In vivo wear performance of highly cross-linked polyethylene vs. yttria stabilized zirconia and alumina stabilized zirconia at a mean seven-year follow-up.

BACKGROUND: Zirconia was introduced as an alternative to alumina for use in the femoral head. The yttria stabilized zirconia material was improved by adding alumina. We evaluated highly cross-linked polyethylene wear performance of zirconia in total hip arthroplasty. The hypothesis was that alumina stabilized zirconia could decrease highly cross-linked polyethylene wear. METHODS: Highly cross-linked polyethylene wear was measured with a computerized method (PolyWare) in 91 hips. The steady-state wear rates were measured based on the radiographs from the first year postoperatively to the final follow-up and were compared between hips with yttria stabilized zirconia and alumina stabilized zirconia. RESULTS: The steady-state wear rate of highly cross-linked polyethylene against zirconia was 0.02 mm/year at a mean follow-up of 7 years. No significant difference was observed between groups with yttria stabilized zirconia and alumina stabilized zirconia. CONCLUSIONS: Addition of alumina to the zirconia material failed to show further reduction of highly cross-linked polyethylene wear and our hypothesis was not verified.

Five-year clinical evaluation of In-Ceram crowns fabricated using GN-I (CAD/CAM) system.

This study prospectively evaluated the clinical performance of computer-assisted design and computer-assisted manufacturing (CAD/CAM)-generated In-Ceram Alumina core crowns in Japanese patients for up to 5 years. A total of 101 In-Ceram crowns with aluminium copings fabricated using the GN-I system were placed in Japanese patients. The crowns were evaluated using a California Dental Association (CDA) quality assessment system at baseline and at all follow-up examinations. Gingival condition was assessed using plaque and bleeding scores. The survival of anterior and posterior crowns was analysed according to the Kaplan-Meier method. The scores of gingival condition were compared between restored crowns and contralateral teeth using a t-test. During the observation period, six crowns were lost to follow-up. Five crowns were fractured from the copings and removed, and four crowns were removed for other reasons. Chipping within the porcelain was detected in three crowns, which were then polished. The cumulative survival rates after 60 months were 96·9% for anterior crowns and 87·7% for posterior ones, and there were no significant differences between anterior and posterior crowns. According to the CDA criteria, most of the crowns were rated as satisfactory during the observation period. There were significant differences in soft tissue conditions between In-Ceram crowns and control teeth at 2- and 5-year examinations. Despite the five fractures from copings, In-Ceram Alumina crowns with copings fabricated using the CAD/CAM (GN-I system) for replacing both anterior and posterior teeth showed predictable results during a 5-year observation period.

Analysis of Al2O3-parylene C bilayer coatings and impact of microelectrode topography on long term stability of implantable neural arrays.

OBJECTIVE: Performance of many dielectric coatings for neural electrodes degrades over time, contributing to loss of neural signals and evoked percepts. Studies using planar test substrates have found that a novel bilayer coating of atomic-layer deposited (ALD) Al2O3 and parylene C is a promising candidate for neural electrode applications, exhibiting superior stability to parylene C alone. However, initial results from bilayer encapsulation testing on non-planar devices have been less positive. Our aim was to evaluate ALD Al2O3-parylene C coatings using novel test paradigms, to rigorously evaluate dielectric coatings for neural electrode applications by incorporating neural electrode topography into test structure design. APPROACH: Five test devices incorporated three distinct topographical features common to neural electrodes, derived from the utah electrode array (UEA). Devices with bilayer (52 nm Al2O3 + 6 µm parylene C) were evaluated against parylene C controls (N ⩾ 6 per device type). Devices were aged in phosphate buffered saline at 67 °C for up to 311 d, and monitored through: (1) leakage current to evaluate encapsulation lifetimes (>1 nA during 5VDC bias indicated failure), and (2) wideband (1-105 Hz) impedance. MAIN RESULTS: Mean-times-to-failure (MTTFs) ranged from 12 to 506 d for bilayer-coated devices, versus 10 to >2310 d for controls. Statistical testing (log-rank test, α = 0.05) of failure rates gave mixed results but favored the control condition. After failure, impedance loss for bilayer devices continued for months and manifested across the entire spectrum, whereas the effect was self-limiting after several days, and restricted to frequencies <100 Hz for controls. These results correlated well with observations of UEAs encapsulated with bilayer and control films. SIGNIFICANCE: We observed encapsulation failure modes and behaviors comparable to neural electrode performance which were undetected in studies with planar test devices. We found the impact of parylene C defects to be exacerbated by ALD Al2O3, and conclude that inferior bilayer performance arises from degradation of ALD Al2O3 when directly exposed to saline. This is an important consideration, given that neural electrodes with bilayer coatings are expected to have ALD Al2O3 exposed at dielectric boundaries that delineate electrode sites. Process improvements and use of different inorganic coatings to decrease dissolution in physiological fluids may improve performance. Testing frameworks which take neural electrode complexities into account will be well suited to reliably evaluate such encapsulation schemes.

