A parametrical finite element analysis for functionally graded material overlay restoration.

The main cause of failure in bonded ceramic restorations is material fracture due to excessive stress concentration at the base of the prosthesis. The design of restorative functionally graded materials (FGM) could represent a major advance in dissipating mechanical stresses during occlusal contacts. The aim of this paper is to carry out a complete factorial design of finite element analyses to optimize a multilayer FGM introduced at the bottom of an overlay prosthesis. The number and thickness of layers vary within a spectrum compatible with ceramic shaping processes whereas Young's moduli variations are set in the range of dental tissues. For a 1.5-mm thick prosthesis, the optimal FGM configuration appears to be a 5 layers of 0.2 mm thickness with a linear distribution of Young's modulus from 30 to 70 GPa. This configuration was implemented in a 3D model of a restored tooth with realistic geometry to validate the proof-of-concept.

Debonding of coin-shaped osseointegrated implants: Coupling of experimental and numerical approaches.

While cementless implants are now widely used clinically, implant debonding still occur and is difficult to anticipate. Assessing the biomechanical strength of the bone-implant interface can help improving the understanding of osseointegration phenomena and thus preventing surgical failures. A dedicated and standardized implant model was considered. The samples were tested using a mode III cleavage device to assess the mechanical strength of the bone-implant interface by combining experimental and numerical approaches. Four rough (Sa = 24.5 µm) osseointegrated coin-shaped implants were left in sheep cortical bone during 15 weeks of healing time. Each sample was experimentally rotated at 0.03°/sec until complete rupture of the interface. The maximum values of the torque were comprised between 0.48 and 0.72 N m, while a significant increase of the normal force from 7-12 N to 31-43 N was observed during the bone-implant interface debonding, suggesting the generation of bone debris at the bone-implant interface. The experimental results were compared to an isogeometric finite element model describing the adhesion and debonding phenomena through a modified Coulomb's law, based on a varying friction coefficient to represent the transition from an unbroken to a broken bone-implant interface. A good agreement was found between numerical and experimental torques, with numerical friction coefficients decreasing from 8.93 to 1.23 during the bone-implant interface rupture, which constitutes a validation of this model to simulate the debonding of an osseointegrated bone-implant interface subjected to torsion.

Mechanical micromodeling of stress-shielding at the bone-implant interphase under shear loading.

Inserting a titanium implant in the bone tissue may modify its physiological loading and therefore cause bone resorption, via a phenomenon called stress-shielding. The local stress field around the bone-implant interphase (BII) created under shear loading may be influenced by different parameters such as the bone-implant contact (BIC) ratio, the bone Young's modulus, the implant roughness and the implant material. A 2-D finite element model was developed to model the BII and evaluate the impact of the aforementioned parameters. The implant roughness was described by a sinusoidal function (height 2Δ, wavelength λ), and different values of the BIC ratio were simulated. A heterogeneous distribution of the maximum shear stress was evidenced in the periprosthetic bone tissue, with high interfacial stress for low BIC ratios and low implant roughness and underloaded regions near the roughness valleys. Both phenomena may lead to stress-shielding-related effects, which were concentrated within a distance lower than 0.8λ from the implant surface. Choosing an implant material with mechanical properties matching those of bone tissue leads to a homogenized shear stress field and could help to prevent stress-shielding effects. Finally, the equivalent shear modulus of the BII was derived to replace its complex behavior with a simpler analytical model in future studies. Schematic illustrations of the 2-D finite element model used in the present study and spatial variation of the maximal shear stress in the periprosthetic bone tissue for different implant roughness and bone-implant contact ratios.

Use of Dental Defects Associated with Low-Dose di(2-Ethylhexyl)Phthalate as an Early Marker of Exposure to Environmental Toxicants.

