The narwhal (Monodon monoceros) cementum-dentin junction: a functionally graded biointerphase.

In nature, an interface between dissimilar tissues is often bridged by a graded zone, and provides functional properties at a whole organ level. A perfect example is a "biological interphase" between stratified cementum and dentin of a narwhal tooth. This study highlights the graded structural, mechanical, and chemical natural characteristics of a biological interphase known as the cementum-dentin junction layer and their effect in resisting mechanical loads. From a structural perspective, light and electron microscopy techniques illustrated the layer as a wide 1000-2000 µm graded zone consisting of higher density continuous collagen fiber bundles from the surface of cementum to dentin, that parallels hygroscopic 50-100 µm wide collagenous region in human teeth. The role of collagen fibers was evident under compression testing during which the layer deformed more compared to cementum and dentin. This behavior is reflected through site-specific nanoindentation indicating a lower elastic modulus of 2.2 ± 0.5 GPa for collagen fiber bundle compared to 3 ± 0.4 GPa for mineralized regions in the layer. Similarly, microindentation technique illustrated lower hardness values of 0.36 ± 0.05 GPa, 0.33 ± 0.03 GPa, and 0.3 ± 0.07 GPa for cementum, dentin, and cementum-dentin layer, respectively. Biochemical analyses including Raman spectroscopy and synchrotron-source microprobe X-ray fluorescence demonstrated a graded composition across the interface, including a decrease in mineral-to-matrix and phosphate-to-carbonate ratios, as well as the presence of tidemark-like bands with Zn. Understanding the structure-function relationships of wider tissue interfaces can provide insights into natural tissue and organ function.

Sensory ability in the narwhal tooth organ system.

The erupted tusk of the narwhal exhibits sensory ability. The hypothesized sensory pathway begins with ocean water entering through cementum channels to a network of patent dentinal tubules extending from the dentinocementum junction to the inner pulpal wall. Circumpulpal sensory structures then signal pulpal nerves terminating near the base of the tusk. The maxillary division of the fifth cranial nerve then transmits this sensory information to the brain. This sensory pathway was first described in published results of patent dentinal tubules, and evidence from dissection of tusk nerve connection via the maxillary division of the fifth cranial nerve to the brain. New evidence presented here indicates that the patent dentinal tubules communicate with open channels through a porous cementum from the ocean environment. The ability of pulpal tissue to react to external stimuli is supported by immunohistochemical detection of neuronal markers in the pulp and gene expression of pulpal sensory nerve tissue. Final confirmation of sensory ability is demonstrated by significant changes in heart rate when alternating solutions of high-salt and fresh water are exposed to the external tusk surface. Additional supporting information for function includes new observations of dentinal tubule networks evident in unerupted tusks, female erupted tusks, and vestigial teeth. New findings of sexual foraging divergence documented by stable isotope and fatty acid results add to the discussion of the functional significance of the narwhal tusk. The combined evidence suggests multiple tusk functions may have driven the tooth organ system's evolutionary development and persistence.

Vestigial tooth anatomy and tusk nomenclature for monodon monoceros.

Narwhal tusks, although well described and characterized within publications, are clouded by contradictory references, which refer to them as both incisors and canines. Vestigial teeth are briefly mentioned in the scientific literature with limited descriptions and no image renderings. This study first examines narwhal maxillary osteoanatomy to determine whether the erupted tusks are best described as incisiform or caniniform teeth. The study also offers evidence to support the evolutionary obsolescence of the vestigial teeth through anatomic, morphologic, and histologic descriptions. Examination of 131 skull samples, including 110 museum skull specimens and 21 harvested skulls, revealed the erupted tusks surrounded by maxillary bone over the entire length of their bone socket insertion, and are thus more accurately termed caniniform or canine teeth. The anatomy, morphology, and development of vestigial teeth in five skull samples are more fully described and documented. Vestigial tooth samples included 14 embedded pairs or individual teeth that were partially exposed or removed from the maxillary bone. Their location was posterior, ventral, and lateral to the tusks, although male vestigial teeth often exfoliate in the mouth lodging between the palatal tissue and underlying maxillary bone. Their myriad morphologies, sizes, and eruption patterns suggest that these teeth are no longer guided by function but rather by random germ cell differentiation and may eventually cease expression entirely. The conclusions reached are that the narwhal tusks are the expression of canine teeth and that vestigial teeth have no apparent functional characteristics and are following a pattern consistent with evolutionary obsolescence.

