Journal of Oral Rehabilitation
Journal of Oral Rehabilitation 2014 41; 108--114
Effect of root morphology on biomechanical behaviour of
premolars associated with abfraction lesions and different
loading types
P . V . S O A R E S , L . V . S O U Z A , C . V E R
IS S I M O , L . F . Z E O L A , A . G . P E R E I R A , P . C .
F . S A N T O S - F I L H O & A . J . F E R N A N D E S - N E T O NCCL Research Group, Department of Operative Dentis-
try, Prosthodontics and Dental Materials, School of Dentistry, Federal University of Uberl^
SUMMARY The aim of this study was to investigate
the biomechanical behaviour of maxillary premolar
teeth regarding root morphology and abfraction
depth, submitted to axial and oblique occlusal load.
The investigation was conducted using 3D finite
element analysis and strain gauge test. Sound
maxillary premolar single and double root were
selected for 3D model generation. The teeth were
scanned for external morphology data acquisition.
The 3D geometry was stored in *.STL and exported
to Bio-CAD software (Rhinoceros-3D) to model
generation. Mesh generation, mechanical properties
and boundary conditions were performed in finite
element software (Femap, Noran Engineering,
USA). Twelve models were generated: sound tooth,
1
25 and 2
5 mm abfraction teeth. 100N compressive
static load was applied: axially and 45° angle to the
long axis on the palatine surface of the buccal cusp.
Two strain gauges were bonded on the teeth
mounted in a mechanical testing machine. Von
Introduction
Non-carious cervical lesions (NCCLs) are pathological
processes characterised by the hard tissue dental loss
at the cement–enamel junction (CEJ) independent of
bacterial process (1, 2). This tooth structure loss is
routinely found and increasingly common in dentistry
clinical practice (1–4). It is generally accepted that the
initiation and progression of NCCLs have multifacto-
rial aetiology involving stress (abfraction), biocorro-
sion (chemical, biochemical and electrochemical
degradation) and friction (wear) (5).
© 2013 John Wiley & Sons Ltd
andia, Uberl^
andia, Brazil
Mises criterion showed that the double-root teeth
associated with 2
5 mm abfraction and oblique
loading presented higher stress values. Axial
loading associated with single-root teeth
propitiated the lowest stress rates. Double root
sound 1
25 and 2
5 mm abfraction teeth associated
with oblique loading showed the highest strain
values (lS): 692
6, 1043
31 and 1236
14, respectively.
Single root sound 1
25 and 2
5 mm abfraction teeth
associated with oblique loading showed 467
10,
401
51 and 420
98 strain values, respectively. Axial
loading showed lower strain rates, ranging from
136
12 to 366
91. The association of deep lesions,
oblique loading and double-root tooth promoted
higher stress and strain concentration.
KEYWORDS: abfraction, finite element analysis,
occlusion, premolar, strain, stress
Accepted for publication 24 October 2013
The aetiological agents together are able to weaken
and promote tooth surface wear. NCCLs are pre-
sented in many configurations, and all of them rep-
resent, in higher or lower degree, tooth
biomechanical down grade (6). NCCLs also increase
with age, which suggests a fatigue component in
their formation associated with occlusal interferences
or any event that changes the dental occlusion, such
as tooth occlusal surface wear, restorative proce-
dures, altered tooth position and tooth brushing
behaviour, with prevalence reported in the range
5–85% (7).
doi: 10.1111/joor.12113
 MECHANICAL BEHAVIOUR OF PREMOLAR TEETH
Abfraction lesions are associated with the cusp flex-
ure, and its prevalence is mostly at premolars buccal
surface (8). Although morphological studies observed
incidence of premolars with double root in index
ranging from 29
66% to 61
32% (9), in the available
literature, there are few detailed investigations of
stress distribution on this group of teeth that is widely
affected by NCCLs. Some authors suggest a relation-
ship between occlusal factors and cervical wear (10),
gingival resection and tooth mobility absence seems
to contribute to NCCL development (8) and even as
the combination of cyclic fatigue stress and biocorro-
sion mechanisms to the formation of NCCLs (11).
Despite the great amount of studies searching the
formation and progression of NCCLs many doubts still
must be solved. The direct relationship between
abfraction size and root morphology for all teeth
groups remains unknown. The proper management of
NCCLs is dependent to the knowledge regarding its
aetiology (11), the anatomical shape and location in
the dental arch of each tooth. The biomechanical
behaviour of the teeth affected by NCCLs varies
according to the loading direction (6), and many
movements performed during chewing and even
parafunctions have not been demonstrated yet.
The stress and strain magnitude the teeth undergo
during physiological and parafunctional movements
performed by the stomatognathic system plays a great
important role on the biomechanical behaviour of the
teeth structures. The association between computer
methodologies such as finite element analysis (FEA)
(12–14) and non-destructive experimental tests like
strain gauge test (15) provides sufficient data for bio-
mechanical analysis and stress–strain behaviour
understanding (16).
The aim of this study was to evaluate the effect of
root morphology type on stress distribution and strain
pattern of maxillary premolars, by varying the deep of
abfraction lesions and the loading direction. The
hypothesis is that double-root premolars with cervical
furcation and deeper abfraction, submitted to oblique
loading, concentrate higher stress and strains in the
tooth structure.
Materials and methods
A sound maxillary premolar extracted due to ortho-
dontic directions under ethics committee on research
by the Federal University of Uberl^ andia approval
© 2013 John Wiley & Sons Ltd
109
(CEP/UFU: #065/11) was selected to base the 3D
models of finite element analysis. The tooth was
placed in a contact scanner* , for external morphology
acquisition, and the data were stored in *.STL files.
Then chemical degradation of the enamel was per-
formed. The premolar root was protected with utility
wax, and enamel was dipped in hydrochloric acid
solution 10% for 10 min. The enamel remove was
confirmed by analysis in stereomicroscope 40X† .
Scanning was performed once more, now aiming to
obtain the external geometry of the coronal dentin
(17). For the pulp generation, the tooth was sectioned
longitudinally using a precision saw‡ and scanned
again. All the *.STL files were exported to CAD soft-
ware (computer assisted design – Rhinoceros 3D 4.0§
). Based on this file, NURBS surfaces (non-uniform
rational Bazier spline) and solids were created.
Two 3D finite element models of extracted human
maxillary premolar single and double root were gen-
erated. These 3D models’ geometry of the tooth was
used for different cervical lesions configurations gen-
eration. The periodontal ligament was performed to
simulate physiological conditions for the laboratory
study. Twelve models were generated according to
the factors under study described in Table 1.
The solid models were exported to a pre-processing
CAE software (computer assisted engineering¶ ), and
the mesh of each structure was performed using 10-
nodes quadratic tetrahedral solid type. Structural
types, linear and elastic, were used for the analysis.
All structures were considered isotropic, linear and
homogeneous, except enamel and dentin considered
orthotropic ones. The mechanical properties necessary
for characterisation of the structures were obtained
through literature review (Tables 2 and 3).
Boundary conditions were defined in the same soft-
ware and are explained in Fig. 1g,h. The occlusal con-
tact was simulated for strain gauge test using a
6
0 mm in diameter sphere under 100N-load applica-
tion. Subsequently, the models were exported to the
FE processing software,** and the solution was run.
The von Mises criteria was used on stress distribution
*MDX-40; Roland Co, Osaka, Japan.
†
Leica, Hanau, Germany.
‡
Isomet 1000; Buehler, Lake Bluff, IL, USA.
§
McNeel North America, Seattle, WA, USA.
¶
FEMAP, Noran Engineering, USA.
**NEi Nastran 9.2; Noran Engineering, Westminster, CA, USA.
110 P . V . S O A R E S et al.

