The narwhal (Monodon monoceros) cementum-dentin junction: a functionally graded biointerphase

In nature, an interface between dissimilar tissues is often bridged by a graded zone, and provides functional properties at a whole organ level. A perfect example is a "biological interphase" between stratified cementum and dentin of a narwhal tooth. This study highlights the graded structural, mechanical, and chemical natural characteristics of a biological interphase known as the cementum-dentin junction layer and their effect in resisting mechanical loads. From a structural perspective, light and electron microscopy techniques illustrated the layer as a wide 1000-2000 μm graded zone consisting of higher density continuous collagen fiber bundles from the surface of cementum to dentin, that parallels hygroscopic 50-100 μm wide collagenous region in human teeth. The role of collagen fibers was evident under compression testing during which the layer deformed more compared to cementum and dentin. This behavior is reflected through site-specific nanoindentation indicating a lower elastic modulus of 2.2 ± 0.5 GPa for collagen fiber bundle compared to 3 ± 0.4 GPa for mineralized regions in the layer. Similarly, microindentation technique illustrated lower hardness values of 0.36 ± 0.05 GPa, 0.33 ± 0.03 GPa, and 0.3 ± 0.07 GPa for cementum, dentin, and cementum-dentin layer, respectively. Biochemical analyses including Raman spectroscopy and synchrotron-source microprobe X-ray fluorescence demonstrated a graded composition across the interface, including a decrease in mineral-to-matrix and phosphate-to-carbonate ratios, as well as the presence of tidemark-like bands with Zn. Understanding the structure-function relationships of wider tissue interfaces can provide insights into natural tissue and organ function.

Sensory ability in the narwhal tooth organ system

The erupted tusk of the narwhal exhibits sensory ability. The hypothesized sensory pathway begins with ocean water entering through cementum channels to a network of patent dentinal tubules extending from the dentinocementum junction to the inner pulpal wall. Circumpulpal sensory structures then signal pulpal nerves terminating near the base of the tusk. The maxillary division of the fifth cranial nerve then transmits this sensory information to the brain. This sensory pathway was first described in published results of patent dentinal tubules, and evidence from dissection of tusk nerve connection via the maxillary division of the fifth cranial nerve to the brain. New evidence presented here indicates that the patent dentinal tubules communicate with open channels through a porous cementum from the ocean environment. The ability of pulpal tissue to react to external stimuli is supported by immunohistochemical detection of neuronal markers in the pulp and gene expression of pulpal sensory nerve tissue. Final confirmation of sensory ability is demonstrated by significant changes in heart rate when alternating solutions of high-salt and fresh water are exposed to the external tusk surface. Additional supporting information for function includes new observations of dentinal tubule networks evident in unerupted tusks, female erupted tusks, and vestigial teeth. New findings of sexual foraging divergence documented by stable isotope and fatty acid results add to the discussion of the functional significance of the narwhal tusk. The combined evidence suggests multiple tusk functions may have driven the tooth organ system's evolutionary development and persistence.

The cost burden of oral, oral pharyngeal, and salivary gland cancers in three groups: commercial insurance, Medicare, and Medicaid

Background

Head and neck cancers are of particular interest to health care providers, their patients, and those paying for health care services, because they have a high morbidity, they are extremely expensive to treat, and of the survivors only 48% return to work. Consequently the economic burden of oral cavity, oral pharyngeal, and salivary gland cancer (OC/OP/SG) must be understood. The cost of these cancers in the U.S. has not been investigated.

Methods

A retrospective analysis of administrative claims data for 6,812 OC/OP/SG cancer patients was undertaken. Total annual health care spending for OC/OP/SG cancer patients was compared to similar patients without OC/OP/SG cancer using propensity score matching for enrollees in commercial insurance, Medicare, and Medicaid. Indirect costs, as measured by short term disability days were compared for employed patients.

Results

Total annual health care spending for OC/OP/SG patients during the year after the index diagnosis was $79,151 for the Commercial population. Health care costs were higher for OC/OP/SG cancer patients with Commercial Insurance ($71,732, n = 3,918), Medicare ($35,890, n = 2,303) and Medicaid ($44,541, n = 585) than the comparison group (all p < 0.01). Commercially-insured employees with cancer (n = 281) had 44.9 more short-term disability days than comparison employees (p < 0.01). Multimodality treatment was twice the cost of single modality therapy. Those patients receiving all three treatments (surgery, radiation, and chemotherapy) had the highest costs of cost of care, from $96,520 in the Medicare population to $153,892 in the Commercial population.

Conclusions

In the U.S., the cost of OC/OP/SG cancer is significant and may be the most costly cancer to treat in the U.S. The results of this analysis provide useful information to health care providers and decision makers in understanding the economic burden of head and neck cancer. Additionally, this cost information will greatly assist in determining the cost-effectiveness of new technologies and early detection systems. Earlier identification of cancers by patients and providers may potentially decrease health care costs, morbidity and mortality.

Preclinical effectiveness of a novel pulp capping material

INTRODUCTION

The purpose of this study was to evaluate the direct pulp capping response to a novel resin-based calcium phosphate cement (RCPC).

METHODS

The RCPC was placed in contact with the exposed healthy pulps of dog teeth and in a follow-up study on the healthy or inflamed pulps of ferret teeth. The inflamed ferret teeth had reversible pulpitis induced with Salmonella typhimurium lipopolysaccharides. After direct pulp capping with RCPC or visible light-curing resin-modified calcium hydroxide material (VLCCH) as a control, the restorations were bonded using a composite resin. The pulp responses and dentin repair were evaluated histologically in dog teeth after 7, 28, or 90 days and in ferret teeth after 45 days.

RESULTS

Most of the RCPC-treated healthy pulps and 75% of the RCPC-treated inflamed ferret teeth had dentin healing and repair, whereas those teeth treated with VLCCH had minimal healing and dentin repair.

CONCLUSIONS

The direct pulp capping of ferret and dog teeth with RCPC was associated with superior healing in comparison to VLCCH.

The Effect of Ultrasonic Post Instrumentation on Root Surface Temperature

This study measured root surface temperature changes when ultrasonic vibration, with and without irrigation, was applied to cemented endodontic posts. Twenty-six, extracted, single-rooted premolars were randomly divided into two groups. Root lengths were standardized, canals instrumented, obturated, and posts cemented into prepared spaces. Thermocouples were positioned at two locations on the proximal root surfaces. Samples were embedded in plaster and brought to 37 degrees C in a water bath. Posts were ultrasonically vibrated for 4 minutes while continuously measuring temperature. Two-way ANOVA compared effects of water coolant and thermocouple location on temperature change. Root surface temperatures were significantly higher (p < 0.001) when posts were instrumented dry. A trend for higher temperatures was observed at coronal thermocouples of nonirrigated teeth and at apical thermocouples of irrigated teeth (p = 0.057). Irrigation during post removal with ultrasonics had a significant impact on the temperature measured at the external root surface.

Light-emitting diode curing light irradiance and polymerization of resin-based composite

BACKGROUND

Light-emitting diode (LED) curing lights are becoming popular; however, questions about their efficiency remain. The authors performed a comprehensive analysis of the properties of resin-based composites cured with LED lights.

METHODS

The authors evaluated seven LED lights and one quartz-tungsten-halogen light (control). They measured intensity, depth of cure (DOC), degree of conversion (DC), hardness and temperature rise. They used three shades of a hybrid resin-based composite and a microfill composite, as well as one shade of another hybrid composite.

