The effect of surface treatment and low-temperature degradation on flexural strength of additive manufactured zirconia.

This study aimed to assess the effect of low-temperature degradation (LTD) and surface treatment on the flexural strength of additive-manufactured (AM) zirconia by comparison to subtractive-manufactured (SM) zirconia. Disc-shaped zirconia specimens were fabricated using AM and SM technology, and each group was assigned to 3 subgroups according to the type of surface treatment: control, sandblasting (SB), and 9% hydrofluoric acid etching (HF). The groups were then further divided into 2 subgroups: unaged and aged. Biaxial flexural strength, crystal phase, surface topography, and surface roughness were measured to evaluate the mechanical properties. Statistical analyses were performed with 3-way ANOVA, followed by the comparison of means with Bonferroni post hoc analyses. The means and standard deviations of the biaxial flexural strength and Weibull parameters were calculated with descriptive statistics. All SM groups showed significantly greater flexural strength than the AM groups (p < .05), and LTD did not affect flexural strength except for the SMHF group (p < .05). After LTD, monoclinic phases (m-phase) were found in all groups, and SEM images showed grain pullout due to zirconia volume expansion in both control groups. Sandblasting significantly affected flexural strength (p < .05), whereas the HF group did not affect flexural strength except in the SMHF group after LTD (p < .05). No significant difference was observed in the surface roughness of AM compared to SM groups conditioned with the same surface treatment regardless of LTD. AM zirconia has comparable mechanical properties to SM zirconia, regardless of low-temperature degradation and surface treatment, which indicates the potential of the AM technique for clinical applications.

Effect of 9% Hydrofluoric Acid Gel Hot-Etching Surface Treatment on Shear Bond Strength of Resin Cements to Zirconia Ceramics.

Background and Objectives: There is no consensus regarding the surface treatment method for achieving optimal bonding strength between zirconia and resin cements. We evaluated the effect of hot-etching with 9% hydrofluoric acid (HF) gel using the Zirconia Etchant Cloud System on zirconia surfaces and the consequent shear bond strength (SBS) of different resin cements to such surface-treated zirconia ceramics. Materials and Methods: Forty-five zirconia specimens were randomly assigned to surface-treatment groups (n = 15/group): no treatment (control, CT); sandblasting with 110-µm Al2O3 at an air pressure of 1 bar for 10 s (SB); hot-etching with 9% HF gel (HE). Post-treatment, specimens were examined using scanning electron microscopy (SEM) and surface roughness (SR) analysis. After treatment, self-adhesive resin cements (Maxcem Elite, MAZIC Cem, RelyX U200, 3M ESPE: Maplewood, MN, USA) were bonded to zirconia specimens, which were stored in distilled water at 37 °C for 24 h. All specimens were then subjected to SBS testing, using a universal testing machine, until failure. Data were analyzed using one-way analysis of variance and Tukey's post hoc test (α = 0.05). Results: In the SEM images, roughness was greater in SB than in HE specimens. Ra and Rt values were highest in SB, followed by HE, and CT specimens. HE specimens showed significantly higher SBS values than CT or SB specimens (p < 0.05). MAZIC Cem cement, with 10-methacryloyloxydcyl dihydrogen phosphate yielded the highest SBS values. Conclusions: Hot-etching with 9% HF gel in a safe shell formed uniformly small, defined holes on the zirconia surface and achieved significantly higher SBS values than sandblasting (p < 0.05). Zirconia prostheses can be bonded micromechanically with resin cement, without the deterioration of properties due to t-m transformation, using chemical acid etching with the Zirconia Etchant Cloud System.

Survival Rates and Clinical Outcomes of Implant Overdentures in Old and Medically Compromised Patients.

