Christina Mitchell

Printability of calcium phosphate: calcium sulfate powders for the application of tissue engineered bone scaffolds using the 3D printing technique.

In this study, calcium phosphate (CaP) powders were blended with a three-dimensional printing (3DP) calcium sulfate (CaSO4)-based powder and the resulting composite powders were printed with a water-based binder using the 3DP technology. Application of a water-based binder ensured the manufacture of CaP:CaSO4 constructs on a reliable and repeatable basis, without long term damage of the printhead. Printability of CaP:CaSO4 powders was quantitatively assessed by investigating the key 3DP process parameters, i.e. in-process powder bed packing, drop penetration behavior and the quality of printed solid constructs. Effects of particle size, CaP:CaSO4 ratio and CaP powder type on the 3DP process were considered. The drop penetration technique was used to reliably identify powder formulations that could be potentially used for the application of tissue engineered bone scaffolds using the 3DP technique. Significant improvements (p<0.05) in the 3DP process parameters were found for CaP (30-110 μm):CaSO4 powders compared to CaP (<20 μm):CaSO4 powders. Higher compressive strength was obtained for the powders with the higher CaP:CaSO4 ratio. Hydroxyapatite (HA):CaSO4 powders showed better results than beta-tricalcium phosphate (β-TCP):CaSO4 powders. Solid and porous constructs were manufactured using the 3DP technique from the optimized CaP:CaSO4 powder formulations. High-quality printed constructs were manufactured, which exhibited appropriate green compressive strength and a high level of printing accuracy.

Fracture toughness of conventional, resin-modified glass–ionomer and composite luting cements

OBJECTIVES This study was conducted to determine if significant differences existed between the fracture toughness of three types of luting cement, and, if the method of mixing conventional glass-ionomer luting cements, hand-mixed or mechanically mixed, influenced the value obtained. METHODS Three types of luting cement were investigated: conventional glass-ionomer cement (two handmixed and two capsulated cements, KetacCem, Fuji I and KetacCem Maxicap, Fuji Cap I), a resin-modified glass-ionomer cement (Vitremer Luting Cement) and a resin composite cement (Scotchbond Resin Cement). Eleven specimens of each of the six cements were fabricated to determine the plane strain fracture toughness using the chevron notch short rod technique. After seven days the specimens were loaded in a water bath, at a crosshead speed of 4 microns/s and the fracture toughness values calculated. RESULTS ANOVA indicated significant differences between the cements (p < 0.0001) and each cement was compared with all others using Fishers PSLD test (p < 0.05). The rank order of results from highest fracture toughness value to lowest (mean +/- s.d.) was Scotchbond Resin Cement (1.31 +/- 0.17), Vitremer Luting Cement (1.08 +/- 0.1), Fuji Cap I (0.37 +/- 0.04), KetacCem Maxicap (0.37 +/- 0.05), Fuji I (0.34 +/- 0.04), KetacCem (0.27 +/- 0.03). SIGNIFICANCE Of the cements tested, the resin composite cement is most likely to resist clinical failure by cement cohesive failure.

The influence of luting cement on the probabilities of survival and modes of failure of cast full-coverage crowns

OBJECTIVES This study compares the probabilities of survival and modes of failure of cast full-coverage crowns bonded with five cements when subjected to tensile pull-off testing. METHODS Five groups of 25 sound human premolar teeth were prepared for full-coverage crowns, impressions recorded and customized castings fabricated in Ni-Cr-Mb bonding alloy. The cements tested were zinc phosphate, a hand-mixed and capsulated conventional glass-ionomer cement, a resin-modified glass-ionomer cement and a resin composite luting cement. The cemented crowns were stored in water at 37 degrees C for 24 h prior to application of a tensile pull-off force at a strain rate of 10 mm/min. The loads at failure were ranked and modelled by derived Weibull functions each describing the probability of a given specimen failing under a given load. Non-parametric statistical analysis was also applied to the results. RESULTS There were no significant differences between the loads at failure of zinc phosphate cement, the hand-mixed or the capsulated glass-ionomer cements. The resin-modified glass-ionomer cement and the resin composite cement failed at significantly higher loads than the other three cements, but were not significantly different from each other. The Weibull modulus ranking for each cement from highest to lowest was resin composite = zinc phosphate, resin-modified glass-ionomer, hand-mixed conventional glass-ionomer and capsulated conventional glass-ionomer cement. SIGNIFICANCE Weibull analysis allows dentists to compare the probability of survival of a crown bonded with different cements at a chosen load giving an indication of cement reliability.

