Amalgam margin breakdown caused by creep fatigue rupture

Creep as a Mechanism for Sealing Amalgams

Creep may be a major factor in amalgam sealing from microleakage. Creep expansion causes amalgam to fill in the tooth/amalgam interface gap and causes the restoration to extrude out of the preparation.

Three-body wear of a hand-consolidated silver alternative to amalgam

Recent studies have investigated a mercury-free silver alternative to amalgam, but the silver powders required a relatively high compaction pressure to consolidate. The aim of the present study was to consolidate a precipitated silver powder into a cohesive solid using an air-driven pneumatic condenser fitted with an amalgam plugger at a clinically realistic load, and to study the mechanisms and rates of three-body wear of the consolidated silver in comparison with that of an amalgam. The silver powder was annealed, rinsed with a dilute acid, and consolidated either in a prepared tooth cavity or in a specimen mold at a load of 15 N. A four-station wear machine was used where each specimen was immersed in a slurry containing polymethyl methacrylate beads, then a steel pin was loaded and rotated against the specimen at a maximum load of 76 N. The flexural strength in MPa (mean +/- SD; n = 10) was 86 +/- 20 for amalgam, 181 +/- 45 for silver with a polished surface, and 202 +/- 21 for silver with a burnished surface. After 4 x 10(5) wear cycles, the wear scar depth in microm was 134 +/- 54 for amalgam, 143 +/- 8 for polished silver, and 131 +/- 9 for burnished silver, which were not significantly different (Tukey's multiple comparison test; family confidence coefficient = 0.95). SEM examination revealed cracks and fracture pits in the worn surface of amalgam, in contrast to a smooth surface in silver. Wear and material removal in amalgam occurred by microfracture and dislodgement of cracked segments, while wear in the silver occurred by ductile deformation and flow of materials. To conclude, the consolidated silver possesses a three-body wear resistance similar to that of amalgam, and a higher resistance to wear-induced damage and cracking than amalgam. The mechanism of wear in amalgam is microfracture and material dislodgement, while that in consolidated silver is ductile deformation and flow of material.

Indentation creep behavior of a direct-filling silver alternative to amalgam

Amalgam creep has been identified as a key parameter associated with marginal breakdown and corrosion. The aim of this study was to evaluate the time-dependent deformation (creep) of a novel silver filling material as an alternative to amalgam. We made the silver specimens by pressing a precipitated powder at room temperature to a density that can be achieved in clinical hand consolidation. The surface of the silver was either polished or burnished. To examine local contact creep and the effect of surface finishing, we used an indentation creep method in which a Vickers indenter was loaded on the specimen surface at a load of 10 N with dwell times of 5 sec to 6x10(4) sec. We used a bonded-interface technique to examine subsurface creep mechanisms. The flexural strength (mean+/-SD; n = 10) was 86+/-20 MPa for amalgam, 180+/-21 MPa for polished silver, and 209+/-19 MPa for burnished silver-values which are significantly different from each other (family confidence coefficient = 0.95; Tukey's multiple-comparison test). Indentation creep manifested as hardness number decreasing with increased dwell time. With dwell time increasing from 5 sec to 6x10(4) sec, the hardness number of amalgam was reduced by approximately 80%; that of the polished silver and the burnished silver was reduced by only 40%. Subsurface creep in amalgam consisted of the shape change of the alloy particles from spherical to elongated shapes, and the separation of matrix grains from each other, possibly due to grain-boundary sliding. Creep of the polished silver occurred by densification reducing porosity and increasing hardness; that of the burnished silver occurred by the displacement of the burnished layer. These results suggest that, due to creep-induced subsurface work-hardening and densification, the consolidated silver exhibits a higher resistance to indentation creep than does amalgam. The hardness number of silver approaches that of amalgam after prolonged indentation loading.

Effect of zinc on strength and fatigue resistance of amalgam

OBJECTIVES

This study was conducted to determine the effect of zinc in amalgam on the static mechanical properties and resistance to fatigue-crack propagation of amalgams.

METHODS

Fatigue, creep, compressive and flexure tests were performed on high-Cu Dispersalloy (Johnson and Johnson Dental Products Co., East Windsor, NJ, USA) and low-Cu Velvalloy (S.S. White Dental Products Int., Philadelphia, PA, USA) in both Zn-containing and Zn-free formulations. Linear Elastic Fracture Mechanics principles were used to characterize the fatigue behavior (crack lengths were monitored).