Aluminum oxide air abrasion particles: a bacteriologic and SEM study.

OBJECTIVE: The objective is to determine if aerobic and anaerobic sampling yields viable biologic contaminants in the aluminum oxide air abrasion powder as delivered by the manufacturer and to determine mean particle size for comparison with the published size from manufacturers and the range of sizes in the powders. METHOD AND MATERIALS: Samples from 15 unopened aluminum oxide powder containers from 9 different manufacturers were plated on aerobic and anaerobic culture media. The cultures were incubated at 35 degrees C and observed at 24-hour intervals. Samples of each of the 15 groups were subjected to scanning electron microscope (SEM) examination. Photomicrographs were obtained and a range and mean particle size determined. RESULTS: Aerobic and anaerobic cultures demonstrated no growth in any of the samples. Mean particle size determined by SEM for 25- to 27.5-micron particles ranged from 27.3 microns to 32.0 microns with standard deviations from 1.06 microns to 7.70 microns. Mean particle size for 50 microns particles ranged from 51.6 microns to 59.7 microns with standard deviations of 5.48 microns to 14.80 microns. CONCLUSION: Aluminum oxide powders as delivered by manufacturers appeared to be free from viable microorganisms. The powder mean particle sizes approximate the labeled sizes closely enough such that they should perform properly in air abrasion tooth preparation.

[Utilization of a porous alumina ceramic spacer in tibial valgus open-wedge osteotomy: fifty cases at 16 months mean follow-up]. / Utilisation d'une cale en céramique d'alumine poreuse dans l'ostéotomie tibiale de valgisation par ouverture interne: cinquante cas avec un recul moyen de 16 mois.

PURPOSE OF THE STUDY: The aim of this work was to study the behavior of an inert porous alumina ceramic spacer used with a plate fixation for open-wedge tibial valgus osteotomy in patients with osteoarthritis of the knee and genu varum. MATERIAL AND METHODS: The population included 50 patients who underwent surgery between October 1994 and December 2000. There were 31 women and 19 men, mean age 55 years at surgery (26 right knees and 24 left knees). Patients were reviewed at 3 weeks, 6 weeks, 3 months, 6 months, and one year, then every 2 years. Clinical and radiological data were available for all patients. RESULTS: Mean follow-up was 16 months. Two patients were lost to follow-up at 5 and 6 months. The results of the open-wedge tibial osteotomy were in agreement with the usual outcome reported in the literature concerning pain relief, functional recovery, joint motion, angle correction, and good preservation of the clinical and radiological result. Three fracture lines were observed on the lateral tibial plateau but did not affect final outcome or angle correction. There was however one case with loss of correction due to fracture of the screws. Radiographically, at 6 months, there were 9 thin lucent lines around the spacer (24%) which did not affect final outcome. Bone healing was achieved at 3 months on the average in all cases except 2 (4%) where healing was achieved at 8 and 13 months. DISCUSSION: The porous alumine spacer is a reliable biocompatible and mechanically stable element helpful for achieving bone healing. Integration into bone tissue was radiographically satisfactory. There were no specific complications related to use of the spacer.

[An evaluation of completely ceramic crowns]. / Een evaluatie van volledig porseleinen kronen.

All-ceramic crowns (Cerestore by Johnson & Johnson) were made on premolars and molars following two procedures: the finishing line was a straight shoulder or a hollow chamber. In vivo replicas were made of the marginal zone on the buccal and on the lingual side. The replicas were studied with scanning electron microscopy. Results showed a relatively large variability in marginal discrepancy in the same crown margin ranging from 12.2 mm to 134.3 mm. In a second series of crowns even discrepancies up to 232.7 mm have been measured. The discrepancy slightly increased after cementation. Several crowns fractured during the try-on session. No crowns fractured after cementation in a six months' interval. The gingiva surrounding the crowns remained healthy. The esthetic results were sometimes poor due to the whitish core not covered by porcelain. This study suggests that the Cerestore crowns are acceptable as a solitary restoration in premolar and molar region but that both esthetics and marginal fit can be improved.