RESULTS

Two LED lights required additional cure time to reach a DOC similar to that of the control light. DC at the top of the samples was independent of the light used. At 2.0 millimeters, the DC for several LED lights was significantly lower than that for the control light and was correlated strongly to the light's intensity. The bottom-to-top ratio for hardness of resin-based composites cured by all but one light was greater than 0.80. All LED lights except one had smaller temperature rise than did the control light.

CONCLUSIONS

Six of the seven LED curing lights performed similarly to a quartz-tungsten-halogen curing light in curing resin-based composites. Clinical Implications. While LED curing lights and a quartz-tungsten-halogen light could cure resin-based composites, some resin-based composites cured with LED lights may require additional curing time or smaller increments of thickness.

Probing the origins and control of shrinkage stress in dental resin composites. II. Novel method of simultaneous measurement of polymerization shrinkage stress and conversion

This study probes the interrelationships between polymerization shrinkage stress development and the polymerization progress with a novel experimental technique. This technique is capable of real time, simultaneous measurement of double-bond conversion and shrinkage stress with the use of a noninvasive near-infrared fiber-optic system, along with a cantilever beam-based tensometer. The results from both filled and unfilled bis-GMA/TEGDMA (70:30 mass ratio) systems showed that the shrinkage stress buildup was concentrated in the latter stages of polymerization, with its dramatic increase linked to the asymptotic approach of conversion to its limiting value. The monotonic increase of shrinkage stress with conversion in the vitrified state is attributed to the dramatic increase of the sample's elastic modulus during the vitrification stage and a certain amount of cooling stress as the sample cools down from the temperature rise caused by the exothermic polymerization and light absorption. Excellent reproducibility of both the polymerization kinetics assessment and the shrinkage stress measurement has been achieved.

Controlling the fluoride dosage in a patient with compromised salivary function

BACKGROUND

High-concentration topical fluorides are used commonly to with compromised salivary function due to irradiation and chemotherapy.

CASE DESCRIPTION

The authors describe a 50-year-old man with previously treated cancer who was using tray-applied topical fluoride gel. He complained of gastric symptoms, difficulty in swallowing, leg muscle soreness and knee joint soreness. A computed tomographic scan revealed thickening of the esophageal walls. An upper endoscopy revealed abnormal motility. The motility test indicated high-amplitude peristalsis and hypertensive lower esophageal sphincter, and urine testing indicated high levels of systemic fluoride. The patient's fluoride regimen was altered, and within a short period his urinary fluoride levels returned to normal and his symptoms resolved.

CLINICAL IMPLICATIONS

Clinicians prescribing home-applied high-concentration fluorides need to be cognizant of the symptoms of fluoride toxicity, carefully monitor the patient's compliance with the treatment regimen, and adjust the dosage or mode of application to control the total ingested dose of fluoride.

Probing the origins and control of shrinkage stress in dental resin-composites: I. Shrinkage stress characterization technique

The accurate and reliable characterization of the polymerization shrinkage stress is becoming increasingly important, as the shrinkage stress still is a major drawback of current dimethacrylate-based dental materials and restricts its range of applications. The purpose of this research is to develop a novel shrinkage stress measurement device to elucidate the shrinkage stress evolution of dental restorative composites while allowing for controlled sample deformation during the polymerization. Furthermore, the device is designed to mimic the clinically relevant cusp-to-cusp displacement by systematically adjusting the instrument compliance, the bonded surface area/unbonded area by sample geometry, and the total bonded area by sample diameter. The stress measurement device based on the cantilever beam deflection theory has been successfully developed and characterized using a commercial dental composite. It was shown that this device is a highly effective, practical and reliable shrinkage stress measurement tool, which enables its facile applications to the investigation of shrinkage stress kinetics of both commercial and experimental composites, as well as for probing various aspects that dictate shrinkage stress development.

Amorphous calcium phosphates for tooth mineralization

The destruction of tooth structure through caries and erosive processes is due to two types of acidic challenges that affect the tooth in different ways. Acidic attack by cariogenic bacteria initially produces subsurface lesions that weaken the enamel and, if left unchecked, can progress through the enamel and dentin and eventually into the pulpal cavity. Erosive attack by acidic foods and beverages removes mineral from the surface of enamel and initially causes dulling and loss of tooth luster; if left unchecked, it can progress to a more severe loss of enamel thickness and contour. This article focuses on the potential means of improving the cosmetic appearance of teeth by depositing mineral into surface defects. Several approaches use the unique properties of amorphous calcium phosphate (ACP) compounds, which have the highest rates of formation and dissolution among all the calcium phosphates. ACP has been shown to rapidly hydrolyze to form apatite, similar to carbonated apatite, the tooth mineral. Products containing ACP or ingredients that form ACP can include toothpastes, mouth rinses, artificial saliva, chewing gums, topically applied coatings, and other vehicles for topical use. When applied, they readily precipitate ACPs on and into tooth-surface defects. These products hopefully will provide users with new tools to restore and enhance the smoothness and luster of their teeth.

Three-body wear of dental resin composites reinforced with silica-fused whiskers

OBJECTIVE

Recent studies used silica-fused whiskers to increase the strength and toughness of resin composites. This study investigated the three-body wear of whisker composites. It was hypothesized that the whisker composites would be more wear resistant than composites reinforced with fine glass particles, and the whisker-to-silica filler ratio would significantly affect wear.

METHODS

Silica particles were mixed with silicon nitride whiskers at seven different whisker/(whisker + silica) mass fractions (%): 0, 16.7, 33.3, 50, 66.7, 83.3, and 100. Each mixture was heated at 800 degrees C to fuse the silica particles onto the whiskers. Each powder was then silanized and incorporated into a dental resin to make the wear specimens. A four-station wear machine was used with specimens immersed in a slurry containing polymethyl methacrylate beads, and a steel pin was loaded and rotated against the specimen at a maximum load of 76 N.

RESULTS

Whisker-to-silica ratio had significant effects (one-way ANOVA; p < 0.001) on wear. After 4 x 10(5) wear cycles, the whisker composite at whisker/(whisker + silica) of 16.7% had a wear scar diameter (mean +/- sd; n = 6) of (643 +/- 39) microm and a wear depth of (82 +/- 19) microm, significantly less than a wear scar diameter of (1184 +/- 34) microm and a wear depth of (173 +/- 15) microm of a commercial prosthetic composite reinforced with fine glass particles (Tukey's multiple comparison). SEM examination revealed that, instead of whiskers protruding from the worn surface, the whiskers were worn with the composite surface, resulting in relatively smooth wear surfaces.

SIGNIFICANCE

Silica-fused whisker reinforcement produced dental resin composites that exhibited high resistance to wear with smooth wear surfaces. These properties, together with the strength and fracture toughness being twice those of current glass particle-reinforced composites, may help extend the use of resin composite to large stress-bearing posterior restorations.

Properties of elastomeric calcium phosphate cement–chitosan composites

OBJECTIVE

Self-hardening calcium phosphate cements (CPC) have been shown to be efficacious in a number of clinical applications. For some applications it is desirable to have CPC in a non-rigid resorbable elastomeric matrix. In the present study, chitosan was evaluated as the matrix for preparing CPC-chitosan composites.

METHODS

Cement specimens were prepared by mixing CPC powder (an equimolar mixture of tetracalcium phosphate and dicalcium phosphate anhydrous) with a chitosan solution at a powder/liquid ratio of 2-2.5. The setting time was measured by a Gilmore needle method. A standard three-point flexural test was used to fracture the specimens at a crosshead speed of 0.5 mm/min. Powder X-ray diffraction analysis was used to determine the conversion of the CPC to hydroxyapatite.

