Three-dimensional finite element analysis

of strength and adhesion of composite

resin versus ceramic inlays in molars
Beata Dejak, DDS, PhD,a and Andrzej Mlotkowski, MEng, PhDb
Medical University, Lodz, Poland; Technical University,
Lodz, Poland

Statement of problem. Previous studies on strength of teeth reconstructed with ceramic or composite resin inlays
have not resolved which restoration material provides the highest strength and marginal integrity.

Purpose. The purpose of this study was to compare strength of mandibular molars restored with composite resin
inlays to those restored with ceramic inlays, according to the Mohr-Coulomb failure criterion, and to analyze contact
stresses in cement-tooth adhesive interfaces of these inlays.

Material and methods. The investigation used a 3-dimensional (3-D) finite element analysis with the use of contact
elements. Seven 3-D models of first molars of the same shape and size were created: IT, intact tooth; UT, unrestored
tooth with an MOD cavity preparation; CRIT, tooth restored with composite resin inlays (True Vitality) with an elastic
modulus equal to 5.4 GPa; CRIH, tooth restored with composite resin inlays (Herculite XRV) (9.5 GPa); CRIC, tooth
restored with composite resin inlays (Charisma) (14.5 GPa); CRIZ, tooth restored with composite resin inlays (Z100)
(21 GPa); and CI, tooth restored with a ceramic (IPS Empress) inlay with an elastic modulus equal to 65 GPa. Each
model was subjected to a force of 200 N directed to the occlusal surface. The stresses occurring in the tested inlays,
composite resin cement layer, and tooth tissues were calculated. To evaluate the strength of materials, the Mohr-Cou-
lomb failure criterion was used. Contact stresses in the cement-tissue adhesive interface were calculated and com-
pared to tensile and shear bond strength of the luting cement to enamel and dentin.

Results. In the teeth restored with composite resin and ceramic inlays, the values of the Mohr-Coulomb failure cri-
terion were lower than in the unrestored tooth with a preparation (UT), but still 2.5 times higher than in the intact
tooth (IT). For the ceramic inlay (CI), the values of the Mohr-Coulomb failure criterion were nearly 3 times higher than
in the composite resin inlays. For the luting agent for the ceramic inlay model, these values were 2-4 times lower than
for the luting agents for the composite resin inlay models. At the adhesive interface between the cement and tooth
around the ceramic inlays, contact tensile and shear stresses were lower than around the composite resin inlays. In the
cervical enamel surrounding the proximal surface of the inlays, the stresses exceeded the tissue strength.

Conclusions. Adhesively bonded composite resin and ceramic inlays reinforce the structure of prepared teeth, but do
not restore their original strength. The proximal enamel surrounding inlays is prone to failure. The value of the Mohr-
Coulomb failure criterion for ceramic inlays was higher than for composite resin inlays. With an increase in the elastic
modulus of inlay materials, the values of the Mohr-Coulomb failure criterion decrease in the luting cement. Contact
tensile and shear stresses on the cement-tissue adhesive interface decrease as well. (J Prosthet Dent 2008;99:131-140)

Clinical Implications
Within the limitations of this in vitro study, ceramic inlays
demonstrated better marginal integrity than the composite
resin inlays. For this reason, composite resin inlays should be
fabricated using materials with high elastic moduli.

Assistant Professor, Department of Prosthetic Dentistry, Medical University.

a

Assistant Professor, Department of Strength of Materials and Structures, Technical University.

