Mechanical characterization of bovine periodontal ligament

This study is part of a research program that aims to develop a constitutive three-dimensional model of the periodontal ligament (PDL) through the identification of pertinent material parameters. As part of this program, bovine PDL was utilized to establish stress-strain responses under tensile and compressive loading conditions. Fresh bovine molars were secured, frozen and prepared to appropriate dimensional specifications. Bar-shaped specimens that comprised portions of dentine, PDL and bone were produced. Push-pull tests were conducted using a specifically constructed loading machine. Full range monotonic stress-strain diagrams were generated. The effect of a rate increase on cyclic S-E diagrams was also determined. The influence of specimen thickness was expressed in terms of modulus of elasticity, strength, uniaxial maximizer strain, and strain energy density. The overall load-response was heavily hysteretic in compression. On the tensile side, after a steep rise, the curve tended to flatten out asymptotically. Variations in rate that spanned four orders of magnitude had no effect on reciprocal load responses. The E-modulus was in the 4-8 MPa range, the strength of the PDL was 1-2 MPa, the maximizer strain was at 45-60% and the strain energy density ranged between 0.3 and 0.4 MPa.     

Mechanical resistance of cemented post and core buildups for ITI‐Bonefit implants

In order to improve the prosthetic versatility of the ITI-Bonefit implant system, a clinical technique was tested whereby a custom made post and core buildup was cemented into implants. Specially designed threaded and serrated posts were machined in precious metal. After the posts were seated into the threaded channel of the implants, cores were built using autopolymerizing resin. Those were then cast and cemented into the implants. For the remainder of the procedure, the buildups were treated like natural abutments using conventional prosthodontic techniques. Mechanical tests were performed to assess the clinical viability of these buildups. The ultimate tensile strength of annealed posts lies in the 700-800 N range. By comparison, the pull-out resistance of posts cemented into natural roots ranged between 108 and 177 N, and the maximum pull-out resistance of manufactured abutments is about 1040 N. When the resistance against lateral forces was tested, the cemented build-ups ranged between 981 and 1128 N, whereas natural teeth fractured between 206 and 903 N depending on the diameter of the root. Manufactured abutments failed at stress levels of about 1020 N. Considering these favorable results, we conclude that the technique described above can be applied clinically for further investigation. Additionally, we suggest some modifications in implant design that would enhance the versatility of the system.     

Using implant connectors to support clinical abrasion probes: a methodological study.

OBJECTIVES: To validate a procedure aimed at assessing the clinical wear rate of full crown veneering materials. To confirm its clinical applicability and alignment capacity in the ancillary profiling apparatus. To quantify the wear rate of a full crown veneering composite (Sinfony, 3M-ESPE) as compared to that of a ceramic (negative control) and an unfilled resin (positive control). METHODS: The technique consisted in utilizing implant supported crowns which were either screw-fastened to endosseous implants via ITI-Straumann Octa connectors or to an Octa analog on an x-y measuring table. After initial contour profiling, 14 crowns were placed in the mouths of seven patients. Six crowns were veneered with composite, four with ceramic and four with an unfilled resin. The crowns were removed at 3, 6, 9, 12, 15, 18 and 24 months and digitalized contour profiles were obtained. Contour profiling consisted in securing the restorations to the x-y table and assessing the z-coordinate using an LVDT stylus. At the end of the experimental period, loss of material was computed as the differences between the initial- and subsequent measurements. RESULTS: The total error of the method was estimated at +/-10 microm. The composite's annual wear rate was 75 microm/year, the ceramic wore at ca. 6 microm/year and the unfilled resin wore at 160 microm/year. Wear was unevenly distributed and concentrated on occlusal contact areas. SIGNIFICANCE: (1) A technique utilizing ITI-Straumann octagonal implant connectors is suitable for clinical use. (2) The veneering composite wears at a rate that is superior to ADA guidelines for composites intended for direct fillings.     

Resistance of ITI implant connectors to multivectorial fatigue load application

PURPOSE: In an effort to provide patients with mechanically optimized implant connectors, this study was designed to assess the relative fatigue resistance of five types of connectors for the ITI implant system: (1) standard (screw-on) abutments torqued to 35, 70, and 140 Ncm; (2) metal Octa connectors torqued to 35 Ncm; (3) ceramic Octa connectors torqued to 15 and 35 Ncm; (4) cemented cast-on abutments; and (5) an experimental screw-retained composite core. MATERIALS AND METHODS: To duplicate the alternating and multivectorial intraoral loading patterns, the specimens were subjected to the rotating cantilever beam test. The implants, their connectors, and abutments were spun around their longitudinal axes while a perpendicular force was applied to the external end. The objective was to determine the force level at which 50% of the specimens would survive 106 load cycles. The mean force levels at 50% failure and their 95% confidence intervals were determined using staircase analysis. RESULTS: The fatigue resistances of the standard (screw-on) abutment, metal Octa connector, and ceramic Octa connector torqued to 35 Ncm were within a few percent of one another. The fatigue resistance of the cemented cast-on abutment was approximately half that of the screwed connectors, and the experimental screw-retained composite core's resistance was about 30%. Increasing the preload in the standard abutments and ceramic Octa connectors increased their fatigue resistance. CONCLUSION: Preloaded screwed components were mechanically superior to cemented cast-on abutments and screw-retained composite buildups. For the screw-on connectors, augmenting preload (ie, torque) augmented the resistance to fatigue loading.     