RESULTS

The CPC-chitosan composites were more stable in water than conventional CPC. They did not disintegrate even when placed in water immediately after mixing. The CPC-chitosan paste hardened within 10 min in all cases. The 1d mean flexural modulus (GPa) for the control CPC was 5.3 (0.3) (mean (standard deviation); n=5), and that for CPC-chitosan composites were between 2.7 (0.3) and 4.7 (0.3). The 1d mean flexural strength (MPa) for the control was 16.6 (1.9), and that for the CPC-chitosan ranged from 4.5 (0.5) and 12.0 (1.0) (n=5). Chitosan did not interfere the conversion of CPC components to hydroxyapatite.

SIGNIFICANCE

This study demonstrates that CPC-chitosan composites are stable in a wet environment and have acceptable mechanical strengths for clinical applications.

Fluoride release from a resin-modified glass-ionomer cement in a continuous-flow system. Effect of pH

Fluoride is added to many dental restorative materials, including glass-ionomer cements, for the specific purpose of leaching fluoride into the surrounding tissues to provide secondary caries inhibition. During the caries process, an acidic environment attacks the dental tissues as well as the glass-ionomer cement. We hypothesized that pH significantly affects the rate of release of fluoride from the glass-ionomer cement. A continuous-flow fluoride-measuring system that monitors the amount of fluoride released over time was used to determine the release of fluoride from a resin-modified glass-ionomer cement (KetacFil). The results show that the release rate began with a fast burst of fluoride which quickly diminished to low levels in 3 days. Under neutral pH conditions, the rate of fluoride release at 72 hrs was significantly slower than at pH 4.

The clinical effect of amorphous calcium phosphate (ACP) on root surface hypersensitivity

Dentin hypersensitivity is a transient condition that often resolves with the natural sclerotic obturation of dentin tubules. A method of rapidly forming calcium phosphate compounds within these tubules can mimic sclerosis and lead to rapid reduction in hypersensitivity. Amorphous calcium phosphates (ACP) can be formed in situ by the sequential application of calcium and phosphate solutions. In this clinical study, 30 patients with reported dentin hypersensitivity were randomly assigned to parallel treatment or placebo groups. In the experimental treatment group, ACP was formed by topical application of a 1.5 mol/L aqueous solution of CaCl2 followed by topical application of 1.0 mol/L aqueous K3PO4. The placebo group was treated with a topical application of 1.0 mol/L aqueous solution of KCl followed by topical application of distilled water. Treatments were repeated at the 7-day and 28-day recall appointments. Response to air and tactile stimuli were measured immediately before treatment using a visual analog scale initially on day 1, then on days 7, 28 and 180. The results showed that both the experimental and placebo treatments resulted in a reduction in hypersensitivity at 180 days. However, the ACP treatment group showed a much more rapid reduction in hypersensitivity over time. The change in sensitivity was much more apparent using the air stimulus than the tactile stimulus. These results show that topical placement of ACP can rapidly reduce dentin hypersensitivity.

Continuous-fiber preform reinforcement of dental resin composite restorations

OBJECTIVES

Direct-filling resin composites are used in relatively small restorations and are not recommended for large restorations with severe occlusal-stresses. The aim of this study was to reinforce composites with fiber preforms, and to investigate the effects of layer thickness and configurations on composite properties. It was hypothesized that fiber preforms would significantly increase the composite's flexural strength, work-of-fracture (toughness) and elastic modulus.

METHODS

Glass fibers were silanized, impregnated with a resin, cured, and cut to form inserts for tooth cavity restorations. Also fabricated were three groups of specimens of 2mm x 2mm x 25 mm: a fiber preform rod in the center of a hybrid composite; a thin fiber layer on the tensile side of the specimens; and a thin fiber layer sandwiched in between layers of a hybrid composite. These specimens were tested in three-point flexure to measure strength, work-of-fracture and modulus. Optical and scanning electron microscopy were used to examine the restorations and the fiber distributions.

RESULTS

Microscopic examinations of insert-filled tooth cavities showed that the fibers were relatively uniform in distribution within the preform, and the inserts were well bonded with the surrounding hybrid composite. Specimens consisting of a fiber preform rod in the center of a hybrid composite had a flexural strength (mean (SD); n=6) of 313 (19)MPa, significantly higher than 120 (16)MPa of the hybrid composite without fibers (Tukey's at family confidence of 0.95). The work-of-fracture was increased by nearly seven times, and the modulus was doubled, due to fiber preform reinforcement. Similar improvements were obtained for the other two groups of specimens.

SIGNIFICANCE

Substantial improvements in flexural strength, toughness and stiffness were achieved for dental resin composites reinforced with fiber preforms. The method of embedding a fiber preform insert imparts superior reinforcement to restorations and should improve the performance of direct-filling resin composites in large restorations with high occlusal-loads.

Effects of different whiskers on the reinforcement of dental resin composites

OBJECTIVE

Whiskers were recently used to reinforce dental composites to extend their use to large stress-bearing restorations. The aim of this study was to investigate the effects of different types of whiskers on composite properties.

METHODS

Silicon nitride and silicon carbide whiskers were each mixed with silica particles at whisker/silica mass ratios of 0:1, 1:5, 1:2, 1:1, 2:1, 5:1, and 1:0, and thermally treated. The composite was heat-cured at 140 degrees C. Strength and fracture toughness were measured in flexure, while elastic modulus and hardness were measured with nano-indentation.

RESULTS

Both whisker type and whisker/silica ratio had significant effects on composite properties (two-way ANOVA; p<0.001). Silicon nitride whiskers increased the composite strength and toughness more than did silicon carbide. Silicon carbide whiskers increased the modulus and hardness more than silicon nitride did. The silicon nitride whisker composite reached a strength (mean+/-SD; n=6) of 246+/-33 MPa at whisker/silica of 1:1, while the silicon carbide whisker composite reached 210+/-14 MPa at 5:1. Both were significantly higher than 114+/-18 MPa of a prosthetic control and 109+/-23 MPa of an inlay/onlay control (Tukey's multiple comparison test; family confidence coefficient=0.95). Fracture toughness and work-of-fracture were also increased by a factor of two. Higher whisker/silica ratio reduced the composite brittleness to 1/3 that of the inlay/onlay control.

SIGNIFICANCE

Whisker type and whisker/silica ratio are key microstructural parameters that determine the composite properties. Reinforcement with silica-fused whiskers results in novel dental composites that possess substantially higher strength and fracture toughness, and lower brittleness than the non-whisker control composites.

Effect of thermal cycling on whisker-reinforced dental resin composites

The mechanical properties of dental resin composites need to be improved in order to extend their use to high stress-bearing applications such as crown and bridge restorations. Recent studies used single crystal ceramic whiskers to reinforce dental composites. The aim of this study was to investigate the effects of thermal cycling on whisker-reinforced composites. It was hypothesized that the whisker composites would not show a reduction in mechanical properties or the breakdown of whisker-resin interface after thermal cycling. Silicon carbide whiskers were mixed with silica particles, thermally fused, then silanized and incorporated into resin to make flexural specimens. The filler mass fraction ranged from 0% to 70%. The specimens were thermal cycled in 5 degrees C and 60 degrees C water baths, and then fractured in three-point bending to measure strength. Nano-indentation was used to measure modulus and hardness. No significant loss in composite strength, modulus and hardness was found after 10(5) thermal cycles (family confidence coefficient=0.95; Tukey's multiple comparison test). The strength of whisker composite increased with filler level up to 60%, then plateaued when filler level was further increased to 70%; the modulus and hardness increased monotonically with filler level. The strength and modulus of whisker composite at 70% filler level were significantly higher than the non-whisker controls both before and after thermal cycling. SEM revealed no separation at the whisker-matrix interfaces, and observed resin remnants on the pulled-out whiskers, indicating strong whisker-resin bonding even after 10(5) thermal cycles. In conclusion, novel dental resin composites containing silica-fused whiskers possessed superior strength and modulus compared to non-whisker composites both before and after thermal cycling. The whisker-resin bonding appeared to be resistant to thermal cycling in water, so that no loss in composite strength or stiffness occurred after prolonged thermal cycling.

