Preparation and optimization of an eggshell membrane-based biomaterial for GTR applications

OBJECTIVES

Guided Tissue Regeneration (GTR) is a popular clinical procedure for periodontal tissue regeneration. However, its key component, the barrier membrane, is largely collagen-based and is still quite expensive, posing a financial burden to the patients as well as healthcare systems and negatively impacting the patient's decision-making. Thus, our aim is to prepare a novel biomimetic GTR membrane utilizing a natural biomaterial, soluble eggshell membrane protein (SEP), which is economical as it comes from an abundant industrial waste from food and poultry industries, unlike collagen. Additive polymer, poly (lactic-co-glycolic acid) (PLGA), and a bioceramic, nano-hydroxyapatite (HAp), were added to improve its mechanical and biological properties.

METHODS

For this barrier membrane preparation, we initially screened the significant factors affecting its mechanical properties using Taguchi orthogonal array design and further optimized the significant factors using response surface methodology. Furthermore, this membrane was characterized using SEM, EDAX, and ATR-FTIR, and tested for proliferation activity of human periodontal ligament fibroblasts (HPLFs).

RESULTS

Optimization using response surface methodology predicted that the maximal tensile strength of 3.1 MPa and modulus of 39.9 MPa could be obtained at membrane composition of 8.9 wt% PLGA, 7.2 wt% of SEP, and 2 wt% HAp. Optimized PLGA/SEP/HAp membrane specimens that were electrospun on a static collector showed higher proliferation activity of HPLFs compared to tissue culture polystyrene and a commercial collagen membrane.

SIGNIFICANCE

From the results observed, we can conclude that SEP-based nanofibrous GTR membrane could be a promising, environment-friendly, and cost-effective alternative for commercial collagen-based GTR membrane products.

Comparison of subcritical growth parameters of a Y-TZP obtained via cyclic or dynamic fatigue tests

OBJECTIVE

The objective of this study was to 1) compare the stress corrosion coefficient (n) of a Y-TZP obtained by two fatigue tests: cyclic and dynamic and 2) evaluate the effect of frequency in the characteristic lifetime and the existence of interaction between the cyclic fatigue and slow crack growth.

METHODS

A total of 145 Y-TZP specimens were produced in accordance with the manufacturer's instructions. These specimens, measuring 4.0 × 3.0 × 25.0 mm, were used for dynamic (n = 70) and cyclic fatigue tests (n = 75). The specimens were obtained from CAD/CAM blocks, sectioned, and sintered in a furnace at 1530 °C with a heating rate of 25 °C/min. They were tested in their "as-sintered" form without any additional surface treatment. The fatigue tests were conducted using a four-point bending to obtain the slow crack growth parameters (n). The cyclic fatigue test was also conducted in two frequencies (2 and 10 Hz), using stress levels between 350 and 600 MPa. Data from these tests were analyzed using ASTM C 1368-00 formulas and Weibull statistics. Scanning electron microscope (SEM) was used for fracture surface analysis to identify the origin of the fracture. Critical defect size was measured and used, along with flexural strength values, to estimate fracture toughness. Dynamic fatigue test data were used to obtain subcritical crack growth (SCG) parameters and perform Weibull statistical analysis. The cyclic fatigue data were used in the General Log-linear Model equation using the ALTA PRO software. Data were analyzed using one-way ANOVA followed by Tukey post-hoc tests and Student's t-test at a significance level of p ≤ 0.05.

RESULTS

In the dynamic fatigue test, the values obtained for σfo and n were 667 and 54, respectively. This parameter indicates how the strength of the material diminishes over time due to internal cracks. The Weibull parameters obtained from the same test results were m = 7.9, σ0 = 968, 9 and σ5% = 767, which indicates the reliability of the material. The Weibull parameters obtained by cyclic fatigue were statistically similar for the two frequencies used, the m* was 0.17 (2 Hz) and 0.21 (10 Hz); characteristic lifetimes (η) were 1.93 × 106 and 40,768, respectively. The n values obtained by cyclic fatigue were 48 and 40 at frequencies of 2 and 10 Hz, respectively. There was no effect of the frequency, the stress level or the interaction of the two in the Y-TZP lifetime, when analysed by General Log Linear Model.

SIGNIFICANCE

the n values obtained by cyclic and dynamic fatigue tests showed no statistically significant difference and the effect of frequency in the characteristic lifetime and the existence of interaction between the cyclic fatigue and subcritical growth were not observed in the tested specimens.

Influence of different surface finishing protocols on the wear behavior of a lithium disilicate glass-ceramic

PURPOSE

This study aims to evaluate the effect of different finishing protocols on the wear behavior of a lithium disilicate glass-ceramic.

MATERIAL AND METHODS

Specimens were produced from lithium disilicate glass-ceramic prefabricated CAD/CAM blocks and divided into three groups, according to the surface treatment (n = 8): control; polishing; glaze. Ceramic specimens were subjected to wear test using a dual-axis chewing simulator. A 49 N load was applied in the axial direction combined with a lateral movement (1 mm path) using a lithium disilicate glass-ceramic spherical piston for a total of 106 cycles. Qualitative analysis of the wear surface was performed using an optical microscope. Quantitative analysis of surface roughness and volume loss was performed using a confocal microscope and a 3D-image editing software, respectively. Surface roughness and volume loss data were analyzed using Friedman's non-parametric statistical test for repeated measures and the Student-Newman-Keuls test (α = 0.050).

RESULTS

There were statistical differences for surface roughness and volume loss of lithium disilicate glass-ceramic specimens in the different experimental conditions (P˂0.001). Control and polishing groups showed similar surface roughness and volume loss values for all testing times. Glaze group had greater wear volume after 103, 104 and 105 cycles. After 106 cycles, surface roughness and volume loss were similar among groups. For the piston, surface roughness was similar over time and among groups.

CONCLUSIONS

A distinct wear behavior was found for glazed glass-ceramic specimens in comparison to control and polished specimens. The end of the simulation, the surface roughness and volume loss was similar for the groups.

Role of gender and age in influencing dentist perceptions of effective leadership capabilities

STATEMENT OF THE PROBLEM

The characteristics of effective leaders in dentistry are unknown, especially as they relate to the perceptions of attributes associated with emotional intelligence.

PURPOSE

The purpose of this study was to survey dentists about their perceptions of the relative importance of emotional intelligence domains in effective leadership and in effective leaders with whom they have worked and to determine whether the differences were based on gender and age.

MATERIAL AND METHODS

A survey was sent to a list of over 50 000 dentists. The survey asked respondents to rate important qualities found in effective leaders in general and to identify important qualities found in the most effective leaders with whom they had worked or by whom they had been mentored. Additionally, demographic information such as the age and gender of the participants was captured in the survey. Descriptive statistics were created and statistical differences (α=.05) between genders were determined.

RESULTS

A total of 256 respondents completed the survey. Self-management and relationship management were perceived to be more important than social awareness or self-awareness. Adaptability was the highest ranked personal competence skill, while conflict management was perceived as the least important personal competence skill. The social competence skills of empathy, organizational awareness, influence, and inspirational leadership were similarly ranked as highly important. When asked to identify the most important leadership skill of previous leaders, respondents noted that conflict management was most important and emotional self-awareness was least important. Women viewed the attributes of adaptability, organizational awareness, and conflict management as more important. Men viewed achievement orientation and coaching or mentoring as more important attributes of leaders. When answers were stratified for age group responses, younger respondents valued relationship management and adaptability, and whether their leader valued and exhibited conflict management more than older respondents. Older respondents were more likely to respond "yes" to valuing self-management and to whether their leader valued and exhibited inspirational leadership.

CONCLUSIONS

Different genders and different age groups view leadership skills in effective leaders differently. The results of this study indicate that women may need different leadership skills to lead colleagues of different ages.

