STATEMENT OF PROBLEM: Moving from the posterior segment in the anterior direction within the dental arch, the process of "incisivization" takes place. The occlusal table is gradually replaced by an incisal edge that has the function of cutting. PURPOSE: This study considers these genetically controlled changes by using strain gauge measurements and finite element analyses to rationalize the clinical and biologic advantages of incisal form. A direct clinical link in the common esthetic procedure of anterior veneering is expected. MATERIAL AND METHODS: Six maxillary incisors were mounted in a positioning device and equipped with 2 strain gauges bonded to the palatal surface: gauge 1 (G1) in the concavity and gauge 2 (G2) on the cingulum. A 50 N load was applied on the palatal side of the incisal edge, perpendicular to the long axis of the tooth. Displacement of the load tip and the palatal strain were recorded after successively removing one third, two thirds, and the total thickness of the facial enamel. The same experiment was reproduced with the finite element method (FEM). Four additional experimental designs were tested with the FEM by simulating the progressive thinning and elimination of palatal enamel and a thickened palatal lobe. Surface tangential stresses and local strain in the area corresponding to gauges 1 and 2 were calculated from the postprocessing files. RESULTS: The FEM was validated by experimental results considering both displacement of the load tip ( approximately 120 +/- 30 microm) and tangential surface strain at G1/G2. Recorded strains were always higher in the concavity when compared with the cingulum; high tensile strains were recorded at G1 after the total removal of the facial enamel. The entire facial surface was submitted to compressive forces. Subsequent compressive stresses were higher ( approximately 150 MPa) when facial enamel was thin or when the palatal enamel was removed. However, their absolute value never reached the elevated and potentially harmful tensile stresses measured in the palatal concavity, especially in the absence of facial enamel (272 MPa). Multiple experimental cracks were generated in the remaining palatal enamel as a consequence of stress redistribution. However, smooth and convex surfaces with local enamel bulk such as the cingulum, the marginal ridges, and the facial cervical third of the anatomic crown showed the lowest stress level. The optimal configuration with regard to the stress pattern was given by the modified natural tooth that exhibited thick palatal enamel and a mostly convex palatal surface. CONCLUSIONS: Palatal concavity that provides the incisor with its sharp incisal edge and cutting ability proved to be an area of stress concentration. This shortcoming can be compensated by specific areas that feature thick enamel such as the cingulum and the marginal ridges. When enamel is worn or removed from the facial surface, its replacement should be carried out by using materials with properties similar to enamel to restore the original biomechanical behavior of the tooth.
Bibliographical noteFunding Information:
This study was supported by the Swiss Science Foundation (Grant 81GE-50071) and in part by the Minnesota Dental Research Center for Biomaterials and Biomechanics.
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