The butterfly effect in oral and maxillofacial surgery: Understanding and applying chaos theory and complex systems principles.

The present paper provides a historical context for chaos theory, originating in the 1960s with Edward Norton Lorenz's efforts to predict weather patterns. It introduces chaos theory, fractal geometry, nonlinear dynamics, and the butterfly effect, highlighting their exploration of complex systems. The authors aim to bridge the gap between chaos theory and oral and maxillofacial surgery (OMFS) through a literature review, exploring its applications and emphasizing the prevention of minor deviations in OMFS to avoid significant consequences. A comprehensive literature review was conducted on PubMed, Web of Science, and Google Scholar databases. The selection process adhered to the PRISMA-ScR guidelines and Leiden Manifesto principles. Articles focusing on chaos theory principles in health sciences, published in the last two decades, were included. The review encompassed 37 articles after screening 386 works. It revealed applications in outcome variation, surgical planning, simulations, decision-making, and emerging technologies. Potential applications include predicting infections, malignancies, dental fractures, and improving decision-making through disease prediction systems. Emerging technologies, despite criticisms, indicate advancements in AI integration, contributing to enhanced diagnostic accuracy and personalized treatment strategies. Chaos theory, a distinct scientific framework, holds potential to revolutionize OMFS. Its integration with advanced techniques promises personalized, less traumatic surgeries and improved patient care. The interdisciplinary synergy of chaos theory and emerging technologies presents a future in which OMFS practices become more efficient, less traumatic, and achieve a level of precision never seen before.

Intrusion of overerupted periodontally compromised posterior teeth using orthodontic mini implants: A mechanobiological finite element study.

INTRODUCTION: The intrusion of posterior teeth had been considered challenging up to the development of orthodontic mini implants. In periodontally compromised teeth, the challenge is even greater, because of the root resorption risk due to periodontal ligament over-compression. Still, the precise strategy to determine the force reduction level remains uncertain. OBJECTIVE: The objective of the study was to determine, by a finite element analysis (FEA), the force reduction needed to avoid root resorption and maintain the efficiency of orthodontic mechanics of periodontally compromised teeth similar to the sound one. METHODS: An anatomical model was constructed representing a premolar inserted into a maxillary bone. Based on the initial model (R0), three bone height loss conditions were simulated (R2 = 2 mm, R4 = 4 mm, and R6 = 6 mm). Two intrusive movements were simulated: pure intrusion (bilateral mini implant) and uncontrolled-tipping intrusion (buccal mini implant). The hydrostatic stress at the periodontal ligament was used to evaluate the risk of root resorption due to over-compression. RESULTS: For bilateral mini implant intrusion, the force had to be decreased by 16%, 32% and 48% for R2, R4 and R6, respectively. For buccal mini implant intrusion, the required reductions were higher (20%, 36% and 56%). A linear relationship between the intrusive force reduction and the alveolar bone height loss was observed in both intrusion mechanics. CONCLUSIONS: According to the FE results, 8% or 9.3% of force reduction for each millimetre of bone height loss is suggested for intrusion with bilateral or buccal mini implant, respectively. The buccal mini implant anchorage must be associated with a supplemental strategy to avoid buccal crown tipping.

Peri-implant bone resorption risk of anterior maxilla narrow single implants: a finite-element analysis.