Fatigue and biocompatibility properties of a poly (methyl methacrylate) bone cement with multi-walled carbon nanotubes

Composites of multi-walled carbon nanotubes (MWCNT) of varied functionality (unfunctionalised and carboxyl and amine functionalised) with polymethyl methacrylate (PMMA) were prepared for use as a bone cement. The MWCNT loadings ranged from 0.1 to 1.0 wt.%. The fatigue properties of these MWCNT-PMMA bone cements were characterised at MWCNT loading levels of 0.1 and 0.25 wt.% with the type and wt.% loading of MWCNT used having a strong influence on the number of cycles to failure. The morphology and degree of dispersion of the MWCNT in the PMMA matrix at different length scales were examined using field emission scanning electron microscopy. Improvements in the fatigue properties were attributed to the MWCNT arresting/retarding crack propagation through the cement through a bridging effect and hindering crack propagation. MWCNT agglomerates were evident within the cement microstructure and the degree of agglomeration was dependent on the level of loading and functionality of the MWCNT. The biocompatibility of the MWCNT-PMMA cements at MWCNT loading levels upto 1.0 wt.% was determined by means of established biological cell culture assays using MG-63 cells. Cell attachment after 4h was determined using the crystal violet staining assay. Cell viability was determined over 7 days in vitro using the standard colorimetric MTT assay. Confocal scanning laser microscopy and SEM analysis was also used to assess cell morphology on the various substrates.

Incorporation of multiwalled carbon nanotubes to acrylic based bone cements: Effects on mechanical and thermal properties

Polymethyl methacrylate (PMMA) bone cement-multiwalled carbon nanotube (MWCNT) nanocomposites with a weight loading of 0.1% were prepared using 3 different methods of MWCNT incorporation. The mechanical and thermal properties of the resultant nanocomposite cements were characterised in accordance with the international standard for acrylic resin cements. The mechanical properties of the resultant nanocomposite cements were influenced by the type of MWCNT and method of incorporation used. The exothermic polymerisation reaction for the PMMA bone cement was significantly reduced when thermally conductive functionalised MWCNTs were added. This reduction in exotherm translated in a decrease in thermal necrosis index value of the respective nanocomposite cements, which potentially could reduce the hyperthermia experienced in vivo. The morphology and degree of dispersion of the MWCNTs in the PMMA matrix at different scales were analysed using scanning electron microscopy. Improvements in mechanical properties were attributed to the MWCNTs arresting/retarding crack propagation through the cement by providing a bridging effect into the wake of the crack, normal to the direction of crack growth. MWCNT agglomerations were evident within the cement microstructure, the degree of these agglomerations was dependent on the method used to incorporate the MWCNTs into the cement.

Probability of failure of orthodontic brackets bonded with different cementing agents

OBJECTIVES The aim of this study was to compare the maximum loads at failure and the probability of failure of three glass ionomer cements and a composite cement bonding orthodontic brackets to human premolar teeth. METHODS The cements studied included a conventional glass ionomer cement, two resin-modified glass ionomer cements and a composite cement. The roots of 200 human premolar teeth were embedded in acrylic resin and the buccal enamel surface of the crown prepared as required. Each cement used to bond the bracket to the enamel was weighted, and light-cured where required. The specimens were stored for 10 min or 24 h at 37 degrees C and 100% humidity. A tensile shear force was applied via a wire loop placed under the wings of the bracket. The maximum load at failure was noted and subjected to Weibull analysis to compare probabilities of survival for each cement. The data obtained was also analyzed using a Kruskal-Wallis test followed by comparison of the groups using Mann-Whitney tests. RESULTS Comparison of the loads at failure revealed that the composite cement was significantly stronger than the glass ionomer cements at 10 min and 24 h (p<0.05). Weibull analysis of the results gave values for the Weibull moduli and probabilities of survival for an orthodontic bracket under a given load for each cement at 10 min and 24 h. SIGNIFICANCE . Glass ionomer cements give a number of clinically significant advantages over composite cement in the retention of brackets. The resin-modified glass ionomer cements tested had a higher probability of survival than the conventional cement tested at 24 h. However, further improvements in their early bond strength would be clinically beneficial.

Comparative study of four glass ionomer luting cements during post pull-out tests

OBJECTIVES The aim of this study was to compare the maximum loads and modes of failure of four glass ionomer luting cements during post pull-out tests. METHODS The cements studied included two based on conventional glass ionomer cement chemistry, i.e., a hand-mixed cement and an encapsulated cement, and two based on the newer light-cured chemistry, i.e., a restorative cement used at a low powder:liquid ratio and an experimental luting cement. One hundred and forty bovine incisors were cut 13 mm from the apex and prepared with post channels, 1.75 mm in diameter and 9 mm long. Ni-Cr-Mb bonding alloy posts were cast and sandblasted prior to cementation into the roots with each of the cements. Twenty-four hours later, pull-out tests were carried out at a strain rate of 0.5 mm/min. The maximum loads and modes of failure were noted. The data obtained were analyzed using a Kruskal-Wallis test followed by comparison of groups using Mann-Whitney tests. RESULTS Comparison of the maximum loads revealed a significant difference between the conventional encapsulated cement and all other cements. Weibull analysis of the results gave values for the Weibull moduli and probabilities of survival for a post under a given load for each cement and indicated that the newer cements performed better than the conventional cements. SIGNIFICANCE Further research into the in vitro and in vivo behavior of the resin-modified glass ionomer cements in clinical situations where light-curing is not possible is justified.

