The wear and tear of teeth

Relationship between tooth macrowear and jaw morphofunctional traits in representative hypercarnivores

The mammalian adult dentition is a non-renewable resource. Tooth attrition and disease must be accommodated by individuals using behavioral, physiological, and/or musculoskeletal shifts to minimize impact on masticatory performance. From a biomechanical perspective, the musculoskeletal system becomes less efficient at producing bite force for a given amount of muscle input force over an individual's life, because tooth-food contact area increases as cusps wear. In this study we ask the question: does mandibular biomechanical performance show evidence of compensation with increasing tooth wear? We use representative taxa of three carnivoran ecomorphologies (meat specialist, scavenger, bone cracker) as a study system to compare morphofunctional data on tooth macrowear, jaw depth, bite mechanical efficiency, and jaw stress during biting. No significant shifts in adult mandibular corpus dimensions occurs in the sampled taxa as canine and carnassial teeth wear. In bone cracking spotted hyenas carnassial biting mechanical efficiency increases significantly with increasing tooth wear, with no significant change in mandibular stress. Analyses of the fossil carnivore Hyaenodon suggests an increase in canine biting efficiency with increased tooth wear, but this may reflect interspecific variation or phylogenetic contingency rather than a life history shift. Overall, these findings indicate that scavenging hyaenids and felid meat specialists do not exhibit morphofunctional compensation for the decreased mechanical capability of worn and dull teeth. Behavioral modifications, rather than musculoskeletal adjustments, may instead play a major role in maintaining food acquisition and processing capabilities for individuals surviving into advanced ontogenetic age and tooth wear. These observations highlight the mammalian masticatory system as having a dynamic performance profile through its useful lifespan, and encourage a more nuanced understanding of past and present carnivore guilds by considering wear-dependent performance changes as a possible source of selection.

Intraoral scanner-based monitoring of tooth wear in young adults: 36-month results

OBJECTIVES

The study continues our longitudinal observation of wear aiming to further monitoring of progression and lesion morphology and to identify relationships with assumed aetiological factors.

MATERIALS AND METHODS

Molars (FDI #36 or #46) of 74 participants (23.8 ± 2.2 years) were scanned (Trios 3, 3Shape) at the third follow-up (T3; observation period 1,111 ± 10 days). Data sets from T3, T2 (24-month follow-up) and T1 (12-month follow-up) were superimposed with baseline in a 3D analysis software (GOM Inspect). Wear was quantified as maximum vertical tissue loss (µm; median, 95% CI) in various occlusal areas (4/5 cusps and 2 ridges). Morphologies were classified into cupping (C), facet (F), and combined cupping-facet (CF). Aetiological factors were assessed with questionnaires.

RESULTS

Wear increased at T3 significantly at low rates in all areas of the occlusal surface (median between 7.0 (4.0;10.5) and 9.5 (6.0;15.0) µm). There was a clear trend for higher loss values in males, but no association with other factors such as nutrition. C and CF showed significantly higher loss values than F. Areas without initial wear developed F first, which either persisted or developed into C and CF.

CONCLUSIONS

Wear continued at low rates with C/CF morphology and sex as significant factors. Cupped lesions seem to develop from facets and thus may not be a valid diagnostic criterion for erosive tooth wear.

CLINICAL RELEVANCE

Wear is a cumulative process that apparently follows complex mechanisms that cannot be conceptualized in simplified terms; C and CF may be indicators for higher progression rates.

Minimally invasive CAD/CAM lithium disilicate partial-coverage restorations show superior in-vitro fatigue performance than single crowns

OBJECTIVE

To analyze the influence of restoration design (partial-coverage restoration vs. crown) and ceramic layer thickness on the performance and failure loads of CAD/CAM-fabricated lithium disilicate (LDS) reconstructions on molars after fatigue.

MATERIALS AND METHODS

Seventy-two posterior monolithic CAD/CAM-fabricated LDS restorations (IPS e.max CAD, Ivoclar Vivadent) with different occlusal/buccal ceramic layer thicknesses (1.5/0.8, 1.0/0.6, and 0.5/0.4 mm) and restoration designs (PCR: non-retentive full-veneer/partial-coverage restoration, C: crown,) were investigated and divided into six groups (n = 12, test: PCR-1.5, PCR-1.0, PCR-0.5; control: C-1.5, C-1.0, C-0.5). LDS restorations were adhesively bonded (Variolink Esthetic DC, Ivoclar Vivadent) to dentin-analogue composite dies (Z100, 3M ESPE). All specimens were subjected to thermomechanical loading (1.2 million cycles, 49 N, 1.6 Hz, 5-55°C) and exposed to single load to failure testing. Failure analysis was performed with light and scanning electron microscopies. Data were statistically analyzed using ANOVA, Tukey-Test, and t-test (p < 0.05).