RESULTS

The incorporation of Zn into these amalgams significantly improved their fatigue and creep resistance, while the effect of Zn on the static compressive and flexure strengths was not consistent. Zn significantly increased (p < 0.05) the resistance to fatigue crack propagation during Stage II crack growth for both amalgams, and increased the variations in crack velocity for a given stress intensity difference, without visibly altering the path or nature of the fatigue cracks. Possible influences on fatigue behavior were the mixed microstructure (particles and matrix), the nature of the crack tip, and creep.

SIGNIFICANCE

The superior resistance to tensile fatigue crack propagation of amalgams containing small amounts of Zn (approximately 1 wt%) in vitro compared with amalgams with no Zn correlated with the superior resistance to marginal breakdown in vivo of Zn-containing amalgams. The range of stress intensities over which stable cracks could propagate was small, while the large variations observed in fatigue crack growth rates for individual materials invalidate predicting a unique fatigue life from the empirical equations obtained.

Modulation of host PGE2 secretion as a determinant of periodontal disease expression

An increasing body of evidence supports the concept that host-produced PGE2 mediates much of the tissue destruction that occurs in periodontal disease. PGE2 levels within the crevicular fluid can serve as a static assessment of ongoing disease activity; i.e., rate of attachment loss and bone resorption. New insights into the mechanisms that regulate PGE2 synthesis provide an altered paradigm of periodontal disease which places the emphasis on host response, rather than the bacterial etiology, as the principal determinant of disease expression. We described a PGE2 host response model as a hypothetical framework to discuss new, possible explanations for host susceptibility to periodontal disease.

Dental amalgam: the materials

The goal of this presentation is to describe the material as it is used clinically, explain why small quantities of Hg can be released, and suggest ideas for amalgams that do not release mercury. A set amalgam is a dynamic material that undergoes many microstructural changes during clinical use, related to both the elevated temperature and corrosion-prone environment in the mouth and mechanical forces applied to the restoration. Amalgams can be divided roughly into two groups by their copper content: low Cu (traditional) and high Cu. High-Cu amalgams generally perform better clinically, but all amalgams corrode to some extent in the mouth. Some corrosion is deemed to be a positive factor, because corrosion product deposition reduces leakage at the margins of restorations; that is, the restorations are partly self-sealing. One of the reasons cited for the improved clinical performance of high-Cu amalgams over low-Cu amalgams is that the corrosion-prone phase, gamma 2, is nearly eliminated in high-Cu amalgams. Future research should involve improvements in the clinical performance of dental amalgams, studies of the mercury release from various types of amalgams and the toxic potential of this exposure, and the development of new amalgam systems that reduce the mercury exposure. Although the longevity of modern amalgams is impressive, it is important for their stability to be increased both clinically and microstructurally. An amalgam should be developed with a stable microstructure that, once set, would not change during clinical use. Microstructural changes lead to clinical deterioration. A stable system would not corrode, and the matrix transformation gamma 1 to beta 1 would be prohibited.(ABSTRACT TRUNCATED AT 250 WORDS)

Inhibition of alveolar bone loss in beagles with the NSAID naproxen

The non-steroidal anti-inflammatory drug(NSAID) naproxen was studied in 11 beagle dogs over a 13-month period to determine its effect on the progression of periodontitis. Following a 6-month pretreatment period, 5 dogs received naproxen daily at a dosage of 2.0 mg/kg for 1 month, then 0.2 mg/kg for 6 months. Six control dogs received a gelatin capsule daily as placebo. Standardized radiographs were used to measure the rate of bone loss during the pretreatment and treatment periods. In the control dogs, the rate of bone loss was seen to increase during the treatment period although the increase was not statistically significant. In dogs treated daily with naproxen, the rate of bone loss in the treatment period was significantly less at 4 months of treatment; however, at 7 months the difference, though lower than pretreatment rate, was not significant. When the percent change in rate of bone loss during the overall 7-month treatment period was compared with pretreatment rate, the control dogs demonstrated a 38% increase in rate of bone loss during the treatment period contrasting with a 61% decrease in bone loss rate in naproxen-treated dogs. The data indicate that the non-steroidal anti-inflammatory drug naproxen can significantly inhibit alveolar bone loss in beagles. At 4 months of treatment the rate of bone loss in the naproxen-treated dogs was significantly less than pretreatment, but at 7 months of treatment the rate was no longer statistically significantly less than baseline. This probably reflects a dose response to naproxen treatment for, after 30 days of the treatment period, the naproxen dosage was reduced 10-fold due to tolerance by the beagle.

