Interactions between dental amalgams and the oral environment

The Effects of Thermocycling on the Physical Properties and Biocompatibilities of Various CAD/CAM Restorative Materials

The purpose of this study is to evaluate the changes in physical properties and biocompatibilities caused by thermocycling of CAD/CAM restorative materials (lithium disilicate, zirconia reinforced lithium silicate, polymer-infiltrated ceramic network, resin nanoceramic, highly translucent zirconia). A total of 225 specimens were prepared (12.0 × 10.0 × 1.5 mm) and divided into three groups subjected to water storage at 37 °C for 24 h (control group), 10,000 cycles in distilled water at 5-55 °C (first aged group), and 22,000 cycles in distilled water at 5-55 °C (second aged group) [(n= 15, each]). The nanoindentation hardness and Young's modulus (nanoindenter), surface roughness (atomic force microscopy (AFM)), surface texture (scanning electron microscopy (FE-SEM)), elemental concentration (energy dispersive spectroscopy (EDS)) and contact angle were evaluated. The morphology, proliferation and adhesion of cultured human gingival fibroblasts (HGFs) were analyzed. The data were analyzed using one-way ANOVA and Tukey's test (p < 0.05). The results showed that the nanoindentation hardness and Young's modulus were decreased after thermocycling aging. Cell viability and proliferation of the material decreased with aging except for the highly translucent zirconia. Zirconia-reinforced lithium silicate exhibited significantly lower cell viability compared to other materials. The surface roughnesses of all groups increased with aging. Cell viability and Cell adhesion were influenced by various factors, including the surface chemical composition, hydrophilicity, surface roughness, and topography.

Minimization of Adverse Effects Associated with Dental Alloys

Metal alloys are one of the most popular materials used in current dental practice. In the oral cavity, metal structures are exposed to various mechanical and chemical factors. Consequently, metal ions are released into the oral fluid, which may negatively affect the surrounding tissues and even internal organs. Adverse effects associated with metallic oral appliances may have various local and systemic manifestations, such as mouth burning, potentially malignant oral lesions, and local or systemic hypersensitivity. However, clear diagnostic criteria and treatment guidelines for adverse effects associated with dental alloys have not been developed yet. The present comprehensive literature review aims (1) to summarize the current information related to possible side effects of metallic oral appliances; (2) to analyze the risk factors aggravating the negative effects of dental alloys; and (3) to develop recommendations for diagnosis, management, and prevention of pathological conditions associated with metallic oral appliances.

Mercury in Dental Amalgam, Online Retail, and the Minamata Convention on Mercury

The Minamata Convention on Mercury (ref. 1) is a global treaty to protect human and environmental health from adverse effects of the toxic element mercury and its compounds. During the Third Conference of Parties (COP-3) in November 2019, elimination of the use of dental amalgam in oral health care was discussed. Dental amalgam is one of the most commonly used restorative materials in oral health care due to its strength and longevity (ref. 2). However, the use of mercury in an amalgam adds to global environmental mercury pollution and can contribute to adverse health effects on humans and other organisms. The outcomes of the COP-3 meeting included a call for information on the availability at a national scale, the economic and technical feasibility of alternatives, and the associated risks or benefits. In this feature, we discuss the risks and benefits of dental amalgam, the global tracking of availability and procurement, and the implications and realities for global phase out. We suggest a better accounting of mercury use in dental amalgam is needed with sales being made only to registered practitioners via a Know Your Customer approach.

Bond strength of commercial veneering porcelain to experimental cast Ti-Cr alloy

This study evaluated bond strengths of three commercial veneering porcelains to experimental cast titanium-chromium (Ti-Cr) alloy and commercially pure titanium (cp-Ti) via three-point bending test. After the bending test, the fractured specimens were analyzed using an electron probe microanalyzer (EPMA). The Ti-Cr specimens showed lower bond strengths than the cp-Ti specimens, irrespective of the layering porcelain material; however, all the strengths exceeded the minimum requirement of ISO 9693-1:2012 (>25 MPa). EPMA revealed that titanium and/or chromium elements were detected on the debonded porcelain surface of the Ti-Cr and cp-Ti specimens in the case of the higher bond strength. Contrastingly, the residual porcelain was retained on the metallic surface in the case of the lower bond strength. Although porcelain bonding to the titanium alloy is influenced by porcelain type, the Ti-Cr alloy could be feasible for porcelain-fused-to-metal restorations.