b

Dejak and Mlotkowski

132
Composite resin or ceramic in-
lays are used for restoration of exten-
sive MOD cavities in posterior teeth.
Composite resins are characterized by
mechanical properties similar to den-
tin.1,2 Their elastic modulus, ultimate
compressive strength, and hardness
depend on the volume of filler in the
restorative material.3 Composite resins
used for indirect and direct restora-
tions exhibit similar flexural strength,
flexural modulus, and hardness.4 In-
direct inlays are adhesively bonded to
teeth using resin cements which have
a higher bond strength to tissue com-
pared to other luting agents, such as
zinc phosphate and glass-ionomer ce-
ments.5,6 Strong, complete bonding of
the inlay to tissue potentially results
in an increase in tooth fracture resis-
tance.7 However, the primary reasons
for failure of composite resin indirect
inlays were fractures of a restoration
or a tooth.8,9 Other failures are related
to a loss of marginal adaptation. The
greatest amount of microleakage in
inlays is reported to be in the cervi-
cal margin at the tooth-cement inter-
face.10,11
Ceramic inlays are primarily com-
posed of leucite-reinforced ceramics.
This material is characterized by an
elastic modulus similar to enamel.12,13
The disadvantages of ceramic are its
hardness, which is greater than enam-
el, low fracture resistance, and low fa-
tigue strength.14-16 The primary causes
of failure of ceramic inlays are cohe-
sive bulk fractures and marginal de-
ficiencies.17,18 Clinically, these failures
are manifested by marginal discolor-
ation and secondary caries.19,20 Mi-
croleakage at margins in enamel has
been found to be significantly lower
than at dentin interfaces.21,22
According to some authors, ce-
ramic inlays maintain better anatomic
form of the surface and exhibit bet-
ter marginal integrity,23,24 as well as
stabilize the weakened cusps better
than composite resin inlays.25,26 Oth-
ers report improved marginal adap-
tation27 and higher strength of teeth
restored with composite resin inlays
compared to ceramic inlays.28-30 Still
The Journal of Prosthetic Dentistry
other reports have shown that the
fracture resistance of teeth with both
ceramic and composite resin inlays
is similar.31-34 Irrespective of the inlay
material, no differences in marginal
adaptation were reported.35 However,
neither composite resin nor ceramic
inlays restored the original strength
of tooth tissues.29,33,36 Previous stud-
ies on strength of teeth restored with
ceramic or composite resin inlays
could not resolve which restoration
material provides greater strength
and marginal integrity.37,38 The aim of
this study was to compare strength
of mandibular molars restored with
composite resin inlays to ceramic in-
lays, according to the Mohr-Coulomb
failure criterion, and to analyze con-
tact stresses in cement-tooth adhesive
interfaces of these inlays. The lowest
Mohr-Coulomb criterion values in the
tooth indicate a higher resistance of
its structure to failure. The inlay ma-
terial around which the lowest value
of Mohr-Coulomb failure criterion
arises in the cement and the smallest
tensile and shear stresses occur in the
adhesive interfaces should have better
marginal adaptation than the others.
MATERIAL AND METHODS
The study was performed using a
3-dimensional (3-D) finite element
analysis (FEA).39 The occlusal surface
of a mandibular right first molar was
scanned with a laser scanner (Cercon;
DeguDent GmbH, Hanau, Germany)
and processed with design software
(Cercon). Then, the molar roots were
embedded in an acrylic resin box, 1.5
x 1.5 mm (Vertex Self Curing; Vertex-
Dental BV, Zeist, The Netherlands),
to the bifurcation. The tooth with
the acrylic resin box was placed in
the universal machine vise and put
onto the flat-surface grinder (Krasnyj
Borec Machine Tools Factory; Orsa,
Belarus, Russia). Precise, 1-mm sec-
tions were cut from the tooth repeat-
edly, perpendicular to its long axis.
Each cross-section of the remaining
structure of the molar was scanned.
Full-scan sets, including coordinates
Volume 99 Issue 2
of the points located on the occlusal
surface and the points on the circum-
ference of the cross-sections of the
studied tooth, were introduced into
the FEA software (ANSYS version 10;
ANSYS Inc, Canonsburg, Pa). Points
on the occlusal surface were selected
in frontal planes, spaced at distances
of 0.1 mm. The points on each plane
were connected by splines. Similarly,
the points on the circumference of in-
dividual cross-sections in horizontal
planes were connected. On the basis
of these splines, an occlusal surface
and surface areas of the cross-sec-
tions of the tooth were created. Then,
enamel and dentin volumes in the
tooth crown model were created.
Roots were generated in a similar
way and then joined with the crown.
Periodontium with a thickness of 0.2
mm was modeled around the roots.
The tooth size and shape were com-
pared to the data from Wheeler.40
Thus, a computer model of an intact
mandibular molar was generated (IT)
(Fig. 1, A).
An additional inlay-shaped vol-
ume with a 3.5-mm-wide and 2.5-
mm-deep isthmus and with a 1.5-mm
by 4.5-mm proximal box was created
in the FEA software preprocessor.41,42
A cavity preparation was created by
deleting the overlapping tooth and
inlay volume. A tooth model with an
inlay-prepared cavity was obtained
(UT) (Fig. 1, B).
Inlays with a 0.1-mm cement layer
were overlapped on the models in a
similar way. Tooth models with com-
posite resin inlays of various elastic
moduli similar to True Vitality (CRIT),
Herculite XRV (CRIH), Charisma
(CRIC), and Z100 (CRIZ) were cre-
ated (Table I). A tooth model with
an IPS Empress leucite ceramic inlay
was developed as well (CI) (Fig. 1, C).
The inlays were bonded to the tooth
structure with the Variolink II com-
posite resin cement.
The values of elastic moduli and
Poisson’s ratios for enamel,12,43 den-
tin,2 periodontium,44 dental pulp,45
True Vitality,46 Herculite XRV,46 Cha-
risma,1 Z100,1 IPS Empress,13 and
Dejak and Mlotkowski
February 2008 133

A B C
1 Tooth models subjected to FEA. A, Mandibular first molar model with roots and periodontium (IT).
B, Mandibular first molar model with cavity preparation (UT). C, Mandibular first molar model with
composite resin or ceramic inlays (CRI).