Statement of the problem: Narrow implants have been recommended in high esthetic demand regions to ensure greater buccal bone thickness (BBT) and minimize soft-tissue recession due to insufficient bone support. However, a limited area of bone-implant interface can increase the risk of peri-implant bone resorption due to occlusal forces. Purpose: This article encourages the use of evidence-based finite element analysis to optimize the aesthetic outcomes in maxillary lateral incisor single-supported implant crown by accurate biomechanical planning. This study aimed to analyze the best implant dimensions that would preserve the maximum BBT and avoid peri-implant bone resorption due to occlusal forces. Materials and methods: A maxilla segment was constructed based on anthropological measurements. Four implant diameters (Ø = 3.25; 3.50; 3.75 or 4.00 mm) and two lengths (L = 10 or 13 mm) were simulated. The occlusal force parameters were defined to simulate clinical conditions. The bone resorption risk analysis was based on Frost's mechanostat theory altering the strain output to strain energy density (SED). The peri-implant bone resorption risk indexes (PIBRri) were calculated by dividing the average of the top ten SED elements of the cortical and trabecular buccal wall by the pathologic resorption limit for each bone. Results: For trabecular bone, only the model Ø4.00L13 exhibited a low PIBRri. For cortical bone, all models presented a low PIBRri, except for models Ø3.25. Conclusion: The selection of a 3.25 mm dental implant to preserve a 2 mm BBT should be avoided since it generates a high peri-implant bone resorption risk induced by occlusal overload.

Effect of processing methods on the chipping resistance of veneered zirconia.

OBJECTIVES: To evaluate the edge chipping resistance (ReA) and the fracture toughness (KC) of 3Y-TZP bilayers produced with the following materials/processing combinations: fluorapatite glass-ceramic applied on zirconia using the traditional layering and hot-pressing (press-on) techniques; feldspathic porcelain using rapid layer technology (RLT); and lithium disilicate glass-ceramic using CAD-on method. The influence of the cooling rate (slow and fast) was analyzed for layering and hot-pressing. METHODS: Bilayer bars (25x4x2 mm) were made following manufacturers' instructions. The edge chipping test was performed in an universal testing machine, using a coupled Vickers indenter. ReA was calculated dividing the critical load at fracture by the edge distance. Fracture toughness was calculated by a regression fit with a fixed slope of 1.5 correlating the critical chipping load regarding edge distance and also with indentation fracture (IF) method. Data were statistically analyzed using ANOVA and Tukey's test (α = 5%). RESULTS: ReA and KC was significantly higher for the CAD-on bilayers. RLT showed intermediate ReA means, and layering and hot-pressing techniques showed the lowest ReA values. For both processing methods there was no effect of the cooling protocol on the ReA and fracture toughness. CONCLUSIONS: There is a significant effect of the material/processing association on the edge chipping resistance and fracture toughness of the bilayers. There was no effect of the cooling protocol on the edge chipping resistance and fracture toughness for the specimens processed by both the layering and hot-pressing techniques.

Orthodontically induced root resorption: A critical analysis of finite element studies' input and output.

INTRODUCTION: Orthodontically induced inflammatory root resorption (OIIRR) constitutes an undesirable risk connected to orthodontic treatment. Finite element analysis (FEA) is a powerful tool to study the risk of OIIRR. However, its efficiency in predicting OIIRR depends on the insertion of the correct inputs and the selection of an output coherent with the clinical failure mechanism. METHODS: By combining a systematic review with a 3-dimensional FEA, this article discusses which are the implications of using certain periodontal ligament (PDL) properties (linear and nonlinear models) and failure criteria. Six orthodontic loading regimes were simulated in a maxillary premolar: pure intrusion, buccal tipping, and their combination applied with either a light (25 cN) or a heavy (225 cN) force. Three stress parameters in the PDL were compared: von Mises stress, minimum principal stress, and hydrostatic stress (σH). RESULTS: The comparison between linear and nonlinear models showed notable differences in stress distribution patterns and magnitudes. For the nonlinear PDL, none of the light-force models reached the critical compressive hydrostatic stress of 4.7 kPa, whereas all the heavy-force models reached it. In addition, the regions of critical compressive σH matched with the regions with resorption craters in clinical studies. In linear models, the σH critical value of 4.7 kPa was reached even in the light-force scenario. CONCLUSIONS: Only compressive hydrostatic stress in PDL satisfied the requirements to be used as an FEA indicator of OIIRR. However, the requirements were satisfied only when a nonlinear PDL model was considered.

