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  • Title: Three-dimensional finite element stress analysis of surface-mounted inlays in repairing pulp-penetrating non-carious cervical lesion of maxillary first premolar.
    Author: Ma D, Qian J.
    Journal: Hua Xi Kou Qiang Yi Xue Za Zhi; 2023 Oct 01; 41(5):541-553. PubMed ID: 37805678.
    Abstract:
    OBJECTIVES: This study aimed to explore the stress distribution of surface-mounted inlays with two ceramic materials and different strategies for fiber post-restoration on pulp-penetrating non-carious cervical lesion in a maxillary first premolar to provide minimally invasive and reasonable restorative methods. METHODS: The cone beam computed tomography data of the standard right upper first premolar were selected. Healthy control (HC) and defective control (DC) finite element models were established. Then, eight experimental models were established according to two different ceramic materials (IPS e.max CAD [LD] and Lava Ultimate [LU]) and different locations of fiber post (without fiber post [NP], fiber post in buccal root canal [B], fiber post in palatal root canal [P], fiber post in both root canals [BP]), namely, LDNP, LDB, LDP, LDBP, LUNP, LUB, LUP, and LUBP. Axial load F1 and lateral load F2 were applied. Maximum principal stress and displacement of the buccal tip were investigated using finite element analysis software. Then, the percentage change of the following indicators in each experimental group was analyzed: stress of defective tip with group DC, stress of enamel and dentine, and displacement of buccal tips with group HC. It was considered similar when the percentage change was less than 5%. RESULTS: LD and LU groups could effectively reduce the stress of the defective tip, but the decreasing amplitude in the former was greater than that of the latter. For the stress of surface-mounted inlays and resin adhesive layer, LD groups were higher than LU groups, and no significant difference in stress peak was found among different experimental groups in the same material. In addition, fiber posts in double root canals could significantly reduce buccal tip displacement. CONCLUSIONS: For pulp-penetrating non-carious cervical lesions, the restorative strategy of surface-mounted inlays could be applied. Compared with Lava Ultimate, IPS e.max CAD could better protect the defective tip tooth. Furthermore, fiber posts in double root canals could decrease overall deformation and increase the retention of surface-mounted inlays. 目的: 探讨2种陶瓷材料贴面式嵌体及纤维桩修复上颌第一前磨牙穿髓型非龋性颈部缺损的应力分布规律，以期为临床选择微创、有效的修复方法提供思考。方法: 选择符合标准的右上第一前磨牙锥形束CT数据，建立健康对照（HC）组、缺损对照（DC）组，根据2种贴面式嵌体材料［IPS e.max CAD（LD）、Lava Ultimate（LU）］以及不同的纤维桩位置［无纤维桩（NP）、颊侧根管纤维桩（B）、腭侧根管纤维桩（P）、颊腭侧根管纤维桩（BP）］，建立8个实验模型（LDNP、LDB、LDP、LDBP、LUNP、LUB、LUP、LUBP）组，模拟轴向和侧向载荷，采用有限元软件分析各结构最大主应力峰值，采用颊尖位移量分析颊尖顶位移变化量。在各实验组中：缺损尖端牙体应力峰值与DC组进行变化量分析；颊尖位移量、釉质应力峰值、牙本质应力峰值与HC组进行变化量分析，变化量百分数相差小于5%认为是无差异的。结果: LD组与LU组均可有效减小缺损尖端牙体的应力峰值，且LD组降幅更为显著。关于贴面式嵌体及树脂粘接剂应力，LD组高于LU组，并且呈现同一材料不同实验组之间应力峰值相近。此外，双根管纤维桩组可显著减小颊尖位移量。结论: 贴面式瓷嵌体可在穿髓非龋性颈部缺损的修复中进行应用，且与Lava Ultimate相比，IPS e.max CAD可更好保护尖端牙体组织，此外推测联合颊腭双根管纤维桩修复时可减小整体变形量及修复体脱粘接事件的发生。. OBJECTIVE: This study aimed to explore the stress distribution of surface-mounted inlays with two ceramic materials and different strategies for fiber post-restoration on pulp-penetrating non-carious cervical lesion in a maxillary first premolar to provide minimally invasive and reasonable restorative methods. METHODS: The cone beam computed tomography data of the standard right upper first premolar were selected. Healthy control (HC) and defective control (DC) finite element models were established. Then, eight experimental models were established according to two different ceramic materials (IPS e.max CAD [LD] and Lava Ultimate [LU]) and different locations of fiber post (without fiber post [NP], fiber post in buccal root canal [B], fiber post in palatal root canal [P], fiber post in both root canals [BP]), namely, LDNP, LDB, LDP, LDBP, LUNP, LUB, LUP, and LUBP. Axial load F1 and lateral load F2 were applied. Maximum principal stress and displacement of the buccal tip were investigated using finite element analysis software. Then, the percentage change of the following indicators in each experimental group was analyzed: stress of defective tip with group DC, stress of enamel and dentine, and displacement of buccal tips with group HC. It was considered similar when the percentage change was less than 5%. RESULTS: LD and LU groups could effectively reduce the stress of the defective tip, but the decreasing amplitude in the former was greater than that of the latter. For the stress of surface-mounted inlays and resin adhesive layer, LD groups were higher than LU groups, and no significant difference in stress peak was found among different experimental groups in the same material. In addition, fiber posts in double root canals could significantly reduce buccal tip displacement. CONCLUSION: For pulp-penetrating non-carious cervical lesions, the restorative strategy of surface-mounted inlays could be applied. Compared with Lava Ultimate, IPS e.max CAD could better protect the defective tip tooth. Furthermore, fiber posts in double root canals could decrease overall deformation and increase the retention of surface-mounted inlays.
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