Curing-light intensity and depth of cure of resin-based composites tested according to international standards

BACKGROUND

Several factors control the light curing of a resin-based composite: the composition of the composite, the shade of the composite, the wavelength and bandwidth of the curing light, the distance of the light from the composite, the intensity of the curing light and the irradiation time. The authors investigated the depth of cure of several shades of five brands of resin-based composites when irradiated via light in the 400- to 515-nanometer wavelength bandwidth at the International Organization for Standardization, or ISO, recommended intensity of 300 milliwatts per square centimeter. The resin-based composites were irradiated for the times recommended by the products' manufacturers.

METHODS

The authors used a curing light adjusted to emit 300 mW/cm2 in the 400-nm to 515-nm wavelength bandwidth to polymerize five samples of each composite brand type and shade. They measured depth of cure using a scraping method described in the ISO standard for resin-based composites. Depth of cure was defined as 50 percent of the length of the composite specimen after uncured material was removed by manual scraping. The authors determined a mean from the five samples of each composite brand and shade.

RESULTS

Thirteen (62 percent) of 21 composite materials met the ISO standard depth-of-cure requirement of 1.5 millimeters. Six of the eight remaining materials met the depth-of-cure requirement when the authors doubled the irradiation time recommended by the product manufacturers.

CONCLUSIONS AND CLINICAL IMPLICATIONS

Curing lights with an intensity of 300 mW/cm2 appear to effectively cure most resin-based composite materials when appropriate curing times are used, which, in some cases, are longer than those recommended by the manufacturers. Dentists should verify the depth of cure of a composite material as a baseline measure, and then check depth of cure periodically to confirm light and material performance. The ISO depth-of-cure measurement method can be used for this purpose.

Dental resin composites containing silica-fused whiskers--effects of whisker-to-silica ratio on fracture toughness and indentation properties

Dental resin composites need to be strengthened in order to improve their performance in large stress-bearing applications such as crowns and multiple-unit restorations. Recently, silica-fused ceramic whiskers were used to reinforce dental composites, and the whisker-to-silica ratio was found to be a key microstructural parameter that determined the composite strength. The aim of this study was to further investigate the effects of whisker-to-silica ratio on the fracture toughness, elastic modulus, hardness and brittleness of the composite. Silica particles and silicon carbide whiskers were mixed at whisker:silica mass ratios of 0:1, 1:5. 1:2, 1:1, 2:1, 5:1, and 1:0. Each mixture was thermally fused, silanized and combined with a dental resin at a filler mass percentage of 60%. Fracture toughness was measured with a single-edge notched beam method. Elastic modulus and hardness were measured with a nano-indentation system. Whisker:silica ratio had significant effects on composite properties. The composite toughness (mean+/-SD; n = 9) at whisker:silica = 2:1 was (2.47+/-0.28) MPa m(1/2), significantly higher than (1.02+/-0.23) at whisker:silica = 0:1, (1.13+/-0.19) of a prosthetic composite control, and (0.95+/-0.11) of an inlay/onlay composite control (Tukey's at family confidence coefficient = 0.95). Elastic modulus increased monotonically and hardness plateaued with increasing the whisker:silica ratio. Increasing the whisker:silica ratio also decreased the composite brittleness, which became about 1/3 of that of the inlay:onlay control. Electron microscopy revealed relatively flat fracture surfaces for the controls, but much rougher ones for the whisker composites, with fracture steps and whisker pullout contributing to toughness. The whiskers appeared to be well-bonded with the matrix, probably due to the fused silica producing rough whisker surfaces. Reinforcement with silica-fused whiskers resulted in novel dental composites that possessed fracture toughness two times higher than, and brittleness less than half of current dental composites.

Strong and macroporous calcium phosphate cement: Effects of porosity and fiber reinforcement on mechanical properties

Because of its excellent osteoconductivity and bone-replacement capability, self-setting calcium phosphate cement (CPC) has been used in a number of clinical procedures. For more rapid resorption and concomitant osseointegration, methods were desired to build macropores into CPC; however, this decreased its mechanical properties. The aims of this study, therefore, were to use fibers to strengthen macroporous CPC and to investigate the effects of the pore volume fraction on its mechanical properties. Water-soluble mannitol crystals were incorporated into CPC paste; the set CPC was then immersed in water to dissolve mannitol, producing macropores. Mannitol/(mannitol + CPC powder) mass fractions of 0, 10, 20, 30, and 40% were used. An aramid fiber volume fraction of 6% was incorporated into the CPC-mannitol specimens, which were set in 3 mm x 4 mm x 25 mm molds and then fractured in three-point flexure to measure the strength, work of fracture, and modulus. The dissolution of mannitol created well-formed macropores, with CPC at 40% mannitol having a total porosity of a 70.8% volume fraction. Increasing the mannitol content significantly decreased the properties of CPC without fibers (analysis of variance; p < 0.001). The strength (mean +/- standard deviation; n = 6) of CPC at 0% mannitol was 15.0 +/- 1.8 MPa; at 40% mannitol, it decreased to 1.4 +/- 0.4 MPa. Fiber reinforcement improved the properties, with the strength increasing threefold at 0% mannitol, sevenfold at 30% mannitol, and nearly fourfold at 40% mannitol. The work of fracture increased by 2 orders of magnitude, but the modulus was not changed as a result of fiber reinforcement. A scanning electron microscopy examination of specimens indicated crack deflection and bridging by fibers, matrix multiple cracking, and frictional pullout of fibers as the reinforcement mechanisms. Macroporous CPCs were substantially strengthened and toughened via fiber reinforcement. This may help extend the use of CPCs with macropores for bony ingrowth to the repair of larger defects in stress-bearing locations.

Correction factors in the EPR dose reconstruction for residents of the Middle and Lower Techa riverside

During 1949-1956, the first Soviet nuclear weapons plant, Mayak, released about 7.6 x 10(7) m(-3) of liquid radioactive waste with a total activity of 10(17) Bq into the Techa River (Southern Urals, Russia). 90Sr contributed 11.6% to the total waste radioactivity. As a result of these radioactive discharges, about 28,000 local residents were exposed to ionizing radiation, and some of them received relatively high doses. Internal exposure of the population residing at the Middle and Lower Techa riverside was mostly from 90Sr deposited in bone and tooth tissues. In order to reconstruct radiation doses to this population group, a study of 35 teeth extracted from local residents was carried out using electron paramagnetic resonance measurements. A total of 73 samples from these 35 teeth (tooth enamel, 33; crown dentin, 20; and root dentin, 20) were prepared and measured with electron paramagnetic resonance. The study revealed high doses (up to 15 Gy) absorbed in tooth enamel of the individuals born during 1945-1949, which was attributed to very high local 90Sr concentration in tooth enamel of this particular age group in the population. The analysis presented here takes into account (a) the time courses both of the release/intake of 90Sr and of the tooth formation, and (b) expected variations in measured absorbed doses due to differing geometric sizes of tooth structures. This methodology enables a more consistent picture to be developed of the 90Sr intake by the Middle and Lower Techa riverside population, based on electron paramagnetic resonance tooth dosimetry.

