RESEARCH REPORTS

Biomaterials & Bioengineering

J.J.-.W. Lee1*, J.-Y. Kwon2, H. Chai3, P.W. Lucas4, V.P. Thompson5, and B.R. Lawn1
Ceramics Division, National Institute of Standards and Technology, Gaithersburg, MD 20899-8520, USA; 2School of Nano and Advanced Materials Engineering, Changwon National University, Changwon, Kyung-Nam, Korea; 3School of Mechanical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel; 4Department of Anthropology, George Washington University, Washington, DC 20052, USA; and 5New York University College of Dentistry, New York, NY 10010, USA; *corresponding author, james.lee@ nist.gov J Dent Res 88(3):224-228, 2009
1

Fracture Modes in Human Teeth

INTRODUCTION

Abstract
The structural integrity of teeth under stress is vital to functional longevity. We tested the hypothesis that this integrity is limited by fracture of the enamel. Experiments were conducted on molar teeth, with a metal rod loaded onto individual cusps. Fracture during testing was tracked with a video camera. Two longitudinal modes of cracking were observed: median cracking from the contact zone, and margin cracking along side walls. Median cracks initiated from plastic damage at the contact site, at first growing slowly and then accelerating to the tooth margin. Margin cracks appeared to originate from the cementoenamel junction, and traversed the tooth wall adjacent to the loaded cusp from the gingival to the occlusal surface. All cracks remained confined within the enamel shell up to about 550 N. At higher loads, additional crack modessuch as enamel chipping and delaminationbegan to manifest themselves, leading to more comprehensive failure of the tooth structure.

Key words: dental enamel, fracture modes, median cracks, margin cracks, occlusal loading.

DOI: 10.1177/0022034508330055 Received June 23, 2008; Last revision October 15, 2008; Accepted November 17, 2008

he manner in which enamel survives or fails in oral function is important to the understanding of tooth longevity in humans and other vertebrates (Lucas, 2004). Little is known about the fundamental nature of enamel fracture processes, particularly in relation to tooth geometry and underlying material microstructure. Teeth are remarkably resilient, and can withstand a considerable degree of cracking before failing catastrophically. Anecdotal evidence in the dental literature describes various forms of tooth splitting and chipping, with fracture confined primarily to the enamel coat, up to exceptionally high loads (Maas and Dumone, 1999). There is the suggestion that fractures originate from intrinsic defects within the enamel, such as tuftshypocalcified fissures extending outward from the dento-enamel junction (DEJ) (Sognnaes, 1949; Osborn, 1969; Lucas, 2004). These defects tend to lie along planes of weakness within the organic sheaths that delineate the enamel prisms. However, there are also indications that certain forms of extrinsic defects can be introduced during mastication, by inter-prism slippage immediately below the occlusal contact (He and Swain, 2007a, 2008). To date, the number of attempts to quantify these fracture processes in relation to biting forces (typically in the range 100 to 400 N) has been limited (Popowics et al., 2001, 2004). In contrast, the nature of failure modes in dental crowns has been welldocumented in the materials science literature (Lawn et al., 2001, 2007; Rekow and Thompson, 2007). The most revealing evidence comes from model crown structures consisting of glass shells back-filled with a polymeric compound and loaded at their top surface with a simulated occlusal contact (Qasim et al., 2005, 2006; Kim et al., 2007; Whitton et al., 2008). While such structures are oversimplistic, especially in geometric aspects, they nevertheless reproduce the essential fracture modes observed clinically. Glass is conveniently transparent, facilitating direct observation of fracture evolution. Some of the important fracture modes are indicated schematically (Fig. 1). Those cracks represented by shading contours are contained within the plane of the diagram, and propagate longitudinally (axially) along the shell wall. Radial cracks (Rad) are generated by flexural stresses at the glass undersurface below the contact, and dominate in thin shells loaded with hard indenters (Chai et al., 1999; Kelly, 1999). Margin cracks (Mar) initiate at the tooth base, and are favored in thin shells loaded with soft indentersa soft contact spreads the load at the top surface, transmitting tensile stress concentrations to the support regions (Qasim et al., 2007; Ford et al., 2008). Both these crack types initiate from preparation flaws in the shell interior wall. In thick shells, the load is borne primarily in the near-contact region by Hertzian stresses. Cone cracks (Con) originate from surface flaws in tensile regions outside the contact, and are axisymmetric about the load axis (Frank and Lawn, 1967; Peterson et al., 1998). Median cracks (Med)

