Fracture resistance and cuspal deflection of incompletely excavated teeth

Journal of Dentistry

Available online 12 December 2013

In Press, Accepted Manuscript — Note to users

 

Abstract

Objectives

Incomplete excavation reduces the risk of pulpal complications, but doubts remain regarding the mechanical properties of incompletely excavated teeth. Remaining carious dentin is suspected to not sufficiently support the restoration and to reduce bond strengths between the tooth and the restoration, with effects possibly varying depending on the depth of the remaining caries lesion. This study investigated fracture resistance (FR) and cuspal deflection (CD) of premolars after leaving or removing demineralized dentin in vitro.

Methods

In 48 premolars, shallow and deep artificial lesions (depths [mean ± SD] of 64 ± 18 μm and 771 ± 176 μm) were created on pulpo-axial walls of standardized mesial-distal-occlusal cavities. Demineralized dentin was either removed or left before adhesively restoring the tooth (n = 12/group). Restored teeth were submitted to thermo-mechanical cycling. CD was subsequently measured at loads of 200 N and 400 N, and teeth submitted to occlusal-perpendicular loading until fracturing occurred.

Results

FR was not significantly different between teeth with or without remaining demineralized dentin regardless of the lesion depth (p > 0.30, t-test). Irrespective of the removal technique, teeth with deep lesions showed significantly decreased FR (p≤0.001). In contrast, CD was significantly increased in teeth with remaining demineralized dentin compared with completely excavated teeth (p≤0.05; Mann-Whitney-test).

Conclusions

Remaining demineralized dentin did not significantly decrease the fracture resistance of premolars in vitro. Effects of increased cuspal deflection on restoration margins should be assessed. This study showed no indication that incomplete excavation increases the risk of non-pulpal complications.

Clinical Significance: Incomplete caries removal seems suitable to treat especially deep lesions. Leaving demineralized dentin does not seem to affect the fracture resistance of incompletely excavated teeth regardless of the lesion depth.