Table I. Materials used to model restoration of molars with ceramic and composite resin inlays
Modulus of
Elasticity
Material Manufacturer (GPa) Poisson’s Ratio

Enamel - 72.7 0.33

Dentin - 18.6 0.31

Periodontium - 0.05 0.45

Dental pulp - 0.002 0.45

Composite resin, Den-Mat Corp, 5.4 0.24

True Vitality Santa Maria, Calif

Composite resin, Kerr Corp, 9.5 0.24

Herculite XRV Orange, Calif

Composite resin, Heraeus Kulzer, 14.1 0.24

Charisma Hanau, Germany

Composite resin, 3M ESPE, 21.0 0.24

Z100 St. Paul, Minn

Ceramic, Ivoclar Vivadent, 65.0 0.19

IPS Empress Schaan, Lichtenstein

Resin cement, Ivoclar Vivadent 8.3 0.35

Variolink II

Variolink II47 were introduced (Table
I). The following values of ultimate
tensile and compressive strength for
enamel (11.5 MPa, 384 MPa),48,49
dentin (105.5 MPa, 297 MPa),49,50
True Vitality (32 MPa, 189 MPa),46
Dejak and Mlotkowski
Herculite XRV ( 39 MPa, 246 MPa),46,51
Charisma (41 MPa, 293 MPa),46 Z100
(54.4 MPa, 448 MPa),1,51 ceramic (40
MPa, 97 MPa),49 and composite resin
cement (45.1 MPa, 178 MPa)52 were
entered. It was assumed that the ma-
terials used in the model were elas-
tic, homogeneous, and brittle, with
isotropic stiffness properties, but
differed in ultimate compressive and
tensile strength properties.
To perform calculations, each
134 Volume 99 Issue 2
tooth model was divided into 3-D,
20-node, structural solid elements
(Solid 186) (Fig. 2, A). The follow-
ing options are available for Solid
186 elements: cube shaped, prism
shaped, tetrahedral shaped, and
pyramid shaped. These elements
are well suited to modeling irregular
meshes. Automatic meshing in the
code matches the shape of elements
to the complex shape of the model.
In the intact tooth model, 24,298 el-
ements joined in 35,176 nodes were A
used, in the tooth model with a cavity
there were 34,785 elements joined in
51,816 nodes, whereas the models of
teeth with inlays had 67,680 elements
joined in 91,207 nodes.
The models were fixed in the
nodes on the external surface of the
periodontium around the mandibu-
lar molar roots. The model of the in-
tact tooth (IT) and the tooth models
with inlays were subjected to pres-
sure, equal to 2.82 MPa, exerted on
the occlusal surfaces (Fig. 2, B). The B
model of the unrestored tooth (UT) 2 A, Mandibular first molar model divided into finite elements. B, Man-
was subjected to pressure of 6.23 dibular first molar model subjected to force directed to occlusal surface.
MPa, exerted on the reduced occlusal
surface. These values for the pressure stress, σ3 is the minimum principal cement-tooth junction was modeled
were chosen to produce a 200-N ver- stress, σtf is the stress in the uniaxi- with bonded contact elements. The
tical reaction force (y direction) along al tension test, and σcf is the failure pairs of contact elements between the
the external surface of the periodon- stress in uniaxial compression.55 By cement and tissues make it possible to
tium. The forces corresponded to the definition, if the criterion [1] is higher demonstrate contact stresses around
force acting on the mandibular molar than 1, it indicates an element failure. the ceramic restoration models evalu-
during the closing phase of mastica- This criterion is simple to interpret. ated. Tensile and compressive contact
tion.53 This type of contact simulation The Mohr-Coulomb failure criterion stresses (perpendicular to the con-
by means of FEA requires a nonlin- was used for all the elements in the nected surfaces) and shear stresses
ear analysis with the load applied in materials of the mandibular molar (parallel to these surfaces) between
a number of steps. Automatic time models studied. The results were pre- cement and teeth at the adhesive in-
stepping was applied in the ANSYS sented graphically as maps of the val- terface were calculated. Areas where
program. ues of the Mohr-Coulomb failure cri- the stresses reached the highest values
Tooth tissues, ceramic, and com- terion distribution in inlay materials, were shown in graphic form. The high-
posite resin materials are character- cement, enamel, and dentin. These est values of tensile contact stresses
ized by different ultimate compressive values were compared to the models in each model were compared to the
and tensile strengths. One of the fail- under consideration. values of tensile bond strength (TBS)
ure criteria used to assess the possi- In problems involving contact be- of the Variolink II cement to enamel
bility of failure in biomaterials under tween 2 boundaries, 1 of the bound- (49.3 MPa) and dentin (1.1 MPa).6
complex stress states is the Mohr- aries is established as the “target” Shear contact stresses in the ce-
Coulomb criterion.54 According to the surface, and the other one as the ment-tooth junction were compared
criterion, the failure of brittle materi- “contact” surface. CONTA174 is used to shear bond strength (SBS) of the
als is predicted when to represent contact between 3-D resin cement to enamel (32.8 MPa)
“target” surfaces (TARGE170) and a and to dentin (15.1 MPa).56 When the
deformable surface, defined by this contact stresses at the cement-tooth
where σ1 is the maximum principal element. The adhesive interface at the interface exceed TBS or SBS of the ce-
The Journal of Prosthetic Dentistry Dejak and Mlotkowski
February 2008
ment to tissues, adhesive failure may
occur. In these areas, the restoration
will be debonded from the tooth and
microleakage may occur.
RESULTS
In the intact tooth model (IT), the
highest value of the Mohr-Coulomb
failure criterion, equaling 0.75, was
in the intercuspal central fissure in
enamel (Fig. 3, A) (Table II). In den-
tin, the maximum value of this crite-
rion did not exceed 0.03 (Fig. 3, B)
(Table II).
For the tooth model with a pre-
pared cavity (UT), in the remaining
cervical enamel at the proximal sur-
135
face, the value of the Mohr-Coulomb
failure criterion reached 2.62 (Fig. 4,
A). In dentin, the maximum value of
0.15 of this criterion occurred along
the buccopulpal line angle (Fig. 4, B)
(Table II). These values were 3.5 times
higher in enamel and approximately 5
times higher in dentin as compared to
the intact tooth.

