Casting alloys: side-effects

Accurate analysis of titanium and PolyEtherEtherKetone materials as an alternative to cobalt-chrome framework in removable partial denture: A systematic review

STATEMENT OF PROBLEM

New materials have emerged in the dental field to replace the cobalt-chrome (CoCr) alloy used for the metal frameworks in removable partial denture (RPD) such as Titanium (Ti) and PolyEtherEtherKetone (PEEK). However, few studies have demonstrated their mechanical and biological performance.

PURPOSE

The purpose of this systematic review was to compare the performance of Ti and PEEK in RPD using CoCr metal framework as a reference.

MATERIAL AND METHODS

This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three data bases were analyzed, including PubMed/MEDLINE, Embase and Web of Science before March 2024. Only studies assessing the mechanical and/or biological properties of RPD in Ti, PEEK and CoCr were included. The quality of the studies was assessed by using the software Rayyan. The risks of bias were assessed with the methodological index for nonrandomized studies (MINORS). The mechanical (retention force, fatigue life, deformation strength, machinability, rigidity, porosity and surface roughness) and biological (plaque indices, ion release and biocompatibility) aspects were assessed.

RESULTS

Among 138 articles identified, only 18 studies were included in this review. Majority had a low to moderate risk of bias. Retention forces and fatigue were significantly lower for Ti and PEEK than for CoCr, and the same was true for Ti rigidity. PEEK showed less deformation. Both materials were suitable for machining. In terms of biological properties, both materials showed adequate biocompatibility for clinical use.

CONCLUSION

Ti and PEEK seems to be promising as alternative materials to CoCr frameworks for RPD, in terms of both their mechanical and biological performance. However, additional studies are needed to better understand their clinical and long-term limitations to enable the best-informed clinical choice for the patients and the professionals.

Postoperative Excessive Bleeding following Stainless-Steel Crown Placement in Healthy Children with a Suggested Approach for Prevention

Stainless-Steel Crown (SSC) placement is a common treatment in children, usually without significant adverse consequences. The present case series reports six healthy children were admitted to emergency rooms in two medical centers with delayed excessive bleeding from their gingiva, adjacent to newly placed SSCs. The bleeding, in some cases, was so extensive, that it induced vomiting and anxiety, among the children and their parents, and in two cases required surgical suturing. In all six cases, the most probable etiology was a toxic reaction to the released nickel or chromium ions from the SSCs, exacerbated by contact with wounded and bleeding gingiva. Expression of this cytotoxic mode of action, due to metal ions released from SSCs, is not well documented in children. Our aims are to raise awareness of this unique complication and to suggest an approach to minimize and prevent its occurrence. Recommended immediate treatment includes frequent rinsing of the gingiva to wash out released metal ions and decrease their toxic effect. Furthermore, in the following appointments, we recommend using only SSCs previously soaked in water for several weeks, using zirconia crowns, or using Hall's technique when appropriate.

Use of liquid-based cytology samples reveals genomic instability and cell death in patients undergoing orthodontic treatment

PURPOSE

To examine the use of liquid-based exfoliative cytology to determine the presence of genomic instability and cell death in the oral mucosa of patients with orthodontic appliances.

METHODS

Fifty-four oral mucosa samples were collected from 18 patients and divided into three stages: T0, before fixation of orthodontic appliances; T1, 25 days after appliance fixation; T2, 90 days after appliance fixation. All samples were Papanicolaou-stained and observed by microscopy (1,000 cells/sample) to ascertain the frequency of micronucleated cells (MN) and nuclear abnormalities (nuclear buds (NB), binucleated (BN), condensed chromatin (CC), karyorrhexis (KR), and karyolysis (KL)). Differences were analyzed statistically using the Mann-Whitney, Wilcoxon, Kruskal-Wallis and chi-squared tests.

RESULTS

After placement of orthodontic appliances, significant differences were observed for genomic instability biomarkers (MN and NB) and cell death (CC, KR and KL) (P < 0.05). Female patients and older patients exhibited a higher frequency of MN.

CONCLUSION

Liquid-based cytology has revealed that orthodontic appliances induce genomic instability and cell death in epithelial tissue of the oral mucosa, facilitating sample preservation and yielding more than one preparation per sample. Future studies should investigate whether such cell damage can be reversed through cell repair or whether cell alterations evolve and lead to disease.

Recent update on potential cytotoxicity, biocompatibility and preventive measures of biomaterials used in dentistry

Dental treatment is provided for a wide variety of oral health problems like dental caries, periodontal diseases, periapical infections, replacement of missing teeth and orthodontic problems. Various biomaterials, like composite resins, amalgam, glass ionomer cement, acrylic resins, metal alloys, impression materials, bone grafts, membranes, local anaesthetics, etc., are used for dental applications. The physical and chemical characteristics of these materials influence the outcome of dental treatment. It also impacts on the biological, allergic and toxic potential of biomaterials. With innovations in science and their positive results, there is also a need for awareness about the biological risks of these biomaterials. The aim of dental treatment is to have effective, yet safe, and long-lasting results for the benefit of patients. For this, it is important to have a thorough understanding of biomaterials and their effects on local and systemic health. Materials used in dentistry undergo a series of analyses before their oral applications. To the best of our knowledge, this is the first and original review that discusses the reasons for and studies on the toxicity of commonly used biomaterials for applications in dentistry. It will help clinicians to formulate a methodical approach for the selection of dental biomaterials, thus providing an awareness for forecasting their risk of toxic reactions.

The Implications of Titanium Alloys Applied in Maxillofacial Osteosynthesis

Titanium alloys are known for their biological, mechanical and chemical properties, which have successfully expanded their use in the maxillofacial field. The internal fixation using titanium miniplates and screws offer a new perspective for the treatment of trauma and in orthognathic surgery and maxillofacial oncology. Although, titanium is highly recommended for its excellent biocompatibility, recent research has focused on identifying the potential local and general implications of the interactions between the human tissue and the metallic particles. This present review aims to outline the existing tissue changes, cellular alterations and future perspectives regarding the use of titanium-based alloys as osteosynthesis materials, taking into consideration the existing present debate whether the routinely removal of these materials should be an indication.

