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BY 4.0 license Open Access Published by De Gruyter Open Access December 3, 2022

The stress distribution of different types of restorative materials in primary molar

  • Mehmet Sami Guler EMAIL logo
From the journal Open Chemistry

Abstract

The aim of this finite element analysis study is to evaluate the stress distributions of different types of restorative materials at Class I cavity in the primary molar. The non-cracked caries-free primary mandibular second molar that is extracted for orthodontic reasons is used to create a three-dimensional model. Two models were prepared as Model 1: the tooth model without restoration (control group) and Model 2: the tooth model with Class I restoration. Five different types of restorative materials were tested in Model 2 (resin modified glass ionomer [Fuji II LC], compomer [Dyract AP], giomer [Beautiful II], glass carbomer [GPC Glass Fill] and ionic resin material with bioactive properties [Activa Kids Bioactive]). A force of 197 N was applied in the vertical and oblique directions in the ANSYS program (Ansys Workbench 19.0, Canonsburg, PA). The maximum Von Mises stress values were compared in the models. The vertical or oblique loading created different stresses in enamel, dentin and restorative materials. The stresses in the enamel tissue were higher than that in the dentin tissue. The stresses in vertical loading were higher than in the oblique loading for restorative materials. The different restorative materials exhibited similar stress distribution patterns, except Activa Kids Bioactive (vertical and oblique loading 446.16 and 8.57, respectively).

1 Introduction

Although there are many technological developments today, tooth caries is still one of the most important problems in dentistry. Teeth should be treated to provide aesthetics, function and phonation. In addition, primary teeth serve as a guide for permanent teeth. By preventing early loss of primary teeth, more complicated treatments that may develop in the future will be minimized.

In the past, amalgam was widely used as a restorative material [1]. Today, parallel to the development of adhesive technological materials, different types of restorative materials are produced. The amalgam was replaced by tooth colored restorative materials, which have superior esthetic properties and require less removal of tooth structure [2,3].

Conventional glass ionomer cements (GICs) are one of the most commonly used materials in pediatric dentistry due to their chemical adhesion to the tooth structure and their fluoride release properties. However, conventional GICs have drawbacks like handling and working difficulties, sensitivity to wetness and fragility [4]. In order to reduce the negative properties of conventional GICs, new materials have been developed such as resin-modified GICs, compomers, giomers, glass carbomers and ionic bioactive resin materials.

At the end of the 1980s resin-modified GICs were developed [5]. This restorative material includes monomeric components such as bisphenol-A-glycidyl methacrylate, urethane dimethacrylate and 2-hydroxyethyl methacrylate. Resin-modified GICs have higher resistance to compression and tensile strength, fracture resistance, modulus of elasticity and retention rates than conventional GICs [6].

Compomer or polyacid-modified composite resin was introduced by early 1990s in dentistry [7]. This restorative material was designed to combine the aesthetics of resin composite with the fluoride release of conventional GICs. Compomer lacks the ability to bond chemically to tooth structure and is able to release fluoride ions even if the amount of released ions is significantly lower than those of GICs [8,9].

Giomer was developed by adding glass ionomer filler particles into composite resins. This restorative material represents promising aesthetic and physical–mechanical properties similar to composite resins. In addition, the fluoride charging and releasing ability offered by giomers are similar to GICs [10].

Glass carbomer was developed in 2008. This material has higher mechanical and chemical properties than conventional GICs. This new material has nanosized hydroxyapatite fluorapatite particles in powder form [11]. The addition of nanoparticles has improved the compressive strength and the wear resistance of cement [12]. Another advantage of glass carbomer cement is its greatly reduced moisture sensitivity [13].

ACTIVA BioACTIVE Restorative (Pulpdent) is a recently developed ionic resin material with bioactive properties. These materials are ionic composite resins, which combine the biocompatibility, chemical bonding and the ability to release fluoride of GIC with the mechanical properties, aesthetics and durability of resin composite. It is able to release and recharge calcium, phosphate and fluoride ions. Activa Kids BioACTIVE Restorative has similar features as ACTIVA BioACTIVE Restorative. However, Activa Kids BioACTIVE Restorative has an opaque white shade to mimic the shade of primary dentition [14,15].

The ideal restorative material should be resistant to occlusal loads or bite force during chewing. In some studies, bite force in primary dentition was evaluated [16,17]. Finite element analysis (FEA) is accepted as an effective method to evaluate the biomechanical properties of new dental restorative materials. As a result of these analyses, potential problems that may be encountered in clinical practice can be identified in advance by computer simulation.