A B
3 A, Distribution of values of Mohr-Coulomb failure criterion in enamel of mandibular first molar model (IT). B,
Distribution of values of Mohr-Coulomb failure criterion in dentin of mandibular first molar model (red color indi-
cates highest values of Mohr-Coulomb failure criterion).
Table II. Values of Mohr-Coulomb failure criteria in materials of models tested
Group Model of
Code Mandibular Molar Inlay Cement Enamel Dentin

IT Intact tooth - - 0.75 0.03

UT Tooth with - - 2.62 0.15

cavity preparation

CRIT Tooth with composite 0.15 0.17 1.89 0.08

resin inlay with elastic
modulus of 5.4 GPa

CRIH Tooth with composite 0.15 0.14 1.89 0.07

resin inlay with elastic
modulus of 9.5 GPa

CRIC Tooth with composite 0.17 0.11 1.89 0.06

resin inlay with elastic
modulus of 14.1 GPa

CRIZ Tooth with composite 0.14 0.09 1.91 0.06

resin inlay with elastic
modulus of 21 GPa

CI Tooth with ceramic 0.42 0.04 1.93 0.06

resin inlay with elastic
modulus of 65 GPa

Dejak and Mlotkowski

136 Volume 99 Issue 2

A B
4 A, Distribution of values of Mohr-Coulomb failure criterion in enamel of mandibular first molar model with cavity
preparation (UT). B, Distribution of values of Mohr-Coulomb failure criterion in dentin of mandibular first molar
model with cavity preparation (red color indicates highest values of Mohr-Coulomb failure criterion).

A B

C D
5 A, Distribution of values of Mohr-Coulomb failure criterion in composite resin inlay with low elastic modulus of
5.4 GPa in mandibular first molar model (CRIT) (red color indicates highest values of Mohr-Coulomb failure crite-
rion). B, Distribution of values of Mohr-Coulomb failure criterion in resin cement surrounding composite resin inlay
with low elastic modulus in mandibular first molar model. C, Distribution of contact tensile and compressive stresses
on adhesive interface between cement and tooth structure around composite resin inlay (MPa) (contact tensile
stresses are marked in blue color and values are negative; MN denotes maximum value of tensile stresses; contact
compressive stresses are marked in red and yellow color and values are positive; MX denotes maximum value of com-
pressive stresses). D, Distribution of contact shear stresses on adhesive interface between cement and tooth structure
around ceramic inlay (MPa) (MX denotes maximum value of stresses and is indicated by red color).

The Journal of Prosthetic Dentistry Dejak and Mlotkowski

February 2008 137
For molars restored with inlays mum values of the Mohr-Coulomb increase in the elastic modulus of the
(CRI and CI), the values of the Mohr- failure criterion did not exceed 0.08 composite resin inlay was followed by
Coulomb failure criterion were lower for any situation (Table II). a decrease in the values of the Mohr-
than in the tooth with a prepared cav- For all composite resin inlay Coulomb failure criterion in the ce-
ity, but they were over 2.5 times higher groups (CRIT, CRIH, CRIC, CRIZ), the ment around the restoration (Table II)
than those for the intact tooth. In the values of the Mohr-Coulomb failure (Fig. 5, B). Contact tensile and shear
narrow enamel that enveloped all in- criterion were similar (Table II). The stresses in the cement-tooth adhesive
lays, at the proximal surface of teeth, maximum values were located in the interface decreased as well (Table
this criterion reached values higher buccal margins of the inlays and in III). The highest tensile stresses, 2.46
than 1 (Table II). In dentin, the maxi- the intercuspal fissures (Fig. 5, A). An MPa, and shear stresses, 1.61 MPa,
Table III. Maximum contact tensile, compressive, and shear stresses in adhesive interface between resin
cement and tooth structure around ceramic and composite resin inlays in mandibular molar models (MPa)

