacement of an inlay. But because of the inherent
weakness of the gingival groove the possible fracture to this wall of the tooth
structure between the groove an the cavosurface angle, so many operators
prefer the inward beveling of the gingival wall, forming an acute angle between
the axial and gingival walls.
Pulpal Wall : Third method of obtaining opposing movements to horizontal
displacing force is by establishing resistance into pulpal wall. The pulp wall
which is flat offers no resistance to horizontal displacement when it is prepared
with two inclined planes it will prevent the lateral displacement of the inlay.
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stickiness of food, occluding and lateral movement forces of the jaws and
the surface area and texture of restoration being pulled.
2) Stress Concentration : Stresses are not uniform throughout the cement but
are concentrated around the junction of the axial and occlusal surfaces (axio
pulpal line angle).
restoration. The strength of the cement is less than the induced stresses.
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It
has its fulcrum almost parallel to the long axis of the tooth being loaded. The
second
is
vertical
force
displacing
or
rotating
the
restoration
forces with very limited horizontal components. This loading will continue
during all centric closures and excursion movements of the mandible.
However, if the incisal angle is intact (Class III), these displacing forces
will be minimal.
3. If the upper and lower anterior teeth meet such that the lowers are labial to
the uppers in centric occlusion (Angles Class III), there will be the same
type of loading conditions mentioned in (1) except the horizontal loading
will tend to rotate or displace restorations labio proximo lingually (for
uppers) and linguo-proximo labially (for lowers).
During excursive
The vertical
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e) Cervical portions of anterior teeth when they are affected with a Class V
lesion or cavity preparation will have a stress pattern similar to posterior
teeth, and the stress pattern is governed by the same factors as in
posterior teeth. In addition, the deeper the overbite is, the more induced
the stresses are at these cervical areas.
f) AS mentioned previously, loss of an axial angle, incisal angle, or tooth
structure at the neck of the tooth will dramatically reduce that tooths
ability to resist loading without fracture failure.
Ideally, a restoration made of tooth colored materials should not be
loaded directly, i.e. there should be intervening tooth structure between the
occluding tooth and the restoration. This situation can only be achieved by
four intact walls surrounding the restoration. Unfortunately, this is usually not
the case. That is why the clinical performance of tooth colored materials
differs from one situation to another, sometimes dramatically.
Anterior teeth have their maximal bulk gingivally. They taper incisally
with the lest bulk at the incisal ridge. So resistance to stress fractures will be
maximum at the gingival end and decrease incisally.
Forces are directed horizontally and vertically on anterior teeth as
mentioned with the force analyses on restorations for these teeth. These forces
accumulate maximal shear stresses at the junction of the clinical root with the
clinical crown and maximum tensile stresses at the incisal ridges, especially
their corners (incisal angles).
The labial enamel plate is much thicker than the lingual or proximal
ones, with maximal thickness of enamel usually at the incisal ridge. The
incisor may be involved in a disclusion mechanism of the mandible with
loading similar to that of the cuspid, but to a much lesser extent.
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applied are at a right angle (b) or oblique (c) to the post axis, the induced
stresses in the root canal walls will be unevenly distributed, i.e. there is a great
possibility of stress concentration due to uneven thickness of the root canal
walls around the post (root taper) while the post remains the same diameter.
This leads to a thin sectioned wall at the very apical end of the post.
On the contrary, taper sided posts and combination type posts will
concentrate stresses due to apical loading (a) in the root canal walls resulting
from its wedge shape. Lateral loading on and around cavity ends of the post,
however, will induce evenly distributed stresses in the root canal walls for the
taper of the post will correspond with the root and root canal taper, leading to
an even thickness of walls occlusoapically.
2. Method of Inserting root canal posts :
During insertion of a post into the root canals, highly threaded posts can
induce ten times the amount and extent of stresses as smooth sided posts.
Serrated surface posts will induce about one and a half to two times the stresses
that are induced by smooth surfaced posts. This can be explained by the
cemented technique utilized by the serrated and smooth surfaced posts.
3. Bulk of dentin in root canal walls :
Naturally, the bulkier that the dentin surrounding a root canal post is, the
less will be the induced stresses per unit volume during the post insertion and
functional use of the post retained restoration. It has been estimated that a
minimum of 2 mm of dentinal root canal wall should surround a post, so that
the stresses induced there will not lead to dentinal failure in the form of cracks
and gross fracture.
