Lesion Morphology Modification Is Unnecessary for Non-carious Cervical Lesion Restorations: A Comparison of Stiff and Flowable Composites

Journal article

Authors/Editors

SONTIPEE AIMMANEE

Strategic Research Themes

composite (Materials Processing )

Publication Details

Author list: Dhammayannarangsi, P.; Na Lampang, S.; Traithipsirikul, P.; Supamongkol, A.; Kittipongphat, P.; Trachoo, V.; Osathanon, T.; Aimmanee, S.; Everts, V.; Samaranayake, L.; Limjeerajarus, N.; Limjeerajarus, C.N.

Publisher: Elsevier

Publication year: 2026

Volume number: 76

Issue number: 1

Start page: 109284

URL: https://www.scopus.com/inward/record.uri?eid=2-s2.0-105022265895&doi=10.1016%2Fj.identj.2025.109284&partnerID=40&md5=9bded12af60ff559acfef883eab448d8

Languages: English-Great Britain (EN-GB)

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Abstract

This study investigates the impact of non-carious cervical lesion (NCCL) morphology – horizontal-oval-round (HOR) and horizontal-oval-wedge (HOW) – and 2 different restoratives – stiff composite (Filtek-Z350XT, Z) vs flowable composite (Filtek-Bulk-Fill Flowable, F) – on fracture risk and stress distribution in human teeth. Forty-five extracted sound maxillary first premolars were allocated into 3 groups (n = 15): sound (S), nonrestored HOR (R), and nonrestored HOW (W). Standardized NCCLs were prepared, and fracture strength was measured using a universal testing machine. One-way ANOVA and posthoc tests ( P < .05) were used for statistical analysis. Validated 3D-FEA models were used to simulate von Mises stress under an average occlusal load (54.64 N) across 7 models: S, R, W, and restored counterparts using Z and F composites (RZ, RF, WZ, WF). Fracture strength was significantly lower in R (509.2 MPa) and W (520.6 MPa) compared with sound teeth (821.7 MPa; P < .001), with no difference between R and W ( P > .05). In nonrestored NCCLs, stress concentrated at the lesion base (13-15 MPa), threefold greater than that in sound teeth. Restoration redistributed stress to 3 to 5 MPa, relocating peak stress to the palatal furcation. Bulk-fill flowable composite reduced interfacial stress (2.3-2.8 MPa) though slightly increased lesion-base stress, while stiff composite showed the inverse (3.0-3.5 MPa). NCCLs compromise tooth strength irrespective of morphology. Restoration improves stress distribution to near-physiological levels without lesion morphology modification. Clinically, this supports conservative restoration, with flowable composites offering biomechanical advantages, though their long-term wear resistance requires further validation. © 2025 The Authors.

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