Antibacterial and biocompatible polyaniline-doped titanium oxide layers

Titanium anodization has been shown to produce crystalline oxides exhibiting photocatalytic reactions that form reactive oxygen species (ROS) when exposed to UV light. The ROS subsequently attack bacteria cells, and thus reduce bacteria attachment on titanium implant surfaces. Polyaniline (PANI) is a conductive polymer that has shown antibacterial properties when electropolymerized onto titanium. Our research group hypothesized the addition of PANI to crystalline titanium oxide surfaces would increase the available free electrons and thus increase photocatalytic activity (PCA). This research led to the development of a novel single-step anodization approach for PANI doping crystalline titanium oxide layers. The objective of the present study was to determine the proper aniline electrolyte concentration needed to maximize the PCA and reduce bacterial attachment on the formed oxides. Aniline concentrations up to 1 M were added into a 1 M sulfuric acid electrolyte. The formed oxides exhibited increased PANI surface coverage but decreased anatase and rutile crystalline titanium oxide phase formation with increasing aniline electrolyte concentrations. Despite exhibiting the lowest levels of anatase and rutile formation, the 0.75 M and 1 M aniline oxides with the greatest PANI surface coverage also exhibited the highest PCA levels. 1 M aniline oxides showed significantly higher PCA under UVA irradiation compared to oxides formed from aniline concentrations up to 0.5 M (p < 0.001). 0.75 M aniline oxides exhibited significant reductions in Staphylococcus aureus attachment with or without UVA irradiation compared to control oxides without PANI. MTT and live/dead assays confirmed cytocompatibility and nearly 100% cell viability for the PANI doped oxides.

Relationship between fracture toughness and fractal dimensional increment in two types of dental glass-ceramics with different fracture surface roughness

OBJECTIVES

Previous studies have reported the fractal dimensional increment of glass-ceramic fracture surfaces. The objective of this study was to determine the relationship between fracture toughness and fractal dimensional increment of two dental glass-ceramics with different volume fraction of crystals and different fracture surface roughness.

METHODS

Bar-shaped specimens were prepared from lithium disilicate (LDS) and nanofluorapatite (NFA) glass-ceramics. One face of each specimen was indented using a Knoop diamond at 25 N (LDS) or 10 N (NFA) followed by loading in 4-point, or 3-point flexure, respectively, until failure. Fracture toughness (Kc) was calculated using the surface crack in flexure (SCF) technique (ASTM C1421). Epoxy replicas of the fracture surfaces were scanned using the atomic force microscope (AFM) followed by noise filtering. The FRACTALS software was used to determine the fractal dimensional increment (D*) by the Minkowski cover algorithm.

RESULTS

Median (25%, 75% quartiles) fracture toughness of LDS bars were 1.62 (1.59, 1.69) MPa m1/2 and NFA bars were 0.68 (0.66, 0.74) MPa m1/2, respectively. The median fractal dimension (D) value (25%, 75% quartiles) before noise filtering were 2.16 (2.15, 2.17) and after noise filtering were 2.14 (2.14, 2.15) for LDS and before noise filtering were 2.29 (2.21, 2.38) and after noise filtering were 2.17 (2.17, 2.18) for NFA. Median (25%, 75% quartiles) surface roughness (Ra) before noise filtering were 139 (119, 188) nm and after noise filtering were 137 (118, 187) nm for LDS and before noise filtering were 7 (6, 15) nm and after noise filtering were 7 (6, 15) nm for NFA.

SIGNIFICANCE

Noise filtering successfully eliminated noise from the material with smooth fracture surfaces (NFA), decreasing the measured fractal dimension. The NFA data fit a Kc vs. D*1/2 statistical model for fused silica previously tested using a similar technique. The equation relating fracture toughness to the fractal dimension was modified, accounting for the toughening mechanisms. Fractal analysis with noise filtering can be used to estimate the fracture toughness of dental glass-ceramics that do not exhibit crack bridging.

A novel single-step anodization approach for PANI-doping oxide surfaces to improve the photocatalytic activity of titanium implants

Crystalline titanium oxides have shown photocatalytic activity (PCA) and the formation of antibacterial reactive oxygen species (ROS) when stimulated with UV light. Polyaniline (PANI) is a conductive polymer that has shown antibacterial effects. Previously, titanium oxides have been PANI-doped using a multi-step approach. In the present study, we compared PANI-doped specimens produced with a two-step method (ACV), to PANI-doped specimens produced by a novel single-step direct anodization (AAn) method, and a control group of anodized un-doped specimens. The surface morphology, oxide crystallinity, surface elemental composition, surface roughness, surface wettability, oxide adhesion, corrosion resistance, PCA, and ROS generation of each oxide group were evaluated. All groups exhibited mixed anatase and rutile phase oxides. The AAn group revealed less anatase and rutile, but more PANI-surface coverage. The AAn group exhibited significantly increased PCA after 60 minutes of direct UVA illumination compared to the ACV group, despite containing lower amounts of anatase and rutile. The ACV and AAn groups showed significant increases in ROS production after 4 hours UVA illumination while the control group showed similar ROS production. These findings suggested that PANI doping using the novel direct anodization technique significantly improved PCA even for oxides containing less crystallinity. The S. aureus attachment response to each oxide group was also compared under UVA pre-illumination, UVA direct illumination, and no illumination (dark) lighting conditions. Although no significant differences were shown in the bacterial response, both PANI-doped groups exhibited less average bacterial attachment compared to the control group. The response of MC3T3-E1 pre-osteoblast cells to each oxide group was evaluated using MTT and live/dead assays, and no evidence of cytotoxicity was found. Since many, if not most, titanium implant devices are routinely anodized as a part of the manufacturing processes, these study findings are applicable to a wide variety of implant applications.

Fracture toughness and fractal analysis of ceramic benchmark materials

Previous studies have reported various methods of measuring the fracture toughness of brittle ceramics. The purpose of the present research was to use a new method of fractal dimension measurement on benchmark materials (silica glass, Viosil SX, Shin-Etsu, n = 13, and silicon nitride standard reference material, SRM2100, NIST, n = 10), to compare the fracture toughness calculated using different methods, and to study the effect of noise filtering on the fractal dimension and fracture surface roughness. Fracture toughness was determined using surface crack in flexure method according to ASTM C1421 and fractal analysis method. Fractal dimension was determined using the Minkowski Cover algorithm on atomic force microscope scans of epoxy replicas of fracture surfaces. The mean ± standard deviation of fracture toughness using surface crack in flexure method and fractals method were 0.97 ± 0.18 MPa·m1/2 and 1.03 ± 0.07 MPa·m1/2 for silica glass and 4.62 ± 0.14 MPa·m1/2 and 2.54 ± 0.07 MPa·m1/2 for silicon nitride, respectively. The mean ± standard deviation of fractal dimension was 2.17 ± 0.03 for silica glass and 2.13 ± 0.01 for silicon nitride. The mean ten-point roughness (Rz) before and after noise filtering was 89 ± 102 nm and 87 ± 101 nm for silica glass and 355 ± 132 nm and 357 ± 134 nm for silicon nitride, respectively. Noise filtering had no significance on the fracture surface roughness of the two materials. The newly developed fractal analysis method can be used to predict the baseline fracture toughness of specimens with unknown failure stress.

Effect of Bone Remodeling on Dental Implant Fatigue Limit Predicted Using 3D Finite Element Analysis

BACKGROUND

To evaluate the effect of bone remodelling around a reduced-diameter dental implant on its fatigue limit using finite element analysis (FEA).

METHODS

A dental implant assembly, which included a reduced-diameter dental implant (Biomet-3i external hex), an abutment (GingiHue^®) and a connector screw (Gold-Tite Square screw), was scanned using micro-computed tomography (Skyscan 1172). Its dimensions were measured using Mimics (Materialise) and an optical microscope (Keyence). The digital replicas of the physical specimens were constructed using SOLIDWORKS (Dassault Systems). A cylindrical bone specimen holder with two layers (cortical and cancellous bone) was designed in SOLIDWORKS. Two assemblies were created: (a) Model 1: Having non-remodelled bone; (b) Model 2: Cancellous bone remodelled at the regions adjacent to the implant screw threads. FEA was performed in ABAQUS (SIMULIA). In Model 1, the Young's modulus of cortical and cancellous bone were 20 GPa and 14 GPa, respectively. For Model 2, the region of the cancellous bone adjacent to the implant screw threads was assigned a Young's modulus of 20 GPa. fe-safe (SIMULIA) was used to estimate the fatigue limit.

RESULTS

The maximum von Mises stress under 100 N load was 439.9 MPa for both models 1 and 2 and was located at the connector screw. The fatigue limit was 116.4 N for both models 1 and 2.

CONCLUSIONS

The results suggest that implant fatigue resistance tested according to ISO 14801 may be accurately predicted without bothering to simulate the non-homogeneous stiffness that occurs at the bone-implant interface in the clinical case.

