Biomechanical performance of an immature maxillary central incisor after revitalization: a finite element analysis

Abstract

Aim To investigate the stress distribution in an immature maxillary incisor and the same tooth after simulated revitalization with deposition of tubular dentine or cementum by finite element analysis (FEA). Methodology A finite element model of a maxillary central incisor was developed on the basis of a µCT scan. The tooth was segmented in two parts: a part that represented a tooth in an immature state and an apical part that represented the tissue formed after revitalization. The apical part was given the mechanical properties of dentine or cementum. The immature tooth and the same tooth reinforced by either dentine or cementum underwent simulation of biting, trauma and orthodontic movement. Von Mises stress values were compared between the scenarios and tooth segments. Results Maximum stress in the immature incisor developed apically; however, dentine‐ and cementum‐reinforced teeth revealed the greatest stress in the external portion of the root decreasing towards the apex. Greatest mechanical stress was caused by dental trauma perpendicular to the long axis of the root followed by biting and orthodontic movement. Stress peaks were lower in the dentine‐reinforced tooth compared with the cementum‐reinforced tooth in all scenarios; however, median stress in the immature part was reduced irrespective of dentine or cementum deposition. Dentine reinforcement caused greater stress values in the apical segment due to absorbance of the applied force, whereas stress was not transferred towards deposited cementum. Conclusions Apposition of simulated hard tissue in a maxillary central incisor after revitalization reduced mechanical stress in the immature tooth. Formation of dentine was advantageous because, unlike cementum, it facilitated an even stress distribution throughout the root resulting in lower stress values.

Cell-Free Approaches for Dental Pulp Tissue Engineering

“…The effects of dentin matrix proteins on dental pulp (stem) cells include chemotaxis, increased expression of genes associated with an odontoblast phenotype, and the induction FIGURE 2 -Finite element analysis of stress distribution patterns during biting in an immature tooth, and after reinforcement by formation of either dentin or cementum 10…”

“…2). Although a general reduction of stress can be observed in the tooth after cementum or dentin formation, the important transfer of stress between dentin and cementum does not take place in the apical segments 10 . With these clinical perspectives in mind, it may be beneficial to achieve true regeneration rather than repair.…”

Effectiveness of Autologous Platelet Concentrates in Management of Young Immature Necrotic Permanent Teeth—A Systematic Review and Meta-Analysis

“…An alternative, calcium silicate-based material, Biodentine, showed promising results, however, its immediate bonding to composite resin restoration may be impaired [ 3 ]. Unfortunately, apexification independent of the material used to produce the apical barrier does not allow for the revitalization and further root development of the immature, necrotic tooth [ 4 ], thereby compromising its prognosis [ 5 , 6 ].…”

Clinical Perspectives of Pulp Regeneration

“…If revitalization leads to unspecific connective tissue and cementum/osteoid hard tissue deposition instead of pulplike tissue and dentin inside the root canal, the root will not gain mechanical strength because of weak mechanical properties of cementum/osteoid hard tissue compared with dentin apposition 6 . However, reduced mechanical strength can also occur after HCSC plug treatment 34 .…”

“…Although this is a transitionary stage during physiological tooth development, this high-risk situation is preserved after HCSC treatment. Recently, it was demonstrated by finite element analysis that the apposition of hard tissue (dentin or cementum) to increase root length and thickness significantly reduces stress 6 .…”