Physico-mechanical properties and prosthodontic applications of Co-Cr dental alloys: a review of the literature

Effect of sanitizing solutions on cobalt chromium alloys for dental prostheses: A systematic review of in vitro studies

STATEMENT OF PROBLEM

Given the wide use of cobalt chromium (Co-Cr) alloys, especially for removable partial dentures, and the importance of chemical solutions to complement the cleaning of dental prostheses, safe disinfection products should be identified for the regular decontamination of Co-Cr dental prostheses.

PURPOSE

The purpose of this systematic review of in vitro studies was to determine the effects on the properties of Co-Cr dental alloys of the various chemical agents used to clean dental prostheses.

MATERIAL AND METHODS

In vitro studies were included based on a literature search conducted in March 2022 in the Medline/PubMed, SCOPUS, Web of Science, Virtual Health Library, and Embase databases. Independent reviewers performed the search, selection, extraction, and analysis of the data. The review was performed based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The quality of the included articles was evaluated by using parameters adapted from the Consolidated Standards of Reporting Trials (CONSORT) guidelines, and the risk of bias analysis was performed based on previous studies.

RESULTS

Among the 15 included studies, the chemical agents evaluated were alkaline peroxides and hypochlorites, mouthwashes containing cetylpyridinium chloride and chlorhexidine, diluted acids, and enzymes. Some peroxides produced increased ion release, surface roughness, and mass loss of the alloys. The hypochlorites were responsible for the greatest surface corrosion, yielding dark stains, rough regions, and depressions. Acetic and peracetic acids and mouthwashes containing chlorhexidine and cetylpyridinium did not produce significant changes in Co-Cr alloys. Most studies presented moderate risk of bias.

CONCLUSIONS

According to the included studies, mouth rinses containing cetylpyridinium chloride or chlorhexidine and solutions with acetic and peracetic acid could be safely used to chemically sanitize Co-Cr prostheses. Alkaline peroxides should be used with caution, and alkaline hypochlorite solutions should be avoided.

Microstructural and mechanical characterization of six Co-Cr alloys made by conventional casting and selective laser melting

STATEMENT OF PROBLEM

Three Co-Cr alloy types (Co-Cr-Mo, Co-Cr-W, and Co-Cr-Mo-W) have been commonly used in the fabrication of dental prostheses. These alloys can be manufactured using either conventional casting or selective laser melting (SLM) techniques. Nevertheless, research that directly compares these materials and/or manufacturing processes in terms of their microstructural and mechanical characteristics is sparse.

PURPOSE

The purpose of this in vitro study was to conduct microstructural and mechanical analysis via X-ray interpretation, optical microscopy, scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDS), image analysis, X-ray diffraction (XRD), instrumented indentation testing (IIT), and 3-point bending testing to characterize Co-Cr-Mo, Co-Cr-W, and Co-Cr-Mo-W alloys produced through conventional casting and SLM.

MATERIAL AND METHODS

Six Co-Cr-based alloys were analyzed and divided into 3 types based on their elemental composition (Co-Cr-Mo, Co-Cr-W, and Co-Cr-Mo-W). Additionally, each group was categorized based on the manufacturing process used (casting or SLM). X-ray scans were used to assess porosity. The microstructures of the specimens were assessed through SEM/EDS examination and XRD analysis. IIT was used to determine the Martens hardness (HM) and elastic index (ηIT), while the elastic modulus (E) was estimated through the 3-point bending test. The mechanical properties were statistically analyzed using 2-way analysis of variance (ANOVA) and the Tukey multiple comparison post hoc test, with alloy type and manufacturing process as discriminating variables (α=.05).

RESULTS

All cast groups exhibited gross porosity, while no pores or other flaws were found in the SLM groups. Based on the XRD results, the crystalline structure of all Co-Cr specimens consisted of the face-centered cubic γ phase (γ-fcc), along with the hexagonal close-packed ε phase (ε-hcp) and Cr23C6 carbide. Different microstructures were identified between the cast and SLM alloys. Significant differences were identified for the mean standard deviation HM (ranging from 2601 ±94 N/mm2 to 3633 ±61 N/mm2) and mean ±standard deviation ηIT (ranging from 16.8 ±0.3% to 20.9 ±0.3%) among alloys prepared by the same manufacturing process, while all SLM alloys had statistically higher HM and ηIT results than their cast counterparts (P<.05). No statistically significant differences were identified for the mean ±standard deviation Eb (ranging from 170 ±25 GPa to 244 ±36 GPa) among the groups prepared with the same manufacturing process (P>.05), but the SLM alloys had significantly higher results (P<.05) than the cast alloys.

CONCLUSIONS

In general, the manufacturing procedure significantly affected the porosity, microstructure, and mechanical properties of the tested Co-Cr alloys. SLM decreased the internal porosity, provided a uniform microstructure, and improved the mechanical properties for all the tested alloy types.

Bond strength and interfacial analysis of six CoCr alloys made by conventional casting and selective laser melting

PURPOSE

To investigate the effects of the elemental composition and the manufacturing process of cobalt chromium-molybdenum (CoCr-Mo), cobalt chromium-tungsten (CoCr-W), and CoCr-Mo-W alloys on metal-ceramic bond strength.

MATERIALS AND METHODS

Six CoCr-based alloys were included in this study, a were classified into three different groups depending on their elemental composition (Ν = 10, for each group). The first group had molybdenum (Mo) as the third alloying element, the second group contained tungsten (W) (without Mo), and the third group included both alloying elements. The groups were further divided by the manufacturing process (casting or selective laser melting, SLM). Interfacial analysis was carried out using backscattered electron imaging (BEI) and energy-dispersive X-ray microanalysis (EDX) operating in line scan mode. The metal-ceramic bond strength was tested by a 3-point bending test according to the ISO 9693 requirements. The fracture mode of all specimens was examined under a stereomicroscope. The bond strength results were statistically analyzed by 2-way ANOVA and Tukey's multiple comparison post hoc test (a = 0.05).

RESULTS

A continuous interface with the porcelain was found without pores, debonding areas, or other defects. Of the major elements found at the interface, Co showed the highest diffusion rate, while titanium (Ti) had the lowest diffusion rate. No statistically significant differences were identified in metal-ceramic bond strength either among materials or between manufacturing processes. The fracture mode was found to be cohesive for all specimens.

CONCLUSIONS

The metal-ceramic bond strength is independent of the current CoCr alloy type and manufacturing process when comparing conventional casting and SLM. Interfacial analysis revealed no differences between the tested groups.

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.

Roughness analysis on porcelain sectional surface of porcelain fused to Co-Cr alloy endocrowns

This study aims to compare the roughness between the central and edge points on the porcelain sectional surface of porcelain fused to Co-Cr alloy endocrowns. Utilizing anatomical data from average molar dimensions, a simplified model for the endocrowns was created. Eight porcelain fused to Co-Cr alloy endocrowns were fabricated with an edge thickness of 0.3 mm. Following casting, firing, cutting, and polishing procedures, the roughness on porcelain sectional surface at both the central and edge points of the inner crown was assessed using an atomic force microscope (AFM). The roughness measurement (Sq value) for the central point on porcelain sectional surface was (10.46 ± 3.37 nm), and for the edge point, it was (10.50 ± 1.99 nm). There was no statistically significant distinction between the central and edge points in terms of roughness. Despite the uneven thickness of the inner crown in porcelain fused to Co-Cr alloy endocrowns, it was observed that this disparity had negligible impact on the internal microstructure of the porcelain. Therefore, its application in dental clinical settings could be deemed viable.

A review on manufacturing processes of cobalt-chromium alloy implants and its impact on corrosion resistance and biocompatibility

Cobalt-Chromium (CoCr) alloys are currently used for various cardiovascular, orthopedic, fracture fixation, and dental implants. A variety of processes such as casting, forging, wrought processing, hot isostatic pressing, metal injection molding, milling, selective laser melting, and electron beam melting are used in the manufacture of CoCr alloy implants. The microstructure and precipitates (carbides, nitrides, carbonitrides, and intermetallic compounds) formed within the alloy are primarily determined by the type of manufacturing process employed. Although the effects of microstructure and precipitates on the physical and mechanical properties of CoCr alloys are well reviewed and documented in the literature, the effects on corrosion resistance and biocompatibility are not comprehensively reviewed. This article reviews the various processes used to manufacture CoCr alloy implants and discusses the effects of manufacturing processes on corrosion resistance and biocompatibility. This review concludes that the microstructure and precipitates formed in the alloy are unique to the manufacturing process employed and have a significant impact on the corrosion resistance and biocompatibility of CoCr alloys. Additionally, a historical and scientific overview of corrosion and biocompatibility for metallic implants is included in this review. Specifically, the failure of CoCr alloys when used in metal-on-metal bearing surfaces of total hip replacements is highlighted. It is recommended that the type of implant/application (orthopedic, dental, cardiovascular, etc.) should be the first and foremost factor to be considered when selecting biomaterials for medical device development.

