Improved mechanical long-term reliability of hip resurfacing prostheses by using silicon nitride.

Although ceramic prostheses have been successfully used in conventional total hip arthroplasty (THA) for many decades, ceramic materials have not yet been applied for hip resurfacing (HR) surgeries. The objective of this study is to investigate the mechanical reliability of silicon nitride as a new ceramic material in HR prostheses. A finite element analysis (FEA) was performed to study the effects of two different designs of prostheses on the stress distribution in the femur-neck area. A metallic (cobalt-chromium-alloy) Birmingham hip resurfacing (BHR) prosthesis and our newly designed ceramic (silicon nitride) HR prosthesis were hereby compared. The stresses induced by physiologically loading the femur bone with an implant were calculated and compared with the corresponding stresses for the healthy, intact femur bone. Here, we found stress distributions in the femur bone with the implanted silicon nitride HR prosthesis which were similar to those of healthy, intact femur bone. The lifetime predictions showed that silicon nitride is indeed mechanically reliable and, thus, is ideal for HR prostheses. Moreover, we conclude that the FEA and corresponded post-processing can help us to evaluate a new ceramic material and a specific new implant design with respect to the mechanical reliability before clinical application.

Direct inkjet printing of dental prostheses made of zirconia.

CAD/CAM milling systems provide a rapid and individual method for the manufacturing of zirconia dental restorations. However, the disadvantages of these systems include limited accuracy, possible introduction of microscopic cracks, and a waste of material due to the principle of the 'subtractive process'. The hypothesis of this study was that these issues can be overcome by a novel generative manufacturing technique, direct inkjet printing. A tailored zirconia-based ceramic suspension with 27 vol% solid content was synthesized. The suspension was printed on a conventional, but modified, drop-on-demand inkjet printer. A cleaning unit and a drying device allowed for the build-up of dense components of the size of a posterior crown. A characteristic strength of 763 MPa and a mean fracture toughness of 6.7 MPam(0.5) were determined on 3D-printed and subsequently sintered specimens. The novel technique has great potential to produce, cost-efficiently, all-ceramic dental restorations at high accuracy and with a minimum of materials consumption.

Crack healing in alumina bioceramics.

OBJECTIVES: Microscopic cracks can occur at the surface of oxide ceramic restorations as a result of the manufacturing process and mainly due to the final mechanical preparation in the dental laboratory. A method is presented to heal up such microscopic cracks by a glass infiltration process. METHODS: Bar specimens made of high purity bio-alumina were manufactured. On two batches of specimens microscopic cracks were induced using the Vickers indentation technique. The small microscopic cracks at the tip of the resulting half-penny-shape cracks were extended by the bridge loading method. The indentation pattern of the specimens of one batch was subsequently glass-infiltrated. The surface layers of the specimens with the Vickers indentation were removed by grinding as far as only the extended microscopic cracks (with and without glass) remained at the surface. The strengths of untreated, micro-damaged, and micro-damaged and glass-infiltrated specimens were determined. The microstructure of the fracture surfaces was analyzed using SEM. RESULTS: The characteristic strength of the specimens decreased from sigma(0)=378 to 196 MPa and the Weibull modulus from m=13.7 to 2.3 due to the micro-damaging. The strength and the scatter-in-strength were significantly improved by the glass infiltration process. The strength of the "healed" specimens (sigma(0)=434 MPa, m=17.3) was even better than that of the untreated samples. SIGNIFICANCE: Microscopic cracks that can occur at the surface of dental restorations made of alumina like abutments or cores of crowns and bridges during the manufacturing and preparation process could reliably be healed by a glass infiltration process.

Influence of preparation of ceramic SEVNB specimens on fracture toughness testing results.

OBJECTIVES: Fracture toughness KIc is an important mechanical property of dental ceramics. One of the most reliable methods to determine the fracture toughness of a ceramic material is the single-edge V-notched-beam (SEVNB) method. The objective of the study is to reveal and quantify the influence of the notch root radius on the fracture toughness value proved on the high strength ceramic material zirconia. METHODS: Bar specimens (n=16) made of high strength zirconia ceramics (3Y-TZP) were notched by a diamond charged cutting wheel. The notch roots were sharpened using the razor blade method with systematically varying notch root radii. The critical stress intensities as a function of the respective notch root radii of all specimens were determined in flexural strength test. RESULTS: The notch root radii showed a pronounced effect on the determined fracture toughness values. Notch root radii between 18 and 167 microm were produced. The respective determined fracture toughness values varied between 5.9 and 13.6 MPam0.5. SIGNIFICANCE: It is of decisive importance to sharpen the notch root radius of a SEVNB specimen to determine the true fracture toughness value. If the notch root radius is above a critical value, the measured fracture toughness value will be overestimated.