Effects of abutment screw preload and preload simulation techniques on dental implant lifetime

Background

This study aimed to investigate how the predicted implant fatigue lifetime is affected by the loss of connector screw preload and the finite element analysis method used to simulate preload.

Methods

A dental implant assembly (DI1, Biomet-3i external hex; Zimmer Biomet) was scanned using microcomputed tomography and measured using Mimics software (Materialise) and an optical microscope. Digital replicas were constructed using SolidWorks software (Dassault Systèmes). The material properties were assigned in Abaqus (Dassault Systèmes). An external load was applied at 30° off-axial loading. Eight levels of connector screw preload (range, 0-32 Ncm) were simulated for DI1. This assembly and an additional model (DI2) having a longer and narrower screw were compared regarding their fatigue limits (using fe-safe software [Dassault Systèmes]) for 2 preloading methods: (1) adding preload torque or (2) adding bolt axial tension.

Results

The maximum von Mises stresses of DI1 (on the connector screw threads) with and without preload were 439.90 MPa and 587.90 MPa. The predicted fatigue limit was the same for preloads from 100% through 80% of the manufacturer^'s recommendation and dropped precipitously between 80% and 70% preload. Adding a preload torque on the screw resulted in a more uniform stress distribution on the screw compared with bolt axial tension, especially for DI2, which had a longer and narrower screw than DI1.

Conclusions

A substantial loss of preload can be accommodated without compromising the fatigue resistance of this dental implant. Computer models should be constructed using torque instead of a bolt axial tension.

Influence of piston material on the fatigue behavior of a glass-ceramic

STATEMENT OF PROBLEM

The lack of standardization regarding the loading piston material used in fatigue tests could limit the interpretation of study findings.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of the piston material on the fatigue behavior of a lithium disilicate glass-ceramic.

MATERIAL AND METHODS

Plate-shaped, 1.2-mm-thick, lithium disilicate glass-ceramic specimens were cemented onto a dentin analog substrate with resin cement. The specimens were divided into 4 groups according to the piston material used in the fatigue test (n=30): metal, glass fiber-reinforced epoxy resin, ceramic, and human tooth. The fatigue test was performed in a mechanical cycling machine by using the boundary technique at 2 Hz in distilled water at 37 °C. The fatigue data were analyzed by using the Weibull distribution and a lifetime-inverse power law relationship. Failures were evaluated with fractography and transillumination.

RESULTS

The Weibull modulus (β) was similar among groups. The exponent of crack growth (n) was significantly greater for glass fiber-reinforced epoxy resin and tooth groups than for metal and ceramic; therefore, the probability of failure (P_f) of glass-ceramic specimens loaded by resin and tooth pistons depended more on load amplitude. Specimens tested with tooth showed the highest value of K (characteristic lifetime), which is an indication of greater survival. Radial crack was the only failure mode observed for all experimental groups.

CONCLUSIONS

The piston material influenced the fatigue survival of the lithium disilicate glass-ceramic. The glass fiber-reinforced epoxy resin piston closely simulated the fatigue behavior induced by the human tooth on the evaluated glass-ceramic.

Mechanical behavior and adhesive potential of glass fiber-reinforced resin-based composites for use as dentin analogues

PURPOSE

To characterize experimental glass fiber-reinforced resin-based composites (GFIR-isophthalic; and GFOR-orthophthalic), evaluating their mechanical behavior and adhesive potential to ceramic in comparison to human dentin and a traditional glass fiber-reinforced epoxy resin (G10).

METHODS

Density (ρ), elastic modulus (E), and Poisson's ratio (ν) were evaluated using 2 mm thick specimens from GFIR, GFOR, human dentin and G10. Biaxial flexural strength (δf), Knoop hardness and surface topography under scanning electron microscopy (SEM) were assessed for GFIR and GFOR specimens. G10 was also tested for δf. For the adhesive potential, ceramic specimens (n=10) bonded to GFIR, GFOR or human dentin were tested for microtensile bond strength (MTBS). Disc-shaped ceramics were cemented onto dentin, GFIR, GFOR and G10 (n=15) and loaded to failure. Data were statistically evaluated using Weibull, ANOVA, and Tukey's test (α=0.05).

RESULTS

The experimental resins (GFIR and GFOR) showed similar values of HK (53.1 and 52.7 GPa), (ν (0.44 and 0.43) and δf (41.2 MPa and 40.7 MPa). Considering the human dentin values for ρ and E, the corresponding values obtained from GFIR, GFOR and G10 were different, with GFOR values being closer to dentin than GFIR and G10. G10 had statistically greater(δf than GFIR and GFOR. Mean bond strength of ceramic to GFIR, GFOR and dentin were statistically similar. The fracture load of resin-cemented ceramic was influenced by substrate.

CLINICAL SIGNIFICANCE

The experimental materials (GFIR and GFOR) showed similar adhesion characteristics to human dentin, however GFOR showed a better potential to be used as a dentin analogue.

Fractal analysis at varying locations of clinically failed zirconia dental implants

OBJECTIVES

Previous studies have shown that the fracture toughness of ceramics can be determined from the fractal dimensions (D) of their fracture surfaces and that the surface should be leveled to obtain an accurate D measurement. This study was to determine the effects of leveling operations and distance from the failure origin on the D values.

METHODS

Twelve clinically failed zirconia implants from four different manufacturers: Axis Biodental (n=7), Z-Systems (n=3), Straumann (n=1), and Swiss Dental Solutions (n=1) were obtained from one of the authors and thoroughly cleaned. Epoxy replicas were made of three locations along the crack path in the center region of each fracture surface (near origin (O), hackle (H), and near compression curl (CC)) using a light body polyvinyl siloxane impression material. Surfaces were scanned in ScanAsyst mode with a scan size of 5μm×5μm and a scan rate of 0.592Hz using the atomic force microscope. The surface scans were then leveled using 1st order flattening operation in the AFM analysis software. The height data before and after the operation were imported into a custom MathCAD script, and FRACTALS software was used to determine the D value by Minkowski Cover algorithm, which was shown previously to be the algorithm with the highest precision. A Wilcoxon signed-rank test, two-way repeated-measures ANOVA, and one-way repeated-measures ANOVA were performed as detailed below.

RESULTS

The data were not normally distributed (S-W p≤0.05), so a non-parametric repeated measures test (Wilcoxon signed-rank test) was selected. The median D values before and after leveling were 2.161 and 2.174, respectively. There was a significant difference before and after leveling (p<0.001). The two-way repeated-measures ANOVA showed no significant difference among the D values for different implant brands (p=0.66) and scanning locations on the fracture surface (p=0.83). After eliminating the implant brand as a factor, the data passed normality and equal variance tests (S-W p=0.88, BF p=0.15). The mean D values and standard deviations from the three locations (O, H, CC) were 2.183±0.031, 2.179±0.024, and 2.175±0.018, respectively. One-way repeated measures ANOVA showed no significant effect of scanning location (p=0.74).

SIGNIFICANCE

The leveling operation successfully removed the tilt without decreasing surface tortuosity, as it increased the D values significantly. The fractal dimension was the same at the three locations on the fracture surfaces. This means that hackle and compression curl regions can be used to determine fracture toughness when the failure origin has been lost.

OPTIMIZATION OF COLLAGEN-ELASTIN-LIKE POLYPEPTIDE-BIOGLASS SCAFFOLD COMPOSITION FOR OSTEOGENIC DIFFERENTIATION OF ADIPOSE-DERIVED STEM CELLS

We have developed a multicomponent hydrogel scaffold that can mimic the bone extracellular matrix by incorporating collagen, elastin-like polypeptide (ELP), and Bioglass. We examined the effects of Bioglass addition to collagen-ELP scaffolds on mechanical properties, physical characteristics, and in vitro osteogenic differentiation, by varying the Bioglass amount and particle size. Response surface methodology with a central composite design predicted 5 mg (6.6 mg/mL) Bioglass with a particle size of 142 ± 5 μm as the optimal amount and particle size to be mixed with 6 mg/mL collagen and 18 mg/mL ELP to obtain a combination of maximized compressive properties. Swelling ratio and FTIR spectroscopy indicated lower hydrophilicity and the presence of hydrophobic and secondary interactions between collagen, ELP, and Bioglass. Scanning electron microscopy showed a nanofibrous morphology of intermingled collagen-ELP-Bioglass network. In vitro osteogenic characterization using human adipose-derived stem cells revealed increased cell attachment and proliferation with increased ALP activity, osteocalcin content, and mineralized deposit formation during a three-week culture. Numerous mineralized deposits composed of calcium and phosphorous were shown by energy dispersive spectroscopy. Overall, our results show that the collagen-ELP-Bioglass multicomponent composites have enhanced mechanical properties with adequate physical features and cell culture properties for bone tissue engineering.

