Biomechanical performance of an immature maxillary central incisor after revitalization: a finite element analysis

Aim To investigate the stress distribution in an immature maxillary incisor and the same tooth after simulated revitalization with deposition of tubular dentine or cementum by finite element analysis (FEA). Methodology A finite element model of a maxillary central incisor was developed on the basis of a mu CT scan. The tooth was segmented in two parts: a part that represented a tooth in an immature state and an apical part that represented the tissue formed after revitalization. The apical part was given the mechanical properties of dentine or cementum. The immature tooth and the same tooth reinforced by either dentine or cementum underwent simulation of biting, trauma and orthodontic movement. Von Mises stress values were compared between the scenarios and tooth segments. Results Maximum stress in the immature incisor developed apically; however, dentine- and cementum-reinforced teeth revealed the greatest stress in the external portion of the root decreasing towards the apex. Greatest mechanical stress was caused by dental trauma perpendicular to the long axis of the root followed by biting and orthodontic movement. Stress peaks were lower in the dentine-reinforced tooth compared with the cementum-reinforced tooth in all scenarios; however, median stress in the immature part was reduced irrespective of dentine or cementum deposition. Dentine reinforcement caused greater stress values in the apical segment due to absorbance of the applied force, whereas stress was not transferred towards deposited cementum. Conclusions Apposition of simulated hard tissue in a maxillary central incisor after revitalization reduced mechanical stress in the immature tooth. Formation of dentine was advantageous because, unlike cementum, it facilitated an even stress distribution throughout the root resulting in lower stress values.