Modulus of elasticity in bending of composites and amalgams

Oral Functional Behaviors and Tooth Factors Associated with Cracked Teeth in Asymptomatic Patients

INTRODUCTION

A cracked tooth may occur due to excessive applied force or tooth weakness. However, there is scant information concerning the cracked tooth risk factors. This study aimed to explore the oral functional behaviors and tooth factors associated with posterior cracked teeth.

METHODS

Fifty-six patients underwent their oral functional behavior assessment via a questionnaire. The intraoral parameters at the patient level (remaining teeth, occluding tooth pairs, overbite, overjet, and occlusal guidance type) and tooth level (remaining marginal ridge number, restored surface number, restorative materials, and cuspal inclination) were examined. The posterior teeth were stained with methylene blue dye and inspected for cracks using a microscope. The correlations between each patient-level parameter and the cracked tooth number/subject were determined using linear regression analysis. The cracked teeth were matched with their contralateral noncracked teeth, and binary regression analysis was used to analyze the association between tooth-level parameters and a cracked tooth. Multivariate regression analysis was performed if more than 1 parameter had a P value ≤.1.

RESULTS

One hundred thirty-five cracked teeth were found. Eating hard food was significantly related to the cracked tooth number (P < .05). In molars, the occlusal surface restoration and cuspal inclination were significantly related to a cracked tooth, except the mesiobuccal cusp. In the multivariate analysis, the distolingual cusp inclination significantly predicted a cracked tooth (P < .05). In premolars, the lingual cusp inclination was associated with a cracked tooth (P < .05).

CONCLUSIONS

Eating hard food, occlusal surface restoration, and steep cuspal inclination were associated with posterior cracked teeth.

Stress analysis of endodontically treated teeth restored with post-retained crowns: A finite element analysis study

BACKGROUND

The authors conducted a study to analyze the stress concentration areas in a tooth restored with a post-retained crown under various conditions.

MATERIALS AND METHODS

The authors constructed a three-dimensional finite element model describing a maxillary second premolar restored with an all-ceramic crown supported by a titanium post and a resin-based composite core. They applied static vertical and horizontal loads of 100 newton to the cusp tip of the crown and recorded Von Mises and tensile stress values. The variables investigated were the presence of the post, coronal and apical post extensions, post diameter, post shape, and post and core material.

RESULTS

The study results showed that horizontal loading generated higher levels of stress than did vertical loading. The greatest stress levels were concentrated at the cervical region and at the post-dentin interface in all models. Under both loads, a higher modulus of elasticity of the post material and a wider post diameter were associated with increased stress values at the post-dentin interface. Reduction of the post extension above the level of bone was associated with increased dentinal stresses near the apex of the post.

CONCLUSIONS

Although endodontic posts provide retention for coronal restorations, they result in dentinal stress values higher than those of crowns without posts. Posts that had a similar modulus of elasticity to dentin and smaller diameters were associated with better stress distribution. Resting coronal restorations on sound dental tissues affected stress distribution more than did the core material or the length of the coronal post extension.

CLINICAL IMPLICATIONS

Many factors influence the distribution of stress within dentin and, consequently, the fracture resistance of teeth restored with post-retained crowns. Clinicians need to keep these factors in mind when performing endodontic procedures that involve placement of post-retained crowns to ensure optimal success.

Edge strength of resin-composite margins

OBJECTIVES

Marginal integrity is a major clinical problem in restorative dentistry. The aim of this study was to evaluate the applicability of an edge strength measurement device in an in vitro test to determine the force required to fracture flakes of material by a Vickers indentation at progressively increasing distances from an interface edge of bulk material.

METHODS

Five representative resin-composites were investigated. Fourteen disks of specimens (12mm diameter x 2.5mm thick) were prepared for each material. These were divided into seven sub-groups corresponding to different edge-distances (0.4, 0.5, 0.6, 0.7, 0.8, 0.9 and 1.0mm). An edge strength measurement device (CK10) (Engineering Systems, Nottingham, UK) was used. The mode of the failure of each specimen was examined under the integral microscope of the CK10.