Cross-sectional observational study exploring clinical risk of titanium allergy caused by dental implants

PURPOSE

Studies have reported cases of metal allergy caused by titanium-containing materials. We wished to clarify the relationship between titanium allergy and dental implants by describing patients who suffered allergic symptoms after they had received such implants.

METHODS

A total of 270 patients who visited a Dental Metal Allergy Clinic at Tokushima University Hospital from April 2010 to March 2014 were the study cohort. Patch testing with 28 types of metal allergens (including four titanium allergens) was undertaken for patients.

RESULTS

A total of 217 patients (80.4 %) exhibited allergy-positive reactions to at least one type of metal allergen. Mercury, palladium, chromium and nickel exhibited a higher prevalence of allergy-positive reactions than other metals. Sixteen patients visited our clinic suffering allergic symptoms after receiving dental implants. Eleven of those patients exhibited allergy-positive reactions for any of the metal allergens, and 4 of these patients had allergy-positive reactions against titanium allergens. The total number of allergy-positive reactions for titanium allergens among all 270 patients was 17 (6.3 %). No patient exhibited a positive reaction only for the titanium allergen.

CONCLUSIONS

The prevalence of allergy-positive reactions for titanium allergens was lower than for other metal allergens. We suggest examination of pre-implant patients who have a history of hypersensitivity reactions to metals.

Proposed ICDRG Classification of the Clinical Presentation of Contact Allergy

The International Contact Dermatitis Research Group proposes a classification for the clinical presentation of contact allergy. The classification is based primarily on the mode of clinical presentation. The categories are direct exposure/contact dermatitis, mimicking or exacerbation of preexisting eczema, multifactorial dermatitis including allergic contact dermatitis, by proxy, mimicking angioedema, airborne contact dermatitis, photo-induced contact dermatitis, systemic contact dermatitis, noneczematous contact dermatitis, contact urticaria, protein contact dermatitis, respiratory/mucosal symptoms, oral contact dermatitis, erythroderma/exfoliative dermatitis, minor forms of presentation, and extracutaneous manifestations.

Metal free, full arch, fixed prosthesis for edentulous mandible rehabilitation on four implants

PURPOSE

The goal of this work is to describe an implant-prosthetic protocol for rehabilitation of edentulous mandible, by using a fixed prosthesis made of fiber-reinforced composite material (FRC). The protocol contemplates a minimal invasive surgery and ensures predictable and safe results, with good aesthetic and performance combined to cost savings.

METHODS

FRC material is used to build the substructure of a prosthetic framework supported by four short implants (5mm long and 4mm wide). The prosthesis substructure is made of Trinia immersed in a matrix of epoxy resin (FRC). It is supplied in milling blocks (pre-cured) for the CAD/CAM (computer-aided design/computer-aided manufacturing) technique. Implants are placed in lower edentulous jaw in position of first molar and canine, each side. Four month after, a resin bar is build based on a stone model, denture teeth are placed and the occlusion is checked. The resin bar and the stone model with milled abutments are scanned and a FRC bar is achieved with the CAD/CAM technique. The teeth are mounted to the substructure trough denture resin. Temporary cementation of framework is achieved on the abutments connected to the implants.

CONCLUSION

A protocol for a fixed mandibular implant-prosthetic rehabilitation is described. The protocol contemplates a minimal invasive surgery and ensures predictable and safe results, with good aesthetic and performance combined to cost savings. In addition, this technique allows performing basic surgery also in presence of atrophy.

Amelogenesis Imperfecta: Rehabilitation and Brainstorming on the Treatment Outcome after the First Year

Amelogenesis imperfecta (AI) affects enamel on primary and permanent dentition. This hereditary disorder is characterized by loss of enamel, poor esthetics, and hypersensitivity. Functional and cosmetic rehabilitation is challenging with variety of treatment options. This report presents the treatment of an AI patient using conventional fixed dentures and discusses issues related to posttreatment complications and prosthetic treatment outcome after 1 year of follow-up. A 19-year-old male AI patient with impaired self-esteem presented with hypersensitive, discolored, and mutilated teeth. Clinical examination revealed compromised occlusion and anterior open-bite. After hygiene maintenance full-coverage porcelain-fused-to-metal fixed restorations were indicated and applied. At the end of the treatment acceptable functional and esthetic results could be achieved. However, nearly a year after treatment a gingival inflammation in the esthetic zone complicated the outcome. Insufficient oral hygiene was to be blamed. Tooth sensitivity present from early childhood in these patients may prevent oral hygiene from becoming a habit. The relaxation due to relieve of hypersensitivity after treatment makes oral hygiene learning difficult. Continuous oral hygiene maintenance motivation may be crucial for the success of the treatment of AI patients. Treatment of AI patients should be carefully planned and an acceptable risk-benefit balance should be established.

Allergic contact dermatitis caused by titanium screws and dental implants

PATIENTS

Titanium has been considered to be a non-allergenic material. However, several studies have reported cases of metal allergy caused by titanium-containing materials. We describe a 69-year-old male for whom significant pathologic findings around dental implants had never been observed. He exhibited allergic symptoms (eczema) after orthopedic surgery. The titanium screws used in the orthopedic surgery that he underwent were removed 1 year later, but the eczema remained. After removal of dental implants, the eczema disappeared completely.

DISCUSSION

Titanium is used not only for medical applications such as plastic surgery and/or dental implants, but also for paints, white pigments, photocatalysts, and various types of everyday goods. Most of the usage of titanium is in the form of titanium dioxide. This rapid expansion of titanium-containing products has increased percutaneous and permucosal exposure of titanium to the population.

CONCLUSIONS

In general, allergic risk of titanium material is smaller than that of other metal materials. However, we suggest that pre-implant patients should be asked about a history of hypersensitivity reactions to metals, and patch testing should be recommended to patients who have experienced such reactions.

A depropargylation-triggered spontaneous cyclization based fluorescent “turn-on” chemodosimeter for the detection of palladium ions and its application in live-cell imaging

A novel depropargylation-triggered spontaneous cyclization reaction based fluorescent turn-on chemodosimeter for the detection of palladium ions has been rationally designed and developed.

