Stress Distribution on Trephine-Resected Root-end in Targeted Endodontic Microsurgery: A Finite Element Analysis |
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| Affiliation: | 1. Department of Comprehensive Treatment Center, Seoul National University Dental Hospital, Seoul, Republic of Korea;2. Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada;3. Dental Research Institute and Department of Oral Anatomy, School of Dentistry, Seoul National University, Seoul, Republic of Korea;4. Division of Endodontology, Department of Oral Health and Diagnostic Sciences, University of Connecticut Health Center, School of Dental Medicine, Farmington, Connecticut;6. Department of Conservative Dentistry, Seoul National University School of Dentistry and Dental Research Institute, Seoul, Republic of Korea;5. Department of Prosthodontics, Seoul National University School of Dentistry and Dental Research Institute, Seoul, Republic of Korea |
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| Abstract: | IntroductionThis study aimed to determine if stress distribution from occlusal loads after targeted endodontic microsurgery (TEMS) differed for trephine-resected flat and curved root-ends, with and without bone graft.MethodsFinite element analysis models were constructed from cone-beam computed tomography data of a TEMS-treated maxillary central incisor. Models included flat and curved resected root-ends, with and without apical bone graft, and normal or root canal filled controls. In centric occlusion, axial force was directed on mesial and distal lingual marginal ridges at 120° angle. For lateral excursion, additional mesiodistal forces were applied from centric occlusion. For edge biting, axial force was directed on the incisal edge. Under occlusal loads, stress distribution patterns on tooth and root-end circumference were analyzed.ResultsIn normal and root filled controls, occlusal stress was distributed on labial and palatal root surfaces, concentrated in the labial cervical area, and maximized at the apex. For resected root-ends, occlusal loads concentrated stress on the labial cervical area. With bone graft, maximum stress concentration shifted to the apex, which implied stress relief and dispersion from the cervical root area. Stress patterns on the root-end were more widely spread in models with apical bone graft, whereas curved root-end showed stress concentrating arc especially when without apical bone support. The mean stress values on root-end circumference were significantly higher in curved than flat root-end (P < .05), especially with apical bone support (P < .05).ConclusionsOcclusal stress patterns on a maxillary central incisor were markedly affected by root-end resection configuration and apical bone support. Trephine-resected curved root-end had stress pattern concentrated on its circumference. Curved and flat root-ends had labial cervical stress that was relieved by bone graft. TEMS resected root-ends should be flattened and bone grafted to disperse stress from occlusal loads. |
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| Keywords: | Finite element analysis root-end preparation targeted endodontic microsurgery tooth displacement von Mises stress |
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