Shape optimization of a 2-unit cantilevered posterior resin-bonded fixed dental prosthesis.

Statement Of Problem: The cantilevered resin-bonded fixed dental prosthesis (RBFDP) is a feasible and minimally invasive treatment option to restore a single missing tooth, especially when the missing tooth space is small (<7 mm) and cost-effectiveness is essential. However, its long-term survival needs to be improved by increasing its structural strength and interfacial adhesion.

Purpose: The purpose of this study was to improve the interfacial bonding and to enhance the structural strength of a 2-unit inlay-retained cantilevered RBFDP with a 2-step numerical shape optimization.

Material And Methods: A finite element model of a mandibular first molar with a second premolar pontic was constructed. A load of 200 N simulating the average occlusal force was applied on the mesial fossa of the pontic. In the first step, an in-house user-defined material subroutine was used to generate the cavity preparation. The subroutine iteratively changed the tooth tissues next to the pontic to composite resin according to the local stresses until convergence was achieved. In the second step, the subroutine was used to optimize the placement of fibers in the pontic by placing fibers in high-stress regions. To assess the debonding resistance and load capacity of the optimized and conventional designs, further analyses were conducted to compare their stresses at the tooth-restoration interface and those within the restoration.

Results: Shape optimization resulted in a shovel-shaped cavity preparation and a pontic with fibers placed near the occlusal surface of the connector region. With the optimized cavity preparation only, the maximum principal stress within the restoration and the tooth structure was reduced from 639.4 MPa to 525.4 MPa and from 381.7 MPa to 352.8 MPa, respectively. With the embedded fibers, the shovel-shaped cavity preparation reduced the maximum interfacial tensile stress by approximately 70% (conventional: 189.6 MPa versus optimized: 57.0 MPa) and the peak maximum principal stress of the veneering composite resin by 45% (conventional: 638.8 MPa versus optimized: 356.5 MPa). The peak maximum principal stress was also reduced for the remaining tooth structure by approximately 30% (conventional: 372.2 MPa versus optimized: 253.1 MPa).

Conclusions: Shape optimization determined that a shovel-shaped retainer with fibers placed near the occlusal surface of the connector area can collectively reduce the interfacial and structural stresses of the 2-unit cantilevered fiber-reinforced RBFDP. This may offer a more conservative treatment option for replacing a single missing tooth.