Simulating porcelain firing effect on the structure, corrosion and mechanical properties of Co-Cr-Mo dental alloy fabricated by soft milling

This study aims at evaluating the effect of simulating porcelain firing on the microstructure, corrosion behavior and mechanical properties of a Co-Cr-Mo alloy fabricated by Metal Soft Milling (MSM). Two groups of Co-28Cr-5Mo specimens (25 × 20 × 3 mm) were prepared by MSM: The as-sintered (AS) specimens and the post-fired (PF) specimens that were subjected to 5 simulating porcelain firing cycles without applying the ceramic mass onto their surface. Phase identification by X-ray Diffraction (XRD), microstructure examination by optical microscopy and Scanning Electron Microscopy combined with Energy-Dispersive X-ray Spectroscopy (SEM/EDX), corrosion testing by cyclic polarization and chronoamperometry in simulated body fluid (SBF), the latter test accompanied by Cr3+ and Cr6+ detection in the electrolyte through the 1.5-diphenylcarbazide (DPC) method and UV/visible spectrophotometry, and mechanical testing by micro-/nano-indentation were conducted to evaluate the effect of the post-firing cycles on the properties of Co-Cr-Mo. The results were statistically analyzed by the t test (p < 0.05: statistically significant). All specimens had a mixed γ-fcc and ε-hcp cobalt-based microstructure with a dispersion of pores filled with SiO2 and a fine M23C6 intergranular presence. PF led to an increase in the ε-Co content and slight grain coarsening. Both AS and PF alloys showed high resistance to general and localized corrosion, whereas neither Cr6+ nor Cr3+ were detected during the passivity-breakdown stage. PF improved the mechanical properties of the AS-alloy, especially the indentation modulus and true hardness (statistically significant differences: p = 0.0009 and 0.006, respectively). MSM and MSM/simulating-porcelain firing have been proven trustworthy fabrication methods of Co-Cr-Mo substrates for metal-ceramic prostheses. Moreover, the post-firing cycles improve the mechanical behavior of Co-Cr-Mo, which is vital under the dynamically changing loads in the oral cavity, whereas they do not degrade the corrosion performance.

Effect of Different Primers on Shear Bond Strength of Base Metal Alloys and Zirconia Frameworks

Ensuring a secure bond between a framework structure and layering composite resin veneer is essential for a long-lasting dental restoration. A variety of primer systems are available to facilitate the adhesive bonding. Nevertheless, the growing preference for efficiency and simplicity in dentistry has made the one-bottle universal primers a desirable option. This study aims to compare the effectiveness of universal primers on the shear bond strength (SBS) of base metal alloy (BMA) and zirconia to layering composite resin. Each 160 BMA and zirconia 20 × 10 × 5 mm test specimen was fabricated. Eight different primers (SunCera Metal Primer, Metal Primer Z, Reliance Metal Primer, Alloy Primer, MKZ Primer, Monobond Plus, ArtPrime Plus, and Clearfil Ceramic Primer Plus) were applied to 20 specimens in each group. Subsequently, a 5 × 2 mm composite resin build-up was applied. SBS tests were performed after 24 h of water storage and after thermocycling (25,000 cycles, 5-55 °C). On BMA, after water storage for 24 h, the bond strength values ranged from 26.53 ± 3.28 MPa (Metal Primer Z) to 29.72 ± 2.00 MPa (MKZ Primer), while after thermocycling, bond strength values ranged from 25.19 ± 1.73 MPa (MKZ Primer) to 27.69 ± 2.37 MPa (Clearfil Ceramic Primer Plus). On a zirconia base, after 24 h, the bond strengths values ranged from 22.63 ± 2.28 MPa (Reliance Primer) to 29.96 ± 2.37 MPa (MKZ Primer) and from 23.77 ± 3.86 MPa (Metal Primer Z) to 28.88 ± 3.09 MPa (Monobond Plus) after thermocycling. While no significant difference in bond strength was found between the primers on the BMA base, five primer combinations differed significantly from each other on zirconia (p = 0.002-0.043). All primers achieved a bond strength greater than 23 MPa on both framework materials after thermocycling. Thus, all primers tested can be applied to both framework materials with comparable results.

Multifunctional modifications of polyetheretherketone implants for bone repair: A comprehensive review

Polyetheretherketone (PEEK) has emerged as a highly promising orthopedic implantation material due to its elastic modulus which is comparable to that of natural bone. This polymer exhibits impressive properties for bone implantation such as corrosion resistance, fatigue resistance, self-lubrication and chemical stability. Significantly, compared to metal-based implants, PEEK implants have mechanical properties that are closer to natural bone, which can mitigate the "stress shielding" effect in bone implantation. Nevertheless, PEEK is incapable of inducing osteogenesis due to its bio-inert molecular structure, thereby hindering the osseointegration process. To optimize the clinical application of PEEK, researchers have been working on promoting its bioactivity and endowing this polymer with beneficial properties, such as antibacterial, anti-inflammatory, anti-tumor, and angiogenesis-promoting capabilities. Considering the significant growth of research on PEEK implants over the past 5 years, this review aims to present a timely update on PEEK's modification methods. By highlighting the latest advancements in PEEK modification, we hope to provide guidance and inspiration for researchers in developing the next generation bone implants and optimizing their clinical applications.

Comparison of the fatigue life of pure titanium and titanium alloy clasps manufactured by laser powder bed fusion and its prediction before manufacturing

PURPOSE

In this study, the fatigue properties of additively manufactured titanium clasps were compared with those of commercially pure titanium (CPTi) and Ti-6Al-4V (Ti64), manufactured using laser powder-bed fusion.

METHODS

Fourteen specimens of each material were tested under the cyclic condition at 1 Hz with applied maximum strokes ranging from 0.2 to 0.5 mm, using a small stroke fatigue testing machine. A numerical approach using finite element analysis (FEA) was also developed to predict the fatigue life of the clasps.

RESULTS

The results showed that although no significant differences were observed between the two materials when a stroke larger than 0.35 mm was applied, CPTi had a better fatigue life under a stroke smaller than 0.33 mm. The distributions of the maximum principal stress in the FEA and the fractured position in the experiment were in good agreement.

CONCLUSIONS

Using a design of the clasp of the present study, the advantage of the CPTi clasp in its fatigue life under a stroke smaller than 0.33 mm was revealed experimentally. Furthermore, the numerical approach using FEA employing calibrated parameters for the Smith-Watson-Topper method are presented. Under the limitations of the aforementioned clasp design, the establishment of a numerical method enabled us to predict the fatigue life and ensure the quality of the design phase before manufacturing.

Castability of a Ti-7.5Mo alloy for fabricating frameworks for removable partial dentures

STATEMENT OF PROBLEM

The properties of commercially pure titanium are better than those of cobalt chromium alloys in various ways. However, casting pure titanium is challenging because of its high melting point and chemical reactivity. Because of excellent mechanical strength, a titanium alloy, Ti-6Al-4V, has been commonly adopted, but the aluminum and vanadium ions released may be cytotoxic.

PURPOSE

The purpose of the present study was to evaluate a new titanium alloy, Ti-7.5Mo, developed by the National Cheng Kung University for casting removable denture frameworks. The casting success rate, porosity, and guide plane or rest fit were compared among frameworks cast with Ti-7.5Mo alloy and pure titanium for 3 types of edentulism.

MATERIAL AND METHODS

Ti-7.5Mo alloy and pure titanium were used to cast frameworks for Kennedy Class I and II and completely edentulous conditions, with 5 frameworks for each condition. Wax patterns of the frameworks were designed and fabricated by using computer-aided design and computer-aided manufacture (CAD-CAM) technology to ensure their geometrical consistency. They were then invested with aluminum oxide-based material and cast. The castings were examined with microcomputed tomography (μCT) for porosity, and fit was evaluated from the thickness of a vinyl polyether silicone material at the guide plane or the rest by using an optical microscope. The casting was determined to be successful if the frameworks were complete. The porosity and fit were statistically evaluated by using 2-way ANOVA (α=.05).

RESULTS

Using pure titanium, the casting success rate was 80%, with only 64% of the major connectors in the deficient castings being complete. The μCT images showed that the percentage of casting defects in Ti-7.5Mo castings was one-third of the pure titanium castings. Furthermore, internal voids were detected in the clasps of the pure titanium castings, while the Ti-7.5Mo castings had few defects in the minor connectors and no radiographically detectable defects in the clasps. The fit analysis demonstrated smaller gaps over both guide planes and rests in the Ti-7.5Mo castings.