Wear of dental materials: Clinical significance and laboratory wear simulation methods -A review

This review focusses on tribological aspects of teeth during function, the clinical significance of wear, wear of natural teeth and restorative materials and laboratory methods to simulate wear of restorative materials. Ceramic, metal alloy and amalgam show low material wear, whereas resin-based materials demonstrate substantial wear in the long term. The clinical wear shows a high variability with the patient factor accounts for about 50% of the variability. Wear as such seldomly compromises the function of the stomatognath system or individual teeth and is in most cases an esthetic problem. Particles that are ingested due to attrition and abrasion wear may pose a health risk to the patient, especially those from composite resin materials. However, systematic clinical studies on that issue are not available. For laboratory research many wear simulation devices and methods have been developed but only few are validated and have a moderate correlation with clinical wear.

Oral lichenoid lesions - a review and update

Background:

Oral lichenoid lesions or reactions (OLLs/OLRs) are clinical and histological contemporaries of the classical oral lichen planus (OLP) that have generated a lot of debate in literature. In contrast to the idiopathic nature of OLP, OLLs are often associated with a known identifiable inciting factor. A superficial examination of these lesions clinically and histologically often reveals many similarities with OLP, but recent data indicate that distinguishable features do exist and form the basis of most classifications.

Aims and Objectives:

This paper attempts to collate available data in English literature on OLLs, highlight distinguishing features clinically and histologically and reflect on the malignant transformation potential and treatment modalities of the condition.

Materials and Methods:

A comprehensive search of medical and dental databases including PubMed, Ovid, Cochrane, Pubget, Researchgate, and non-medical search engines were utilized for the review. The search words included “oral lichen planus”, “oral lichenoid lesions”, “oral drug reactions”, “lichenoid dysplasia”, and “adverse effects of dental materials”.

Review Results:

OLLs seem to grossly underrated and most cases were clubbed as OLP. Definite clinical and histological features were uncovered to establish the identity of this lesion. Associations with dental restorative materials, drugs, and medications have been conclusively proven in the etiology of this condition. Specific markers are being utilized to diagnose the condition and monitor its progress.

Conclusion:

Substantial differentiating features were uncovered to delineate OLLs as a separate entity with definite etiology, pathogenesis, and a high malignant transformation rate compared with OLP.

Correlation between long-term in vivo amalgam restorations and the presence of heavy elements in the dental pulp

PROJECT

To measure the levels of heavy metals (Hg, Sn) in the dental pulp and blood samples of patients with long-term amalgam restorations.

PROCEDURE

12 amalgam restored and 12 non-restored, sound teeth were chosen and access cavity preparation to the pulp chamber was made. The contents were transferred and dissolved in 5mL of concentrated nitric acid followed by placement in an oven at 180°C for tissue digestion. After cooling the tubes each digested sample was transferred to an atomic absorption system to measure the levels of heavy metals. The blood samples of five patients in each group were randomly analyzed to determine the levels of these heavy metals in the blood and if there were a correlation between these levels in blood and pulp. Data were analyzed by t-test at a P<0.05 level of significance.

RESULTS

No significant difference was seen between the levels of Hg and Sn in pulp tissues (P>0.05); however, the blood analysis showed higher level of Hg amalgam group (P=0.009). The analysis between the pulp and blood samples showed positive correlations for both Hg and Sn elements in dental pulp and the blood (P=1.000) (P=0.900).

CONCLUSIONS

The long-term presence of dental amalgam (at least 5 years) did not result in any remarkable changes in the levels of mercury and tin in the pulp tissue; however, there were increases in the level of mercury in the blood circulation even five years following the placement of the restoration.

Induction of apoptosis and up-regulation of cellular proliferation in oral leukoplakia cell lines inside electric field

OBJECTIVE

In dentistry, metallic alloys are used for dentures, restorative materials, and orthodontic devices. Electric voltages up to 950 mV may occur between different dental alloys in the oral cavity. This study aimed to investigate physiologic reactions of oral leukoplakia cells in vitro to electric fields.

STUDY DESIGN

A human leukoplakia cell line (MSK-LEUK1), cultivated in keratinocyte growth medium (KGM-2) supplemented with growth factors in 5% CO(2) humidified air at 37°C, was exposed to electric field strength of 1-20 V/m for 24 hours in a custom-made pulse chamber. The cells were then analyzed for proliferation with the use of BrdU assay and for apoptosis with the use of TUNEL assay. Findings were assessed with the use of fluorescent microscopy. Ultrastructural changes were studied by transmission electron microscopy.

RESULTS

Electric field strength of 1-10 V/m led to up-regulation of cell proliferation rate from 10.64% to 44.06% (P = .0001). The apoptotic index increased significantly (P = .0001) from 20.03% at 1 V/m to 46.56% at 10 V/m. Individual cell keratinization was seen in leukoplakia cells treated with 16 V/m.

CONCLUSIONS

Oral galvanism induces subcellular changes in oral precancer cells in vitro that closely simulate some of the morphologic features of oral squamous cell carcinoma cells in vivo.