BACKGROUND: Markers of exposure to environmental toxicants are urgently needed. Tooth enamel, with its unique properties, is able to record certain environmental conditions during its formation. Enamel formation and quality are dependent on hormonal regulation and environmental conditions, including exposure to endocrine disrupting chemicals (EDCs). Among EDCs, phthalates such as di-(2-ethylhexyl) phthalate (DEHP) raise concerns about their contribution to various pathologies, including those of mineralized tissues. OBJECTIVES: The effects of exposure to low-doses of DEHP on the continually growing incisors were analyzed in mouse males and females. METHODS: Adult male and female C57BL/6J mice were exposed daily to 0.5, 5, and 50µg/kg per day DEHP for 12 wk and their incisors clinically examined. Incisors of males were further analyzed by scanning electron microscopy (SEM), micro X-ray computed tomography (micro-computed tomography; µCT), and nanoindentation for the enamel, histology and real-time quantitative polymerase chain reaction (RT-qPCR) for the dental epithelium. RESULTS: Clinical macroscopic observations of incisors showed various dose-dependent dental lesions such as opacities, scratches, and enamel breakdown in 30.5% of males (10 of 34 total incisors across three independent experiments), and 15.6% of females (7 of 46 incisors) at the highest dose, among which 18.1% (6 of 34 total incisors across three independent experiments) and 8.9% (4 of 46 incisors), respectively, had broken incisors. SEM showed an altered enamel surface and ultrastructure in DEHP-exposed male mice. Further characterization of the enamel defects in males by µCT showed a lower mineral density than controls, and nanoindentation showed a lower enamel hardness during all stages of enamel mineralization, with more pronounced alterations in the external part of the enamel. A delay in enamel mineralization was shown by several approaches (µCT, histology, and RT-qPCR). DISCUSSION: We conclude that DEHP disrupted enamel development in mice by directly acting on dental cells with higher prevalence and severity in males than in females. The time window of DEHP effects on mouse tooth development led to typical alterations of structural, biochemical, and mechanical properties of enamel comparable to other EDCs, such as bisphenol A. The future characterization of dental defects in humans and animals due to environmental toxicants might be helpful in proposing them as early markers of exposure to such molecules. https://doi.org/10.1289/EHP10208.

The role of lateral branches on effective stiffness and local overstresses in dentin.

The 3D microstructure of dentinal tissue, the main tissue of the tooth, is the subject of an increasingly comprehensive body of knowledge. The relationship between this microstructure and the mechanical behaviour of dentinal tissue remains, nonetheless, under question. This article proposes an original SEM analysis of dentin microstructure, accounting for lateral branches, and a mechanical model based on these findings. An interesting observation is that lateral branches have a dense collar, as do tubules. The diameter of these branches as well as a percentage area are quantified all along the depth of a dentin sample. We use these unprecedented data to build an orthotropic homogenized model of dentin. The heterogeneities of microstructure are taken into account using level-set functions. The results reveal that the lateral branches slightly influence the global homogenized elastic behavior of the dentin tissue, albeit creating stress concentration areas that are highly influenced by the inclination of the traction with respect to the tubule and branches.

3D-printed protected face shields for health care workers in Covid-19 pandemic.

The coronavirus pandemic resulted in a shortage of protective equipment. To meet the request of eye-protecting devices, an interdisciplinary consortium involving practitioners, researchers, engineers and technicians developed and manufactured thousands of inexpensive 3D-printed face shields, inside hospital setting. This action leads to the concept of "concurrent, agile, and rapid engineering".

Strategies to optimize bonding of adhesive materials to molar-incisor hypomineralization-affected enamel: A systematic review.

BACKGROUND: Children with first permanent molar affected by molar-incisor hypomineralization (MIH) show high treatment failure rate. AIM: To conduct a systematic review on bonding of adhesive materials to MIH-affected enamel, so as to identify all the methods suggested to optimize it and to determine the best bonding protocol(s). DESIGN: An exhaustive literature search was conducted on MEDLINE/PubMed, the Cochrane Library, and Web of Science databases, up to October 2018. Laboratory and clinical studies, involving adhesive restorations bonded to MIH-affected enamel, with at least a comparative group were included. Two authors independently selected studies, collected data, and assessed bias risk. RESULTS: After title and abstract review and duplicate exclusion, 14 articles were selected on the 496 eligible papers. After full reading, 4 articles were excluded. Finally, 10 studies (6 laboratory and 4 clinical studies) were included. CONCLUSIONS: Bond strength of composite was not significantly different when using self-etch compared with etch-and-rinse adhesives. Deproteinization after etching for etch-and-rinse adhesives enhanced bond strength; this could allow to keep MIH-affected enamel. Icon® showed an erratic penetration; however, a preliminary deproteinization after etching could improve bond strength. A study reported no significant differences in sealant retention rate, whereas another recommended to previously apply an adhesive.

