Nanoscale properties and deformation of human enamel and dentin.

This research uses quasi-static nanoindentation and nanoscratching to quantify human tooth deformation as a function of enamel rod and dentin tubule orientations at the nanoscale. Nanoindentation tests were performed on enamel and dentin to determine elastic modulus, hardness, and observe fracture. Additionally, nanoscratch tests were performed to determine pileup geometry and parameters such as recovery, scratch hardness, and scratch roughness. In enamel, it was found that nanofiber orientation gives rise to unique microcrack propagation and nanofiber behavior that affect these properties. For dentin, densification and organic content affect these properties.

Sensitivity of corneal biomechanical and optical behavior to material parameters using design of experiments method.

The optical performance of the human cornea under intraocular pressure (IOP) is the result of complex material properties and their interactions. The measurement of the numerous material parameters that define this material behavior may be key in the refinement of patient-specific models. The goal of this study was to investigate the relative contribution of these parameters to the biomechanical and optical responses of human cornea predicted by a widely accepted anisotropic hyperelastic finite element model, with regional variations in the alignment of fibers. Design of experiments methods were used to quantify the relative importance of material properties including matrix stiffness, fiber stiffness, fiber nonlinearity and fiber dispersion under physiological IOP. Our sensitivity results showed that corneal apical displacement was influenced nearly evenly by matrix stiffness, fiber stiffness and nonlinearity. However, the variations in corneal optical aberrations (refractive power and spherical aberration) were primarily dependent on the value of the matrix stiffness. The optical aberrations predicted by variations in this material parameter were sufficiently large to predict clinically important changes in retinal image quality. Therefore, well-characterized individual variations in matrix stiffness could be critical in cornea modeling in order to reliably predict optical behavior under different IOPs or after corneal surgery.

Multivariate evaluation of the cutting performance of rotary instruments with electric and air-turbine handpieces.

STATEMENT OF PROBLEM: Laboratory studies of tooth preparation often involve single values for all variables other than the one being tested. In contrast, in clinical settings, not all variables can be adequately controlled. For example, a new dental rotary cutting instrument may be tested in the laboratory by making a specific cut with a fixed force, but, in clinical practice, the instrument must make different cuts with individual dentists applying different forces. Therefore, the broad applicability of laboratory results to diverse clinical conditions is uncertain and the comparison of effects across studies difficult. PURPOSE: The purpose of this in vitro study was to examine the effects of 9 process variables on the dental cutting of rotary cutting instruments used with an electric handpiece and compare them with those of a previous study that used an air-turbine handpiece. MATERIAL AND METHODS: The effects of 9 key process variables on the efficiency of a simulated dental cutting operation were measured. A fractional factorial experiment was conducted by using an electric handpiece in a computer-controlled, dedicated testing apparatus to simulate dental cutting procedures with Macor blocks as the cutting substrate. Analysis of variance (ANOVA) was used to assess the statistical significance (α=.05). RESULTS: Four variables (targeted applied load, cut length, diamond grit size, and cut type) consistently produced large, statistically significant effects, whereas 5 variables (rotation per minute, number of cooling ports, rotary cutting instrument diameter, disposability, and water flow rate) produced relatively small, statistically insignificant effects. These results are generally similar to those previously found for an air-turbine handpiece. CONCLUSIONS: Regardless of whether an electric or air-turbine handpiece was used, the control exerted by the dentist, simulated in this study by targeting a specific level of applied force, was the single most important factor affecting cutting efficiency. Cutting efficiency was also significantly affected by factors simulating patient/clinical circumstances and hardware choices. These results highlight the greater importance of local clinical conditions (procedure, dentist) in understanding dental cutting as opposed to other hardware-related factors.

Designed experiment evaluation of key variables affecting the cutting performance of rotary instruments.