Effects of fiber length and volume fraction on the reinforcement of calcium phosphate cement

A self-setting calcium phosphate cement (CPC) transforms into solid hydroxyapatite during setting at body temperature, and has been used in a number of medical and dental procedures. However, the inferior mechanical properties of CPC prohibits its use in unsupported defects, stress-bearing locations or reconstruction of thin bones. The aim of the present study was to strengthen CPC with fiber reinforcement, to examine the effect of fiber length and volume fraction, and to investigate the reinforcement mechanisms. Previous studies employed either short fibers for random distributions, or continuous fibers that were as long as the specimen size with preferred orientations such as unidirectional alignment. In the present study, a novel methodology was developed in which fibers several times longer than the specimen mold size were randomly mixed with the CPC paste to approximate the isotropy associated with short fibers, and at the same time achieve the high reinforcement efficacy associated with continuous fibers. Carbon fibers of 8 microm diameter were used with fiber lengths ranging from 3 mm to 200 mm, and fiber volume fraction from 1.9% to 9.5%. A three-point flexural test was used to fracture the specimens. Scanning electron microscopy was used to examine crack-fiber interactions and specimen fracture surfaces. The composite containing fibers of 75 mm in length at a volume fraction of 5.7% achieved a flexural strength about 4 times, and work-of-fracture 100 times, greater than the unreinforced CPC. It is concluded that randomly mixing the CPC paste with carbon fibers that were several times longer than the specimen mold size resulted in substantial improvements in strength and fracture resistance; the reinforcement mechanisms were crack bridging and fiber pullout; and fiber length and volume fraction were key microstructural parameters that determined the cement properties.

Whisker-reinforced dental core buildup composites: effect of filler level on mechanical properties

The strength and toughness of dental core buildup composites in large stress-bearing restorations need to be improved to reduce the incidence of fracture due to stresses from chewing and clenching. The aims of the present study were to develop novel core buildup composites reinforced with ceramic whiskers, to examine the effect of filler level, and to investigate the reinforcement mechanisms. Silica particles were fused onto the whiskers to facilitate silanization and to roughen the whisker surface for improved retention in the matrix. Filler level was varied from 0 to 70%. Flexural strength, compressive strength, and fracture toughness of the composites were measured. A nano-indentation system was used to measure elastic modulus and hardness. Scanning electron microscopy (SEM) was used to examine the fracture surfaces of specimens. Whisker filler level had significant effects on composite properties. The flexural strength in MPa (mean +/- SD; n = 6) increased from (95+/-15) for the unfilled resin to (193+/- 8) for the composite with 50% filler level, then slightly decreased to (176+/-12) at 70% filler level. The compressive strength increased from (149+/-33) for the unfilled resin to (282+/-48) at 10% filler level, and remained equivalent from 10 to 70% filler level. Both the modulus and hardness increased monotonically with filler level. In conclusion, silica particle-fused ceramic single-crystalline whiskers significantly reinforced dental core buildup composites. The reinforcement mechanisms appeared to be crack deflection and bridging by the whiskers. Whisker filler level had significant effects on the flexural strength, compressive strength, elastic modulus, and hardness of composites.

Effects of whisker-to-silica ratio on the reinforcement of dental resin composites with silica-fused whiskers

Resin composites need to be strengthened to improve their performance in large stress-bearing restorations. This study aimed to reinforce composites with whiskers and to investigate the effects of the whisker:silica ratio. It was hypothesized that changing the whisker-silica ratio would affect the whisker-matrix bonding and the filler's distribution, and hence alter the composite properties. Silica particles and whiskers were mixed at various whisker:silica mass ratios, thermally fused, and combined with a dental resin at filler mass fractions of 0-65%. Whisker:silica ratio and filler level had significant effects on composite properties. At 60% filler level, the silica composite (whisker:silica = 0:1) had a flexural strength (mean +/- SD; n = 6) of 104 +/- 21 MPa; that at a whisker:silica ratio of 1:0 was 74 +/- 36 MPa. However, that of the silica-fused whisker composite (whisker:silica = 5:1) was 210 +/- 14 MPa, compared with 109 +/- 23 MPa and 114 +/- 18 MPa of two prosthetic controls. Mixing silica with whiskers minimized whisker entanglement, improved filler distribution in the matrix, and facilitated whisker silanization and bonding to the matrix, thus resulting in substantially stronger composites.

Physicochemical evaluation of bioactive polymeric composites based on hybrid amorphous calcium phosphates

Amorphous calcium phosphate (ACP)-filled methacrylate composites were recently found to effectively remineralize in vitro caries-like enamel lesions. Their inferior mechanical properties compared to glass-filled composites, however, limit their use as a dental restorative material. In this study, the feasibility of introducing glass-forming elements (tetraethoxysilane or zirconyl chloride) during the low-temperature synthesis of ACP was investigated. Composites based on such hybrid fillers (mass fraction, 40%) were evaluated to establish whether hybridization strengthened the composites via improved interfacial interactions with the polymer phase without compromising the release of the mineral ions. Two types of visible-light cured resins were prepared: BTHZ resin from 2, 2-bis[p-(2'-hydroxy-3'-methacryloxypropoxy)phenyl]propane (BisGMA), triethylene glycol dimethacrylate (TEGDMA), 2-hydroxyethyl methacrylate (HEMA) and zirconyl methacrylate (ZrM), and TP resin from TEGDMA and pyromellitic glycerol dimethacrylate (PMGDM). Hybridized fillers and BTHZ- and TP-based composites were characterized by the IR spectroscopy, X-ray diffraction, dissolution/transformation kinetic studies, and biaxial flexure strength (BFS) testing before and after immersion in buffered saline solutions. The feasibility of improving the BFS via hybridization, while retaining, if not enhancing the remineralizing potential was demonstrated for BTHZ-based composites. Both BFS and remineralizing ability of the TP-composites, however, deteriorated upon their exposure to an aqueous environment. Therefore, hybridized ACP-filled BTHZ composites have a potential for utilization in more demanding restorative, sealant, and adhesive applications.

Reinforcement of a self-setting calcium phosphate cement with different fibers

A water-based calcium phosphate cement (CPC) has been used in a number of medical and dental procedures due to its excellent osteoconductivity and bone replacement capability. However, the low tensile strength of CPC prohibits its use in many unsupported defects and stress-bearing locations. Little investigation has been carried out on the fiber reinforcement of CPC. The aims of the present study, therefore, were to examine whether fibers would strengthen CPC, and to investigate the effects of fiber type, fiber length, and volume fraction. Four different fibers were used: aramid, carbon, E-glass, and polyglactin. Fiber length ranged from 3-200 mm, and fiber volume fraction ranged from 1.9-9.5%. The fibers were mixed with CPC paste and placed into molds of 3 x 4 x 25 mm. A flexural test was used to fracture the set specimens and to measure the ultimate strength, work-of-fracture, and elastic modulus. Scanning electron microscopy was used to examine specimen fracture surfaces. Fiber type had significant effects on composite properties. The composite ultimate strength in MPa (mean +/- SD; n = 6) was (62+/-16) for aramid, (59+/-11) for carbon, (29+/-8) for E-glass, and (24+/-4) for polyglactin, with 5.7% volume fraction and 75 mm fiber length. In comparison, the strength of unreinforced CPC was (13+/-3). Fiber length also played an important role. For composites containing 5.7% aramid fibers, the ultimate strength was (24+/-3) for 3 mm fibers, (36+/-13) for 8 mm fibers, (48 +/-14) for 25 mm fibers, and (62+/-16) for 75 mm fibers. At 25 mm fiber length, the ultimate strength of CPC composite was found to be linearly proportional to fiber strength. In conclusion, a self-setting calcium phosphate cement was substantially strengthened via fiber reinforcement. Fiber length, fiber volume fraction, and fiber strength were found to be key microstructural parameters that controlled the mechanical properties of CPC composites.

