Comparison of mechanical and surface properties of two 3D printed composite resins for definitive restoration.

STATEMENT OF PROBLEM: Additive manufacturing (AM) technology is emerging as an innovative approach in the dental field. In recent years, manufacturers have introduced 3-dimensionally printed composite resins (3D-CRs) that are specifically designed for the AM of definitive prostheses; however, the mechanical and surface properties of these materials require investigation. PURPOSE: The purpose of this in vitro study was to assess and compare the mechanical and surface properties of 2 commercially available 3D-CRs for definitive restoration after artificial aging. MATERIAL AND METHODS: Saremco print Crowntec; Saremco Dental AG and Varseo Smile Crown Plus; Bego GmbH were printed with a layer thickness of 50 µm at a 90-degree angle. A total of 20 bar-shaped specimens (25×2×2 mm) were produced from each material to measure the flexural strength (σf) and elastic modulus (E) using a 3-point bend test, and 5 disk-shaped specimens (Ø15×3 mm) from each material were used to measure the surface microhardness using a microhardness test. Half of the specimens were tested under dry conditions, while the other half were immersed in distilled water for 30 days. Five disk-shaped specimens (Ø15×3 mm) from each material were used to evaluate surface roughness before and after undergoing toothbrushing simulations. Additionally, 5 disk-shaped specimens (Ø15×1 mm) were used to assess water sorption (wsp) and solubility (wsl) over 28 days. Statistical analyses were conducted using the Wilcoxon matched-pairs signed-rank test (1-tailed) with 90% power (α=.05). RESULTS: The mean ±standard deviation flexural strength values were 123.4 ±8.7 MPa for Saremco print Crowntec and 109.9 ±15.8 MPa for Varseo Smile Crown Plus. After aging, these values were 97.5 ±15.2 MPa for Saremco print Crowntec and 94.2 ±11.7 MPa for Varseo Smile Crown Plus. The mean Vickers hardness values were 33.2 ±0.8 N/mm2 for Saremco print Crowntec and 31.5 ±0.6 N/mm2 for Varseo Smile Crown Plus. After aging, the mean values were 31.7 ±0.9 N/mm2 for Saremco print Crowntec and 29.6 ±1.0 N/mm2 for Varseo Smile Crown Plus. The mean modulus of elasticity was 4.2 ±0.3 GPa for Saremco print Crowntec and 3.82 ±0.2 GPa for Varseo Smile Crown Plus. After 21 days, the mean sorption values were 11.52 ±0.6 mg/mm3 for Saremco print Crowntec and 12.43 ±0.4 mg/mm3 for Varseo Smile Crown Plus. After 28 days, the mean solubility values were 1.36 ±0.4 mg/mm3 for Saremco print Crowntec and 0.98 ±0.3 mg/mm3 for Varseo Smile Crown Plus. Significant differences were found between the 2 3D-CRs in flexural strength in the dry state (P=.03), in Young modulus after 30 days of water immersion (P=.023), and in Vickers hardness in the dry state (P=.01) and after 30 days of water immersion (P=.018). CONCLUSIONS: Both 3D-CRs provided good in vitro performance and the mechanical properties required for long-term clinical application. Artificial aging decreased the flexural strength of both 3D-CRs.

Fluoride Concentrations in Different Brands of Toothpaste Marketed in Saudi Arabia.

OBJECTIVES: This study aimed to evaluate the concentrations of total fluoride (TF), total soluble fluoride (TSF) and ionic fluoride (IF) in various toothpaste brands marketed in Saudi Arabia and compare them with the labelled values. METHODS: Twenty toothpaste brands were randomly selected from supermarkets and hypermarkets in Riyadh, Saudi Arabia. For each brand, two samples from different production batches were purchased and labelled as sample 1 and sample 2. TF and TSF were determined chemically, while IF was measured with fluoride electrodes. The measured fluoride concentrations were compared with the labelled values and the recommended 1000-1500 ppm range for effective caries prevention. RESULTS: In total, 40 toothpaste samples were analysed (20 from each of two batches). For TF, six toothpastes in sample 1 exceeded the standard limit of 1500 ppm, with a range of 2102-2462 ppm, while nine in sample 2 surpassed the limit, ranging from 1538 to 1846 ppm. Conversely, eight toothpastes in sample 1 and two in sample 2 were below the minimum recommended level of 1000 ppm, with ranges of 308-923 ppm and 615-923 ppm, respectively. The TSF ranged from 924 to 2157 ppm in sample 1 and 923-2154 ppm in sample 2. The IF varied from 615 to 2462 ppm in sample 1 and 308-2154 ppm in sample 2. CONCLUSIONS: Most toothpaste brands had fluoride levels within the recommended concentration range. However, a significant number exhibited fluoride levels either below the minimum effective dose or exceeding the maximum recommended limit. Fluoride variance in toothpaste demands awareness for dentists and public health to guide optimal caries prevention.

