An in vitro study of the effect of environment and storage time on the fracture properties of bone cement

Bending Behaviour of Polymeric Materials Used on Biomechanics Orthodontic Appliances

This paper discusses the issues of strength and creep of polymeric materials used in orthodontic appliances. Orthodontic biomechanics is focused on the movement of individual teeth or dental groups as a result of the force applied by orthodontic appliances. Stresses in the construction of functional and biomechanical appliances is generated when using the apparatus in the oral cavity. The orthodontic appliance must maintain its shape and not be damaged during treatment so strength and creep resistance are fundamental properties. It was assumed that the clinical success of orthodontic appliances can be determined by these performance properties. The aim of the work was the experimental assessment of comparative bending strength and creep resistance of selected popular polymer materials used in the production of biomechanical orthodontic appliances. Four commercial materials manufactured by the world class producers were tested: NextDent Ortho Rigid (Vertex-Dental B.V., Soesterberg, The Netherlands) marked as "1A"; Erkocryl (ERKODENT Erich Kopp GmbH, Pfalzgrafenweiler, Germany)-"2A"; Vertex Orthoplast (Vertex Dental B.V.), blue, marked as "3A" and material with the same name as "3A" but orange, marked in the article as "4A". All the tests were carried out after aging in artificial saliva for 48 h at a temperature of 37 °C. Flexular strength and flexular modulus were made using the three point bending method according to the ISO 178 technical standard. Creep tests were carried out according to the method contained in ISO 899-2. The creep test was carried out in an artificial saliva bath at 37 °C. The creep tests showed significant differences in the strength, modulus and deformability of the tested materials. The strength reliability of the tested materials also varied. The research shows that the 2A material can be used for orthodontic applications in which long-term stresses should be lower than 20 MPa.

Effects of sterilization on the mechanical properties of poly(methyl methacrylate) based personalized medical devices

BACKGROUND

Nowadays, personalized medical devices are frequently used for patients. Due to the manufacturing procedure sterilization is required. How different sterilization methods affect the mechanical behavior of these devices is largely unknown.

MATERIALS AND METHODS

Three poly(methyl methacrylate) (PMMA) based materials (Vertex Self-Curing, Palacos R+G, and NextDent C&B MFH) were sterilized with different sterilization methods: ethylene oxide, hydrogen peroxide gas plasma, autoclavation, and γ-irradiation. Mechanical properties were determined by testing the flexural strength, flexural modulus, fracture toughness, and impact strength.

RESULTS

The flexural strength of all materials was significantly higher after γ-irradiation compared to the control and other sterilization methods, as tested in a wet environment. NextDent C&B MFH showed the highest flexural and impact strength, Palacos R+G showed the highest maximum stress intensity factor and total fracture work.

CONCLUSION

Autoclave sterilization is not suitable for the sterilization of PMMA-based materials. Ethylene oxide, hydrogen peroxide gas plasma, and γ-irradiation appear to be suitable techniques to sterilize PMMA-based personalized medical devices.

The influence of storage temperature on the antibiotic release of vancomycin-loaded polymethylmethacrylate

Periprosthetic joint infection is devastating and increases medical expenditure and socioeconomic burden. Antibiotic-loaded cement spacer is useful in the interim period before the reimplantation surgery. Prefabricated antibiotic-loaded cement spacers can decrease operation time but have been limitedly used clinically. In the literature, there is no clear recommendation on the storage temperature for the prefabricated cement spacers. We used an in vitro model to analyze whether the storage temperature at 25°C, 4°C, or −20°C for 2 weeks or 3 months could affect the release of vancomycin from the cement. We found that the storage temperature and time had no significant effects on the pattern and amount of vancomycin release. The patterns of vancomycin release from the cement stored at different temperatures were similar with an abrupt release in the first 3 days and steadily declined in the following period. This study provides a preliminary result to justify the storage of fabricating antibiotic-loaded cement spacer sterilely packed at room temperature. Further studies to examine the effects of storage temperature on the mechanical strength and the release pattern of other antibiotics should be done to provide more evidence to support the clinical use of prefabricated ready-to-use antibiotic-loaded cement spacer.

Cement-implant interface contamination: possible reason of inferior clinical outcomes for rough surface cemented stems

BACKGROUND

Shape-closed cemented implants rely on a stronger bond and have displayed inferior clinical outcomes when compared to force-closed designs. Implant contamination such as saline, bone marrow and blood prior to cement application has the potential to affect the cement-implant bond. The consequences of implant contamination were investigated in this study.