Can maxilla and mandible bone quality explain differences in orthodontic mini-implant failures?

Purpose: This study aimed to compare the risk of orthodontic mini-implant (OMI) failure between maxilla and mandible. A critical analysis of finite-element studies was used to explain the contradiction of the greatest clinical success for OMIs placed in the maxilla, despite the higher quality bone of mandible. Materials and Methods: Four tridimensional FE models were built, simulating an OMI inserted in a low-dense maxilla, control maxilla, control mandible, and high-dense mandible. A horizontal force was applied to simulate an anterior retraction of 2 N (clinical scenario) and 10 N (overloading condition). The intra-bone OMI displacement and the major principal bone strains were used to evaluate the risk of failure due to insufficient primary stability or peri-implant bone resorption. Results: The OMI displacement was far below the 50-100 µm threshold, suggesting that the primary stability would be sufficient in all models. However, the maxilla was more prone to lose its stability due to overload conditions, especially in the low-dense condition, in which major principal bone strains surpassed the pathologic bone resorption threshold of 3000 µstrain. Conclusions: The differences in orthodontic mini-implant failures cannot be explained by maxilla and mandible bone quality in finite-element analysis that does not incorporate the residual stress due to OMI insertion.

Why a zero CTE mismatch may be better for veneered Y-TZP structures.

OBJECTIVE: Compare residual stress distribution of bilayered structures with a mismatch between the coefficient of thermal expansion (CTE) of framework and veneering ceramic. A positive mismatch, which is recommended for metal-ceramic dental crowns, was hypothesized to contribute to a greater chipping frequency in veneered Y-TZP structures. In addition, the multidirectional nature of residual stresses in bars and crowns is presented to explore some apparent contradictions among different studies. METHODS: Planar bar and crown-shaped bilayered specimens with 0.7 mm framework thickness and 1.5 mm porcelain veneer thickness were investigated using finite element elastic analysis. Eight CTE mismatch conditions were simulated, representing two framework materials (zirconia and metal) and six veneering porcelains (distinguished by CTE values). Besides metal-ceramic and zirconia-ceramic combinations indicated by the manufacturer, models presenting similar mismatch values (1 ppm/°C) with different framework materials (metal or zirconia) and zirconia-based models with metal-compatible porcelain veneers were also tested. A slow cooling protocol from 600 °C to room temperature was simulated. The distributions of residual maximum and minimum principal stresses, as well as stress components parallel to the long axis of the specimens, were analysed. RESULTS: Planar and crown specimens generated different residual stress distributions. When manufacturer recommended combinations were analysed, residual stresses obtained for zirconia models were significantly higher than those for metal-based models. When zirconia frameworks were combined with metal-compatible porcelains, the residual stress values were even higher. Residual stresses were not different between metal-based and zirconia-based models if the CTE mismatch was similar. SIGNIFICANCE: Some conclusions obtained with planar specimens cannot be extrapolated to clinical situations because specimen shape strongly influences residual stress patterns. Since positive mismatch generates compressive hoop stresses and tensile radial stresses and since zirconia-based crowns tend to be more vulnerable to chipping, a tensile stress-free state generated with a zero CTE mismatch could be advantageous.

Influence of residual thermal stresses on the edge chipping resistance of PFM and veneered zirconia structures: Experimental and FEA study.