Surface Characteristics and Adhesion of Veneering Composite Resin to PAEK-Based Substructure Restorative Materials.

PURPOSE: To evaluate and compare the shear bond strength (SBS) of composite veneering material to polyetherketoneketone (PEKK), polyetheretherketone (PEEK), zirconia (YZ), and nickel-chromium alloy (NiCr) substructure restorative materials. MATERIALS AND METHODS: Forty samples (12 × 2 mm) were prepared from four materials: PEKK, PEEK, zirconia, and NiCr alloy (n = 10). The Vickers hardness was evaluated before preparing the surface for bonding by shot-blasting using 110 µm Al2 O3 particles. The surface roughness (Ra) of each sample was determined using a noncontact optical profilometer. The veneering resin was bonded onto each sample following primer application. The prepared samples were then subjected to an SBS test using a universal testing machine at 0.5 mm/min crosshead speed. Failure modes and surface topography following debonding were assessed. The data were statistically analyzed using ANOVA and Tukey's post-hoc comparison test (p < 0.05).  RESULTS: The highest and lowest mean surface roughness was observed in PEEK (3.45 ±0.13 µm) and NiCr (1.87 ±0.07 µm) materials, respectively. A significant difference in roughness values was observed between the materials except for NiCr and YZ (p = 0.547). Concerning SBS, PEEK and NiCr exhibited the highest (16.23 ±0.96 MPa) and lowest (10.1 ±0.63 MPa) values. The mean difference in SBS indicated a statistically significant difference between the material groups (p < 0.01). CONCLUSIONS: PEKK materials demonstrated significantly lower SBS than PEEK and significantly higher SBS values than conventional zirconia and alloy materials. A positive and significant correlation between mean roughness and SBS was observed, but the causality could be either intrinsic to the material or the roughness.

Evaluation of the design-driven prediction of removable partial denture retention.

STATEMENT OF PROBLEM: Removable partial dentures (RPDs) are a cost-effective treatment designed to replace missing teeth for partially edentulous patients. However, RPDs often have insufficient retention, which results in treatment failure and patient dissatisfaction. PURPOSE: The purpose of this clinical study was to investigate the factors related to RPD retention that affect patient satisfaction, to clinically validate a newly published model for predicting RPD retention based on the number and position of missing teeth and clasps, and to identify the predictions of patient satisfaction to improve the guidelines for RPD design. MATERIAL AND METHODS: Seventy-five patients treated with 107 RPDs delivered at the McGill University Dental Clinic (Montreal, Canada) and Estaing University Hospital (Clermont-Ferrand, France) participated in this study. Data on the RPD design were collected from the clinical records, and the retention of each RPD was tested with the mathematical model designed for predicting RPD retention. Data on patient satisfaction with their RPDs were collected by using a standardized questionnaire (McGill Denture Satisfaction Instrument). Statistical analysis of factors related to RPD retention and patient satisfaction was performed by using the chi-square test and Mann-Whitney test, while the developed model for predicting RPD retention was evaluated by using sensitivity and specificity analysis. RESULTS: The average satisfaction score for all RPDs was 8.2 ±1.7 out of 10. Patients were more satisfied with RPDs in the maxillary arch, tooth-supported, or retained by ≥3 clasps than with RPDs in the mandibular arch, with distal extension bases, or retained by <3 clasps. The materials used for RPD fabrication (metal-based or acrylic resin-based), the number of missing teeth, and the presence of indirect retention were not associated with patient satisfaction. Participants were significantly more satisfied with RPD designs predicted by the developed mathematical model to have enough retention than with RPD designs predicted to have insufficient retention. The mathematical model for predicting the RPD retention showed a clinical specificity of 83% in predicting patient satisfaction. CONCLUSIONS: RPD retention predicted from the number and position of clasps and missing teeth might help to determine patient satisfaction. In addition, patient satisfaction with RPDs was influenced by the arch type, the presence of a distal extension base, and the number of clasps.