The cost burden of oral, oral pharyngeal, and salivary gland cancers in three groups: commercial insurance, Medicare, and Medicaid.

BACKGROUND: Head and neck cancers are of particular interest to health care providers, their patients, and those paying for health care services, because they have a high morbidity, they are extremely expensive to treat, and of the survivors only 48% return to work. Consequently the economic burden of oral cavity, oral pharyngeal, and salivary gland cancer (OC/OP/SG) must be understood. The cost of these cancers in the U.S. has not been investigated. METHODS: A retrospective analysis of administrative claims data for 6,812 OC/OP/SG cancer patients was undertaken. Total annual health care spending for OC/OP/SG cancer patients was compared to similar patients without OC/OP/SG cancer using propensity score matching for enrollees in commercial insurance, Medicare, and Medicaid. Indirect costs, as measured by short term disability days were compared for employed patients. RESULTS: Total annual health care spending for OC/OP/SG patients during the year after the index diagnosis was $79,151 for the Commercial population. Health care costs were higher for OC/OP/SG cancer patients with Commercial Insurance ($71,732, n = 3,918), Medicare ($35,890, n = 2,303) and Medicaid ($44,541, n = 585) than the comparison group (all p < 0.01). Commercially-insured employees with cancer (n = 281) had 44.9 more short-term disability days than comparison employees (p < 0.01). Multimodality treatment was twice the cost of single modality therapy. Those patients receiving all three treatments (surgery, radiation, and chemotherapy) had the highest costs of cost of care, from $96,520 in the Medicare population to $153,892 in the Commercial population. CONCLUSIONS: In the U.S., the cost of OC/OP/SG cancer is significant and may be the most costly cancer to treat in the U.S. The results of this analysis provide useful information to health care providers and decision makers in understanding the economic burden of head and neck cancer. Additionally, this cost information will greatly assist in determining the cost-effectiveness of new technologies and early detection systems. Earlier identification of cancers by patients and providers may potentially decrease health care costs, morbidity and mortality.

Preclinical effectiveness of a novel pulp capping material.

INTRODUCTION: The purpose of this study was to evaluate the direct pulp capping response to a novel resin-based calcium phosphate cement (RCPC). METHODS: The RCPC was placed in contact with the exposed healthy pulps of dog teeth and in a follow-up study on the healthy or inflamed pulps of ferret teeth. The inflamed ferret teeth had reversible pulpitis induced with Salmonella typhimurium lipopolysaccharides. After direct pulp capping with RCPC or visible light-curing resin-modified calcium hydroxide material (VLCCH) as a control, the restorations were bonded using a composite resin. The pulp responses and dentin repair were evaluated histologically in dog teeth after 7, 28, or 90 days and in ferret teeth after 45 days. RESULTS: Most of the RCPC-treated healthy pulps and 75% of the RCPC-treated inflamed ferret teeth had dentin healing and repair, whereas those teeth treated with VLCCH had minimal healing and dentin repair. CONCLUSIONS: The direct pulp capping of ferret and dog teeth with RCPC was associated with superior healing in comparison to VLCCH.

Setting expansion of gray and white mineral trioxide aggregate and Portland cement.