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originate from tensile concentrations below plastic deformation zones (Lawn et al., 1980; Jung et al., 2000). Cone cracks dominate in highly brittle materials, median cracks in more deformable materials. All these crack types remain confined within the shell, and penetrate the polymeric sublayer only at excessively high loads. The question is which, if any, of these fracture modes is/are responsible for the failure of natural teeth. Relative to the glasse used in the model experiments and the porcelain used in dental crowns, tooth enamel possesses a highly oriented prism microstructure, and is more deformable (He and Swain, 2007b). To address this question, we conducted fracture experiments on extracted third molar teeth by loading their cusps with a hard disk indenter and viewing fractures in situ with a video camera. We focused on molars because they sustain the highest functional loads. The use of a hard contact was taken as a worst case, representative of biting on a hard food or foreign object.

Med

Con Rad

Enamel

Mar Dentin Y

MATERIALS & METHODS

Extracted third molar teeth were obtained from the American Dental Association laboratories at the National Institute of Standards and Technology, with full patient consent and according to an IRB-approved protocol. These teeth were from persons 18 to 25 yrs old, and were kept in aqueous solution prior to being tested. Average tooth width was 10 mm and crown height 7.5 mm. Cursory examination of their surfaces revealed the pre-existence of crack-like defects of various lengths in many cases, extending from the enamel margins toward the cuspal area. Individual teeth (N = 25) were mounted with roots embedded in an epoxy block. The specimens were placed onto the platform of a mechanical testing machine with cusps uppermost. They were kept moist by being replenished with squirts of water during testing. Load was applied vertically at the most prominent cusp of each tooth with the flat end of a tungsten carbide (WC) rod, representative of local biting on hard food or a foreign object. A video camera was used for in situ viewing of crack growth around the buccal or lingual wall adjacent to the loaded cusp. Oblique lighting was adjusted to provide optimum contrast at the fracture sites. Crack-front positions were measured from video clips as a function of applied load during testing (Fig. 1). Some additional tests were made with a spherical WC indenter of 3.2 mm radius centered between the molar cusps. These tests were meant to determine the effect of load redistribution at the occlusal surface. To investigate the crack morphology, we obtained transverse sections (parallel to the occlusal plane) by serial polishing to a 1-m diamond paste finish.

Figure 1. Schematic showing main sources of fracture in brittle shell structure, radial (Rad), median (Med), margin (Mar), and cone (Con). (Representation ignores such details as local cusp radius and variations in enamel thickness.) All shaded cracks shown lie in the plane of the Fig. and extend longitudinally through enamel (shading indicates progressing crack fronts). Cone crack is axisymmetric with surfaces normal to the plane of the diagram.

RESULTS
In situ observations revealed clear evidence of the evolution of 2 dominant fracture modes during loading. An example is shown for a test with a WC rod indenter on a single cusp (Fig. 2). The first sign of damage was an irreversible plastic flattening of the cusp, followed by emergence of median cracks from the plastic zone (Fig. 2a). Increasing the load drove these cracks along the side face of the tooth in a stable manner, until they reached the suprabulge of the tooth crown, at which point they stabilized. No detectable load drops were observed up to