Dental resin composites containing ceramic whiskers and precured glass ionomer particles

OBJECTIVES

Glass ionomer, resin-modified glass ionomer, and compomer materials are susceptible to brittle fracture and are inadequate for use in large stress-bearing posterior restorations. The aim of this study was to use ceramic single crystal whiskers to reinforce composites formulated with precured glass ionomer, and to examine the effects of whisker-to-precured glass ionomer mass ratio on mechanical properties, fluoride release, and polishability of the composites.

METHODS

Silica particles were fused onto silicon nitride whiskers to facilitate silanization and to improve whisker retention in the matrix. Hardened glass ionomer was ground into a fine powder, mixed with whiskers, and used as fillers for a dental resin. Four control materials were also tested: a glass ionomer, a resin-modified glass ionomer, a compomer, and a hybrid composite. A three-point flexural test was used to measure flexural strength, modulus, and work-of-fracture. A fluoride ion-selective electrode was used to measure fluoride release. Composite surfaces polished simulating clinical procedures were examined by SEM and profilometry.

RESULTS

At whisker/(whisker + precured glass ionomer) mass fractions of 1.0 and 0.91, the whisker composite had a flexural strength in MPa (mean (SD); n = 6) of (196 (10)) and (150 (16)), respectively, compared to (15 (7)) for glass ionomer, (39 (8)) for resin-modified glass ionomer, (89 (18)) for compomer, and (120 (16)) for hybrid composite. The whisker composite had a cumulative fluoride release of nearly 20% of that of the glass ionomer after 90 days. The whisker composites had surface roughness comparable to the hybrid resin composite.

SIGNIFICANCE

Composites filled with precured glass ionomer particles and whiskers exhibit moderate fluoride release with improved mechanical properties; the whisker-to-glass ionomer ratio is a key microstructural parameter that controls fluoride release and mechanical properties.

Indentation modulus and hardness of whisker-reinforced heat-cured dental resin composites

OBJECTIVES

Recent studies showed that ceramic whisker reinforcement imparted a two-fold increase in the strength of dental composites. The aim of this study was to investigate the indentation response and measure the elastic modulus, hardness, and brittleness of whisker-reinforced heat-cured resin composites as a function of filler level, heat-cure temperature, and heat-cure duration.

METHODS

Silica particles were fused onto silicon nitride whiskers to facilitate silanization and to roughen the whiskers for improved retention in matrix. Whisker filler mass fractions of 0, 20, 40, 60, 70, 74 and 79% were tested. Heat-cure temperature ranged from 100 to 180 degrees C, and duration from 10 min to 24 h. A nano-indentation system enabled the measurement of elastic modulus. Fracture toughness was measured and composite brittleness index was calculated. An inlay/onlay composite and a prosthetic composite were tested as controls.

RESULTS

Whisker filler level and heat-cure duration had significant effects on composite properties, while heat-cure temperature had non-significant effects. The whisker composite with 79% filler level had a modulus in GPa (mean (SD); n = 6) of 26.9 (1.0), significantly higher than 15.1 (0.2) of an inlay/onlay control, and 16.1 (0.3) of a prosthetic control (Tukey's multiple comparison test; family confidence coefficient = 0.95). The fracture toughness in MPa.m1/2 was 2.22 (0.26) for the whisker composite, higher than 0.95 (0.11) for inlay/onlay control, and (1.13 +/- 0.19) for prosthetic control. The brittleness index was (0.49 +/- 0.07) for whisker composite, lower than (1.02 +/- 0.12) for inlay/onlay control and (0.63 +/- 0.13) for prosthetic control.

SIGNIFICANCE

Whisker filler level had a profound influence, heat-cure duration had significant effects, while temperature did not have significant effects, on the properties of whisker composite. The whisker composite had significantly higher elastic modulus and fracture toughness, and lower brittleness than the inlay/onlay and prosthetic controls.

Edge-bevel fracture resistance of three direct-filling materials

Edge strength is defined in this study as the resistance to fracture of the beveled extension normally located at the cavosurface margin of a dental restoration. The edge strength of direct-filling alloy restorations plays an important role in maintaining the integrity of margins at tooth-alloy interfaces during functional loading. The purpose of this study was to determine the relative strength of an experimental consolidated silver material in comparison to other direct filling materials. The method used was designed as a simulation for relative edge-strength clinical properties. Stainless steel dies were formed from disks 5 mm thick, each with a centered hole tapered (1/48) toward the bottom side of the disk. A 41 degrees bevel, 0.5 mm wide as viewed from above, was placed on the top-side of the disk. Dispersalloy (D) or Unison (U) amalgam, Z-100 composite (C), hand-consolidated silver powder (HAg), or pneumatically consolidated silver powder (PAg) was used to fill the die opening. Excess was polished from both sides of the disk with 600-grit abrasive paper. The sample was loaded from the beveled side with a 3 mm-in-diameter flat-ended plunger at a rate of 1.0 mm/minute until failure. Failure load and total energy to failure were recorded and compared. Tukey's multiple comparison test (p < 0.05) ranked the materials (U) > (HAg) > (D) > (PAg) > (C) for fracture strength and (HAg) > (D) > (U) > (PAg) > (C) for fracture energy.

Dental applications of amorphous calcium phosphates

Certain commercial materials and equipment are identified in this paper to specify the experimental procedure. In no instance does such identification imply recognition or endorsement by the National Institute of Standards and Technology or the ADA Health Foundation, or that the material or equipment identified is necessarily the best available for the purpose.

Single-crystalline ceramic whisker-reinforced carboxylic acid-resin composites with fluoride release

Currently available glass-ionomer, resin-modified glass-ionomer, and compomer materials have relatively low strength and toughness and, therefore, are inadequate for use in large stress-bearing posterior restorations. In the present study, ceramic single-crystalline whiskers were mixed with fluorosilicate glass particles and used as fillers to reinforce experimental carboxylic acid-resin composites. The carboxylic acid was a monofunctional methacryloxyethyl phthalate (MEP). Five mass fractions of whisker/(whisker + fluorosilicate glass), and corresponding resin (resin + MEP), were evaluated. Four control materials were also tested for comparison: a glass ionomer, a resin-modified glass ionomer, a compomer, and a hybrid composite resin. Flexural specimens were fabricated to measure the flexural strength, elastic modulus, and work-of-fracture (an indication of toughness). Fluoride release was measured by using a fluoride ion selective electrode. The properties of whisker composites depended on the whisker/(whisker + fluorosilicate glass) mass fraction. At a mass fraction of 0.8, the whisker composite had a flexural strength in MPa (mean +/- sd; n = 6) of 150 +/- 16, significantly higher than that of a glass ionomer (15 +/- 7) or a compomer control (89 +/- 18) (Tukey's multiple comparison test; family confidence coefficient = 0.95). Depending on the ratio of whisker:fluorosilicate glass, the whisker composites had a cumulative fluoride release up to 60% of that of a traditional glass ionomer. To conclude, combining ceramic whiskers and fluorosilicate glass in a carboxylic acid-resin matrix can result in fluoride-releasing composites with significantly improved mechanical properties.