[Biomechanical testing of DIAKOR implants by photoelastic stress analysis]. / DIAKOR implantátumok biomechanikai vizsgálata feszültségoptikai módszer segítségével.

Diakor aluminium oxide implants of different forms and sizes have been investigated and compared by photoelastic stress analysis. On forming the conditions of investigations the authors aimed at the modelization based upon the physiological direct implant-bone contact, installing implants having resin that is optically double refractive. In the sample results show a move advantageous stress relation at multi grooved implants of extended dimensions.

Shear bond strengths between alumina-toughened zirconia cores and veneering ceramics and their susceptibility to aging.

OBJECTIVE: To evaluate the shear bond strength (SBS) between alumina-toughened zirconia (ATZ) cores and veneering ceramics, investigate the effect of aging in artificial saliva on SBS and compare it with that of yttria-stabilized tetragonal zirconia polycrystals(Y-TZP). METHODS: Bars of ATZ and Y-TZP were layered with veneering ceramics in accordance to the recommendation of the manufacturer. Half of each group (n = 10) was aged at 134 °C (under 2 bar pressure) in an autoclave for 48 h. Subsequently, all specimens were subjected to shear force in a universal testing machine. The interface and fractured surface of the specimens were evaluated using scanning electron microscopy and X-ray energy dispersive spectroscopy. RESULTS: The initial mean SBS values in MPa±SD were 28.9±8.0 for ATZ and 26.2±7.6 for Y-TZP. After aging, the mean SBS values for ATZ and Y-TZP were 22.9±4.9 MPa and 22.8±6.9 MPa, respectively. Neither the differences between the SBS values of the ATZ and Y-TZP groups nor the influence of aging on all groups were statistically significant. CONCLUSIONS: The SBS between the ATZ core and the veneering ceramics was not affected by aging. The SBS of ATZ to veneering ceramics was not significantly different compared with that of Y-TZP.

Dependence of radon emanation of red mud bauxite processing wastes on heat treatment.

Natural radioactivity content, radon emanation and some other physical characteristics of red mud were investigated, so that to identify the possibilities of the safe utilization of such material as a building material additive. Based on the radionuclide concentration, red mud is not permitted to be used directly as a building material, however, mixing of a maximum 20% red mud and 80% clay meets the requirements. The main aim of this work was to determine the dependence of the emanation factor of red mud firing temperature and some other parameters. The relevant experimental procedure was carried out in two different ways: without any additional material, and by adding a known amount of sawdust (5-35 wt%) then firing the sample at a given temperature (100-1000 degrees C). The average emanation factor of the untreated dry red mud was estimated to 20%, which decreased to about 5% at a certain heat treatment. Even lower values were found using semi-reductive atmosphere. It has been concluded that all emanation measurements results correlate well to the firing temperature, the specific surface and the pore volume.

Low wear and friction in alumina/alumina total hip joints: a hip simulator study.

We studied the wear of state-of-the-art alumina/alumina total hip joints with the uniaxial five-station, and the three-axis single-station hip joint simulators of Helsinki University of Technology. The diameters of the joints were 26, 28 and 32 mm. Visual examination and weighing of the components showed no wear. Scanning electron microscopy showed that (a) the wear marks were slight, consisting of removal of grains, multidirectional grooving and mild abrasion, (b) the wear mechanisms were similar to those seen in components removed from patients, and (c) there was no marked difference in the specimens worn in the uniaxial vs. three-axis simulator. The coefficient of friction was measured throughout the 5 million cycle wear test with the three-axis simulator. The average value was 0.007. We conclude that alumina/alumina joints had low wear and friction under the present test conditions. The results are promising, since minimal wear is one of the prerequisites for long-term success in prosthetic joints.

Standard addition method applied to solid-state stripping voltammetry: determination of zirconium in minerals and ceramic materials.

An application of the standard addition method to stripping voltammetry of solid materials immobilized in inert electrodes is described. The method allows the determination of the mass fraction of a depositable metal M in a material on addition of known amounts of a standard material containing M to a mixture of that material and a reference compound of a second depositable metal, R. After a reductive deposition step, voltammograms recorded for those modified electrodes immersed in a suitable electrolyte produce stripping peaks for the oxidation of the deposits of M and R. If no intermetallic effects appear the quotients between the peak areas and the peak currents for the stripping oxidation of M and R vary linearly with the mass ratio of the added standard and the reference compound, thus providing an electrochemical method for determining the amount of M in the sample. The method has been applied to the determination of Zr in minerals, ceramic frits, and pigments, using ZnO as reference material and ZrO(2) as the standard.