this stage of crack evolution. In most of the teeth examined, margin cracks also propagated longitudinally during the loading, but in an opposite direction. In the example shown, this crack appeared somewhere between the intermediate load (Fig. 2b) and the high load (Fig. 2c). In other cases, margin cracks appeared at lower or higher loads, depending on the presence (or otherwise) of pre-existing cracks in the side walls. Once they began propagating, these cracks grew quickly beyond the suprabulge toward the cusp. Again, no detectable load drops were observed to this point. To quantify the crack growth responses, we measured crack sizes for a selected number of teeth (N = 15) as a function of load P (Fig. 3). Coordinate X denotes the vertical distance between the tip of the median crack and cuspal contact, coordinate Y the distance between the tip of the margin crack and the cemento-enamel junction (CEJ) at nominal height 7.5 mm (Fig. 1). Median cracks initiated at P < 100 N and grew steadily to the margin at P = 450900 N. In the case of margin cracks, initiation began from dormant tufts at P = 200400 N and propagated stably along the enamel, ultimately reaching the cusp at P = 300450 N. In some cases (Fig. 3), median and margin cracks propagated simultaneously (filled symbols), whereas in others one crack

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7.5 Median crack size, X (mm) C

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Median crack

5.0

2.5

C 0 200 400 600 800 1000

7.5 Margin crack size, Y (mm)

5.0

2.5 Margin crack 0 C 0 200 400 600 800 1000 Occlusal load, P (N)

Figure 2. In situ side views of molar loaded at a cusp with metal plate, at force (a) 101 N, (b) 322 N, and (c) 371 N, showing propagation of longitudinal median (Med) and margin (Mar) cracks.

Figure 3. Plot of crack dimension X (medians) and Y (margins) as function of load P (N = 15 specimens). Note different scales on vertical axis. Horizontal dashed lines in the lower diagram indicate dormant pre-existing margin crack; vertical lines indicate abrupt jumps in crack size. Each symbol represents different tooth. Filled symbols indicate cases where median and margin cracks were observed simultaneously; unfilled symbols indicate one dominant crack type. (Filled diamond symbols correspond to tooth in Fig. 2.) C--C denotes load above which chipping occurs.

dominated the other (unfilled symbols). Manipulation of the lighting indicated a ribbon-like, longitudinal crack geometry for both crack types, with no crack penetration into the dentin. Overloading led to extensive plasticity and accompanying proliferation of cracking, with chipping and more catastrophic failure from delamination of the enamel from the dentin at P = 500850 N, or by longitudinal splitting of the entire tooth at P = 10001200 N. These events were preceded by flattening of the load-displacement response, followed by substantial load drops. Limited cone cracking was observed at these overloads. Interestingly, no subsurface radial cracks of the kind seen in thin glass domes were identified in the teeth tested, indicating that the enamel was sufficiently thick to minimize flexural stresses. Loading with a spherical indenter of radius 3.2 mm seated between the cusps tended to suppress median cracks, by redistributing the load onto more than one cusp, but had little effect on the growth of margin cracks.

Means and standard deviations of critical loads for each crack type were measured on all mounted teeth (N = 25): for median cracks to reach the margin, 666 195 N; for margin cracks to reach the occlusal cusp, 353 82 N; for enamel delamination and chipping, 673 175 N. Optical micrographs of transverse sections through a molar cusp loaded with a WC rod to 450 N confirmed the longitudinal nature of the subsurface crack patterns (Fig. 4). In shallow sections (Fig. 4a), the dentin is not exposed. The fracture traces emanating from the contact zone are median cracks. These cracks remained visible with continued polishing until they disappeared at a depth 2 mm. In the second section (Fig. 4b), portions of both the enamel and dentin are visible. The features traversing from the DEJ to the enamel outer surface are margin cracks. These cracks appear to emerge from tufts at the DEJ.