RESULTS

Eight crown samples (C-0.5) and one PCR specimen (PCR-0.5) revealed cracks after fatigue, resulting in an overall success rate of 87.5% (crowns: 75%, PCRs: 96.88%). Direct comparisons of PCRs versus crowns for thicknesses of 0.5 mm (p < 0.001) and 1.0 mm (p = 0.004) were significant and in favor of PCRs. Minimally invasive PCRs (0.5 and 1.0 mm) outperformed crowns with the identical ceramic thickness. No difference was detected (p = 0.276) between thickness 1.5 mm PCRs and crowns.

CONCLUSIONS

Minimally invasive monolithic CAD/CAM-fabricated posterior LDS PCRs (0.5 and 1.0 mm) resulted in superior failure load values compared to minimally invasive crowns. Minimally invasive crowns (0.5 mm) are prone to cracks after fatigue.

CLINICAL SIGNIFICANCE

Minimally invasive CAD/CAM-fabricated LDS PCR restorations with a non-retentive preparation design should be considered over single crowns for molar rehabilitation.

A narrative review of cracks in teeth: Aetiology, microstructure and diagnostic challenges

OBJECTIVES

To summarize the available evidence of crack formation in teeth and to discuss the limitations of the current clinical diagnostic modalities for crack detection in teeth.

BACKGROUND

Cracks are a common clinical finding in teeth and yet clinicians still struggle to identify the full extent and orientation of cracks for their appropriate timely management. The biomechanics of crack development can be due to multiple factors and can differ from an unrestored tooth to a restored or endodontically treated tooth.

DATA & SOURCES

This narrative review has been designed following the guidelines published by Green et al. 2006 [1] Published literature in the English language that addresses the objectives of this review up to July 2022 was sourced from online databases and reference lists. The relevance of the papers was assessed and discussed by two reviewers. A total of 101 publications were included in this narrative review.

CONCLUSIONS

The initiation and development of cracks in teeth are likely linked to an interplay between the masticatory forces and fracture resistance of the remaining tooth structure. From the identified literature, the quality and quantity of remaining tooth structure in a restored or endodontically-treated tooth affects the biomechanics of crack development compared to an unrestored tooth. The extent, orientation, and size of the cracks do affect a clinician's ability to detect cracks in teeth. There is still a need to develop reliable diagnostic tools that will accurately identify cracks in teeth beneath restorations to enable effective monitoring of their propagation and provide appropriate interventions.

CLINICAL SIGNIFICANCE

The development and propagation of cracks in an unrestored tooth differ greatly from a restored and endodontically treated tooth; mainly linked to the quantity and quality of the remaining tooth structure and the forces acting on them. Identifying the extent of cracks in teeth remains challenging for early clinical intervention.

Three-dimensional microscopic comparison of wear behavior between immature and mature enamel: an in vitro study

BACKGROUND

Dental enamel, the hardest outermost layer of a human tooth, is subjected to occlusal forces throughout life during different oral function as talking, mastication etc. Due to this continuous stress, wear causes the loss of this protective shell. This study aimed to detect microscopic differences in enamel's wear behavior among different age groups of adolescents and adults.

AIMS AND METHODS

Enamel specimens from immature open-apex and mature closed-apex premolars were subjected to simulated occlusal wear of impact and sliding wear test ISWT. Upper and lower enamel specimens were made to come in contact under controlled conditions. The enamel specimens' surfaces were examined using different microscopes. The upper and lower specimens were subjected to the following tests; pre-test light microscopy examination, enamel specimens' preparation for ISWT, scanning laser confocal microscopy of upper specimens, three-dimensional (3D) colored laser microscope and a Profilometer imaging of the lower specimens.

RESULTS

Wear characteristics, including wear areas, crater depths, and relation to enamel microstructures, differed among different age groups. Immature enamel from the upper specimens was more resistant to chipping than mature enamel with no statistically significant wear area difference. The immature enamel craters from the lower specimens were wider and deeper than those in the mature enamel; the wear areas in the mature enamel in the lower specimens were almost flat and smooth. The wear areas in the immature enamel in the lower specimens were significantly larger than those in the mature enamel.

CONCLUSIONS

Wear characteristics of the immature enamel are different from those of the mature enamel. Hence, it should be repaired using restorative materials with compatible wear properties.