Studies on the survival rate of implant overdentures in medically compromised patients are limited because most studies exclude patients with systemic diseases affecting implant prognosis. This retrospective study aimed to evaluate the survival rate and clinical outcomes of dental implants used for overdentures in medically compromised patients. A total of 20 patients (9 men, 11 women; mean age: 67.55 ± 6.84 years, range: 53-81 years) were included. Fourteen patients had more than two systemic diseases, and nine patients had more than three systemic diseases. The mean follow-up period was 39.05 months. Of the 60 implants, 2 failed, resulting in an implant survival rate of 96.6%. No statistical differences were found in implant survival rates according to sex, age, implant diameter, restored arch, or opposing dentition (p > 0.05). A significant difference in mean marginal bone loss (MBL) was noted for restoring the arch (p = 0.022) and opposing dentition (p = 0.036). Implants placed in the mandible and with opposing removable partial dentures and complete dentures showed lower mean MBL. No significant differences in implant MBL were observed in terms of age, sex, or implant diameter (p > 0.05). Favorable clinical outcomes can be expected from implant overdentures using two or four implants in edentulous patients with systemic diseases by ensuring that the patients have a sufficient healing period and regular checkups.

Effect of topographical control by a micro-molding process on the activity of human Mesenchymal Stem Cells on alumina ceramics.

BACKGROUND: Numerous studies have reported that microgrooves on metal and polymer materials can affect cell adhesion, proliferation, differentiation and guidance. However, our knowledge of the cell activity associated with microgrooves on ceramics, such as alumina, zirconia, hydroxyapatite and etc, is very incomplete, owing to difficulties in the engraving of microgrooves on the hard surface of the base material. In this study, microgrooves on alumina were fabricated by a casting process using a polydimethylsiloxane micro-mold. The cell responses of Human Mesenchymal Stem Cells on the alumina microgrooves were then evaluated. RESULTS: Microgrooves on an alumina surface by micro-mold casting can enhance the adhesion, differentiation of osteoblasts as well as gene expression related to osteoblast differentiation. The ALP activity and calcium concentration of the cells on alumina microgrooves were increased by more than twice compared to a non-microgrooved alumina surface. Moreover, regarding the osteoblast differentiation of hMSCs, the expression of ALP, RUNX2, OSX, OC and OPN on the microgrooved alumina were all significantly increased by 1.5 ~ 2.5 fold compared with the non-microgrooved alumina. CONCLUSION: Altering the topography on alumina by creating microgrooves using a micro-molding process has an important impact on the behavior of hMSCs, including the adhesion, differentiation of osteoblasts and osteoblast-specific gene expression. The significant increase in hMSC activity is explained by the increasing of material transportation in parallel direction and by the extending of spreading distance in perpendicular direction.

The effect of resin cements and primer on retentive force of zirconia copings bonded to zirconia abutments with insufficient retention.

PURPOSE: The purpose of this study was to investigate the effect of resin cements and primer on the retentive force of zirconia copings bonded to zirconia abutments with insufficient retention. MATERIALS AND METHODS: Zirconia blocks (Lava, 3M ESPE, St. Paul, MN, USA) were obtained and forty sets of zirconia abutments and copings were fabricated using CAD/CAM technology. They were grouped into 4 categories as follows, depending on the types of resin cements used, and whether the primer is applied or not:Panavia F2.0 (P), Panavia F2.0 using Primer (PRIME Plus, Bisco Inc, Schaumburg, IL, USA) (PZ), Superbond C&B (S), and Superbond C&B using Primer (SZ). For each of the groups, the cementation was conducted. The specimens were kept in sterilized water (37℃) for 24 hours. Retentive forces were tested and measured, and a statistical analysis was carried out. The nature of failure was recorded. RESULTS: The means and standard deviations of retentive force in Newton for each group were 265.15 ± 35.04 N (P), 318.21 ± 22.24 N (PZ), 445.13 ± 78.54 N (S) and 508.21 ± 79.48 N (SZ). Superbond C&B groups (S & SZ) showed significantly higher retentive force than Panavia F2.0 groups (P & PZ). In Panavia F2.0 groups, the use of primer was found to contribute to the increase of retentive force. On the other hand, in Superbond C&B groups, the use of primer did not influence the retention forces. Adhesive failure was observed in all groups. CONCLUSION: This study suggests that cementation of the zirconia abutments and zirconia copings with Superbond C&B have a higher retentive force than Panavia F2.0. When using Panavia F2.0, the use of primer increases the retentive force.

