Evaluation of the bond strengths of 3 endodontic cements via push-out test

In this study, the push-out method was used to evaluate the bond strengths of 3 types of endodontic cements according to their composite base: methacrylate, epoxy resin, and an experimental copaiba oil resin. The study hypothesis was that the methacrylate-based and experimental cements would have bond strengths equal to or greater than that of the epoxy resin-based cement. Thirty bovine tooth roots, 18 mm long, were divided into 3 groups (n = 10) based on the chosen cement treatment. After treatment, the specimens were sectioned and submitted to a push-out test. Results showed that there was no statistically significant difference (P < 0.05) between the cements used or between the middle and apical thirds of the roots. It could be concluded that the tested cements had satisfactory and similar bond strengths to dentin.

Optimisation of a two-liquid component pre-filled acrylic bone cement system: a design of experiments approach to optimise cement final properties

The initial composition of acrylic bone cement along with the mixing and delivery technique used can influence its final properties and therefore its clinical success in vivo. The polymerisation of acrylic bone cement is complex with a number of processes happening simultaneously. Acrylic bone cement mixing and delivery systems have undergone several design changes in their advancement, although the cement constituents themselves have remained unchanged since they were first used. This study was conducted to determine the factors that had the greatest effect on the final properties of acrylic bone cement using a pre-filled bone cement mixing and delivery system. A design of experiments (DoE) approach was used to determine the impact of the factors associated with this mixing and delivery method on the final properties of the cement produced. The DoE illustrated that all factors present within this study had a significant impact on the final properties of the cement. An optimum cement composition was hypothesised and tested. This optimum recipe produced cement with final mechanical and thermal properties within the clinical guidelines and stated by ISO 5833 (International Standard Organisation (ISO), International standard 5833: implants for surgery-acrylic resin cements, 2002), however the low setting times observed would not be clinically viable and could result in complications during the surgical technique. As a result further development would be required to improve the setting time of the cement in order for it to be deemed suitable for use in total joint replacement surgery.

Influence of instrumentation techniques and irrigating solutions on bond strength of glass fiber posts to root dentin

This study sought to evaluate how instrumentation techniques and irrigating solutions affected the bond strength of glass fiber posts. For this study, 80 human maxillary central incisors were selected. Endodontic access was obtained, root canal length was measured, and the coronal third was prepared using Gates-Glidden drills. The specimens were embedded in acrylic resin and randomly assigned to 8 groups (n = 10): manual instrumentation only (Group 1), rotary instrumentation only (Group 2), irrigation with 2.5% sodium hypochlorite (NaOCl) (Group 3), irrigation with 2% chlorhexidine (CHX) (Group 4), manual instrumentation and irrigation with 2.5% NaOCl (Group 5), manual instrumentation and irrigation with 2% CHX (Group 6), rotary instrumentation and irrigation with 2.5% NaOCl (Group 7), and rotary instrumentation and irrigation with 2% CHX (Group 8). Specimens in Groups 5-8 also received a 1 minute final rinse with ethylenediaminetetraacetic acid. Canals were filled and the specimens stored for 30 days in distilled water. The restoration material was removed down to the apical 4 mm of the root canal. The glass fiber posts were luted with resin cement and stored for 24 hours at 37°C. Specimens were subjected to a tensile strength test at a constant speed of 1.0 mm/minute and a load of 2,000 kgf. The results were analyzed by analysis of variance and Tukey's test. Irrigation with 2.5% NaOCl reduced the bond strength of fiber posts significantly (P < 0.01), while CHX showed no effect (P > 0.05). It was concluded that irrigation with 2.5% NaOCl has a negative effect on micromechanical retention of glass fiber posts, whether manual or rotary instrumentation is used.

High-viscosity cement significantly enhances uniformity of cement filling in vertebroplasty: an experimental model and study on cement leakage

STUDY DESIGN

Experimental study using a laboratory leakage model.

OBJECTIVE

To examine the working hypothesis that high-viscosity cements will spread uniformly, thus significantly reducing the risk of leakage.

SUMMARY OF BACKGROUND DATA

In vertebroplasty, forces that govern the flow of bone cement in the trabecular bone skeleton are an essential determinant of the uniformity of cement filling. Extraosseous cement leakage has been reported to be a major complication of this procedure. Leakage occurs due to the presence of a path of least resistance caused by irregularities in the trabecular bone or shell structure. Ideally, cement uniformly infiltrates the trabecular bone skeleton and does not favor specific paths. Cement viscosity is believed to affect the infiltration forces and flow during the procedure. Clinically, altering the time between cement mixing and delivery modifies the viscosity of bone cement.

METHODS

An experimental model of the leakage phenomenon of vertebroplasty was developed. A path, simulating a blood vessel, was created in the model to perturb the forces underlying cement flow and to favor leakage. Cement of varying viscosities was injected in the model, and, thereafter, the filling pattern, cement mass that has leaked, time at which leakage occurred, and injection pressure were measured.