Effect of the NSAID piroxicam, topically administered, on the development of gingivitis in beagle dogs

A single-blind investigation was designed to study the effects of piroxicam in preventing gingival inflammation and plaque formation in beagle dogs. Twelve 1-year-old beagles were brought to optimum oral hygiene and gingival health. Thereafter, they were fed a moist plaque-promoting diet and were divided into three groups. The first group received daily administration of 1.0 ml placebo gel (methylcellulose) painted on the teeth. The second group received 1.0 ml of gel containing 2 mg/ml piroxicam and the third group received 1.0 ml liquid containing 2 mg/ml of piroxicam. Placebo and test solutions were applied daily, and dogs were examined biweekly for evaluation of plaque accumulation, gingival inflammation, bleeding upon gentle probing and tooth staining. Data were analyzed using the Krushkal-Wallis test. Over the treatment period, plaque accumulation was substantial in all three groups and was not significantly different between the three groups. By week 2, the gingival index in the piroxicam-treated dogs was significantly lower than that of the placebo-treated group and remained so throughout the study, with the exception of wk 6 and 12 in the topical gel-treated group. Mean percent bleeding sites were also significantly less in the piroxicam-treated groups than in the control dogs. Staining of the teeth increased for all groups over the 16-wk treatment period. These data indicate that piroxicam can significantly inhibit the development of gingival inflammation in beagle dogs.

Influence of cavity depth on marginal degradation of amalgam restorations

In a 5-year clinical trial it was observed that the marginal degradation of class-II amalgam restorations could be related to the bulk of the restoration. The association between the occlusal cavity depth and the marginal degradation was observed after 6 months and varied for the different types of alloy. Ridit scores of the marginal degradation were correlated to various indices of the cavity sizes, to assess the possible reason for this association. The possibilities of the relationship being an indirect effect caused by longer condensation times or by poorer condensation due to the use of larger condenser sizes were rejected. Furthermore, the possibility that the association was the result of potential buildup of stresses on the restoration margins caused by flexible cusps and axial walls was not apparent. A possible mechanism may be that marginal degradation is the result of short-term or long-term expansion, or even extrusion of amalgam. Expansion may theoretically be caused over short periods by temperature changes or over long periods by corrosion or phase shifts in the amalgam. The theory does not exclude the role of creep or corrosion and may furthermore explain the lack of correlation between in-vitro tests and in-vivo performance of amalgam restorations.

Relationship of restoration width, tooth position, and alloy to fracture at the margins of 13- to 14-year-old amalgams

The effect of width of the restoration, tooth position, and amalgam type on the fracture of the margins of 13- to 14-year-old, high-copper, amalgam restorations was evaluated. The evaluation assessed 193 photographs of restorations by use of ridit analysis and a rank-ordering test. The results indicated that the width of the restoration was the predominant factor and that tooth position and the different high-copper alloys were less significant. Interactions between tooth position and width indicated that lower premolars with conservative restorations exhibited the least fracture at the margins, and upper premolars with a wide preparation exhibited the most. It is postulated that tooth deflection under mastication may play a role in long-term fracture at the margins of amalgams.

Altering the progression of human alveolar bone loss with the non-steroidal anti-inflammatory drug flurbiprofen

The treatment of human periodontal diseases relies on mechanical and antimicrobial suppression of the etiologic bacteria. The ability to alter the progression of periodontitis by additionally blocking host pathways involved in the destructive process is an area of current research. Prostaglandins and other metabolites of arachidonic acid are believed to be important host mediators of the bone resorption of diseases such as periodontitis. We have previously examined the effect of inhibitors of prostaglandin production, non-steroidal anti-inflammatory drugs (NSAIDs), on inhibiting alveolar bone loss in beagles. The present study was designed to examine the effect of the NSAID, flurbiprofen, on slowing the radiographic loss of alveolar bone in the human. Fifty-six individuals with radiographic evidence of alveolar bone loss were recruited for study. Forty-four patients remained in the study for the data analysis of loss of alveolar bone. Following a 6 month baseline pretreatment period to measure the radiographic progression of bone loss, half of the patients were administered flurbiprofen, 50 mg. b.i.d., while half were administered a placebo. All patients received a subgingival scaling and pumice by a hygienist every 6 months. The rate of alveolar bone loss in a 2 year treatment period was compared to the baseline 6 month pretreatment period within and between patient groups. Throughout the study, teeth exhibiting obvious loss of bone were exited from study and treated with conventional mechanical therapy. At the end of the pretreatment period both patient groups had a similar mean rate of alveolar bone loss.(ABSTRACT TRUNCATED AT 250 WORDS)