Martyn Sherriff

Measurement of the microhardness and young's modulus of human enamel and dentine using an indentation technique

Conventional quasi-static and dynamic test methods have a number of limitations when used to measure the mechanical properties of enamel and dentine. These are due to the complex structure of the material and the small specimen size. In this investigation, a microindentation technique was used to measure the hardness and Youngs modulus of human enamel and dentine and any variations with location. Freshly extracted molar teeth were sectioned, and the cut surfaces were ground and polished progressively to 1 micron. The polished surfaces were indented at different distances from the surface and amelodentinal junction with a Knoop indentor. Measurements of the length of the long indentation diagonal were used to calculate a value for hardness. It has been shown that the a-value for Youngs modulus of a material can be calculated by comparing the ratio of the long and short diagonals on an indented specimen with the actual ratio of the indentor as any changes will be due to elastic recovery in the specimen. Values obtained for the Knoop hardness of enamel and dentine were in good agreement with those of other workers. It was also possible to show that there was a decrease in hardness with depth from the surface in enamel. The hardness of dentine increased with distance from the amelodentinal junction. Values for Youngs modulus for dentine were in good agreement with those of other workers, and there was an increase in modulus with depth from the amelodentinal junction from 8.7 to 11.2 GNm-2. Values for Youngs modulus of enamel were not as easy to calculate because of surface- and subsurface damage.

Alignment efficiency of Damon3 self-ligating and conventional orthodontic bracket systems: a randomized clinical trial.

INTRODUCTION The aim of this study was to compare the efficiency of mandibular tooth alignment and the clinical effectiveness of a self-ligating and a conventional preadjusted edgewise orthodontic bracket system. METHODS A multicenter randomized clinical trial was conducted in 2 orthodontic clinics. Sixty-two subjects (32 male, 30 female; mean age, 16.27 years) with mandibular incisor irregularities of 5 to 12 mm and a prescribed extraction pattern including the mandibular first premolars were randomly allocated to treatment with Damon3 self-ligating (Ormco, Glendora, Calif) or Synthesis (Ormco) conventionally ligated brackets. Fully ligated 0.014-in nickel-titanium archwires were used first in both groups, followed by a sequence of 0.014 x 0.025-in and 0.018 x 0.025-in nickel-titanium, and 0.019 x 0.025-in stainless steel. Study casts were taken at the start of treatment (T1), the first archwire change (T2), and the placement of the final 0.019 x 0.025-in archwire (T3). Cephalometric lateral skull and long-cone periapical radiographs of the mandibular incisors were taken at T1 and T3. RESULTS No significant difference was noted (P >0.05) in initial rate of alignment for either bracket system. Initial irregularity influenced subsequent rate of movement, but sex, age, and appliance type were statistically insignificant. Alignment was associated with an increase in intercanine width, a reduction in arch length, and proclination of the mandibular incisors for both appliances, but the differences were not significant. Incisor root resorption was not clinically significant and did not differ between systems. CONCLUSIONS Damon3 self-ligating brackets are no more efficient than conventional ligated preadjusted brackets during tooth alignment.

The prognostic value of individual histologic grading parameters in small lingual squamous cell carcinomas. The importance of the pattern of invasion

Background. The histologic grading of the deep invasive margin of oral squamous cell carcinoma recently has been shown to have prognostic value, but previous series have not been homogeneous enough to allow grading parameters to be assessed individually.

Three-point bending test of fiber posts

Five different types of fiber posts (carbon fiber Composipost radio-opaque, quartz fiber Aestheti-Plus, carbon fiber Carbotech, glass fiber Light post, and silica fiber Snowpost) were submitted to a three-point bending test after being stored for 1 yr under three different conditions: dry storage at room temperature, storage in 37 degrees C water, and storage in bovine teeth that were endodontically treated and restored with composite resin. The posts were observed before and during the test by confocal microscopy. More voids were found within the Composipost radio-opaque than in other posts. Posts of all groups that were stored in water showed flexural strength values lower than posts that were stored dry. In all storage conditions, Carbotech posts showed higher flexural strength values than Composiposts and Snowposts, and Aestheti-Plus posts showed higher flexural strength values than Snowposts. Posts that were stored in bovine teeth showed flexural strength values similar to those of posts that were stored dry. It was concluded that fiber posts must not be in contact with oral fluids and that during the 1-yr storage in bovine teeth, they were sufficiently protected from this contact by the apical root canal filling and by the coronal composite resin filling.

The Effects of Social Class and Dental Attendance on Oral Health

The relationship between socio-economic status (SES) and oral health is well-established. We investigated whether the association between SES and the number of sound teeth in adults is explained by dental attendance patterns, in turn determined by the effect of SES on barriers to dental attendance. Data on 3817 participants from the 1998 Adult Dental Health Survey in the UK were analyzed. Using structural equation modeling, we found a model with 4 factors (aging, SES, attendance-profile, and barriers-to-dental-attendance) providing an adequate fit to the covariance matrix of the 9 covariates. The final model suggests that the association between SES and the number of sound teeth in adults in the UK is partially explained by the pathway [SES → barriers-to-dental-attendance → dental-attendance-profile → number-of-sound-teeth]. A direct relationship, SES → number-of-sound-teeth, is also significant.

Expression of epidermal growth factor receptor on oral squamous cell carcinoma.

