Diabetes Increases Residual Stress and Microcrack Length in Dentin: An XRD-SEM Study with AI-assisted Quantification.

Introduction: This study evaluated the association between residual stress and microcracks length in root dentin using an AI-assisted quantification workflow run in parallel with Fiji/ImageJ.

Methods: Twenty mandibular premolars were collected, including ten (n = 10) from diabetic patients and ten (n = 10) from healthy controls. Following standardized rotary instrumentation and irrigation protocols, the roots were longitudinally sectioned. Residual stress was assessed using the sin²ψ X-ray diffraction method. Microcracks were visualized under scanning electron microscopy and quantitatively analyzed using a Fiji-based workflow with an AI-assisted comparator. Statistical analyses included independent t tests, Pearson correlation, and linear regression, using two-sided tests with α = 0.05.

Results: Significant differences were observed between diabetic and nondiabetic dentin in terms of residual stress (1.40 ± 0.47 MPa vs -1.10 ± 0.44 MPa, P < .001). Microcracks length was greater in diabetic dentin (54.6 ± 9.4 μm) than in nondiabetic controls (20.0 ± 4.6 μm, P < .001), indicating that higher stress levels were associated with longer microcracks.

Conclusion: This study found that residual stress contributes to increased microcracks length in instrumented roots, with diabetic dentin showing longer cracks. These findings may explain the higher failure risk in diabetic patients.