Biocompatibility and Durability of Diazonium Adhesives on Dental Alloys.

PURPOSE: A new type of diazonium-based adhesive has been recently developed by our team to bind dental alloys (Titanium, stainless steel, and cobalt chromium) to dental polymers. Here, we explored the endurance of the resulting adhesive after thermal-cycling and autoclave aging. MATERIALS AND METHODS: Polished samples of titanium (Ti), stainless steel (SS) and cobalt chromium (Co-Cr) were coated with a diazonium-based adhesive. Untreated samples served as controls (n = 12 per each condition). X-ray photoelectron spectroscopy (XPS) was performed to characterize the elemental compositions of the different surfaces. Biocompatibility of the coated alloys was assessed with human gingival fibroblasts (HGF). Inductively coupled plasma (ICP) and total organic carbon (TOC) analyses were used to quantify the ions and organic matters released from the diazonium coated alloys. Endurance of the adhesives was assessed by exposing the samples to autoclaving and thermal-cycling. The tensile strength of the poly(methylmethacrylate) (PMMA)-alloy bond was also tested. RESULTS: Results of mechanical testing demonstrated a higher endurance of the coated CoCr, Ti, and SS compared to the uncoated alloys. The human fibroblasts cultured on the substrates remained alive and metabolically active, and the coatings did not release significant amounts of toxic chemicals in solutions. CONCLUSIONS: The results further support the use of diazonium-based adhesives as new coupling agents for dental applications.

Determining the retention of removable partial dentures.

STATEMENT OF PROBLEM: Removable partial dentures (RPDs) provide a cost-effective treatment for millions of partially edentulous patients worldwide. However, they often fail because of loss of retention. One reason for this problem is lack of precise guidelines for designing retentive RPDs. PURPOSE: The purpose of this in vitro study was to determine the forces produced by food and clasps during mastication to develop an algorithm for predicting RPD retention and to help determine the optimal number of clasps. MATERIAL AND METHODS: The forces that food exerts on acrylic resin teeth during simulated mastication and the retention forces provided by clasps (wrought wire, circumferential, and I-bar) engaging on teeth were measured using a universal testing machine. A statistical analysis was performed with a 1-way ANOVA and repeated-measures ANOVA while the developed algorithm was evaluated by using sensitivity and specificity analysis. RESULTS: The force exerted by food mastication on each individual tooth ranged between 1.7 and 12.2 N, depending on the type of tooth, tooth anatomy, occlusion, and food. The retention force of the clasps after cyclic testing ranged between 2.9 and 14.5 N, depending on the type of tooth abutment and clasp. Using these measurements, an algorithm was developed to predict RPD retention. The algorithm was confirmed experimentally on 36 RPDs, showing a sensitivity of 96%, specificity of 100%, and an accuracy of 97%. CONCLUSIONS: The forces generated by food mastication on teeth varied according to the type of tooth, occlusion, and food. The retention force of RPD clasps varied according to the type of tooth and clasp. An algorithm for predicting RPD retention and determining the optimal number of clasps was developed and validated experimentally.

Patient satisfaction with laser-sintered removable partial dentures: A crossover pilot clinical trial.

