Mechanical failure of posterior teeth due to caries and occlusal wear- A modelling study.

OBJECTIVES: The purpose of the present work is to explore the effect of occlusal wear and different types and degrees of caries on the mechanical performance and structural integrity of posterior teeth. METHODS: Three-dimensional (3D) computational models with different combinations of caries parameters (caries location, caries size and caries induced pulp shrinkage) and occlusal wear factors (enamel thickness, marginal ridge height and cuspal slope) were developed and analyzed using the extended finite element method (XFEM) to identify the stress distribution, crack initiation load and ultimate fracture load values. The effect of a non-drilling conservative treatment using resin infiltration on the recovery of mechanical properties of carious molar teeth was also investigated. RESULTS: Presence of fissural caries, worn proximal marginal ridge and decreased enamel thickness due to occlusal wear, imparted a significant negative effect on the crack initiation load value of the lower molar models. Accordingly, models with intact and strong proximal marginal ridge, generally exhibited higher crack initiation loading, regardless of caries size and location. Presence of fissure caries drastically decreased (55%-70%) the crack initiation load compared to sound teeth. The depth of the fissural lesion and the presence of proximal caries did not have a major effect on crack initiation load values. However, increasing the caries size resulted in lower final fracture load values in most of the cases. Accordingly, the groups with combined and connected large fissural and proximal lesions experienced the largest drop in the fracture load values compared to sound tooth models. The worst condition consisted of two connected large proximal and fissural caries with no proximal marginal ridge, in which the fracture load dramatically decreased to only 25% of that for sound teeth with intact marginal ridge. On the other hand, decreased cuspal slope due to occlusal wear and shrinkage of the pulp due to caries appeared to have a protective role and a direct relation with the fracture resistance of the tooth. Following the application of resin infiltration on the carious models, the crack initiation load and the fracture load could recover up to 75% and 90% of the values for the corresponding sound tooth models, respectively. SIGNIFICANCE: Presence of fissural caries, if not treated (either with remineralization, resin infiltration or restoration), can be a major risk factor in the initiation of tooth fracture. When combined with decreased enamel thickness and loss of proximal marginal ridge due to mechanical or chemical wear, the weakening effect of the caries will be amplified specially in teeth with steep cuspal slopes. The application of a conservative treatment with resin infiltration can be an effective approach in prevention of further mechanical failure of demineralized enamel. The findings of this study emphasize the importance of early interventions in the management of caries for the prevention of future cuspal or tooth fracture especially in subjects with higher risk factors for tooth fracture such as caries, wear and bruxism.

Monolithic crowns fracture analysis: The effect of material properties, cusp angle and crown thickness.

OBJECTIVES: This study aimed to investigate the collective influence of material properties and design parameters on the fracture behavior of monolithic dental crowns. METHODS: Three-dimensional (3D) models (N=90) with different combinations of design parameters (thickness, cusp angle and occlusal notch geometry) and material type (lithium disilicate, feldspar ceramic, zirconia, hybrid resin ceramic and hybrid polymer-infiltrated ceramic) were developed for the failure analysis using extended finite element method (XFEM) to identify the stress distribution, crack initiation load, fracture surface area and fracture pattern. Analytical formulation, in vitro fracture tests and fractographic analysis of dedicated models were also performed to validate the findings of the XFEM simulation. RESULTS: For all material types considered, crowns with a sharp occlusal notch design had a significantly lower fracture resistance against occlusal loading. In most of the models, greater crown thickness and cusp angle resulted in a higher crack initiation load. However, the effect of cusp angle was dominant when the angle was in the low range of 50° for which increasing thickness did not enhance the crack initiation load. SIGNIFICANCE: Comparing the critical load of crack initiation for different models with the maximum biting force revealed that for the studied monolithic materials excluding zirconia, a design with a rounded occlusal notch, 70° cusp angle and medium thickness (1.5mm occlusal) is an optimum combination of design parameters in terms of tooth conservation and fracture resistance. Zirconia crowns exhibited sufficient strength for a more conservative design with less thickness (1.05mm occlusal) and sharper cusp angle (60°).

