Stress distributions in adhesively cemented ceramic and resin-composite Class II inlay restorations: a 3D-FEA study

Objectives: The purpose of this study was to investigate the effect of differences in the resin-cement elastic modulus on stress-transmission to ceramic or resin-based composite inlay-restored Class II MOD cavities during vertical occlusal loading. Methods: Three finite-element (FE) models of Class II MOD cavity restorations in an upper premolar were produced. Model A represented a glass–ceramic inlay in combination with an adhesive and a high Youngʹs modulus resin-cement. Model B represented the same glass–ceramic inlay in combination with the same adhesive and a low Youngʹs modulus resin-cement. Model C represented a heat-cured resin-composite inlay in combination with the same adhesive and the same low Youngʹs modulus resin cement. Occlusal vertical loading of 400 N was simulated on the FE models of the restored teeth. Ansys™ FE software was used to compute the local von Mises stresses for each of the models and to compare the observed maximum intensities and distributions. Experimental validation of the FE models was conducted. Results: Complex biomechanical behavior of the restored teeth became apparent, arising from the effects of the axial and lateral components of the constant occlusal vertical loading. In the ceramic-inlay models, the greatest von Mises stress was observed on the lateral walls, vestibular and lingual, of the cavity. Indirect resin-composite inlays performed better in terms of stress dissipation. Glass–ceramic inlays transferred stresses to the dental walls and, depending on its rigidity, to the resin-cement and the adhesive layers. For high cement layer modulus values, the ceramic restorations were not able to redistribute the stresses properly into the cavity. However, stress-redistribution did occur with the resin-composite inlays. Significance: Application of low modulus luting and restorative materials do partially absorb deformations under loading and limit the stress intensity, transmitted to the remaining tooth structures.