Effects of the lining material, thickness and coverage on residual stress of class II molar restorations by multilayer technique

OBJECTIVE This study aims to analyse the influence of different lining material, thickness and coverage on residual stress of class II molar restoration by the multilayer technique through the three-dimensional (3D) finite element (FE) method. The objective is to reveal the correlations between the base layer configurations and the residual stress distributions of the tooth. METHODS A 3D reconstructed model of an extracted first molar was built through micro-CT images and a class II mesio-occlusal-distal cavity was prepared using computer-aided engineering (CAE) software. A bilayer technique was then applied, and 3D FE analyses were performed under polymerization contraction loading. Glass ionomer composites (Vitrebond and Ionosit) and flowable composite resin (Luxa Flow and Z350 Flowable Restorative) were used as lining materials. Moreover, several sensitivity analyses with dozens of hypothetical lining materials were conducted to provide definitive results. The thickness of the base layers was set to be distinct (0.5 mm or 1 mm) so as to reveal its effect on the stress alleviation. Various lining strategies with the liner covering different areas of the cavity walls (Closed Sandwich, Open Sandwich and Special Open Sandwich) were adopted to determine the effects of the base layers. RESULTS Adoption of an appropriate liner could effectively reduce the polymerization shrinkage stress. The mechanical properties of the base layer can affect the residual stresses, basically a lower Young's modulus and lower Poisson's ratio (of lining material) result in better stress mitigation, therefore reducing the stress transmitted to the dentin. Increase of the lining thickness within a certain range could lead to a decrease in the probability of stress concentration formation. Lining strategies had the strongest influence on the stress distributions. Different lining coverage could cause various stress responses, and covering all cavity walls with the lining material had the optimal performance among all the simulations in this study. SIGNIFICANCE The multilayer technique is an effective way to prolong the service life of resin composites restorations. A thorough evaluation of the sandwich technique through the FE method can provide a better understanding of the stress distributions of the restoration, and reveal its internal mechanisms.