Table 1. Finite element analysis and laboratory tests’ groups set below the cement enamel junction-CEJ) and other
according to the root morphology, lesion depth and type of load one perpendicular to the tooth long axis on mesial
surface of the buccal crown.
Morphology Lesion depth Load Groups
In addition, two strain gauges were fixed to another
Single Root Sound Axial SSA specimen not subjected to load application, to com-
Oblique SSO pensate temperature dimensional alterations. The
1,5 Axial SL1A
loading location direction was the same for FEA mod-
Oblique SL1O
els. The specimens were submitted to axial and obli-
2,5 Axial SL2A
Oblique SL2O que compressive 0
5 mm min 1 a speed loading,
Double Root Sound Axial DSA applied with a 6-mm sphere and a knife-shape tip,
Oblique DSO respectively, until 100 N maximum limit. Mechanical
1,5 Axial DS1A testing machine§§ was used. The data obtained were
Oblique DS1O
transferred to a computer using specific acquisition,
2,5 Axial DS2A
Oblique DS2O signal transformation and data analysis software (Aq-
Dados 7.02 and AqAnalisys; Lynx). The strain mea-
S, single-rooted; D, double root; S, sound; L1, lesion 1.25 mm;
surements were obtained by values from mesial and
L2, lesion 2.5 mm; A, axial; O, oblique.
root vestibular strain gauges and submitted to statisti-
cal analysis.
Table 2. Pulp and support structures isotropic mechanical prop- The strain values showed normal and homogeneous
erties
distribution and were analysed using 3-way analysis
of variance (ANOVA) and Tukey’s honestly significant
Isotropic Elastic Poisson’s
structure modulus (GPa) ratio References difference statistical tests (P < 0
05).