RESULTS

The force (N)-to-fracture at a distance of 0.5mm from the edge was defined as the edge strength. The highest failure force (edge strength) was observed for Tetric Ceram (174.2N) and the lowest for Filtek Supreme (enamel) (87.0N). Correlations between the failure-forces to fracture materials with edge-distance were regression analyzed giving coefficients (r) ranging from 0.94 (p=0.02) to 0.99 (p=0.01). Two modes of failure were observed: chipping and--generally at greater distances--cracking.

SIGNIFICANCE

Edge strength is a definable and potentially useful parameter to characterize this aspect of clinically related behavior. A standardized distance of 0.5mm from the specimen's edge, when chipping failure prevails, is suitable and convenient as a reference point.

Properties of a Dental Resin Composite with a Spherical Inorganic Filler

Of the materials tested in this study, the spherical filler composite (Estelite Σ) had similar properties as the nano-composite (Filtek Supreme). Thus, Estelite Σcan be used in anterior regions and restricted posterior restorations. All the materials had a similar shrinkage pattern, in that about 99% of the shrinkage occurred prior to 24 hours; thus, for direct resin composite restorations, a strong initial bonding strength with bonding agent would be necessary.

The Clinical Repair of Teeth Using Direct Filling Materials: Engineering Considerations

This paper reviews the way in which teeth damaged by caries may be repaired clinically. The mechanical effects of caries are described, as are the materials available to repair the damage caused by this disease. Studies are reported which have shown that caries reduces the compressive strength of the tooth to less than 50 per cent of its original value and that, by use of appropriate materials and placement techniques, this can be restored to some 80 per cent of this value. However, very few studies have been carried out which view tooth repair from an engineering perspective. Instead, emphasis is placed on determining clinical durability of repairs. This is related to repair strength but brings in other factors, such as the oral hygiene of the patient. Despite this complication, durability studies show that modern restorative materials perform well under clinical conditions, from which it may be concluded that the repair process allows a structure to be fabricated that is essentially sound from an engineering view-point, even if inferior to the original tooth structure provided by nature.

Two-year evaluation of a new nano-ceramic restorative material

The purpose of this prospective study was to evaluate the clinical performance of a new restorative material (Ceram.X) in combination with a new primer-adhesive (K-0127). One operator placed two Class I or II restorations in molars of 43 patients. One molar was restored with Ceram.X/K-0127, the other one with Tetric Ceram/Syntac Classic. At baseline, after 1 and 2 years, the restorations were evaluated by one evaluator using modified Ryge's criteria. After 2 years, 31 patients were examined. One Ceram.X-restoration had to be removed for root canal treatment due to pulpitis. Thus, failure rate of Ceram.X was 3.2% and of Tetric Ceram, 0%. In both groups, no sensitivity, no recurrent caries, and no changes in surface texture were recorded after 2 years. One restoration in each group showed slight changes in color stability (score B). Marginal discoloration (score B) was found concerning three Ceram.X-restorations (10.0%) and two Tetric Ceram-restoration (6.5%). Marginal integrity was score B for four Ceram.X-restorations (13.3%) and for four Tetric Ceram-restorations (12.9%). No statistically significant differences were found (p>0.05). After 2 years of clinical service, 96.8% of Ceram.X/K-0127 and 100% of Tetric Ceram/Syntac Classic restorations were in place and performed clinically well.

Mechanical Property Aspects of a Biomineral Based Dental Restorative System

A two component, capsule mixed dental restorative system based on a biomineral has been developed. After mixing the two components the material is to be regarded as a chemically bonded ceramic (CBC). In this work some basic mechanical properties has been evaluated and compared to high strength glass ionomer cement (GIC) and an amalgam. In addition the microstructure and fractured surfaces of the material has been investigated. The strength measurements show that the CBC material have comparable initial strength to an amalgam as measured by DTS. The flexural and the compressive strength of the fully hardened CBC material are comparable with a high strength GIC. The setting time showed to be easily adjustable and a final setting under 6 minutes can be reached. The microstructure of the CBC material shows that all components have been fully dispersed resulting in a homogenous microstructure. When looking at the fracture surface of tested DTS samples of the CBC material a “pull-out” effect was revealed originating from the fibres added to the composition to increase the strength.