Existence of an electrically insulating layer in amalgam-containing galvanic couples

OBJECTIVE

Avoiding the placement of amalgam and noble metal restorations in interproximal contact is recommended due to anticipated galvanic corrosion of the amalgam. There is a similar concern for amalgam/amalgam galvanic couples. It was the objective of this study to determine if an electrically insulating layer forms in the contact area of these galvanic couples. The existence of an electrically insulating layer, which could reduce the galvanic corrosion rate, would be indicated by different corrosion potentials for the two restorations of the couple.

METHODS

Using a convenience sample of 158 human subjects, corrosion potentials were measured on each restoration of three types of galvanic couples: amalgam/noble metal (n=8), amalgam/amalgam (n=93) and noble metal/noble metal (n=7). Measurements were made with a Ag/AgCl micro-reference electrode and a high impedance voltmeter. All restorations were at least 6 months old.

RESULTS

Statistical analysis showed that the mean absolute corrosion potential differences and the simultaneous confidence intervals of the couples were, respectively, amalgam/noble metal: 62 (31)mV and (27, 99)mV, amalgam/amalgam: 11 (14)mV and (7, 15)mV and noble metal/noble metal: 7 (10)mV and (0, 19)mV.

SIGNIFICANCE

The amalgam/noble metal couples had consistent and mostly large corrosion potential differences between their restorations, which indicated the presence of an electrically insulating layer. An electrically insulating layer was also indicated for the amalgam/amalgam and noble metal/noble metal couples. The layer is probably composed of non-metallic corrosion products, biofilms, and possibly, dental calculus, which could reduce galvanic corrosion rates to small or negligible values.

Microtensile bond strengths of two adhesive resins to discolored dentin after amalgam removal

Studies have reported the discoloration of dentin beneath amalgam restorations. The purpose of this study was to test the hypothesis that the bond strengths of adhesive resins to this discolored dentin are lower than those to normal dentin, and are related to the presence of metallic ions or corrosion products. Amalgam-filled extracted human teeth were used. After the removal of amalgam, the discolored dentin and surrounding normal dentin were bonded with Single Bond or Clearfil SE Bond and tested for microtensile bond strengths. The bond strengths of Single Bond and Clearfil SE Bond to normal dentin were greater than to discolored dentin. Clearfil SE Bond demonstrated higher bond strength to normal dentin than did Single Bond. However, no differences were found between the bond strengths to the discolored dentin of both adhesives. Elemental micro-analysis revealed various amounts of tin in all discolored dentin.

Corrosion potential recovery of dental amalgam restorations following prophylaxis

OBJECTIVE

Dental amalgam restorations are subjected to abrasion during selective prophylaxis that can damage or remove the protective oxide and result in increased rates of corrosion and chemical dissolution of mercury. It was the objective of this research to study the corrosion potential change of dental amalgam restorations to obtain an indication of the time required for in vivo repassivation following prophylaxis.

METHODS

The corrosion potentials of 27 Class I and Class II amalgam restorations were measured pre- and post-prophylaxis using a high impedance voltmeter and a Ag/AgCl micro-reference electrode. Prophylaxis was performed for approximately 2s on each amalgam surface using a slow-speed handpiece with a rubber-cup and commercial abrasive paste. Subjects thoroughly rinsed before the post-prophylaxis corrosion potentials were measured. The data were analyzed using a confidence interval, a t-test and correlation analysis.

RESULTS

The pre- and post-prophylaxis mean corrosion potentials were, respectively, -132 (27)mV and -126 (27)mV. The mean of the differences between the pre- and post-prophylaxis corrosion potentials was 6.1 (28)mV, with an associated 95% confidence interval of (-4.8, 17)mV. A t-test showed the mean absolute difference in corrosion potential was less than 50 mV (p<0.0001).

SIGNIFICANCE

The results of this study show that the post-prophylaxis recovery of the corrosion potential of amalgam restorations occurred by at most 10-44 min, indicating that the period of elevated corrosion rate and elevated chemical dissolution rate of mercury, due to oxide damage or removal, may be short-lived.

Time-dependent corrosion potential of newly-placed admixed dental amalgam restorations

OBJECTIVE

It was the objective of this study to measure the corrosion potential over time of newly-placed admixed dental amalgam restorations as a possible indicator of corrosion activity.

METHODS

The corrosion potentials of 271 amalgam restorations, 4-min to 24-month old were measured in a convenience sample of 81 subjects. The selected restorations had no occlusal or interproximal contact with other metallic restorations. Eighty-one percent of the restorations aged 4 min to 7 months were made from zinc-containing admixed high-copper amalgam. The remaining amalgams were an unknown mixture of admixed high-copper and single-composition-alloy amalgams.