CONCLUSIONS

Ti-7.5Mo alloy had better castability than pure titanium. Based on the results, Ti-7.5Mo alloy is suitable for dental casting and may provide better performance.

Effect of ultraviolet irradiation treatment on shear bond strength between polymethyl methacrylate and cobalt-chromium-molybdenum alloy

We aimed to elucidate the effects of ultraviolet (UV) irradiation on the shear bond strength (SBS) between heat-cured polymethyl methacrylate (PMMA) and a Co-Cr-Mo alloy. Disk-shaped Co-Cr-Mo alloy prepared by casting were subjected to different UV treatment times (0, 15, and 30 min). To determine the effect of UV treatment on surface properties of the alloy, surface roughness, wettability, and chemical compositions were analyzed. To evaluate the SBS, cylindrical PMMA was bonded to the UV-treated alloy, and subsequently subjected to the SBS test after 24 h of storage at room temperature or following 10,000 thermal cycles (n=10/group). After the UV treatment, the surface roughness remained unchanged, but oxidation resulted in the surface exhibiting greater hydrophilic characteristics. The UV-treated group showed significantly higher SBS values than those of the non-treated group (p<0.001). These results suggested that UV treatment-mediated oxidation improved the bond strength between PMMA and Co-Cr-Mo alloy.

Serum Albumin Aggregation Facilitated by Cobalt and Chromium Metal Ions

The interaction of serum proteins with cobalt (Co) and chromium (Cr) ions is poorly understood, but it is suspected to result in protein aggregation, which may alter the corrosion process of biomedical CoCr alloys or result in adverse health effects. Here, we study the aggregation ability and mechanism of bovine serum albumin (BSA) induced or accelerated by aqueous Co(II) and Cr(III) ions. The metal salts were selected by chemical speciation modeling, and they did not affect the pH or precipitate under simulated physiological conditions (150 mM NaCl and pH 7.3). The counterion of Cr(III) influenced the binding to BSA only at physiologically irrelevant low ionic strength. This study used a variety of spectroscopic and light scattering methods. It was determined that both metal ions and an equimolar mixture of metal ions have the potential to induce protein aggregation. Melting curves collected by circular dichroism spectroscopy indicate that Co(II) significantly reduced BSA's melting temperature when compared with Cr(III) or an equimolar mixture of Co(II) and Cr(III), both of which increased the melting temperature of BSA. The metal ions in solution preferentially interacted with BSA, resulting in the depletion of metal ions from the surrounding protein-free solution. Finally, this study suggests that the likely mechanism for Co(II)- and Cr(III)-induced BSA aggregation is salt bridging between protein molecules.

Effect of different digital technology on the adaptation and retention of Co-Cr partial denture frameworks

PURPOSE

To evaluate the overall adaptation and retention of class I cobalt-chromium (Co-Cr) removable partial denture (RPD) frameworks using three different computer-aided design and computer-aided manufacturing (CAD-CAM) technologies: Indirect wax milling with lost wax technique (LWT), direct milling, and selective laser melting (SLM) technique.

MATERIALS AND METHODS

An educational maxillary stone model (Kennedy class I) was scanned after preparing rest seats to create a resin model. The resin model was scanned, and the RPD framework was digitally designed and saved as a standard tessellation language (STL) file. Twenty-four Co-Cr RPD frameworks were then constructed and divided into three groups (n = 8) based on fabrication technique: Group A (indirect wax milling with LWT), Group B (direct milling), and Group C (selective laser melting). In Group A, the STL file was used to mill the design from castable resin blanks which were then cast by the LWT. In Group B, the STL file was used to mill the design from the Co-Cr blank directly. Finally in Group C, the STL file was used to print the design from Co-Cr powder using SLM 3D printed technique. Geomagic Control X software was used to measure the overall adaptation of the fabricated RPD frameworks, Retention was also tested using a universal testing machine. One-way Analysis of Variance (ANOVA) test was used to compare the three groups then the Tukey HSD post-hoc test was used for pair-wise comparisons. The significance level was set at p ≤ 0.05.

RESULTS

Regarding the overall adaptation, Group B (0.71 ± 0.02 mm) showed significantly higher adaptation than Group A (0.96 ± 0.06 mm) and Group C (1.05 ± 0.16 mm). Regarding retention, Group B (2.03 ± 0.34 N) showed significantly higher retention than Group A (1.00 ± 0.13 N) and Group C (0.78 ±0.17 N).

CONCLUSION

Based on the findings of this in vitro study, Co-Cr RPD frameworks fabricated by direct milling technique revealed the best adaptation and retention.

Ion release and biocompatibility of Co-Cr alloy fabricated by selective laser melting from recycled Co-Cr powder: An in vitro study

STATEMENT OF PROBLEM

As the cobalt chromium (Co-Cr) powder used in selective laser melting (SLM) is costly, reusing the remaining powder after multiple cycles provides an economic and environmental benefit. However, knowledge of the cytotoxic effect of the alloy fabricated from recycled powder is lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the biological effects of the Co-Cr ions released from the alloy fabricated from the recycled powder on the human gingival fibroblasts (HGFs) and normal oral keratinocytes (NOKs).

MATERIAL AND METHODS

Disk-shaped Co-Cr specimens were fabricated by using the SLM technique from powders with different proportions of recycled to unused and from different recycling times. Co and Cr ions released from the disks immersed in the Dulbecco Modified Eagle Medium (DMEM) for 24 hours or 7 days were measured by inductively coupled plasma mass spectrometry (ICP-MS). Biocompatibility of Co-Cr alloy was detected by incubation of HGFs and NOKs in DMEM containing Co and Cr ions for 24 hours. The ANOVA test was used to evaluate statistically significant differences among different groups (α=.05).

RESULTS

Compared with the alloy fabricated from 100% unused powder, the concentrations of Co and Cr ions increased with the increase of recycled to unused powder ratio or with the increase in the recycling times. HGFs and NOKs showed an increase in apoptosis, intracellular oxidative stress (ROS), hypoxia-inducing factor1α (HIF-1α), and proinflammatory cytokines (tumor necrosis factor alpha [TNF- α], interleukin 6 [IL-6], interleukin 8 [IL-8], and vascular endothelial growth factor [VEGF]) with the increase of Co-Cr ions in a concentration-dependent manner. A significant reduction in cell proliferation was found with the increase in the concentrations of Co and Cr ions (P<.05).

CONCLUSIONS

The results of this study indicated that Co-Cr alloy fabricated from partially recycled powder or powder with different recycling times released significantly more Co and Cr ions and showed higher cytotoxicity to HGFs and NOKs than the alloy fabricated from unused powder.

Microscopic and Mechanical Characterization of Co-Cr Dental Alloys Joined by the TIG Welding Process

Due to their good mechanical and other properties, cobalt-chromium alloys (Co-Cr) are often used in prosthetic therapy. The metal structures of prosthetic works can be damaged and break, and depending on the extent of the damage, they can be re-joined. Tungsten inert gas welding (TIG) produces a high-quality weld with a composition very close to that of the base material. Therefore, in this work, six commercially available Co-Cr dental alloys were joined by TIG welding, and their mechanical properties were evaluated to determine the quality of the TIG process as a technology for joining metallic dental materials and the suitability of the Co-Cr alloys used for TIG welding. Microscopic observations were made for this purpose. Microhardness was measured using the Vickers method. The flexural strength was determined on a mechanical testing machine. The dynamic tests were carried out on a universal testing machine. The mechanical properties were determined for welded and non-welded specimens, and the results were statistically evaluated. The results show the correlation between the investigated mechanical properties and the process TIG. Indeed, characteristics of the welds have an effect on the measured properties. Considering all the results obtained, the TIG-welded I-BOND NF and Wisil M alloys showed the cleanest and most uniform weld and, accordingly, satisfactory mechanical properties, highlighting that they withstood the maximum number of cycles under dynamic load.

Mechanical properties and accuracy of removable partial denture frameworks fabricated by digital and conventional techniques: A systematic review

STATEMENT OF PROBLEM

Providing a removable partial denture (RPD) can be a complex, time-consuming, and error-prone procedure. Computer-aided design and computer-aided manufacturing (CAD-CAM) techniques have shown promising clinical outcomes; however, the influence of manufacturing techniques on the properties of RPD components is unclear.

PURPOSE

The purpose of this systematic review was to determine the accuracy and mechanical properties of RPD components fabricated with conventional and digital methods.

MATERIAL AND METHODS

This study followed the guidelines of the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) and was registered on the international prospective register of systematic reviews (PROSPERO) database (CRD42022353993). An electronic search was conducted on PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library in August 2022. Only in vitro studies comparing the digital with the lost-wax casting technique were included. The quality of the studies was assessed by using the methodological index for nonrandomized studies (MINORS) scale.