Modelling of stress distribution and fracture in dental occlusal fissures.

The aim of this study was to investigate the fracture behaviour of fissural dental enamel under simulated occlusal load in relation to various interacting factors including fissure morphology, cuspal angle and the underlying material properties of enamel. Extended finite element method (XFEM) was adopted here to analyse the fracture load and crack length in tooth models with different cusp angles (ranging from 50° to 70° in 2.5° intervals), fissural morphologies (namely U shape, V shape, IK shape, I shape and Inverted-Y shape) and enamel material properties (constant versus graded). The analysis results showed that fissures with larger curved morphology, such as U shape and IK shape, exhibit higher resistance to fracture under simulated occlusal load irrespective of cusp angle and enamel properties. Increased cusp angle (i.e. lower cusp steepness), also significantly enhanced the fracture resistance of fissural enamel, particularly for the IK and Inverted-Y shape fissures. Overall, the outcomes of this study explain how the interplay of compositional and structural features of enamel in the fissural area contribute to the resistance of the human tooth against masticatory forces. These findings may provide significant indicators for clinicians and technicians in designing/fabricating extra-coronal dental restorations and correcting the cuspal inclinations and contacts during clinical occlusal adjustment.

Microstructural and Mechanical Characterization of CAD/CAM Materials for Monolithic Dental Restorations.

PURPOSE: To determine and compare the microstructure, flexural strength, flexural modulus, fracture strength, and microhardness of four types of computer-aided design/computer-aided manufacturing (CAD/CAM) materials for monolithic dental restorations. MATERIALS AND METHODS: A lithium disilicate (LD; IPS e.max CAD), a zirconia-reinforced lithium silicate (ZLS; VITA Suprinity), a hybrid high-performance polymer (HPP) composite resin (GC Cerasmart), and a hybrid polymer-infiltrated ceramic network (PICN) material (VITA Enamic) were used to manufacture monolithic ceramic posterior crowns (n = 10) that were adhesively cemented on resin-based composite dies and loaded until fracture. In addition, 40 rectangular bars (n = 10) were milled and polished for three-point flexural strength testing. Microhardness (Vickers indentation), as well as quantitative (energy dispersive spectroscopy) and qualitative (scanning electron microscopy) structural analysis were conducted on fracture surfaces. Data were analyzed by one-way ANOVA and Tukey HSD post-hoc test (p = 0.05). RESULTS: Mechanical testing results showed that the material type has a significant effect on the fracture strength (p < 0.0001) of the monolithic crowns with ZLS and LD presenting significantly higher fracture strength than the PICN and HPP hybrid materials. LD showed the highest flexural strength (p < 0.0001) followed by ZLS, HPP, and PICN, respectively. The lowest flexural modulus and hardness were presented by HPP whereas ZLS had the highest flexural modulus and hardness. The LD presented the highest modulus of resilience and the PICN the lowest. CONCLUSIONS: All CAD/CAM crown materials exhibited high values of fracture and flexural resistance, making them suitable materials for posterior full-crown restorations. Glass-ceramics suffered more from catastrophic and nonreparable fracture patterns, whereas minimal chipping and type II fracture patterns were more common in hybrid materials. The combination of more flexibility, less stiffness, and increased softness with satisfactory flexural and fracture strength values observed in PICN and HPP makes these two hybrid materials suitable choices for chairside monolithic crown fabrication.

Missing Surface Estimation Based on Modified Tikhonov Regularization: Application for Destructed Dental Tissue.