One possible reason for the sealing ability of mineral trioxide aggregate (MTA) is its slight expansion upon setting. Both gray mineral trioxide aggregate (GMTA) and white mineral trioxide aggregate (WMTA) are composed of approximately 75% Portland cement (PC). WMTA differs from GMTA in its lower content of tetracalcium aluminoferrite. This difference in composition may affect setting expansion. The purpose of this study was to compare the hydroscopic linear setting expansions of GMTA, WMTA, and PC with a new device. Materials were mixed with water, placed into a cylindrical mold, and covered with sterile water or Hank's balanced salt solution (HBSS). Expansion changes were measured by using a linear variable displacement transformer dilatometer. One-way analysis of variance and post hoc tests (alpha = 0.05) showed the mean expansion at 24 hours was 1.02% for GMTA, 0.29% for PC, and 0.08% for WMTA in water immersion and 0.68% for GMTA and 0.11% for WMTA in HBSS immersion. GMTA expanded significantly more than WMTA in either water or HBSS immersion.

The effect of ultrasonic post instrumentation on root surface temperature.

This study measured root surface temperature changes when ultrasonic vibration, with and without irrigation, was applied to cemented endodontic posts. Twenty-six, extracted, single-rooted premolars were randomly divided into two groups. Root lengths were standardized, canals instrumented, obturated, and posts cemented into prepared spaces. Thermocouples were positioned at two locations on the proximal root surfaces. Samples were embedded in plaster and brought to 37 degrees C in a water bath. Posts were ultrasonically vibrated for 4 minutes while continuously measuring temperature. Two-way ANOVA compared effects of water coolant and thermocouple location on temperature change. Root surface temperatures were significantly higher (p < 0.001) when posts were instrumented dry. A trend for higher temperatures was observed at coronal thermocouples of nonirrigated teeth and at apical thermocouples of irrigated teeth (p = 0.057). Irrigation during post removal with ultrasonics had a significant impact on the temperature measured at the external root surface.

Light-emitting diode curing light irradiance and polymerization of resin-based composite.

BACKGROUND: Light-emitting diode (LED) curing lights are becoming popular; however, questions about their efficiency remain. The authors performed a comprehensive analysis of the properties of resin-based composites cured with LED lights. METHODS: The authors evaluated seven LED lights and one quartz-tungsten-halogen light (control). They measured intensity, depth of cure (DOC), degree of conversion (DC), hardness and temperature rise. They used three shades of a hybrid resin-based composite and a microfill composite, as well as one shade of another hybrid composite. RESULTS: Two LED lights required additional cure time to reach a DOC similar to that of the control light. DC at the top of the samples was independent of the light used. At 2.0 millimeters, the DC for several LED lights was significantly lower than that for the control light and was correlated strongly to the light's intensity. The bottom-to-top ratio for hardness of resin-based composites cured by all but one light was greater than 0.80. All LED lights except one had smaller temperature rise than did the control light. CONCLUSIONS: Six of the seven LED curing lights performed similarly to a quartz-tungsten-halogen curing light in curing resin-based composites. Clinical Implications. While LED curing lights and a quartz-tungsten-halogen light could cure resin-based composites, some resin-based composites cured with LED lights may require additional curing time or smaller increments of thickness.

Controlling the fluoride dosage in a patient with compromised salivary function.

BACKGROUND: High-concentration topical fluorides are used commonly to with compromised salivary function due to irradiation and chemotherapy. CASE DESCRIPTION: The authors describe a 50-year-old man with previously treated cancer who was using tray-applied topical fluoride gel. He complained of gastric symptoms, difficulty in swallowing, leg muscle soreness and knee joint soreness. A computed tomographic scan revealed thickening of the esophageal walls. An upper endoscopy revealed abnormal motility. The motility test indicated high-amplitude peristalsis and hypertensive lower esophageal sphincter, and urine testing indicated high levels of systemic fluoride. The patient's fluoride regimen was altered, and within a short period his urinary fluoride levels returned to normal and his symptoms resolved. CLINICAL IMPLICATIONS: Clinicians prescribing home-applied high-concentration fluorides need to be cognizant of the symptoms of fluoride toxicity, carefully monitor the patient's compliance with the treatment regimen, and adjust the dosage or mode of application to control the total ingested dose of fluoride.