Experimental approaches to assess the effect of composition of abrasives in the cause of dental microwear

Dental microwear is used to investigate feeding ecology. Animals ingest geological material in addition to food. The full effect of geological abrasives on tooth wear is unknown. To evaluate mineralogical abrasives as tooth wear agents, rats were fed food manufactured with quartz silt, diatomaceous earth, and calcium carbonate. Rats were assigned to treatments and fed for 15 days. Molars were scanned with a Sensofar Plu Neox confocal microscope and evaluated using ISO-25178-2 parameters and traditional microwear variables using light microscopy. Using a pellet-diet as the control, all treatments had influence on microwear and discriminant function analyses indicated that unique surface textures had been produced. ISO variables with high discriminatory values were correlated to scratch and pit frequencies, but more ISO parameters identified changes associated with numbers of scratches than changes associated with pits. The microwear changes associated with the abrasive inclusions were co-dependent on the type of diet that the abrasives had been added to. The abrasives had less effect with pellets but produced more modified and more differentiated microwear when added to the transgenic dough. Although abrasives produce distinctive surface textures, some knowledge of the properties of food with the abrasives is needed to identify the abrasive agent.

The design, development, and calibration of cervical abrasion index of treatment needs probe for measurement of cervical abrasion

Context:

Although a common dental problem, there are no simple instruments or reliable methods to measure cervical abrasion.

Aim:

To study the design, development, calibration, efficacy, and compliance of usage of a novel Cervical Abrasion Index of Treatment Need (CAITN) probe to measure cervical abrasion.

Settings and Design:

The ex-vivo study was conducted as a part of comprehensive study for the development of standardized CAITN probe and index with a standard methodology for recording the abrasion.

Materials and Methods:

The compliance and usage of the probe were assessed by a standardized set of questionnaires to the interns followed by an ex-vivo study in 100 subjects. Gold standard comparisons with Vernier caliper, inter-examiner, and intra-examiner reliability were analyzed using SPSS.

Results:

Data from the questionnaire indicate that 100% of examiners had no difficulty in handling the instrument or measuring and reading the values. Comparison between the CAITN probe and the gold standard was statistically significant indicating a correlation for cervical abrasion measurement between the two methods (p < 0.001). The mean difference between the two measurements using the CAITN probe and gold standard method was calculated with paired t-test and was insignificant (p > 0.05). High statistical significant correlation was also found for intra-examiner and inter-examiner reliability measurement of CAITN probe (p < 0.001).

Conclusion:

The design and structure of the CAITN probe are standardized with a fair gold standard comparison and that the novel probe can be used as an effective tool to measure the depth of cervical abrasion and its treatment needs.

Nanoscopic wear behavior of dentinogenesis imperfecta type II tooth dentin

OBJECTIVES

The aim of this study was to investigate the wear behavior of Dentinogenesis imperfecta type II (DGI-II) dentin and elucidate the correlation between its tribological properties and components.

METHODS

The mid-coronal dentin of normal and DGI-II teeth were divided into two groups: perpendicular and parallel to the dentin tubules. The microstructure of dentin was detected using atomic force microscopy (AFM). The wear behavior of dentin was evaluated by nanoscratch tests and scanning electron microscopy (SEM). Meanwhile, changes in molecular groups and chemical composition were analyzed by Raman and Energy-Dispersive X-ray (EDX) tests, respectively. Nanohardness was also evaluated.

RESULTS

AFM images of DGI-II dentin illustrated a decrease in the number of tubules and the tubule diameter. Nanoscratch test showed a higher friction coefficient and a greater depth-of-scratch in DGI-II dentin. The wear resistance of DGI-II dentin was reduced independent of tubule orientation. EDX results indicated that DGI-II dentin mineral content decreased and Raman spectra results showed DGI-II dentin had a decreased collagen matrix structure stability coupled with hypomineralization. Furthermore, a significant reduction in nanohardness and elastic modulus of DGI-II dentin was observed. Regression analysis revealed a close correlation between dentin components and inferior wear resistance.

CONCLUSIONS

All results indicated the wear behavior of DGI-II dentin was significantly deteriorated, presumably caused by the disorder in microstructures and the reduction of chemical composition.

