Impact wear behavior of human tooth enamel under simulated chewing conditions

Characterizing the microstructures of mammalian enamel by synchrotron phase contrast microCT

The enamel of mammalian teeth is a highly mineralized tissue that must endure a lifetime of cyclic contact and is inspiring the development of next-generation engineering materials. Attempts to implement enamel-inspired structures in synthetic materials have had limited success, largely due to the absence of a detailed understanding of its microstructure. The present work used synchrotron phase-contrast microCT imaging to evaluate the three-dimensional microstructure of enamel from four mammals including Lion, Gray Wolf, Snow Leopard, and Black Bear. Quantitative results of image analysis revealed that the decussation pattern of enamel consists of discrete diazone (D) and parazone (P) bands of rods organized with stacking arrangement of D+/P/D-/P in all mammals evaluated; the D+ and D- refer to distinct diazone bands with juxtaposed rod orientations from the reference plane. Furthermore, the rod orientations in the bands can be described in terms of two principal angles, defined here as the pitch and yaw. While the pitch angle increases from the outer enamel to a maximum (up to ≈ 40°) near the dentin enamel junction, minimal spatial variations are observed in yaw across the enamel thickness. There are clear differences in the decussation parameters of enamel across species that are interpreted here with respect to the structural demands placed on their teeth. The rod pitch and band width of enamel are identified as important design parameters and appear to be correlated with the bite force quotient of the four mammals evaluated. STATEMENT OF SIGNIFICANCE: The multi-functionality of tooth enamel requires both hardness and resistance to fracture, properties that are generally mutually exclusive. Ubiquitous to all mammalian teeth, the enamel is expected to have undergone adaptations in microstructure to accommodate the differences in diet, body size and bite force across animals. For the first time, we compare the complex three-dimensional microstructure of enamel from teeth of multiple mammalian species using synchrotron micro-computed tomography. The findings provide new understanding of the "design" of mammalian enamel microstructures, as well as how specific parameters associated with the decussation of rods appear to be engineered to modulate its fracture resistance.

Comparative study on the impact-sliding wear behaviour of CAD/CAM resin-ceramic materials and tooth enamel

OBJECTIVES

To compare the impact-sliding wear of different CAD/CAM resin-ceramic materials and tooth enamel, and explore the corresponding wear damage mechanism.

METHODS

Human tooth enamel (EN), Vita ENAMIC (Vita, VE), Lava Ultimate (3 M, LU), and GC CERASMART (GC, CS) were used in this study. The hardness, elastic modulus, and roughness values of the samples were measured. Further, impact-sliding wear tests were performed in a ball-on-flat configuration with spherical zirconia antagonists and the coefficients of friction (CoF) were recorded simultaneously. Additionally, a white light interferometer was used to determine the volume losses and scanning electron microscopy was used to observe the wear morphology of the wear scars and the damage feature in the vertical sections to clarify the damage mechanism during the impact-sliding wear test.

RESULTS

EN exhibited the highest elastic modulus and CoF, followed by VE, LU, and CS. The hardness and roughness of EN and VE were similar and were higher than those of LU and CS. Throughout the wear tests, VE exhibited the highest volume loss, whereas CS exhibited the lowest. The wear damage characteristics of VE were similar to those of EN, displaying brittle fractures of inorganic substances and plastic deformation of organic substances in the impact part, exhibiting plough marks in the sliding parts. In the case of LU and CS, the entire wear areas displayed plastic deformation of the resin matrix, exfoliation of the filler particles, and plough marks.

SIGNIFICANCE

Enamel and polymer-infiltrated ceramic network materials exhibit similar wear damage modes. Additionally, the high-density nanocomposite resin material is the most resistant to impact-sliding wear from a tribological perspective.