Total-etch versus self-etch adhesive

BACKGROUND

Self-etching adhesives are believed to prevent postoperative sensitivity when used under posterior resin-based composite restorations. The authors tested a twofold hypothesis: a self-etch, or SE, adhesive would result in less postoperative sensitivity than a total-etch, or TE, adhesive; an SE adhesive would result in poorer enamel marginal integrity than a TE adhesive.

METHODS

Patients were selected on the basis of requiring Class I and II restorations in molars and premolars. The authors placed 30 restorations with the SE material (Clearfil SE Bond, Kuraray America, New York) and 36 restorations with Prime & Bond NT (Dentsply Caulk, Milford, Del.), which uses 34 percent phosphoric acid to etch enamel and dentin simultaneously. Preparations were of standard design, with all margins in enamel without beveling. Upon rubber dam isolation, the authors conditioned the enamel and dentin walls with the self-etching primer (for Clearfil SE Bond) or etched with the proprietary 34 percent phosphoric acid (for Prime & Bond NT), followed by application of the corresponding dentin adhesive. Teeth were restored with the proprietary hybrid resin-based composite indicated for posterior restorations: Clearfil AP-X for Clearfil SE Bond or Esthet-X Micro Matrix Restorative for Prime & Bond NT. The restored teeth were evaluated preoperatively and at two weeks, eight weeks and six months postoperatively for sensitivity to cold (ice), air and masticatory forces, as well as for marginal discoloration.

RESULTS

Analysis of variance revealed no statistically significant differences in postoperative sensitivity between the SE and TE materials at any recall time. Marginal discoloration was rated as "absent" for all restorations at six months. Only one tooth displayed sensitivity to occlusal forces at six months.

CONCLUSION

The SE adhesive did not differ from the TE adhesive in regard to sensitivity and marginal discoloration.

CLINICAL IMPLICATIONS

Postoperative sensitivity may depend on the restorative technique rather than on the type of dentin adhesive used.

Compressive and tensile zones in the cement interface of full crowns: a technical note on the concept of resistance

PURPOSE

The objectives of the study were: 1) to map the stresses acting on the cement interface of crown and abutment analogs during loading; and 2) to provide a theoretical basis for the hypothesis that resistance to lateral dislodgment is a function of the distribution of compressive force vectors acting on the cement lute.

MATERIALS AND METHODS

Three-dimensional finite element (FE) meshes of crown and abutment analogs were constructed and loaded in a direction perpendicular to the axes of symmetry of the abutments. Three parameters were investigated: taper (10 degrees and 20 degrees of convergence), abutment substrate (Ni-Cr alloy and dentin), and type of cement (zinc oxide eugenol, zinc phosphate, glass ionomer, and composite resin). The tensile and compressive components of the resulting force systems were plotted along two axes (z: parallel to the axis of symmetry of the crown/abutment complex; and y: perpendicular to z, i.e., parallel to the direction of loading). Von Mises stresses were also generated.

RESULTS

First, it was shown that the restoration's axis of rotation was located inside the abutment cone and was perpendicular to and intersected the axis of symmetry of the crown/abutment complex. Second, stress distribution was dependent on the three parameters investigated. Varying taper led to shifts due mainly to alterations in specimen geometry, whereas the abutment substrate and the cement type had a bearing on the level of the axis of rotation. The smaller the modulus of elasticity of the abutment substrate or the cement lute, the farther apical the location of the axis of rotation.

CONCLUSIONS

Conventional schemes for explaining crown dislodgment in which the restoration rotates around an axis located at the preparation margin should be reassessed. The results of the FE analysis are compatible with the hypothesis that resistance to lateral dislodgment is a function of the distribution of compressive force vectors acting on the cement interface.

