Fracture strength of human teeth with cavity

preparations
Jose Mondelli, C.D., M.S.D., Ph.D.,* Lincoln Steagall, C.D., M.S.D., Ph.D.,**
Aquira Ishikiriama, C. D., M.S.D., *** Maria Fidela de Lima Navarro, C.D., M.S.D.,***
and Francisco Bruno Soares, C.D. ****
Universidade de SLo Paulo, Faculdade de Odontologia de Bauru, Bauru, SP, Brasil

F ailure of dental restorations is a major concern.

The most common causes are faulty cavity prepara-
intercuspal dimension.‘.
effect of the buccolingual
‘-’ Vale”, “’ investigated
width of MOD cavity
the

tion and improper manipulation of restorative ma- preparations prepared in sound teeth. His stress
terials. Another cause of failure is the geometric form studies encouraged conservative cavity preparations.
of the cavity preparation, which may lead to fracture However, a well-controlled investigation of the
of the tooth. effects of stress upon the cusps of occlusal prepara-
The anatomic forms of posterior teeth with cusps tions of various widths should ascertain the validity
and fossae present a design possessing a tendency to of conservative occlusal preparations.
deflect the cusps under stress (Fig. 1, A).’ While This article reports the fracture strength of teeth
sound teeth rarely fracture from the stresses of prepared with three buccolingual widths of occlusal
mastication, fracture of a cusp may occur in teeth preparations.
which have been weakened by caries and the cavity
preparation required for restoration. MATERIALS AND METHODS
The typical intracoronal cavity preparation, espe- Freshly extracted sound premolars from patients
cially in the maxillary premolars, exaggerates the 20 to 25 years of age were cleaned and fixed in
height of the cusps (Fig. 1, B). The weakened or neutral formalin for 72 hours.” Only teeth which fell
unsupported cusps are subjected to stresses which within the range of dimensions established by
tend to deflect or fracture them at the buccopulpal Galan12 were accepted for testing. The teeth were
or linguopulpal line angles (Fig., 1, C). While a examined by stereoscopic microscopy. Those with
fracture may not occur, deflection of a weakened cracks or fractures were rejected.
cusp may open the tooth-restoration interface and The roots of the teeth were embedded in a
lead to subsequent marginal leakage (Fig. 1, C). It is self-curing polystyrene resin which did not develop
evident that the buccolingual width of the occlusal exothermic heat.“’ The exposed crown was main-
preparation may contribute toward weakening of tained in a vertical position by a metal brace. The
the cusps. teeth, with roots embedded in the polystyrene base,
Cavity forms have been based on Black’s princi- were stored in distilled water. The period of storage
ples.’ For Class I and II cavity preparations, Black did not exceed 1 week after extraction.
advocated an occlusal width of one-third the bucco- The cavities were prepared with a No. 169
lingual intercuspal distance. Present-day equipment smooth-tapered fissure bur under high speed and
and restorative materials permit more conservative finished with the same bur under conventional speed
geometric forms. Modern cavity preparation permits and with hand instruments.
narrow occlusal designs, one-fourth the buccolingual Class I occlusal preparations. The buccal and
lingual walls were parallel to each other. The mesial
and distal walls diverged slightly toward the occlu-
*Professor and Chairman, Department of Operative Dentistry.
sal. The mean cavity depth was 2.5 mm.
**Associate Professor, Department of Operative Dentistry.
***Assistant Professor, Department of Operative Dentistry.
The cavities were prepared to satisfy three critical
****Fellow of Fundask de Amparo g Pesquisa do Estado de SHo dimensions of the isthmus. These differed in the
Paula. buccolingual width as a fraction of t.he intercuspal

0022-3913/80/040419 + 04$00.40/0Q 1980 The C. V. Mosby Co. THE JOURNAL OF PROSTHETIC’ DENTISTRY 419
 MONDELLI ET AL

FRACTUREOF TOOTH

Fig. 1. Effect of cavity preparation and restoration on the strength of an upper premolar.
(Adapted from Bassett and associates.‘) A, The form of the cusps influences the direction of
stress. B, The cavity preparation exaggerates the height of the cusps. C, Marginal leakage may
be produced by deflection of the cusp.