RESULTS

The data were fit to a mixed-effects model with random patient effects to allow for the correlation, using the maximum likelihood method. The early data best fit a quadratic model with an initially rapidly rising corrosion potential that leveled off to a constant mean value of -146 (60)mV (versus Ag/AgCl, 3M KCl at 35 degrees C) by approximately 7 months. Most of the ennoblement occurred within the first 4 months after restoration placement.

SIGNIFICANCE

This in vivo study observed a slower rate of corrosion potential ennoblement for admixed amalgam restorations than would be predicted from in vitro studies. The slower rate is believed due to the combination of mechanical, chemical and biological forces in the mouth that are generally absent using simulated conditions. The slower rate of ennoblement suggests a slower rate of achieving maximum corrosion resistance than would be predicted using in vitro studies.

Disinfectants' effect on mercury release from amalgam

BACKGROUND

Mercury environmental discharge is under increased scrutiny by the U.S. Environmental Protection Agency (EPA). Dental amalgam should be processed properly to prevent an additional environmental burden. Some processing agencies require that submitted amalgam be noninfectious. Investigations have demonstrated that oxidizing disinfectants mobilize mercury from amalgam into solution and add mercury to the environmental burden if it is disposed of improperly. The authors conducted a study to evaluate the effect of representative disinfectants on amalgam mercury release.

METHODS

The authors sized a high-copper spherical amalgam alloy to match that typically found in dental unit suction traps. They exposed 20 grams of the alloy to several disinfectant solutions and evaluated the filtered supernatant solution for mercury content.

RESULTS

Chlorine disinfectant materials discharged the most mercury ions, followed by bromide, iodophor, peroxide/peracetic acid and phenolic disinfectants. The quaternary ammonium compound did not discharge mercury ions above the detection limit (0.2 parts per billion) into solution.

CONCLUSIONS

A quaternary ammonium compound did not mobilize mercury ions into solution when used as a disinfectant agent for amalgam. Chlorine disinfectants mobilized mercury ions the most, followed by bromide, iodophor, peroxide/peracetic acid and phenolic disinfectants.

CLINICAL IMPLICATIONS

Dentists are obligated to be good environmental stewards and should follow practices that reduce environmental mercury release. Dental personnel should be aware that oxidizing disinfectants mobilize mercury ions into solution, which will be added to the environment if they are processed improperly. If required by processing, dental personnel should consider the different oxidizing effects of commonly used disinfectants.

Healing of oral lichenoid lesions after replacing amalgam restorations: a systematic review

OBJECTIVE

We sought to systematically review the literature related to oral lichenoid lesions (OLLs) and amalgam restorations.

STUDY DESIGN

Cohort and case-controlled studies (no randomized controlled trials or controlled clinical trials available) were reviewed with respect to inclusion criteria and data on patients with OLLs, treatment interventions, and the measurement of outcomes.

RESULTS

Fourteen cohort and 5 case-controlled trials met the criteria. The study population consisted of 1158 patients (27% male and 73% female; age range, 23-79 years). From 16% to 91% of patients had positive patch test results for at least 1 mercury compound. Of 1158 patients, 636 had to have their restorations replaced. The follow-up period ranged from 2 months to 9 1/2 years. Complete healing ranged from 37.5% to 100%. The greatest improvements were seen in lesions in close contact with amalgam.

CONCLUSIONS

Protocols must be standardized to obtain valid results. The replacement of amalgam restorations can result in the resolution or improvement of OLLs. Patch testing seems to be of limited value. The topographic relationship between an OLL and an amalgam restoration is a useful--but not conclusive--marker.

A validated cold vapour-AAS method for determining mercury in human red blood cells

A cold vapour-atomic absorption spectrometry (CV-AAS) method for determining mercury in dental students and clinical teaching staff red blood cells at a dental school using amalgam as a restorative material has been validated. A number of blood samples (n = 122) from dental students in years I to V, clinical teachers in restorative dentistry and controls were collected and analysed. Accuracy, linearity, precision (repeatability and reproducibility) and robustness of the method have been determined, and detection and quantification limits have been calculated. Linearity of response was verified for concentrations ranging from 5 to 40 microgL(-1) of mercury. Correlation coefficient of the calibration straight lines was always >/=0.99. Intra-day precision of the method gave coefficient of variation (CV) of 5.51%. Inter-day precision of the method calculated after analysis of five different concentrations of mercury standard solutions by the same analyst in different days and by two different analysts in different days gave coefficient of variation 4.89 and 5.44%, respectively. The accuracy of the method was calculated a CRM NIST 966 (toxic metals in bovine blood) total amount of mercury was found a concentration of 28.83 +/- 2.2 microgL(-1). Recovery was 89.27%. Robustness of the method evaluated by changing different experimental conditions under which analyses performed, fractional factorial design was done for assessing robustness of the method. Root mean square error was found out as 1.56. Limits of detection and quantification were 1.84 and 4.03 microg of Hg per litre of sample, respectively. Results show the suitability of the method for direct measurement of mercury in red blood cells and the importance of the working conditions for people dealing with amalgam at a dental school.