Probing the origins and control of shrinkage stress in dental resin composites. II. Novel method of simultaneous measurement of polymerization shrinkage stress and conversion.

This study probes the interrelationships between polymerization shrinkage stress development and the polymerization progress with a novel experimental technique. This technique is capable of real time, simultaneous measurement of double-bond conversion and shrinkage stress with the use of a noninvasive near-infrared fiber-optic system, along with a cantilever beam-based tensometer. The results from both filled and unfilled bis-GMA/TEGDMA (70:30 mass ratio) systems showed that the shrinkage stress buildup was concentrated in the latter stages of polymerization, with its dramatic increase linked to the asymptotic approach of conversion to its limiting value. The monotonic increase of shrinkage stress with conversion in the vitrified state is attributed to the dramatic increase of the sample's elastic modulus during the vitrification stage and a certain amount of cooling stress as the sample cools down from the temperature rise caused by the exothermic polymerization and light absorption. Excellent reproducibility of both the polymerization kinetics assessment and the shrinkage stress measurement has been achieved.

Three-body wear of dental resin composites reinforced with silica-fused whiskers.

OBJECTIVE: Recent studies used silica-fused whiskers to increase the strength and toughness of resin composites. This study investigated the three-body wear of whisker composites. It was hypothesized that the whisker composites would be more wear resistant than composites reinforced with fine glass particles, and the whisker-to-silica filler ratio would significantly affect wear. METHODS: Silica particles were mixed with silicon nitride whiskers at seven different whisker/(whisker + silica) mass fractions (%): 0, 16.7, 33.3, 50, 66.7, 83.3, and 100. Each mixture was heated at 800 degrees C to fuse the silica particles onto the whiskers. Each powder was then silanized and incorporated into a dental resin to make the wear specimens. A four-station wear machine was used with specimens immersed in a slurry containing polymethyl methacrylate beads, and a steel pin was loaded and rotated against the specimen at a maximum load of 76 N. RESULTS: Whisker-to-silica ratio had significant effects (one-way ANOVA; p < 0.001) on wear. After 4 x 10(5) wear cycles, the whisker composite at whisker/(whisker + silica) of 16.7% had a wear scar diameter (mean +/- sd; n = 6) of (643 +/- 39) microm and a wear depth of (82 +/- 19) microm, significantly less than a wear scar diameter of (1184 +/- 34) microm and a wear depth of (173 +/- 15) microm of a commercial prosthetic composite reinforced with fine glass particles (Tukey's multiple comparison). SEM examination revealed that, instead of whiskers protruding from the worn surface, the whiskers were worn with the composite surface, resulting in relatively smooth wear surfaces. SIGNIFICANCE: Silica-fused whisker reinforcement produced dental resin composites that exhibited high resistance to wear with smooth wear surfaces. These properties, together with the strength and fracture toughness being twice those of current glass particle-reinforced composites, may help extend the use of resin composite to large stress-bearing posterior restorations.

Amorphous calcium phosphates for tooth mineralization.

The destruction of tooth structure through caries and erosive processes is due to two types of acidic challenges that affect the tooth in different ways. Acidic attack by cariogenic bacteria initially produces subsurface lesions that weaken the enamel and, if left unchecked, can progress through the enamel and dentin and eventually into the pulpal cavity. Erosive attack by acidic foods and beverages removes mineral from the surface of enamel and initially causes dulling and loss of tooth luster; if left unchecked, it can progress to a more severe loss of enamel thickness and contour. This article focuses on the potential means of improving the cosmetic appearance of teeth by depositing mineral into surface defects. Several approaches use the unique properties of amorphous calcium phosphate (ACP) compounds, which have the highest rates of formation and dissolution among all the calcium phosphates. ACP has been shown to rapidly hydrolyze to form apatite, similar to carbonated apatite, the tooth mineral. Products containing ACP or ingredients that form ACP can include toothpastes, mouth rinses, artificial saliva, chewing gums, topically applied coatings, and other vehicles for topical use. When applied, they readily precipitate ACPs on and into tooth-surface defects. These products hopefully will provide users with new tools to restore and enhance the smoothness and luster of their teeth.