4. Length of clinical root involved with the root canal post :
Although the tooth to receive a root canal post should be non-vital and
endodontically treated, the clinical crown portion of the tooth is much more
dehydrated than the clinical root portion as the dentin portion of the root still
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The more
dehydration that there is, the less will be the modulus of resilience and
elasticity of the dentin, and consequently the less will be the dentins ability to
absorb and resist stresses without failure.
5. Ferrule or embracing features of the restoration :
Post-core and dowel coping foundations for endodontically treated teeth
will always induce stresses in the root canal walls and remaining tooth
structures which can only be counteracted by embracing the buccal and lingual
cuspal elements of the tooth and/or banding (circumferential embracing) the
tooth at its most apical part of the clinical crown (i.e. area of maximum
stresses). Such bracing is referred to as the Ferrule effect. The Ferrule feature
of the restoration should involve at least 2 mm of crown length to counteract
stresses induced by the post. Using less than 2 mm of crown tooth structure,
the counteracting Ferrule effect will be reduced. The closer this embracing
feature is to the junction between the clinical crown and the root, the more
effective it will be. This is the major protecting feature against induced stresses
in a restoration for endodontically treated teeth.
6. Lateral Locking Mechanisms for the post and restoration :
Because most premade posts are rounded in cross-section there is a great
tendency for the post and the restoration retained by the post to rotate under
torsional forces. This rotational tendency can induce unnecessary stresses in
remaining tooth structures. The presence of a method to lock the post and the
restoration against such rotation (e.g. a lateral pin, internal boxes, opposing
walls, etc) will drastically reduce the effect of torsional forces.
7. Presence of a pulp chamber with pronounced walls :
Walls of the pulp chamber, especially if they are opposing each other,
will increase the frictional retention of the foundation or restoration,
minimizing the retention demands on the pot and thereby minimizing stresses
in the root canal walls.
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1:1, will definitely concentrate intolerable stresses on the lateral walls of the
root canal adjacent to the apical end of the post.
13. Hydraulic pressure during post cementation :
If there are no lateral vents in the post, or if the post diameter is very
close to that of the post channel diameter, the semi-liquid cement mix, during
the cementation of the posts, may exert tremendous amounts of hydraulic
pressure that exceed the elastic limit of the surrounding dentin or prevent
complete seating of the post.
14. Surface texture and shape of the root end of the post :
Greater post surface roughness and/or the presence of a chisel, wedge,
or irregular configuration on the root end of the post, increases the possibilities
of stress concentration on the root canal walls. The concentration of these
stresses will increase with increasing proximity of the pot to the involved root
canal anatomy.
15. The length of the post relative to the entire length of the root :
Generally, speaking the more that the root canal length is involved with
a post, the more evenly distributed and the better resisted the stresses will be in
the root canal walls. On the other hand, the apical one third of root canals
usually have a very limited thickness of dentin walls. By placing the tip of the
root pot there, with attendant possibilities of substantial stresses being
concentrated at that tip, catastrophic failures become inevitable. As a rule from
one half to two thirds of the root canal should encapsulate the post if the forces
transmitted by the post are to be adequately dissipated.
16. Shape of the post in cross section relative to the shape of the post channel :
A post should have a circumference that coincides with the post channel.
Differences, e.g. rounded post in an oval post channel, will concentrate stresses
at isolated locations in the root canal wall, possibly exceeding the local
breaking point of the dentin.
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less stresses than continuous threading. The wider and more frequent that the
interruptions are, the less will be the stresses. Interruptions (cross cuts) further
serve to facilitate escape of debris during post insertion. The more extended
that the threads are laterally, the more the surface interfacial contact with
dentin will be and consequently, the higher the stresses.
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encountered in function.
Retention and resistance can be maximized by shaping the preparation so
that as much of its surface as possible will experience compression and
shear when the restoration is subjected to an unseating force.
RETENTION :
It is the ability of the preparation to impede removal of the restoration along
its path of insertion.
Under this condition, the cement bond subjected to tension and shear.
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Degree of taper
ii)
iii)
iv)
i) Degree of Taper :
The more nearly parallel the opposing walls of a preparation, the greater
will be the retention. Thus retention decreases as taper increases.