Group Tensile Stress Compressive Stress Shear Stress

Code Model (MPa) (MPa) (MPa)

CRIT Composite resin 2.47 4.27 1.61

inlay with elastic
modulus of 5.4 GPa

CRIH Composite resin 1.56 5.10 1.42

inlay with elastic
modulus of 9.5 GPa

CRIC Composite resin 1.49 5.61 1.29

inlay with elastic
modulus of 14.1 GPa

CRIZ Composite resin 1.40 6.18 1.16

inlay with elastic
modulus of 21 GPa

CI Ceramic inlay 1.34 7.81 0.96

with elastic modulus
of 65 GPa

A B
6 A, Distribution of contact tensile and compressive stresses on adhesive interface between cement and tooth
structure around ceramic inlay (CI) (MPa) (contact tensile stresses are marked in blue color and values are nega-
tive; MN denotes maximum value of stresses; contact compressive stresses are marked in red and yellow color and
values are positive; MX denotes maximum value of compressive stresses). B, Distribution of contact shear stresses on
adhesive interface between cement and tooth structure around ceramic inlay (MPa) (MX denotes maximum value of
stresses and is indicated by red color).
Dejak and Mlotkowski
138
occurred around the composite resin
inlay with the lowest elastic modulus
(Table III). Maximum contact tensile
stresses arose near the buccal cavo-
surface margin (Fig. 5, C). Maximum
contact shear stresses occurred on the
lingual axial wall close to the lingual
cavosurface line (Fig. 5, D).
Among all the studied inlay mate-
rials, the highest value of the Mohr-
Coulomb failure criterion (0.42) oc-
curred in the ceramic (CI) (Table II).
Simultaneously, in the cement around
the ceramic inlay, the value was lower
than around the composite resin in-
lays (Table II). Also, the contact ten-
sile stresses of 1.34 MPa and the con-
tact shear stresses of 0.96 MPa in the
cement-tooth junction around these
inlays were the lowest values among
the models under investigation (Table
III). The maximum contact tensile
stress was observed along the inlay
axial walls, especially in the proximal
portion (Fig. 6, A). The highest con-
tact shear stress arose near the lingual
cavosurface (Fig. 6, B).
DISCUSSION
The lowest value of the Mohr-
Coulomb failure criterion was found
in the intact mandibular first molar
model structures. For the tooth pre-
pared for an MOD inlay, these values
were 3.5 times higher and reached
2.62 in the proximal cervical enamel.
According to the Mohr-Coulomb fail-
ure criterion, enamel is prone to fail-
ure in this location. The results of the
investigations confirm the clinical ob-
servations that the MOD cavity prep-
aration in a tooth significantly weak-
ens its structure.32 Fracture resistance
of such teeth is lowered by 59-76%,
compared to intact teeth.29,33,36
In the models of teeth with inlays,
the values of the Mohr-Coulomb fail-
ure criterion were 2.5 times higher
than in the intact tooth model, but
considerably lower than in the tooth
with a prepared cavity. The adhe-
sively bonded inlay not only restores
the missing tissues, but reinforces the
structure of the prepared tooth.32,33
The Journal of Prosthetic Dentistry
Unfortunately, the original fracture
resistance of the tooth was not fully
regained.29,36
For the ceramic inlay, the values of
the Mohr-Coulomb failure criterion
were nearly 3 times higher than for
the composite resin inlays. Primary
reasons for clinical, cohesive fracture
of ceramic inlays are defects in the
materials and cyclic fatiguing in the
oral cavity.18 In the present study it
was assumed that the inlay materi-
als were homogeneous, without any
defects. With such an assumption,
under the load applied, the stresses
in the composite resin and ceramic
inlays did not exceed the strength of
these materials.
As the elastic modulus of inlays
increased, the values of the Mohr-
Coulomb failure criterion increased
in enamel and decreased in dentin.
Around all the inlays, in the narrow
cervical enamel, at the proximal sur-
face of the teeth, the criterion value
was higher than 1. According to the
criterion, enamel is prone to failure in
this location, which can contribute to
the occurrence of microleakage in in-
lays.21,22 In vitro studies showed that
composite resin and ceramic inlays
lose their marginal adaptation pri-
marily on proximal surfaces after cy-
clic loading,10,11, 27 which is manifested
by the occurrence of a gap between
