Cusp reinforcement by bonding of amalgam restorations

The purpose of the present study was to assess the effectivenes of several adhesives in bonding amalgam in order to recover tooth stiffness. A non-destructive experimental methodology was adopted, using strain gauges bonded to the midbuccal surfaces of 40 teeth, with sequential evaluation of loaded intact, prepared and restored stages of the same tooth. Continuous strain measurement as a function of the applied load was acquired by A/D equipment and a data acquisition programme. The strain-force behaviour of the sound teeth under non-axial force up to 97.5 N served as the baseline. The five experimental groups (8 x 5) consisted of control (no adhesive) and four different adhesives. One-way analysis of variance with repeated measures was calculated for the deformation ratio, relative stiffness and recovery values. Reductions in tooth structure by cutting a mesio-occlusal-distal preparation, width one-third intercuspal distance, resulted in 39-52% loss of buccal cusp stiffness. Non-bonded amalgam produced negligible increase (5%) in the stiffness recovery values of the buccal cusps. The adhesives splinted the cusps together, thereby decreasing cuspal flexure and increasing relative stiffness values. Recovery values obtained ranged from 39% to 61%. Assuming that cusp fracture occurs as a result of brittle tooth structure fatigue, amalgam adhesives may contribute to the strengthening of weakened cusps.