Pulp 0
003 0
45 (23)

Polyether 50 0
45 (16)
Polystyrene 13
5 0
31 (16)
resin
analysis¶. For the strain gauge test, fourteen intact
human maxillary premolar (n = 7), seven single and
seven double root with cervical third furcation, free of
cracks and defects were selected. The teeth were
extracted due periodontal problems or orthodontic
directions under ethics committee on research by the
Federal University of Uberl^ andia (#065/11) approval
and were divided into two groups (Table 1).
The teeth were prepared with sequential decrease
according to lesion depth using 3118 diamond drill.††
All the variables were tested on the same sample
(sound, L1, L2 related to oblique and axial loads).The
periodontal ligament and bone were simulated with
impression material based on polyether and polysty-
rene resin, respectively (16). Two strain gauges‡‡ were
fixed on all samples. The first one positioned parallel
to the tooth long axis on vestibular root (3
0 mm
Results
Von Mises results are shown in Figs 2 and 3. Loading
direction made significant difference on the stresses
distribution pattern.
High stresses were found inside the enamel at the
force application area, cervical enamel and dentine
inside the lesion area during axial loading (Figs 2 and
3). The higher stress concentration was observed on
palatine surface along the tooth in oblique loading.
Furcation region, vestibular surface of the buccal cusp
and the bucco-cervical enamel also showed more
stress concentration on oblique loading than axial
loading (Figs 2 and 3). Oblique loading increased the
stress concentration in mesial surface, lesion central
line and root furcation, Table 4.
The highest von Mises stresses values are shown in
Fig. 3 DL2. The greatest stress concentration was
found under oblique loading inside the abfraction
lesion centre, vestibular and palatine root, in the CEJ
and furcation region mainly, vestibular surface of the
buccal cusp and the bucco-cervical enamel.

†† §§
KG Sorensen, S~
ao Paulo, SP, Brazil. EMIC DL 2000; EMIC Test Equipment and Systems Ltda, S~
ao Jos

e
‡‡
PA-06-040AB-120LEN; Excel Sensors, S~ao Paulo, Brazil. dos Pinhais, Brazil.

© 2013 John Wiley & Sons Ltd

 MECHANICAL BEHAVIOUR OF PREMOLAR TEETH 111

Table 3. Dentin and enamel orthotropic mechanical properties

Elasticity modulus (e) (GPa) Shear coefficient (g) (GPa) Poisson ratio

Orthotropic structure (16) Longitudinal Transverse Longitudinal Transverse Longitudinal Transverse

Enamel 73
72 63
27 20
89 24
07 0
23 0
45

Dentine 17
07 5
61 1
7 6
0 0
3 0
33

The measurements showed different strains for
mesial and radicular surfaces. The mesial surface
showed no statistical significant difference between
the variables. For radicular surface, strain patterns
were highly consistent among all the teeth tested.
Highly significant effects of root (P < 0
000), loading
direction (P < 0
000) and lesion (P < 0
004) were
found on root strain gauge, Table 4.
Discussion
The hypothesis that double-root premolar with cervi-
cal furcation presenting deep abfraction and submitted
to oblique loading concentrated the highest stress and
strains in the tooth structure was accepted.
Morphological root configuration plays an impor-
tant role on stress distribution pattern. The high stress
concentration occurs due to the small resistance of
the root area (13). The present study showed highest
stress concentration on double-root premolars proba-
bly due to less surface area compared with single-
rooted teeth beyond of furcation adjacent to the cervi-
cal region shown by the first ones.
Few detailed investigations of stress distribution in
premolars with two roots have been carried out in
the available literature (12). Premolars show the high-
est clinical incidence of fractures among the posterior
teeth, probably due to the anatomical disadvantage of
having the furcation adjacent to the cervical region,
marked grooves on root and crown, as well as cervical