RESULTS

A strong relationship was found between the uniformity of the filling pattern and the elapsed time from cement mixing and viscosity, respectively. Specifically, 3 distinct cement leakage patterns were observed: immediate leakage was observed when cement was injected 5-7 minutes following mixing. The cement was of a low viscosity and more than 50% of the total cement injected leaked. Moderate leakage was observed when injection occurred 7-10 minutes following mixing. Less than 10% of the cement leaked, and the viscosity was at a transient state between the low viscosity of immediate leakage and a higher viscosity, doughy cement. Cement leakage ceased completely when cement was delivered after 10 minutes. The viscosity of the cement in this case was high, and the cement was of a dough-like consistency.

CONCLUSIONS

High-viscosity cement seems to stabilize cement flow. However, the forces required for the delivery of high-viscosity cement may approach or exceed the human physical limit of injection forces. Although the working time of the cement is about 17 minutes, it may not be manually injectable with a standard syringe and cannula after 10 minutes, at which time cement leakage ceased completely.

Osteochondral graft fixation using a bioresorbable bone cement

Multiple osteochondral grafts can be used to resurface large joint defects in both humans and horses. In humans, immediate postoperative weight bearing can be prevented, however in the equine, it is unavoidable. Early weight bearing can create detrimental graft micromotion. The aim of this study was to investigate the role of a bioresorbable cement in improving the initial stability of multiple osteochondral graft repairs of large subchondral cystic lesions in the horse. Configurations employed for filling a 20mm diameter cylindrical defect included: (A) twelve 4.5mm diameter grafts with cement, (B) five 6.5mm diameter grafts with cement, (C) four each of 4.5mm and 6.5mm grafts with cement and (D) cement only. Intact bone slices (E) were also tested. Push-out tests were used to quantify construct to host sidewall interface fixation. Configuration (A) proved clinically impractical (n=3). Configurations (B) (n=6), and (C) (n=4) had statistically similar interface stiffnesses and failure stresses (43+/-8 and 30+/-12 MPa and 0.96+/-0.1 and 1.2+/-0.3 Mpa, respectively) suggesting that they are equally susceptible to interface movement in the immediate postoperative period. By way of comparison, defects filled only with cement had an average stiffness of 53+/-7MPa and failure stress of 1.8+/-0.3 MPa (n=6) while the intact femoral condyle demonstrated a stiffness of 108+/-7 MPa and failure stress of 18+/-0.4 MPa (n=6). Cement augmentation improved immediate postoperative stability of multiple osteochondral graft constructs over uncemented constructs, although in all cases the observed moduli of elasticity and yield stress values were lower than those observed for cement only and intact bone test specimens. (all numbers are mean+/-SEM).

The biomechanical effects of kyphoplasty on treated and adjacent nontreated vertebral bodies

It remains unclear whether adjacent vertebral body fractures are related to the natural progression of osteoporosis or if adjacent fractures are a consequence of augmentation with bone cement. Experimental or computational studies have not completely addressed the biomechanical effects of kyphoplasty on adjacent levels immediately following augmentation. This study presents a validated two-functional spinal unit (FSU) T12-L2 finite element model with a simulated kyphoplasty augmentation in L1 to predict stresses and strains within the bone cement and bone of the treated and adjacent nontreated vertebral bodies. The findings from this multiple-FSU study and a recent retrospective clinical study suggest that changes in stresses and strains in levels adjacent to a kyphoplasty-treated level are minimal. Furthermore, the stress and strain levels found in the treated levels are less than injury tolerance limits of cancellous and cortical bone. Therefore, subsequent adjacent level fractures may be related to the underlying etiology (weakening of the bone) rather than the surgical intervention.

Effect of the hydrophilic nanofiller loading on the mechanical properties and the microtensile bond strength of an ethanol-based one-bottle dentin adhesive

This study evaluated the hypothesis that if hydrophilic nanofillers were dispersed evenly within the adhesive layer under moist conditions, adding them to a one-bottle dentin adhesive might improve the mechanical properties of the adhesive layer, and accordingly increase the bond strength. The flexural strength (FS), the degree of conversion (DC), and the microtensile bond strength (MTBS) to the dentin of four experimental ethanol-based one-bottle dentin adhesives containing 0, 0.5, 1.0, and 3.0 wt % of 12-nm hydrophilic fumed silica were evaluated, and the distribution of the nanofillers were compared using transmission electron microscopy (TEM). Although the nanofiller content did not affect the DC, the FS tended to increase with increasing nanofiller content. The MTBS appeared to increase when up to 1.0 wt % of the nanofillers were added, but they were statistically not significant. However, when 3.0 wt % of the nanofillers were added, the MTBS decreased significantly comparing to the adhesive containing 0.5 wt % nanofillers (p < 0.05). The TEM image suggested that if the nanofillers within the adhesive were 3.0 wt % and applied to a wet dentin surface, they aggregated easily into large clusters and would decrease the MTBS.

