Stress distribution of bulk-fill resin composite in class II restorations.

PURPOSE: To study the influence of the resin bonding layer thickness and the bulk filling material stiffness in adhesive class II mesio-occlusal-distal (MOD) restorations using numerical finite element analysis (FEA).

METHODS: Four 3D-FE models of teeth restored with different filling material stiffness and resin bonding layer thickness were built-up and analyzed. The 3D model of a sound lower molar was also analyzed and compared with restored ones. The tooth tissues (enamel, dentin), dental restoration and bolus on the occlusal surface, was divided into 3D solid CTETRA elements with four grid points. The adhesive bonding around the dental restoration was modeled with shell elements. Polymerization shrinkage was simulated with a thermal expansion approach. Mechanical behavior of restored models in terms of stress and displacement distributions, under the combination effects of polymerization shrinkage and occlusal load (600 N), was analyzed. All the materials were assumed to behave as elastic materials throughout the entire deformation.

RESULTS: Numerical results show that the mechanical response of the restored models was very different compared to the sound tooth ones, where the stress was uniformly distributed from enamel to dentin with no critical stress concentration. In the restored models, the highest stress values were detected in the enamel, near the enamel-dentin interface and in the bulk restorative material. Tooth preparations A and B showed lower gradient stresses than corresponding C and D. The value of the vertical displacement components in models A and B were higher than corresponding C and D. The maximum displacement values were mainly located around the groove and were higher by an order of magnitude than the sound models. The results showed better mechanical response with models A and B compared to C and D. It is also evident that resin bonding thickness slightly affected the stress level of the restored teeth.

CLINICAL SIGNIFICANCE: Class II MOD direct bulk resin composite restorations showed a high susceptibility to damage at the marginal and internal tissue interfaces depending on their own stiffness. The use of resin-based bulk filling materials is not recommended for large class II MOD adhesive restorations due to mechanical behavior failure risk.