Cementum thickening leads to lower whole tooth mobility and reduced root stresses: An in silico study on aging effects during mastication

In the course of a lifetime the crowns of teeth wear off, cementum thickens and the pulp closes-in or may stiffen. Little is known about how these changes affect the tooth response to load. Using a series of finite element models of teeth attached to the jawbone, and by comparing these to a validated model of a 'young' pig 3-rooted tooth, the effects of these structural changes were studied. Models of altered teeth show a stiffer response to mastication even when material properties used are identical to those found in 'young' teeth. This stiffening response to occlusal loads is mostly caused by the thicker cementum found in 'old' teeth. Tensile stresses associated with bending of dentine in the roots fall into a narrower distribution range with lower peak values. It is speculated that this is a possible protective adaptation mechanism of the aging tooth to avoid fracture. The greatest reduction in lateral motion was seen in the bucco-lingual direction. We propose that greater tooth motion during mastication is typical for the young growing animal. This motion is reduced in adulthood, favoring less off-axis loading, possibly to counteract natural bone resorption and consequent compromised anchoring.

Replica-based inspection of enamel wear microfeatures

BACKGROUND

Surface replication is a nondestructive evaluation technique applied in examining surface wear by recording surface irregularities, especially in conditions when surfaces of interest cannot be further manipulated to fit directly under a microscope to be examined. Enamel is the outermost protective layer of the human teeth and is constantly stressed by mastication forces which results in enamel wear.

OBJECTIVE

To date, a procedure combining the clinical and microscopic examination of enamel surfaces is absent, which hinders the early diagnosis and comprehension of the wear process.

METHODS

This study investigated the role of replication sheets in registering microscopic wear on human enamel surfaces by both negative and positive replication techniques.

RESULTS

The sheets replicated wear features successfully. Sheets were compatible to use with multiple microscopes, with proper preparation, including high resolution microscopes such as the scanning electron microscope and transmitting electron microscope.

Shape, size, and quantity of ingested external abrasives influence dental microwear texture formation in guinea pigs

Food processing wears down teeth, thus affecting tooth functionality and evolutionary success. Other than intrinsic silica phytoliths, extrinsic mineral dust/grit adhering to plants causes tooth wear in mammalian herbivores. Dental microwear texture analysis (DMTA) is widely applied to infer diet from microscopic dental wear traces. The relationship between external abrasives and dental microwear texture (DMT) formation remains elusive. Feeding experiments with sheep have shown negligible effects of dust-laden grass and browse, suggesting that intrinsic properties of plants are more important. Here, we explore the effect of clay- to sand-sized mineral abrasives (quartz, volcanic ash, loess, kaolin) on DMT in a controlled feeding experiment with guinea pigs. By adding 1, 4, 5, or 8% mineral abrasives to a pelleted base diet, we test for the effect of particle size, shape, and amount on DMT. Wear by fine-grained quartz (>5/<50 µm), loess, and kaolin is not significantly different from the abrasive-free control diet. Fine silt-sized quartz (∼5 µm) results in higher surface anisotropy and lower roughness (polishing effect). Coarse-grained volcanic ash leads to significantly higher complexity, while fine sands (130 to 166 µm) result in significantly higher roughness. Complexity and roughness values exceed those from feeding experiments with guinea pigs who received plants with different phytolith content. Our results highlight that large (>95-µm) external silicate abrasives lead to distinct microscopic wear with higher roughness and complexity than caused by mineral abrasive-free herbivorous diets. Hence, high loads of mineral dust and grit in natural diets might be identified by DMTA, also in the fossil record.

Nature's design solutions in dental enamel: Uniting high strength and extreme damage resistance

The most important demand of today's high-performance materials is to unite high strength with extreme fracture toughness. The combination of withstanding large forces (strength) and resistance to fracture (toughness), especially preventing catastrophic material failure by cracking, is of utmost importance when it comes to structural applications of these materials. However, these two properties are commonly found to be mutually exclusive: strong materials are brittle and tough materials are soft. In dental enamel, nature has combined both properties with outstanding success - despite a limited number of available constituents. Made up of brittle mineral crystals arranged in a sophisticated hierarchical microstructure, enamel exhibits high stiffness and excellent toughness. Different species exhibit a variety of structural adaptations on varying scales in their dental enamel which optimise not only fracture toughness, but also hardness and abrasion behaviour. Nature's materials still outperform their synthetic counterparts due to these complex structure-property relationships that are not yet fully understood. By analysing structure variations and the underlying mechanical mechanisms systematically, design principles which are the key for the development of advanced synthetic materials uniting high strength and toughness can be formulated. STATEMENT OF SIGNIFICANCE: Dental enamel is a hard protective tissue that combines high strength with an exceptional resistance to catastrophic fracture, properties that in classical materials are commonly found to be mutually exclusive. The biological material is able to outperform its synthetic counterparts due to a sophisticated hierarchical microstructure. Between different species, microstructural adaptations can vary significantly. In this contribution, the different types of dental enamel present in different species are reviewed and connections between microstructure and (mechanical) properties are drawn. By consolidating available information for various species and reviewing it from a materials science point of view, design principles for the development of advanced biomimetic materials uniting high strength and toughness can be formulated.