(a) (b) (c) (g)

(d) (e) (f) (h)

Fig. 1. Bio-CAD models showing

different morphologies, cervical
lesions depth and applied load.
Abbreviations in Table 1. (a) SS; (b)
SL1; (c) SL2; (d) DS; (e) DL1; (f)
DL2; oblique (g) and axial (h) load
used in all the models.

© 2013 John Wiley & Sons Ltd

112 P . V . S O A R E S et al.

constriction of the crown (18). Besides that, premolars

Fig. 2. Stress distribution by von Mises in single-root premolar
(MPa).
Fig. 3. Stress distribution by von Mises in double-root premolar
(MPa).
show low crown volume when it comes to chewing
effort compared with molars. These factors’ associa-
tion, presumably, makes premolars more susceptible
to fracture, and tooth structure loss arising from ab-
fraction must be considered a serious additional weak-
ening factor.
Any occlusal contact that generates stress at the
cervical area is theoretically able to create and pro-
gress abfraction lesions once not only axial or oblique
loading, but the intensity and frequency must be con-
sidered. Furthermore, stresses and strains due to
excessive axis loading, which can generate and pro-
gress NCCL’s, oblique loads generate higher stress on
the cervical areas than vertical loads (19). Although
both exhibit harmful effects to dental structure if
applied at very frequent and high levels, lateral occlu-
sal force produces compressive stress on the side
towards the tooth bends and tensile stress on the
opposite side (13). This load application promotes
compressive and tensile stress acting on the tooth
structure, influencing on disruption of chemical bonds
between the enamel crystals in cervical region (12,
13). Von Mises criterion showed stress concentration
within the structure, in general with the highest scale
values corresponding to greatest stress.
The marginal ridges and proximal contact areas are
sites of low strain, while high strains are found in CEJ
during oblique loading. The strain values tend to be
more concentrated on buccal and lingual surfaces
rather than on proximal ones (15). Researchers have
used the application of different force magnitudes in
FEA models, ranging from 100 to 500 N, to compare
FEA studies problematic (2, 12, 13, 20), showing that
increased loading did not cause changes in the overall
pattern stress but increased its values (12). On the
other hand, oblique loading caused higher strain val-
ues accumulation resulting in tensile and compressive
areas.
It was observed that deeper abfraction showed
higher stress concentration within tooth structure
showing that once tooth tissue has been lost, the
stress concentration in the NCCL area around the CEJ
increases in magnitude and accelerates the process of
tissue loss. Additionally, the abfraction lesion shape
and size determine the severity of stress concentration
and influence on depth lesion evolution (21).
In this study, the FEA method allowed the
identification and analysis of the highest stress

© 2013 John Wiley & Sons Ltd

 MECHANICAL BEHAVIOUR OF PREMOLAR TEETH 113

Table 4. Mean values of maximum strain (in lS and SD) and statistical categories defined by Tukey’s test (n = 7) considering the
root morphology, type of loading and lesion size depth

Single root Double root

Load Sound 1,25 2,5 Sound 1,25 2,5

Aa Aa Aa Aa Aa
Axial 136 12 (53,08) 182 01 (96,33) 199 03 (64,59) 236 29 (84,56) 280 65 (73,92) 366 91
(153,77)Aa
Oblique 467 10 (221,06)Ab* 401 51 (66,07)Ab* 420 98 (95,19)Ab* 692 6 (228,26)Ab* 1043 31 (416,72)Bb* 1 236 14
(290,35)Bb*