ceramic inlays and tissues.20
As the elastic modulus of inlay
materials increased, the values of
the Mohr-Coulomb failure criterion
decreased in the composite resin lut-
ing cement. Failure criteria were 2 to
4 times lower in cement around the
ceramic inlay than around the com-
posite resin inlays (Table II). With an
increase in the inlay elastic modulus,
contact tensile and shear stresses in
the cement-tissue adhesive interface
decreased as well (Table III). In this
study, contact tensile stresses did not
exceed TBS of the cement to enamel.
Around the ceramic inlays, tensile
stresses were nearly 2 times lower
than around the composite resin in-
lays with low elastic modulus. This
result confirms clinical observations
Volume 99 Issue 2
that ceramic inlays demonstrate bet-
ter marginal integrity compared to
composite resin inlays.23,24 This is also
in agreement with the FEA 2-D find-
ings of Magne et al,37 according to
which the porcelain inlays reduced
tension at the dentin-adhesive inter-
face and featured better potential
protection against debonding at the
dentin restoration interface, com-
pared to the composite resin inlay.
The result of the study does not con-
firm the work of Ausiello et al,38 which
demonstrated that ceramic MOD in-
lays created higher stress levels at the
internal surfaces of the cavity. Ausi-
ello et al maintained that application
of low modulus restorative materials
limits the stress intensity transmitted
to the remaining tooth structures.
The composite resin inlays redistrib-
uted stresses and presented elastic
biomechanics similar to those of the
sound tooth.
It is impossible to include all of the
factors encountered in the oral envi-
ronment in a computer simulation.
In this study, simplified 3-D models
of the mandibular first molars with
composite resin and ceramics inlays
were subjected to the single loading
condition that can be generated in
the final clenching phase of the masti-
cation cycle. In vivo, teeth are loaded
with complex and variable forces. The
differences in tensile and compres-
sive strengths of dental materials and
tissues, but not anisotropic material
properties, were accounted for in the
models. Results of this study should
assist clinicians in selecting materials
for inlays.
CONCLUSIONS
Within the limitations of this
study, the following conclusions were
drawn:
1. Adhesively bonded inlays rein-
force the structure of prepared teeth
but do not restore their original failure
resistance. According to the Mohr-
Coulomb failure criterion, the cervical
enamel around inlays at the proximal
surface of molars is prone to failure.
Dejak and Mlotkowski
February 2008
2. The value of the Mohr-Cou-
lomb failure criterion in ceramic in-
lays was nearly 3 times higher than for
the composite resin inlays. Stresses in
the inlays did not exceed the strength
of these materials.
3. An increase in the elastic modu-
lus of inlay materials is associated with
a decrease in the values of the Mohr-
Coulomb failure criterion for the resin
luting agent modeled. The values of
the Mohr-Coulomb failure criterion
were 2 to 4 times lower around the
ceramic inlay than around the com-
posite resin inlays.
4. An increase in the elastic modu-
lus of inlay materials is followed by a
decrease in contact tensile and shear
stresses in the cement-tissue adhesive
interface. Ceramic inlays provide po-
tentially better marginal adaptation
than composite resin inlays. For that
reason, composite resin inlays should
be made of materials with elastic
moduli higher than dentin.
REFERENCES
1. Willems G, Lambrechts P, Braem M, Celis
JP, Vanherle G. A classification of dental
composites according to their morphologi-
cal and mechanical characteristics. Dent
Mater 1992; 8:310-9.
2. Craig RG, Peyton FA. Elastic and mechani-
cal properties of human dentin. J Dent Res
1958; 37:710-8.
3. Kim KH, Ong JL, Okuno O. The effect
of filler loading and morphology on the
mechanical properties of contemporary
composites. J Prosthet Dent 2002;87:642-
9.
4. Cesar PF, Miranda WG Jr, Braga RR. Influ-
ence of shade and storage time on the
flexural strength, flexural modulus, and
hardness of composites used for indirect
restorations. J Prosthet Dent 2001;86:289-
96.
5. Michelini FS, Belser UC, Scherrer SS, De