Review of Cracked Tooth Syndrome: Etiology, Diagnosis, Management, and Prevention

Cracked tooth syndrome refers to a series of symptoms caused by cracked teeth. This article reviews the current literature on cracked tooth syndrome from four aspects, etiology, diagnosis, management, and prevention, to provide readers integrated information about this. The article begins with an introduction to the odontiatrogenic factors and then covers the noniatrogenic factors that induce cracked tooth syndrome. While the former discusses inappropriate root canal therapy and improper restorative procedures, the latter covers the topics such as the developmental and functional status of cracked tooth syndrome. This is then followed by the description of common clinical diagnosis methods, the prospects of new technologies, and summaries of current clinical management methods, including immediate management and direct and indirect restoration. In the final section, preventive methods and their importance are proposed, with the aim of educating the common population.

Wear evaluation of CAD-CAM dental ceramic materials by chewing simulation

PURPOSE

To evaluate the wear of computer-aided design/computer-aided manufacturing (CAD-CAM) dental ceramic materials opposed by enamel as a function of increased chewing forces.

MATERIALS AND METHODS

The enamel cusps of healthy human third molar teeth (n = 40) opposed by materials from CAD-CAM dental ceramic groups (n = 10), including Vita Enamic® (ENA), a polymer-infiltrated ceramic network (PICN); GC Cerasmart® (CERA), a resin nanoceramic; Celtra® Duo (DUO), a zirconia-reinforced lithium silicate (ZLS) ceramic; and IPS e.max ZirCAD (ZIR), a polycrystalline zirconia, were exposed to chewing simulation (1,200,000 cycles; 120 N load; 1 Hz frequency; 0.7 mm lateral and 2 mm vertical motion). The wear of both enamel cusps and materials was quantified using a 3D laser scanner, and the wear mechanisms were evaluated by scanning electron microscopy (SEM). The results were analysed using Welch ANOVA and Kruskal Wallis test (α = .05).

RESULTS

ZIR showed lower volume loss (0.02 ± 0.01 mm³) than ENA, CERA and DUO (P = .001, P = .018 and P = .005, respectively). The wear of cusp/DUO [0.59 mm³ (0.50-1.63 mm³)] was higher than cusp/CERA[0.17 mm³ (0.04-0.41 mm³)] (P = .007). ZIR showed completely different wear mechanism in SEM.

CONCLUSION

Composite structured materials such as PICN and ZLS ceramic exhibit more abrasive effect on opposing enamel due to their loss against wear, compared to uniform structured zirconia. The resin nanoceramic causes the lowest enamel wear thanks to its flexible nano-ceramic microstructure. While zirconia appears to be an enamel-friendly material in wear volume loss, it can cause microstructural defects of enamel.

Surface Hardening Behavior of Enamel by Masticatory Loading: Occurrence Mechanism and Antiwear Effect

Previous studies have suggested that surface hardening occurs in human tooth enamel under certain loading conditions. However, the occurrence mechanism and significance remain unclear. In this study, the surface hardening behavior of enamel under masticatory loading was studied in vitro using impact treatment and the nanoindentation/scratch technique to identify the mechanism and antiwear effect. The fundamental block of enamel is made of hydroxyapatite (HAP) nanofibers, which consist of fine nanoparticles held together by protein. These fibers respond to masticatory loading in two ways: bending deflection at low loads and fragmentation at high loads. When the contact pressure exceeds the bonding strength between the nanoparticles, the HAP fibers split into fine nanoparticles and then form a surface layer consisting of tightly packed nanoparticles. This results in surface hardening dominated by an increased hardness and elastic modulus. The maximum degree and depth of surface hardening were determined as approximately 60% and 100 nm, respectively. With the occurrence of surface hardening, the wear resistance of the enamel is enhanced, which is manifested by a reduced friction coefficient and wear volume. In summary, the surface hardening of enamel induced by masticatory loading is a result of HAP nanoparticle rearrangement as a response of the enamel hierarchical structure to high chewing loads. It is adaptive overload protection derived from the enamel hierarchical structure and plays a critical role in resisting excessive wear induced by high chewing loads.

