Shihab Romeed

A novel method of forming micro- and macroporous monetite cements

Second to autologous bone grafts are the calcium phosphate cements (CPCs) used as synthetic bone substitutes due to their chemical similarity to the mineral component of bone. Their ability to conform to complex bone defects and excellent osteoconductivity also render them excellent scaffolds for bone tissue engineering, although they do have their own limitations. Calcium phosphates can be divided into two main categories, namely apatite and brushite. Apatites exhibit low solubility, whereas, calcium phosphates that set to form brushite, are metastable, which degrade rapidly, but do subsequently form hydroxyapatite that retards the rate. In contrast dicalcium phosphate anhydrous (monetite) has a higher solubility than octacalcium phosphate and does not transform to an apatite; thus, it is able to continue to degrade with time. Herein, a new method was used via the addition of sodium chloride to β-tricalcium phosphate and monocalcium phosphate monohydrate to form micro- and macroporous monetite (DCPA). The X-ray diffraction and FTIR spectra confirmed the formation of monetite in the presence of both, 6.2 M NaCl solution or 60% of solid sodium chloride. The maximum compressive strength (σc = 12.3 ± 1.8 MPa) and the Youngs modulus (E = 1.0 ± 0.1 GPa) of the monetite cements obtained were comparable to the upper limits of the values reported for cancellous bone and also higher than that reported by other routes used to form monetite. The porous cements analysed by microCT revealed an interconnected porosity with the preliminary in vitro biological evaluation indicating favourable osteoblast cell attachment and growth.

Stress Analysis of Occlusal Forces in Canine Teeth and Their Role in the Development of Non-Carious Cervical Lesions: Abfraction

Non-carious cervical tooth lesions for many decades were attributed to the effects of abrasion and erosion mainly through toothbrush trauma, abrasive toothpaste, and erosive acids. However, though the above may be involved, more recently a biomechanical theory for the formation of these lesions has arisen, and the term abfraction was coined. The aim of this study was to investigate the biomechanics of abfraction lesions in upper canine teeth under axial and lateral loading conditions using a three-dimensional finite element analysis. An extracted human upper canine tooth was scanned by μCT machine (Skyscan, Belgium). These μCT scans were segmented, reconstructed, and meshed using ScanIP (Simpleware, Exeter, UK) to create a three-dimensional finite element model. A 100u2009N load was applied axially at the incisal edge and laterally at 45° midpalatally to the long axis of the canine tooth. Separately, 200u2009N axial and non-axial loads were applied simultaneously to the tooth. It was found that stresses were concentrated at the CEJ in all scenarios. Lateral loading produced maximum stresses greater than axial loading, and pulp tissues, however, experienced minimum levels of stresses. This study has contributed towards the understanding of the aetiology of non-carious cervical lesions which is a key in their clinical management.

Stress analysis of different post‐luting systems: a three‐dimensional finite element analysis

BACKGROUNDnThe longevity of endodontically treated teeth is usually determined by the adequacy of root canal treatments, coronal seal and favourable stress distribution within the remaining tooth tissues. The aim of this study was to investigate the influence of post material and luting cement on the biomechanics of endodontically treated teeth using three-dimensional finite element analysis (3-D FEA).nnnMETHODSnA 3 mm section of endodontically treated canine tooth was scanned and reconstructed for 3-D modelling and FE analyses. A metal post (MP) and a glass fibre post (GFP) were tested individually with four luting cements [zinc phosphate (ZPH), glass ionomer (GI), resin modified glass ionomer (RMGI) and resin based cements (RC)]. A push-out test was conducted by subjecting all models to 100 N perpendicular loading at the post.nnnRESULTSnThe maximum stresses generated along the MP-cement interface were significantly higher than corresponding stresses in the GFP-cement interface regardless of the cement type. GFP generated seven times higher stresses within the root dentine than metal posts when ZPH and GI were used, and three times higher when RMGI and RC were used. The displacement of GFP was double (50 μ) the displacement of MP (20 μ) in all groups.nnnCONCLUSIONSnThe low elastic modulus of GFP generated lower stresses along its interface and higher stresses within the root dentine, therefore the probability of debonding and root fracture in the GFP group was lower.