RESULTS

Of the 17 selected studies, 5 evaluated the accuracy of RPD components as well as the mechanical properties, 5 studies evaluated only the component accuracy, and another 7 evaluated only the mechanical properties. The accuracy was similar regardless of the technique, with discrepancies within clinically acceptable values (50 to 426.3 μm). The surface roughness was higher for 3D-printed clasps and lower for milled clasps (P<.05). The metal alloy significantly influenced the porosity, with the highest number of pores obtained by casting for Ti clasps and by rapid prototyping for Co-Cr clasps.

CONCLUSIONS

In vitro studies showed that the digital technique provided similar accuracy to that of the conventional technique within a clinically acceptable range. The manufacturing technique influenced the mechanical properties of RPD components.

Different Undercut Depths Influence on Fatigue Behavior and Retentive Force of Removable Partial Denture Clasp Materials: A Systematic Review

PURPOSE

To perform a systematic review that provides an overview of the current literature on fatigue behavior of removable partial denture (RPD) clasp materials based on different retentive areas.

MATERIALS AND METHODS

The review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Electronic searches were done via PubMed, Scopus, and OVID for studies reporting on RPD clasps and the fatigue failure of clasp materials. Inclusion criteria were English language with full text and in vitro studies only. Exclusion criteria were studies that did not assess the fatigue of RPD clasp materials. A quality assessment and selection of full-text articles were performed according to Consolidated Standards of Reporting Trials criteria.

RESULTS

A total of 182 articles were initially identified and screened. After applying inclusion and exclusion criteria, 15 articles were selected for the final analysis. Seven of the included studies utilized a vertical insertion/removal testing approach. Ten studies used the constant deflection test. Three studies used untapered specimens, and 12 studies used tapered specimens. Ten studies performed post-test analysis.

CONCLUSIONS

Cobalt-chromium (CoCr) is the strongest material in terms of fatigue in relation to the undercut depth and the modern, digitally manufactured RPD clasp materials also exhibit comparable fatigue behavior. Recent RPD clasp materials such as polyetheretherketone (PEEK) or laser sintered CoCr, however, require further study in terms of their fatigue behavior. In order to improve the quality of future studies, a standardized and calibrated fatigue testing method is needed with standardized specimen size and shape, which will reduce the risk of bias and enable meta-analysis for bulk comparison between studies.

PEEK for Oral Applications: Recent Advances in Mechanical and Adhesive Properties

Polyetheretherketone (PEEK) is a thermoplastic material widely used in engineering applications due to its good biomechanical properties and high temperature stability. Compared to traditional metal and ceramic dental materials, PEEK dental implants exhibit less stress shielding, thus better matching the mechanical properties of bone. As a promising medical material, PEEK can be used as implant abutments, removable and fixed prostheses, and maxillofacial prostheses. It can be blended with materials such as fibers and ceramics to improve its mechanical strength for better clinical dental applications. Compared to conventional pressed and CAD/CAM milling fabrication, 3D-printed PEEK exhibits excellent flexural and tensile strength and parameters such as printing temperature and speed can affect its mechanical properties. However, the bioinert nature of PEEK can make adhesive bonding difficult. The bond strength can be improved by roughening or introducing functional groups on the PEEK surface by sandblasting, acid etching, plasma treatment, laser treatment, and adhesive systems. This paper provides a comprehensive overview of the research progress on the mechanical properties of PEEK for dental applications in the context of specific applications, composites, and their preparation processes. In addition, the research on the adhesive properties of PEEK over the past few years is highlighted. Thus, this review aims to build a conceptual and practical toolkit for the study of the mechanical and adhesive properties of PEEK materials. More importantly, it provides a rationale and a general new basis for the application of PEEK in the dental field.

Metallic Dental Implants Wear Mechanisms, Materials, and Manufacturing Processes: A Literature Review

OBJECTIVES

From the treatment of damaged teeth to replacing missing teeth, dental biomaterials cover the scientific interest of many fields. Dental biomaterials are one of the implants whose effective life depends vastly on their material and manufacturing techniques. The purpose of this review is to summarize the important aspects for metallic dental implants from biomedical, mechanical and materials science perspectives. The review article will focus on five major aspects as mentioned below. Tooth anatomy: Maximizing the implant performance depends on proper understanding of human tooth anatomy and the failure behavior of the implants. Major parts from tooth anatomy including saliva characteristics are explored in this section. Wear mechanisms: The prominent wear mechanisms having a high impact on dental wear are abrasive, adhesive, fatigue and corrosion wear. To imitate the physiological working condition of dental implants, reports on the broad range of mastication force and various composition of artificial saliva have been included in this section, which can affect the tribo-corrosion behavior of dental implants. Dental implants classifications: The review paper includes a dedicated discussion on major dental implants types and their details for better understanding their applicability and characteristics. Implant materials: As of today, the most established dental implant materials are SS316L, cobalt chrome alloy and titanium. Detailed discussion on their material properties, microstructures, phase transformations and chemical compositions have been discussed here. Manufacturing techniques: In terms of different production methods, the lost wax casting method as traditional manufacturing is considered. Selective Laser Melting (SLM) and Directed Energy Deposition (DED) as additive manufacturing techniques (AM) have been discussed. For AM, the relationships between process-property-performance details have been explored briefly. The effectiveness of different manufacturing techniques was compared based on porosity distribution, mechanical and biomechanical properties.

SUMMARY

Despite having substantial research available on dental implants, there is a lack of systematic reviews to present a holistic viewpoint combining state-of-the-art from biomedical, mechanical, materials science and manufacturing perspectives. This review article attempts to combine a wide variety of analyzing approaches from those interdisciplinary fields to deliver deeper insights to researchers both in academia and industry to develop next-generation dental implants.

Functional engineering strategies of 3D printed implants for hard tissue replacement

Three-dimensional printing technology with the rapid development of printing materials are widely recognized as a promising way to fabricate bioartificial bone tissues. In consideration of the disadvantages of bone substitutes, including poor mechanical properties, lack of vascularization and insufficient osteointegration, functional modification strategies can provide multiple functions and desired characteristics of printing materials, enhance their physicochemical and biological properties in bone tissue engineering. Thus, this review focuses on the advances of functional engineering strategies for 3D printed biomaterials in hard tissue replacement. It is structured as introducing 3D printing technologies, properties of printing materials (metals, ceramics and polymers) and typical functional engineering strategies utilized in the application of bone, cartilage and joint regeneration.

Investigation of the effect of bonding factors on strength of porcelain bond to soft metal alloys after application of thermal cycle

BACKGROUND

The chemical bond between the metal and the porcelain component is likely to fail in metal-porcelain restorations. This is due to the thick oxide layer that Cr-Co alloys create. This study aimed to investigate the effect of metal conditioner on controlling the oxide layer formed on the surface of the Sintron alloy and the strength of the metal-porcelain bond.

MATERIALS AND METHODS

In this in vitro study, 33 samples were divided into three groups based on surface treatment (n = 11). In all three groups, an oxide layer was created. In the first group, Shofu metal conditioner, in the second group, metal conditioner of Creation, and in the third group, no metal conditioner was applied. All samples were then subjected to 3000 heat cycles between 5° and 55°C with a stop time of 5 s. The specimens were then placed in a universal testing machine for shear bond testing. A force was applied between the alloy and the porcelain by a 5 kN load cell at the speed of 1 mm/min until a fraction occurred. Intergroup comparison was made by the one-way analysis of variance followed by the Tukey's multiple comparisons test (α = 0.05) .

RESULTS

The mean shear bond strength of the first group was 34.93 MPa and the mean shear bond strength of the second group was 31.37 MPa. The mean shear bond strength of the first and the second group was significantly higher than the third group (23.37 MPa) (PV < 0.001).

CONCLUSION

The use of metal conditioners between ceramill Sintron alloy and porcelain (Vita VMK MASTER) led to increasing the bond strength.

Mechanical and electrochemical characterization of 3D printed orthodontic metallic appliances after in vivo ageing

OBJECTIVES

Three-dimensional (3D) printing technology is a promising technique for fabricating custom orthodontic metallic appliances. Aim of this study was to assess the effect of intraoral aging on the mechanical / electrochemical properties of 3D-printed orthodontic metallic appliances.

METHODS

Twelve molar orthodontic distalization appliances 3D-printed from cobalt chromium (Co-Cr) alloy were retrieved after intraoral use and twenty blocks fabricated under similar conditions were used as control. The samples' microstructural / elemental composition assessment was assessed with SEM/EDS, while their mechanical properties (modulus of elasticity [E_IT], Martens hardness [HM] and the elastic index [η_IT]) were measured by instrumented indentation testing. Finally, the samples' electrochemical features were assessed with a potentiostat-connected cell arrangement in terms of open circuit potential (OCP), corrosion potential (E_z), current density (I₃₀₀) and breaking potential (E_pit). Results were analyzed by t-test / Mann-Whitney test (α = 0.05).