Material Tissue Interaction--From Toxicity to Tissue Regeneration

The topic of material tissue interaction has gained increasing interest over recent decades from both the dental profession and the public. The primary goal initially was to avoid adverse reactions after the application of dental materials. New laboratory test methods have been developed, and currently premarket testing programs, which attempt to guarantee a basic level of patient safety, are legally required worldwide. The dentist is responsible for selecting the correct indication as well as the proper handling of any newly emerging risk. Apart from this phenomenon-oriented "inert materials concept," the "analytical concept" focuses primarily on analyzing the reasons for adverse reactions, and identifying their associated modifying factors, in order to prevent them or to develop new and more biocompatible materials. The "concept of bioactivity" involves addressing the possibility of positively influencing tissue by materials application, such as the generation of tertiary dentin or antibacterial effects. Finally, tissue regeneration may be supported and promoted by the use of various suitable materials (matrices/scaffolds) into which stem cells can migrate or be seeded, leading to cell differentiation and the generation of new tissue. These new dental materials must also fulfill additional requirements such as controlled degradability in order to be suitable for clinical use. Clearly, the field of material tissue interaction is complex and comprises a wide range of issues. To be successful as dentists in the future, practitioners should remain informed of these important new developments and have the argumentative competence to both properly advise and treat their patients.

Allergic Reactions to Dental Materials-A Systematic Review

INTRODUCTION

Utility of various dental materials ranging from diagnosis to rehabilitation for the management of oral diseases are not devoid of posing a potential risk of inducing allergic reactions to the patient, technician and dentist. This review aims to develop a systematic approach for the selection and monitoring of dental materials available in the market thereby giving an insight to predict their risk of inducing allergic reactions.

MATERIALS AND METHODS

Our data included 71 relevant articles which included 60 case reports, 8 prospective studies and 3 retrospective studies. The source of these articles was Pub Med search done with the following terms: allergies to impression materials, sodium hypochlorite, Ledermix paste, zinc oxide eugenol, formaldehyde, Latex gloves, Methyl methacrylate, fissure sealant, composites, mercury, Nickel-chromium, Titanium, polishing paste and local anaesthesia. All the relevant articles and their references were analysed. The clinical manifestations of allergy to different dental materials based on different case reports were reviewed.

RESULTS

After reviewing the literature, we found that the dental material reported to cause most adverse reactions in patients is amalgam and the incidence of oral lichenoid reactions adjacent to amalgam restorations occur more often than other dental materials.

CONCLUSION

The most common allergic reactions in dental staff are allergies to latex, acrylates and formaldehyde. While polymethylmethacrylates and latex trigger delayed hypersensitivity reactions, sodium metabisulphite and nickel cause immediate reactions. Over the last few years, due to the rise in number of patients with allergies from different materials, the practicing dentists should have knowledge about documented allergies to known materials and thus avoid such allergic manifestations in the dental clinic.

Iatrogenic Damage to the Periodontium by Chemicals and Dental Materials

The toxicity and tissue reactions to dental materials are receiving more attention as a wide variety of materials are used and as federal agencies demonstrate more concern in this area. A further indication of the importance of the interaction of materials and tissues is the development of recommended standard practices and tests for the biological interaction of materials.

Titanium allergy: a literature review

Titanium has gained immense popularity and has successfully established itself as the material of choice for dental implants. In both medical and dental fields, titanium and its alloys have demonstrated success as biomedical devices. Owing to its high resistance to corrosion in a physiological environment and the excellent biocompatibility that gives it a passive, stable oxide film, titanium is considered the material of choice for intraosseous use. There are certain studies which show titanium as an allergen but the resources to diagnose titanium sensivity are very limited. Attention is needed towards the development of new and precise method for early diagnosis of titanium allergy and also to find out the alternative biomaterial which can be used in place of titanium. A review of available articles from the Medline and PubMed database was done to find literature available regarding titanium allergy, its diagnosis and new alternative material for titanium.

Investigation of contact allergy to dental materials by patch testing

BACKGROUND

Dental products are widely used by patients and dental personnel alike and may cause problems for both. Dental materials could cause contact allergy with varying manifestations such as burning, pain, stomatitis, cheilitis, ulcers, lichenoid reactions localized to the oral mucosa in patients, and hand dermatitis in dental personnel. Patch testing with the dental series comprising commonly used materials can be used to detect contact allergies to dental materials.

AIM

This study aimed to identify contact allergy among patients who have oral mucosal lesions after dental treatment and among dental personnel who came in contact with these materials.

MATERIALS AND METHODS

Twenty patients who had undergone dental procedures with symptoms of oral lichen planus, oral stomatitis, burning mouth, and recurrent aphthosis, were included in the study. Dental personnel with history of hand dermatitis were also included in the study. Patch testing was performed using Chemotechnique Dental Series and results interpreted as recommended by the International Contact Dermatitis Research Group (ICDRG).

RESULTS

Out of 13 patients who had undergone dental treatment/with oral symptoms, six patients with stomatitis, lichenoid lesions, and oral ulcers showed positive patch tests to a variety of dental materials, seven patients with ulcers had negative patch tests, seven dental personnel with hand dermatitis showed multiple allergies to various dental materials, and most had multiple positivities.

CONCLUSION

The patch test is a useful, simple, noninvasive method to detect contact allergies among patients and among dental personnel dealing with these products. Long term studies are necessary to establish the relevance of these positive patch tests by eliminating the allergic substances, identifying clinical improvement, and substituting with nonallergenic materials.

The Challenge for Innovation in Direct Restorative Materials

During the past 50 years, a series of key UN conferences have established a framework to minimize human health risks from environmental exposures to key chemicals. In January 2013, more than 140 countries agreed to the text of new treaty to minimize Hg effects on the environment (the Minamata Convention). Dental caries is omnipresent around the globe, affecting 60% to 90% of school children and most adults, and producing discomfort that affects quality of life. Dental amalgam is frequently used to treat carious lesions and its use releases mercury into the environment. The best way to avoid the use of dental amalgam is to emphasize caries prevention. Alternatives to amalgam are suitable in some applications, but no replacement for amalgam has been found for large posterior restorations. For any restorative material, safety and environmental impacts are part of clinical risk assessment. Safety is freedom from unacceptable risks. Risk is a combination of probability of exposure and severity of harm. Best management practices are crucial to manage dental amalgam, but these impose additional that are disproportionately more for developing countries. The Minamata Convention seeks a phase-out of all mercury-based products except dental amalgam, where a phase-down is the present goal. For dentistry, the most important focus is the promotion of caries prevention and research on new materials.