Estimation of missing digital information is mostly addressed by one or two-dimensional signal processing methods; however, this problem can emerge in multi-dimensional data including 3D images. Examples of 3D images dealing with missing edge information are often found using dental micro-CT, where the natural contours of dental enamel and dentine are partially dissolved or lost by caries. In this paper, we present a novel sequential approach to estimate the missing surface of an object. First, an initial correct contour is determined interactively or automatically, for the starting slice. This contour information defines the local search area and provides the overall estimation pattern for the edge candidates in the next slice. The search for edge candidates in the next slice is performed in the perpendicular direction to the obtained initial edge in order to find and label the corrupted edge candidates. Subsequently, the location information of both initial and nominated edge candidates are transformed and segregated into two independent signals (X-coordinates and Y-coordinates) and the problem is changed into error concealment. In the next step, the missing samples of these signals are estimated using a modified Tikhonov regularization model with two new terms. One term contributes in the denoising of the corrupted signal by defining an estimation model for a group of mildly destructed samples, and the other term contributes in the estimation of the missing samples with the highest similarity to the samples of the obtained signals from the previous slice. Finally, the reconstructed signals are transformed inversely to edge pixel representation. The estimated edges in each slice are considered as initial edge information for the next slice and this procedure is repeated slice by slice until the entire contour of the destructed surface is estimated. The visual results as well as quantitative results (using both contour-based and area-based metrics) for seven image datasets of tooth samples with considerable destruction of the dentin-enamel junction (DEJ) demonstrates that the proposed method can accurately interpolate the shape and the position of the missing surfaces in computed tomography images in both two and three dimensions (e.g. 14.87 ±3.87 µ m of mean distance (MD) error for the proposed method versus 7.33 ±0.27 µm of MD error between human experts and 1.25 ±~0 % error rate (ER) of the proposed method versus 0.64 ±~0 % of ER between human experts (~1% difference)).

Efficacy of Fluoride Varnishes with Added Calcium Phosphate in the Protection of the Structural and Mechanical Properties of Enamel.

The aim of this study was to investigate the efficacy of various fluoride varnishes in the protection of the structural and nanomechanical properties of dental enamel. Demineralized enamel specimens were imaged using a high-resolution micro-CT system and lesion parameters including mineral density and lesion depth were extracted from mineral density profiles. Nanoindentation elastic modulus and hardness were calculated as a function of penetration depth from the load-displacement curves. The average depth of the lesion in specimens with no prior fluoride varnish treatment was 86 ± 7.19 µm whereas the varnish treated specimens had an average depth of 67 ± 7.03 µm (P < 0.05). The mineral density of enamel lesions with no fluoride varnish treatment had an average of 1.85 gr/cm3 which was 25% lower than the corresponding value in varnish treated enamel and 37% lower than sound enamel. While, in the varnish treated group, elastic modulus and hardness values had decreased by 18% and 23%, respectively, the corresponding values in the non-varnish treated specimens had a reduction of 43% and 54% compared to the sound enamel. The findings from this study highlight the preventive role of fluoride varnishes. Addition of calcium and phosphate does not seem to enhance or inhibit the prevention or remineralization performance of fluoride varnishes.

Micro-CT analysis of naturally arrested brown spot enamel lesions.

OBJECTIVES: The aim of this study was to characterize the mineral density parameters through natural enamel brown spot lesions (BSLs) and to visualize and map their mineral distribution pattern in comparison to enamel whitespot lesions (WSLs). METHODS: Study specimens included seventeen proximal WSLs (ICDAS 1, 2), seventeen proximal BSLs and seventeen sound proximal specimens (ICDAS 0) collected from The Oral Surgery Department at Sydney Dental Hospital, Sydney, Australia. Imaging was undertaken using a high resolution, desktop micro-computed tomography system. A calibration equation was used to transform the grey level values of the images into true mineral density values. The qualitative analysis and the quantification of the lesion parameters including the mineral density and the thickness of the enamel lesion surface layer were performed using mineral density profiles plotted in FIJI and the visualized mineral maps in MATLAB respectively. RESULTS: The maps of brownspot lesions revealed irregular demineralization patterns with faint boundaries and outlines. The regular triangular shape of proximal lesions was recognizable only in some parts of individual BSLs or was completely unrecognizable within the entire lesion. Scattered free-form areas of high density enamel were observed within or close to the surface of BSLs. A layer of high density enamel with a mineral density close to that of sound enamel was observed in all of the BSLs. The mean mineral density of the body of BSLs, including the scattered areas of high mineral density, was significantly higher than the corresponding values in white-spot lesions. The mean thickness of the surface layer in BSLs (79±15µm) was also significantly higher than white-spot lesions (51±11µm) (p<0.05). CONCLUSION: This study demonstrated that the mineralization parameters such as density and the thickness of the surface layer as well as distribution patterns through natural enamel brown spot lesions (BSLs) are different from enamel white-spot lesions (WSLs). The higher mineral density of the body of the lesion and the increased thickness of the surface layer in brown spot enamel lesions may suggest possible subsurface remineralization in the majority of naturally arrested BSLs.