Structural changes and biological responsiveness of an injectable and mouldable monetite bone graft generated by a facile synthetic method

Brushite (dicalcium phosphate dihydrate) and monetite (dicalcium phosphate anhydrous) are of considerable interest in bone augmentation owing to their metastable nature in physiological fluids. The anhydrous form of brushite, namely monetite, has a finer microstructure with higher surface area, strength and bioresorbability, which does not transform to the poorly resorbable hydroxyapatite, thus making it a viable alternative for use as a scaffold for engineering of bone tissue. We recently reported the formation of monetite cements by a simple processing route without the need of hydrothermal treatment by using a high concentration of sodium chloride in the reaction mix of β-tricalcium phosphate and monocalcium phosphate monohydrate. In this paper, we report the biological responsiveness of monetite formed by this method. The in vitro behaviour of monetite after interaction and ageing both in an acellular and cellular environment showed that the crystalline phase of monetite was retained over three weeks as evidenced from X-ray diffraction measurements. The crystal size and morphology also remained unaltered after ageing in different media. Human osteoblast cells seeded on monetite showed the ability of the cells to proliferate and express genes associated with osteoblast maturation and mineralization. Furthermore, the results showed that monetite could stimulate osteoblasts to undergo osteogenesis and accelerate osteoblast maturation earlier than cells cultured on hydroxyapatite scaffolds of similar porosity. Osteoblasts cultured on monetite cement also showed higher expression of osteocalcin, which is an indicator of the maturation stages of osteoblastogenesis and is associated with matrix mineralization and bone forming activity of osteoblasts. Thus, this new method of fabricating porous monetite can be safely used for generating three-dimensional bone graft constructs.

Zygomatic implants: the impact of zygoma bone support on biomechanics.

Maxillectomy and severely resorbed maxilla are challenging to restore with provision of removable prostheses. Dental implants are essential to restore esthetics and function and subsequently quality of life in such group of patients. Zygomatic implants reduce the complications associated with bone grafting procedures and simplify the rehabilitation of atrophic maxilla and maxillectomy. The purpose of this study was to compare, by means of 3-dimensional finite element analysis, the impact of different zygomatic bone support (10, 15, and 20 mm) on the biomechanics of zygomatic implants. Results indicated that maximum stresses within the fixture were increased by 3 times when bone support decreased from 20 to 10 mm and were concentrated at the fixture/bone interface. However, stresses within the abutment screw and the abutment itself were not significantly different regardless of the bone support level. Supporting bone at 10 mm sustained double the stresses of 15 and 20 mm. Fixtures deflection was decreased by 2 to 3 times when bone support level increased to 15 mm and 20 mm, respectively. It was concluded that zygomatic bone support should not be less than 15 mm, and abutment screw is not at risk of fracture regardless of the zygomatic bone support.Abstract Maxillectomy and severely resorbed maxilla are challenging to restore with provision of removable prostheses. Dental implants are essential to restore aesthetics and function and subsequently quality of life in such group of patients. Zygomatic implants reduce the complications associated with bone grafting procedures and simplify the rehabilitation of atrophic maxilla and maxillectomy. The purpose of this study was to compare, by means of three-dimensional finite element analysis, the impact of different zygomatic bone support (10, 15, and 20mm) on the biomechanics of zygomatic implants. Results indicated maximum stresses within the fixture were increased by three times, when bone support decreased from 20 to 10mm, and concentrated at fixture/bone interface. However, stresses within the abutment screw and abutment itself were not significantly different regardless of the bone support level. Supporting bone at 10mm suffered double the stresses of 15 and 20mm. Fixtures deflection was decreased by two to three times when bone level support increased to 15mm and 20mm respectively. It was concluded that zygomatic bone support should not be less than 15mm and abutment screw is not at risk of fracture regardless of the zygomatic bone support.