OBJECTIVE: Chipping fractures of the veneering porcelain are frequently reported for veneered all-ceramic crowns. In the present study, the edge chipping test is used to measure the toughness and the edge chipping resistance of veneered zirconia and porcelain-fused-to-metal (PFM). The aim is to describe an edge chipping method developed with the use of a universal testing machine and to verify the accuracy of this method to determine the influence of residual thermal stresses on the chipping fracture resistance of veneering porcelain. A finite element analysis (FEA) was used to study the residual stress profiles within the veneering porcelain. METHODS: Veneered zirconia and PFM bar specimens were subjected to either a fast or a slow cooling protocol. The chipping resistances were measured using the edge chipping method. The load was applied in two different directions, in which the Vickers indenter was placed in the veneering porcelain either parallel or perpendicular to the veneer/framework interface. The mean edge chipping resistance (ReA) and fracture toughness (KC) values were analysed. ReA was calculated by dividing the critical force to cause the chip by the edge distance. KC was given by a fracture analysis that correlates the critical chipping load (FC) regarding edge distance (d) and material toughness via KC=FC/(ßd1.5). RESULTS: The ReA revealed similar values (p>0.005) of chipping resistance for loads applied in the parallel direction regardless of framework material and cooling protocol. For loads applied in the perpendicular direction to the veneer/framework interface, the most chip resistant materials were slow cooled veneered zirconia (251.0N/mm) and the PFM fast cooled (190.1N/mm). KC values are similar to that for monolithic porcelain (0.9MPa.√m), with slightly higher values (1.2MPa.√m) for thermally stressed PFM fast cooled and veneered zirconia slow cooled groups. SIGNIFICANCE: The developed and reported edge chipping method allows for the precise alignment of the indenter in any predetermined distance from the edge. The edge chipping method could be useful in determining the different states of residual thermal stresses on the veneering porcelain.

How mechanical stresses modulate enamel demineralization in non-carious cervical lesions?

OBJECTIVE: To introduce an experimental non-carious cervical lesion (NCCL) model for studying the influence of presence and type of stress (tension or compression) on acid effects involved in NCCL formation on the enamel near the cement-enamel junction (CEJ). METHODS: 108 bovine incisors were cut into 18 × 3×3 mm3 beams, with a notch in the cervical region to generate a standardized area of stress concentration. Half of the specimens were immersed in distilled water and the other half in acetic acid solution (pH 4.5) for 72h. Each group was divided into three subgroups. Two subgroups underwent 800gf static loading, with the specimen positioned in a bending jig with the buccocervical region under either tension or compression. The load was applied simultaneously to immersion (in water or in acid). The third subgroup was not subjected to loading. Transversal and longitudinal 0.05 mm plates of the specimens were analyzed under a light microscope (40, 100 and 200×) to measure the enamel demineralization depth and to assess the presence of cracks, fractures and gaps at the enamel-dentin junction. The demineralization depth data were submitted to ANOVA and Tukey's test at a 5% significance level. RESULTS: Enamel demineralization depth (µm) was higher under tension (158±19 in transversal sections and 229±32 in longitudinal sections) than under compression (transversal: 129±16 and longitudinal: 167±10) or unstressed condition (transversal: 138±21 and longitudinal: 187±21). Specimens immersed in acid and subjected to tensile stress presented enamel micro fractures and wider gaps in the dentin-enamel junction. SIGNIFICANCE: Enamel demineralization was significantly higher in the presence of tensile stress, due to wider gaps between dentin and enamel, stress corrosion cracking and increased enamel permeability to acid.

Descriptions of crack growth behaviors in glass-ZrO2 bilayers under thermal residual stresses.