The clinical effect of amorphous calcium phosphate (ACP) on root surface hypersensitivity.

Dentin hypersensitivity is a transient condition that often resolves with the natural sclerotic obturation of dentin tubules. A method of rapidly forming calcium phosphate compounds within these tubules can mimic sclerosis and lead to rapid reduction in hypersensitivity. Amorphous calcium phosphates (ACP) can be formed in situ by the sequential application of calcium and phosphate solutions. In this clinical study, 30 patients with reported dentin hypersensitivity were randomly assigned to parallel treatment or placebo groups. In the experimental treatment group, ACP was formed by topical application of a 1.5 mol/L aqueous solution of CaCl2 followed by topical application of 1.0 mol/L aqueous K3PO4. The placebo group was treated with a topical application of 1.0 mol/L aqueous solution of KCl followed by topical application of distilled water. Treatments were repeated at the 7-day and 28-day recall appointments. Response to air and tactile stimuli were measured immediately before treatment using a visual analog scale initially on day 1, then on days 7, 28 and 180. The results showed that both the experimental and placebo treatments resulted in a reduction in hypersensitivity at 180 days. However, the ACP treatment group showed a much more rapid reduction in hypersensitivity over time. The change in sensitivity was much more apparent using the air stimulus than the tactile stimulus. These results show that topical placement of ACP can rapidly reduce dentin hypersensitivity.

Properties of elastomeric calcium phosphate cement-chitosan composites.

OBJECTIVE: Self-hardening calcium phosphate cements (CPC) have been shown to be efficacious in a number of clinical applications. For some applications it is desirable to have CPC in a non-rigid resorbable elastomeric matrix. In the present study, chitosan was evaluated as the matrix for preparing CPC-chitosan composites. METHODS: Cement specimens were prepared by mixing CPC powder (an equimolar mixture of tetracalcium phosphate and dicalcium phosphate anhydrous) with a chitosan solution at a powder/liquid ratio of 2-2.5. The setting time was measured by a Gilmore needle method. A standard three-point flexural test was used to fracture the specimens at a crosshead speed of 0.5 mm/min. Powder X-ray diffraction analysis was used to determine the conversion of the CPC to hydroxyapatite. RESULTS: The CPC-chitosan composites were more stable in water than conventional CPC. They did not disintegrate even when placed in water immediately after mixing. The CPC-chitosan paste hardened within 10 min in all cases. The 1d mean flexural modulus (GPa) for the control CPC was 5.3 (0.3) (mean (standard deviation); n=5), and that for CPC-chitosan composites were between 2.7 (0.3) and 4.7 (0.3). The 1d mean flexural strength (MPa) for the control was 16.6 (1.9), and that for the CPC-chitosan ranged from 4.5 (0.5) and 12.0 (1.0) (n=5). Chitosan did not interfere the conversion of CPC components to hydroxyapatite. SIGNIFICANCE: This study demonstrates that CPC-chitosan composites are stable in a wet environment and have acceptable mechanical strengths for clinical applications.

Effects of different whiskers on the reinforcement of dental resin composites.

