Influence of cavity design on the biomechanics of direct composite resin restorations in Class IV preparations

This study evaluated the effect of cavity design on stress distribution and fracture resistance of direct composite resin restorations in Class IV preparations. A finite element analysis (FEA) model of the maxillary central incisor with a Class IV cavity was established. Five model variations were studied: (i) a 1-mm bevel (ii) a 2-mm bevel, (iii) a plain chamfer, (iv) a stair-step chamfer, and (v) butt joints (a control configuration). All FEA variations modeled a tooth restored with composite resin loaded under 100 N at an angle of 45 degrees to the longitudinal axis. The interfacial von Mises stress was evaluated. The FEA was complemented with an in vitro assessment. Fracture resistance of direct composite resin restorations was tested with a universal testing machine and fracture patterns were observed. Finite element analysis showed that stress in chamfer and stair-step chamfer models was more homogenously distributed, while stress in bevel models was relatively concentrated at lingual regions. Fracture resistance of a 1-mm bevel preparation was lower than for the 2-mm bevel, plain chamfer, and stair-step chamfer preparations, but was higher than for butt joints. The stair-step chamfer group presented the most favorable failure pattern. Considering biomechanics and esthetics, the present study indicates that the stair-step chamfer and 2-mm bevel should be recommended for clinical restoration.