Regional structural characteristics of bovine periodontal ligament samples and their suitability for biomechanical tests

Mechanical testing of the periodontal ligament requires a practical experimental model. Bovine teeth are advantageous in terms of size and availability, but information is lacking as to the anatomy and histology of their periodontium. The aim of this study, therefore, was to characterize the anatomy and histology of the attachment apparatus in fully erupted bovine mandibular first molars. A total of 13 teeth were processed for the production of undecalcified ground sections and decalcified semi-thin sections, for NaOH maceration, and for polarized light microscopy. Histomorphometric measurements relevant to the mechanical behavior of the periodontal ligament included width, number, size and area fraction of blood vessels and fractal analysis of the two hard-soft tissue interfaces. The histological and histomorphometric analyses were performed at four different root depths and at six circumferential locations around the distal and mesial roots. The variety of techniques applied provided a comprehensive view of the tissue architecture of the bovine periodontal ligament. Marked regional variations were observed in width, surface geometry of the two bordering hard tissues (cementum and alveolar bone), structural organization of the principal periodontal ligament connective tissue fibers, size, number and numerical density of blood vessels in the periodontal ligament. No predictable pattern was observed, except for a statistically significant increase in the area fraction of blood vessels from apical to coronal. The periodontal ligament width was up to three times wider in bovine teeth than in human teeth. The fractal analyses were in agreement with the histological observations showing frequent signs of remodeling activity in the alveolar bone - a finding which may be related to the magnitude and direction of occlusal forces in ruminants. Although samples from the apical root portion are not suitable for biomechanical testing, all other levels in the buccal and lingual aspects of the mesial and distal roots may be considered. The bucco-mesial aspect of the distal root appears to be the most suitable location.     

Fatigue behavior in water of Y-TZP zirconia ceramics after abrasion with 30 μm silica-coated alumina particles

Objective

The use of a 30 μm alumina-silica coated particle sand (CoJet™ Sand, 3M Espe), has shown to enhance the adhesion of resin cements to Y-TZP. The question is whether or not sandblasting 30 μm particles does negatively affect the fatigue limit (S-N curves) and the cumulative survival of Y-TZP ceramics.

Method

Four zirconia materials tested were: Zeno (ZW) (Wieland), Everest ZS (KV) (KaVo), Lava white (LV) and Lava colored (LVB) (3M Espe). Fatigue testing (S-N) was performed on 66 bar of 3 mm × 5 mm × 40 mm with beveled edges for each zirconia material provided by the manufacturers. One half of the specimens were CoJet sandblasted in the middle of the tensile side on a surface of 5 mm × 6 mm. Cyclic fatigue (N = 30/group) (sinusoidal loading/unloading at 10 Hz between 10% and 100% load) was performed in 3-point-bending in a water tank. Stress levels were lowered from the initial static value (average of N = 3) until surviving 1 million cycles. Fatigue limits were determined from trend lines. Kaplan-Meier survival analysis was performed to determine the failure stress at the median percentile survival level for 1 million of cycles before and after sandblasting. The statistical analyses used the log-rank test. Characterization of the critical flaw was performed by SEM for the majority of the failed specimens.

Results

The fatigue limits “as received” (ctr) were: LV = 720 MPa, LVB = 600 MPa, KV = 560 MPa, ZW = 470 MPa. The fatigue limits “after CoJet sandblasting” were: LV = 840 MPa, LVB = 788 MPa, KV = 645 MPa, ZW = 540 MPa. The increase in fatigue limit after sandblasting was 15% for Zeno (ZW) and Everest (KV), 17% for Lava (LV) and 31% for Lava colored (LVB). The KM median survival stresses in MPa were: ZW(ctr) = 549 (543-555), ZW(s) = 587 (545-629), KV(ctr) = 593 (579-607), KV(s) = 676 (655-697), LVB(ctr) = 635 (578-692), LVB(s) = 809 (787-831), LV(ctr) = 743 (729-757), LV(s) = 908 (840-976). Log-rank tests were significantly different (p < 0.001) for all sandblasted groups vs. the “as received” except for Zeno (Wieland) (p = 0.295). Failures started from both intrinsic and machined flaws.

Significance

30 μm particle sandblasting did significantly improve the fatigue behavior of three out of four Y-TZP ceramic materials and can therefore be recommended for adhesive cementation procedures. This study was supported in part by grants from the Swiss Society for Reconstructive Dentistry (SSRD) and 3M Espe.     

UFT/leucovorin and mitomycin C as salvage treatment in patients with advanced colorectal cancer - a retrospective analysis

Active anticancer drugs and/or combination regimens for the treatment of patients failing oxaliplatin, irinotecan and 5-fluorouracil are desperately needed. In this analysis we describe the safety and efficacy of the combination of mitomycin C, UFT and leucovorin in such an extensively pretreated patient population. Between January 2002 and June 2004, a total of 41 patients were treated with mitomycin C (8 mg/m on day 1) and UFT (350 mg/m)+ leucovorin (90 mg) both divided into three daily doses from day 1 to day 14 every 4 weeks. All patients had failed prior first-line and second-line treatment with oxaliplatin, irinotecan and 5-fluorouracil. The aim of this retrospective analysis was to evaluate the efficacy and safety data of this potential salvage therapy regimen. Thirty-nine patients were evaluable for the response. The overall response rate (intent-to-treat) was 7.3% (95% confidence interval, 2.5-19.4%) and disease stabilization was achieved in 29.3%. Median time to progression was 2.5 months (range, 1.5-13.5) and median overall survival was 6 months (range, 1.5-26). Myelosuppression was the most frequent side effect. Grade 3 hematotoxicity, however, was observed in only three patients. The most common nonhematological toxicities consisted of mild and reversible nausea, emesis and diarrhea; again, severe symptoms were only occasionally seen. These data show that the combination of mitomycin C/UFT/leucovorin is safe and active in about one-third of patients in terms of abrogation of progression in extensively pretreated metastatic colorectal cancer.