STATEMENT OF PROBLEM: Laboratory studies of tooth preparation are often performed under a limited range of conditions involving single values for all variables other than the 1 being tested. In contrast, in clinical settings not all variables can be tightly controlled. For example, a new dental rotary cutting instrument may be tested in the laboratory by making a specific cut with a fixed force, but in clinical practice, the instrument must make different cuts with individual dentists applying a range of different forces. Therefore, the broad applicability of laboratory results to diverse clinical conditions is uncertain and the comparison of effects across studies is difficult. PURPOSE: The purpose of this study was to examine the effect of 9 process variables on dental cutting in a single experiment, allowing each variable to be robustly tested over a range of values for the other 8 and permitting a direct comparison of the relative importance of each on the cutting process. MATERIAL AND METHODS: The effects of 9 key process variables on the efficiency of a simulated dental cutting operation were measured. A fractional factorial experiment was conducted by using a computer-controlled, dedicated testing apparatus to simulate dental cutting procedures and Macor blocks as the cutting substrate. Analysis of Variance (ANOVA) was used to judge the statistical significance (α=.05). RESULTS: Five variables consistently produced large, statistically significant effects (target applied load, cut length, starting rpm, diamond grit size, and cut type), while 4 variables produced relatively small, statistically insignificant effects (number of cooling ports, rotary cutting instrument diameter, disposability, and water flow rate). CONCLUSIONS: The control exerted by the dentist, simulated in this study by targeting a specific level of applied force, was the single most important factor affecting cutting efficiency. Cutting efficiency was also significantly affected by factors simulating patient/clinical circumstances as well as hardware choices. These results highlight the importance of local clinical conditions (procedure, dentist) in understanding dental cutting procedures and in designing adequate experimental methodologies for future studies.

Performance of single-use and multiuse diamond rotary cutting instruments with turbine and electric handpieces.

STATEMENT OF PROBLEM: As single-use rotary cutting instruments and electric handpieces become more available, the performance of these instruments with electric as compared to turbine handpieces requires evaluation. In addition, if rotary cutting instruments marketed as single-use instruments are used for multiple patients, the effects on their performance of cleaning, sterilization, and repeated use are of interest to the clinician. PURPOSE: The purpose of the study was to evaluate how the cleaning, autoclaving, and repeated use of single-use and multiuse rotary cutting instruments, with either a turbine or electric handpiece, affected their performance. MATERIAL AND METHODS: The effects on cutting performance of 2 handpieces (turbine and electric), 2 cleaning and sterilization conditions (cleaned and autoclaved versus noncleaned and nonautoclaved), and 6 different diamond rotary cutting instruments (4 single-use and 2 multiuse) during simulated tooth preparations were evaluated by using a 24-treatment condition full-factorial experimental design. A computer-controlled dedicated testing apparatus was used to simulate the cutting procedures, and machinable glass ceramic blocks were used as the cutting substrate for tangential cuts. In addition, for each treatment condition, 8 consecutive cuts, for a total of 192 cuts, were measured to assess the durability of the rotary cutting instruments. A linear mixed model was used to study the effect of instrument type, handpiece, cleaning, and sterilization, as well as the status and number of cuts on the outcome variables. The Tukey honestly significant difference test was used for the post hoc pairwise comparisons (α=.05). RESULTS: Performance, as measured by the rate of advancement, decreased with the repeated use of rotary cutting instruments (P<.001), while cleaning and sterilization procedures improved the average performance of the 8 cuts (P=.002). The electric handpiece showed a greater load than the turbine (P<.001) and a lower rate/load metric, but no differences in the rate of advancement. Significant differences were also detected among the different rotary cutting instruments tested with the Two Striper, which showed the highest cumulative performance of all groups. CONCLUSIONS: The repeated use of both single-use and multiuse rotary cutting instruments decreased cutting performance. The use of a cleaning and sterilization procedure between cuts improved the average cutting performance. During a tangential cutting process, although the ease of advancement (rate/load) was greater for the turbine, the electric handpiece did not produce a statistically different cutting rate.

In vitro comparison of the cutting efficiency and temperature production of ten different rotary cutting instruments. Part II: electric handpiece and comparison with turbine.