Quantitative characterization and micro-CT mineral mapping of natural fissural enamel lesions.

OBJECTIVES: The aim of this study was to characterize the mineral distribution pattern of natural fissural enamel lesions and to quantify structural parameters and mineral density of these lesions in comparison to proximal white spot enamel lesions. METHODS: Imaging was undertaken using a high-resolution desktop micro-computed tomography system. A calibration equation was used to transform the grey level values of images into true mineral density values. The value of lesion parameters including the mineral density and the thickness of the surface layer of the enamel lesion were extracted from mineral density profiles. RESULTS: The thickness of the surface layer showed variation among different lesions and it ranged from 0-90 µm in proximal lesions and 0-137 µm in fissural lesions. The average thickness of surface layer in fissural lesions was significantly higher than smooth surface proximal lesions. Sound fissural enamel showed lower mineral density compared to proximal enamel. CONCLUSION: Micro-CT and the suggested de-noising and visualization method provide an efficient high-resolution approach for non-destructive evaluation of fissural lesions. Using these methods, the current study revealed the exclusive pattern and structure of fissural enamel lesions which may provide a basis for future studies on prevention and remineralization of these lesions. CLINICAL SIGNIFICANCE: The common demineralization pattern of fissural lesions, which indicates the extension of the lesion in two directions towards the pulp horns, may explain the early inflammation and symptoms of the pulp in fissural lesions even when the lesion base appears far from the pulp roof in normal radiographs. In addition, the presence of the surface layer, indicates that vigorous probing of the occlusal fissures may lead to breakage and cavitation of the enamel lesions.

A comparative study of new and current methods for dental micro-CT image denoising.

OBJECTIVES: The aim of the current study was to evaluate the application of two advanced noise-reduction algorithms for dental micro-CT images and to implement a comparative analysis of the performance of new and current denoising algorithms. METHODS: Denoising was performed using gaussian and median filters as the current filtering approaches and the block-matching and three-dimensional (BM3D) method and total variation method as the proposed new filtering techniques. The performance of the denoising methods was evaluated quantitatively using contrast-to-noise ratio (CNR), edge preserving index (EPI) and blurring indexes, as well as qualitatively using the double-stimulus continuous quality scale procedure. RESULTS: The BM3D method had the best performance with regard to preservation of fine textural features (CNREdge), non-blurring of the whole image (blurring index), the clinical visual score in images with very fine features and the overall visual score for all types of images. On the other hand, the total variation method provided the best results with regard to smoothing of images in texture-free areas (CNRTex-free) and in preserving the edges and borders of image features (EPI). CONCLUSIONS: The BM3D method is the most reliable technique for denoising dental micro-CT images with very fine textural details, such as shallow enamel lesions, in which the preservation of the texture and fine features is of the greatest importance. On the other hand, the total variation method is the technique of choice for denoising images without very fine textural details in which the clinician or researcher is interested mainly in anatomical features and structural measurements.

Concentrated growth factor increases Schwann cell proliferation and neurotrophic factor secretion and promotes functional nerve recovery in vivo.