STATEMENT OF PROBLEM: Clinical data regarding newly introduced laser-sintered removable partial dentures (RPDs) are needed before this technique can be recommended. Currently, only a few clinical reports have been published, with no clinical studies. PURPOSE: This clinical trial compared short-term satisfaction in patients wearing RPDs fabricated with conventional or computer-aided design and computer-aided manufacturing (CAD-CAM) laser-sintering technology. MATERIAL AND METHODS: Twelve participants with partial edentulism were enrolled in this pilot crossover double-blinded clinical trial. Participants were randomly assigned to wear cast or CAD-CAM laser-sintered RPDs for alternate periods of 30 days. The outcome of interest was patient satisfaction as measured using the McGill Denture Satisfaction Instrument. Assessments was conducted at 1, 2, and 4 weeks. The participant's preference in regard to the type of prosthesis was assessed at the final evaluation. The linear mixed effects regression models for repeated measures were used to analyze the data, using the intention-to-treat principle. To assess the robustness of potential, incomplete adherence, sensitivity analyses were conducted. RESULTS: Statistically significant differences were found in patients' satisfaction between the 2 methods of RPD fabrication. Participants were significantly more satisfied with laser-sintered prostheses than cast prostheses in regard to general satisfaction, ability to speak, ability to clean, comfort, ability to masticate, masticatory efficiency, and oral condition (P<.05). At the end of the study, 5 participants preferred the laser-sintered, 1 preferred the cast RPD, and 3 had no preference. CONCLUSIONS: The use of CAD-CAM laser-sintering technology in the fabrication of removable partial dentures may lead to better outcomes in terms of patient satisfaction in the short term. The conclusion from this pilot study requires confirmation by a larger randomized controlled trial. CLINICAL TRIAL: ClinicalTrials.gov. A study about patient satisfaction with laser-sintered removable partial dentures; NCT02769715.

Knowledge, Attitude, and Practices toward the Novel Coronavirus Infection in Dental Laboratories in the Kingdom of Saudi Arabia: Cross-Sectional Study.

This study aimed to assess dental technologists/technicians knowledge, attitudes, and practice during the COVID-19 pandemic in Saudi Arabia. This cross-sectional study was conducted among workers in dental laboratories in Saudi Arabia. A validated questionnaire was developed based on previous literature and distributed online. The questionnaire assessed the study population's knowledge, attitude, and practice regarding infection control protocol for COVID-19. Descriptive statistics of categorical variables were conducted. The response rate was 58.3%, where most respondents are male at a rate of 97%. Most of the participants (82%) were aware of the various infection control measures for COVID-19 in a dental laboratory. Forty-eight participants showed a level of knowledge range between 80 and 100%, while 27 and 30 participants reported moderate and low level of knowledge, respectively. Only 67% of the participants strongly agree that dental cast and fabricated/repaired restorations should be transferred in a very close and protective package to control infection. About 70% of participants indicated they always wear protective gear/goggles and should be warned while working in the dental laboratory. As the pumice slurry was utilized frequently to clean and polish the prostheses, 66% of participants agreed that pumice slurry should be always changed regularly. Regarding COVID-19 infection control procedures, dental technologists/technicians showed good knowledge, attitude, and practice; however, considering how infectious the virus is, more measures should be taken into consideration. Effective communication and collaboration between the laboratory and the dental clinic are essential for infection control.

Trueness, Flexural Strength, and Surface Properties of Various Three-Dimensional (3D) Printed Interim Restorative Materials after Accelerated Aging.

Various 3D printing systems for interim fixed dental restorations are commercially available. This study aimed to evaluate the physical and mechanical properties of 3D printed resins used for interim restorations fabricated using various 3D printing systems and printing angulations after accelerated aging. Three different interim restorative materials were provided and printed using their specific 3D printing systems (A: NextDent; B: Asiga; C: Nova3D), and the testing specimens from each system were printed at two building angles: (1) 0° and (2) 90°. The six groups were A1, A2, B1, B2, C1, and C2, with sixteen specimens per group. Half of the specimens in each group (N = 8) were subjected to accelerated aging, including simulated brushing and thermocycling. Three-point bending, surface roughness, and Vickers microhardness tests were performed. Two-way ANOVA and Fisher's multiple tests were used for statistical analyses. The most accurate systems were found in groups C1 and C2 for length, A1 and B1 for width, and A1 and C1 for height. The specimen trueness only changed after aging for groups B1, B2, and C1. The flexural strength of the A2 group (151 ± 7 MPa) before aging was higher than that of the other groups, and the strength decreased after aging only for groups A1 and A2. The flexural strength, microhardness, and surface roughness of the 3D printed interim resins after aging varied depending on the material, system used, and printing angle.

Coffee Staining and Simulated Brushing Induced Color Changes and Surface Roughness of 3D-Printed Orthodontic Retainer Material.