RESULTS

The used Co-Cr alloy was found to have a highly homogenous structure with no significant differences between retrieved and new specimens in HM (4037.7 ± 215.6 vs 4090.9 ± 259.8 N/mm²), E_IT (120.0 ± 13.2 vs 123.8 ± 12.9 GPa), or n_IT (28.4 ± 2.6 vs 28.6 ± 2.9 %) (P > 0.05 in all instances). Metallic surfaces retained the same oxidation tendency and oxide dissolution rate in passive region in both groups (P > 0.05 for OCP, E_z, and I₃₀₀). However, intraorally-aged specimens had a significantly lower breakdown potential due to degraded protection efficacy of surface oxide (P = 0.003 for E_pit).

SIGNIFICANCE

The tested 3D-printed Co-Cr orthodontic appliances present clinically-acceptable mechanical properties that remained unaffected by intraoral ageing, which however degraded the protection of surface oxide against pitting corrosion.

The origin of jerky dislocation motion in high-entropy alloys

Dislocations in single-phase concentrated random alloys, including high-entropy alloys (HEAs), repeatedly encounter pinning during glide, resulting in jerky dislocation motion. While solute-dislocation interaction is well understood in conventional alloys, the origin of individual pinning points in concentrated random alloys is a matter of debate. In this work, we investigate the origin of dislocation pinning in the CoCrFeMnNi HEA. In-situ transmission electron microscopy studies reveal wavy dislocation lines and a jagged glide motion under external loading, even though no segregation or clustering is found around Shockley partial dislocations. Atomistic simulations reproduce the jerky dislocation motion and link the repeated pinning to local fluctuations in the Peierls friction. We demonstrate that the density of high local Peierls friction is proportional to the critical stress required for dislocation glide and the dislocation mobility.

Dislocations in high-entropy alloys encounter pinning during glide resulting in jerky motion. Here the authors demonstrate that the density of high local Peierls force is proportional to the critical stress required for their glide and mobility.

Physicomechanical properties of cobalt-chromium removable partial denture palatal major connectors fabricated by selective laser melting

STATEMENT OF PROBLEM

Additive manufacturing by selective laser melting (SLM) has been claimed to be less challenging than conventional casting of cobalt-chromium (Co-Cr) removable partial dentures (RPDs), providing significant improvements. However, how the physicomechanical properties of Co-Cr RPDs fabricated by SLM compare with those fabricated by conventional casting is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the physicomechanical properties of Co-Cr RPD palatal major connectors fabricated by SLM compared with those fabricated by conventional casting.

MATERIAL AND METHODS

A master die simulating a maxillary arch of Kennedy class III modification 1 was scanned to create a virtual 3-dimensional (3D) cast. Two groups of 5 Co-Cr RPD major connectors were fabricated. In the 3D printing group, the Co-Cr major connector was virtually designed and exported for direct SLM 3D printing. For the conventional group, Co-Cr major connectors were constructed conventionally. The Co-Cr major connectors were virtually superimposed with the master die for surface adaptation analysis. Additional comparative analyses of surface roughness, relative density, microhardness, and microstructure of the 2 groups were performed. Data were analyzed by using independent t tests (α=.05).

RESULTS

The overall volumetric and linear discrepancies were significantly higher (P<.05) in the 3D printing group. Significant differences in the surface roughness (P<.05) and microhardness (P<.05) were observed, with the 3D printing group having higher surface roughness and microhardness than the conventional group. Unlike conventional connectors, the microstructure of 3D-printed connectors showed fine homogeneous granules.

CONCLUSIONS

Compared with the conventional casting technique, SLM 3D printing enabled the fabrication of Co-Cr RPD major connectors with higher microhardness and fine homogenous microstructure. However, the surface adaptation and surface roughness of SLM 3D printing Co-Cr connectors were worse than those produced conventionally. Both techniques showed similar relative densities.

Current and future trends in the teaching of removable partial dentures in dental schools in Malaysia: A cross sectional study

AIMS

To investigate, using a validated questionnaire, the teaching of removable partial dentures (RPDs) in dental schools of Malaysia.

MATERIALS AND METHODS

A validated questionnaire to investigating trends in the teaching of RPDs in dental schools in Oceania was emailed (in English version form) to Heads of Restorative/Prosthodontics/course coordinators in the 13 dental schools in Malaysia. Follow-up reminders were sent and participants were given six weeks to complete and return the questionnaire. Data was entered into an Excel spreadsheet and results compiled and analyzed.

RESULTS

Completed questionnaires were received from 13 dental school - a 100% response rate. All schools (n = 13) provided a preclinical technical course in RPD design. In most schools (n = 9, 69.2%), course work was supervised by senior lecturers while rest of the institutions made use of associate professor/professors. There were significant differences (p<0.05) between dental schools in terms of the contact hours dedicated to preclinical teaching. Students received an average of 62 h of instruction. Didactic instruction was the primary focus with practical (78 h) and didactic teaching (32 h). All dental schools (n = 13) provided practical surveyor design teaching (8 h). The staff student ratio for formal lectures (1:61), tutorials (1:29) and lab demonstrations (1:12) were recorded. Majority of the schools (n = 11, 84.6%) employed paired teaching in clinical sessions. All schools (n = 13, 100%) emphasized on increased teaching of RPD design and prescription writing in future clinical RPD courses.

CONCLUSION

Teaching of RPDs in Malaysia may be considered sufficient and comparable to the teaching in other parts of the world.

CLINICAL SIGNIFICANCE

Whilst the teaching of partial dentures at Dental Schools in Malaysia provides the core competencies involved in partial denture design and construction based on sound fundamental, scientific principles they should address the challenges of teaching partial dentures and other areas of dental education including improving working conditions for dental professionals.

Electrochemical characterization of three types of Co-Cr based alloys manufactured by casting and selective laser melting according to ISO 10271

OBJECTIVE

To characterize the effect of elemental composition and manufacturing process on the electrochemical properties of Co-Cr-Mo, Co-Cr-W and Co-Cr-Mo-W alloys.

METHODS

Six Co-Cr based alloys were included in this study. All alloys are Co-Cr based alloys, classified in three different types according to their elemental composition. The first group has Mo as the third alloying element while the second one has W instead of Mo. The third one has both alloying elements. The groups are further divided by the manufacturing process (casting or Selective Laser Melting(SLM)). All groups were subjected to static immersion, open circuit potential, anodic scan, SEM/EDX analysis, static and cyclic tarnish testing according to ISO 10271 requirements. The ionic release was evaluated by inductively coupled plasma mass spectrometry and the results were statistically analyzed by two way ANOVA and Tukey test (a=0.05).

RESULTS

No statistical differences were identified for Co-Cr-Mo alloy for all elements and their total ionic release between casting and SLM manufacturing processes, in contrast to significantly lower values for SLM groups for the other two groups. All groups tested demonstrated similar performance in OCP and AS testing while no gross elemental changes before and after AS were identified following EDX analysis. All alloys fulfilled the requirements of tarnish resistance CONCLUSIONS: The ionic release is dependent on alloy type and manufacturing process while all groups were found to fulfill the requirements of international standards for ionic release, corrosion and tarnish resistance and thus an acceptable clinical performance is anticipated.

An In Vitro Study on the Shear Bond Strength of Feldspathic Porcelain to Nickel Chromium Alloy and Cobalt Chromium Alloy after Various Surface Treatments

Background

To evaluate and compare the shear bond strength of feldspathic porcelain to four distinctively surface-treated Ni-Cr and Co-Cr alloys and to assess the impact of oxidation-heat treatment on porcelain to base metal alloy bond strength.

Methods

40 specimens each of nickel-chromium alloy and cobalt-chromium alloy were cast. A total of four groups of specimens were created. Group I was surface-treated by sandblasting with 50 μm alumina particles, Group II was surface-treated by sandblasting with 110 μm alumina particles, Group III and Group IV were surface-treated with 250 μm alumina particles. In Group IV, after sandblasting initially with 250 μm alumina particles, the alloys were subjected to oxidation and resandblasting with 250 μm alumina particles. Each of the specimen was coated with opaque and body porcelain and fired to a total thickness of 2 mm porcelain. A universal measuring machine was used to assess shear bond strength at a crosshead speed of 0.5 mm/min.