Low pressure dependent elasticity of porous ceramics

The primary goal of this study was to characterize the influence of the pore-saturated gas media and their physical properties on the elasticity of porous ceramic materials. Resonant ultrasound spectroscopic measurements were performed on test specimens of alumina with ~40% porosity, zirconia with ~48% porosity, and sintered fully dense zirconia to determine the hydrostatic pressure-dependent macroscopic elasticity. Here, we report the variation of elasticity of porous and full dense samples over approximately five orders of magnitude (800-0.02 psi) in absolute pressure. The time evolution of mechanical equilibrium of the porous materials at low pressure and high-temperature conditions will also be discussed.

Using fractal geometry to examine failed implants and prostheses

OBJECTIVE

To develop a novel protocol that is precise and accurate for analyzing the fracture surfaces of ceramic specimens using fractal geometry and to demonstrate its use on both clinically retrieved specimens and standard test specimens.

METHODS

A MathCAD script was written to transfer data from atomic force microscope scans to the FRACTALS software of John Russ. This software provided six algorithms for analyzing surfaces, so an experiment was conducted to determine which algorithm provided the most precision in fractal dimensional increment (D*) values and to calibrate that algorithm on surfaces generated with known D* values. Physical specimens were then tested using the chosen algorithm. These included pure silica glass fractured in deionized water versus nominally identical specimens fractured in saliva. Light body polyvinysiloxane was used to make impressions of Y-TZP fracture surfaces, and replicas were casted using a low-viscosity, low-shrinkage epoxy. Clinically failed Y-TZP dental implants were also examined. In addition, the fracture toughness and D* values of four ceramic materials (silicon nitride, silica glass, Y-TZP, and lithium disilicate glass-ceramic) were tested using standard geometry flexure beam specimens (ISO 6872).

RESULTS

The Minkowksi Cover algorithm was the most precise algorithm, and it had a negative bias that was corrected. There was no difference in D* based on water vs. saliva environment (p>0.05), and D* values from the deionized water group had lower standard deviation. The mean D* value obtained from the epoxy replicas 2.247 (0.007) was the same as that obtained from the original Y-TZP specimens 2.245 (0.002) (p=0.43, paired t-test). All scanned areas of the dental implants were fractal in nature, and there was no difference in fractal dimension between the locations near the failure origin and those far from the origin (on the compression curl) (p=0.74, repeated measures ANOVA). There was little scatter in the data collected using the revised protocol on ISO 6872 specimens, and the regression models succeeded in passing through the origin while achieving a good fit to the data (R2=0.99 and 0.95).

SIGNIFICANCE

The new protocol proved to be a powerful tool in analyzing fracture surfaces of dental ceramic materials.

Effect of loading frequency on cyclic fatigue lifetime of a standard-diameter implant with an internal abutment connection

OBJECTIVE

To investigate the effect of loading frequency on the fatigue lifetime of one standard-diameter titanium dental implant system.

METHODS

Thirty-six titanium dental implant specimens (Bone Level RC, Straumann) were assembled following manufacturer's instructions and torqued into cylindrical holder blocks following the apparatus specified by the ISO 14801 test standard. Stainless steel loading hemispheres were bonded on the abutments with a moment arm of 11mm. The holder blocks had layers of differing stiffness to simulate human jaw bone. Constant-stress fatigue lifetime testing was conducted at two frequencies (2Hz and 15Hz) with a stress ratio of 0.1 until fracture in deionized water at 37°C on servo-hydraulic load frames (MTS). The fractured specimens were retrieved and examined using fractographic technique to determine the failure mode. The lifetime data were fit to a general log-linear regression model.

RESULTS

The coefficient for the load amplitude term of the regression model indicated that increasing load amplitude had a statistically significant negative effect on the fatigue lifetime. The coefficients for the cyclic frequency term and the load-frequency interaction term were not significantly different from zero, which indicated that increasing loading frequency did not have an influence on the number of cycles to failure. Fractographic analysis showed that all specimens exhibited an identical combined fracture of abutment and abutment screw adjacent to the bone level.

SIGNIFICANCE

Higher loading frequency at least up to 15Hz may be used for future studies of some implant systems to improve the efficiency of fatigue testing.

Dental Implants

Systematic reviews of literature over the period between 2008 and 2017 are discussed regarding clinical evidence for the factors affecting survival and failure of dental implants. The factors addressed include publication bias, tooth location, insertion torque, collar design, implant-abutment connection design, implant length, implant width, bone augmentation, platform switching, surface roughness, implant coatings, and the use of ceramic materials in the implant body and abutment.

Fatigue lifetime prediction of a reduced-diameter dental implant system: Numerical and experimental study

OBJECTIVE

To validate the fatigue lifetime of a reduced-diameter dental implant system predicted by three-dimensional finite element analysis (FEA) by testing physical implant specimens using an accelerated lifetime testing (ALT) strategy with the apparatus specified by ISO 14801.

METHODS

A commercially-available reduced-diameter titanium dental implant system (Straumann Standard Plus NN) was digitized using a micro-CT scanner. Axial slices were processed using an interactive medical image processing software (Mimics) to create 3D models. FEA analysis was performed in ABAQUS, and fatigue lifetime was predicted using fe-safe^® software. The same implant specimens (n=15) were tested at a frequency of 2Hz on load frames using apparatus specified by ISO 14801 and ALT. Multiple step-stress load profiles with various aggressiveness were used to improve testing efficiency. Fatigue lifetime statistics of physical specimens were estimated in a reliability analysis software (ALTA PRO). Fractured specimens were examined using SEM with fractographic technique to determine the failure mode.

RESULTS

FEA predicted lifetime was within the 95% confidence interval of lifetime estimated by experimental results, which suggested that FEA prediction was accurate for this implant system. The highest probability of failure was located at the root of the implant body screw thread adjacent to the simulated bone level, which also agreed with the failure origin in physical specimens.

SIGNIFICANCE

Fatigue lifetime predictions based on finite element modeling could yield similar results in lieu of physical testing, allowing the use of virtual testing in the early stages of future research projects on implant fatigue.

Photofunctionalization of anodized titanium surfaces using UVA or UVC light and its effects against Streptococcus sanguinis

UV light preirradiation of anodized titanium oxide layers has recently been shown to produce a photocatalytic effect that may reduce early bacterial attachment on titanium surfaces. Streptococcus species have been identified as primary early colonizers and contribute to early biofilm formation on dental implant surfaces. Anodized layers with primarily amorphous, primarily anatase, primarily rutile, and mixtures of anatase and rutile phase oxides were preirradiated with UVA or UVC light for 10 min. Nanoscale surface roughness and pre- and post-UV-irradiated wettability were measured for each anodization group. Sample groups were subjected to streptococcus sanguinis for a period of 24 h. Bacterial attachment and killing efficacy were measured and compared to the corresponding non-UV control groups. UVA treatments showed trends of at least a 20% reduction in bacterial attachment regardless of the crystallinity, or combination of oxide phases present. Anodized layers consisting of primarily anatase phase on the outermost surface were shown to have a killing efficacy of at least 50% after preirradiation with UVA light. Anodized layers containing disperse mixtures of anatase and rutile phases at the outermost surface showed at least a 50% killing efficacy after pre-irradiation with either UVA or UVC light. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2284-2294, 2018.

Effect of different aging methods on the mechanical behavior of multi-layered ceramic structures

OBJECTIVE

To evaluate the effect of two aging methods (mechanical cycling and autoclave) on the mechanical behavior of veneer and framework ceramic specimens with different configurations (monolithic, two and three-layers).

METHODS

Three ceramics used as framework for fixed dental prostheses (YZ-Vita In-Ceram YZ; IZ-Vita In-Ceram Zirconia; AL-Vita In-Ceram AL) and two veneering porcelains (VM7 and VM9) were studied. Bar-shaped specimens were produced in three different designs: monolithic, two layers (porcelain-framework) and three layers (porcelain-framework-porcelain). Specimens were tested for three-point flexural strength at 1MPa/s in 37°C artificial saliva. Three different experimental conditions were evaluated (n=10): control; mechanical cycling (2Hz, 37°C artificial saliva); and autoclave aging (134°C, 2 bars, 5h). Bi-layered specimens were tested in both conditions: with porcelain or framework ceramic under tension. Fracture surfaces were analyzed using stereomicroscope and scanning electron microscopy. Results were statistically analyzed using Kruskal-Wallis and Student-Newman-Keuls tests.