This in vitro study evaluated the influence of combined coffee staining and simulated brushing-induced color changes and surface roughness on 3D-printed orthodontic retainers. Specimens measuring 10 × 10 × 0.75 mm3 were obtained either by conventional vacuum forming or 3D printing at four print angulations (0°, 15°, 30°, and 45°) (n = 10). The prepared specimens were immersed in a coffee beverage and then mechanically brushed using a simulating device. The specimen's color difference (ΔE) and surface roughness (Ra) were quantified using a spectrophotometer and a non-contact profilometer, respectively. The highest and lowest mean ΔE values were recorded for the 3D-printed-45° (4.68 ± 2.07) and conventional (2.18 ± 0.87) groups, respectively. The overall mean comparison of ΔE between the conventional and 3D-printed groups was statistically significant (p < 0.01). After simulated brushing, all groups showed a statistically significant increase in the Ra values (p < 0.01). The highest Ra was in the 3D-printed-45° (1.009 ± 0.13 µm) and conventional (0.743 ± 0.12 µm) groups, respectively. The overall ΔE of 3D-printed orthodontic retainers was not comparable to conventional VFRs. Among the different angulations used to print the retainers, 15° angulations were the most efficient in terms of color changes and surface roughness and were comparable to conventional VFRs.

The Effect of Femtosecond Laser Surface Patterns on the Effectiveness of Resin Composite to Zirconia Bonding.

This laboratory study aimed to evaluate the effect of different surface patterns using femtosecond laser treatment on the enclosed mold shear bond strength (EM-SBS) of resin composite to zirconia (ZrO2) surfaces and to contrast it with the widely used tribochemical silica coating (TBC) surface conditioning method. A set of fifteen rectangular ZrO2 blocks were randomly divided into five groups according to surface pretreatment: Control G0-no treatment; G1-TBC with silane application; G2-femtosecond laser irradiation with horizontal lines 30 µm apart; G3-femtosecond laser irradiation with horizontal lines 15 µm apart; and G4-femtosecond laser irradiation with cross lines 30 µm apart. The pretreated surfaces were characterized by a surface profilometer, tensiometer and scanning electron microscope. The EM-SBS of resin composite stubs to ZrO2 was measured followed by fractographic analysis. The surface roughness and water contact angle were observed to be statistically higher among the femtosecond laser groups compared to the TBC and control groups. The G4 group exhibited the highest EM-SBS among all the groups, irrespective of the ageing conditions used. At the end of 5000 thermocycles, G4 exhibited EM-SBS of 14.05 ± 4.21 MPa compared to 13.80 ± 3.01 MPa in G1 and 5.47 ± 0.97 MPa in G0. The two-way ANOVA revealed a significant effect of both study groups and ageing conditions on the EM-SBS (p < 0.001). Utilization of femtosecond laser technology holds promise as a potential and alternative mechanical retention approach for enhancing the bonding strength of the resin composite to ZrO2.

Assessment of effect of accelerated aging on interim fixed dental materials using digital technologies.

PURPOSE: This study assessed the physical and mechanical properties of interim crown materials fabricated using various digital techniques after accelerated aging. MATERIALS AND METHODS: Three groups of interim dental restorative materials (N = 20) were tested. The first group (CO) was fabricated using a conventional manual method. The second group (ML) was prepared from prefabricated resin blocks for the milling method and cut into specimen sizes using a cutting disc. The third group (3D) was additively manufactured using a digital light-processing (DLP) 3D printer. Aging acceleration treatments using toothbrushing and thermocycling simulators were applied to half of the specimens corresponding to three years of usage in the oral environment (N = 10). Surface roughness (Ra), Vickers microhardness, 3-point bending, sorption, and solubility tests were performed. A 2-way analysis of variance (ANOVA) and Fisher's multiple comparison test were used to compare the results among the groups. RESULTS: The mean surface roughness (Ra) of the resin after accelerated aging was significantly higher in the CO and ML groups than that before aging, but not in the 3D group. All groups showed reduced hardness after accelerated aging. The flexural strength values were highest in the 3D group, followed by the ML and CO groups after accelerated aging. Accelerated aging significantly reduced water sorption in the ML group. CONCLUSION: According to the tested material and 3D printer type, both 3D-printed and milled interim restoration resins showed higher flexural strength and modulus, and lower surface roughness than those prepared by the conventional method after accelerated aging.

Efficacy of antimicrobial photodynamic therapy versus antiviral therapy in the treatment of herpetic gingivostomatitis among children: Aa randomized controlled clinical trial.

