On the morphology and failure of worn human molar cusps

Objectives: Enamel wear is a common occurrence that may lead to tooth failure. Beyond reducing enamel thickness, wear exposes different regions of enamel microstructure to various types of stresses. This work was aimed at elucidating the effect of enamel wear on enamel morphology and tooth resilience in human molar teeth undergoing large-scale contact. Methods: Intact/polished molar cusps were indented with a hard disk/ball. The unloaded specimens were sectioned longitudinally or transversely, and the damage examined by optical and scanning electron microscopy. The onset of cracks at the dentin horn apex was determined by a FEM stress analysis that modeled a cusp as truncated, conical enamel shell supported by dentin. Results: The damage consisted of radial and cylindrical cracks growing under the contact, sparsely distributed radial cracks in the enamel shell region, and cracking from tufts at the dentin horn apex (TA cracks). The damage under the contact circle exhibited shear deformation zones. These zones helped relieve contact stresses, absorb energy, contain damage, and solicit cylindrical cracks in order to avoid growth of wear-sensitive cone cracks. Enamel tufts provided stress shielding while Hunter-Schreger Bands helped maintain this benefit by enforcing a collaborative cracking. The TA cracks were deemed a primary cause for tooth failure. The FEA predicted well the onset of these cracks. Making use of in vivo enamel wear data, the analysis showed that cusp failure might routinely occur at old age. Significance: The results provided new information on the response of the interior part of enamel to contact loading. This included the resistant effects of the waviness of enamel rods, interrods and tufts. The unique microstructure of enamel gave rise to shear bands under the contact circle that helped relieve contact stresses, absorb energy and contain damage. Enamel interrods solicited cylindrical cracking in order to avoid the wearsensitive cone cracks. The onset of cracks at the dentin horn apex (TA cracks) was deemed critical to a tooth survival. The FEA showed that this cracking mode might routinely occur at old age due to natural enamel wear. Finally, the occlusal force needed to initiate the TA cracks in intact cusps can help explain the natural design logic involving the maximum bite force of hominid species.