METHODS

Fifty Titanium alloy (Ti-6Al-4V) dowels were separated into ten groups based on surface roughness and contaminant, and then cemented in polyvinyl chloride tubes. Push-out testing was performed at 1mm per minute. The roughness of the dowel surface was measured before and after the testing. The dowel surface and cement mantel were analyzed using a Scanning Electron Microscopy (SEM) to determine the distribution and characteristics of any debris and contaminants on the surface.

RESULTS

Contaminants largely decreased stem-cement interfacial shear strength, especially for rough surfaces. Saline produced the greatest decrease, followed by blood. The effect of bone marrow was less pronounced and similar to that of oil. Increasing surface roughness increased the interfacial bonding strength, even with contaminants. There was a non-significant increase in mean bonding strength for smooth surfaces with bone marrow and oil contamination. SEM showed that contaminants influence the interfacial bond by different mechanisms. More debris was found on rough samples following testing.

CONCLUSIONS

The results of this study underscore the importance of keeping an implant free from contamination, and suggest if contamination does occur, a saline rinse may further decrease the stability of an implant. The deleterious effects of contamination on rough surface cement bonding were considerable, and indicate that contamination at the time of surgery may, in part, contribute to inferior clinical outcomes for rough surfaced cemented stems.

Long-term effects of storage and thermal cycling on the marginal adaptation of provisional resin crowns: A pilot study

STATEMENT OF PROBLEM

Provisional resin crowns may be used for an extended period while complex treatments are completed. The crowns function intraorally; therefore, moisture absorption and thermal cycling may affect the physical properties of acrylic resin, causing a change in marginal gap size.

PURPOSE

The purpose of this pilot study was to examine the effect of long-term water absorption and thermal cycling on marginal gap size of polymethyl methacrylate copolymer and bis-acrylic composite resin crowns.

MATERIAL AND METHODS

Specimens (n = 10) were fabricated from 2 acrylic resins: a polymethyl methacrylate (Alike) and a bis-acrylic composite resin (Provitec). Specimens were first fabricated on a metal master die. Custom die stems were fabricated for each specimen from a low-fusing alloy (Cerroblend) to eliminate the factor of polymerization shrinkage. Specimens were then fitted to assure a standardized, pre-experimental marginal gap range of < or = 25 microm. Specimens were stored in a humidor at 37 degrees C and 97% relative humidity for 1 year and subsequently thermal cycled (5 degrees C to 60 degrees C, 6-second dwell time, for 8000 cycles). Measurements in micrometers of the marginal gap were recorded using a microscope equipped with a digital video camera and image analysis software before and after treatment. A 2-way analysis of variance with a split design was performed for factors of materials and treatment (alpha = .05).

RESULTS

For the factor of material, there was no significant difference; however, there was a significant difference between treatments, with a significantly greater increase in marginal gap size after thermal cycling (P < .002).

CONCLUSION

Provisional crowns made from either a bis-acrylic resin composite or a polymethyl methacrylate copolymer demonstrated loss of marginal adaptation during a simulated long-term period of service.

Anterior spinal column augmentation with injectable bone cements

A vertebral fracture, whether originating from osteoporosis or trauma, can be the cause of pain, disability, deformation and neurological deficit. The treatment of vertebral compression fractures has, for many years until the advent of vertebroplasty, consisted of bedrest and analgesics. Vertebroplasty is a percutaneous technique during which bone cement is injected in a vertebral body to provide immediate pain relief by stabilization. Inflatable bone tamps can, prior to the injection of cement, be used to create a void in the vertebral body, in which case the technique is known as balloon vertebroplasty (or kyphoplasty). The chance of extracorporal cement leakage is smaller for balloon vertebroplasty than for vertebroplasty. Some authors also claim to have gained some correction in vertebral body height or angulation. Both interventions can be used for several indications, including osteoporotic compression fractures and osteolytic lesions of the vertebral body such as myeloma, hemangioma or metastasis, and also for traumatic burst fractures in combination with pedicle screw instrumentation. Polymethyl methacrylate cement is the bone void filler that is used most frequently, although the application of calcium phosphate cements has been studied widely in vitro, in vivo and also in small-scale clinical series. The clinical results of (balloon-) vertebroplasty are favorable with 85-95% of all patients experiencing immediate and long-lasting relief of pain. Serious complications are relatively rare but include neurological deficit and pulmonary embolism. In this paper, both vertebroplasty and balloon vertebroplasty and their respective indications, techniques and results are described in relation with the application and limitations of permanent and resorbable injectable bone cements.