Results

Two-way ANOVA followed by Tukey's post hoc test was used to assess the significant difference within the groups. Unpaired t-test was used for the intergroup comparison of the obtained data. The study showed that the size of the air abrasion particles used for sandblasting significantly influenced the porcelain to metal surface bond strength, with p value <0.001. The bond strength values of the two alloys tested showed no major variations. Result also showed that oxidation influences the metal-ceramic bond strength.

Conclusions

The bond strength of the metal-ceramic interface is influenced by the alloy's surface treatment. The oxidation process impacts the bond strength of the metal-ceramic system.

Mg-, Zn-, and Fe-Based Alloys With Antibacterial Properties as Orthopedic Implant Materials

Implant-associated infection (IAI) is one of the major challenges in orthopedic surgery. The development of implants with inherent antibacterial properties is an effective strategy to resolve this issue. In recent years, biodegradable alloy materials have received considerable attention because of their superior comprehensive performance in the field of orthopedic implants. Studies on biodegradable alloy orthopedic implants with antibacterial properties have gradually increased. This review summarizes the recent advances in biodegradable magnesium- (Mg-), iron- (Fe-), and zinc- (Zn-) based alloys with antibacterial properties as orthopedic implant materials. The antibacterial mechanisms of these alloy materials are also outlined, thus providing more basis and insights on the design and application of biodegradable alloys with antibacterial properties as orthopedic implants.

Removable Partial Denture Frameworks in the Age of Digital Dentistry: A Review of the Literature

Alloys of cobalt chromium have been used for decades to create frameworks for removable partial dentures. While cobalt chromium has multiple advantages, such as strength and light weight, the casting process is laborious and requires special care to ensure that human error is minimized. Furthermore, the display of metal clasps in these frameworks may be considered a limitation at times, especially with esthetically demanding patients. The introduction of digital technology to manufacturing in dentistry has brought forward new methods of fabricating cobalt chromium frameworks, some of which eliminate the casting process. Moreover, the development of high-performance polymers for use as removable partial denture frameworks brings multiple advantages, but raises concerns over design guidelines and principles. This review examines alternatives to conventionally cast frameworks so that clinicians may make evidence-based decisions when choosing framework materials and fabrication methods in the rapidly advancing world of digital dentistry.

Strength of Polyether Ether Ketone Composite as a Major Connector Material for Removable Partial Dentures

PEEK composite was tested mechanically as a maxillary removable partial denture (RPD) framework material instead of cast cobalt chromium alloy. Methods: Partial edentulous upper jaw cast was scanned using structured-light 3D scanner, palatal strap (PS) designs for RPD were designed by a designing dental laboratory software. CAD/CAM machine fabricated PSs patterns using their designs’ STL software files. PSs were made from poly-ether-ether ketone (PEEK) reinforced by ceramic fillers using thermal injection press technique and Co-Cr alloy using centrifugal casting, each material group was subdivided into two subgroups according to storage conditions (stored and non-stored subgroups), storage took place in deionized water for about 180 days at 37.5 ± 2 o C. All specimens were subjected to fracture resistance test using universal testing machine then maximum compression load (MCL) result values were subjected to statistical analysis. PEEK composite specimens were scanned by field emission microscope (FEM) and energy dispersive spectroscopy. Storage water of PEEK composite was analyzed using atomic absorption spectroscopy (AAS). Results: In either stored or non-stored subgroups of PEEK composite straps they showed significant lower mean MCL values than corresponding alloy subgroups (p=0.0001). FEM scanning showed fillers agglomerations in non-stored PEEK composite and their nearly absence from stored PEEK composite specimens. AAS detected Al element in PEEK composite storage water. Conclusion: Mechanically thermally injected ceramic reinforced PEEK composite could not replace cast Co-Cr alloy as PSs material for maxillary RPD. Biocompatibility concerns raised in this study due to suspected Al leaching and ceramic fillers dissolution from PEEK composite matrix.

Comparing Castability of Nickel-Chromium, Cobalt-Chromium, and Non-Precious Gold Color Alloys, Using two Different Casting Techniques

STATEMENT OF THE PROBLEM

The castability of nonprecious gold color alloy using torch/ centrifugal and induction/vacuum-pressure casting techniques has not been studied yet.

PURPOSE

This study was conducted to compare the castability of nickel chromium, cobalt-chromium and nonprecious gold color alloy using torch/centrifugal and induction/ vacuum-pressure casting techniques.

MATERIALS AND METHOD

In this in vitro study, a total number of 54 identical acrylic wax meshes were prepared and divided into 6 different groups of 9 each. Group 1: nickel-chromium alloy, which was casted with induction technique. Group 2: nickel-chromium alloy was casted with centrifugal technique. Group 3: cobalt-chromium alloy was casted with induction technique. Group 4: cobalt-chromium alloy was casted with centrifugal technique. Group 5: nonprecious gold color alloy was casted with induction technique. Group 6: nonprecious gold color alloy was casted with centrifugal technique. Then castability of specimens was measured using modified Whitlock's method. The results were analyzed using two way ANOVA and post hoc tests.

RESULTS

ANOVA test revealed no statistically significant difference between different alloys with a p Value of 0.313. Moreover, it represented no significant differences within the groups regarding alloy types and casting techniques with a p Value of 0.511 and 0.682, respectively.

CONCLUSION

No significant difference was found in the castability value of nickel-chromium, cobalt-chromium, and nonprecious gold color alloys. In addition, the castability value of three alloys tested in this study was not different by using torch/centrifugal or induction/vacuum-pressure casting machines.

Comparative analysis of the surface properties and corrosion resistance of Co-Cr dental alloys fabricated by different methods

STATEMENT OF PROBLEMS

The complex oral environment leads to the corrosion of dental alloy materials and the release of metal ions that may have a negative impact on health. Digital manufacturing is increasingly being used in dentistry, but whether digitally manufactured prostheses have better resistance to corrosion than traditional cast prostheses is unclear.

PURPOSE

The purpose of this in vitro study was to determine the surface properties and corrosion resistance of dental cobalt-chromium (Co-Cr) alloys fabricated by lost-wax casting (CAST), selective laser melting (SLM), and computer numerical control milling (CNC).

MATERIAL AND METHODS

The surface characteristics of the specimens were analyzed via scanning electron microscopy and energy-dispersive spectroscopy (SEM-EDS), metallurgical observation, and X-ray diffraction (XRD). For corrosion resistance, the specimens were immersed in artificial saliva at a pH 2.3 and 6.8 for 1, 4, and 7 weeks. Then, inductively coupled plasma-mass spectrometry (ICP-MS) was used to detect the main metal ion. Electrochemical impedance spectroscopy (EIS) was conducted based on a 3-electrode system to assess the electrochemical corrosion resistance. An ANOVA test was used to evaluate statistically significant differences among the groups (α=.05).

RESULTS

The SLM and CNC specimens showed more homogenous microstructures, less ion release at different times and pH, and more charge transfer resistance than CAST specimens.

CONCLUSIONS

Compared with casting, SLM-printing and CNC-milling have advantages in terms of surface properties and corrosion resistance.

Biomedical Alloys and Physical Surface Modifications: A Mini-Review

Biomedical alloys are essential parts of modern biomedical applications. However, they cannot satisfy the increasing requirements for large-scale production owing to the degradation of metals. Physical surface modification could be an effective way to enhance their biofunctionality. The main goal of this review is to emphasize the importance of the physical surface modification of biomedical alloys. In this review, we compare the properties of several common biomedical alloys, including stainless steel, Co-Cr, and Ti alloys. Then, we introduce the principle and applications of some popular physical surface modifications, such as thermal spraying, glow discharge plasma, ion implantation, ultrasonic nanocrystal surface modification, and physical vapor deposition. The importance of physical surface modifications in improving the biofunctionality of biomedical alloys is revealed. Future studies could focus on the development of novel coating materials and the integration of various approaches.

Effects of heat treatment on the microstructure, residual stress, and mechanical properties of Co-Cr alloy fabricated by selective laser melting

The mechanical properties and residual stress of dental Co-Cr-Mo (CCM) alloy depend on the manufacturing and post-processing methods, which affect the prognosis of dental prostheses. Two CCM alloys manufactured by casting and selective laser melting (SLM) were compared, and the effect of heat treatment temperature for CCM alloys manufactured by SLM method was evaluated. Specimens were fabricated by casting (Cast Co-Cr) and SLM (SLM Co-Cr). SLM Co-Cr specimens were heat treated at 750, 950, and 1150 °C to compare their properties. Microstructures were analyzed via scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), and electron backscattered diffraction (EBSD), and the residual stress was measured via x-ray diffraction (XRD). Mechanical properties were evaluated by a Vickers hardness test and a tensile test; fractography was performed after this. The SLM Co-Cr group exhibited a decrease in porosity, grain size, increase in solid solution limit, and high residual stress compared to Cast Co-Cr; the ultimate tensile strength, yield strength, and hardness were also higher. The microstructures, residual stresses, and mechanical properties differed significantly depending on the heat treatment, and the strength and hardness showed a tendency inverse to that of the elongation. Type I residual stresses mostly decreased after 750 °C heat treatment, however type II and III residual stresses remained even after 1150 °C heat treatment. SLM presented superior mechanical properties to casting. Considering the reduction of tensile residual stress and increased ductility, CCM alloys should be heat treated at a temperature of 950 °C or higher.