OBJECTIVE: Whiskers were recently used to reinforce dental composites to extend their use to large stress-bearing restorations. The aim of this study was to investigate the effects of different types of whiskers on composite properties. METHODS: Silicon nitride and silicon carbide whiskers were each mixed with silica particles at whisker/silica mass ratios of 0:1, 1:5, 1:2, 1:1, 2:1, 5:1, and 1:0, and thermally treated. The composite was heat-cured at 140 degrees C. Strength and fracture toughness were measured in flexure, while elastic modulus and hardness were measured with nano-indentation. RESULTS: Both whisker type and whisker/silica ratio had significant effects on composite properties (two-way ANOVA; p<0.001). Silicon nitride whiskers increased the composite strength and toughness more than did silicon carbide. Silicon carbide whiskers increased the modulus and hardness more than silicon nitride did. The silicon nitride whisker composite reached a strength (mean+/-SD; n=6) of 246+/-33 MPa at whisker/silica of 1:1, while the silicon carbide whisker composite reached 210+/-14 MPa at 5:1. Both were significantly higher than 114+/-18 MPa of a prosthetic control and 109+/-23 MPa of an inlay/onlay control (Tukey's multiple comparison test; family confidence coefficient=0.95). Fracture toughness and work-of-fracture were also increased by a factor of two. Higher whisker/silica ratio reduced the composite brittleness to 1/3 that of the inlay/onlay control. SIGNIFICANCE: Whisker type and whisker/silica ratio are key microstructural parameters that determine the composite properties. Reinforcement with silica-fused whiskers results in novel dental composites that possess substantially higher strength and fracture toughness, and lower brittleness than the non-whisker control composites.

Curing-light intensity and depth of cure of resin-based composites tested according to international standards.

BACKGROUND: Several factors control the light curing of a resin-based composite: the composition of the composite, the shade of the composite, the wavelength and bandwidth of the curing light, the distance of the light from the composite, the intensity of the curing light and the irradiation time. The authors investigated the depth of cure of several shades of five brands of resin-based composites when irradiated via light in the 400- to 515-nanometer wavelength bandwidth at the International Organization for Standardization, or ISO, recommended intensity of 300 milliwatts per square centimeter. The resin-based composites were irradiated for the times recommended by the products' manufacturers. METHODS: The authors used a curing light adjusted to emit 300 mW/cm2 in the 400-nm to 515-nm wavelength bandwidth to polymerize five samples of each composite brand type and shade. They measured depth of cure using a scraping method described in the ISO standard for resin-based composites. Depth of cure was defined as 50 percent of the length of the composite specimen after uncured material was removed by manual scraping. The authors determined a mean from the five samples of each composite brand and shade. RESULTS: Thirteen (62 percent) of 21 composite materials met the ISO standard depth-of-cure requirement of 1.5 millimeters. Six of the eight remaining materials met the depth-of-cure requirement when the authors doubled the irradiation time recommended by the product manufacturers. CONCLUSIONS AND CLINICAL IMPLICATIONS: Curing lights with an intensity of 300 mW/cm2 appear to effectively cure most resin-based composite materials when appropriate curing times are used, which, in some cases, are longer than those recommended by the manufacturers. Dentists should verify the depth of cure of a composite material as a baseline measure, and then check depth of cure periodically to confirm light and material performance. The ISO depth-of-cure measurement method can be used for this purpose.

Dental resin composites containing silica-fused whiskers--effects of whisker-to-silica ratio on fracture toughness and indentation properties.

Dental resin composites need to be strengthened in order to improve their performance in large stress-bearing applications such as crowns and multiple-unit restorations. Recently, silica-fused ceramic whiskers were used to reinforce dental composites, and the whisker-to-silica ratio was found to be a key microstructural parameter that determined the composite strength. The aim of this study was to further investigate the effects of whisker-to-silica ratio on the fracture toughness, elastic modulus, hardness and brittleness of the composite. Silica particles and silicon carbide whiskers were mixed at whisker:silica mass ratios of 0:1, 1:5. 1:2, 1:1, 2:1, 5:1, and 1:0. Each mixture was thermally fused, silanized and combined with a dental resin at a filler mass percentage of 60%. Fracture toughness was measured with a single-edge notched beam method. Elastic modulus and hardness were measured with a nano-indentation system. Whisker:silica ratio had significant effects on composite properties. The composite toughness (mean+/-SD; n = 9) at whisker:silica = 2:1 was (2.47+/-0.28) MPa m(1/2), significantly higher than (1.02+/-0.23) at whisker:silica = 0:1, (1.13+/-0.19) of a prosthetic composite control, and (0.95+/-0.11) of an inlay/onlay composite control (Tukey's at family confidence coefficient = 0.95). Elastic modulus increased monotonically and hardness plateaued with increasing the whisker:silica ratio. Increasing the whisker:silica ratio also decreased the composite brittleness, which became about 1/3 of that of the inlay:onlay control. Electron microscopy revealed relatively flat fracture surfaces for the controls, but much rougher ones for the whisker composites, with fracture steps and whisker pullout contributing to toughness. The whiskers appeared to be well-bonded with the matrix, probably due to the fused silica producing rough whisker surfaces. Reinforcement with silica-fused whiskers resulted in novel dental composites that possessed fracture toughness two times higher than, and brittleness less than half of current dental composites.