In vivo galvanic currents of intermittently contacting dental amalgam and other metallic restorations

OBJECTIVE

It was the objective of this study to determine the magnitude of in vivo galvanic currents produced by simulating electrical contact between occluding metallic restorations, and to examine the influence of restoration age, difference in pre-contact corrosion potentials, and surface area.

METHODS

A convenience sample of 106 human subjects was studied. A Ag/AgCl micro-reference electrode and a high impedance voltmeter were used to measure the pre-contact corrosion potentials. Galvanic couples (n = 194) were next formed by simultaneously contacting occluding restorations with gold-plated probe tips for 15 s. The resulting current-time transients were measured with a zero-resistance ammeter and recorded with an electronic data acquisition program. The vast majority of couples measured contained at least one dental amalgam restoration.

RESULTS

Galvanic current-time transients were typically characterized by an immediate and rapid rise to a peak current, followed by an exponential decay to a much lower value at 15 s. For couples with a restoration < or = 12 mo old, median peak current and median current at 15 s were 2.26 microA (range 0.24-13.06 microA) and 0.57 microA (range 0.03-6.47 microA), respectively. For couples with a restoration >12 mo old, median peak current and median current at 15 s were 1.40 microA (range 0.24-12.09 microA) and 0.37 microA (range 0.00-3.05 microA), respectively. Couples with fresh amalgams (< or = 6 mo) generally had elevated currents (range 2.56-102.54 microA).

SIGNIFICANCE

A wide range of galvanic currents resulted from electrical contact of restorations in vivo. These currents were influenced by restoration age and total surface area of the galvanic couple. For amalgam-amalgam couples, the difference in the pre-contact corrosion potentials may be useful in predicting galvanic currents, when the difference is at least 24 mV.

Blood mercury levels of dental students and dentists at a dental school

OBJECTIVE

To determine the blood mercury levels in dental students and clinical teaching staff in a dental school using amalgam as a restorative material.

SETTING

A dental school in Ege University, Turkey surveyed during one academic year.

SUBJECTS AND METHODS

Cross-sectional study of groups of dental students (n=92) in years I to V, clinical teachers in restorative dentistry (n=16) and controls (n=14). Mercury concentration was estimated in venous blood samples using a cold vapour atomic absorption method at the commencement and end of the academic year. Daily air mercury levels were determined in clinical and teaching areas by measuring the darkening of palladium chloride discs using spectrophotometry.

RESULTS

There were statistically significant increases (p<0.001) in plasma mercury concentration between measurements in all groups at the end of the academic year. Red cell mercury levels were also consistently elevated. Although the highest levels of mercury were recorded in persons working with amalgam, increased levels were also found in subjects working in the teaching classrooms but not with amalgam (controls and first year students).

CONCLUSION

Increased mercury levels appeared to be due to background exposure from spillage of mercury and amalgam residues on floors. Increased mercury hygiene and regular control of working atmosphere should be implemented to prevent mercury exposure in the dental pre-clinical laboratory.

Inhibition of human gelatinases by metals released from dental amalgam

The interaction between metal ions and the oral environment is a major subject matter in dental research. Matrix metalloproteinases (MMPs) have been implicated in pathologic oral processes such as periodontal tissue destruction, root caries, tumor invasion and temporomandibular joint disorders. The aim of this study was to test the effect of metal ions released from dental amalgam on the major gingival gelatinolytic MMPs. Gingival human explants were cultured overnight in DMEM and the activity of secreted enzymes was analyzed by gelatin zymography in buffers conditioned with dispersed phase or concentional phase dental amalgams. The major enzymes present in conditioned media were characterized as MMP-2 and MMP-9 by immunoprecipitation. The proteolytic activities of MMP-2 and MMP-9 were strongly inhibited by dispersed phase amalgams conditioned buffers. Inhibition of MMP-2 and MMP-9 activities was partly prevented by the addition of 1,10 phenanthroline, a divalent metal chelator, to the amalgam conditioned buffers. Dental amalgam conditioned buffer also inhibited the degradation of denatured type I collagen by purified MMP-2 on liquid phase assays. These findings suggest that the activity of oral tissue MMPs may be modulated by metal ions released from dental amalgam.