Secondary closure of an extraction socket using the double-membrane guided bone regeneration technique with immediate implant placement.

PURPOSE: Immediate implantation presents challenges regarding site healing, osseointegration, and obtaining complete soft-tissue coverage of the extraction socket, especially in the posterior area. This last issue is addressed herein using the double-membrane (collagen membrane+high-density polytetrafluoroethylene [dPTFE] membrane) technique in two clinical cases of posterior immediate implant placement. METHODS: An implant was placed immediately after atraumatically extracting the maxillary posterior tooth. The gap between the coronal portion of the fixture and the adjacent bony walls was filled with allograft material. In addition, a collagen membrane (lower) and dPTFE membrane (upper) were placed in a layer-by-layer manner to enable the closure of the extraction socket without a primary flap closure, thus facilitating the preservation of keratinized mucosa. The upper dPTFE membrane was left exposed for 4 weeks, after which the membrane was gently removed using forceps without flap elevation. RESULTS: There was considerable plaque deposition on the outer surface of the dPTFE membrane but not on the inner surface. Moreover, scanning electron microscopy of the removed membrane revealed only a small amount of bacteria on the inner surface of the membrane. The peri-implant tissue was favorable both clinically and radiographically after a conventional dental-implant healing period. CONCLUSIONS: Secondary closure of the extraction socket and immediate guided bone regeneration using the double-membrane technique may produce a good clinical outcome after immediate placement of a dental implant in the posterior area.

Evaluation of Spinal Fusion Using Bone Marrow Derived Mesenchymal Stem Cells with or without Fibroblast Growth Factor-4.

OBJECTIVE: In this study, the authors assessed the ability of rat bone marrow derived mesenchymal stem cells (BMDMSCs), in the presence of a growth factor, fibroblast growth factor-4 (FGF-4) and hydroxyapatite, to act as a scaffold for posterolateral spinal fusion in a rat model. METHODS: Using a rat posterolateral spine fusion model, the experimental study comprised 3 groups. Group 1 was composed of 6 animals that were implanted with 0.08 gram hydroxyapatite only. Group 2 was composed of 6 animals that were implanted with 0.08 gram hydroxyapatite containing 1 x 10(6)/ 60 microL rat of BMDMSCs. Group 3 was composed of 6 animals that were implanted with 0.08 gram hydroxyapatite containing 1 x 10(6)/ 60 microL of rat BMDMSCs and FGF-4 1 microG to induce the bony differentiation of the BMDMSCs. Rats were assessed using radiographs obtained at 4, 6, and 8 weeks postoperatively. After sacrifice, spines were explanted and assessed by manual palpation, high-resolution microcomputerized tomography, and histological analysis. RESULTS: Radiographic, high-resolution microcomputerized tomographic, and manual palpation revealed spinal fusion in five rats (83%) in Group 2 at 8 weeks. However, in Group 1, three (60%) rats developed fusion at L4-L5 by radiography and two (40%) by manual palpation in radiographic examination. In addition, in Group 3, bone fusion was observed in only 50% of rats by manual palpation and radiographic examination at this time. CONCLUSION: The present study demonstrates that 0.08 gram of hydroxyapatite with 1 x 10(6)/ 60 microL rat of BMDMSCs induced bone fusion. FGF-4, added to differentiate primitive 1 x 10(6)/ 60 microL rat of BMDMSCs did not induce fusion. Based on histologic data, FGF-4 appears to induce fibrotic change rather than differentiation to bone by 1 x 10(6)/ 60 microL rat of BMDMSCs.