Influence of annealing temperature on the strength of dental glass ceramic materials.

OBJECTIVES: Dental glass ceramic components are always loaded by residual stresses because of the manufacturing process. For a reliable mechanical characterization, residual stress-free specimens are needed. Residual stresses can be removed by an annealing process. The hypothesis of this work was, that the annealing temperature must be individually chosen to reliably remove possible residual stresses without changing the characteristics of the glass ceramic material. METHODS: Knoop-indented specimens made of the glass ceramic materials Duceram Opaker (Degudent, Hanau, Germany, formerly Ducera, Rosbach, FRG), Empress 1 (Ivoclar Vivadent, Schaan, Liechtenstein), In-Ceram Alumina (Vita Zahnfabrik, Bad Säckingen, Germany), Optec OPC (Jeneric Pentron, Wellingford, USA), and Vita Omega Opaker (Vita Zahnfabrik, Bad Säckingen, Germany) were annealed at various temperatures below and above the respective glass transition temperature. The Weibull strength parameters and the lengths of the indentations before and after annealing were determined. RESULTS: A strength increase caused by relaxation of residual stresses was found after annealing at elevated temperatures. A local maximum of increased strength was determined after annealing at a temperature of 100K below the glass transition temperature. After annealing at temperatures above the glass transition temperature, microplasticity was observed. SIGNIFICANCE: It is recommended to anneal glass ceramic components that are intended to be mechanically characterized at a temperature 100K below the respective glass transition temperature before testing to determine 'true' mechanical values that are not influenced by possible residual stresses.

Effect of ion exchange of glazed dental glass ceramics on strength parameters.

Ion exchange treatments can significantly increase the strength of dental glass ceramic core materials by induced compressive residual stresses. However, the core materials of dental restorations need to be veneered or at least to be stained and glazed for esthetic and functional reasons. The objective of this study was to determine the effect of different ion exchange treatments on the strength parameters of stained and glazed glass ceramics. Batches of specimens made of a leucite reinforced dental glass with and without staining and glazing layer, untreated, single ion exchanged (KNO3), and dual ion exchanged (1. KNO3/27, 2. 30 mol% NaNO3/70 mol% KNO3) were tested. The strength of the core material was increased from 117 to 213 MPa by single ion exchange. Staining and glazing increased the strength up to 165 MPa. Single ion exchange of the stained and glazed core caused only a slight additional strength increase up to 173 MPa. The dual ion exchanged stained and glazed core exhibit a strength of 195 MPa and decreased the large strength scatter because of a well-designed residual stress profile. We conclude that dual ion exchange treatments could significantly increase the mechanical reliability of stained and glazed glass ceramic restorations.

A major focus of Legionnaires' disease in Bloomington, Indiana.

Thirty-nine cases of Legionnaires' disease in a 16-month period were identified in visitors to and residents of Bloomington, Indiana. Thirty-five patients had spent at least one night at the Indiana Memorial Union in the 2 weeks before becoming ill. Five of 32 sporadic cases nationwide between 1 January and 31 March 1978 were retrospectively shown to be in persons who had recently visited the Union. The risk of acquiring Legionnaires' disease as a Union visitor was at least 17 times greater than that for Bloomington residents 20 years or older. Employees who had worked at the Union 5 years or longer were more likely to be seropositive than workers in other Bloomington hotels. Legionnaires' disease bacterium was isolated from five environmental sites in Bloomington. A cooling tower may have been involved in disease spread, but it was not the only source. Hypochlorite solution was added to cooling tower water as a precautionary measure; however, one case was confirmed in a man with Union exposure 9 days after hypochlorite treatment had begun.

The ultrasonic demonstration of gastric lesions.

Fifteen cases of circumferential gastric antral disease identified by upper gastrointestinal (GI) series over a 12-month period were studied by a gray-scale ultrasound. In 93 per cent of the patients studied, a characteristic ovoid anechoic area containing a dense central collection of echoes was identified. The abnormality was located in the midline or slightly to either side, just dorsal to the inferior margin of the liver on longitudinal sections. The lesions studied included primary and secondary malignancy, lymphoma, corrosive gastritis, and granulomatous disease of childhood. In each instance a barium study of the stomach confirmed the location of the lesion. A prospective study of 50 normal individuals revealed one patient in whom the characteristic appearance was found at ultrasound and who subsequently had a normal upper GI series. Thus, although the ultrasound appearance of antral thickening may rarely be found in normal individuals, this characteristic appearance should strongly suggest gastric pathology, necessitating an upper GI series.