Assessment of the interplay between scaffold geometry, induced shear stresses, and cell proliferation within a packed bed perfusion bioreactor.

By favoring cell proliferation and differentiation, perfusion bioreactors proved efficient at optimizing cell culture. The aim of this study was to quantify cell proliferation within a perfusion bioreactor and correlate it to the wall shear stress (WSS) distribution by combining 3-D imaging and computational fluid dynamics simulations.NIH-3T3 fibroblasts were cultured onto a scaffold model made of impermeable polyacetal spheres or Polydimethylsiloxane cubes. After 1, 2, and 3 weeks of culture, constructs were analyzed by micro-computed tomography (µCT) and quantification of cell proliferation was assessed. After 3 weeks, the volume of cells was found four times higher in the stacking of spheres than in the stacking of cube.3D-µCT reconstruction of bioreactors was used as input for the numerical simulations. Using a lattice-Boltzmann method, we simulated the fluid flow within the bioreactors. We retrieved the WSS distribution (PDF) on the scaffolds surface at the beginning of cultivation and correlated this distribution to the local presence of cells after 3 weeks of cultivation. We found that the WSS distributions strongly differ between spheres and cubes even if the porosity and the specific wetted area of the stackings were very similar. The PDF is narrower and the mean WSS is lower for cubes (11 mPa) than for spheres (20 mPa). For the stacking of spheres, the relative occupancy of the surface sites by cells is maximal when WSS is greater than 20 mPa. For cubes, the relative occupancy is maximal when the WSS is lower than 10 mPa. The discrepancies between spheres and cubes are attributed to the more numerous sites in stacking of spheres that may induce 3-D (multi-layered) proliferation.

Shear bond strength and interface analysis between a resin composite and a recent high-viscous glass ionomer cement bonded with various adhesive systems.

OBJECTIVE: This study investigated the shear bond strength (SBS) and interface between a resin composite and a new high-viscous glass ionomer cement (HV-GIC), a HV-GIC, a resin-modified glass ionomer cement (RM-GIC), a bulk-fill flowable composite, and a regular flowable composite bonded with various adhesive systems. METHODS AND MATERIALS: A resin composite (Filtek Z350) was bonded to a new HV-GIC (EQUIA Forte Fil) using various adhesive systems, including a universal adhesive in self-etch and etch-and-rinse mode (Scotchbond Universal), a two-step etch-and-rinse adhesive (Scotchbond 1-XT), a one-step self-etch adhesive (Optibond All-in-one) tested also after silane application (Monobond Plus), and a coating material (EQUIA Forte Coat). The resin composite was also bonded to a HV-GIC (Fuji IX GP), a RM-GIC (Fuji II LC), a bulk-fill flowable composite (SDR), and a regular flowable composite (Tetric Evo Flow) with the universal adhesive in self-etch mode (Scotchbond Universal). Two-way ANOVA followed by Dunnett's post hoc test was used to investigate the difference in SBS. Failures were analyzed by chi-square test. Bonding interfaces were examined by environmental scanning electron microscopy (E-SEM). RESULTS: SBS to EQUIA Forte Fil was significantly lower with Scotchbond 1-XT than with all other adhesive systems. By using Scotchbond Universal with the self-etch technique, the SBS to EQUIA Forte Fil was significantly higher than the SBS to Fuji IX GP and significantly lower than the SBS to Fuji II LC, SDR, and Tetric Evo Flow. E-SEM images showed an intimate contact at all interfaces examined. CONCLUSION: EQUIA Forte Fil showed satisfactory SBS and interfaces with all adhesives tested. CLINICAL RELEVANCE: Bonding between the resin composite and HV-GIC can be achieved using a universal adhesive in self-etch mode, an easy-to-use adhesive system.

Mesoscale porosity at the dentin-enamel junction could affect the biomechanical properties of teeth.