STATEMENT OF PROBLEM: The cutting behavior of dental rotary cutting instruments is influenced by the handpiece used. While the turbine handpiece has been extensively tested in previous studies, limited published information exists on the use of rotary cutting instruments with the electric handpiece system and on possible interactions between rotary cutting instruments and handpiece type. PURPOSE: The purpose of this study was to examine the cutting performance of a wide selection of rotary cutting instruments tested with the electric handpiece and compare the results with those of the air-turbine handpiece (Part I), identifying possible interactions between handpiece type and rotary cutting instruments. MATERIAL AND METHODS: Ten groups of rotary cutting instruments (n=30) designed for tooth preparation were selected: 9 diamond (7 multi-use, 2 disposable) and 1 carbide. Macor blocks (n=75) were used as a substrate, and 4 cuts were made on each specimen, using a new rotary cutting instrument each time, for a total of 300 cuts. The cuts were performed with an electric handpiece (Intramatic Lux K200), with the same methods used in the Part I study. To qualitatively evaluate the rotary cutting instrument surface characteristics, 1 specimen from each group was examined 3 times with a scanning electron microscope (SEM): before use, then after use, but before being cleaned and sterilized, and finally, after ultrasonic cleaning. To compare rotary cutting instrument performance between the turbine and electric handpieces, the data were analyzed using 2-way ANOVA to study the main effects of the group of rotary cutting instruments, handpieces, and their interaction. For analysis of the significant main effect, 1-way ANOVA and Tukey's Studentized Range test were used (alpha=.05). RESULTS: Compared to the baseline temperature, all rotary cutting instruments showed a reduction of the temperature in the simulated pulp chamber when tested with the electric handpiece. The Great White Ultra (carbide bur) showed the highest rate of advancement (0.17 mm/s) and lowest applied load (108.35 g). Considering all rotary cutting instruments as a single group, the electric handpiece showed mean lower temperature (26.68 degrees C), higher rate of advancement (0.12 mm/s), and higher load (124.53 g) than the air-turbine handpiece (28.37 degrees C, 0.11 mm/s, and 121.7 g, respectively). Considering each single group of rotary cutting instruments, significant differences were found for the electric or air-turbine handpiece. CONCLUSIONS: The tested carbide bur showed greater cutting efficiency than the tested diamond rotary cutting instruments when used with the electric handpiece. The electric handpiece showed a higher cutting efficiency than the turbine, especially when used with the carbide bur, probably due to its greater torque.

In vitro comparison of the cutting efficiency and temperature production of 10 different rotary cutting instruments. Part I: Turbine.

STATEMENT OF PROBLEM: Standards to test the cutting efficiency of dental rotary cutting instruments are either nonexistent or inappropriate, and knowledge of the factors that affect their cutting performance is limited. Therefore, rotary cutting instruments for crown preparation are generally marketed with weak or unsupported claims of superior performance. PURPOSE: The purpose of this study was to examine the cutting behavior of a wide selection of rotary cutting instruments under carefully controlled and reproducible conditions with an air-turbine handpiece. MATERIAL AND METHODS: Ten groups of rotary cutting instruments (n=30) designed for tooth preparation were selected: 9 diamond rotary cutting instruments (7 multi-use, 2 disposable) and 1 carbide bur. One bur per group was imaged with a scanning electron microscope (SEM) at different magnifications. Macor blocks (n=75) were used as a substrate, and 4 cuts were made on each specimen, using a new rotary cutting instrument each time, for a total of 300 cuts. The cuts were performed with an air-turbine handpiece (Midwest Quiet Air). A computer-controlled, custom-made testing apparatus was used to monitor all sensors and control the cutting action. The data were analyzed to compare the correlation of rotary cutting instrument type, grit, amount of pressure, cutting rate, revolutions per minute (rpm), temperature, and type of handpiece, using 1-way ANOVA and Tukey's Studentized Range test (alpha=.05). RESULTS: Compared to the baseline temperature, all rotary cutting instruments showed a reduction of temperature in the simulated pulp chamber. The Great White Ultra (carbide bur) showed a significantly higher rate of advancement (0.15 mm/s) and lower applied load (106.46 g) and rpm (304,375.97). CONCLUSIONS: Tooth preparation with an adequate water flow does not cause harmful temperature changes in the pulp chamber, regardless of rotary cutting instrument type. The tested carbide bur showed greater cutting efficiency than all diamond rotary cutting instruments.

Effect of subgingival depth of implant placement on the dimensional accuracy of the implant impression: an in vitro study.