RESULTS

Only for AL group, mechanical cycling and autoclave aging significantly decreased the flexural strength values in comparison to the control (p<0.01). YZ, AL, VM7 and VM9 monolithic groups showed no strength degradation. For multi-layered specimens, when the porcelain layer was tested in tension (bi and tri-layers), the aging methods evaluated also had no effect on strength (p≥0.05). Total and partial failure modes were identified.

SIGNIFICANCE

Mechanical cycling and autoclave aging protocols had no effect on the flexural strength values and failure behavior of YZ and IZ ceramic structures. Yet, AL monolithic structures showed a significant decrease in flexural strength with any of the aging methods.

Effect of ceramic infrastructure on the failure behavior and stress distribution of fixed partial dentures

OBJECTIVES

The effect of the ceramic infrastructure (IS) on the failure behavior and stress distribution of fixed partial dentures (FPDs) was evaluated.

METHODS

Twenty FPDs with a connector cross-section of 16 mm(2) were produced for each IS and veneered with porcelain: (YZ) Vita In-Ceram YZ/Vita VM9 porcelain; (IZ) Vita In-Ceram Zirconia/Vita VM7 porcelain; (AL) Vita In-Ceram AL/Vita VM7 porcelain. Two experimental conditions were evaluated (n = 10). For control specimens, load was applied in the center of the pontic at 0.5 mm/min until failure, using a universal testing machine, in 37°C deionized water. For mechanical cycling (MC) specimens, FPDs were subjected to MC (2 Hz, 140 N, 10(6) cycles) and subsequently tested as described for the control group. For YZ, an extra group of 10 FPDs were built with a connector cross-section of 9 mm(2) and tested until failure. Fractography and FEA were performed. Data were analyzed by ANOVA and Tukey's test (α = 0.05).

RESULTS

YZ16 showed the greatest fracture load mean value, followed by YZ16-MC. Specimens from groups YZ9, IZ16, IZ16-MC, AL16 and AL16-MC showed no significant difference for the fracture load.

SIGNIFICANCE

The failure behavior and stress distribution of FPDs was influenced by the type of IS. AL and IZ FPDs showed similar fracture load values but different failure modes and stress distribution. YZ showed the best mechanical behavior and may be considered the material of choice to produce posterior FPDs as it was possible to obtain a good mechanical performance even with a smaller connector dimension (9 mm(2)).

Effect of elasticity on stress distribution in CAD/CAM dental crowns: Glass ceramic vs. polymer-matrix composite

OBJECTIVES

Further investigations are required to evaluate the mechanical behaviour of newly developed polymer-matrix composite (PMC) blocks for computer-aided design/computer-aided manufacturing (CAD/CAM) applications. The purpose of this study was to investigate the effect of elasticity on the stress distribution in dental crowns made of glass-ceramic and PMC materials using finite element (FE) analysis.

METHODS

Elastic constants of two materials were determined by ultrasonic pulse velocity using an acoustic thickness gauge. Three-dimensional solid models of a full-coverage dental crown on a first mandibular molar were generated based on X-ray micro-CT scanning images. A variety of load case-material property combinations were simulated and conducted using FE analysis. The first principal stress distribution in the crown and luting agent was plotted and analyzed.

RESULTS

The glass-ceramic crown had stress concentrations on the occlusal surface surrounding the area of loading and the cemented surface underneath the area of loading, while the PMC crown had only stress concentration on the occlusal surface. The PMC crown had lower maximum stress than the glass-ceramic crown in all load cases, but this difference was not substantial when the loading had a lateral component. Eccentric loading did not substantially increase the maximum stress in the prosthesis.

CONCLUSIONS

Both materials are resistant to fracture with physiological occlusal load. The PMC crown had lower maximum stress than the glass-ceramic crown, but the effect of a lateral loading component was more pronounced for a PMC crown than for a glass-ceramic crown.

CLINICAL SIGNIFICANCE

Knowledge of the stress distribution in dental crowns with low modulus of elasticity will aid clinicians in planning treatments that include such restorations.

Accuracy and precision of fractal dimension measured on model surfaces

OBJECTIVES

To develop a method, which is precise, accurate, and insensitive to the angle of inclination for determining the fractal dimensional increment (D*) of a surface.

METHODS

Brownian interpolation was used to generate simulated ceramic fracture surfaces having known D* values of 0.1, 0.2, 0.3, and 0.4 with 10 surfaces at each D* value. Each surface was inclined at four angles (0°, 3°, 5°, and 7°) from horizontal. The 160 (40×4) surfaces were analyzed by a variety of methods including Minkowski Cover (MC), Root Mean Square Roughness vs. Area (RMS), Kolmogorov Box (KB), Hurst Exponent (HE), Slit Island Box (SIB), and Slit Island Richardson (SIR). The coefficient of variation (CV) and mean error were used to identify the methods with best precision (lowest CV) and accuracy (lowest mean error), respectively, and three-way ANOVA followed by Turkey's HSD (α=0.05) was used to identify significant effects.

RESULTS

CV was significantly affected by fractal dimension (p=0.002) and method (p<0.001) but not by angle of inclination (p=0.765). The CV value for MC was lower than those for other methods (p≤0.05). Mean error was significantly affected by three-way interaction between fractal dimension, method, and angle of inclination (p<0.001). The mean error for KB was higher than those for other methods (p≤0.05) for inclined surfaces.

SIGNIFICANCE

MC was determined to have the best combination of precision, accuracy, and lack of sensitivity to angle of inclination for Brownian interpolation surfaces having D* values in the range commonly reported for ceramic fracture surfaces.

Evidence of yttrium silicate inclusions in YSZ-porcelain veneers

This report introduces the discovery of crystalline defects that can form in the porcelain veneering layer when in contact with yttria-stabilized zirconia (YSZ). The focus was on dental prostheses and understanding the defects that form in the YSZ/porcelain system; however the data reported herein may have broader implications toward the use and stability of YSZ-based ceramics in general. Specimens were cut from fully sintered YSZ plates and veneering porcelain was applied (<1 mm thick) to one surface and fired under manufacturer's recommended protocol. Scanning electron microscopy (SEM) with integrated electron dispersive X-ray (EDAX) was used for microstructural and elemental analysis. EDAX, for chemical analysis and transmission electron diffraction (TED) for structural analysis were both performed in the transmission electron microscope (TEM). Additionally, in order to spatially resolve Y-rich precipitates, micro-CT scans were conducted at varying depths within the porcelain veneer. Local EDAX (SEM) was performed in the regions of visible inclusions and showed significant increases in yttrium concentration. TEM specimens also showed apparent inclusions in the porcelain and selected area electron diffraction was performed on these regions and found the inclusions to be crystalline and identified as either yttrium-silicate (Y2 SiO5 ) or yttrium-disilicate (Y2 Si2 O7 ). Micro-CT data showed that yttrium-silicate precipitates were distributed throughout the thickness of the porcelain veneer. Future studies are needed to determine whether many of the premature failures associated with this materials system may be the result of crystalline flaws that form as a result of high temperature yttrium diffusion near the surfaces of YSZ.

Nanopore formation on the surface oxide of commercially pure titanium grade 4 using a pulsed anodization method in sulfuric acid

Titanium and its alloys form a thin amorphous protective surface oxide when exposed to an oxygen environment. The properties of this oxide layer are thought to be responsible for titanium and its alloys biocompatibility, chemical inertness, and corrosion resistance. Surface oxide crystallinity and pore size are regarded to be two of the more important properties in establishing successful osseointegration. Anodization is an electrochemical method of surface modification used for colorization marking and improved bioactivity on orthopedic and dental titanium implants. Research on titanium anodization using sulphuric acid has been reported in the literature as being primarily conducted in molarity levels 3 M and less using either galvanostatic or potentiostatic methods. A wide range of pore diameters ranging from a few nanometers up to 10 μm have been shown to form in sulfuric acid electrolytes using the potentiostatic and galvanostatic methods. Nano sized pores have been shown to be beneficial for bone cell attachment and proliferation. The purpose of the present research was to investigate oxide crystallinity and pore formation during titanium anodization using a pulsed DC waveform in a series of sulfuric acid electrolytes ranging from 0.5 to 12 M. Anodizing titanium in increasing sulfuric acid molarities showed a trend of increasing transformations of the amorphous natural forming oxide to the crystalline phases of anatase and rutile. The pulsed DC waveform was shown to produce pores with a size range from ≤0.01 to 1 μm(2). The pore size distributions produced may be beneficial for bone cell attachment and proliferation.