In this paper, the 3D-morphology of the porosity in dentin is investigated within the first 350µm from the dentin-enamel junction (DEJ) by fluorescence confocal laser scanning microscopy (CLSM). We found that the porous microstructure exhibits a much more complex geometry than classically described, which may impact our fundamental understanding of the mechanical behavior of teeth and could have practical consequences for dental surgery. Our 3D observations reveal numerous fine branches stemming from the tubules which may play a role in cellular communication or mechanosensing during the early stages of dentinogenesis. The effect of this highly branched microstructure on the local mechanical properties is investigated by means of numerical simulations. Under simplified assumptions on the surrounding tissue characteristics, we find that the presence of fine branches negatively affects the mechanical properties by creating local stress concentrations. However, this effect is reduced by the presence of peritubular dentin surrounding the tubules. The porosity was also quantified using the CSLM data and compared to this derived from SEM imaging. A bimodal distribution of channel diameters was found near the DEJ with a mean value of 1.5-2µm for the tubules and 0.3-0.5µm for the fine branches which contribute to 30% of the total porosity (∼1.2%). A gradient in the branching density was observed from the DEJ towards the pulp, independently of the anatomical location. Our work constitutes an incentive towards more elaborate multiscale studies of dentin microstructure to better assess the effect of aging and for the design of biomaterials used in dentistry, e.g. to ensure more efficient bonding to dentin. Finally, our analysis of the tubular network structure provides valuable data to improve current numerical models.

Bond strength and interfacial morphology of orthodontic brackets bonded to eroded enamel treated with calcium silicate-sodium phosphate salts or resin infiltration.

OBJECTIVE: To investigate the shear bond strength (SBS) of orthodontic brackets bonded to eroded enamel treated with preventive approaches and to examine the enamel/bracket interfaces. MATERIALS AND METHODS: Ninety-one brackets were bonded to seven groups of enamel samples: sound; eroded; eroded+treated with calcium silicate-sodium phosphate salts (CSP); eroded+infiltrated by ICON®; eroded+infiltrated by ICON® and brackets bonded with 1-month delay; eroded+infiltrated by an experimental resin; and eroded+infiltrated by an experimental resin and brackets bonded with 1-month delay. For each group, 12 samples were tested in SBS and bond failure was assessed with the adhesive remnant index (ARI); one sample was examined using scanning electron microscopy (SEM). RESULTS: Samples treated with CSP or infiltration showed no significant differences in SBS values with sound samples. Infiltrated samples followed by a delayed bonding showed lower SBS values. All of the values remained acceptable. The ARI scores were significantly higher for sound enamel, eroded, and treated with CSP groups than for all infiltrated samples. SEM examinations corroborated the findings. CONCLUSIONS: Using CSP or resin infiltration before orthodontic bonding does not jeopardize the bonding quality. The orthodontic bonding should be performed shortly after the resin infiltration.

Influence of CAD/CAM tool and material on tool wear and roughness of dental prostheses after milling.

STATEMENT OF PROBLEM: Computer-aided design/computer-aided manufacturing (CAD/CAM) machining influences the surface roughness of dental restorations and tool wear. Roughness must be suitable to meet clinical requirements, and the tool must last as long as possible. PURPOSE: The purpose of this pilot study was to investigate the influence of the CAD/CAM tool-material couple on tool wear and surface roughness after milling. MATERIAL AND METHODS: Three tools (Lyra conical tool Ø1 mm; GACD SASU, Lyra conical tool Ø1.05 mm; GACD SASU, and Cerec cylinder pointed tool 12S; Sirona Dental Systems GmbH) and 3 CAD/CAM materials (Lava Ultimate; 3M ESPE, Mark II; VITA Zahnfabrik H. Rauter GmbH, and Enamic; VITA Zahnfabrik H. Rauter GmbH) were tested. The tool wear of 6 tool-material couples at a feed rate of 2 m/min was analyzed before and after 8 minutes of flank and climb milling with optical and scanning electron microscopy (SEM) observations and tool weighing. The surface roughness after milling was observed for 9 tool-material couples for flank and climb milling. Feed rates of 1, 2, 3, and 4.8 m/min were used for each couple. Ra, Rt, Rz, Sa, Sq, and Sz roughness criteria were measured. A paired comparison of tool-material couples was conducted with the Kruskal-Wallis test. RESULTS: The Mark II material led to more severe tool wear. Milling of Lava Ultimate resulted in chip deposits on the tool grit. The Cerec cylinder pointed tool 12S was less worn for each material tested. The Cerec cylinder pointed tool 12S and the Lyra conical tool Ø1.05 mm provided similar roughness measurements for the 3 materials tested. The Lyra conical tool Ø1.05 mm tool provided better roughness than the Lyra conical tool Ø1 mm tool for the Enamic material. CONCLUSION: Tool lifetime calculated by volume of milled material removed should be the measure provided by CAD/CAM manufacturers instead of a number of blocks. This tool lifetime should be provided for the milling conditions associated with the material milled. Material hardness and tool grit are key factors for achieving a given roughness.