Allergy related to dental implant and its clinical significance

The oral cavity provides an ideal and unique environment for study of biological processes involving metallic dental aids. Dental materials within the mouth interact continually with physiological fluids. Oral tissues are exposed to a veritable bombardment of both chemical and physical stimuli as well as the metabolism of many species of bacteria; yet, for the most part, oral tissues remain healthy. The pH of saliva varies from 5.2 to 7.8. Teeth, restorations, or any prosthesis including dental implants in the oral cavity have to function in one of the most inhospitable environments in the human body. They are subject to larger temperature and pH variations than most other parts of the body. Corrosion, the graded degradation of materials by electrochemical attack, is of concern particularly when dental implants are placed in the hostile electrolytic environment provided by the human mouth. Allergic reactions may occur from the presence of ions produced from the corrosion of implants. The present article describes various manifestations of allergic reactions due to implant material in the oral cavity.

Virulence modulation of Candida albicans biofilms by metal ions commonly released from orthodontic devices

The installation of metal devices leads to an increase in the salivary concentration of metal ions and in the growth of salivary Candida spp. However, the relationship between released metal ions and Candida virulence has not been previously examined. The objective of this study was to evaluate whether metal ions affect fungal virulence. We prepared culture media containing Ni(2+), Fe(3+), Cr(3+), Co(2+) or a mixture of these metal ions at concentrations similar to those released in saliva of orthodontic patients. Biofilms of Candida albicans SC5314 were grown for 72 h and their biomasses were determined. The supernatants were analyzed for secretory aspartyl protease (SAP) and hemolysin activities. To verify changes in virulence following treatment with metals, proteolytic and hemolytic activities were converted into specific activities. The results revealed that all ions, except Co(2+), caused increases in biofilm biomass. In addition, Ni(2+) caused an increase in SAP activity and Fe(3+) reduced hemolytic activity. However, the SAP and hemolysin activities in the presence of the mixture of ions did not differ from those of control. These results indicate that metal ions released during the degradation of orthodontic appliances can modulate virulence factors in C. albicans biofilms.

Stability of Phosphonic Self Assembled Monolayers (SAMs) on Cobalt Chromium (Co-Cr) Alloy under Oxidative conditions

Cobalt Chromium (Co-Cr) alloys has been widely used in the biomedical arena for cardiovascular, orthopedic and dental applications. Surface modification of the alloy allows us to tailor the interfacial properties to address critical challenges of Co-Cr alloy in medical applications. Self assembled monolayers (SAMs) of Octadecylphosphonic acid (ODPA) have been used to form thin films on the oxide layer of the Co-Cr alloy surface by solution deposition technique. The SAMs formed were investigated for their stability to oxidative conditions of ambient laboratory environment over periods of 1, 3, 7 and 14 days. The samples were then characterized for their stability using X-ray Photoelectron Spectroscopy (XPS), Atomic Force Microscopy (AFM) and Contact Angle Measurements. Detailed high energy XPS elemental scans confirmed the presence of the phosphonic monolayer after oxidative exposure which suggested that the SAMs were firmly attached to the oxide layer of Co-Cr alloy. AFM images gave topographical data of the surface and showed islands of SAMs on Co-Cr alloy surface, before and after SAM formation and also over the duration of the oxidative exposure. Contact angle measurements confirmed the hydrophobicity of the surface over 14 days. Thus the SAMs were found to be stable for the duration of the study. These SAMs could be subsequently tailored by modifying the terminal functional groups and could be used for various potential biomedical applications such as drug delivery, biocompatibility and tissue integration.

Titanium allergy: could it affect dental implant integration?

PURPOSE

Degradation products of metallic biomaterials including titanium may result in metal hypersensitivity reaction. Hypersensitivity to biomaterials is often described in terms of vague pain, skin rashes, fatigue and malaise and in some cases implant loss. Recently, titanium hypersensitivity has been suggested as one of the factors responsible for implant failure. Although titanium hypersensitivity is a growing concern, epidemiological data on incidence of titanium-related allergic reactions are still lacking.

MATERIALS AND METHODS

A computer search of electronic databases primarily MEDLINE and PUBMED was performed with the following key words: 'titanium hypersensitivity', 'titanium allergy', 'titanium release' without any language restriction. Manual searches of the bibliographies of all the retrieved articles were also performed. In addition, a complementary hand search was also conducted to identify recent articles and case reports.

RESULTS

Most of the literature comprised case reports and prospective in vivo/in vitro trials. One hundred and twenty-seven publications were selected for full text reading. The bulk of the literature originated from the orthopaedic discipline, reporting wear debris following knee/hip arthroplasties. The rest comprised osteosynthesis (plates/screws), oral implant/dental materials, dermatology/cardiac-pacemaker, pathology/cancer, biomaterials and general reports.

CONCLUSION

This review of the literature indicates that titanium can induce hypersensitivity in susceptible patients and could play a critical role in implant failure. Furthermore, this review supports the need for long-term clinical and radiographic follow-up of all implant patients who are sensitive to metals. At present, we know little about titanium hypersensitivity, but it cannot be excluded as a reason for implant failure.