STATEMENT OF PROBLEM: In some instances, an implant needs to be placed deep subgingivally, which may result in a less accurate impression of the implant. PURPOSE.: The purpose of this study was to evaluate the effect of subgingival depth of implant placement on the accuracy of implant impressions. MATERIAL AND METHODS: A stone master model was fabricated with 5 implant analogs (RN synOcta analog), embedded parallel to each other, at the center (E) and the 4 corners (A, B, C, and D). The vertical position of the shoulders of the implants was intentionally different among the implants: A and E were flush with the top surface of the model; B was 2 mm below, and C and D were 4 mm below the surface. The horizontal distances of implants A, B, C, and D from E were measured with a measuring microscope. A cross-shaped metal measuring bar was then fabricated and connected to E, with the arms of the casting designed to be 2 mm above the top surface of the model and incorporating a reference mark. With the measuring bar connected to E, the vertical distances from the apical surface of A, B, C, and D to the measuring reference marks were measured with a digital micrometer. The body of the impression coping for implant D was modified by adding 4 mm of additional impression coping, while standard impression copings were used for all other implants. Open tray impressions were made using medium-body polyether material (Impregum Penta) or a combination of putty and light-body vinyl polysiloxane (VPS) material (Elite HD+) (n=15). Then casts were poured with type IV dental stone. The vertical and horizontal distances of the casts were measured with the methods outlined above for the master model. The distortion values that were determined as differences between the measurements of the master model and those of the casts were collected for statistical analysis. Two-way and 1-way repeated measures ANOVA followed by Tukey's HSD test were performed to compare the distortion values (alpha=.05). RESULTS: For vertical measurements, 2-way repeated measures ANOVA showed no significant depth (P=.36), material (P=.24), or interaction effects (P=.06). However, it showed significant depth effect for horizontal measurements (P=.01). Within the polyether group, 1-way repeated measures ANOVA showed significant differences in horizontal measurements among the implants with different depths (P=.03). The post hoc Tukey's test showed that the impression of 4-mm-deep implants with normal impression copings (C) was significantly less accurate than impressions of 0-mm-deep implants (A) (P=.02). Within the VPS group, there was no significant difference among the implants with different depths (P=.09). CONCLUSIONS: There was no effect of implant depth on the accuracy of the VPS group. However, for the polyether group, the impression of an implant placed 4 mm subgingivally showed a greater horizontal distortion compared to an implant placed more coronally. Adding a 4-mm extension to the retentive part of the impression coping eliminated this difference.

Measurement of the rotational misfit and implant-abutment gap of all-ceramic abutments.

PURPOSE: The specific aims of this study were to measure the implant and abutment hexagonal dimensions, to measure the rotational misfit between implant and abutments, and to correlate the dimension of the gap present between the abutment and implant hexagons with the rotational misfit of 5 abutment-implant combinations from 2 manufacturers. MATERIALS AND METHODS: Twenty new externally hexed implants (n = 10 for Nobel Biocare; n = 10 for Biomet/3i) and 50 new abutments were used (n = 10; Procera Zirconia; Procera Alumina; Esthetic Ceramic Abutment; ZiReal; and GingiHue post ZR Zero Rotation abutments). The mating surfaces of all implants and abutments were imaged with a scanning electron microscope before and after rotational misfit measurements. The distances between the corners and center of the implant and abutment hexagon were calculated by entering their x and y coordinates, measured on a measuring microscope, into Pythagoras' theorem. The dimensional difference between abutment and implant hexagons was calculated and correlated with the rotational misfit, which was recorded using a precision optical encoder. Each abutment was rotated (3 times/session) clockwise and counterclockwise until binding. Analysis of variance and Student-Newman-Keuls tests were used to compare rotational misfit among groups (alpha = .05). RESULTS: With respect to rotational misfit, the abutment groups were significantly different from one another (P < .001), with the exception of the Procera Zirconia and Esthetic Ceramic groups (P = .4). The mean rotational misfits in degrees were 4.13 +/- 0.68 for the Procera Zirconia group, 3.92 +/- 0.62 for the Procera Alumina group, 4.10 +/- 0.67 for the Esthetic Ceramic group, 3.48 +/- 0.40 for the ZiReal group, and 1.61 +/- 0.24 for the GingiHue post ZR group. There was no correlation between the mean implant-abutment gap and rotational misfit. CONCLUSIONS: Within the limits of this study, machining inconsistencies of the hexagons were found for all implants and abutments tested. The GingiHue Post showed the smallest rotational misfit. All-ceramic abutments without a metal collar showed a greater rotational misfit than those with a metal collar.