A New Method Combining Finite Element Analysis and Digital Image Correlation to Assess Macroscopic Mechanical Properties of Dentin.

A literature review points out a large discrepancy in the results of the mechanical tests on dentin that can be explained by stress and strain assessment during the tests. Errors in these assessments during mechanical tests can lead to inaccurate estimation of the mechanical properties of the tested material. On top of that, using the beam theory to analyze the bending test for thick specimens will increase these experimental errors. After summarizing the results of mechanical tests on dentin in the literature, we focus on bending tests and compare the stress assessment obtained by finite element analysis (FEA) and by beam theory application. We show that the difference between the two methods can be quite large in some cases, leading us to prefer the use of FEA to assess stresses. We then propose a new method based on coupling finite element analysis and digital image correlation (DIC) to more accurately evaluate stress distributions, strain distributions and elastic modulus in the case of a three-point bending test. To illustrate and prove the feasibility of the method, it is applied on a dentinal sample so that mean elastic modulus and maximum tensile stress are obtained (11.9 GPa and 143.9 MPa). Note that the main purpose of this study is to focus on the method itself, and not to provide new mechanical values for dentin. When used in standard mechanical testing of dentin, this kind of method should help to narrow the range of obtained mechanical properties values.

White spots on enamel: treatment protocol by superficial or deep infiltration (part 2).

In this 2nd part, the current treatment of white spot lesions by erosion/infiltration is presented, beginning with a reminder of the principle of superficial infiltration, which enables most early carious lesions, fluorosis and post-traumatic lesions to be treated. However, this technique has met with frequent failures in cases of MIH or deep lesions of traumatic origin or those associated with fluorosis. For this reason a new deep infiltration technique is proposed: thanks to its global treatment concept, this enables all white spots to be treated. The place of whitening in these treatment options is discussed, with explanations of the main reasons for its failures.

White defects on enamel: diagnosis and anatomopathology: two essential factors for proper treatment (part 1).

Early-stage caries (white spots), fluoroses, traumatic hypomineralizations and molar incisive hypomineralization (MIH) all present, to differing degrees, clinical symptoms involving white marks on the enamel. This article shows that proper diagnosis leads to better understanding of the three-dimensional aspects of the lesion, thereby ensuring the appropriate choice of a specific treatment.

Demineralized dentin 3D porosity and pore size distribution using mercury porosimetry.

OBJECTIVES: The objectives of this study were to assess demineralized dentin porosity and quantify the different porous features distribution within the material using mercury intrusion porosimetry (MIP) technique. We compared hexamethyldisilazane (HMDS) drying and lyophilization (LYO) (freeze-drying) in sample preparation. METHODS: Fifty-six dentin discs were assigned into three groups. The control (CTR) group discs were superficially acid-etched (15s 37% H(3)PO(4)) to remove the smear layer and then freeze-dried whereas LYO and HMDS groups samples were first totally demineralized using EDTA 0.5M and then freeze-dried and HMDS-dried respectively. MIP was used to determine open porosity and pore size distribution of each pair of samples. Field emission scanning electron microscopy (FESEM) was used to illustrate the results. RESULTS: The results showed two types of pores corresponding either to tubules and micro-branches or to inter-fibrillar spaces created by demineralization. Global porosity varied from 59% (HMDS-dried samples) to 70% (freeze-dried samples). Lyophilization drying technique seems to lead to less shrinkage than HMDS drying. FESEM revealed that collagen fibers of demineralized lyophilized samples are less melted together than in the HMDS-dried samples. SIGNIFICANCE: Demineralized dentin porosity is a key parameter in dentin bonding that will influence the hybrid layer quality. Its characterization could be helpful to improve the monomers infiltration.