The expression of the receptor for epidermal growth factor (EGF) in normal oral mucosa, papillomas and squamous cell carcinoma (SCC) has been determined by immunohistology and autophophorylation studies. Immunoreactive receptor was localised using two antibodies which recognise the receptor; EGFR1 which reacts with sequences in the external domain of the receptor and F4 which recognises sequences in the internal domain. EGFR was present on basal, suprabasal and some spinous cells of normal oral mucosa. Regional variation in the distribution of receptor was apparent. A similar pattern of receptor expression was seen on oral papillomas. The distribution and intensity of epidermal growth factor receptor (EGFR) expression varied between 20 patients with oral SCC. The staining patterns seen with the two antibodies were similar on all tissue types. The protein tyrosine-kinase activity of the receptor present on eight oral SCC was also examined by immunoprecipitation and autophosphorylation studies. This procedure also demonstrated variations in the amount of functional EGFR in these tumours. There was no significant correlation between the level of EGFR expression and tumour behaviour.

An in vivo investigation into bond failure rates with a new self-etching primer system

Self-etching primers have recently been introduced to simplify the orthodontic bonding process. The aim of this study was to compare the effectiveness of such a product with conventional 2-stage etching and priming with 37% o-phosphoric acid and a conventional unfilled primer. Twenty consecutive patients having orthodontic bonds placed were selected to participate in this cross-mouth control study. Diagonally opposite quadrants were randomly allocated to either the self-etching primer group or the conventional etching and priming group. A total of 364 teeth were bonded with a light-cured diacrylate adhesive; bond failures were then monitored over 6 months. There were 20 bond failures (10.99%) in the self-etching primer group and 9 bond failures (4.95%) in the conventional etch and priming group over this period. The results were analyzed with the McNemar test and 95% confidence interval. The difference between the failure proportions was -0.06 with an associated 95% confidence interval of -0.121 to 0.001. This study produced weak evidence to suggest that bond failures with a self-etching primer will be higher than those with conventional etching and priming. This increased likelihood of bond failure must be weighed against the time advantage of the self-etching primer when used at the initial bonding appointment.

The measurement and prevention of erosion and abrasion

OBJECTIVES To develop a reproducible method to measure tooth wear and assess the protection given by dentine bonding agents in an erosive/abrasive wear regime. METHODS Seal and Protect (Dentsply, UK) and Optibond Solo (Kerr, UK) were each applied to 20 extracted teeth and subjected to 3000 cycles in a reciprocating erosion/abrasion wear machine. A further 20 teeth, without protection, were subjected to the same wear regime and were either brushed in water or immersed in acid. Impressions were taken by a standardised technique and were scanned with a non-contacting laser profilometer. The amount of erosion was measured at the same co-ordinates before and after erosion using 2mm diameter metal discs as reference points. RESULTS The amount of wear on Seal and Protect had a mean 24.8 microm (SD 57.4 microm) and for Solo it was 1.4 microm (24.5 microm), and this difference was statistically significant (p=0.02). There was no statistically significant difference in the wear measured on the teeth brushed in water or immersed in acid. The wear measured on the unprotected teeth was 243 microm (SD 120 microm) and was statistically significantly different to the protected surfaces (p=0.001). CONCLUSION Both Seal and Protect and Solo protected the teeth in this wear regime and the technique could be used clinically for patients with uncontrolled dental erosion.

The association of tooth wear, diet and dietary habits in adults aged 18–30 years old☆

OBJECTIVE The association of acidic foods and drinks to the development of erosive tooth wear was investigated in a single cohort of adults aged 18-30 years. METHOD A tooth wear index was recorded on 1010 participants who had a mean age of 21.9 years (SD 0.1) and of which 70% were female and 30% males. Participants completed a previously validated questionnaire containing 50 questions about current and historical dietary habits. Data were analysed at the tooth level using odds ratio. RESULTS Tooth wear was statistically significantly associated to acidic foods and drinks with high titratable acidity and dietary habits, including drinking from a glass and holding drinks, (OR 5 and 6.5 respectively). A history of heartburn was statistically significantly associated to palatal dentine exposure (p≤0.05 and OR 7.6). CONCLUSION In this sample of adults, tooth wear was associated to a number of acidic dietary products and drinking habits.

Perception of discomfort during initial orthodontic tooth alignment using a self-ligating or conventional bracket system: a randomized clinical trial

The aim of this study was to compare the degree of discomfort experienced during the period of initial orthodontic tooth movement using Damon3 self-ligating and Synthesis conventional ligating pre-adjusted bracket systems. Sixty-two subjects were recruited from two centres (32 males and 30 females; mean age 16 years, 3 months) with lower incisor irregularity between 5 and 12 mm and a prescribed extraction pattern, including lower first premolar teeth. These subjects were randomly allocated for treatment with either bracket system. Fully ligated Damon3 0.014-inch Cu NiTi archwires were used for initial alignment in both groups. Following archwire insertion, the subjects were given a prepared discomfort diary to complete over the first week, recording discomfort by means of a 100 mm visual analogue scale at 4 hours, 24 hours, 3 days, and 1 week. The subjects also noted any self-prescribed analgesics that were taken during the period of observation. Data were analysed using repeated measures analysis of variance. There were no statistically significant differences in perceived discomfort levels between the two appliances; discomfort did not differ at the first time point and did not develop differently across subsequent measurement times. Overall, this investigation found no evidence to suggest that Damon3 self-ligating brackets are associated with less discomfort than conventional pre-adjusted brackets during initial tooth alignment, regardless of age or gender.