Rijk WG. Tensile bond strength of gold
and porcelain inlays to extracted teeth
using three cements. Int J Prosthodont
1995;8:324-31.
6. Hikita K, Van Meerbeek B, De Munck J,
Ikeda T, Van Landuyt K, Maida T, et al.
Bonding effectiveness of adhesive luting
agents to enamel and dentin. Dent Mater
2007;23:71-80.
7. Yamada Y, Tsubota Y, Fukushima S. Effect
of restoration method on fracture resis-
tance of endodontically treated maxillary
premolars. Int J Prosthodont 2004;17:94-8.
8. Pallesen U, Qvist V. Composite resin fillings
and inlays. An 11-year evaluation. Clin Oral
Investig 2003;7:71-9.
9. Kukrer D, Gemalmaz D, Kuybulu EO,
Dejak and Mlotkowski
Bozkurt FO. A prospective clinical study of
ceromer inlays: results up to 53 months. Int
J Prosthodont 2004;17:17-23.
10.Peixoto RT, Poletto LT, Lanza MD, Buono
VT. The influence of occlusal finish line con-
figuration on microleakage of indirect com-
posite inlays. J Adhes Dent 2002;4:145-50.
11.Gerdolle DA, Mortier E, Loos-Ayav C, Jac-
quot B, Panighi MM. In vitro evaluation of
microleakage of indirect composite inlays
cemented with four luting agents. J Prosthet
Dent 2005;93:563-70.
12.Habelitz S, Marshall SJ, Marshall GW Jr,
Balooch M. Mechanical properties of hu-
man dental enamel on the nanometre scale.
Arch Oral Biol 2001;46:173-83.
13.Albakry M, Guazzato M, Swain MV. Biaxial
flexural strength, elastic moduli, and x-ray
diffraction characterization of three press-
able all-ceramic materials. J Prosthet Dent
2003;89:374-80.
14.Gorman CM, McDevitt WE, Hill RG. Com-
parison of two heat-pressed all-ceramic
dental materials. Dent Mater 2000;16:389-
95.
15.Nakamura T, Ohyama T, Imanishi A,
Nakamura T, Ishigaki S. Fracture resistance
of pressable glass-ceramic fixed partial den-
tures. J Oral Rehabil 2002;29:951-5.
16.Ohyama T, Yoshinari M, Oda Y. Effects of
cyclic loading on the strength of all-ceramic
materials. Int J Prosthodont 1999;12:28-
37.
17.Studer S, Lehner C, Brodbeck U, Scharer
P. Short-term results of IPS-Empress inlays
and onlays. J Prosthodont 1996;5:277-87.
18.Kramer N, Frankenberger R. Clinical perfor-
mance of bonded leucite-reinforced glass
ceramic inlays and onlays after eight years.
Dent Mater 2005;21:262-71.
19.Fradeani M, Aquilano A, Bassein L. Lon-
gitudinal study of pressed glass-ceramic
inlays for four and a half years. J Prosthet
Dent 1997;78:346-53.
20.Isidor F, Brondum K. A clinical evalua-
tion of porcelain inlays. J Prosthet Dent
1995;74:140-4.
21.Mota CS, Demarco FF, Camacho GB, Pow-
ers JM. Microleakage in ceramic inlays luted
with different resin cements. J Adhes Dent
2003;5:63-70.
22.Manhart J, Schmidt M, Chen HY, Kun-
zelmann KH, Hickel R. Marginal quality
of tooth-colored restorations in class II
cavities after artificial aging. Oper Dent
2001;26:357-66.
23.Manhart J, Chen HY, Neuerer P, Scheiben-
bogen-Fuchsbrunner A, Hickel R. Three-
year clinical evaluation of composite and
ceramic inlays. Am J Dent 2001;14,95-9.
24.Thordrup M, Isidor F, Horsted-Bindslev P.
Comparison of marginal fit and microleak-
age of ceramic and composite inlays: an in
vitro study. J Dent 1994;22:147-53.
25.Mehl A, Kunzelmann KH, Folwaczny M,
Hickel R. Stabilization effects of CAD/CAM
ceramic restorations in extended MOD
cavities. J Adhes Dent 2004;6:239-45.
26.Bremer BD, Geurtsen W. Molar fracture
resistance after adhesive restoration with
ceramic inlays or resin-based composites.
Am J Dent 2001;14,216-20.
27.Soares CJ, Martins LR, Fernandes Neto AJ,
Giannini M. Marginal adaptation of indi-
139
rect composites and ceramic inlay systems.
Oper Dent 2003;28:689-94.
28.Soares CJ, Martins LR, Pfeifer JM, Giannini
M. Fracture resistance of teeth restored
with indirect-composite and ceramic inlay
systems. Quintessence Int 2004;35:281-6.
29.St-Georges AJ, Sturdevant JR, Swift EJ Jr,
Thompson JY. Fracture resistance of pre-
pared teeth restored with bonded inlay res-
torations. J Prosthet Dent 2003;89:551-7.
30.Brunton PA, Cattell P, Burke FJ, Wilson
NH. Fracture resistance of teeth restored
with onlays of three contemporary tooth-
colored resin-bonded restorative materials.
J Prosthet Dent 1999;82:167-71.
31.da Silva SB, Hilgert LA, Busato AL. Fracture
resistance of resin-based composite and
ceramic inlays luted to sound human teeth.
Am J Dent 2004;17:404-6.