An in vitro microleakage study of three restorative techniques for Class II restorations in posterior teeth

Microleakage associated with a silver reinforced restorative glass ionomer cement used alone and also as a laminate restoration with a composite resin and dentine adhesive in extracted premolar and molar teeth was evaluated. The influence of artificial saliva, thermal and load cycling was also determined. The composite and dentine adhesive alone were used for comparative purposes. The results showed that the composite resin/dentine adhesive restorations showed substantial microleakage at both the cervical and occlusal margins of the Class II restorations, whereas the glass ionomer alone showed little or no leakage after storage in water for seven days at 37 degrees C. These results were confirmed when the restorations were thermo-cycled and load stressed. The addition of glass ionomer as a base to the composite forming the laminate restoration reduced the leakage substantially and in certain conditions the leakage was less than that observed with glass ionomer restoratives alone.

Elastic and fracture properties of dental direct filling materials

Five dental direct filling materials were tested in tension and compression in order to define their stress-strain behaviour for both types of applied stress. In addition, fracture toughness was determined from three-point bending tests. Linear and non-linear stress-strain behaviour was observed, and the response was specific for each material and also to the type of applied stress. Fracture resistance was also found to be material specific, which was related to differences in composition.

Current concepts in dentin bonding: focusing on dentinal adhesion factors

With greater need for treating root surface lesions, dentinal adhesives are more in demand. For successful treatment, all factors--dentin, tooth, patient and materials--must be considered.

Examining tooth flexure effects on cervical restorations: a two-year clinical study

This study evaluated the clinical performance of dentinal adhesives in seven various material/technique combinations. No statistically significant differences were observed among the restorative combinations, or among technique variables after two years in terms of retention, sensitivity or USPHS categories. However, other factors related to tooth flexure--such as occlusal stress, patient age, restorative material and restoration location--showed statistically significant associations with retention failures. These results support a tooth flexural theory of restoration retention.

Influence of test method on failure stress of brittle dental materials

A bi-axial flexure test (piston-on-three-balls), a four-point flexure test, and a diametral tensile test were used to measure the failure stress of four brittle dental materials: zinc phosphate cement, body porcelain, opaque porcelain, and visible light-cured resin composite. Furthermore, the fracture probability of the bi-axial test specimens was predicted from the results of the four-point flexure test, with use of statistical fracture theory. Bi-axial failure stresses calculated from an equation developed by Marshall (1980) exhibited no significant difference for zinc phosphate cement as a function of piston size, specimen thickness, presence or absence of a stress-distributing film, and loading rate. The four-point flexure strength values of zinc phosphate cement and opaque procelain were significantly lower (p less than 0.05) than the corresponding mean bi-axial strength values, while the mean four-point flexure strength values of body porcelain and resin composite were not significantly lower (p greater than 0.05) than the corresponding mean bi-axial strength values. The diametral tensile strength of all materials was significantly lower than the bi-axial flexure strength. The mean bi-axial flexure strengths of zinc phosphate cement and opaque porcelain were much higher than the theoretical values predicted from surface flaw theory, while the strength values for body porcelain and resin composite were comparable with those determined from the four-point flexure test. These results demonstrate that the strength of zinc phosphate cement depends not only upon the geometric factors, but also upon sample preparation conditions.

Clinical evaluation of two posterior composite resins: two-year results

Two composite resins were evaluated for clinical acceptability as restorative materials in Class I and II cavities over a 2-year-period. In addition, dispersed phase alloy was evaluated for comparison. All restorations were assessed for anatomical form, marginal integrity and marginal leakage using modified United States Public Health Service (USPHS) criteria. At the 2-year recall, 96% of the composites and 100% of the amalgams were rated 'alpha' or 'bravo', using the parameters of assessment defined in this study. However, a significant number of shifts from the baseline, within the level of acceptability, had occurred. The two composites showed the greatest number of shifts for anatomical form and marginal leakage, while there were no differences between the composites and the amalgam for shifts in marginal integrity. Although a very high level of acceptability was determined for all of the materials, the frequency of rating change within categories for the composites was a cause of concern with regard to their long-term clinical use.