Effect of temperature variation on the cytotoxicity of cast dental alloys and commercially pure titanium

Cell culture system has been used to evaluate alloy cytotoxicity under different environments, testing the extracts, but the effect of temperature variation on the cytotoxicity of dental alloys has not been analyzed. Objective: The aim of the present study was to investigate if temperature variation could affect dental alloy cytotoxicity, testing alloy extracts in an epithelial cell culture system. Material and methods: Discs of Ni-Cr, Co-Cr-Mo, Ni-Cr-Ti, Ti-6Al-4V and commercially pure titanium (cp Ti) were cast by arc melting, under argon atmosphere, injected by vacuum-pressure. Discs were immersed in artificial saliva and subjected to different temperatures: 37°C and thermocycling (37°C/5°C/37°C/55°C/37°C). After thermocycling, extracts were put in a subconfluent culture during 6 h, and the number of cells and their viability were used to evaluate cytotoxicity in these temperatures. For each alloy, data from temperature conditions were compared by Student's t-test (α=0.05). Results: The cytotoxicity tests with alloy/metal extracts showed that Ni-Cr, Co-Cr-Mo, Ti-6Al-4V and cp Ti extracts (p>0.05) did not affect cell number or cell viability, while Ni-Cr-Ti (p<0.05) extract decreased cell number and viability when the alloy was subjected to thermocycling. Conclusion: Within the limitations of the present study, the Ni-Cr-Ti alloy had cell number and viability decreased when subjected to temperature variation, while the other alloys/metal extracts did not show these results.

The abrasive effect of a porcelain and a nickel-chromium alloy on the wear of human enamel and the influence of a carbonated beverage on the rate of wear

PURPOSE

This study was conducted to determine the abrasive effect of a porcelain and an Ni-Cr alloy on the wear of human enamel, and the influence of a carbonated beverage on the rate of wear.

MATERIALS AND METHODS

Tooth specimens were prepared by embedding 48 freshly extracted mandibular first premolars in acrylic. Twenty-four of these specimens were abraded against Ni-Cr, and the remaining 24 against porcelain in artificial saliva and carbonated beverage media, respectively (n = 12), on a specially designed abrasive testing machine at a constant load of 40 N with 6 mm amplitude for 15,000 cycles. The cusp heights of the tooth specimens were measured both before and after abrasion using a profile projector. The abraded cast specimens were subjected to profilometry for computing the surface roughness; the abrading media was subjected to atomic absorption spectrophotometry for analyzing Ni and Cr ion levels. Data obtained were statistically analyzed.

RESULTS

Porcelain specimens in a medium of carbonated beverage caused the highest wear of tooth specimens. The lowest wear of tooth specimens was Ni-Cr specimens in artificial saliva medium. Carbonated beverage caused significantly higher wear of tooth specimens when abraded against Ni-Cr and porcelain specimens than did artificial saliva. The mean quantitative surface roughness of porcelain specimens was significantly higher than that of Ni-Cr specimens, irrespective of the medium in which abrasion testing was conducted. There was no statistically significant difference between the concentrations of Ni ions released in artificial saliva and carbonated beverage media. Also, there was no statistically significant difference between the concentrations of Cr ions released in artificial saliva and carbonated beverage media.

CONCLUSIONS

The wear of human enamel was significantly higher in the presence of carbonated beverage than artificial saliva and against porcelain when compared with Ni-Cr. The surface roughness of porcelain in the presence of carbonated beverage was found to be highest, and the release of Ni and Cr was not affected by carbonated beverage.

Oral Keratinocyte Responses to Nickel-based Dental Casting Alloys In Vitro

Adverse reactions of oral mucosa to nickel-based dental casting alloys are probably due to corrosion metal ion release. We exposed H400 oral keratinocytes to two Ni-based dental alloys (Matchmate and Dsign10) as well as NiCl 2 (1—40 μg/mL Ni2+). Alloy derived Ni2+ media concentrations were determined. Direct culture on both alloys resulted in inhibited growth with a greater effect observed for Dsign10 (higher ion release). Indirect exposure of cells to conditioned media from Dsign10 negatively affected cell numbers (~64% of control by 6 days) and morphology while Matchmate-derived media did not. Exposure to increasing NiCl2 negatively affected cell growth and morphology, and the Granulocyte-macrophage colony-stimulating factor (GM-CSF) transcript was significantly up-regulated in cells following direct and indirect exposure to Dsign10. NiCl2 exposure up-regulated all cytokine transcripts at 1 day. At day 6, IL-1β and IL-8 transcripts were suppressed while GM-CSF and IL-11 increased with Ni2+ dose. Accumulation of Ni2+ ions from alloys in oral tissues may affect keratinocyte viability and chronic inflammation.

Titanium allergy in dental implant patients: a clinical study on 1500 consecutive patients

BACKGROUND

In dentistry, allergic reactions to Ti implants have not been studied, nor considered by professionals. Placing permanent metal dental implants in allergic patients can provoke type IV or I reactions. Several symptoms have been described, from skin rashes and implant failure, to non-specific immune suppression.

OBJECTIVE

Our objective was to evaluate the presence of titanium allergy by the anamnesis and examination of patients, together with the selective use of cutaneous and epicutaneous testing, in patients treated with or intending to receive dental implants of such material.

MATERIAL AND METHODS

Thirty-five subjects out of 1500 implant patients treated and/or examined (2002-2004) were selected for Ti allergy analysis. Sixteen presented allergic symptoms after implant placement or unexplained implant failures [allergy compatible response group (ACRG)], while 19 had a history of other allergies, or were heavily Ti exposed during implant surgeries or had explained implant failures [predisposing factors group (PFG)]. Thirty-five controls were randomly selected (CG) in the Allergy Centre. Cutaneous and epicutaneous tests were carried out.

RESULTS

Nine out of the 1500 patients displayed positive (+) reactions to Ti allergy tests (0.6%): eight in the ACRG (50%), one in the PFG (5.3%)(P=0.009) and zero in the control group. Five positives were unexplained implant failures (five out of eight).

CONCLUSIONS

Ti allergy can be detected in dental implant patients, even though its estimated prevalence is low (0.6%). A significantly higher risk of positive allergic reaction was found in patients showing post-op allergy compatible response (ACRG), in which cases allergy tests could be recommended.

Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation

Lichen planus, a chronic autoimmune, mucocutaneous disease affects the oral mucosa (oral lichen planus or OLP) besides the skin, genital mucosa, scalp and nails. An immune mediated pathogenesis is recognized in lichen planus although the exact etiology is unknown. The disease most commonly affects middle-aged females. Oral lichenoid reactions (OLR) which are considered variants of OLP, may be regarded as a disease by itself or as an exacerbation of an existing OLP, by the presence of medication (lichenoid drug reactions) or dental materials (contact hypersensitivity). OLP usually presents as white striations (Wickham's striae), white papules, white plaque, erythema, erosions or blisters. Diagnosis of OLP is established either by clinical examination only or by clinical examination with histopathologic confirmation. Direct immunofluorescence examination is only used as an adjunct to the above method of diagnosis and to rule out specific autoimmune diseases such as pemphigus and pemphigoid. Histopathologic features of OLP and OLR are similar with suggestions of certain discriminatory features by some authors. Topical corticosteroids are the treatment of choice for OLP although several other medications have been studied including retinoids, tacrolimus, cyclosporine and photodynamic therapy. Certain OLP undergo malignant transformation and the exact incidence and mechanisms are still controversial. In this paper, etiopathogenesis, diagnosis, management and malignant transformation of OLP and OLR have been reviewed.

Biocompatibility of dental casting alloys

Most cast dental restorations are made from alloys or commercially pure titanium (cpTi). Many orthodontic appliances are also fabricated from metallic materials. It has been documented in vitro and in vivo that metallic dental devices release metal ions, mainly due to corrosion. Those metallic components may be locally and systemically distributed and could play a role in the etiology of oral and systemic pathological conditions. The quality and quantity of the released cations depend upon the type of alloy and various corrosion parameters. No general correlation has been observed between alloy nobility and corrosion. However, it has been documented that some Ni-based alloys, such as beryllium-containing Ni alloys, exhibit increased corrosion, specifically at low pH. Further, microparticles are abraded from metallic restorations due to wear. In sufficient quantities, released metal ions-particularly Cu, Ni, Be, and abraded microparticles-can also induce inflammation of the adjacent periodontal tissues and the oral mucosa. While there is also some in vitro evidence that the immune response can be altered by various metal ions, the role of these ions in oral inflammatory diseases such as gingivitis and periodontitis is unknown. Allergic reactions due to metallic dental restorations have been documented. Ni has especially been identified as being highly allergenic. Interestingly, from 34% to 65.5% of the patients who are allergic to Ni are also allergic to Pd. Further, Pd allergy always occurrs with Ni sensitivity. In contrast, no study has been published which supports the hypothesis that dental metallic materials are mutagenic/genotoxic or might be a carcinogenic hazard to man. Taken together, very contradictory data have been documented regarding the local and systemic effects of dental casting alloys and metallic ions released from them. Therefore, it is of critical importance to elucidate the release of cations from metallic dental restorations in the oral environment and to determine the biological interactions of released metal components with oral and systemic tissues.

A clinical evaluation of cobalt-chromium metal-ceramic fixed partial dentures and crowns: A three- to seven-year retrospective study

STATEMENT OF PROBLEM

In severely compromised dentition, loading of long-span and cantilever metal-ceramic fixed partial dentures (FPDs) could result in framework deformation and porcelain fractures. The use of cobalt-chromium (Co-Cr) alloys may be advantageous, but there is little information on the longevity of, and complications with, prostheses made with these alloys.

PURPOSE

The aim of this retrospective study was to report the survival and complication rates of Co-Cr metal-ceramic FPDs and crowns followed over a 3- to 7-year period.

MATERIAL AND METHODS

The study included 42 patients with a total of 51 FPDs and 12 single crowns assigned to 1 of 3 groups. The 3 groups comprised patients with abutment teeth with a questionable prognosis (n=10), advanced chronic periodontitis (n=19), or abutment teeth with a positive prognosis (n=13). The FPDs had a mean of 9.7 units (range of 3-14). Of the FPDs, 32 were provided with a cantilever on 1 side (n=24) or both sides (n=8). The mean observation time was 51 months (range of 28-82). All patients were examined by 2 independent prosthodontists using the California Dental Association (CDA) assessment system for evaluation. One-way ANOVA with Fisher's LSD post hoc test and the Mann-Whitney U test were used for statistical analyses (alpha=.05).

RESULTS

Seventeen (34%) of the FPDs had biological and/or technical complications. Six (12%) FPDs were completely or partially removed during the observation period, 1 framework fractured, and 9 (17.6%) FPDs had ceramic fractures. Fifteen of the 21 fractured FPD units were related to FPDs that were placed in 3 patients with bruxing habits. The CDA rating for marginal integrity was "excellent" for more than 98% of the abutments. No patients reported adverse reactions to the material.

CONCLUSIONS

Metal-ceramic FPDs made of cobalt-chromium alloy performed acceptably in the questionable prognosis and advanced chronic periodontitis groups.

In vitro IL-1beta release from gingival fibroblasts in response to pure metals, dental alloys and ceramic

Little information is available on the immunological basis for side-effects of dental materials. The objective of this study is to evaluate effects of pure metals, dental alloys and ceramic on cell viability and interleukin-1 beta (IL-1beta) release in three-dimensional human gingival fibroblast cultures as an indicator of their biological performance in gingival tissues. The gingival fibroblast cultures were exposed to test specimens fabricated from nickel, iron, molybdenum, copper, indium, gold, Ni-Cr-Mo alloy (Remanium CS), Au-Pt-In alloy (Pontostar) and a dental ceramic (In-ceram). Cell viability was determined by the MTT method 24 and 48 h after exposure. Assays for IL-1beta were carried out by ELISA. Statistical analysis was performed applying the non-parametric Mann-Whitney pairwise test. Dental ceramic and gold did not influence cell viability after 24 and 48 h. Cell viability was determined after 24 and 48 h to nickel (79-77%), iron (92-90%), molybdenum (86-83%), copper (48-36%), indium (90-90%), Remanium CS (83-80%), Pontostar (94-91%) compared with control cultures. Dental ceramic, Pontostar and gold had no significant influence on IL-1beta secretion. The highest amounts of IL-1beta (10-fold) levels were determined in cell cultures exposed to copper. Indium, molybdenum and iron induced twofold IL-1beta levels compared with untreated control cultures. These results support that some metals may alter immune responses and thereby contribute to a variety of dental pathological conditions and three-dimensional cell culture models for gingival fibroblasts appear to be suitable for in vitro studies.