Fatigue loading and R-curve behavior of a dental glass-ceramic with multiple flaw distributions

OBJECTIVES

To determine the effects of surface finish and mechanical loading on the rising toughness curve (R-curve) behavior of a fluorapatite glass-ceramic (IPS e.max ZirPress) and to determine a statistical model for fitting fatigue lifetime data with multiple flaw distributions.

MATERIALS AND METHODS

Rectangular beam specimens were fabricated by pressing. Two groups of specimens (n=30) with polished (15 μm) or air abraded surface were tested under rapid monotonic loading in oil. Additional polished specimens were subjected to cyclic loading at 2 Hz (n=44) and 10 Hz (n=36). All fatigue tests were performed using a fully articulated four-point flexure fixture in 37°C water. Fractography was used to determine the critical flaw size and estimate fracture toughness. To prove the presence of R-curve behavior, non-linear regression was used. Forward stepwise regression was performed to determine the effects on fracture toughness of different variables, such as initial flaw type, critical flaw size, critical flaw eccentricity, cycling frequency, peak load, and number of cycles. Fatigue lifetime data were fit to an exclusive flaw model.

RESULTS

There was an increase in fracture toughness values with increasing critical flaw size for both loading methods (rapid monotonic loading and fatigue). The values for the fracture toughness ranged from 0.75 to 1.1 MPam(1/2) reaching a plateau at different critical flaw sizes based on loading method.

SIGNIFICANCE

Cyclic loading had a significant effect on the R-curve behavior. The fatigue lifetime distribution was dependent on the flaw distribution, and it fit well to an exclusive flaw model.

Three-dimensional finite element modelling of all-ceramic restorations based on micro-CT

OBJECTIVES

To describe and apply a method of modelling dental crowns and three-unit fixed partial dentures (FPD) for finite element analyses (FEA) from 3D images obtained using a micro-CT scanner.

METHODS

A crown and a three-unit fixed partial denture (FPD) made of a ceramic framework (Y-TZP) and veneered with porcelain (VM9) were scanned using an X-ray micro-CT scanner with a pixel size of 6.97 μm. Slice images from both structures were generated at each 0.034 mm and processed by an interactive image control system (Mimics). Different masks of abutments, framework and veneer were extracted using thresholding and region growing tools based on X-ray image brightness and contrast. 3D objects of each model were incorporated into non-manifold assembly and meshed simultaneously. Volume meshes were exported to the FEA software (ABAQUS), and the load-generated stress distribution was analyzed.

RESULTS

FEA models showed great shape resemblance with the structures. The use of non-manifold assembly ensured matching surfaces and coinciding nodes between different structural parts. For the crown model, tensile stresses were concentrated in the internal surface of the core, near to the applied load. For the FPD model, the highest tensile stresses were located in the framework, on the cervical area of connectors and pontic.

CONCLUSIONS

Valid 3D models of dental crown and FPD can be generated by combining micro-CT scanning and Mimics software, emphasizing its importance as design tool in dental research.

CLINICAL SIGNIFICANCE

The 3D FEA method described in this work is an important tool to predict the stress distribution, assisting on structural design of dental restorations.

Effect of the microstructure on the lifetime of dental ceramics

OBJECTIVES

To evaluate the effect of the microstructure on the Weibull and slow crack growth (SCG) parameters and on the lifetime of three ceramics used as framework materials for fixed partial dentures (FPDs) (YZ - Vita In-Ceram YZ; IZ - Vita In-Ceram Zirconia; AL - Vita In-Ceram AL) and of two veneering porcelains (VM7 and VM9).

METHODS

Bar-shaped specimens were fabricated according to the manufacturer's instructions. Specimens were tested in three-point flexure in 37°C artificial saliva. Weibull analysis (n=30) and a constant stress-rate test (n=10) were used to determine the Weibull modulus (m) and SCG coefficient (n), respectively. Microstructural and fractographic analyzes were performed using SEM. ANOVA and Tukey's test (α=0.05) were used to statistically analyze data obtained with both microstructural and fractographic analyzes.

RESULTS

YZ and AL presented high crystalline content and low porosity (0.1-0.2%). YZ had the highest characteristic strength (σ(0)) value (911MPa) followed by AL (488MPa) and IZ (423MPa). Lower σ(0) values were observed for the porcelains (68-75MPa). Except for IZ and VM7, m values were similar among the ceramic materials. Higher n values were found for YZ (76) and AL (72), followed by IZ (54) and the veneering materials (36-44). Lifetime predictions showed that YZ was the material with the best mechanical performance. The size of the critical flaw was similar among the framework materials (34-48μm) and among the porcelains (75-86μm).

SIGNIFICANCE

The microstructure influenced the mechanical and SCG behavior of the studied materials and, consequently, the lifetime predictions.

Fatigue testing of laser treated endosseous implants with an internal trilobe connection

This study investigated the effect of laser treatment on the fatigue resistance of a 3.5-mm diameter implant with an internal trilobe connection. Twenty two implants were embedded into acrylic resin blocks. Half the specimens were used as control group, and the other half were laser treated circumferentially around the 1.5-mm polished collar with argon shielding. Implants were fatigue tested using a step-stress accelerated lifetime test in a servo-hydraulic test machine. Despite the trend pointing towards higher fatigue resistance of laser treated specimens versus controls, step-stress analysis did not determine significant differences in the fatigue lifetimes.

Effects of stress rate and calculation method on subcritical crack growth parameters deduced from constant stress-rate flexural testing

OBJECTIVES

To more efficiently determine the subcritical crack growth (SCG) parameters of dental ceramics, the effects of stressing rate and choice of statistical regression model on estimates of SCG parameters were assessed.

METHODS

Two dental ceramic materials, a veneering material having a single critical flaw population (S) and a framework material having partially concurrent flaw populations (PC), were analyzed using constant stress-rate testing, or "dynamic fatigue", with a variety of testing protocols. For each material, 150 rectangular beam specimens were prepared and tested in four-point flexure according to ISO6872 and ASTM1368. A full-factorial study was conducted on the following factors: material, stress rate assumed vs. calculated, number of stress rates, and statistical regression method.

RESULTS

The proportion of specimens for which the statistical models over-estimated reliability was not significantly different based on regression method for Material S (P = 0.96, power = 94%) and was significantly different based on regression method for Material PC (P < 0.001). The standard method resulted in SCG parameters, n and l nB, of 35.9 and -11.1 MPa(2)s for Material S and 12.4 and 9.61 MPa(2)s for Material PC, respectively.

SIGNIFICANCE

The method of calculation that uses only the median strength value at each stress rate provided the most robust SCG parameter estimates. Using only two stress rates resulted in fatigue parameters comparable to those estimated using four stress rates having the same range. The stress rate of each specimen can be assumed to be the target stress rate with negligible difference in SCG parameter estimates.

Fatigue behavior in water of Y-TZP zirconia ceramics after abrasion with 30 μm silica-coated alumina particles

OBJECTIVE

The use of a 30 μm alumina-silica coated particle sand (CoJet™ Sand, 3M Espe), has shown to enhance the adhesion of resin cements to Y-TZP. The question is whether or not sandblasting 30 μm particles does negatively affect the fatigue limit (S-N curves) and the cumulative survival of Y-TZP ceramics.

METHOD

Four zirconia materials tested were: Zeno (ZW) (Wieland), Everest ZS (KV) (KaVo), Lava white (LV) and Lava colored (LVB) (3M Espe). Fatigue testing (S-N) was performed on 66bar of 3 mm × 5 mm × 40 mm with beveled edges for each zirconia material provided by the manufacturers. One half of the specimens were CoJet sandblasted in the middle of the tensile side on a surface of 5 mm × 6 mm. Cyclic fatigue (N=30/group) (sinusoidal loading/unloading at 10 Hz between 10% and 100% load) was performed in 3-point-bending in a water tank. Stress levels were lowered from the initial static value (average of N=3) until surviving 1 million cycles. Fatigue limits were determined from trend lines. Kaplan-Meier survival analysis was performed to determine the failure stress at the median percentile survival level for 1 million of cycles before and after sandblasting. The statistical analyses used the log-rank test. Characterization of the critical flaw was performed by SEM for the majority of the failed specimens.