Tukey’s categories with same letters are not statistically significant from each other (P < 0
05). Capital letters were used to compare
groups in the horizontal lines (axial loading) one each root morphology; lower case letters were used to compare groups in the verti-
cal lines (lesion depth), and asterisk indicates significant difference for pairwise comparison between single and biradicular for each
group. P values calculated by 3-way ANOVA with interaction of all factors.

concentrations areas and guided the bonding of the
strain gauges (Fig. 2). The measured strains followed
the pattern observed with the FEA modelling. The
double-root maxillary premolars with cervical furca-
tion and 2.5 mm depth of lesion under oblique load-
ing concentrated more stress in the tooth structure
than the other teeth The single-root sound teeth asso-
ciated with axial loading showed the smallest stress
concentration values. Although FEA is able to identify
three-dimensional stress fields and makes stress mea-
surement and realistic simulations possible to be
developed (2), the entire intra-oral factors and biolog-
ical dynamics of the tooth and its supporting struc-
tures cannot be included accurately in the computer
simulation (22).
A strain gauge is sensitive only to the strain in the
direction of the gauge axis. The results showed by the
mesial gauge were not statistically significant, con-
firming that stress concentration on the proximal sur-
face is low, showing that stress could be more
concentrated within the lesion, as was seen by the FE
method. The strain gauge measurements’ biggest limi-
tation is the impossibility of placing the extensometer
within the lesion to visualise the inside deformation.
Despite this limitation, the strain gauge method was
able to show that root morphology, increased depth
of abfraction and oblique loading mainly affect the
biomechanical behaviour of premolars increasing
strain on its structure. Abfraction represents serious
fragility increase in the tooth structure during oblique
loading on double-rooted premolars.
As a further interesting finding, this study high-
lights the importance of linking methodologies (labo-
ratory and computational) for the full understanding
of the biomechanical behaviour of dental structures
and showed that measurements using strain gauges
were consistent with the FEA model for loading direc-
tions, root morphology and lesion size. Although
some authors reported that the stress distribution pat-
tern influence in the abfraction development is yet to
be established (15), this study demonstrates that obli-
que loading increases the strain values in tooth struc-
ture, especially within the lesion.
The NCCL progress is multifactorial, including acidic
environment exposure and cyclic fatigue stress due to
endogenous or exogenous acid substances present
inside the mouth and masticatory effort, respectively
(11). Stress concentration and biocorrosion cannot be
underestimated once less tooth mobility and dentin
exposure by gingival resection allow deeper NCCLs
development (8). The wear promoted by acidic action
would not be effective if tooth structure was not weak-
ened by stress concentration, and cyclic fatigue, axial
or oblique ones mainly (6), would not cause much
damage as if the tooth surface was not exposed to bio-
corrosion. The aetiological agents together are able to
exceed the fracture limits of teeth structure. This find-
ing seems to demonstrate an important point of failure
that must be detected during the diagnostics to accom-
plish full rehabilitation. Others studies should be made
to achieve the complete relationship of root morphol-
ogy, all kinds and shapes of NCCL and oral environ-
ment situations involved. Within the limitations of
this study, it can be concluded that the presence of
abfraction or any other NCCL associated with double-
root premolar and oblique loading promotes high
stress concentration inside the lesion and on furcation,
and high strain levels are found on cervical region.

© 2013 John Wiley & Sons Ltd

114 P . V . S O A R E S et al.
Acknowledgments
The authors thank the Department of Products Devel-
opment of the Renato Archer’s Center of Information
Technology, Campinas, SP, Brazil, and Pedro Yoshito
Noritomi, for his valuable contribution to the FE
method. The authors also thank the LIPO (Integrated
Dental Research Laboratory) and NCCL Research
Group from Faculty of Dentistry, Federal University of
Uberl^andia, Brazil, for structure offered to perform
the strain gauge method. This study was supported by
grants from the Foundation for Research Support of
Minas Gerais FAPEMIG.
Conflict of interest
The authors declare no conflict of interest.
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Correspondence: Dr. Paulo V. Soares, Department of Operative Den-
tistry and Dental Materials, Federal University of Uberlandia, Aven-
ida Para, 1720 – Campus Umuarama – Bloco 2B, Sala 2B 24,
Uberl^andia, Minas Gerais 38400-902, Brazil. E-mail: paulovso-
ares@yahoo.com.br
© 2013 John Wiley & Sons Ltd