Breaking crown dentine in whole teeth: 3D observations of prevalent fracture patterns following overload

Teeth with intact crowns rarely split or fracture, despite decades of cyclic loading and occasional unexpected overload. This is largely attributed to the presence of dentine, since cracking and fracture of enamel have been frequently reported. Dentine is similar to bone, comprising mineralised collagen fibres as a main constituent. Unlike cortical bone, however, where microcracking and damage arrest are essential for re/modelling and healing, dentine can neither remodel nor regenerate. This raises questions regarding the evolutionary benefits of toughening, leading to uncertainty whether cracks actually appear in dentine in situ. Here we study the notion that circumpulpal dentine is usually protected against, rather than damaged by severe overloads, even though it is not much more massive or stronger than it needs to be. To address this, we examined hydrated teeth still within whole jawbones of freshly-slaughtered skeletally mature pigs, mechanically loaded until fracture. Force displacement curves, optical and electron microscopy combined with 3D microstructural analysis by conventional micro-computed tomography (μCT) revealed mostly brittle fracture paths in circumpulpal crown dentine. Once overload cracks reach this mass of dentine they propagate rapidly along straight paths often parallel to the enamel flanks of the oblong shovel shaped premolars. We find infrequent signs of active toughening mechanisms with minimal crack diversion, ligament bridging and microcracking. When such toughening is seen, it mainly appears in softer dentine in the root, or near the dentine-enamel-junction (DEJ) in mantle dentine. We observed shear bands in overloaded circumpulpal dentine, due to mutual gliding of upper and lower segments. These shear bands are formed as periodic arrays of rotated dentine fragments. The 3D data consistently demonstrate the importance of the layered tooth structure, containing a stiff outer enamel shell, a soft sub-DEJ interlayer and a stiff circumpulpal dentine bulk, for deflecting cracks from splitting the tooth.

Dentin Tubule Occlusion Potential of Novel Dentifrices Having Fluoride Containing Bioactive Glass and Zinc Oxide Nanoparticles

OBJECTIVE

To compare the in vitro potential of dentin tubule occlusion of two novel experimental dentifrices consisting of fluoride containing bioactive glass (BG) with zinc oxide nanoparticles.

MATERIALS AND METHODS

Forty-eight dentin discs (n = 48) were divided into 6 groups (n = 8), based on their brushing dentifrices: Group 1 = artificial saliva (AS; control); Group 2 = fluoride dentifrice (Colgate Palmolive©, UK); Group 3 = experimental nonactive agent dentifrice; Group 4 = experimental dentifrice with 1.5% BG; Group 5 = experimental dentifrice with 4% BG; and Group 6 = BioMinF© dentifrice. Postbrushing, the discs were subjected to acidic challenge with 6% wt citric acid (pH = 4.0) for 1 min. Scanning electron microscope (SEM) and energy-dispersive X-ray (EDX) spectroscopy were performed pre- and post-citric acid challenges, and percentages of tubule occlusion assessed.

RESULTS

SEM micrographs of group 1 (AS) show no tubule occlusion (0%), whereas those of groups 2 and 3 show partial tubule occlusion (25 to <50% of tubules occluded). The SEM micrographs of dentifrices containing fluoride-BG (groups 4, 5, and 6) show that most of the tubules (>50 and <100%) were occluded. For all the groups (excluding group 1), pre- and post-citric acid challenge values are statistically significant (p < 0.05). EDX analysis reveals the presence of zinc in experimental dentifrices only.

CONCLUSION

The results of novel experimental dentifrices are comparable to those of the BioMinF©, in terms of tubule occlusion. Dentifrices containing BG could serve as an alternative in dentin sensitivity management.

Influence of bonding surface and bonding methods on the fracture resistance and survival rate of full-coverage occlusal veneers made from lithium disilicate ceramic after cyclic loading

OBJECTIVES

The purpose of this laboratory study was to evaluate the influence of bonding method and type of dental bonding surface on fracture resistance and survival rate of resin bonded occlusal veneers made from lithium disilicate ceramic after cyclic loading.