OBJECTIVES: This study was intended to separate residual stresses arising from the mismatch in coefficients of thermal expansion between glass and zirconia (ZrO2) from those stresses arising solely from the cooling process. Slow crack growth experimentes were undertaken to demonstrate how cracks grow in different residual stress fields. METHODS: Aluminosilicate glass discs were sintered onto ZrO2 to form glass-ZrO2 bilayers. Glass discs were allowed to bond to the ZrO2 substrate during sintering or prevented from bonding by means of coating the ZrO2 with a thin boron nitrade coating. Residual stress gradients on "bonded" and "unbonded" bilayers were assessed using birefringence measurements. Unbonded glass discs were further tested under biaxial flexure in dynamic fatigue conditions in order to evaluate the effect of residual stress on the slow crack growth behavior. RESULTS: When fast-ccoling was induced, residual tensile stresses on the glass increased significantly on the side toward the ZrO2 substrate. By allowing the bond between glass and ZrO2, those tensile stresses observed in unbonded specimens are overwhelmed by the contraction mismatch stresses between the ZrO2 substrate and the glassy overlayer. Specimens containing residual tensile stresses on the bending surface showed a time-dependent strength increase in relation to stress-free annealed samples in the dynamic biaxial bending test, with this effect being dependent on the magnitude of the residual tensile stress. The phenomenon observed is explained here on the basis of the water toughening effect, in which water diffuses into the glass promoting local swelling. An additional residual tensile stress at the crack tip adds an applied-stress-independent (Kres) term to the total tip stress intensity factor (Ktip), increasing the stress-enhanced diffusion and the shielding of the crack tip through swelling of the crack faces. SIGNIFICANCE: Residual stresses in the glass influence the crack growth behavior of veneered-ZrO2 bilayered dental prostheses. The role of water in crack growth might be of higher complexity when residual stresses are present in the glass layer.

Experimental and finite element study of residual thermal stresses in veneered Y-TZP structures.

The main complications of zirconia-based laminated systems are chipping and delamination of veneering porcelain, which has been found to be directly associated with the development of residual thermal stresses in the porcelain layer. This study investigates the effects of cooling rate and specimen geometry on the residual stress states in porcelain-veneered zirconia structures. Bilayers of three different shapes (bars, semi-cylindrical shells, and arch-cubic structures) with 1.5 mm and 0.7 mm thickness of dentin porcelain and zirconia framework, respectively, were subjected to two cooling protocols: slow cooling (SC) at 32 °C/min and extremely-slow cooling (XSC) at 2 °C/min. The residual thermal stresses were determined using the Vickers indentation method and validated by finite element analysis. The residual stress profiles were similar among geometries in the same cooling protocol. XSC groups presented significantly higher tensile stresses (p = 0.000), especially for curved interfaces. XSC is a time-consuming process that showed no beneficial effect regarding residual stresses compared to the manufacturer recommended slow cooling rate.

Influence of physical assessment of different light-curing units on irradiance and composite microhardness top/bottom ratio.

The aim of this study was to evaluate the influence of the physical assessment of different light-curing units from 55 dental offices on the irradiance and composite microhardness top/bottom ratio, and the influence of the radiometers for LED or QTH light sources on irradiance measurement. The irradiance of each light-curing unit was evaluated with two radiometers, either for LED or QTH light. A questionnaire regarding the type of source (LED or QTH), time of use, date of last maintenance and light-curing performance assessment applied. The physical assessments were evaluated regarding damage or debris on the light tip. For each light-curing unit, three composite specimens were made (diameter = 7 mm; thickness = 2 mm) with polymerizing time of 20 s, in order to perform the microhardness (Knoop) test. Data were analyzed by Kruskal-Wallis and Dunn test (α = 0.01). There was wide variation in irradiance (0-1000 mW/cm(2)). Approximately 50 % of the light-curing units presented radiation lower than 300 mW/cm(2); 10 % of light-curing units, especially those with LED source, presented values higher than 800 mW/cm(2), and 43 % of light-curing units worked with adequate irradiance between 301 and 800 mW/cm(2). In almost 60 % of cases, no maintenance of light-curing units was performed in a period of 3 to 10 years. The age of the light-curing units and the use of inadequate tips interfered negatively in irradiance. The data emphasize the importance of periodic maintenance of light-polymerizing, light-curing units.

Association of orthodontic force system and root resorption: A systematic review.