Two-body wear test of enamel against laboratory polished and clinically adjusted zirconia

AIM

A two-body wear test experiment was performed on human enamel, in simulated chewing motion, against non-veneered zirconia ceramic. Aim-1 was to ascertain the effect of zirconia roughness on enamel wear. Aim-2 was to ascertain the relative enamel wear between enamel-zirconia wear pair and enamel-enamel control pair.

MATERIALS

Six molar and premolar human enamel cusps per group were used for a dental wear test against laboratory polished (LP) zirconia and laboratory polished and clinically adjusted (LP + CA) zirconia. Enamel antagonists were tested against incisor teeth as a control group to demonstrate laboratory enamel wear.

METHODOLOGY

Two-body wear tests were conducted in a dual-axis biomimetic dental wear simulator. 49N loading force was used for 120,000 cycles with 1 mm lateral movement of the test specimen at 1.6Hz frequency, under constant ambient temperature water flow. Surface roughness before testing was determined using 3D profilometry. Loss of enamel height and volume i.e. vertical wear and volumetric wear respectively, were measured by superimposition of before and after testing scans by 3D laser scanning. Scanning electron microscopy was used for surface morphology assessment. One-way ANOVA and Post Hoc Multiple Comparisons with Bonferroni corrections were used at the 5% significance level to determine whether surface finish affected volumetric and vertical enamel loss. The relationship between volumetric and vertical loss of enamel was assessed using Pearson's correlation test.

RESULTS

No significant difference was found between LP and LP + CA zirconia in vertical and volumetric enamel wear results. Control enamel had significantly higher vertical and volumetric enamel wear than LP and LP + CA zirconia. Pearson correlation revealed a strong relationship between vertical wear and volumetric wear of enamel.

CONCLUSION

Within the constraints of the test method in this experiment, zirconia irrespective of surface preparation, was found to cause less vertical and volumetric enamel wear compared to control enamel. No statistically significant difference was seen between LP zirconia and LP + CA zirconia.

Influence of zirconia and lithium disilicate tooth- or implant-supported crowns on wear of antagonistic and adjacent teeth

PURPOSE

To investigate the influence of crown material (lithium-disilicate, 3Y-TZP zirconia) and abutment type (rigid implant, resin tooth with artificial periodontium) on wear performance of their antagonist teeth and adjacent teeth.

MATERIALS AND METHODS

A mandibular left first molar (#36) with adjacent human teeth (mandibular left second premolar: #35, mandibular left second molar: #37) and antagonistic human teeth (maxillary left second premolar: #25, maxillary left first molar: #26, maxillary left second molar: #27) was prepared simulating a section of the jaw. Samples were made with extracted human molars (Reference), crowned implants (Implant), or crowned resin tooth analogues (Tooth). Crowns (tooth #36; n = 16/material) were milled from lithium-disilicate (Li, IPS e.max CAD) or 3Y-TZP zirconia (Zr, IPS e.max ZirCAD, both Ivoclar Vivadent). Thermal cycling and mechanical loading (TCML) in the chewing simulator were applied simulating 15 years of clinical service. Wear traces were analyzed (frequency [n], depth [µm]) and evaluated using scanning electron pictures. Wear results were compared by one-way-ANOVA and post-hoc-Bonferroni (α = 0.05).

RESULTS

After TCML, no visible wear traces were found on Zr. Li showed more wear traces (n = 30–31) than the reference (n = 21). Antagonistic teeth #26 showed more wear traces in contact to both ceramics (n = 27–29) than to the reference (n = 21). Strong wear traces (> 350 µm) on antagonists and their adjacent teeth were found only in crowned groups. Abutment type influenced number and depth of wear facets on the antagonistic and adjacent teeth.

CONCLUSION

The clinically relevant model with human antagonistic and adjacent teeth allowed for a limited comparison of the wear situation. The total number of wear traces and strong wear on crowns, antagonistic and adjacent teeth were influenced by crown material.