Dental amalgam and mercury in dentistry

Mercury in dentistry has re-emerged as a contentious issue in public health, predominantly because so many people are inadvertently exposed to mercury in order to obtain the benefits of dental amalgam fillings, and the risks remain difficult to interpret. This commentary aims to examine the issues involved in public policy assessment of the continued use of dental amalgam in dentistry. More than 30 per cent of Australian adults are concerned about mercury from dental amalgam fillings but only a small percentage report having their amalgam fillings removed. The placement of dental fillings nearly halved between 1983 and 1997, but many millions of dental amalgam fillings exist in the Australian community. These fillings release mercury (mercury vapour or inorganic ions) at a low level (about 2-5 micrograms/day in an adult). Evidence on the health effect of dental amalgams comes from studies of the association between their presence and signs or symptoms of adverse effects or health changes after removal of dental amalgam fillings. More formal risk assessment studies focus on occupational exposure to mercury and health effects. Numerous methodological issues make their interpretation difficult but new research will continue to challenge policymakers. Policy will also reflect prudent and cautious approaches, encouraging minimization of exposure to mercury in potentially more sensitive population groups. Wider environmental concerns and decreasing tolerance of exposure to other mercury compounds (for example, methylmercury in seafoods) will ensure the use of mercury in dentistry remains an issue, necessitating dentists keep their patients informed of health risks and respect their choices.

Inhibition of human gingival gelatinases (MMP-2 and MMP-9) by metal salts

OBJECTIVES

The interaction between metal ions and the oral environment is a major subject matter in dental research. Matrix metalloproteinases (MMPs) have been implicated in several pathologic oral processes such as periodontal tissue destruction, root caries, tumour invasion and temporomandibular joint disorders. The aim of this work was to test the effect of Zn, Cu, Sn and Hg ions on the activity of the major gingival gelatinolytic MMPs.

METHODS

Gingival explants were cultured overnight in DMEM and the activity of secreted enzymes was analyzed by gelatin zymography in buffers containing different metal ion concentrations. The major gelatinolytic proteinases present in the conditioned media were characterized as MMP-2 and MMP-9 by immunoprecipitation with specific antibodies. The eletrophoretic bands were scanned and the transmittance values were analyzed with the Sigmagel software (Sigma).

RESULTS

ZnSO4 was a strong inhibitor of MMP-2 (I50 = 15 microM) and MMP-9 (I50 = 40 microM), whereas CuSO4, HgSO4 and SnCl2 showed less efficient inhibition potential.

SIGNIFICANCE

Our findings show that the activity of oral tissue MMPs may be modulated by metal ions present in the oral environment. Therefore, the accumulation of metals in connective tissue may interfere with the formation and resorption of the extracellular matrix components.

Copper

Copper is an essential trace element, which is an important catalyst for heme synthesis and iron absorption. Following zinc and iron, copper is the third most abundant trace element in the body. Copper is a noble metal, like silver and gold. Useful industrial properties include high thermal and electrical conductivity, low corrosion, alloying ability, and malleability. Most of the metallic copper appears in electrical applications. Copper is a constituent of intrauterine contraceptive devices and the release of copper is necessary for their contraceptive effects. The average daily intake of copper in the US is about 1 mg Cu with the primary source being the diet. The bioavailability of copper from the diet is about 65-70% depending on a variety of factors including chemical form, interaction with other metals, and dietary components. The biological half-life of copper from the diet is 13-33 days with bilary excretion being the major route of elimination. Copper sulfate is a gastric irritant that produces erosion of the lining of the gastrointestinal tract. Chronic copper toxicity is rare and primarily affects the liver. Wilson's disease and Indian childhood cirrhosis are examples of severe chronic liver disease that results from the genetic predisposition to the hepatic accumulation of copper. The serum copper concentration ranges up to approximately 1.5 mg/L in healthy persons. Gastrointestinal symptoms occur at whole blood concentrations near 3 mg Cu/L. Chelating agents (CaNa2EDTA, BAL) are recommended in severe poisoning, but there are little pharmacokinetic data to evaluate the effectiveness of these agents.

Alzheimer's disease, dental amalgam and mercury

BACKGROUND

Mercury, or Hg, is a neurotoxin that has been speculated to play a role in the pathogenesis of Alzheimer's disease, or AD. Dental amalgam releases low levels of Hg vapor and is a potential source of Hg for a large segment of the adult population.

METHODS

The authors studied 68 subjects with AD and 33 control subjects without AD to determine Hg levels in multiple brain regions at autopsy and to ascertain the subjects' dental amalgam status and history. The subjects were from central Kentucky and Elm Grove, Wis. The authors conducted dental amalgam assessments during the lives of the majority of subjects and in some subjects at the time of autopsy only. The authors also determined three dental amalgam index scores--Event (placement, repair or removal of amalgam), Location and Time In Mouth--in addition to the numbers of and surface area of occlusal amalgam restorations. The authors determined Hg levels in multiple brain regions and performed full neuropathologic evaluations to confirm the normal status of the brain or the presence of AD.