INTRODUCTION: In this systematic review, we assessed the literature to determine which evidence level supports the association of orthodontic force system and root resorption. METHODS: PubMed, Cochrane, and Embase databases were searched with no restrictions on year, publication status, or language. Selection criteria included human studies conducted with fixed orthodontic appliances or aligners, with at least 10 patients and the force system well described. RESULTS: A total of 259 articles were retrieved in the initial search. After the review process, 21 full-text articles met the inclusion criteria. Sample sizes ranged from 10 to 73 patients. Most articles were classified as having high evidence levels and low risks of bias. CONCLUSIONS: Although a meta-analysis was not performed, from the available literature, it seems that positive correlations exist between increased force levels and increased root resorption, as well as between increased treatment time and increased root resorption. Moreover, a pause in tooth movement seems to be beneficial in reducing root resorption because it allows the resorbed cementum to heal. The absence of a control group, selection criteria of patients, and adequate examinations before and after treatment are the most common methodology flaws.

Influence of fiber post cementation length on coronal microleakage values in vitro and finite element analysis.

AIM: This study aims to evaluate, the Influence of different fiber posts cementation lengths by finite element analysis (FEA) and coronal microleakage. MATERIALS AND METHODS: Fifty anterior bovine teeth were sectioned to obtain roots with 16 mm length. The coronal length of the post was 6 mm for all groups, while the radicular length were varied 6, 8, 10 or 12 mm. The fiber posts surfaces were cleaned with alcohol and silanized. Then the posts were cemented using a two steps total etch-and-rinse adhesive system + conventional resin cement. Forty teeth were submitted to mechanical cycling (45°; 2.000.000 cycles; 90N; 4Hz; 37°C) and ten teeth with radicular length of 12 mm was not submitted, ser ving as c ontrol. So, the experimental design was composed by different ratios of post coronal length/post radicular length and mechanical cycling (MC): Gr1- 1/1 + MC; Gr2- 3/4 + MC; Gr3- 3/5 + MC; Gr4- 1/2 + MC. All groups were immersed in a 1% toluidine blue solution. After 24 hours, the teeth were longitudinally sectioned and the microleakage scores was given by a blind operator. Data were submitted to Kruskal-Wallis test (p = 0.05). The experimental variables were simulated in two-dimensional finite element analysis (2D-FEA). The maximum principal stress distributions were compared. RESULTS: No difference was observed in microleakage values between the cycled groups, whilst the control groups showed the lowest values. FEA analysis showed similar maximum principal stress distribution between the groups. CONCLUSION: Mechanical cycling affected the values of coronal microleakage and different cementation length generated similar values of coronal microleakage and stress distribution. CLINICAL SIGNIFICANCE: These results showed that from the microleakage point of view, more conservative cementation lengths have the same effect as longer cementation lengths.

Experimental and FE displacement and polymerization stress of bonded restorations as a function of the C-Factor, volume and substrate stiffness.

OBJECTIVES: To determine the free surface displacement of resin-composite restorations as a function of the C-Factor, volume and substrate stiffness, and to compare the results with interfacial stress values evaluated by finite element analysis (FEA). METHODS: Surface displacement was determined by an extensometer using restorations with 4 or 6mm diameter and 1 or 2mm depth, prepared in either bovine teeth or glass. The maximum displacement of the free surface was monitored for 5 min from the start of photoactivation, at an acquisition rate of 1s(-1). Axisymmetric cavity models were performed by FEA. Structural stiffness and maximum stresses were investigated. RESULTS: For glass, displacement showed a stronger correlation with volume (r=0.771) than with C-Factor (r=0.395, p<0.001 for both). For teeth, a stronger correlation was found with C-Factor (r=0.709; p<0.001) than with volume (r=0.546, p<0.001). For similar dimensions, stress and displacement were defined by stiffness. Simultaneous increases in volume and C-Factor led to increases in stress and surface displacement. Maximum stresses were located at the cavosurface angle, internal angle (glass) and at the dentine-enamel junction (teeth). The displacement of the restoration's free surface was related to interfacial stress development. CONCLUSIONS: Structural stiffness seems to affect the shrinkage stress at the tooth/resin-composite interface in bonded restorations. Deep restorations are always problematic because they showed high shear stress, regardless of their width. FEA is the only tool capable of detecting shear stress due to polymerization as there is still no reliable experimental alternative.