Evaluation of Wear Resistance of Dental Chairside CAD/CAM Glass Ceramics Reinforced by Different Crystalline Phases

The mechanical properties of crystalline phase of glass ceramics are critical. This study aimed to evaluate wear resistance of different crystalline-reinforced dental chairside computer-aided design/computer-aided manufacturing (CAD/CAM) glass ceramics. Materials of feldspar (Vita Mark II, VM), leucite (IPS Empress CAD, EC), lithium disilicate (IPS e.max CAD, EX), lithium disilicate enriched with zirconia (Vita Suprinity, VS), and enamel were embedded, grounded, and polished, respectively. Samples were indented with a Vickers hardness tester to test the fracture resistance (KIC). Two-body wear tests were performed in a reciprocal ball-on-flat configuration under artificial saliva. The parameters of load force (50 N), reciprocating amplitude (500 μm), frequency (2 Hz), and the test cycle (10,000 cycles) were selected. Specimen microstructure, indentation morphology, and wear scars were observed by scanning electron microscope (SEM), optical microscopy, and three-dimensional profile microscopy. EX, VS, and EC demonstrated significantly higher KIC values than the enamel, while ceramic materials showed smaller wear depth results. Cracks, massive delamination, and shallow plow were seen on the enamel worn scar. Long deep plow, delamination, and brittle cracks are more common for VM and EC, and short shallow plow and smooth subsurface are the characteristics of EX and VS. Greater fracture toughness values indicated higher wear resistances of the materials for the test glass ceramics. The CAD/CAM glass ceramics performed greater wear resistance than enamel. Feldspar- and leucite-reinforced glass ceramics illustrated better wear resistance similar to enamel than lithium disilicate glass ceramics, providing amicable matching with the opposite teeth.

The Nfic-osterix pathway regulates ameloblast differentiation and enamel formation

Enamel makes up the outermost layer of the crown and its hardness protects other dental tissues from various stimuli. Enamel cannot be regenerated once damaged because ameloblasts are lost during the tooth eruption. Since the ameloblast differentiation mechanism is still unknown, further research is essential for developing treatments for defective or damaged enamel. Previously, we have reported that osteoblast differentiation and bone formation were regulated through the runt-related transcription factor 2 (Runx2)-nuclear factor 1-C (Nfic)-osterix (Osx) pathway where Nfic directly controls Osx expression. This pathway regulates odontoblast differentiation and dentin formation as well. The aim of this study was to investigate if the same pathway is applicable for ameloblast differentiation. Structural enamel defects with disorganized ameloblasts and decreased proliferation activity of the cervical loop were observed in Nfic^-/- mice incisors. Expression of the ameloblast differentiation markers was also downregulated significantly in Nfic^-/- mice. Real-time PCR analyses suggested that Runx2, Nfic, and Osx regulate the expression of ameloblast differentiation markers, where Runx2 is upstream of Nfic, and Nfic controls Osx expression. Therefore, we suggest the Runx2-Nfic-Osx pathway as one of the key factors that regulate ameloblast differentiation.

Enamel Microcracks Induced by Simulated Occlusal Wear in Mature, Immature, and Deciduous Teeth

Enamel wear, which is inevitable due to the process of mastication, is a process in which the microcracking of enamel occurs due to the surface contacting very small hard particles. When these particles slide on enamel, a combined process of microcutting and microcracking in the surface and subsurface of the enamel takes place. The aim of this study was to detect microscopic differences in the microcrack behavior by subjecting enamel specimens derived from different age groups (immature open-apex premolars, mature closed-apex premolars, and deciduous molars) to cycles of simulated impact and sliding wear testing under controlled conditions. Our findings indicated that the characteristics of the microcracks, including the length, depth, count, orientation, and relation to microstructures differed among the study groups. The differences between the surface and subsurface microcrack characteristics were most notable in the enamel of deciduous molars followed by immature premolars and mature premolars whereby deciduous enamel suffered numerous, extensive, and branched microcracks. Within the limitations of this study, it was concluded that enamel surface and subsurface microcracks characteristics are dependent on the posteruptive age with deciduous enamel being the least resistant to wear based on the microcrack behavior as compared to permanent enamel.