Retention of adhesive cement on the tooth surface after crown cementation

STATEMENT OF PROBLEM Adhesive cements increase crown retention, but it is unknown if traces of cement remain undetected on the tooth surface after clinical removal of excess cement, which could exacerbate plaque retention. PURPOSE This study measured the surface area, volume, mean depth, and maximum depth of a resin composite and a compomer luting cement left adherent on the tooth surface after removal of excess cement, as judged clinically. METHODS AND MATERIAL Four groups of specimens (n = 48) were prepared for full coverage crowns: group AC bonding alloy with chamfer finish line, group G gold alloy with chamfer finish line, group PC porcelain with a chamfer finish line, and group PS porcelain with a shoulder finish line. Two profiles of the mesial and distal surfaces of the teeth were carried out: (1) tooth with crown seated but not cemented and (2) tooth with the crown cemented in place. Two cements and 2 methods of cement removal were studied. RESULTS A 4-way analysis of variance for cement, crown type, method of removal, and tooth surface morphology showed that significantly greater volumes and mean depth, but not surface areas, of resin composite cement remained adherent than compomer cement (P<.05). Among crown types, significant differences were found for cement volume (group G>AC, G>PC, G>PS), cement surface area (group AC>PC, G>PC, G>PS), and maximum cement depth (group G>AC). There was no significant difference between the 2 methods of cement removal. Significantly larger surface areas and maximum depths of cement were retained on the anatomically grooved mesial surface of the maxillary first premolars than on the ungrooved distal surface. CONCLUSION Subclinical cement retention occurred after crown cementation, which was influenced by cement, crown type, and tooth surface morphology but not method of cement removal.

Effects of Heat Treatment on the Mechanical and Degradation Properties of 3D-Printed Calcium-Sulphate-Based Scaffolds

Three-dimensional printing (3DP) has been employed to fabricate scaffolds with advantages of fully controlled geometries and reproducibility. In this study, the scaffold structure design was established through investigating the minimum feature size and powder size distribution. It was then fabricated from the 3DP plaster-based powders (CaSO4·1/2H2O). Scaffolds produced from this material demonstrated low mechanical properties and a rapid degradation rate. This study investigated the effects of heat treatment on the mechanical and in vitro degradation properties of the CaSO4 scaffolds. The occurrence of dehydration during the heating cycle offered moderate improvements in the mechanical and degradation properties. By using a heat treatment protocol of 200°C for 30 min, compressive strength increased from 0.36 ± 0.13 MPa (pre-heat-treated) to 2.49 ± 0.42 MPa (heat-treated). Heat-treated scaffolds retained their structure and compressive properties for up to two days in a tris-buffered solution, while untreated scaffolds completely disintegrated within a few minutes. Despite the moderate improvements observed in this study, the heat-treated CaSO4 scaffolds did not demonstrate mechanical and degradation properties commensurate with the requirements for bone-tissue-engineering applications.

Capsulated versus hand-mixed glass-ionomer luting cements for post retention

OBJECTIVES Glass-ionomer luting cements are supplied in two forms, as loose powder and liquid to be hand-mixed (HM) or pre-proportioned in a capsule to be mechanically mixed (MM). This study was to determine if post retention in pull-out tests was affected by the method of mixing the cement. METHODS Two hundred stainless steel posts of diameter 1.75 mm were cemented within post-channels prepared in stainless steel cylinders using two hand-mixed cements FJL and KCL (Fuji I Luting Cement and Ketac-Cem Luting Cement) and two capsulated cements FJC and KCM (Fuji Cap I and Ketac-Cem Maxicap). Three groups of test specimens were prepared. In Group I each cement was mixed as recommended by the manufacturer, Group II cements were placed within a capsule and mechanically mixed and in Group III cements were removed from the capsule and mixed by hand. Specimens were stored for 1 h at 37 degrees C and 100% humidity prior to post pull-out tests at a crosshead speed of 10 mm min-1. The maximum loads at failure were subjected to Weibull analysis and Mann-Whitney tests to determine probabilities of survival and significant differences between the groups. RESULTS Significant differences (P < 0.05) were found between all pairs of cements tested except KCM(MM) vs FJL(HM), FJL(MM) vs KCL(HM), KCL(MM), vs KCL(HM), FJC(HM) vs FJC(MM), KCL(MM) vs FJL(MM). CONCLUSIONS The capsulated cements as supplied by the manufacturers are preferable to the equivalent hand-mixed formulations, as they give higher probabilities of survival when subjected to a given load. Both capsulated and hand-mixed formulations of Fuji had higher probabilities of survival compared to the corresponding Ketac cements. The probability of post survival can be altered by the method of mixing the cement.