Evaluation of biomechanical effects of different treatment procedures and materials used in teeth with incomplete root development using finite element analysis

Abstract

Aim: The purpose of the present study is to evaluate, using finite element analysis (FEA), the stresses generated by the applications of partial pulpotomy, apexification, and regenerative endodontic procedure (REP), as well as the materials that can be used in these treatment procedures—calcium hydroxide (CH), mineral trioxide aggregate (MTA), BioAggregate (BA), and Biodentine (BD)—under functional forces on models of teeth having incomplete root development.

Methodology: A maxillary incisor tooth model with complete root development and surrounding tissues was created three-dimensionally, utilizing tomography data in a computer environment. Based on this model, two healthy tooth models with complete and incomplete root development were created. In addition, 17 treatment procedure models were simulated, performing the applications of partial pulpotomy, apexification, and REP, using the materials CH, MTA, BA, and BD. Von Mises stress values that were generated in the tooth by applying functional mastication force were examined with FEA in three regions: apical, middle, and cervical. The results were evaluated using Altair Evolve structural analysis software and taking Von Mises criteria into consideration while the stress value range was limited from 0 to 10+ MP.

Results: Completion of root development decreased the stresses in the teeth that had incomplete root development. In the partial pulpotomy models, the stresses that formed in the teeth decreased after completion of apexogenesis, and once again, completion of root development by formation of cement-like tissue following REP decreased the stresses that formed in the teeth. The highest stress values were detected in the apical and middle root regions of the models that simulated apexification, compared to other models. The evaluations of the materials used in these treatment procedures revealed that the highest stress values formed in the models that simulated the use of CH. MTA, BioAggregate, and Biodentine generated similar levels of stress, whereas the lowest level of stress was generated in the model that applied MTA.

Conclusion: The selection of treatment procedures that stimulate root development is helpful in reducing stresses generated in teeth that have incomplete root development. Treatment models performed using MTA strengthened the tooth structure more than treatments performed using CH, BA, or BD.