Sensitivities of medial meniscal motion and deformation to material properties of articular cartilage, meniscus and meniscal attachments using design of experiments methods.

This study investigated the role of the material properties assumed for articular cartilage, meniscus and meniscal attachments on the fit of a finite element model (FEM) to experimental data for meniscal motion and deformation due to an anterior tibial loading of 45 N in the anterior cruciate ligament-deficient knee. Taguchi style L18 orthogonal arrays were used to identify the most significant factors for further examination. A central composite design was then employed to develop a mathematical model for predicting the fit of the FEM to the experimental data as a function of the material properties and to identify the material property selections that optimize the fit. The cartilage was modeled as isotropic elastic material, the meniscus was modeled as transversely isotropic elastic material, and meniscal horn and the peripheral attachments were modeled as noncompressive and nonlinear in tension spring elements. The ability of the FEM to reproduce the experimentally measured meniscal motion and deformation was most strongly dependent on the initial strain of the meniscal horn attachments (epsilon(1H)), the linear modulus of the meniscal peripheral attachments (E(P)) and the ratio of meniscal moduli in the circumferential and transverse directions (E(theta)E(R)). Our study also successfully identified values for these critical material properties (epsilon(1H) = -5%, E(P) = 5.6 MPa, E(theta)E(R) = 20) to minimize the error in the FEM analysis of experimental results. This study illustrates the most important material properties for future experimental studies, and suggests that modeling work of meniscus, while retaining transverse isotropy, should also focus on the potential influence of nonlinear properties and inhomogeneity.

The influence of drill wear on cutting efficiency and heat production during osteotomy preparation for dental implants: a study of drill durability.

PURPOSE: The authors evaluated, under conditions simulating implant placement, the cutting efficiency, durability, heat production, and wear of implant drills. MATERIALS AND METHODS: Osteotomies were performed on bovine ribs using a surgical unit mounted in a testing apparatus. A software program controlled the apparatus and recorded temperatures, depths, and drilling times. Seven brands of drills were tested (Nobel Biocare, 3i/Implant Innovations, Steri-Oss, Paragon, Implamed, Lifecore, and ITI). Spade, twist, tri-flute, and TiN-coated drill designs were evaluated and compared during 100 successive osteotomies. Scanning electron microscopic and energy-dispersive x-ray spectroscopic examinations were performed, and hardness was measured. RESULTS: Two 2-mm drills (Nobel Biocare and 3i/Implant Innovations) had mean removal rates significantly greater than the others (P < .05). The 2-mm twist drill design with a low hardness (Implamed) exhibited plastic deformation at the cutting edge, loss of cutting efficiency, and drill fracture. The TiN-coated drills (Steri-Oss and Paragon) showed greater wear and significantly lower removal rates (P < .05) than noncoated drills. Temperature increases with different drills were not significantly different at depths of 5 or 15 mm or between 2-mm or 3-mm drills. With 1 exception (the 2.3-mm Paragon drill at a depth of 15 mm), the temperatures generated by the different types of drills were not significantly different. Clinically harmful temperatures were detected only at a depth of 15 mm during 5 osteotomies and coincided with a marked decrease in the rate of drill advancement with a resulting continuous drilling action. DISCUSSION: Temperatures generated at depths of 5 and 15 mm by the different drill types and diameters were not significantly different and, with only 5 exceptions, were clinically safe. Several differences between brands were noted in regard to cutting efficiency and durability, underscoring the importance of material selection and quality on drill performance. CONCLUSIONS: Drill design, material, and mechanical properties significantly affect cutting efficiency and durability. Coolant availability and temperature were the predominant factors in determining bone temperatures. Implant drills can be used several times without resulting in bone temperatures that are potentially harmful. Continuous drilling in deep osteotomies can produce local temperatures that might be harmful to the bone.

Tooth preparation: a study on the effect of different variables and a comparison between conventional and channeled diamond burs.

