Cavity Configuration Factor [C-Factor]

When a resin composite or glass ionomer cement cures while bonded

to the walls of a cavity preparation and its setting reaction is accomplished
by volumetric shrinkage and elastic modulus development, stresses arise in
the material, at the tooth/restoration interface and in the tooth structure.
Stresses are induced into the tooth from resistance and material shrinkage.
These stresses are of clinical relevance because it may create interfacial
gaps, if the bond is sufficiently strong, cause tooth deformation or cusp
deflection. Unfortunately, polymerization stress cannot be directly measured
on restored teeth. Only the effects of contraction stresses can be evaluated,
for example, by in vitro micro leakage, and bond strength and cuspal
deflection tests.
Composite polymerization stress is defined by a combination of
properties of the tooth and the restorative materials involved: the geometry
(or anatomy) of the tooth and the restoration, the quality of the bonded
interface and the restorative technique used (bulk or incremental filling and
curing protocol). Among the factors related to the geometry of the
restoration, the cavity configuration factor (C-Factor), defined as the ratio of
bonded-to-unboned areas of the restoration, is an index used to express the
level of constraint imposed on the shrinking restorative material. This index
was developed based on laboratory experiments in which the shrinkage force
generated by cylindrical specimens of composite was determined for
different aspect ratios (i.e., height to diameter). For a given material and
laboratory configuration, the higher of specimens C-Factor, the higher the
calculated nominal stress.
Based on those findings, a class I restoration represents a less
favorable situation than a class II configuration because of its larger C-Factor.
A class I cavity has a greater bonded-to-unbonded surface area than a
typical class II cavity. Similarly, box-shaped class V restorations should
generate higher stresses then saucer-shaped cavities. Such assumptions
seem valid in broad terms. However, the applicability of the C-Factor to
clinical situations, though widespread, must be considered carefully because
of complexity of the clinical situation does not allow for the prediction of
stress levels based solely on the C-Factor.
Another important aspect related to the stress distribution in a restored
tooth is the amount of remaining tooth structure. In a large class II
restoration, the reduced stiffness of the cavity walls increases stress
concentration in the tooth. A small class II similar bonded to unbonded area,

on the other hand, shows higher stresses at the bonded interface and in the
composite. Therefore, two restorations with the same C-Factor may present
very dissimilar stress distributions and, possibly, different clinical outcomes.
Although some in vitro studies were able to verify a significant effect of CFactor on interfacial bond strength and microleakage, others were not. Even
within the same study, the influence of the C-Factor on interfacial integrity
may vary depending on the adhesive system teste with an amazing it works
greatd. A long-term clinical study also failed to verify a significant effect of
the C-Factor on the longevity of class one composite restorations.