The mechanism of corrosion of palladium–silver binary alloys in artificial saliva

Palladium dental casting alloys are alternatives to gold alloys. The aim of this study was to determine the electrochemical behaviour and the corrosion mechanism of binary silver-palladium alloys. Seven binary silver-palladium alloys and pure palladium and silver were tested in a model saliva solution. Electrochemical tests included corrosion potential, polarization resistance, and potentiodynamic polarization measurements. The corrosion products, which may be theoretically formed, were determined by thermodynamic calculation. The behaviour of silver and silver-rich alloys was dominated by the preferential formation of a thiocyanate surface layer, which controlled the free corrosion potential. Palladium dissolved in the form of a thiocyanate complex, but the surface became passivated by either palladium oxide or solid palladium thiocyanate layer, the thermodynamic calculations indicating preference for the oxide. Palladium-rich alloys showed evidence of silver depletion of the surface, resulting in behaviour similar to palladium. Examination of binary silver-palladium alloys has made possible determination of the role of the components of the alloys and model saliva in the corrosion behaviour. The findings are applicable to the more complex commercial dental alloys containing silver and palladium as major components.

[Tolerance induction towards nickel. From animal model to humans]

Nickel is the most common contact allergen in humans. Until recently, many questions concerning tolerance mechanisms to nickel were unresolved. Besides human ex vivo, intervention and observation studies, the establishment of a reproducible mouse model has contributed to the analysis of these mechanisms. A more detailed understanding of the pathogenesis of nickel allergy and tolerance towards nickel by investigations in an animal model and in human studies is a prerequisite for developing specific prevention and therapy of nickel allergy. With this article, we provide a review of the investigations concerning nickel allergy and give perspectives towards oral tolerance induction to nickel in the animal model and in humans.

Clinical response to allergies in patients

Allergenic reactions are becoming a more prevalent concern of practitioners in health-related fields. As patient susceptibility increases, the need for understanding and successfully treating such heterogeneous responses becomes paramount. This article presents a theoretical bioengineering model that considers the influences of specific concentrations on their chemical effects. This model then is applied to contemporary orthodontics in which nickel and, to a lesser extent, chromium are antagonists in as many as 1 in 500 patients-which, for North America, amounts to about 4000 patients per year. For the occasional patient who responds positively to a questionnaire, a skin patch test would be administered to establish whether alternative alloys could be used, whether they be gold, platinum, nickel-free stainless steel, or titatnium-molybdenum alloys.

Effect of sphered particles on the firing contraction of porcelain inlay processed by cold isostatic pressing

The effect of the sphered particles on the contraction ratio of porcelain inlay processed by the cold isostatic pressure (CIP) method was investigated. The conventional lathe-cut porcelain powder was crushed to finer particles and the secondary particles with spherical shape by adding binders of acrylic resin, wax, and polyvinyl alcohol, respectively. Porcelain powder was molded as a disc-shaped green body in a refractory model and compressed at 200 MPa by CIP. From this green compact, the sintered porcelain was obtained by only one step of firing. The porcelain discs were then used for the measurements of contraction ratio, scanning microscopic observation, biaxial flexure strength, Vickers hardness, and density. Firing contraction was decreased to about 1% in the sphered particle groups, compared with 7% of the lathe-cut porcelain powder. Although biaxial flexure strength was about 85 MPa, which is lower than the 120 MPa of the control group, and the density was significantly decreased by about 10% from the 2.4 g/cm3 of the control substance, Vickers hardness, which ranged from 531 to 537, showed no significant differences among all of the groups. The CIP method could save labor in the process of making porcelain inlays, and sphered powders could contribute significantly to a decrease in the contraction ratio in the sintering process.

Evaluation of immunologic profile in patients with nickel sensitivity due to use of fixed orthodontic appliances

The aim of this study was to develop a new approach to testing the impact of nickel antigen on in vitro cell-proliferation assay, to identify adverse reactions to casting alloys among orthodontic patients. Cell-proliferation assay in vitro was used as the basic methodology to assess the influence of such variables as source of nickel antigen, type of serum used to supplement the culture medium, and number of cells in the culture. We selected 35 orthodontic patients who were classified as nickel sensitive and non-nickel sensitive, based on their clinical records. Our results showed that hexahydrated nickel sulfate at 10 microg/mL, 10% of autologous sera, and 2 x 10(5) cells was the best condition for inducing the most marked nickel proliferation response in vitro. This optimized method was able to distinguish nickel-sensitive from non-nickel-sensitive dental patients and also to discriminate those with positive skin tests. Our data suggest that continuous exposure to nickel casting alloys might lead to oral tolerance mechanisms that modulate nickel sensitivity, as evidenced by the lower cell proliferation index in patients undergoing orthodontic treatment over 24 months. Finally, our findings demonstrated a known nickel-induced type 2 immune response and a marked lack of type 1 immunity (interferon gamma) as the hallmarks of nickel-sensitive patients. Further studies are needed to clarify the major cell phenotype associated with this type 2 immune response and the lack of type 1 immunity observed in nickel-sensitive people.

Reporting on adverse reactions to dental materials--intraoral observations at a clinical follow-up

OBJECTIVES

A national reporting system designed to monitor adverse reactions to dental materials was established in Norway in 1993. The activities have also included clinical examination of patients with suspected reactions to dental materials. The ongoing activities are coordinated by the Dental Biomaterials Adverse Reaction Unit at the University of Bergen. The reporting procedure is based on voluntary spontaneous reporting by dentists and physicians. The reports could be based on subjective symptoms or objective findings, or both. The aim of the present study was to compare reported objective intraoral findings with those found during examination at the unit.

METHODS

Reported reactions were compared with clinical findings obtained following dental and medical examination at the unit. From 1993 to 1999, a total of 899 reports were received while 253 patients were referred and examined at the unit.

RESULTS

The reports on patients who were examined at the unit involved mainly reactions related to amalgam fillings (84%), metals in fixed dentures (11%), resin-based materials and cements (4%), materials used in removable dentures (2%), and endodontic materials (2%). Edema, lichenoid reactions, ulcers/vesicles, erythema, and atrophy were found in 80 patients during the examination at the unit. For 35 of these patients, the intraoral findings at the unit were also given in the reports. For another 45 patients, objective intraoral signs of reactions were found upon examination at the unit, but these findings had not been reported.