An in vivo comparison of working length determination by only root-ZX apex locator versus combining root-ZX apex locator with radiographs using a new impression technique.

OBJECTIVE: The objective of this study was to compare, in vivo, the accuracy of working length determination using only the Root-ZX electronic apex locator versus adjusting Root-ZX measurements after obtaining a working length radiograph. STUDY DESIGN: The working length was determined in 25 premolar root canals using Root-ZX and K-files were fixed at these positions. Radiographs were acquired and interpreted, and the recorded working length measurement was adjusted, if necessary, for a combined measurement. The teeth were then extracted in an effort to determine the position of the file tip to the root canal constriction. On the basis of the position of the file tip to the apical foramen, polyvinylsiloxane impressions of the root apex were taken, or the root was imbedded in acrylic resin and ground in order to measure the position of the file tip to the apical constriction. RESULTS: The Root-ZX alone detected the apical constriction within +/- 0.5 mm in 84% of the samples (21 of 25 canals). However, 96% (24 of 25 canals) were within this range when the combination of Root-ZX and radiographs was used. We noted no statistical significance between these 2 methods (P > .05). CONCLUSION: Using a Root ZX Electronic Apex Locator combined with radiographs is recommended for the determination of working length, although there was no statistical significance between those 2 groups in this study.

Nanosized hydroxyapatite powder synthesized from eggshell and phosphoric acid.

The present research describes synthesis of highly sinterable, nano-sized hydroxyapatite (HAp) powders using a wet chemical route with recycled eggshell and phosphoric acid as calcium and phosphorous sources. The raw eggshell was easily turned to CaO by the calcining process, and phosphoric acid was mixed with the calcined eggshell by the wet, ball-milling method. The crystalline development and microstructures of the synthesized powders and sintered samples were examined by X-ray diffractometry and scanning electron microscopy, respectively. The observed phases on the powder synthesis process were dependent on the mixing ratio (wt%) of the calcined eggshell to phosphoric acid and the heating temperature. The ball-milled, nano-sized HAp powder, which has an average particle size of 70 nm, was fully densified at 1300 degrees C for 1h. The Ca/P ratio for stoichiometric composition of HAp was controlled by adjustment of the mixing ratio.

Properties and cyclic fatigue of glass infiltrated tape cast alumina cores produced using a water-based solvent.

OBJECTIVE: The purpose of this study was to investigate the properties of tape cast alumina composite produced using a water-based solvent and its possible clinical use as an all ceramic crown system in a fixed partial denture. Durability of the system will be measured by fatigue test to simulate the masticating conditions of the oral cavity. METHODS: The optimal weight ratio of water-based alumina tape was determined by tensile strength, shrinkage ratio and durability. The coefficient of thermal expansion, fracture toughness, biaxial flexural strength and flexural strength after fatigue test of a composite produced from alumina tape at optimal weight ratios were determined and compared to In-Ceram alumina core (control). RESULTS: The weight ratio of alumina/(alumina+binder+plasticizer) of 0.84 and binder/(binder+plasticizer) of 0.5 was observed to be the optimal composition for achieving excellent composite properties. Coefficient of thermal expansion of the sintered alumina tape was observed to be 7.3x10(-6)/degrees C, and this value was increased to 7.5x10(-6)/degrees C after infiltrating the sintered tape with glass. The fracture toughness and biaxial flexural strength of glass infiltrated alumina tape was observed to be 4.6 MPa m(1/2) and 498 MPa, respectively. After cyclic loading for 10(2)-10(6) cycles, no significant change in the biaxial flexural strength was observed between the glass infiltrated alumina core and the In-Ceram alumina core (p>0.05). SIGNIFICANCE: The observed properties provide evidence that the water-based tape cast alumina-glass composite is suitable for clinical use as an all ceramic crown system in a fixed partial denture.