Influence of specimen dimensions and their derivatives (C-factor and volume) on polymerization stress determined in a high compliance testing system.

OBJECTIVE: To verify the null hypothesis that in a high compliance testing system stress magnitude was not influenced by specimen dimensions and, therefore, by its cavity configuration factor (C-factor) and volume. METHODS: Twelve experimental groups were defined according to the specimen height (0.5, 1, 2 or 4mm) and diameter (4, 6 or 8mm). A selfcure composite (Bisfil 2B, Bisco) was inserted between the flat surfaces of two acrylic rods attached to the opposite ends of a universal testing machine. An extensometer with a gauge length of 10mm was attached to both rods to monitor specimen height. Force development was monitored for 30min and nominal stress was calculated dividing the maximum force value by the crossection of the rod. A second set of data was obtained dividing nominal stress by the corresponding longitudinal compliance (LC) of the system for that particular specimen size. Data was analyzed using two-way ANOVA/Tukey test (nominal stress), Kruskal/Wallis (normalized stress), both at alpha=5%, and regression analysis having either C-factor or volume as independent variable. RESULTS: Regression analysis involving nominal stress did not reveal strong relationships with the independent variables (C-factor: 0.437, volume: 0.662). A strong relationship was found between normalized stress and specimen volume (Radj(2)=0.886). Normalized stress showed no relationship with specimens' C-factor. Pairwise comparisons between groups with similar volumes revealed that normalized stress increased at higher C-factors. SIGNIFICANCE: By eliminating the influence of longitudinal compliance, a strong relationship between polymerization stress and specimen volume was revealed in a high compliance testing system.

Residual stresses in Y-TZP crowns due to changes in the thermal contraction coefficient of veneers.

OBJECTIVE: To test the hypothesis that the difference in the coefficient of thermal contraction of the veneering porcelain above (αliquid) and below (αsolid) its Tg plays an important role in stress development during a fast cooling protocol of Y-TZP crowns. METHODS: Three-dimensional finite element models of veneered Y-TZP crowns were developed. Heat transfer analyses were conducted with two cooling protocols: slow (group A) and fast (groups B-F). Calculated temperatures as a function of time were used to determine the thermal stresses. Porcelain αsolid was kept constant while its αliquid was varied, creating different Δα/αsolid conditions: 0, 1, 1.5, 2 and 3 (groups B-F, respectively). Maximum (σ1) and minimum (σ3) residual principal stress distributions in the porcelain layer were compared. RESULTS: For the slowly cooled crown, positive σ1 were observed in the porcelain, orientated perpendicular to the core-veneer interface ("radial" orientation). Simultaneously, negative σ3 were observed within the porcelain, mostly in a hoop orientation ("hoop-arch"). For rapidly cooled crowns, stress patterns varied depending on Δα/αsolid ratios. For groups B and C, the patterns were similar to those found in group A for σ1 ("radial") and σ3 ("hoop-arch"). For groups D-F, stress distribution changed significantly, with σ1 forming a "hoop-arch" pattern while σ3 developed a "radial" pattern. SIGNIFICANCE: Hoop tensile stresses generated in the veneering layer during fast cooling protocols due to porcelain high Δα/αsolid ratio will facilitate flaw propagation from the surface toward the core, which negatively affects the potential clinical longevity of a crown.

A method to investigate the shrinkage stress developed by resin-composites bonded to a single flat surface.