However, in order to avoid undercuts and to allow complete seating of the
restoration during cementation, the walls must have some taper.
An overall taper or angle of convergence of 6 degrees is considered as
appropriate i.e. approximately 3 degrees being produced on each surface,
external or internal, by the sides of a tapered instrument.
ii) Total Surface Area of Cement Film :
The greater the surface area of cement film or the of the preparation, the
greater the retention of the restoration.
The total surface are of preparation is influenced by the size of the tooth,
the extent of coverage by the restoration and features such as grooves and
boxes that are placed in the preparation.
iii) Area under shear :
More important for retention than the total surface area is the area of
cement that will experience shearing rather than tensile stress when the
restoration is subjected to forces along the path of insertion.
To decrease the failure potential, it is essential to minimize tensile stress.
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For the shear strength of the cement to be utilized, the preparation must
have opposing walls, i.e. two surfaces of the preparation in separate planes
must be nearly parallel with each other an the line of draw.
To obtain the greatest area of cement under shear, the direction in which a
restoration can be removed must be limited to essentially one path.
Thus the addition of parallel sided grooves, limits the path of withdrawal to
one direction, thereby reducing the possibility of dislodgment.
The length and width of the preparation is an important factors in retention :
a long preparation as well as wider preparation has greater retention than
does a shorter or a narrower preparation.
iv) Surface Roughness :
Adhesion of dental cements depends primarily on projections of the cement
into microscopic irregularities on the surfaces to be joined.
Therefore
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The same general displacing forces are present in the posterior partial
crown as in the anterior partial crown, but the ability of the preparation to resist
displacement is more favourable than in the anterior teeth. The occlusal forces
may be occlusal, horizontal or any one component of force indicated by P.
Minimum problems exerts when the force is vertical, for the resistance
is equal and opposite. When the force tends to displace the casting lingually, it
does so along the paths R1, R2 and R3 with its rotation center at point F.
Resistance in this displacing force is furnished by the ribs of gold lying
within the axial groove and by that portion of the proximal and surface
extending lingually from the proximal groove and lying within the areas R 1, R2
and R3. In addition, the occlusal surface lying to plane R 2 R3 offers resistance
when force P is applied in mesiolingual direction, the tendency is to rotate the
casting mesiodistally with the rotation centre being point F, the mesiobuccal
wall. The resistance is this displacing force is developed by the rib of gold
lying into distoproximal groove and by the portion of the casting coming in
contact with the proximal surface lying between the areas R 1 and R2.
Additional resistance to displacement is offered by the occlusal inclined planes
R3, R4 and R5.
When force P is applied in the distal direction, the tendency is to rotate
the casting occlusally, with its dislodgment along the areas R 1 and R2 with F
serving as the point of fulcrum.
The resistance to this displacing force is furnished by the rib of gold
lying in the mesio proximal groove and also by the buccal and mesioproximal
walls lying within the areas R1 and R2.
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The mesioaxial and distoaxial walls are more favourable for developing
parallelism to frictional resistance. The buccal and lingual surfaces due to their
natural contour, do not afford the same opportunity for paralleling walls. The
occlusal planes are reproduced at a lower level.
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CONCLUSION
Optimal functional capacity and stability of occlusal relationships are
major considerations in every phase of restorative dentistry.
The first phase objective of a cavity preparation design is to establish the
best possible configuration that can cope with the distribution and magnitude of
stresses in tooth structure and restoration without failure. To design such a
configuration one must first comprehend the nature of loading and resistance to
such loading.
Restoration not only mechanically replace the lost part but, acts as a
medium through which physical and mechanical forces are transmitted to the
tooth and investing tissues. Each tooth ahs its own stress patterns. A thorough
knowledge in dental materials is necessary to understand the physical
properties including their response to stress.
Before any restorative procedure, always check location of the tooth in
the arch and the patients occlusal relationship. The functional, non functional
cuspal elements should be noted bye examining the involved teeth during static
and functional mandibular movements The operator can then recognize the
nature of stresses that can be expected in the remaining tooth structure
especially the occluding ones.
From these informations obtained during the patient evaluation, the
operator must envision the restoration replacing lost tooth structure being
subjected to functional loading and then try to plan the best tooth preparation to
both retain this restoration and make it resistant to these loads.
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