RESULTS

The authors found no significant association of AD with the number, surface area or history of having dental amalgam restorations. They also found no statistically significant differences in brain Hg level between subjects with AD and control subjects.

CONCLUSIONS

Hg in dental amalgam restorations does not appear to be a neurotoxic factor in the pathogenesis of AD. The authors found that brain Hg levels are not associated with dental amalgam, either from existing amalgam restorations or according to subjects' dental amalgam restoration history.

CLINICAL IMPLICATIONS

Dental amalgam restorations, regardless of number, occlusal surface area or time, do not relate to brain Hg levels.

Evaluation of restorative and implant alloys galvanically coupled to titanium

OBJECTIVES

As the success of implants leads to their increasing use in restorative dentistry, attention should be devoted to the galvanic combination of restorative materials with titanium. This paper used continuous corrosion potential monitoring in conjunction with zero-resistance ammetry to obtain galvanic corrosion properties of restorative and implant materials coupled with titanium (ASTM F67-Grade II).

METHODS

Direct coupling or galvanic experiments were conducted on eight restorative and implant materials coupled to titanium. Deaerated artificial saliva solution in a specifically designed corrosion cell simulated an oral crevice situation. Open circuit potentials (Eo.c.) of each material in the couple, coupled corrosion potentials (Ecouple corr), coupled corrosion current density (lcouple corr) and the resultant charge transfer were monitored. The results were analyzed using single factor ANOVA and Duncan's multiple range tests.

RESULTS

Noble restorative (Au-, Ag-, and Pd-based) alloys coupled to titanium were found to be least susceptible to galvanic corrosion. Co-Cr-Mo, Ni-Cr and Fe-based alloys coupled to tatanium were found to be moderately susceptible to galvanic corrosion due to mechanical-electrochemical interaction. Ni-Cr-Be alloy coupled to titanium was found to be highly susceptible to galvanic corrosion. The in vitro test results for the titanium/Disperalloy combination does not concur with the published clinical performance of this combination, and thus warrants further investigation.

SIGNIFICANCE

From the data obtained in this study and current literature profiles, acceptable restorative couples were developed for use as clinical guidelines in restorative dentistry.

Antimicrobial activity of amalgams, alloys and their elements and phases

OBJECTIVES

This in vitro study aimed to evaluate the antibacterial effect of amalgams, alloys, elements and phases against two cariogenic bacteria, Actinomyces viscosus and Streptococcus mutans.

METHODS

Test materials comprised: (i) commercial amalgams comprising Amalcap (Vivadent), Cavex Avalloy LC and DP (Cavex), Cupromuc (Merz), Fluoralloy and Synalloy (Dentoria); (ii) Ag-Cu alloy; (iii) gamma, gamma 1, gamma 2 and Cu6Sn5 phases; (iv) pure metal samples and chloride solutions of copper, mercury, tin and zinc; and (v) aqueous sodium fluoride. Bacterial suspensions of each of the two bacteria were grown in the presence of the test materials for 24 h. Antimicrobial effectiveness was assessed by measuring reduction in optical density at 640 nm using a visible spectrophotometer.

RESULTS

Cupromuc/Fluoralloy, non gamma 2 amalgams and Amalcap displayed high, moderate and no antibacterial activity, respectively. Antibacterial effectiveness was not related to copper content. Whereas mercury, copper, Ag-Cu alloy, fluoride and zinc showed antibacterial activity (Hg > Cu > F > Zn), tin, gamma phases and Cu6Sn5 showed no such activity.

SIGNIFICANCE

Although the fluoride and copper solutions were most effective at 50 micrograms ml-1 concentration, their antibacterial action was still significant, albeit reduced, at 10 micrograms ml-1 concentration. This was not the case for mercury chloride which was just as effective at both concentrations. Our results show that although mercury and copper contribute significantly to the antibacterial properties of amalgams, a high copper content does not necessarily relate to high antibacterial effectiveness. These elements could be useful in conferring antibacterial properties to amalgam although their effects on host cells must be investigated.

Changes in surface levels of mercury, silver, tin, and copper of dental amalgam treated with carbamide peroxide and hydrogen peroxide in vitro

OBJECTIVES

The effect of 10% carbamide peroxide or 10% hydrogen peroxide on the surface levels of mercury, silver, tin, and copper of amalgam fillings was tested in vitro with scanning electron microscopy and energy dispersive spectrometric microanalysis.