CONCLUSION

A spontaneous reporting system is a cost-effective method for monitoring intraoral reactions associated with dental materials. Considering the increasing number and complexity of these materials, there appears to be a need for continuous validation of reports by a speciality unit. In order to receive more accurate information about the adverse reactions, it would be advisable that the reporting forms include more detailed guidance regarding signs of reactions that practitioners should be on the look out for and consider.

Principles of biocompatibility for dental practitioners

This article is an evidence-based tutorial on the principles of biocompatibility. Although the technical issues of biocompatibility may seem beyond the scope of most practicing dentists, knowledge of these issues is fundamentally important to ensure the health of patients, dental staff members (including laboratory personnel), and practitioners themselves. Furthermore, the legal liability of dentists is often linked to biocompatibility issues. The biocompatibility of a material is not absolute; it must be measured with regard to the way the material is used. Measuring biocompatibility is a complex process that involves in vitro and in vivo tests. These tests contribute to understanding biologic responses to a material but cannot define the material's biocompatibility with 100% certainty. Practitioners should understand enough about biocompatibility testing methods to critically judge advertising claims and ask relevant questions of manufacturers. Because there is no infallible way to assess biologic response to a material, decisions about the clinical use of a material ultimately must weigh the biologic risks of a material against its potential benefits.

Mechanical, thermal, and chemical analyses of the binary system Au-Ti in the development of a dental alloy

Investigations in the binary system gold-titanium (Au-Ti) were performed in regard to the development of a universal dental alloy suited for inlays, for the conventional crown and bridge technique, as well as for the ceramic-fused-to-metal technique. With nine alloys with increasing Ti content from 0-10 atom %, microstructure, mechanical properties, thermal properties, and corrosion were determined in the as-cast state and after simulation of ceramic firing. The microstructure shows an increasing formation of a second phase with increasing Ti content, crystallizing dendritically, which, according to the binary phase diagram must be the intermetallic phase TiAu(4). The results of the measurements reveal that with increasing Ti content, hardness, Young's modulus, proof stress, and tensile strength strongly increase in the range of 2-6 atom % Ti and with higher Ti content remain constant. Elongation after fracture decreases with a Ti content above 2 atom %. The coefficient of thermal expansion decreases linearly with increasing Ti content. Thermal distortion decreases exponentially with increasing Ti content. The corrosion test showed an increasing release of Ti with increasing Ti content. Lowest corrosion was observed in the simulated state with intact oxide layer. Appropriate properties for dental application were found in the range of 6.5 at% Ti.

Electrochemical characteristics of high-Pd alloys in relation to Pd-allergy

OBJECTIVE

The aim of this study was to determine whether the Pd-Cu-based dental ceramic alloys possess any electrochemical characteristics distinguishable from that of other Pd-containing alloys. Of all Pd-containing alloys, this particular alloy group has been linked to frequent incidence of allergy and hypersensitivity reactions. Electrochemical corrosion may instigate these reactions.

METHODS

Four groups of alloys, Pd-Cu, Pd-Ga-(with and without Ag), Pd-Ag, and Au-Pd, were evaluated by traditional corrosion measurement techniques in a phosphated buffer saline solution at 20 degrees C. The electrochemical characteristics measured were: (1) 20 h open circuit potential (OCP); (2) 20 h corrosion rate (Icorr); and (3) anodic polarization (E-i) curves.

RESULTS

The OCP values (232 +/- 25 mV) of the Ag-free Pd-Ga and Pd-Cu-based alloys were higher than and distinctly different from that (144 +/- 52 mV) of the Ag-containing alloys. The Icorr values of different alloys, despite varied compositions, were indistinguishable from one another. The E-i curves of all alloys were essentially similar, with the Ag-containing (> 5 wt%) alloys showing a subtle difference in their anodic slope within 100 mV above their corrosion potentials.

SIGNIFICANCE

The OCP values of Pd-Cu alloys and the Ag-free Pd-Ga alloy are comparable to that reported for pure Pd (239 +/- 21 mV), which indicates that during corrosion these alloys undergo dealloying and consequent Pd-enrichment on their surface. Such a condition is conducive to the release of allergenic Pd++ ions and offers a plausible explanation for the frequent incidence of hypersensitivity reactions associated with the Pd-Cu alloys. The OCP values in other alloys are attributed to dealloying followed by surface enrichment with Ag and/or Au and the possible formation of an insoluble AgCl surface film on the respective alloy surfaces. These events have the potential to suppress or prevent Pd++ ion release. Alloys showing these characteristics have seldom been linked to allergic reactions.

Biocompatibility of dental casting alloys: a review

STATEMENT OF PROBLEM

Dental casting alloys are widely used in applications that place them into contact with oral tissues for many years. With the development of new dental alloys over the past 15 years, many questions remain about their biologic safety. Practitioners must choose among hundreds of alloy compositions, often without regard to biologic properties.

PURPOSE

This article is an evidence-based tutorial for clinicians. Concepts and current issues relevant to the biologic effects of dental casting alloys are presented.

SUMMARY

The single most relevant property of a casting alloy to its biologic safety is its corrosion. Systemic and local toxicity, allergy, and carcinogenicity all result from elements in the alloy being released into the mouth during corrosion. Little evidence supports concerns of casting alloys causing systemic toxicity. The occurrence of local toxic effects (adjacent to the alloy) is not well documented, but is a higher risk, primarily because local tissues are exposed to much higher concentrations of released metal ions. Several elements such as nickel and cobalt have relatively high potential to cause allergy, but the true risk of using alloys containing these elements remains undefined. Prudence dictates that alloys containing these elements be avoided if possible. Several elements in casting alloys are known mutagens, and a few such as beryllium and cadmium are known carcinogens in different chemical forms. Despite these facts, carcinogenic effects from dental casting alloys have not been demonstrated. Prudent practitioners should avoid alloys containing these known carcinogens.

CONCLUSION

To minimize biologic risks, dentists should select alloys that have the lowest release of elements (lowest corrosion). This goal can be achieved by using high-noble or noble alloys with single-phase microstructures. However, there are exceptions to this generality, and selection of an alloy should be made on a case-by-case basis using corrosion and biologic data from dental manufacturers.