AIM: The aim of the present study was to evaluate the effect of antimicrobial photodynamic therapy (aPDT) as an adjunctive treatment to topical antiviral therapy for the treatment of children having herpetic gingivostomatitis. MATERIALS AND METHODS: 45 individuals (age group 12-18 years) with herpetic gingivostomatitis (HG) were divided into three groups on the basis of provision of treatment. (a) Group A: topical anti-viral therapy (TAT) (n = 14, mean age = 17.0 years) (b) Group B: antimicrobial photodynamic therapy (aPDT) (n = 15, mean age =17.7 years) and (c) Group C: topical anti-viral therapy + adjunctive aPDT (n = 16, mean age = 18.0 years) respectively. Pain scores [visual analogue scale (VAS) and McGill Pain Questionnaire (MPQ)] were assessed and HSV-1 was quantified. ENZYME LINKED IMMUNOSORBENT ASSAY (ELISA) was used to compute the pro-inflammatory cytokine including interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α). The analysis of the mean values and inter group comparisons were evaluated with the Mann-Whitney test. The Friedman test was used to establish the comparison of the changes observed in HSV quantification, pain scores, and pro-inflammatory cytokines. ANOVA tests were employed for the quantification of differences observed at follow-ups. The assessments for the clinical trial were done at baseline, immediate after post-op, two, and four weeks, and three and six months respectively. RESULTS: According to the analysis of the data obtained after the clinical assessment, the three groups reported a decrease in the pain scores, HSV-1 quantification and levels of the pro-inflammatory cytokines. However, Group C (TAT + aPDT) reported improvement in the observed parameters which was statistically significant in comparison to Group A (TAT) and Group B (aPDT) respectively. CONCLUSION: Antimicrobial photodynamic therapy (aPDT) in conjunction with topical antiviral therapy (TAT) helped in reducing the pain scores and pro-inflammatory cytokine levels in herpetic gingivostomatitis among children.

Topographical changes and bactericidal efficacy of antimicrobial photodynamic therapy on titanium implant surface.

BACKGROUND: reExtensive rsearch has been done on various disinfection modalities used to achieve an aseptic implant surface. However, the bacterial efficacy and the topographical alterations resulting from the use of these techniques have never been compared. OBJECTIVE: This study aimed to evaluate and compare the disinfection efficacy and surface changes on a bacteria contaminated titanium block following application of various disinfectants. METHOD: Ultrasonically cleaned titanium blocks were contaminated with Porphyromonas gingivalis and Tannerella forsythia. The infected titanium implants were randomly divided into four experimental groups and decontaminated using antimicrobial photodynamic therapy (aPDT), laser therapy, chlorhexidine and hydrogen peroxide. Bacterial viability and surface changes following decontamination were analyzed. RESULT: Bacterial viability decreased in all the groups, with aPDT having the highest reduction. Surface roughness remained unchanged whereas the contact angle lessened in the aPDT group. CONCLUSION: aPDT could possibly be a suitable alternative to other disinfection regimen to treat periimplantitis.

Analytical model of I-bar clasps for removable partial dentures.

OBJECTIVE: Clasps of removable partial dentures (RPDs) often suffer from fatigue stress that leads to plastic deformation, loss of retention, and RPD failure. Recently, computer-based technologies were proposed to optimize clasp geometry design. The objective of this study was to create an analytic model of I-bar clasps for computer-aided design (CAD)-RPD. METHODS: The analytical model based on mechanical laws was established to simulate I-bar clasp retention, and optimize its design. The model considered the lengths of the vertical (L1) and horizontal (L2) arms of the I-bar as well as the radius (r) of its half-round cross-section. The analytical model was validated with mechanical experiments evaluating the retention of cobalt-chromium (Co-Cr) clasps in vitro and compared with finite element analysis (FEA). RESULTS: The analytical model was in good agreement with the mechanical experiments and FEA, and showed that I-bar clasp design could provide optimal mechanical performance as long as the length of arms (L1 and L2) do not exceed 6 mm. Clasps with L1 > 8 mm and L2 > 9 mm presented stress values exceeding the fatigue limit of Co-Cr. The proposed solution was to increase the radius of I-bar to conserve the initial mechanical performance of Co-Cr. SIGNIFICANCE: Co-Cr I-bar clasps perform best on teeth with reduced mesiodistal dimensions (canine and premolar), and their designs could be optimized to prevent stress from reaching the yield strength and the fatigue failure limit.