In the literature review, it has been determined that there are limited studies about ACTIVA Kids BioACTIVE, which is a newly developed material [18,19,20,21]. However, there is no study evaluating the stress distributions using FEA of ACTIVA Kids BioACTIVE. The aim of this study was to evaluate the stress distribution of different restorative materials at Class I cavity in primary molar teeth using FEA. The tested hypothesis is that there will be no differences in the stress distribution of different restorative materials at Class I cavity in the primary molar tooth.

2 Materials and methods

The non-cracked caries-free primary mandibular second molar that is extracted for orthodontic reasons is used to create a three-dimensional (3D) model. The original DICOM data obtained from the computed tomography of this tooth were transferred to a computer program (Mimics 10.01, Materialise, Leuven, Belgium). The geometry was simplified using a computer-aided design program (SolidWorks 2014 Premium, Concord, MA), and a 3D design was created. The appropriate tooth preparation for Class I cavity was simulated on a 3D solid model of the tooth.

Two models were prepared as Model 1: the tooth model without restoration (control group) and Model 2: the tooth model with Class I restoration, respectively (Figure 1a and b). Five different restorative materials were tested in Model 2 (resin-modified glass ionomer [Fuji II LC], compomer [Dyract AP], giomer [Beautiful II], glass carbomer [GPC Glass Fill] and ionic resin material with bioactive properties [Activa Kids Bioactive]). The mechanical properties of the tooth and restorative materials (elastic modulus and Poisson’s ratio) were obtained from the manufacturer and published studies (Table 1) [4,22,23,24,25]. The models were transferred to ANSYS Workbench (Ansys Workbench 19.0, Canonsburg, PA) for mathematical solutions and automatic mesh generation (Figure 1c). In each model, 335,549 elements and 489,228 nodes were used. All of the models were considered as linear, homogeneous, and isotropic materials.

Figure 1 
               Model 1 and Model 2: (a) Model 1: tooth model without restoration (control group), (b) Model 2: tooth model with Class I restoration and (c) meshed model.
Figure 1

Model 1 and Model 2: (a) Model 1: tooth model without restoration (control group), (b) Model 2: tooth model with Class I restoration and (c) meshed model.

Table 1

Mechanical properties of the tooth and restorative materials

Materials Elastic modulus (GPa) Poisson’s ratio Literature
Enamel (primary teeth) 80.35 0.33 [22]
Dentine (primary teeth) 19.89 0.31 [22]
Pulp 2 0.45 [22]
Fuji II LC (resin-modified glass ionomer) 10.8 0.30 [23]
Dyract AP (compomer) 10.70 0.28 [24]
Beautiful II (giomer) 11.30 0.30 [25]
GPC Glass Fill (glass carbomer) 8.3 0.30 [4]
Activa Kids Bioactive (ionic resin material with bioactive properties) 2.35 0.25 *

*Experimentally tested.

A force of 197 N was applied to simulate the bite force for primary dentition [16]. The force was applied to the prepared models at two different angles (in the vertical loading to simulation of functional occlusal loads and in the oblique loading to simulation of lateral chewing forces) at occlusal contact points. In oblique loading, the force is given from lingual to buccal, forming an angle of 45° with the long axis of the tooth. A total force of 197 N was applied from the occlusal contact points in both loading conditions.

The stresses that occur as a result of the forces applied on enamel, dentin and restorative material in the models were compared by considering the maximum Von Mises stress values. The maximum Von Mises stress values were calculated as MPa. Stress distributions in the models are shown using color scales, with decreasing values from red to blue. The dark blue represents areas experiencing minimal Von Mises stress and red represents areas experiencing maximal Von Mises stress.

3 Results

3.1 Von Mises stress values in models with vertical loading

The maximum Von Mises stress values are shown in Table 2 for models with vertical loading. The Von Mises stress distribution is given in Figure 2a–f for models with vertical loading.

Table 2

Maximum Von Mises stress values (MPa) in models with vertical loading

Models Restorative material Enamel Dentin
Model 1 405.05 35.59
Model 2A 431.56 225.29 40.46
Model 2B 433.61 225.86 40.30
Model 2C 431.05 224.32 40.19
Model 2D 434.16 230.24 42.28
Model 2E 446.16 241.70 50.34

Model 1: Tooth model without restoration (control group).

Model 2: Tooth model with Class I restoration.

Model 2A: Resin-modified glass ionomer (Fuji II LC).

Model 2B: Compomer (Dyract AP).

Model 2C: Giomer (Beautiful II).

Model 2D: Glass carbomer (GPC Glass Fill).

Model 2E: Ionic resin material with bioactive properties (Activa Kids Bioactive).