Strengthening composite resin restorations with ceramic whisker reinforcement

Due to their tendency to fracture, current composite formulations are unsuitable for use in large stress-bearing direct posterior restorations that involve cusps. This study investigated the use of single-crystalline ceramic whiskers for the reinforcement of composite resins. The whisker-reinforced composite materials exhibited physical characteristics (i.e., flexural strength, work-of-fracture, and elastic modulus) that were significantly greater (P < 0.05; Student's t test) than those of traditional composite formulations. The experimental materials also had a surface smoothness that was essentially comparable to hybrid composite control specimens.

Three-body wear of a hand-consolidated silver alternative to amalgam

Recent studies have investigated a mercury-free silver alternative to amalgam, but the silver powders required a relatively high compaction pressure to consolidate. The aim of the present study was to consolidate a precipitated silver powder into a cohesive solid using an air-driven pneumatic condenser fitted with an amalgam plugger at a clinically realistic load, and to study the mechanisms and rates of three-body wear of the consolidated silver in comparison with that of an amalgam. The silver powder was annealed, rinsed with a dilute acid, and consolidated either in a prepared tooth cavity or in a specimen mold at a load of 15 N. A four-station wear machine was used where each specimen was immersed in a slurry containing polymethyl methacrylate beads, then a steel pin was loaded and rotated against the specimen at a maximum load of 76 N. The flexural strength in MPa (mean +/- SD; n = 10) was 86 +/- 20 for amalgam, 181 +/- 45 for silver with a polished surface, and 202 +/- 21 for silver with a burnished surface. After 4 x 10(5) wear cycles, the wear scar depth in microm was 134 +/- 54 for amalgam, 143 +/- 8 for polished silver, and 131 +/- 9 for burnished silver, which were not significantly different (Tukey's multiple comparison test; family confidence coefficient = 0.95). SEM examination revealed cracks and fracture pits in the worn surface of amalgam, in contrast to a smooth surface in silver. Wear and material removal in amalgam occurred by microfracture and dislodgement of cracked segments, while wear in the silver occurred by ductile deformation and flow of materials. To conclude, the consolidated silver possesses a three-body wear resistance similar to that of amalgam, and a higher resistance to wear-induced damage and cracking than amalgam. The mechanism of wear in amalgam is microfracture and material dislodgement, while that in consolidated silver is ductile deformation and flow of material.

Microleakage of a consolidated silver direct filling material

Microleakage of an experimental direct filling material comprised of a chemically precipitated silver powder that had been surface treated with a dilute acid to promote cold welding upon consolidation was evaluated. Microleakage was compared to both dispersed-phase and spherical amalgam by use of an in vitro gas-diffusion method and in class 5 restorations placed in extracted human teeth. The effect of two cavity varnishes and two dentin adhesives as cavity liners on microleakage was also evaluated using extracted teeth. Microleakage of silver powder consolidated with dental instruments was less than that found with dental amalgam. The use of copal or polyamide cavity varnish resulted in the lowest combination of microleakage on dentin and enamel margins.

Two-body sliding wear of a direct-filling silver alternative to amalgam

OBJECTIVE

This study investigated the wear resistance of a mercury-free silver direct-filling material and a dental amalgam.

METHOD AND MATERIALS

A precipitated silver powder was rinsed with dilute fluoboric acid and consolidated into a cohesive solid. For tooth cavity restoration and flexural testing, the silver was consolidated with a dental amalgam plugger at a load of 15 N. For wear testing, because of the relatively large specimen size, the silver was pressed at a pressure of 150 MPa, yielding a density similar to that obtained by hand consolidation.

RESULTS

The silver had a flexural strength twice that of amalgam. Pin-on-disk wear resulted in a smooth surface and hardening in silver, as measured by indentation inside the wear tracks, in contrast to the damage that was found in amalgam. The wear track cross-sectional area (n = 12) at 10(6) revolutions was not statistically significantly different among amalgam, polished silver, and burnished silver.

CONCLUSION

The consolidated silver exhibited work hardening and surface densification during wear and, as a result, was more resistant to wear-induced damage than amalgam.

Surface treatment of mercury-free alloys

Finishing and polishing methods were examined for two metallic direct restorative materials being proposed as possible alternatives to amalgam, namely a gallium alloy and a consolidated silver alloy. The polished surfaces were compared to a conventional spherical amalgam (Tytin). After initial surface treatment with a 12-fluted tungsten carbide bur in a high-speed dental hand-piece, three polishing methods were evaluated: slow-speed polishing burs, rubber polishing points, and polishing disks (Sof-Lex). Each of these methods was followed by an additional surface treatment in which a pumice-flour/water slurry was applied with a rotary brush and a final surface treatment with a zinc-oxide/ethanol slurry that was applied with rotary rubber cups. The surface roughness was evaluated by profilometric measurements and light microscopy. The results showed that the smoothest surfaces for all metals were achieved with rotary finishing and polishing disks. Using the rubber points resulted in surfaces that were statistically similar to the disk-polished surfaces on all three materials. The polished surface of gallium alloy was consistently slightly rougher than that of amalgam. The consolidated silver also presented a consistently rougher surface than did amalgam, although these differences were not statistically significant. The additional polishing with pumice and zinc oxide improved the luster, but did not significantly improve the measured surface smoothness in any of the restorative materials studied.

Ceramic whisker reinforcement of dental resin composites

Resin composites currently available are not suitable for use as large stress-bearing posterior restorations involving cusps due to their tendencies toward excessive fracture and wear. The glass fillers in composites provide only limited reinforcement because of the brittleness and low strength of glass. The aim of the present study was to reinforce dental resins with ceramic single-crystalline whiskers of elongated shapes that possess extremely high strength. A novel method was developed that consisted of fusing silicate glass particles onto the surfaces of individual whiskers for a two-fold benefit: (1) to facilitate silanization regardless of whisker composition; and (2) to enhance whisker retention in the matrix by providing rougher whisker surfaces. Silicon nitride whiskers, with an average diameter of 0.4 microm and length of 5 microm, were coated by the fusion of silica particles 0.04 microm in size to the whisker surface at temperatures ranging from 650 degrees C to 1000 degrees C. The coated whiskers were silanized and manually blended with resins by spatulation. Flexural, fracture toughness, and indentation tests were carried out for evaluation of the properties of the whisker-reinforced composites in comparison with conventional composites. A two-fold increase in strength and toughness was achieved in the whisker-reinforced composite, together with a substantially enhanced resistance to contact damage and microcracking. The highest flexural strength (195+/-8 MPa) and fracture toughness (2.1+/-0.3 MPa x m(1/2)) occurred in a composite reinforced with a whisker-silica mixture at whisker:silica mass ratio of 2:1 fused at 800 degrees C. To conclude, the strength, toughness, and contact damage resistance of dental resin composites can be substantially improved by reinforcement with fillers of ceramic whiskers fused with silica glass particles.