Effect of thermal cycling on whisker-reinforced dental resin composites.

The mechanical properties of dental resin composites need to be improved in order to extend their use to high stress-bearing applications such as crown and bridge restorations. Recent studies used single crystal ceramic whiskers to reinforce dental composites. The aim of this study was to investigate the effects of thermal cycling on whisker-reinforced composites. It was hypothesized that the whisker composites would not show a reduction in mechanical properties or the breakdown of whisker-resin interface after thermal cycling. Silicon carbide whiskers were mixed with silica particles, thermally fused, then silanized and incorporated into resin to make flexural specimens. The filler mass fraction ranged from 0% to 70%. The specimens were thermal cycled in 5 degrees C and 60 degrees C water baths, and then fractured in three-point bending to measure strength. Nano-indentation was used to measure modulus and hardness. No significant loss in composite strength, modulus and hardness was found after 10(5) thermal cycles (family confidence coefficient=0.95; Tukey's multiple comparison test). The strength of whisker composite increased with filler level up to 60%, then plateaued when filler level was further increased to 70%; the modulus and hardness increased monotonically with filler level. The strength and modulus of whisker composite at 70% filler level were significantly higher than the non-whisker controls both before and after thermal cycling. SEM revealed no separation at the whisker-matrix interfaces, and observed resin remnants on the pulled-out whiskers, indicating strong whisker-resin bonding even after 10(5) thermal cycles. In conclusion, novel dental resin composites containing silica-fused whiskers possessed superior strength and modulus compared to non-whisker composites both before and after thermal cycling. The whisker-resin bonding appeared to be resistant to thermal cycling in water, so that no loss in composite strength or stiffness occurred after prolonged thermal cycling.

Acid-Assisted Consolidation of Silver Alloys for Direct Fillings.

Silver-rich metal powders cold-welded by consolidation have been investigated as possible direct dental filling material. The surface of the silver powder must undergo an acid treatment to remove existing contaminants and prevent formation of new surface contaminants during consolidation. This study was designed to investigate the effect of the acid treatment on the strength of the consolidated alloy, its reactivity with the surrounding tooth structure, and its reactions with certain cavity liners. This study investigated the effects of pH and concentration of fluoboric acid on the flexural strength of silver powder consolidated into rectangular beams in a partial 4 × 4 design. The study also assessed, by visible and scanning electron microscopy, what effect the acid-treated powders had on dentin that had been pre-coated with different cavity liners. Mean flexural strengths for beams consolidated using dental hand instruments were in the range (77.0 ± 9.28) MPa to (166.1 ± 17.6) MPa, where the quoted uncertainties are standard uncertainties (i.e., one standard deviation estimates). ANOVA indicated that fluoboric acid pH was highly significant (p < 0.0001) with lower pH values resulting in higher flexural strength. Concentration alone was not a significant factor for flexural strengths, but there was a significant interaction between concentration and pH (p < 0.0001). Microscopy revealed that the acid-treated silver powder demineralized approximately 2 µm of dentin when used with no liner. The use of copal or polyamide varnishes eliminated most of this demineralization, but the use of a dentin adhesive liner resulted in some dislodgment and breakdown of the adhesive film by the acid. The results of this study indicate that this silver powder when treated with dilute fluoboric acid at a pH of approximately 1.0 can result in a filling material with strength equivalent to currently used conventional amalgam. The demineralization of tooth structure appears to be minimal and can be eliminated with the use of cavity liners.