32.Cotert HS, Sen BH, Balkan M. In vitro
comparison of cuspal fracture resistances
of posterior teeth restored with various
adhesive restorations. Int J Prosthodont
2001;14:374-8.
33.Dalpino PH, Francischone CE, Ishikiriama
A, Franco EB. Fracture resistance of teeth
directly and indirectly restored with com-
posite resin and indirectly restored with
ceramic materials. Am J Dent 2002;15:389-
94.
34.Shor A, Nicholls J, Phillips KM, Libman WJ.
Fatigue load of teeth restored with bonded
direct composite and indirect ceramic
inlays in MOD class II cavity preparations.
Int J Prosthodont 2003;16:64-9.
35.Dietschi D, Moor L. Evaluation of the
marginal and internal adaptation of differ-
ent ceramic and composite inlay systems
after an in vitro fatigue test. J Adhes Dent
1999;1:41-56.
36.Santos MJ, Bezerra RB. Fracture resistance
of maxillary premolars restored with direct
and indirect adhesive techniques. J Can
Dent Assoc 2005;71:585-585d.
37.Magne P, Belser UC. Porcelain versus com-
posite inlays/onlays: effects of mechanical
loads on stress distribution, adhesion, and
crown flexure. Int J Periodontics Restorative
Dent 2003;23:543-55.
38.Ausiello P, Rengo S, Davidson CL, Watts
DC. Stress distributions in adhesively ce-
mented ceramic and resin-composite Class
II inlay restorations: a 3D-FEA study. Dent
Mater 2004;20:862-72.
39.Zienkiewicz OC, Taylor RL. Finite ele-
ment method: volume 1, the basis. 5th ed.
Oxford: Butterworth-Heinemann; 2000. p.
87-110.
40.Ash MM, Nelson N. Wheeler’s dental
anatomy, physiology, and occlusion. 8th
ed. Philadelphia: Saunders; 2002. p. 297-
306.
41.Banks RG. Conservative posterior ceramic
restorations: a literature review. J Prosthet
Dent 1990;63:619-26.
42.Broderson SP. Complete-crown and par-
tial-coverage tooth preparation designs for
bonded cast ceramic restorations. Quintes-
sence Int 1994;25:535-9.
43.Farah JW, Craig RG, Meroueh KA. Finite
element analysis of three- and four-unit
bridges. J Oral Rehabil 1989;16:603-11.
44.Rees JS, Jacobsen PH. Elastic modulus of
the periodontal ligament. Biomaterials
140
1997;18:995-9.
45.Farah JW, Craig RG. Finite element stress
analysis of a restored axisymmetric first
molar. J Dent Res 1974;53:859-66.
46.Eldiwany M, Powers JM, George LA.
Mechanical properties of direct and post-
cured composites. Am J Dent 1993;6:222-
4.
47.Magne P, Perakis N, Belser UC, Krejci I.
Stress distribution of inlay-anchored adhe-
sive fixed partial dentures: a finite element
analysis of influence of restorative materials
and abutment preparation design. J Pros-
thet Dent 2002;87:516-27.
48.Giannini M, Soares CJ, de Carvalho RM.
Ultimate tensile strength of tooth struc-
tures. Dent Mater 2004;20:322-9.
49.Craig RG, Powers JM, Wataha JC. Dental
materials: properties and manipulation.
8th ed. St. Louis: Mosby; 2003. p. 78, 84.
50.Sano H, Ciucchi B, Matthews WG, Pashley
DH. Tensile properties of mineralized and
demineralized human and bovine dentin. J
Dent Res 1994;73:1205-11.
51.Lee SY, Greener EH. Effect of excitation
energy on dentine bond strength and com-
posite properties. J Dent 1994;22:175-81.
52.White SN, Yu Z. Compressive and diametral
tensile strengths of current adhesive luting
agents. J Prosthet Dent 1993;69:568-72.
53.Gibbs CH, Mahan PE, Lundeen HC,
Brehnan K, Walsh EK, Holbrook WB. Oc-
clusal forces during chewing and swallow-
ing as measured by sound transmission. J
Prosthet Dent 1981;46:443-9.
54.Yu M. Advances in strength theories for
materials under complex stress state in the
20th century. Appl Mech Rev 2002;55:169-
218.
55.Bhatti MA. Fundamental finite element
Volume 99 Issue 2
analysis and applications: with Mathemat-
ica and Matlab computations. New Jersey:
John Wiley & Sons; 2005. p. 472-5.
56.Abo-Hamar SE, Hiller KA, Jung H, Federlin
M, Friedl KH, Schmalz G. Bond strength of
a new universal self-adhesive resin luting
cement to dentin and enamel. Clin Oral
Investig 2005;9:161-7.
Corresponding author:
Dr Beata Dejak
Department of Prosthetic Dentistry
Medical University of Lodz
92-213 Lodz
251 Pomorska St.
Lodz
POLAND
Fax: 00 48 42 675-74-50
E-mail: bdejak@poczta.onet.pl
Copyright © 2008 by the Editorial Council for
The Journal of Prosthetic Dentistry.

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The Journal of Prosthetic Dentistry Dejak and Mlotkowski