RESULTS

The fatigue limits "as received" (ctr) were: LV=720 MPa, LVB=600 MPa, KV=560 MPa, ZW=470 MPa. The fatigue limits "after CoJet sandblasting" were: LV=840 MPa, LVB=788 MPa, KV=645 MPa, ZW=540 MPa. The increase in fatigue limit after sandblasting was 15% for Zeno (ZW) and Everest (KV), 17% for Lava (LV) and 31% for Lava colored (LVB). The KM median survival stresses in MPa were: ZW(ctr)=549 (543-555), ZW(s)=587 (545-629), KV(ctr)=593 (579-607), KV(s)=676 (655-697), LVB(ctr)=635 (578-692), LVB(s)=809 (787-831), LV(ctr)=743 (729-757), LV(s)=908 (840-976). Log-rank tests were significantly different (p<0.001) for all sandblasted groups vs. the "as received" except for Zeno (Wieland) (p=0.295). Failures started from both intrinsic and machined flaws.

SIGNIFICANCE

30 μm particle sandblasting did significantly improve the fatigue behavior of three out of four Y-TZP ceramic materials and can therefore be recommended for adhesive cementation procedures. This study was supported in part by grants from the Swiss Society for Reconstructive Dentistry (SSRD) and 3M Espe.

Analysis of subcritical crack growth in dental ceramics using fracture mechanics and fractography

OBJECTIVES

The aim of this study was to test the hypothesis that the flexural strengths and critical flaw sizes of dental ceramic specimens will be affected by the testing environment and stressing rate even though their fracture toughness values will remain the same.

METHODS

Ceramic specimens were prepared from an aluminous porcelain (Vitadur Alpha; VITA Zahnfabrik, Bad Säckingen, Germany) and an alumina-zirconia-glass composite (In-Ceram Zirconia; VITA Zahnfabrik). Three hundred uniaxial flexure specimens (150 of each material) were fabricated to dimensions of 25 mmx4 mmx1.2 mm according to the ISO 6872 standard. Each group of 30 specimens was fractured in water using one of four different target stressing rates ranging on a logarithmic scale from 0.1 to 100 MPa/s for Vitadur Alpha and from 0.01 to 10 MPa/s for In-Ceram Zirconia. The fifth group was tested in inert environment (oil) with a target stressing rate of 100 MPa/s for Vitadur Alpha and 1000 MPa/s for In-Ceram Zirconia. The effects of stressing rate and environment on flexural strength, critical flaw size, and fracture toughness were analyzed statistically by Kruskal-Wallis one-way ANOVA on ranks followed by post hoc comparisons using Dunn's test (alpha=0.05). In addition, 20 Vitadur Alpha specimens were fabricated with controlled flaws to simplify fractography. Half of these specimens were fracture tested in water and half in oil at a target stressing rate of 100 MPa/s, and the results were compared using Mann-Whitney rank sum tests (alpha=0.05). A logarithmic regression model was used to determine the fatigue parameters for each material.

RESULTS

For each ceramic composition, specimens tested in oil had significantly higher strength (P<or=0.05) and smaller critical flaw size (significant for Vitadur Alpha, P<or=0.05) than those tested in water but did not have significantly different fracture toughness (P>0.05). Specimens tested at faster stressing rates had significantly higher strength (P<or=0.05) but did not have significantly different fracture toughness (P>0.05). Regarding critical flaw size, stressing rate had a significant effect for In-Ceram Zirconia specimens (P<or=0.05) but not for Vitadur Alpha specimens (P>0.05). Fatigue parameters, n and lnB, were 38.4 and -12.7 for Vitadur Alpha and were 13.1 and 10.4 for In-Ceram Zirconia.

SIGNIFICANCE

Moisture assisted subcritical crack growth had a more deleterious effect on In-Ceram Zirconia core ceramic than on Vitadur Alpha porcelain. Fracture surface analysis identified fracture surface features that can potentially mislead investigators into misidentifying the critical flaw.

Recent advances in materials for all-ceramic restorations

The past 3 years of research on materials for all-ceramic veneers, inlays, onlays, single-unit crowns, and multi-unit restorations are reviewed in this article. The primary changes in the field were the proliferation of zirconia-based frameworks and computer-aided fabrication of prostheses, and a trend toward more clinically relevant in vitro test methods. This article includes an overview of ceramic fabrication methods, suggestions for critical assessment of material property data, and a summary of clinical longevity for prostheses constructed of various materials.

Comparative Analysis of Endodontic Pathfinders

Because no scientific literature exists regarding endodontic pathfinders, the aim of this study was to compare such instruments. Ten different pathfinder-type files were analyzed with respect to dimensional characteristics, pitch, and rigidity; efficiency, wear, and distortion were assessed by using an in vitro simulation exercise. SEM cross-sections and tip images were obtained and analyzed. To assess efficacy and distortion, 10 operators attempted to achieve patency with the files in small, S-shaped canals in acrylic blocks. Trends in canal negotiation efficiency and file distortion were recorded. Results showed that the Hi-5 (Miltex, York, PA) and C+ files (Dentsply/Maillefer, Johnson City, TN) were the least flexible, whereas the Pathfinder CS (SybronEndo, Glendora, CA) and Pathfinder SS (SybronEndo) files were the most. Pathfinder SS, S finder (JSDental/Sendoline, Ridgefield, CT), and D finder (Mani, Tochigi-ken, Japan) were the most efficient during the simulation exercise. Within the parameters of this study, pitch, taper, cross-section, heat tempering, metal type, tip geometry, and operator skills all influenced pathfinder efficiency.

Effect of abutment angulation on the strain on the bone around an implant in the anterior maxilla: A finite element study

STATEMENT OF PROBLEM

Angled abutments are often used to restore dental implants placed in the anterior maxilla due to esthetic or spatial needs. The effect of abutment angulation on bone strain is unknown.

PURPOSE

The purpose of the current study was to measure and compare the strain distribution on the bone around an implant in the anterior maxilla using 2 different abutments by means of finite element analysis.

MATERIAL AND METHODS

Two-dimensional finite element models were designed using software (ANSYS) for 2 situations: (1) an implant with a straight abutment in the anterior maxilla, and (2) an implant with an angled abutment in the anterior maxilla. The implant used was 4x13 mm (MicroThread). The maxillary bone was modeled as type 3 bone with a cortical layer thickness of 0.5 mm. Oblique loads of 178 N were applied on the cingulum area of both models. Seven consecutive iterations of mesh refinement were performed in each model to observe the convergence of the results.

RESULTS

The greatest strain was found on the cancellous bone, adjacent to the 3 most apical microthreads on the palatal side of the implant where tensile forces were created. The same strain distribution was observed around both the straight and angled abutments. After several iterations, the results converged to a value for the maximum first principal strain on the bone of both models, which was independent of element size. Most of the deformation occurred in the cancellous bone and ranged between 1000 and 3500 microstrain. Small areas of cancellous bone experienced strain above the physiologic limit (4000 microstrain).

CONCLUSIONS

The model predicted a 15% higher maximum bone strain for the straight abutment compared with the angled abutment. The results converged after several iterations of mesh refinement, which confirmed the lack of dependence of the maximum strain at the implant-bone interface on mesh density. Most of the strain produced on the cancellous and cortical bone was within the range that has been reported to increase bone mass and mineralization.

Influence of remaining coronal tooth structure location on the fracture resistance of restored endodontically treated anterior teeth

STATEMENT OF PROBLEM

A restored endodontically treated tooth is less likely to fracture when there is axial tooth structure between the core base and preparation finish line. However, an accurate prognosis requires knowing whether fracture resistance depends on a complete circumferential distribution of tooth structure or tooth structure in a specific location related to the applied force.

PURPOSE

This in vitro study investigated the fracture resistance of restored endodontically treated teeth when residual axial tooth structure was limited to one half the circumference of the crown preparation.