STUDY DESIGN

Samples of amalgam were treated for 14 and 28 days with either 10% carbamide peroxide or 10% hydrogen peroxide solutions and compared with phosphate buffer controls.

RESULTS

A significant increase in mercury levels occurred after treatment with carbamide peroxide for 14 days (p < 0.01) and 28 days (p < 0.001) and after treatment with hydrogen peroxide for 28 days (p < 0.001). A significant increase in silver levels occurred after treatment with carbamide peroxide for 14 days (p < 0.05) and 28 days (p < 0.01) and subsequent to treatment with hydrogen peroxide for 14 days (p < 0.05) and 28 days (p < 0.001). A significant reduction in tin levels occurred after treatment with hydrogen peroxide for 14 days (p < 0.01) and 28 days (p < 0.001), and after treatment with carbamide peroxide for 28 days (p < 0.01). A significant reduction in copper levels was found after treatment with carbamide peroxide for 14 days (p < 0.05).

CONCLUSIONS

It appears that prolonged treatment with bleaching agents may cause microstructural changes in amalgam surfaces, possibly increasing exposure of patients to toxic byproducts.

Caracterização e estudo da corrosão do amálgama dentário Dispersalloy por meio das técnicas de polarização potenciodinâmica e espectroscopia de impedância

Neste trabalho realizou-se um estudo de caracterização metalúrgica do amálgama dentário Dispersalloy produzido pela empresa Dentsply Ind. e Com. Ltda., por meio da análise da sua composição química, utilizando-se a técnica espectrofotométrica de absorção atômica, procedendo-se em seguida, a análise metalográfica, utilizando-se microscopia eletrônica de varredura. A seguir, foi realizado um estudo de resistência à corrosão, utilizando-se técnicas eletroquímicas tradicionais de polarização e espectroscopia de impedância, em meio e condições que simulam a agressividade do ambiente bucal. Para isto, as amostras foram obtidas pelo processo de amalgamação mecânica, método usualmente utilizado pelos dentistas no próprio consultório, para a preparação da restauração dentária. A liga comercial Dispersalloy, representante da categoria de amálgamas de alto teor de cobre, tipo fase dispersa, foi escolhida para este estudo por ser bastante comercializada nos mercados nacional e internacional e, também por ser uma liga metálica moderna, bastante estudada, mas que ainda sofre corrosão no meio bucal.

Corrosion of amalgams under sliding wear

OBJECTIVES

During mastication, dental amalgams are simultaneously subjected to corrosion by the oral environment and to a sliding-wear process by biting forces. In the present study, the effect of sliding wear on the corrosion behavior of two high-copper dental amalgams was investigated.

METHODS

An experimental apparatus was utilized that allows electrochemical testing under sliding-wear conditions. Corrosion potential measurements and anodic polarization scans were conducted in 0.1 M NaCl solution under sliding wear to characterize the behavior of two commercial, high-copper, single composition dental amalgams. In addition, long duration tests were conducted to assess possible corrosion and wear synergistic effects.

RESULTS

The results showed that sliding wear caused a sharp reduction in the corrosion potential, a significant increase in the corrosion rate and a decrease in the repassivation rate of both amalgams. These effects are due to the mechanical removal by the wear process of the surface protective film formed on dental amalgams. The simultaneous action of sliding wear and corrosion can also induce embrittlement that leads to cracking.

SIGNIFICANCE

The present evidence suggests that this cracking may be one of the major contributors to marginal failures of dental amalgam restorations.

Influence of amalgams, bases, and varnish on seal composition at restoration tooth interfaces

Eighty extracted, noncarious premolars were restored with one of 20 different combinations of restorative materials: a high- or low-copper amalgam, unlined or lined with one of five bases, and varnished or unvarnished. The teeth were aged in 1% NaCl and after 3 months and 1 year the seal material deposited on the cut tooth cavity surface and the surface of the amalgam restoration was analyzed by use of energy dispersive x-ray analysis. Atomic weight percentages of marginal seal elements were statistically examined with ANOVA and Tukey's test with significance set at p < 0.05. The results indicated that only one type of seal was formed centered around tin. More marginal seal material was present in the 1-year specimens. Restoration materials used affected the deposition rate of marginal seal material. Low-copper amalgam-restored teeth formed more seal material with significantly greater amounts of chlorine and tin. Less marginal seal material was found in varnished cavities. A calcium hydroxide base produced a thick marginal seal with a significantly different composition of elements compared with the unlined and zinc-based specimens. Tin in Poly-F Plus polycarboxylate cement did not significantly increase the tin content of the marginal seal. Base materials can play a role in determining crevice pH. The findings have bearing on improved longevity of amalgam restorations.