METHODS

Fourty-eight extracted molars were divided into three groups (N=16) depending on the preparation: within enamel, within dentin/enamel or within enamel/composite resin filling. Lithium disilicate occlussal veneers were fabricated with a fissure-cusp thickness of 0.3-0.6mm. Restorations were etched (5% HF), silanated and adhesively luted using a dual-curing luting composite resin. Test groups were divided into two subgroups, one using a only a self-etching primer, the other additionally etching the enamel with phosphoric acid. After water storage (37°C; 21d) and thermocycling (7500 cycles; 5-55°C), specimens were subjected to dynamic loading in a chewing simulator (600,000 cycles; 10kg/2Hz). Surviving specimens were loaded until fracture using a universal testing machine.

RESULTS

All specimens survived artificial aging, several specimens showed some damage. ANOVA revealed that enamel etching provided statistically significantly (p≤0.05) higher fracture resistance than self-etching when bonding to enamel and dentin. Self-etching provided statistically significant (p≤0.05) higher fracture resistance for the enamel-composite group than for the enamel group. Enamel etching provided statistically significant (p≤0.05) higher fracture resistance for the enamel and dentin group than for groups enamel and enamel-composite.

SIGNIFICANCE

Etching enamel improved the fracture resistance of occlusal veneers when bonding to dentin and enamel and increased the survival rate when bonding to enamel.

The Materials of Mastication: Material Science of the Humble Tooth

Dental functional morphology, as a field, represents a confluence of materials science and biology. Modern methods in materials testing have been influential in driving the understanding of dental tissues and tooth functionality. Here we present a review of dental enamel, the outermost tissue of teeth. Enamel is the hardest biological tissue and exhibits remarkable resilience even when faced with a variety of mechanical threats. In the light of recent work, we progress the argument that the risk of mechanical degradation across multiple scales exhibits a strong and continued selection pressure on structural organization of enamel. The hierarchical nature of enamel structure presents a range of scale-dependent toughening mechanisms and provides a means by which natural selection can drive the specialization of this tissue from nanoscale reorganization to whole tooth morphology. There has been much learnt about the biomechanics of enamel recently, yet our understanding of the taxonomic diversity of this tissue is still lacking and may form an interesting avenue for future research.

Cup-Shaped Tooth Wear Defects: More than Erosive Challenges?

BACKGROUND/AIM

The underlying mechanism of the development of cups and grooves on occlusal tooth surfaces is still unclear. The aim of this study was to evaluate factors contributing to in vitro cup formation, in order to elucidate the clinical process.

METHODS

A total of 48 extracted human molar teeth were exposed to acidic aqueous solutions at pH of 4.8 and 5.5 in constant motion, in combination with different loading conditions: no load (0N group, control), 30 N (30N group) or 50 N (50N group) (n = 8 per group). Before and after 3 months of exposure (1,422,000 loading cycles), the samples were scanned using a non-contact profilometer. Pre- and post-exposure scans were subtracted and height loss and volume tissue loss were calculated. Representative samples with wear and cupping lesions were imaged using scanning electron microscopy, light microscopy and micro-computed tomography.

RESULTS

Average height and volume tissue loss at pH 5.5 was 54 µm and 3.4 mm3 (0N), 52 µm and 3.4 mm3 (30N) and 58 µm and 3.7 mm3 (50N), respectively, with no statistically significant differences. Average height and volume loss at pH 4.8 were 135 µm and 8.7 mm3 (0N), 172 µm and 12.6 mm3 (30N) and 266 µm and 17.8 mm3 (50N), respectively, with a statistically significant difference between 0N and 50N (p < 0.002). Cup-shaped lesions had formed only at pH of 4.8, in the 30N and 50N groups.

CONCLUSION

The study showed that a cup can arise fully in enamel and that mechanical loading in addition to erosive challenges are required.

The application of cellulose acetate replication sheets in enamel wear investigations

Surface replication is a nondestructive evaluation technique applied in examining surfaces' cracks/wear. This is quite valuable when the surface of interest cannot be further manipulated by cutting or polishing to fit directly under a microscope. Replication by acetate sheets is one of the techniques applied in industrial, metallographic and anthropological wear/examination. Enamel is the outermost protective layer of human teeth and is subjected to mechanical stresses due to the masticatory function; thus, wear is inevitable in human teeth. This relatively inert hard tissue has been reported to possess some properties of both metals and glasses due to its unique delicate microstructure. This study investigated the applicability of replication sheets in registering wear induced features on human enamel surfaces. The sheets replicated wear features successfully with compatibility to use with multiple microscopes. Acetate sheets have a potential in enamel wear replication.