OBJECTIVES: To purpose a method for predicting the shrinkage stress development in the adhesive layer of resin-composite cylinders that shrink bonded to a single flat surface, by measuring the deflection of a glass coverslip caused by the shrinkage of the bonded cylinders. The correlation between the volume of the bonded resin-composite and the stress-peak was also investigated. METHODS: A glass coverslip deflection caused by the shrinkage of a bonded resin-composite cylinder (diameter: d=8 mm, 4 mm, or 2 mm, height: h=4 mm, 2 mm, 1 mm, or 0.5 mm) was measured, and the same set-up was simulated by finite element analysis (3D-FEA). Stresses generated in the adhesive layer were plotted versus two geometric variables of the resin-composite cylinder (C-Factor and volume) to verify the existence of correlations between them and stresses. RESULTS: The FEA models were validated. A significant correlation (p<0.01, Pearson's test) between the stress-peak and the coverslip deflection when the resin-composites were grouped by diameter was found for diameters of 2 and 4 mm. The stress-peak of the whole set of data showed a logarithmic correlation with the bonded resin-composite volume (p<0.001, Pearson's test), but did not correlate with the C-Factor. SIGNIFICANCE: The described method should be considered for standardizing the stress generated by the shrinkage of resin-composite blocks bonded to a single flat surface.

Assessment of nose protector for sport activities: finite element analysis.

There has been a significant increase in the number of facial fractures stemming from sport activities in recent years, with the nasal bone one of the most affected structures. Researchers recommend the use of a nose protector, but there is no standardization regarding the material employed. Clinical experience has demonstrated that a combination of a flexible and rigid layer of ethylene vinyl acetate (EVA) offers both comfort and safety to practitioners of sports. The aim of the present study was the investigation into the stresses generated by the impact of a rigid body on the nasal bone on models with and without an EVA protector. For such, finite element analysis was employed. A craniofacial model was constructed from images obtained through computed tomography. The nose protector was modeled with two layers of EVA (1 mm of rigid EVA over 2 mm of flexible EVA), following the geometry of the soft tissue. Finite element analysis was performed using the LS Dyna program. The bone and rigid EVA were represented as elastic linear material, whereas the soft tissues and flexible EVA were represented as hyperelastic material. The impact from a rigid sphere on the frontal region of the face was simulated with a constant velocity of 20 m s(-1) for 9.1 µs. The model without the protector served as the control. The distribution of maximal stress of the facial bones was recorded. The maximal stress on the nasal bone surpassed the breaking limit of 0.13-0.34 MPa on the model without a protector, while remaining below this limit on the model with the protector. Thus, the nose protector made from both flexible and rigid EVA proved effective at protecting the nasal bones under high-impact conditions.

Fraturas nasais em esportes: sua ocorrência e importância / Nasal fracture in sports: its occurrence and importance

Introdução: O aumento do número de participantes nas mais variadas modalidades desportivas e de praticantes em recinto fechado trouxe também um aumento significativo de traumas orofaciais nos esportes, principalmente fraturas nasais, que ocupam o terceiro lugar em ocorrência em todas as modalidades desportivas. Objetivo e revisão de literatura: Trazer conhecimento das causas, da ocorrência e da importância da fratura nasal no esporte, já que é de responsabilidade do cirurgião-dentista confeccionar meios de proteção bucomaxilofaciais nos esportes, área em que a Odontologia do Esporte vem se sedimentando. Conclusão: Um afastamento prolongado do atleta acarreta a ele grande prejuízo físico e psicológico, assim como prejuízo financeiro para seu clube. Deve-se ter atenção para meios de proteção para o atleta.

Introduction: The increasing number of participants in various sports, mainly those practiced indoors, brought a significant increase of orofacial injuries in sports, especially nasal fractures, which rank third in incidence in all sports. Objective and literature review: To study the causes, occurrence and importance of nasal fracture in sports, as providing ways of protecting the maxillofacial area in sports is the responsibility of the dentist, area in which Sports Dentistry is establishing itself. Conclusion: A long athlete withdrawal carries great physical and psychological damage, as well as financial loss to his club. Attention in providing ways of protection for the athlete is required.