In the recent years, there has been an increasing interest in the research of biomechanical aspects of biomaterials and human tissues (1-3). Although studies conducted in vivo and in vitro have provided some of the answers in this field, dental and medical research is usually costly, and may be ethically questionable and time-consuming (4,5). Because of this, the use of numerical models and in vitro simulations became a valuable tool for saving time and money associated with laboratory and clinical research (6). Previous studies have reported different techniques for generating three-dimensional (3D) solid models of the teeth (7-9). Nowadays, technological development brings new possibilities for efficient generation of sophisticated 3D solid models. For example, using specialized software, these models can be generated based on computed-tomography (CT) scan data (5,10-12). In addition, the application of finite element analysis (FEA) allows calculation of stress and strain within tooth structure and biomaterials, which can hardly be measured in vivo (13). Cavity design preparation has a great impact on stress values and fracture resistance of a tooth (7,14-16). It is a factor of a paramount importance, especially in cases of restoring maxillary premolars with extensive mesio-occlusal-distal (MOD) cavities (14,17,18). From the biomechanical point of view, different opinions have been reported on the most appropriate restorative procedure in such cases. Kuijs et al have found that ceramic, indirect resin composite and direct resin composite provide comparable fatigue resistance in a cusp replacing restorations (19). These findings were supported by clinical trials performed by van Dijken and Hickel et al (20,21). On the other hand, Soares et al found that MOD cavities restored with resin composite placed with direct technique attained better biomechanical performance than those restored with laboratory processed resin and ceramic restorations (15,16). Another study also confirmed that in comparison with ceramic restorations, resin composite restoration had higher fatigue resistance (17). As opposed to preparation for direct restoration, cavity preparation for indirect restorations requires removal of additional amount of tooth structure (22). The situation is the same with the cavity preparation for the amalgam (23). Since the quantity of the tooth structure removed while doing cavity preparation affects the biomechanical characteristics of the restored tooth, the use of adhesive direct restorations should be recommended for reinforcing the remaining dental structure (2,16). When planning the design of MOD cavity preparation, cavity wall thickness and cusp reduction should be carefully considered. Usually, cusp reduction is recommended when cavity isthmus width is 2/3 of intercuspal width (7,24). Although this promotes more dental tissue reduction (25), it was shown that the reduction of cuspal height by 2.0 mm increases fracture resistance of a premolar when restored with direct resin composite (26,27). On the other hand, cavity wall thickness is not well defined. Macpherson et al found that 2.25 mm wall thickness is critical for restoring fracture resistance of tooth with MOD cavity (28), but another study, which investigated 1.0-3.0 mm wall thicknesses, reported that the thickness of remaining cavity walls was not relevant to fracture resistance (27). The aim of this study was to investigate the effect of cavity design preparation on stress values in remaining tooth structures restored with resin composite. The null hypothesis was that stress values were not significantly influenced by the cavity wall thickness and cusp reduction.