Influence of Digital Technologies and Framework Design on the Load to Fracture of Co-Cr Posterior Fixed Partial Denture Frameworks

PURPOSE

To compare the load to fracture of cobalt-chromium (Co-Cr) 3-unit posterior fixed partial denture (FPD) frameworks manufactured by conventional and digital techniques and to evaluate the influence of the framework design on the fracture load.

MATERIAL AND METHODS

Eighty 3-unit Co-Cr posterior FPD frameworks were fabricated with two designs: intermediate pontic (n = 40) and cantilever (n = 40). Each design was randomly divided into four groups (n = 10): casting, direct metal laser sintering, soft metal milling, and hard metal milling. After thermal cycling, all specimens were subjected to a 3-point bending test until fracture. Data were statistically analyzed using one-way ANOVA, Welch and Brown-Forsythe test, Ryan-Einot-Gabriel-Welsch F and Tamhane T2 post hoc test, Student's t test, and Weibull statistics (α = 0.05).

RESULTS

Significant differences (p < 0.001; F = 39.59) were found among intermediate pontic frameworks (except between laser sintering and hard metal milling), and cantilevered frameworks (F = 36.75) (except between laser sintering and hard metal milling, and casting and soft metal milling). The cantilever groups showed load to fracture values significantly lower than those of the intermediate pontic (p < 0.001; F = 28.29). The Weibull statistics corroborated the results.

CONCLUSIONS

Hard metal milling and laser sintered frameworks exhibited the highest load to fracture values. However, all tested frameworks demonstrated clinically acceptable load to fracture values. The framework design directly affected the fracture load, with drastically lower values in cantilevered frameworks.

Additively Manufactured Commercial Co-Cr Dental Alloys: Comparison of Microstructure and Mechanical Properties

Laser-powder bed fusion (LPBF) is one of the preferred techniques for producing Co-Cr metal structures for dental prosthodontic appliances. However, there is generally insufficient information about material properties related to the production process and parameters. This study was conducted on samples produced from three different commercially available Co-Cr dental alloys produced on three different LPBF machines. Identically prepared samples were used for tensile, three-point bending, and toughness tests. Light microscopy (LM), scanning electron microscopy (SEM), and electron backscatter diffraction (EBSD) analyses of microstructure were performed after testing. Differences were observed in microstructures, which reflected statistically significant differences in mechanical properties (one-way analysis of variance (ANOVA) and Scheffé post hoc test (α = 0.05)). The material produced on the 3D Systems DMP Dental 100 had 24 times greater elongation ε than the material produced on the Sysma MySint 100 device and the EOS M100 machine. On the other hand, the material produced on the EOS M100 had significantly higher hardness (HV0.2) than the other two produced materials. However, the microstructure of the Sysma specimens with its morphology deviates considerably from the studied group. LPBF-prepared Co-Cr dental alloys demonstrated significant differences in their microstructures and, consequently, mechanical properties.

Influence of inner crown thickness on the bonding strength of porcelain fused to Co-Cr alloy endocrown

PURPOSE

The purpose of this study was to investigate the influence of inner crown thickness on the bonding strength of porcelain fused to Co-Cr alloy endocrown by shear strength test.

METHODS

According to the molar average anatomical data to obtain a simplified model for endocrowns, porcelain fused to Co-Cr alloy endocrowns were fabricated with four inner crown thicknesses: 0.3 mm, 0.5 mm, 0.8 mm, and 1.0 mm group, eight specimens were fabricated for each thickness group. Shear bond strength test was used to observe the metal-porcelain bonding strength, scanning electron microscope (SEM) and energy dispersive spectrometer (EDS) analysis were performed after the test to evaluate the interface of metal-porcelain.

RESULTS

The shear bond strength means (in MPa) were: 10.50 ± 2.55 (0.3 mm), 13.21 ± 2.27 (0.5 mm), 14.47 ± 1.46 (0.8 mm), and 15.78 ± 2.81 (1.0 mm), one-way ANOVA showed that there was a statistically significant difference among the thicknesses (P < 0.05). The SEM observation showed tight bonding, and the EDS analysis showed element diffusion phenomenon at the metal-porcelain interface.

CONCLUSION

The bonding strength of porcelain fused to Co-Cr alloy endocrown varied according to the different thickness of inner crown and the thinner inner crown was recommended for tooth defects with limited prosthodontic space.

Polycarbonate-urethane coating can significantly improve talus implant contact characteristics

Talus implants can be utilized in cases of talus avascular necrosis and has been regarded as a promising treatment method. However, existing implants are made of stiff materials that directly oppose natural cartilage. The risk of long-term cartilage wear and bone fracture from the interaction between the cartilage and stiff implant surfaces has been documented in post-hemiarthroplasty of the hip, knee and ankle joints. The aim is to explore the effects of adding a layer of compliant material (polycarbonate-urethane; PCU) over a stiff material (cobalt chromium) in talus implants. To do so, we obtained initial ankle geometry from four cadaveric subjects in neutral standing to create the finite element models. We simulated seven models for each subject: three different types of talus implants, each coated with and without PCU, and a biological model. In total, we constructed 28 finite element models. By comparing the contact characteristics of the implant models with their respective biological model counterparts, our results showed that PCU coated implants have comparable contact area and contact pressure to the biological models, whereas stiff material implants without the PCU coating all have relatively higher contact pressure and smaller contact areas. These results confirmed that adding a layer of compliant material coating reduces the contact pressure and increases the contact area which in turn reduces the risk of cartilage wear and bone fracture. The results also suggest that there can be clinical benefits of adding a layer of compliant material coating on existing stiff material implants, and can provide valuable information towards the design of more biofidelic implants in the future.

Optimization of the Manufacturing Process by Molding Cobalt-Chrome Alloys in Assembled Dental Frameworks

In oral rehabilitation, the treatment of partial edentulism (PEd) is performed by removable partial dentures (RPD) or assembled prosthetic works (APW) composed of several components, fixed to the prosthetic field (Pa) and a removable one (Pb), in order to facilitate the daily hygiene but also the damping of the occlusal forces applied in mastication. Cobalt-Chromium alloys are materials used to manufacture modern prosthetic assembles. In order for this study to be relevant, it was necessary to standardize the design of the framework (Pa) in terms of shape and volume so that the experiment could be reproducible for the five Co-Cr alloys: 0-A (Co-Cr-Mo), 5-A and 10-A (Co-Cr-Mo-W), 15-A and 16.4-A (Co-Cr-W-Fe) and for the three fabrication methods of dental assembled prosthetic frameworks: refractory duplicate method (RD) resulting removable framework (Pb), direct construction method (DC) resulting removable framework (Pb-) and casting over metal method (CoM) resulting removable framework (Pb+). The time allocated to the adaptation process (AP), mechanical processing and sandblasting, in order to assemble the two components was between 43–70 min, even though the assembly between the Pa-framework and the complementary framework (Pb+) was not necessary, CoM-method hs been provide the elimination of AP step. By applying the arithmetic simple rule of three, the percentages for each of the three methods used were calculated, the values of the difference were obtained. The CoM method improves the joining precision between the components of the removable assembly of prosthetic frameworks by 91.7% compared to the RD method and by 80.62% compared to the DC method. According to the efficiency of the methods used in the precision of joining between frameworks components, their order is: casting over metal, direct construction and refractory duplicate method.

An integrated benefit-risk assessment of cobalt-containing alloys used in medical devices: Implications for regulatory requirements in the European Union

In 2017, the European Union (EU) Committee for Risk Assessment (RAC) recommended the classification of metallic cobalt (Co) as Category 1B with respect to its carcinogenic and reproductive hazard potential and Category 2 for mutagenicity but did not evaluate the relevance of these classifications for patients exposed to Co-containing alloys (CoCA) used in medical devices. CoCA are inherently different materials from Co metal from a toxicological perspective and thus require a separate assessment. CoCA are biocompatible materials with a unique combination of properties including strength, durability, and a long history of safe use that make them uniquely suited for use in a wide-range of medical devices. Assessments were performed on relevant preclinical and clinical carcinogenicity and reproductive toxicity data for Co and CoCA to meet the requirements under the EU Medical Device Regulation triggered by the ECHA re-classification (adopted in October 2019 under the 14th Adaptation to Technical Progress to CLP) and to address their relevance to patient safety. The objective of this review is to present an integrated overview of these assessments, a benefit-risk assessment and an examination of potential alternative materials. The data support the conclusion that the exposure to CoCA in medical devices via clinically relevant routes does not represent a hazard for carcinogenicity or reproductive toxicity. Additionally, the risk for the adverse effects that are known to occur with elevated Co concentrations (e.g., cardiomyopathy) are very low for CoCA implant devices (infrequent reports often reflecting a unique catastrophic failure event out of millions of patients) and negligible for CoCA non-implant devices (not measurable/no case reports). In conclusion, the favorable benefit-risk profile also in relation to possible alternatives presented herein strongly support continued use of CoCA in medical devices.