Effects of artificial aging and progression of cracks on thin occlusal veneers using SD-OCT

OBJECTIVES

The purpose of this study was to evaluate the effects of artificial aging on thin glass-ceramic occlusal premolar veneers, adhesively bonded to dentin, by examining the changes caused by artificial aging using spectral domain optical coherence tomography (SD-OCT). In addition, the development of cracks in the ceramic veneers and their possible influence on the behavior of the ceramic restorations were examined.

METHODS

In total, 48 extracted sound upper premolars were prepared in the dentin for occlusal veneers milled from lithium disilicate ceramic blocks (IPS e.max CAD, Ivoclar Vivadent, Liechtenstein). All restorations were adhesively bonded using resin cement (Variolink Esthetic DC, Ivoclar Vivadent). Specimens were 3-dimensionally and 2-dimensionally imaged by SD-OCT (Telesto II, Thorlabs GmbH, Germany), then subjected to thermal-dynamic loading in a chewing simulator with 1,200,000 cycles at a load of 10 kg. Specimens were 2D and 3D imaged again after the artificial aging. Finally, they were subjected to quasi-static loading using a universal testing machine until failure occurred and later examined microscopically to assess the mode of failure. ANOVA test was performed for statistical analysis of data and Tukey's post-hoc test was used to compare the groups at 5% significance level. Chi-Square Test and Fischer's Exact Test of Independence were conducted to test the association between nominal variables.

RESULTS

No changes or irregularities were observed in the cement layer or tooth substrate after the aging process. However, wear of the ceramic was noticed at the surface of contact with the antagonist during the test. The development of cracks was detected in 23% of the specimens. Cracks did not affect the fracture strength (p > 0.05) but influenced the mode of failure (p ≤ 0.001).

SIGNIFICANCE

Optical coherence tomography allows an easy and non-invasive method to internally scan teeth and restorations. Development of cracks in the ceramic did not affect the fracture strength of the restorations but might lead to a more catastrophic type of failure.

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.

Fractographic Analysis of a Split Tooth Presenting Radiographically as a Horizontal Root Fracture in an Unrestored Mandibular Second Molar

INTRODUCTION

Spontaneously catastrophic fracture of intact unrestored molar teeth is not common. Nevertheless, cracks do occur that progress apically, resulting in the complete splitting of the tooth and root. This report describes a catastrophic fracture that occurred in an unrestored mandibular second molar resulting in a previously unreported combination of a longitudinal and horizontal root fracture, appearing radiographically as a single horizontal root fracture.

METHODS

Tooth fragments were examined clinically, stereoscopically, and by scanning electron microscopy. Fractographic analysis was used to investigate the dynamics involved in fracture initiation, structural resistances encountered during progression of the fracture, and reasons for direction changes culminating in the unusual radiographic appearance.

RESULT

The uniqueness of this report is that it describes fractographic evidence of factors contributing to the initiation and progression of an in vivo crack. It shows fracture markings that are evidence of the energy dissipation mechanisms. The topographic location of these markings confirmed that cracks occur in vivo in stages with different rates of progression.

CONCLUSION

This analysis helps to explain why split teeth are uncommon and highlights some of the multitude of factors that have to coincide for a tooth to catastrophically fracture. The report describes the mechanism of fracture and should stimulate clinicians and researchers to investigate cracking of teeth by undertaking fractographic analysis of extracted cracked teeth.

Influence of various bonding techniques on the fracture strength of thin CAD/CAM-fabricated occlusal glass-ceramic veneers

OBJECTIVES

To evaluate the efficiency of immediate dentin sealing and the effects of different bonding protocols on the fracture strength of CAD/CAM occlusal veneers bonded to exposed dentin.

METHODS

Ninety-six extracted maxillary premolars were initially divided into three main groups with 32 specimens each: without immediate dentin sealing, immediate dentin sealing/total etching and immediate dentin sealing/selective etching. Teeth were identically prepared in the dentin to receive occlusal veneers of 0.8mm thickness, milled from lithium disilicate ceramic blocks (IPS e.max CAD). Each main group was later subdivided, according to the pre-cementation surface etching protocol (total/selective), into two subgroups with 16 specimens each. All restorations were adhesively bonded using a resin cement (Variolink Esthetic). Half of the specimens of each subgroup were subjected to thermo-dynamic loading in a chewing simulator with 1,200,000 cycles at 10kg load. The other half and the surviving specimens were subjected to quasi-static loading until failure. Statistical analysis was performed using three-way ANOVA and Tukey's post-hoc tests.

RESULTS

All specimens except one survived the artificial aging. A significantly higher fracture strength of restorations (p ≤ 0.001) was obtained when immediate dentin sealing was followed regardless of the etching method with values ranging from a minimum of 1122 ± 336N to a maximum of 1853 ± 333N. Neither the pre-cementation treatment nor the artificial aging had a statistical significant effect on the fracture strength.