The influence of the viscosity classification of an acrylic bone cement on its in vitro fatigue performance

The goal of the present work was to investigate the influence of the viscosity classification of an acrylic bone cement on its in vitro fatigue performance, as determined in fully-reversed tension-compression (+/-15 MPa) fatigue tests. The test matrix comprised six commercially available bone cements [Orthoset1, (OS1), Orthoset(R)3 (OS3), CemexRX (CRX), Cemex XL (CXL), Palacos R (PR) and Osteopal (OP)], two methods of mixing the cement constituents (hand-mixing and vacuum-mixing), two methods of fabricating the test specimens (direct molding and molding followed by machining), two specimen cross-sectional shapes (rectangular or "flat" and circular or "round"), and four test frequencies (1, 2, 5, and 10 Hz). In total, 185 specimens, distributed among 20 sets, were tested. The test results (number of fatigue stress cycles, N_f) were processed using the linearized transformation of the three-parameter Weibull distribution, whence estimates of the Weibull mean, N_[WM], were obtained. Statistical analysis of the ln N_f results (Mann-Whitney test; alpha<0.05) and a comparison of the N_[WM] estimates for specimen sets in which the formulations have essentially the same composition but different viscosity classification (namely, OS1 versus OS3, CRX versus CXL, and PR versus OP) showed that, in the majority of the comparisons carried out, the viscosity classification of a bone cement does not exert a significant influence on its in vitro fatigue performance.

Use of explicit criteria for total hip joint replacement fixation techniques

We developed a tool to judge the appropriateness of indications and fixation mechanisms for total hip joint replacement (THJR) and applied it to a sample of patients. Criteria were developed using a modified Delphi panel judgment process, following the RAND methodology (RAM). We recruited, during 1 year, patients with a diagnosis of osteoarthritis undergoing THJR in five public hospitals. The appropriateness of the THJR intervention and the fixation mechanism was judged by the explicit criteria developed by a panel of experts. Of the 216 scenarios scored by the panel for the use of each of three fixation mechanisms, the cemented fixation was considered inappropriate in 69.5%, versus just 33.3% for the non cemented. Of those scenarios considered appropriate, the most appropriate mechanism of fixation was considered to be non cemented (74.4%), while cemented (17.8%) and hybrid (7.8%) scenarios were scored as appropriate less often. The previous explicit criteria were applied to 583 real patients. After evaluation of the interventions, 30% of the fixation mechanisms used were considered appropriate, while 21.8% inappropriate. Appropriate use of fixation mechanisms varied among hospitals. RAM can provide explicit criteria to help in clinical decision making and evaluating indications for a THJR intervention. Nevertheless, in the case of the appropriateness of fixation mechanisms, due to the lack of evidence, the panel criteria were biased towards the non cemented technique, which had important implications for the evaluation of some hospitals.

Practitioner variability effects on dentin bonding with an acetone-based one-bottle adhesive

PURPOSE

The objective of this study was to investigate the effect of operator variability on the marginal performance of resin composite restorations bonded with an acetone-base one-bottle adhesive in standardized dentin preparations.

MATERIALS AND METHODS

Five general practitioners were recruited for this trial. In the first group, each dentist received six extracted human teeth with dentin preparations (Ø 3.5 mm, 1.5 mm deep), cut in flatground proximal dentin, and original packages of Gluma One Bond adhesive and Charisma resin composite (Heraeus-Kulzer, Werheim, Germany) including instructions for use. For the second group, the operators were orally instructed, emphasizing the importance of the moist technique, before they received another six teeth for restoration with the same materials. Finally, a third group of six preparations was restored in order to evaluate a possible training effect. The restored teeth were stored in a hygrophor prior to removal of excess material and microscopic determination of the maximum marginal gap width (MGW). Statistical analyses were performed with the Kruskal-Wallis and Wilcoxon tests at p < 0.05.

RESULTS

Apart from two samples, preparation margins in the first test group showed gaps between 1 and 12 microns. In the second and third groups, 15 and 16 restorations were gap free, respectively. Significant interoperator variation was found in the first group only. Marginal performance of group 1 restorations was significantly inferior to groups 2 and 3, which were not different (p = 0.79).

CONCLUSION

Application of the one-bottle adhesive is technique-sensitive and requires meticulous attention to the instructions.

Mechanical performance of dental amalgam--composite interfaces

Composite veneering of amalgam is the most aesthetical solution to extensive direct tooth restoration and is applied with success in specific clinical situations. An in-vitro technique has been used to evaluate the mechanical performance of one amalgam bonded to four different composites. The amalgam-composite interfaces were subjected to tensile stress and shear stress at break tests, using dumb-bell and sandwich specimens in a PC-controlled electronic dynamometer equipped with innovative grips. Mean values were higher for tensile stress than for shear stress. Further studies and clinical experimentation will be necessary to explore the question of long-term reliability.

Short-term bond strengths between adhesive cements and dental alloys

The tensile bond strength between three polycarboxylate cements and Types I and III gold, 304 stainless steel, and cobalt-chrome alloy was compared to that obtained with a silico-phosphate and a zinc phosphate cement. The polycarboxylate cements showed higher strengths with almost all alloys than did the other two.

Evaluation of a composite resin crown and bridge luting agent

Laboratory evaluation of an aromatic thermosetting acrylic crown and bridge cement is reported. Crown retention, as measured, was independent of film thickness. Because the material was insoluble and gave improved adhesion to gold alloy and tooth structure, it could offer greater latitudes in crown and bridge techniques.