Bone extracts immunomodulate and enhance the regenerative performance of dicalcium phosphates bioceramics.

Immunomodulation strategies are believed to improve the integration and clinical performance of synthetic bone substitutes. One potential approach is the modification of biomaterial surface chemistry to mimic bone extracellular matrix (ECM). In this sense, we hypothesized that coating synthetic dicalcium phosphate (DCP) bioceramics with bone ECM proteins would modulate the host immune reactions and improve their regenerative performance. To test this, we evaluated the in vitro proteomic surface interactions and the in vivo performance of ECM-coated bioceramic scaffolds. Our results demonstrated that coating DCP scaffolds with bone extracts, specifically those containing calcium-binding proteins, dramatically modulated their interaction with plasma proteins in vitro, especially those relating to the innate immune response. In vivo, we observed an attenuated inflammatory response against the bioceramic scaffolds and enhanced peri-scaffold new bone formation supported by the increased osteoblastogenesis and reduced osteoclastogenesis. Furthermore, the bone extract rich in calcium-binding proteins can be 3D-printed to produce customized hydrogels with improved regeneration capabilities. In summary, bone extracts containing calcium-binding proteins can enhance the integration of synthetic biomaterials and improve their ability to regenerate bone probably by modulating the host immune reaction. This finding helps understand how bone allografts regenerate bone and opens the door for new advances in tissue engineering and bone regeneration. STATEMENT OF SIGNIFICANCE: Foreign-body reaction is an important determinant of in vivo biomaterial integration, as an undesired host immune response can compromise the performance of an implanted biomaterial. For this reason, applying immunomodulation strategies to enhance biomaterial engraftment is of great interest in the field of regenerative medicine. In this article, we illustrated that coating dicalcium phosphate bioceramic scaffolds with bone-ECM extracts, especially those rich in calcium-binding proteins, is a promising approach to improve their surface proteomic interactions and modulate the immune responses towards such biomaterials in a way that improves their bone regeneration performance. Collectively, the results of this study may provide a conceivable explanation for the mechanisms involved in presenting the excellent regenerative efficacy of natural bone grafts.

An analytical model to design circumferential clasps for laser-sintered removable partial dentures.

OBJECTIVE: Clasps of removable partial dentures (RPDs) often suffer from plastic deformation and failure by fatigue; a common complication of RPDs. A new technology for processing metal frameworks for dental prostheses based on laser-sintering, which allows for precise fabrication of clasp geometry, has been recently developed. This study sought to propose a novel method for designing circumferential clasps for laser-sintered RPDs to avoid plastic deformation or fatigue failure. METHODS: An analytical model for designing clasps with semicircular cross-sections was derived based on mechanics. The Euler-Bernoulli elastic curved beam theory and Castigliano's energy method were used to relate the stress and undercut with the clasp length, cross-sectional radius, alloy properties, tooth type, and retention force. Finite element analysis (FEA) was conducted on a case study and the resultant tensile stress and undercut were compared with the analytical model predictions. Pull-out experiments were conducted on laser-sintered cobalt-chromium (Co-Cr) dental prostheses to validate the analytical model results. RESULTS: The proposed circumferential clasp design model yields results in good agreement with FEA and experiments. The results indicate that Co-Cr circumferential clasps in molars that are 13mm long engaging undercuts of 0.25mm should have a cross-section radius of 1.2mm to provide a retention of 10N and to avoid plastic deformation or fatigue failure. However, shorter circumferential clasps such as those in premolars present high stresses and cannot avoid plastic deformation or fatigue failure. SIGNIFICANCE: Laser-sintered Co-Cr circumferential clasps in molars are safe, whereas they are susceptible to failure in premolars.

Removable partial denture alloys processed by laser-sintering technique.