PURPOSE: The purpose of this study was to evaluate the different variables involved in tooth cutting to characterize intrapulpal temperature generation, cutting efficiency, and bur durability when using conventional and channeled diamond burs. MATERIALS AND METHODS: Forty premolars and 60 molars were selected for the study. Four diamond burs were paired according to grit size: 125-microm grit: Brasseler Coarse (Control 1) and TDA System (Test 1) burs; and 180-microm grit: Brasseler CRF (Control 2) and NTI Turbo Diamond (Test 2) burs. Each bur was used twice when cutting the premolar teeth, whereas it was used for 60 cuts when cutting the molar teeth. The data were analyzed to compare the correlation of bur design, grit and wear, amount of pressure, advancement rate, revolutions per minute, cutting time and rate, and proximity to the pulp chamber with intrapulpal temperature generation, cutting efficiency, and bur longevity. The mean values of test and control burs in each group were compared using an ANOVA (p < 0.05 for significant differences) for temperature generation and an ANOVA and the Tukey multiple range test (p< or = 0.05) for cutting efficiency and bur longevity. RESULTS: No significant difference was found in intrapulpal temperature generation while cutting premolar and molar teeth with conventional and channeled diamond burs. In both groups, the mean temperature recorded during and after the cutting procedure was lower than the baseline temperature. For premolar teeth, no significant difference was established for control and test burs for the load required to cut into the tooth and the cutting rate. However, both test burs showed significantly fewer revolutions per minute when compared to their control counterparts. For the molar teeth, the Brasseler CRF bur required a significantly lower cutting load when compared to the NTI bur, whereas no difference was noted between the other pair of burs. The cutting rate was significantly higher for both control burs, whereas revolutions per minute (rpm) were greater for control coarser burs only. Overall, channeled burs showed a significantly lower cutting efficiency when compared to conventionally designed burs. CONCLUSION: Within the limitations of this study, channeled burs showed no significant advantage over conventional diamond burs when evaluating temperature generation and bur durability. Moreover, the cutting efficiency of conventional burs was greater than that of channeled burs.

Verification jig for implant-supported prostheses: A comparison of standard impressions with verification jigs made of different materials.

STATEMENT OF PROBLEM: Implant verification jigs are routinely used during the fabrication of implant-supported prostheses. The dimensional accuracy of these jigs is unknown. PURPOSE: The purposes of this study were to (1) compare the dimensional accuracy of verification jigs with that of conventional impression procedures and (2) measure the dimensional accuracy of 3 resin materials used to fabricate verification jigs. MATERIALS AND METHODS: Thirty verification jigs and 20 impressions were made of 3 externally hexed Steri-Oss implants in a master stone base according to the following groups (n = 10 per group): (Group 1) Jig: GC pattern resin; (Group 2) Jig: Duralay resin; (Group 3) Jig: Triad gel resin; (Group 4) Impression: closed-tray impression copings; and (Group 5) Impression: open-tray impression copings. A stone base was fabricated for each experimental jig and impression. Master stone base and experimental stone bases were measured with the following methods: X and Y coordinates of each implant center were obtained with a traveling microscope by averaging the X and Y coordinates of the implant external hex corners. The origins of the coordinates during measurement of each base were arbitrary. Distances between implant center points were calculated by use of the Pythagorean theorem. Vertical measurements (Z-plane) were obtained with a digital caliper at the 2 terminal-implant locations. Interimplant distances and vertical measurements were subtracted from those of the master base, and the resultant distortion values were analyzed with analysis of variance and Tukey Studentized range tests. Statistical significance was set at P<.05. RESULTS: Verification jigs were not significantly more accurate than standard impression procedures. Open-tray impressions showed a significantly greater vertical distortion (Z-R location: 262 +/- 158 microm; P=.0001; Z-L location 333 +/- 189; P=.0001) compared with the other groups. Triad gel jigs showed a significantly greater distortion in one interimplant distance (C-L) than closed-tray impressions (P=.04), whereas Duralay jigs exhibited significant greater distortion than closed-tray and open-tray impressions in the interimplant distance R-C (P=.006). Although not significantly different from other groups, the closed-tray group showed the lowest mean distortion values in all measurements. CONCLUSION: Within the limitations of this study, the accuracy provided by verification jigs was not significantly superior to standard impression procedures. The results suggest that jig fabrication does not improve the dimensional accuracy of stone casts. Open-tray impressions showed a significantly greater inaccuracy in the vertical plane.