Concentrated growth factor (CGF) is a newly generated complex that comprises a fibrin matrix incorporating growth factors and plasmatic and leukocyte cytokines. It has been widely used in bone regenerative medicine. However, the effect of CGF on peripheral nerve regeneration had not been previously investigated. The aim of the present study was to evaluate the possibility of using CGF for nerve regeneration by i) investigating the effect of CGF on the proliferation of Schwann cells (SCs) and secretion of neurotrophic factors nerve growth factor (NGF) and glial cell line­derived neurotrophic factor (GDNF) in vitro; and ii) analyzing the effect of CGF on functional nerve recovery after nerve injury in vivo. CGF was prepared from venous blood taken from rats, and using scanning electron microscopy (SEM) we noted that it featured a fiber­like appearance with pore size ranging from 0.1 to 1.0 µm. The soluble component of CGF was used to produce conditioned media with which to treat the Schwann cell line. A cell counting kit-8 assay and cell cycle analysis were both used to study the proliferative effect of CGF on SCs. Reverse transcription-quantitative PCR and western blot analysis demonstrated that there was an increase in the mRNA and protein expression of NGF and GDNF, both of which are markers of SC neurotrophic secretion. A model of sciatic nerve crush injury was established for the in vivo experiment, and CGF was found to increase the sciatic functional index (indicative of nerve function). We noted that CGF increased SC proliferation and secretion of neurotrophic factors in vitro, and promoted functional recovery after peripheral nerve injuries in vivo. These results suggest that CGF is a promising candidate biomaterial for peripheral nerve regeneration, and may potentially be utilized to repair nerve injuries.

Developing a new dental implant design and comparing its biomechanical features with four designs.

BACKGROUND: As various implant geometries present different biomechanical behaviors, the purpose of this work was to study stress distribution around tapered and cylindrical threaded implant geometries using three-dimensional finite element stress analysis. METHODS: Seven implant models were constructed using Computer Assisted Designing system. After digitized models of mandibular section, the crowns were created. They were combined with implant models, which were previously imported into CATIA software. The combined solid model was transferred to ABAQOUS to create a finite element meshed model which was later analyzed regarding the highest maximum and minimum principal stresses of bone. RESULTS: For all models, the highest stresses of cortical bone were located at the crestal cortical bone around the implant. Threaded implants, triangular thread form and taper body form showed a higher peak of tensile and compressive stress than non-threaded implants, square thread form and straight body form, respectively. A taper implant with triangular threads, which is doubled in the cervical portion of the body, had a significantly lower peak of tensile and compressive stress in the cortical bone than straight/taper triangular or square threaded implant forms. CONCLUSION: For the investigation of bone implant interfacial stress, the non-bonded state should be studied too. Confirmative clinical and biological studies are required in order to benefit from the results of this study.

Human papilloma virus as a possible factor in the pathogenesis of oral lichen planus.

BACKGROUND: Oral lichen planus (OLP) is a common chronic inflammatory mucocutaneous disease. Clinical diagnosis of OLP requires clinical work-up and histologic examination to rule out possible dysplasia and carcinoma. It is possible that oral mucosal viral infections including HPV infection may have a causative role in OLP pathogenesis. The aim of this study was to examine the coincidence of human papilloma virus type 18 and oral lichen planus. METHODS: This study was a case-control study. Twenty nine paraffinized specimens of previously diagnosed oral lichen planus and 14 paraffinized specimens of nonpathogenic mucosa were studied. Polymerase Chain Reaction (PCR) analyze used for detection of DNA HPV 18. The data were analyzed with SPSS software and Fisher's exact test was used to find the possible relation between HPV18 infection and oral lichen planus. RESULTS: Nine out of 29 (31.0%) lichen planus samples and one out of 14 (7.1%) controls were HPV 18 positive. No significant correlation (P = 0.128) was observed between HPV18 infection and oral lichen planus. CONCLUSION: According to the findings there might be a co-incidence of human papilloma virus type 18 and oral lichen planus.