Filling cavities or restoring teeth?

Teeth seldom fracture under normal functional loading. This indicates that the natural tooth design is optimized for the distribution of regular masticatory forces by means of its properties and structure. When a tooth is restored with an intracoronal restoration, however, the incidence of tooth fracture increases. Since remaining tissues do not change, the restorative actions apparently alter the original stress distributions. In this study, the effect of different restoration types (unbonded amalgam and bonded composite restorations) were compared with the original stress conditions of the intact tooth, using finite element analysis. It was shown that an unbonded amalgam restoration did not restore the original stress conditions but led to much higher stresses in the buccal and lingual enamel and to higher tensile stresses in the cavity floor. The unbonded amalgam thus filled the cavity but did not restore the tooth. In contrast, a bonded composite restoration restored the original stress pattern in the tooth if there was no polymerization shrinkage. Polymerization shrinkage causes residual tensile stresses in the dentin around the cavity and in the buccal and lingual enamel. Residual tensile stresses in the buccal and lingual enamel are momentary compensated by compressive stress components during occlusal loading. It was concluded that bonding and elimination of residual stresses are prerequisites for restoring the original tooth integrity.