MATERIAL AND METHODS

Fifty extracted maxillary anterior teeth were sectioned 18 mm from their apices, endodontically treated, and divided into 5 groups of 10 teeth each. Four groups were prepared with full shoulder crown preparations having axial wall heights of 2 mm around the preparation circumferences. In 3 of the groups with axial tooth structure, one half of the axial tooth structure was removed, palatally, labially, or proximally, and groups were identified according to the site of retained coronal tooth structure. For the fifth group, all axial tooth structure was removed to the level of the preparation shoulder. Thus, in 1 group the axial walls were circumferential, 360 degrees around the preparations (Complete group), in 3 groups the axial walls were continuous for 180 degrees (Palatal, Labial, and Proximal groups), and the last group had no retained coronal tooth structure incisal to the finish line (Level group). All 50 prepared teeth were then restored with quartz fiber posts (Bisco), composite resin (Bisco) cores, and metal crowns. A universal testing machine compressively loaded the tooth specimens from the palatal at a crosshead speed of 0.5 cm/min at an angle of 135 degrees to the long axis of teeth until failure occurred. A survival analysis was conducted using a log-rank test followed by Holm-Sidak pairwise tests (alpha=.05) to detect significant differences in median failure load between groups. The mode of failure was determined by visual inspection of all specimens.

RESULTS

The median failure load (P<.001) was 607 N, 782 N, 358 N, 375 N, and 172 N for the Complete, Palatal, Labial, Proximal, and Level groups, respectively. The predominant mode of failure was an oblique palatal to facial root fracture for the groups with remaining coronal tooth structure. In the Level group, post debonding was the predominant mode of failure.

CONCLUSION

For restored endodontically treated teeth that do not have complete circumferential tooth structure between the core and preparation finish line, the location of the remaining coronal tooth structure may affect their fracture resistance.

Immediate Bonding to Bleached Enamel

When immediate bonding to bleached enamel is to be implemented, organic-solvent based adhesives are not capable of eliminating or reducing the adverse effect of bleaching systems on bond strength.

Resin bonding to sclerotic, noncarious, cervical lesions

Noncarious, cervical, wedge-shaped, sclerotic lesions are commonly encountered in clinical practice. In such lesions, dentin has been pathologically altered, often resulting in partial or complete obliteration of the dentinal tubules. These lesions are known to respond to etching and bonding differently from normal dentin, leading to complications during clinical treatment. A search of the literature was performed to obtain background information on the most commonly cited etiologic factors, clinical diagnoses, and morphologic and chemical characterizations along with an extensive review of all potential obstacles to bonding the most recent adhesives to such a dentinal substrate. Recent progress in adaptive strategies to render dentin more receptive to resin bonding is emphasized in this article, and the major drawbacks of these strategies are discussed.

Fracture resistance of three all-ceramic restorative systems for posterior applications

STATEMENT OF PROBLEM

The failure loads of all-ceramic crowns are influenced not only by the fracture resistance of the component materials but also by prosthesis geometry and size and location of flaws, thus there is a need for a study that compares the fracture resistance of all-ceramic systems using a simple and reproducible specimen geometry that includes flaws occurring at material interfaces.

PURPOSE

The research aim was to compare the in vitro fracture resistance and origin of failure of simulated first molar crowns fabricated using 3 all-ceramic systems, IPS Empress 2, Procera AllCeram, and In-Ceram Zirconia.

MATERIAL AND METHODS

Twenty axisymmetric crowns of each system were fabricated to fit a preparation with 1.5- to 2.0-mm occlusal reduction. The center of the occlusal surface on each of 15 specimens per ceramic system was axially loaded to fracture in a universal testing machine, and the maximum load (N) was recorded. Fractured surfaces were examined using optical and electron microscopy to determine the most prevalent origin of failure in each ceramic system. Five crowns per system were sectioned, and thickness of the luting agent, core material, and veneer porcelain layers were measured. The 95% confidence intervals of the Weibull modulus and characteristic failure load were compared between the 3 systems. Two-way multivariate analysis of variance was used to analyze the thickness of the luting agent, ceramic core, and veneer porcelain layers (alpha=.05).

RESULTS

The 95% confidence intervals for Weibull modulus were 1.8 to 2.3 (IPS Empress 2), 2.8 to 3.6 (Procera AllCeram), and 3.9 to 4.9 (In-Ceram Zirconia). The 95% confidence intervals for characteristic failure load were 771 to 1115 N (IPS Empress 2), 859 to 1086 N (Procera AllCeram), and 998 to 1183 (In-Ceram Zirconia). The origin of failure was most commonly found at the interface between the ceramic core and veneer porcelain for IPS Empress 2 and between the ceramic core and luting agent layer for the other systems.

CONCLUSIONS

There was no significant difference in fracture resistance; however, there was a significant difference in failure origin between the all-ceramic systems studied.

Effect of no ferrule on failure of teeth restored with bonded posts and cores

This study investigated how the absence of a ferrule affected the failure load of teeth that had been restored with bonded fiber posts and resin cores. There was a significant difference (p < 0.001) between the ferrule and nonferrule groups' load to failure. For the ferrule group, root fracture was the predominant mode of failure; in the nonferrule group, debonding failures were predominant.

Influence of powder/liquid mixing ratio on porosity and translucency of dental porcelains

STATEMENT OF PROBLEM

Dental technicians use a variety of techniques when condensing dental porcelains. It is unclear whether these techniques affect the total porosity and translucency of dental porcelains.

PURPOSE

The objective of this study was to determine whether varying the powder/liquid ratio during condensation affects porosity and translucency of porcelains. Material and methods Duceram LFC dentin, Duceram LFC incisal, IPS Eris dentin, and IPS Eris incisal porcelains were studied. For each specimen, 1.0 g of porcelain powder was mixed with 1 of 3 different volumes of deionized water to form a slurry with a thin, medium, or thick consistency. The slurries were condensed in a plastic syringe mold, fired, and polished to a 3-microm finish to form 12 groups of 4 specimens each (14-mm diameter, 1.10-mm thickness). The apparent density (g/mL) of each specimen was measured using Archimedes method, and the porosity (%) calculated. Each specimen was coupled to standard ceramic tiles using an immersion liquid, and the color shade was measured in CIE Yxy coordinates using a tristimulus colorimeter. Translucency was assessed by calculating the contrast ratio of shade value (Y) in front of black versus white backgrounds. Two-way analysis of variance and Tukey's multiple comparison tests (alpha = .05) were used to test for significant effects of factors.

RESULTS

Porcelain type and powder/liquid ratio had a significant interactive effect on the apparent density (P < .001) and on total porosity (P = .003); however, there was no consistent trend. The powder/liquid ratio did not significantly affect translucency (P = .28), but porcelain type had a significant effect on translucency (P < .001).

CONCLUSION

In this in vitro study, total porosity of specimens prepared using 4 porcelains was found to be sensitive to powder/liquid ratio; whereas translucency was found to be insensitive to powder/liquid ratio.

SEM/EDS evaluation of porcelain adherence to gold-coated cast titanium

The adhesion between titanium and dental porcelain is related to the diffusion of oxygen to the reaction layer formed on cast-titanium surfaces during porcelain firing. The diffusion of oxygen could be suppressed by coating the titanium surface with a thin gold layer. This study characterized the effects of gold coating on titanium-ceramic adhesion. ASTM grade II CP titanium was cast into a MgO-based investment (Selevest CB, Selec). The specimen surfaces were air abraded with 110-microm Al(2)O(3) particles. Gold coating was applied on titanium surfaces by three methods: gold-paste (Deck Gold NF, Degussa-Ney) coating and firing at 800 degrees C for three times, single gold-paste coating and firing followed by sputter coating (40 mA, 500 s), and sputter coating (40 mA, 1000 s). Surfaces only air abraded with Al(2)O(3) particles were used as controls. An ultra-low-fusing dental porcelain (Vita Titankeramik, Vident) was fused on titanium surfaces. Specimen surfaces were characterized by SEM/EDS and XRD. The titanium-ceramic adhesion was evaluated by a biaxial flexure test (N = 8), and area fraction of adherent porcelain (AFAP) was determined by EDS. Numerical results were statistically analyzed by one-way ANOVA and the Student-Newman-Keuls test at alpha = 0.05. SEM fractography showed a substantial amount of porcelains remaining on the gold-sputter-coated titanium surfaces. A new Au(2)Ti phase was found on gold-coated titanium surface after the firing. Significantly higher (p <.05) AFAP values were determined for the gold-sputter-coated specimens compared to the others. No significant differences were found among the other groups and the control. Results suggested that gold coatings used in this study are not effective barriers to completely protect titanium from oxidation during the porcelain firing, and porcelain adherence to cast titanium can be improved by gold-sputter coating used in the present study.