SIGNIFICANCE

Immediate dentin sealing protocol is recommended whenever dentin is exposed during the preparation for thin glass-ceramic occlusal veneers.

Three-Dimensional Analysis of Enamel Crack Behavior Using Optical Coherence Tomography

The aim of this study was to nondestructively analyze enamel crack behavior on different areas of teeth using 3D swept source-optical coherence tomography (SS-OCT). Ten freshly extracted human teeth of each type on each arch ( n = 80 teeth) were inspected for enamel crack patterns on functional, contact and nonfunctional, or noncontact areas using 3D SS-OCT. The predominant crack pattern for each location on each specimen was noted and analyzed. The OCT observations were validated by direct observations of sectioned specimens under confocal laser scanning microscopy (CLSM). Cracks appeared as bright lines with SS-OCT, with 3 crack patterns identified: Type I - superficial horizontal cracks; Type II - vertically (occluso-gingival) oriented cracks; and Type III - hybrid or complicated cracks, a combination of a Type I and Type III cracks, which may or may not be confluent with each other. Type II cracks were predominant on noncontacting surfaces of incisors and canines and nonfunctional cusps of posterior teeth. Type I and III cracks were predominant on the contacting surfaces of incisors, cusps of canines, and functional cusps of posterior teeth. Cracks originating from the dental-enamel junction and enamel tufts, crack deflections, and the initiation of new cracks within the enamel (internal cracks) were observed as bright areas. CLSM observations corroborated the SS-OCT findings. We found that crack pattern, tooth type, and the location of the crack on the tooth exhibited a strong correlation. We show that the use of 3D SS-OCT permits for the nondestructive 3D imaging and analysis of enamel crack behavior in whole human teeth in vitro. 3D SS-OCT possesses potential for use in clinical studies for the analysis of enamel crack behavior.

Dental abrasion as a cutting process

A mammalian tooth is abraded when a sliding contact between a particle and the tooth surface leads to an immediate loss of tooth tissue. Over time, these contacts can lead to wear serious enough to impair the oral processing of food. Both anatomical and physiological mechanisms have evolved in mammals to try to prevent wear, indicating its evolutionary importance, but it is still an established survival threat. Here we consider that many wear marks result from a cutting action whereby the contacting tip(s) of such wear particles acts akin to a tool tip. Recent theoretical developments show that it is possible to estimate the toughness of abraded materials via cutting tests. Here, we report experiments intended to establish the wear resistance of enamel in terms of its toughness and how friction varies. Imaging via atomic force microscopy (AFM) was used to assess the damage involved. Damage ranged from pure plastic deformation to fracture with and without lateral microcracks. Grooves cut with a Berkovich diamond were the most consistent, suggesting that the toughness of enamel in cutting is 244 J m(-2), which is very high. Friction was higher in the presence of a polyphenolic compound, indicating that this could increase wear potential.

Morphological Symmetry of Maxillary Anterior Teeth before and after Prosthodontic Planning: Comparison between Conventional and Digital Diagnostic Wax-Ups

OBJECTIVE

The aim of this study was to evaluate the impact of different prosthodontic planning methods on the morphological symmetry of maxillary anterior teeth.

MATERIALS AND METHODS

In 13 patients receiving fixed prosthodontic treatment, dental models were obtained from the Oral Health Centre of Western Australia. Two forms of diagnostic prosthodontic planning were executed: conventional wax-up and digital wax-up. The asymmetry was evaluated at two levels: tooth morphological asymmetry (TMA) and anterior segment morphological asymmetry (ASMA). For the TMA, the labial surface of each anterior tooth was superimposed on a mirror image of the contralateral tooth. The ASMA involved superimposition of the combined labial surface of all the anterior teeth on one side on the mirror image of the combined labial surface of the contralateral side. For each asymmetry, the discrepancies in the form of 3D Euclidean distances were calculated and statistically evaluated by the Kruskal-Wallis test (p = 0.05).

RESULTS

At the TMA level, the digital wax-up models had significantly less asymmetry (p < 0.00) than the pre-treatment and conventional wax-up models. The pre-treatment and conventional wax-up models had similar asymmetry (p = 0.35). However, at the ASMA level, the difference between the models was insignificant (p > 0.05).

CONCLUSION

In this study, the single tooth symmetry had improved after the digital wax-up. However, the conventional wax-up had a minimal impact on single tooth symmetry. ASMA was minimally affected by the two wax-ups.