Figure 2 
                  Distribution of Von Mises stress for models with vertical loading: (a) tooth model without restoration (control group), (b) tooth model with Class I restoration (resin-modified glass ionomer), (c) tooth model with Class I restoration (compomer), (d) tooth model with Class I restoration (giomer), (e) tooth model with Class I restoration (glass carbomer) and (f) tooth model with Class I restoration (ionic resin material with bioactive properties).
Figure 2

Distribution of Von Mises stress for models with vertical loading: (a) tooth model without restoration (control group), (b) tooth model with Class I restoration (resin-modified glass ionomer), (c) tooth model with Class I restoration (compomer), (d) tooth model with Class I restoration (giomer), (e) tooth model with Class I restoration (glass carbomer) and (f) tooth model with Class I restoration (ionic resin material with bioactive properties).

When the distribution of Von Mises stress values as a result of vertical loading is examined, more intense stress accumulation is observed in enamel than in dentin. In addition, it was observed that the maximum stress values were formed in the force application areas. The tested restorative materials exhibited similar stress distribution patterns, except Activa Kids Bioactive. The stress values of vertical loading for restorative materials were listed as Activa Kids Bioactive > GPC Glass Fill > Dyract AP > Fuji II LC > Beautiful II.

3.2 Von Mises stress values in models with oblique loading

The maximum Von Mises stress values are shown in Table 3 for models with oblique loading. The Von Mises stress distribution is given in Figure 3a–f for models with oblique loading.

Table 3

Maximum Von Mises stress values (MPa) in models with oblique loading

Models Restorative material Enamel Dentin
Model 1 374.71 62.13
Model 2A 20.52 369.22 79.84
Model 2B 20.51 369.15 79.82
Model 2C 20.91 369.09 79.83
Model 2D 18.26 369.96 79.93
Model 2E 8.57 372.32 80.05

Model 1: Tooth model without restoration (control group).

Model 2: Tooth model with Class I restoration.

Model 2A: Resin-modified glass ionomer (Fuji II LC).

Model 2B: Compomer (Dyract AP).

Model 2C: Giomer (Beautiful II).

Model 2D: Glass carbomer (GPC Glass Fill).

Model 2E: Ionic resin material with bioactive properties (Activa Kids Bioactive).

Figure 3 
                  Distribution of Von Mises stress for models with oblique loading: (a) tooth model without restoration (control group), (b) tooth model with Class I restoration (resin-modified glass ionomer), (c) tooth model with Class I restoration (compomer), (d) tooth model with Class I restoration (giomer), (e) tooth model with Class I restoration (glass carbomer) and (f) tooth model with Class I restoration (ionic resin material with bioactive properties).
Figure 3

Distribution of Von Mises stress for models with oblique loading: (a) tooth model without restoration (control group), (b) tooth model with Class I restoration (resin-modified glass ionomer), (c) tooth model with Class I restoration (compomer), (d) tooth model with Class I restoration (giomer), (e) tooth model with Class I restoration (glass carbomer) and (f) tooth model with Class I restoration (ionic resin material with bioactive properties).

When the distribution of Von Mises stress values as a result of oblique loading is examined, more intense stress accumulation is observed in enamel than in dentin. In addition, it was observed that the maximum stress values were formed in the force application areas. The tested restorative materials exhibited similar stress distribution patterns, except Activa Kids Bioactive. The stress values of oblique loading for restorative materials were listed as Beautiful II > Fuji II LC > Dyract AP > GPC Glass Fill > Activa Kids Bioactive.

4 Discussion

Stresses occurring in the restorative material and in the oral environment are highly difficult to calculate under clinical conditions. FEA simulates the clinical conditions and provides us to evaluate the stresses in the restored teeth. This study aimed to evaluate the different restorative material’s stress distribution under occlusal forces. The different restorative materials tested in our study exhibited similar stress distribution patterns, except Activa Kids Bioactive. Therefore, the null hypothesis was partially rejected.

Researchers have also emphasized that the distribution of the maximum von Mises stresses change in FEA when the direction of the applied force and the application area are changed [26,27]. In order to simulate the masticatory force, Owais et al. used 176 N in early primary stage and 240 N in late primary stage as maximum occlusal bite force [17]. Abu-Alhaija et al. used 197 N force by evaluating many closely related studies in his study [16]. In accordance with the studies made in this study, vertical and oblique static force of 197 N was applied to the restored teeth to simulate mastication force.