An In Vitro Assessment of Gutta-Percha Coating of New Carrier-Based Root Canal Fillings

The first aim of this paper was to evaluate the push-out bond strength of the gutta-percha coating of Thermafil and GuttaCore and compare it with that of gutta-percha used to coat an experimental hydroxyapatite/polyethylene (HA/PE) obturator. The second aim was to assess the thickness of gutta-percha around the carriers of GuttaCore and HA/PE obturators using microcomputed tomography (μCT). Ten (size 30) 1u2009mm thick samples of each group (Thermafil, GuttaCore, and HA/PE) were prepared. An orthodontic wire with a diameter of 0.5u2009mm was attached to the plunger of an Instron machine in order to allow the push-out testing of the gutta-percha coating. Five samples of (GuttaCore and HA/PE) were scanned using μCT. The data obtained were analysed with one-way analysis of variance and Tukey post hoc test. HA/PE obturators exhibited significantly higher push-out bond strength (P < 0.001) determined at 6.84 ± 0.96 than those of Guttacore around 3.75 ± 0.75 and Thermafil at 1.5 ± 0.63. GuttaCore demonstrated significantly higher bond strength than Thermafil (P < 0.001). μCT imaging revealed that the thickness of gutta-percha around the experimental HA/PE carrier was homogeneously distributed. The bondability and thickness of gutta-percha coating around HA/PE carriers were superior to those of GuttaCore and Thermafil obturators.

Marginal bone loss influence on the biomechanics of single implant crowns.

AbstractMarginal bone loss, whether it is physiological or pathological, is one of the implant treatment complications. The biomechanical consequences of marginal bone loss could be catastrophic particularly when the abutment screw is at supraosseous level. This study aimed at investigating marginal bone loss influence on the biomechanics of single implant crown using finite element (FE) analysis. Four FE models for a 3.5 × 13 mm implant supported by 4 bone levels (8.5 mm, 10 mm, 11.5 mm, and 13 mm) were subjected to 3 loading conditions: vertical, oblique, and horizontal. The results indicated 5–10 times increase in maximum von Mises stresses under oblique and horizontal loading. The maximum stresses within the fixture were concentrated at the bone/fixture interface with highest value under horizontal loading at 10 mm bone support. Abutment screw was most susceptible to fracture as the highest stress was concentrated at the screw/fixture interface. Cortical bone suffered its greatest stress level at the fixture/bone interface at 10 mm bone support. However, increasing bone support to 11.5 mm has improved the fracture resistance of the abutment screw to a great extent especially under oblique and vertical loading. Severe marginal bone loss might be attributed for abutment screw and fixture head fracture especially under horizontal loading.

Extrasinus zygomatic implant placement in the rehabilitation of the atrophic maxilla: three-dimensional finite element stress analysis.

Placement of zygomatic implants lateral to the maxillary sinus, according to the extrasinus protocol, is one of the treatment options in the rehabilitation of severely atrophic maxilla or following maxillectomy surgery in patients with head and neck cancer. The aim of this study was to investigate the mechanical behavior of a full-arch fixed prosthesis supported by 4 zygomatic implants in the atrophic maxilla under occlusal loading. Results indicated that maximum von Mises stresses were significantly higher under lateral loading compared with vertical loading within the prosthesis and its supporting implants. Peak stresses were concentrated at the prosthesis-abutments interface under vertical loading and the internal line angles of the prosthesis under lateral loading. The zygomatic supporting bone suffered significantly lower stresses. However, the alveolar bone suffered a comparatively higher level of stresses, particularly under lateral loading. Prosthesis displacement under vertical loading was higher than under lateral loading. The zygomatic bone suffered lower stresses than the alveolar bone and prosthesis-implant complex under both vertical and lateral loading. Lateral loading caused a higher level of stresses than vertical loading.