Removable partial dentures (RPDs) are traditionally made using a casting technique. New additive manufacturing processes based on laser sintering has been developed for quick fabrication of RPDs metal frameworks at low cost. The objective of this study was to characterize the mechanical, physical, and biocompatibility properties of RPD cobalt-chromium (Co-Cr) alloys produced by two laser-sintering systems and compare them to those prepared using traditional casting methods. The laser-sintered Co-Cr alloys were processed by the selective laser-sintering method (SLS) and the direct metal laser-sintering (DMLS) method using the Phenix system (L-1) and EOS system (L-2), respectively. L-1 and L-2 techniques were 8 and 3.5 times more precise than the casting (CC) technique (p < 0.05). Co-Cr alloys processed by L-1 and L-2 showed higher (p < 0.05) hardness (14-19%), yield strength (10-13%), and fatigue resistance (71-72%) compared to CC alloys. This was probably due to their smaller grain size and higher microstructural homogeneity. All Co-Cr alloys exhibited low porosity (2.1-3.3%); however, pore distribution was more homogenous in L-1 and L-2 alloys when compared to CC alloys. Both laser-sintered and cast alloys were biocompatible. In conclusion, laser-sintered alloys are more precise and present better mechanical and fatigue properties than cast alloys for RPDs. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1174-1185, 2018.

Bio-inspired and optimized interlocking features for strengthening metal/polymer interfaces in additively manufactured prostheses.

Biomedical and dental prostheses combining polymers with metals often suffer failure at the interface. The weak chemical bond between these two dissimilar materials can cause debonding and mechanical failure. This manuscript introduces a new mechanical interlocking technique to strengthen metal/polymer interfaces through optimized additively manufactured features on the metal surface. To reach an optimized design of interlocking features, we started with the bio-mimetic stress-induced material transformation (SMT) optimization method. The considered polymer and metal materials were cold-cured Poly(methyl methacrylate) (PMMA) and laser-sintered Cobalt-Chromium (Co-Cr), respectively. Optimal dimensions of the bio-inspired interlocking features were then determined by mesh adaptive direct search (MADS) algorithm combined with finite element analysis (FEA) and tensile experiments such that they provide the maximum interfacial tensile strength and stiffness while minimizing the stress in PMMA and the displacement of PMMA at the Co-Cr/PMMA interface. The SMT optimization process suggested a Y-shape as a more favorable design, which was similar to mangrove tree roots. Experiments confirmed that our optimized interlocking features increased the strength of the Co-Cr/PMMA interface from 2.3 MPa (flat interface) to 34.4 ±â€¯1 MPa, which constitutes 85% of the tensile failure strength of PMMA (40.2 ±â€¯1 MPa). STATEMENT OF SIGNIFICANCE: The objective of this study was to improve metal/polymer interfacial strength in dental and orthopedic prostheses. This was achieved by additive manufacturing of optimized interlocking features on metallic surfaces using laser-sintering. The interlocking design of the features, which was a Y-shape similar to the roots of mangrove trees, was inspired by a bio-memetic optimization algorithm. This interlocking design lowered the PMMA displacement at the Co-Cr/PMMA interface by 70%, enhanced the interfacial strength by more than 12%, and increased the stiffness by 18% compared with a conventional bead design, meanwhile no significant difference was found in the toughness of both designs.

Metal-composite adhesion based on diazonium chemistry.

OBJECTIVE: Composite resins do not adhere well to dental alloys. This weak bond can result in failure at the composite-metal interface in fixed dental prostheses and orthodontic brackets. The aim of this study was to develop a new adhesive, based on diazonium chemistry, to facilitate chemical bonding between dental alloys and composite resin. METHODS: Samples of two types of dental alloys, stainless steel and cobalt chromium were primed with a diazonium layer in order to create a surface coating favorable for composite adhesion. Untreated metal samples served as controls. The surface chemical composition of the treated and untreated samples was analyzed by X-ray photoelectron spectroscopy (XPS) and the tensile strength of the bond with composite resin was measured. The diazonium adhesive was also tested for shear bond strength between stainless steel orthodontic brackets and teeth. RESULTS: XPS confirmed the presence of a diazonium coating on the treated metals. The coating significantly increased the tensile and shear bond strengths by three and four folds respectively between the treated alloys and composite resin. CONCLUSION: diazonium chemistry can be used to develop composite adhesives for dental alloys. SIGNIFICANCE: Diazonium adhesion can effectively achieve a strong chemical bond between dental alloys and composite resin. This technology can be used for composite repair of fractured crowns, for crown cementation with resin based cements, and for bracket bonding.