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DISCUSSION
This study identifies the principal fracture modes in human molar teeth in cusp loading. Longitudinal median and margin cracks appear dominant. Cracks develop at relatively low loads, or pre-exist, and grow steadily with increasing load to circumferential envelopment at much higher loads, typically at 300500 N. At this point, the tooth might appear to be on the verge of total fracture, but the tests reveal no reduction in capacity to support the applied load until levels in excess of 550 N (Popowics et al., 2001). It is the capacity of severely cracked teeth to remain intact while continuing to support high loads that gives them their remarkable damage tolerance. Part of this tolerance is attributable to the unique structure whereby highly stabilized cracks remain confined to the brittle enamel coat without compromising the underlying dentinal support. Part may also be due to a process of self-repair by infusion of organic matter into fissures from fluids within the dentin interior or from saliva in the oral cavity. The origins of the 2 primary crack systems observed here war- Figure 4. Sequential transverse section views through molar cusp loaded to 450 N. Depth polished from rant further consideration. Margin top surface: (a) 0.6 mm, (b) 4.4 mm. Dentin is exposed in (b). Magnified view of portion of (b) shown cracks appear to originate from in inset at upper right. Comparison with in situ side views enables the identification of individual cracks intrinsic tufts within the enamel at as median or margin. Margin cracks appear to initiate from tufts (T). White circle indicates top surface the DEJ. These defects are com- area of plastic contact. Note different scales in two micrographs. monplace in dentition (Osborn, Once initiated, the median cracks grow toward and intersect the 1969) and evolve with age of the patient from continual oral DEJ, assuming a geometry not unlike that of their subsurface radial function. Despite intrusion of organic matter into the fissures counterparts (Chai and Lawn, 2006). At this point, the cracks are (Palamara et al., 1989), interfacial closure and healing are driven primarily by flexural stresses, in which case the failure condiunlikely to be complete, so the defects remain prime sources for tion is dependent on enamel thickness (Rudas et al., 2005). As ensuing crack extension. Such extensions are noted directly in indicated, margin cracks grow out of pre-existing internal defects transverse sections. Decussation (crossing) of the rod structure (Popowics et al., 2004). The intensity of the tensile stresses will then adjacent to the CEJ and DEJ could complicate the crack path, be determined by the cross-sectional area of the enamel shell in the thus inhibiting propagation (Osborn, 1973). In contrast, median vicinity of the margin, and thus depend on both cusp radius and cracks appear to initiate from extrinsic defects within a quasi-plasenamel thickness. Detailed fracture mechanics studies are needed to tic yield zone immediately below the contact. Slippage interfaces or establish relationships between the critical loads to generate these 2 shear faults are well-known in brittle ceramics to act as stress crack types and underlying geometry and material parameters. intensifiers for crack initiation (Lawn and Evans, 1977), except The observed dominance of median and margin cracks does that, in teeth, the slip faults and ensuing cracks generate preferennot exclude the existence of other fracture modes in exceptional tially on inter-prism surfaces (He and Swain, 2007a, 2008). circumstances. Subsurface radial cracks may be favored in cases Whereas considerable attention has been given in the literature to where the enamel coat is unusually thin and/or the cuspal radius analysis of radial and cone cracks in brittle coatings (Lawn et al., uncommonly large, as in some mammals (Lucas et al., 2008). 2001, 2007), somewhat less has been given to margin and median These cracks are likely to initiate from tufts at the DEJ. They cracks. The generation of median cracks requires precursor plasticmight also occur in human teeth in which the enamel has been ity, favored by concentrated loads at small local cusps in contact thinned by excessive wear and bruxing. Once developed, radial with hard food objects (Peterson et al., 1998; Lucas et al., 2008).

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cracks are expected to propagate in a manner similar to that of medians, i.e., traversing the cuspal region past the suprabulge to the margin. Chipping failures are observed at overloads, by linkage of median/margin cracks, resulting, in some cases, in detachment of enamel flakes from the dentin. Cone cracks can also occur, but we observe them only at overloads, well after the initiation of medians. These cracks are not favored by the enamel microstructure, because they would have to grow laterally relative to the prisms, corresponding to a direction of high toughness (Xu et al., 1998). Dentin fracture occurs only at exceptionally high loads (Popowics et al., 2001). The balance between competing fracture modes could also be altered by changes in the simulated biting configuration, e.g., off-axis or tangential loading (Qasim et al., 2006; Zhang et al., 2008), cyclic loading, etc.

ACKNOWLEDGMENTS
Funding from the GWU Strategic Plan for Academic Excellence and support of GWU Vice-President Lehman are gratefully acknowledged, as is support from an NSF/IGERT grant (no. 9987590). Extracted human teeth were supplied by the American Dental Association at NIST.

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