In a study, where time-dependent forces were applied to the long axis of the tooth at 0°, 45° and 90°, the highest stress was observed in the vertical force [28]. In our study, the restored teeth were subjected to oblique and vertical forces and the highest von Mises stress analysis values recorded in the restorative materials were in the vertical forces. Also, the maximum von Mises stress values of restored teeth were found at the force application areas, especially occlusal contact areas. In accordance with our study, in a study examining the distribution of stress in Class II cavities in primary teeth maximum stress was obtained in occlusal contact regions [25].

Enamel is the structure whose elastic modulus is the highest within the tooth restoration system. Therefore, enamel did not yield to the applied force and resulted in increased stress for the tooth model without restoration. However, when a vertical load was applied to the tooth model with Class I restoration, the stress on the restorative material increased while the stress on enamel and dentin decreased. Stress from the occlusal force was concentrated in the structure that had direct contact with restorative material. From there, the stress was transferred to the surrounding structure such as enamel and dentine. The stress values of restorative materials were listed as Activa Kids Bioactive > GPC Glass Fill > Dyract AP > Fuji II LC > Beautiful II when a vertical load was applied to the tooth model with Class I restoration. When an oblique load was applied to the tooth model with Class I restoration, the stress on the restorative material decreased while the stress on the enamel and dentin increased. The stress values of restorative materials were listed as Beautiful II > Fuji II LC > Dyract AP > GPC Glass Fill > Activa Kids Bioactive when an oblique load was applied to the tooth model with Class I restoration. It can be said that the reason for this difference in stress distributions in restorative materials is caused by elastic modulus. Researchers have noticed that the different elastic modules of dentine and restorative materials cause great stresses to occur because of the failure of the mechanical continuity between the restoration and the tooth structure [29]. In addition, vertical or oblique load had a great impact on the stress distribution. The stress was transferred prominently to the enamel and dentine at the oblique load.

The elastic modulus plays an important role in the success of restorations performed on primary molars. As consistent with the results of our study, Sengul et al. reported low stress values in materials with elastic modulus close to enamel [25]. It has been reported in previous studies that as the elastic modulus of the restorative material increases, the stress within the material increases, and accordingly the stress transmitted to the dental tissues decreases [30,31]. This result is consistent with the findings of our study. It was found that the maximum von miss value for Activa Kids Bioactive was higher than other restorative materials according to the present study results. The group with the highest stress values transmitted to enamel and dentin tissue is the model with Activa Kids Bioactive. Considering our study, it can be said that the elastic modulus has an important role in the distribution of stress in the restorative materials used, and clinicians should consider this factor to increase the clinical success rate while selecting the restorative materials.

This study has some limitations. First, only five different restorative materials were tested, so results may vary when using different materials. Second, the mandibular primary second molar was used for testing, so results may vary when different teeth are used. Third, our study is an in vitro study and the results of in vitro studies for restorative materials may not properly reflect clinical studies.

Studies employing FEA in the literature are mostly on permanent teeth. In this study, the stress distributions resulting from the forces exerted in different directions on Class I cavity models performed with different restorative materials on primary teeth were evaluated by FEA. It is aimed to determine current, aesthetic and durable restorations and restorative materials in the dental treatments of pediatric patients. However, for more clear results of the clinical success of the restorative materials and restoration techniques used in primary teeth, studies with more in vivo follow-up and additional studies in which FEA results are compared through different in vitro analysis methods are required.

5 Conclusion

  • The tested restorative materials exhibited similar stress distribution patterns, except Activa Kids Bioactive (vertical and oblique loading 446.16 and 8.57, respectively).

  • The highest stress values transmitted to enamel tissues both vertical and oblique loading were in Activa Kids Bioactive applied models (vertical and oblique loading 241.70 and 372.32, respectively).

  • The highest stress values transmitted to dentin tissues both vertical and oblique loading were in Activa Kids Bioactive applied models (vertical and oblique loading 50.34 and 80.05, respectively).

  • Elastic modulus of restorative materials has an important role in the success of restorations. As the elastic modulus of the restorative materials increases, the stresses in the dental tissues decrease. Therefore, the restorative materials with a higher elastic modulus should be preferred in patients with malocclusion.

Acknowledgment

The author would like to thank Prof. Dr Cigdem Guler for consultancy on dental issues.

  1. Funding information: Author states no funding involved.

  2. Author contributions: M.S.G. has performed all the work (simulation, analyses, and writing) and accepts the responsibility for releasing this material.

  3. Conflict of interest: Author states no conflict of interest.

  4. Ethical approval: The conducted research is not related to either human or animal use.

  5. Data availability statement: Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

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Received: 2022-10-12
Revised: 2022-10-24
Accepted: 2022-10-30
Published Online: 2022-12-03

© 2022 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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