A comparison of the marginal fit of In-Ceram, IPS Empress, and Procera crowns.

The in vitro marginal fit of three all-ceramic crown systems (In-Ceram, Procera, and IPS Empress) was compared. All crown systems were significantly different from each other at P = 0.05. In-Ceram exhibited the greatest marginal discrepancy (161 microns), followed by Procera (83 microns), and IPS Empress (63 microns). There were no significant differences among the various stages of the crown fabrication: core fabrication, porcelain veneering, and glazing. The facial and lingual margins exhibited significantly larger marginal discrepancies than the mesial and distal margins.

Metal release from total hip articulations in vitro: substantial from CoCr/CoCr, negligible from CoCr/PE and alumina/PE.

We used a hip joint simulator to compare the metal release from CoCr/CoCr, CoCr/PE, and alumina/PE total hip articulations. The metal release was quantified by analyzing the Co, Cr, and Ni contents of the bovine serum lubricant used with atomic absorption spectroscopy. CoCr/CoCr articulations released substantial amounts of metal, whereas CoCr/PE was equal to the control, alumina/PE, in that metal release was negligible. The metal release was in accordance with the known clinical wear rates of CoCr/CoCr articulations. The largest dimensional changes occurred in polyethylene cups, the penetrations of CoCr heads to the polyethylene cups being twice that of the alumina head, which is consistent with clinical experience. The research on the wear behavior of different materials, aiming to find a prosthesis with negligible wear, needs to be continued. Due to the substantial metal release, the CoCr/CoCr articulation is hardly the final solution of the wear problem in total hip arthroplasty.

Impact resistance of ceramic brackets according to ophthalmic lenses standards.

The overall resistance to accidental blows of the many ceramic brackets that are sold today has not been explored. Facing a similar diversity, the eyeglasses industry has chosen to standardize the testing of lenses by subjecting them to the drop of a steel ball. By slightly modifying this test, 10 brands of ceramic brackets were examined. In most cases, the findings coincided with those found by other authors when duplicating debonding. Thus, polycrystalline ceramics with bulkier structures and glazed surfaces were found to be more resistant to impact than the monocrystalline brackets, the loftier real "twins," and the less dense attachments. Protruding tie wings and bases were liabilities, and domed configurations seemed to deflect the blows. Bulkier "single" designs alone did not offer a guarantee of impact resistance when not accompanied by an appropriate microstructure and a smooth surface. The ceramic brackets most resistant to impact were found to be 20/20 by American Orthodontics and Fascination by Dentaurum. Medium resistance was displayed by Lumina by Ormco, Allure III and Allure by GAC, Transcend 2000 and Transcend by Unitek/3M; the last was not as good as the other four. The least resistant were Illusion by Ortho-Organizers, Intrigue by Lancer Orthodontics, and Starfire TMB by "A"-Co. Probably because of its real twin design, the last bracket lends itself to the highest probability for accidental breakage. Although resistance to impact and accidental debonding is desirable from the point of view of treatment, the advantage should be weighted against the chance of enamel fracture. Indeed a weak bracket attached with a soft adhesive may be preferable when the chance of an increased exposure to accidental blows is probable. In such cases, the ceramic may take the brunt of the force, instead of the tooth.

Cora rotary pump for implantable left ventricular assist device: biomaterial aspects.

Our group is developing a left ventricular assist device based on the principle of the Maillard-Wankel rotative compressor: it is a rotary, not centrifugal, pump that produces a pulsatile flow. Stringent requirements have been defined for construction materials. They must be light, yet sufficiently hard and rigid, and able to be machined with high precision. The friction coefficient must be low and the wear resistance high. The materials must be chemically inert and not deformable. Also, the materials must be biocompatible, and the blood contacting surface must be hemocompatible. We assessed the materials in terms of physiochemistry, mechanics, and tribology to select the best for hemocompatibility (determined by studies of protein adsorption; platelet, leukocyte, and red cell retention; and hemolysis, among other measurements) and biocompatibility (determined by measurement of complement activation and toxicity, among other criteria). Of the materials tested, for short- and middle-term assistance, we chose titanium alloy (Ti6Al4V) and alumina ceramic (Al2O3) and for long-term and permanent use, composite materials (TiN coating on graphite). We saw that the polishing process of the substrate must be improved. For the future, the best coating material would be diamond-like carbon (DLC) or crystalline diamond coating.