Effect of Ozone on Corrosion Behavior of a Cobalt–Chromium Alloy Used in Removable Partial Denture Framework: An In Vitro Study

Aim:

The aim of this study was to evaluate the effect of the ozonated water on corrosion of a cobalt–chromium (Co-Cr)-based alloy, which is applied for the fabrication of metal frameworks of removable partial dentures.

Materials and Methods:

In this in vitro study, a total of 30 disk-shaped samples of a Co-Cr alloy were papered and randomly divided into two groups of 15 specimens. In group 1 (control), the specimens were stored in distilled water (DW), and in group 2, the specimens were stored in ozonated water. Around 90 immersions were performed, and the weight change of each specimen was determined. The ion release was analyzed using an inductively coupled plasma-optical emission spectrophotometer. The potentiodynamic polarization test was performed for each group to assess the corrosion resistance of the Co-Cr alloy. The statistical analysis was performed using SPSS version 22. Data were analyzed by independent samples’ t-test.

Results:

The results showed no significant difference between the weight changes of the two groups. The test using an inductively coupled plasma-optical emission spectrophotometer demonstrated no significant difference between the groups in Co and Cr ions release. In the potentiodynamic polarization test, both groups present similar corrosion behavior, and ozonated water has no deleterious effect on the corrosion resistance and passive range of the Co-Cr alloy compared to DW.

Conclusion:

As compared to DW, ozonated water has no significant deleterious effect on the corrosion resistance of the Co-Cr frameworks and can be used for cleaning the removable partial dentures.

3D and 4D printing in dentistry and maxillofacial surgery: Printing techniques, materials, and applications

3D and 4D printing are cutting-edge technologies for precise and expedited manufacturing of objects ranging from plastic to metal. Recent advances in 3D and 4D printing technologies in dentistry and maxillofacial surgery enable dentists to custom design and print surgical drill guides, temporary and permanent crowns and bridges, orthodontic appliances and orthotics, implants, mouthguards for drug delivery. In the present review, different 3D printing technologies available for use in dentistry are highlighted together with a critique on the materials available for printing. Recent reports of the application of these printed platformed are highlighted to enable readers appreciate the progress in 3D/4D printing in dentistry.

Impact of laser parameters on additively manufactured cobalt-chromium restorations

STATEMENT OF PROBLEM

The selective laser melting (SLM) process has become popular for the fabrication of frameworks for metal-ceramic restorations, although their surface roughness is greater than with cast or milled frameworks. Limited information is available regarding the surface mechanical characteristics of cobalt-chromium (Co-Cr) SLM-manufactured restorations.

PURPOSE

The purpose of this in vitro study was to adapt the laser parameters for a remelting strategy, scanning the outer boundary of Co-Cr specimens, to reduce surface roughness and solidification defects, to determine microhardness, to investigate surface morphology and microstructure, and to establish surface mechanical characteristics.

MATERIAL AND METHODS

Co-Cr specimens were SLM manufactured by using a typical melting (TM) strategy and an adaptive remelting (AR) strategy. The AR strategy involves rescanning 50% of the contour, varying the laser parameters. The roughness parameters considered were Ra and Rz. Vickers hardness was measured by microindentation with a 9.81-N force (ASTM E384-17). The surface morphology was investigated by scanning electron microscopy, the chemical composition by energy-dispersive X-ray spectroscopy, and the phase identification by using X-ray diffraction. The mechanical surface properties measured were the nanohardness, elastic modulus, and dissipation energy. One-way ANOVA with the Tukey procedure was used to compare the groups (α=.05).

RESULTS

The innovative AR strategy reduced the surface roughness by 45% compared with TM, comparable with their cast counterpart. The smoothest AR surface was obtained by using 75 W and 350 mm/s for the first scanning of the contour, followed by a second remelting with 80 W and 700 mm/s. The microstructure of AR specimens had limited solidification defects, a chemical composition similar to that of raw powder, and a surface microhardness over 600 HV1. A fine grain structure in a single matrix phase was detected both on TM and AR specimens. The mechanical characteristics of the smoothest Co-Cr surface were 218 GPa elastic modulus, 746 HV_IT Vickers nanohardness, 21 243 pJ plastic energy, and 26% nanoindentation work ratio. Significant differences were observed between the melting strategies (P<.05) both for surface roughness and microhardness.

CONCLUSIONS

The laser scanning strategy affects both the surface roughness and the hardness of SLM-manufactured specimens. The results show that using the AR strategy and proper laser parameters can reduce the roughness and increase the surface hardness of Co-Cr specimens made of conventional powder feedstock.

Effect of Cu and Ti electrodes on surface and electrochemical properties of Electro Discharge Machined (EDMed) structures made of Co-Cr and Ti dental alloys

OBJECTIVES

Previous studies have shown that the use of Cu electrodes compromises the electrochemical properties of Co-Cr and Ti alloys used for the fabrication of implant retained superstructures by Electro Discharge Machining (EDM). A possible solution is the use of Ti instead of Cu electrodes and thus the aim of this study was to evaluate the effect of Cu and Ti electrodes on surface and electrochemical properties of two types of dental alloys used for fabrication of implant retained superstructures after EDM.

METHODS

Three full arch frameworks were prepared from a Co-Cr and three from Ti6Al7Nb alloy. One framework from each alloy was used as control, one was subjected to EDM with Cu electrodes and the last one with Ti electrodes. Morphological and elemental characterization was studied by SEM/EDX. The electrochemical properties of the alloys were evaluated by Open Circuit Potential (OCP) and Linear Sweep Voltammetry (LSV) in Ringer's solution. Electrochemical data were analyzed statistically by one way ANOVA and SNK multiple comparison tests at a = 0.05 RESULTS: All groups demonstrate the typical surface after EDM treatment with almost circular valleys and an increase in C and O content compared to control groups. Both alloys demonstrated an uptake of C and Cu by Cu electrodes and C and Ti after treatment with Ti electrodes. The use of Cu electrodes had a detrimental effect on corrosion resistance of Ti alloy.

SIGNIFICANCE

The use of Ti electrodes mitigates the degradation of electrochemical properties compared to Cu electrodes and from this standpoint is safer for the EDM of implant retained superstructures made of Co-Cr and Ti alloys.

In-Situ XRD Study of Phase Transformation Kinetics in a Co-Cr-W-Alloy Manufactured by Laser Powder-Bed Fusion

The additive manufacturing process of laser powder-bed fusion (L-PBF) is an increasingly popular approach for patient-specific production of dental frameworks made from Co-Cr alloys. Macroscopically, frameworks produced in this way exhibit high anisotropy especially in Young’s modulus, and are missing standardized requirements. Microscopically, pronounced texture and high residual stresses are characteristic. To reduce resulting detrimental effects, the as-built (AB) parts are heat treated. Dependent on the treatment temperature, effects like the transformation of the γ-phase matrix in the AB condition to ϵ-phase, precipitation, stress relief, and grain growth were observed. While the existence of these processes was established in the past, little is known about their kinetics. To fill this gap, these effects were studied with in-situ X-ray diffraction (XRD) methods in isothermal heat treatments (HTs) at four different sample surface temperatures TS reaching from 650∘C to 900∘C. Furthermore, room temperature ex situ XRD and SEM/EDS measurements completed the analysis. An evaluation of the datasets, with single peak fitting and QXRD methods, yielded the following results. In the HTs below a certain threshold, a γ-to-ϵ transformation was observed in the sample bulk and close to the sample surface. In the latter case, evidence for a partially strain-induced transformation related to oxide formation was present. Above this threshold and possibly slightly below, σ- and Laves-phase precipitated. Additionally, peak profile evolutions hinted at a drop of inter- and intragranular stresses within the first 30 to 60 min. Therefore, an HT of about 30 to 60 min slightly above the threshold is proposed as optimal for reducing residual stresses while retaining a predominantly single-phased microstructure, possibly superior in corrosion properties and likewise in bio-compatibility.