distance. The narrow occlusal preparation measured Ten teeth were prepared for each of the three
one-fourth the intercuspal distance. The isthmus of occlusal widths of each type of cavity preparation.
the medial preparation wasone-third the intercuspal This provided 30 specimens for each class of cavity.
distance, and the isthmus of the wide preparation Ten control teeth were included, for a total of 100
was one-half the intercuspal distance (Fig. 2, A). specimens to be tested.
Class II two surface preparations. The occlusal The specimens were subjected to a compressive
portions were essentially the same as the Class I axial load in a universal testing machine* at a
preparations. The three dimensions established for crosshead speed of 0.5 mm/min.‘* A steel sphere 4
the Class I preparations also applied to the occlusal mm in diameter contacted the buccal and lingual
portions of the Class II preparations (Fig. 2, B). The cusps of the test teeth, simulating contact with the
occlusal depth averaged 2.5 mm. buccal cusp of a mandibular premolar (Fig. 3).
The buccal and lingual walls of the proximal
RESULTS AND DISCUSSION
portions were parallel to each other and perpendicu-
lar to the gingival wall. The axial wall tapered Table I shows the statistical analysis of experimen-
slightly from gingival to occlusal and formed a tal conditions. Table II presents the means and
rounded line angle with the pulpal wall. The proxi- standard deviations for the experimental condi-
mal depth varied from 1 mm at the gingival wall to 2 tions.
mm at the axiopulpal line angle. The buccolingual The control teeth presented the highest mean
dimension of the proximal portion averaged one- values. The values decreased progressively for the
third the buccolingual width of the tooth. experimental teeth as greater amounts of dentin and
Class II MOD preparations. The dimensions used enamel were removed. The highest strength for a
for the two surface Class II preparations were also tooth with a prepared cavity, the narrowest Class I
applied to the MOD preparations. The only differ- ljreparation, was less than that of the control teeth.
ence was the inclusion of another proximal surface This is in disagreement with the results of Vale:, ”
(Fig. 2, C). who reported that MOD preparations with an isth-
Controls. Caries free and otherwise sound teeth
were selected for the controls. *Losenhausenwerk, Diisseldorf, West Germany.

420 APRIL 1980 VOLUME 43 NUMBER 4

FRACTURE STRENGTH OF TEETH

Table I. Analysis of variance for conditions

in 10 different levels

Source of
variation df ss MS F

Condition 9 86,438.88 9,604.32 128.72*

Residue 90 6,715.U 74.61
Total 99 93J54.03

*Significant at p < .Ol.

mus of one-fourth the intercuspal distance required

only a slightly greater load than a sound tooth to
cause fracture. Our findings indicate that this is true
only for the Class I preparation.
The results indicated that, in all preparations, the
LI~ZXWJS the isthmus-the greater the load needed to
cause fracture. This is statistically true for the three
occlusal dimensions tested in the Class I prepara-
tions. However, for the Class II preparations, only
those with an isthmus measuring one-fourth the
intercuspal distance were statistically superior to
preparations with the other two dimensions. The
differences between the occlusal portions of Class II
preparations with one-third and one-half the inter-
cuspal distance were not statistically significant.
These results suggest that amalgam restorations
should be inserted in Class II preparation prepared
with an occlusal isthmus measuring one-fourth to
one-third the intercuspal distance. Cast restorations
with cuspal protection are indicated for preparations
in which the occlusal isthmus measures one-half or
more the intercuspal distance.
The width of the isthmus has a lesser impact on
Class I than on Class II preparations. This is proba-
bly due to the presence of the marginal ridges in the
Class I. Gable’” observed that teeth with Class I
restorations rarely fracture as a result of excessive
loads. In Class I restorations the stresses pass into the Fig. 2. A, Occlusal, B, Mesioclusal, and C, Mesiocluso-
remaining hard tissues. In Class II restorations the distal cavities prepared in upper premolars, with different
wedge effect, added to the load, remained within the buccolingual isthmus widths (one fourth, one third, and
one half of the intercuspal distance).
cavity, causing horizontal stresses which tend to
fracture the cavity walls.
The occlusal portions of Class II amalgam restora- CONCLUSIONS
tions require wider buccolingual widths than those The conclusions drawn from this study specifically
in gold restorations. From the standpoint of flow this apply to maxillary premolars.
is undesirable.“’ However, increased strength of the All occlusal cavity preparations decrease the
occlusal portion of the amalgam restoration may be strength of teeth in proportion to the width of the
obtained from increased depth, since the increase in preparation. The Class I occlusal preparation
strength equals the square of the depth. Therefore it reduces the strength of the tooth less than the
is advisable to prepare narrower and deeper occlusal occlusal portion of the Class II preparation with
portions for Class II amalgam restorations. equal width.

THE JOURNAL OF PROSTHETIC DENTISTRY 421

 MONDELLI ET AL

Fig 3. Occlusal load applied to a prepared tooth (A) and to a sound tooth (B). Note the
longitudinal fracture that separates the buccal and lingual cusps.

Table II. Means and standard deviations (in parentheses) for the 10 experimental conditions (values in
kgf, corresponding to 10 tests)

Condition

Class I Class II-MO Class II-MOD

Tukey
Control % ‘h ‘h ‘h ‘h ‘I5 1%

140.8 125.2 85.4 67.5 117.2 67.9 60.9 86.4 61.0 51.2 15.00
(14.94) (10.6) (6.6) (3.6) (13.4) (5.3) (2.2) (8.4) (5.2) (6.6)

The width of the isthmus was a statistically 9. Vale, W. A.: Cavity preparation. Irish Dent J 2:33, 1956.
10. Vale, W. A.: Cavity preparation and further thoughts on
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high speed. Br Dent J 107:333, 1959.
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provides greater strength regardless of the Class of Williams and Wilkins Co.
the cavity. 12. Galan, Jr., J.: ContribuiqPo ao estudo das principais dimeh-
sees dos dentes humanos permanentes de leucodermas brasi-
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422 APRIL 1960 VOLUME 43 NUMBER 4