Indentation creep behavior of a direct-filling silver alternative to amalgam

Amalgam creep has been identified as a key parameter associated with marginal breakdown and corrosion. The aim of this study was to evaluate the time-dependent deformation (creep) of a novel silver filling material as an alternative to amalgam. We made the silver specimens by pressing a precipitated powder at room temperature to a density that can be achieved in clinical hand consolidation. The surface of the silver was either polished or burnished. To examine local contact creep and the effect of surface finishing, we used an indentation creep method in which a Vickers indenter was loaded on the specimen surface at a load of 10 N with dwell times of 5 sec to 6x10(4) sec. We used a bonded-interface technique to examine subsurface creep mechanisms. The flexural strength (mean+/-SD; n = 10) was 86+/-20 MPa for amalgam, 180+/-21 MPa for polished silver, and 209+/-19 MPa for burnished silver-values which are significantly different from each other (family confidence coefficient = 0.95; Tukey's multiple-comparison test). Indentation creep manifested as hardness number decreasing with increased dwell time. With dwell time increasing from 5 sec to 6x10(4) sec, the hardness number of amalgam was reduced by approximately 80%; that of the polished silver and the burnished silver was reduced by only 40%. Subsurface creep in amalgam consisted of the shape change of the alloy particles from spherical to elongated shapes, and the separation of matrix grains from each other, possibly due to grain-boundary sliding. Creep of the polished silver occurred by densification reducing porosity and increasing hardness; that of the burnished silver occurred by the displacement of the burnished layer. These results suggest that, due to creep-induced subsurface work-hardening and densification, the consolidated silver exhibits a higher resistance to indentation creep than does amalgam. The hardness number of silver approaches that of amalgam after prolonged indentation loading.

Fluoride-releasing dental restorative materials

In the 1940s, dentists observed that secondary caries was rarely associated with silicate cement restorations. While the relatively stable dimensional properties of those restorations were undoubtedly a factor in this fortunate circumstance, the fact that fluoride was inherent in the composition of the material received the greater credit. By the mid-1980s, a wide variety of fluoride-releasing dental restorative materials were available to dentists and dental consumers, and the cariostatic effect of fluoride ions on enamel caries had been demonstrated in many studies. This paper reviews much of the fluoride-related research conducted on fluoride-releasing amalgam, glass-ionomer cements, composites, primers, sealants, liners, acrylic resins, and orthodontic bracket bonding materials. The need for standardization of test methods is addressed, as is the need for more controlled clinical trials and additional research.

Acid-Assisted Consolidation of Silver Alloys for Direct Fillings

Silver-rich metal powders cold-welded by consolidation have been investigated as possible direct dental filling material. The surface of the silver powder must undergo an acid treatment to remove existing contaminants and prevent formation of new surface contaminants during consolidation. This study was designed to investigate the effect of the acid treatment on the strength of the consolidated alloy, its reactivity with the surrounding tooth structure, and its reactions with certain cavity liners. This study investigated the effects of pH and concentration of fluoboric acid on the flexural strength of silver powder consolidated into rectangular beams in a partial 4 × 4 design. The study also assessed, by visible and scanning electron microscopy, what effect the acid-treated powders had on dentin that had been pre-coated with different cavity liners. Mean flexural strengths for beams consolidated using dental hand instruments were in the range (77.0 ± 9.28) MPa to (166.1 ± 17.6) MPa, where the quoted uncertainties are standard uncertainties (i.e., one standard deviation estimates). ANOVA indicated that fluoboric acid pH was highly significant (p < 0.0001) with lower pH values resulting in higher flexural strength. Concentration alone was not a significant factor for flexural strengths, but there was a significant interaction between concentration and pH (p < 0.0001). Microscopy revealed that the acid-treated silver powder demineralized approximately 2 μm of dentin when used with no liner. The use of copal or polyamide varnishes eliminated most of this demineralization, but the use of a dentin adhesive liner resulted in some dislodgment and breakdown of the adhesive film by the acid. The results of this study indicate that this silver powder when treated with dilute fluoboric acid at a pH of approximately 1.0 can result in a filling material with strength equivalent to currently used conventional amalgam. The demineralization of tooth structure appears to be minimal and can be eliminated with the use of cavity liners.

Direct metallic amalgam alternative: a research update

Discussions between two group leaders at the National Institute of Standards and Technology (NIST) led to the suggestion that a mercury-free, silver-based material could be used for dental direct-filling applications. This concept brought about a new approach that, nonetheless, is still based on powder technology such as amalgams. The resulting material also retains the tin and silver components of conventional amalgams. The condensation of a loose powder mixture into a cohesive solid relies, however, on cold-welding across atomically clean silver-silver interfaces after a mild acid treatment of the surfaces. The National Institute of Dental Research (NIDR) and American Dental Association Health Foundation (ADAHF) became involved in the research in 1992, and ADAHF scientists continue to collaborate with NIST metallurgists and electrochemists toward the further development of this promising new technology.

Cyclic contact fatigue of a silver alternative to amalgam

OBJECTIVE

To purpose of this study was to compare the cyclic contact fatigue resistance of a novel mercury-free silver direct filling material to that of a dental amalgam (Dispersalloy).

METHODS

The silver specimens were made by pressing a precipitated powder at room temperature with a pressure of 150 MPa, which can be achieved in clinical hand-consolidation. To simulate clinical contact of restorations against enamel cusps, a cyclic contact fatigue methodology was employed. A spherical indenter was used to repeatedly indent the specimen, while the accumulation of deformation and damage was examined as a function of the number of cycles up to 5 x 10(5). Student's t test, analysis of variance (ANOVA) and Duncan's multiple range test were used to compare the specimen groups for significant differences in flexural strength, indentation impression diameter, and hardness. A type I error of alpha = 0.05 was considered as significant. Subsurface damage was examined by using a bonded-interface technique.

RESULTS

As a result of cyclic indentation, microcracks were produced in the amalgam, but no cracks were found in the silver filling material. At fewer numbers of cycles, indentation produced larger impressions in silver (e.g., diameter = [450 +/- 31] microns at 10(2) cycles) than in amalgam ([145 +/- 20] microns) due to a lower hardness of the former. However, with increasing number of cycles, damage accumulated more rapidly in the amalgam, while the silver beneficially work-hardened in repeated indentations. At 5 x 10(5) cycles, the difference in impression diameter between silver and amalgam ([582 +/- 20] microns vs. [568 +/- 42] microns) become insignificant (p > 0.1, Student's t test).

SIGNIFICANCE

The mercury-free silver direct filling material is more resistant to microcracking and to cyclic contact fatigue than amalgam, and the indentation impression sizes in the consolidated silver and dental amalgam are not statistically different at large numbers of cycles.

Promising new dental materials on the horizon

The rapidly evolving field of materials science is providing dentistry with new treatments and alternatives. Calcium phosphate materials are under development for bone repair and replacement, root surface desensitization, and for caries prevention, by greatly increasing the remineralizing efficiency of fluorides. Composites fabricated from calcium phosphates and polymers may have application as pulp capping and cavity-basing materials. An alternative to mercury dental amalgam is being investigated; it is composed of silver powders that are cold-welded in the presence of a dilute acid. These materials are only a few of the technologies that may profoundly affect the future delivery of dental care.

Surface roughness of glass-ceramic insert-composite restorations: assessing several polishing techniques

The authors compared the effectiveness of seven polishing methods on glass-ceramic insert-composite restorations placed in plastic resin squares. The polishing methods used carbide dental finishing burs and diamond polishing paste, diamond abrasive finishing burs and diamond polishing paste, diamond abrasive finishing burs and composite resin finishing disks, diamond abrasive finishing burs and composite resin polishing points, diamond abrasive finishing burs only, diamond abrasive finishing burs followed by resin impregnated disks and an aluminum oxide polishing abrasive paste, and diamond abrasive finishing burs followed by diamond polishing paste. All systems achieved comparable smoothness except the carbide finishing burs, which damaged the insert-composite margin.