Stephen D. Campbell

Ceramics in dentistry: Historical roots and current perspectives

This article presents a brief history of dental ceramics and offers perspectives on recent research aimed at the further development of ceramics for clinical use, at their evaluation and selection, and very importantly, their clinical performance. Innovative ceramic materials and ceramics processing strategies that were introduced to restorative dentistry since the early 1980s are discussed. Notable research is highlighted regarding (1) wear of ceramics and opposing enamel, (2) polishability of porcelains, (3) influence of firing history on the thermal expansion of porcelains for metal ceramics, (4) machining and CAD/CAM as fabrication methods for clinical restorations, (5) fit of ceramic restorations, (6) clinical failure mechanisms of all-ceramic prostheses, (7) chemical and thermal strengthening of dental ceramics, (8) intraoral porcelain repair, and (9) criteria for selection of the various ceramics available. It is found that strong scientific and collaborative foundations exist for the continued understanding and improvement of dental ceramic systems.

Fracture-surface analysis of dental ceramics

This study demonstrated that quantitative fractography can be used to study failed aluminous and glass-ceramic central porcelains. Fracture surfaces of DICOR and Vitadur-N core porcelain modulous-of-rupture bars were studied to identify fracture mirror features useful in (1) locating the source of fracture and (2) calculating the stress at fracture in clinically failed restorations. The morphology of fracture surfaces results from events related to the initiation and propagation of the crack front during failure. Modulus-of-rupture testing was performed in four-point bending. Fracture surfaces were studied by scanning electron microscopy. The mean fracture stress for the Vitadur-N porcelain was 94.7 +/- 12.4 MPa (13,730 psi); for DICOR the fracture stress was 55.4 +/- 10.6 MPa (8,030 psi). The standard quantitative fractography relationship between in mirror radius and ln fracture stress was followed for both materials. This quantitative fractography relationship was used to calculate the in vivo stress at failure in a clinically fractured DICOR molar crown. Five clinically failed DICOR crowns were seen to fail from the internal surface.

Frequency of ST-segment depression produced by mental stress in stable angina pectoris from coronary artery disease

Physical exertion is a well-documented trigger of transient myocardial ischemia in patients with coronary disease. More recently, studies have shown that mental stress may also be a cause of myocardial ischemia. The purpose of this study was to examine the relationship of physical activities and perceived mental states to myocardial ischemia while patients were going about their normal daily activities. Twenty-eight patients with documented coronary artery disease underwent ambulatory monitoring of the electrocardiogram. Physical activity and perceived mental status were recorded by patients in a diary which was then graded according to intensity of the activity. Analyses of the continuous electrocardiographic recordings were done separately from the analysis of the diaries. The time of each episode of ischemia, the duration of each episode in minutes and the number of episodes in each 24-hour period were calculated. A total of 372 episodes of ST-segment depression occurred in 912 hours of monitoring. Ischemic events occurring during usual physical and usual mental activities were most frequent (36%). Twenty-six percent of ischemic episodes occurred during increased physical activity, but usual mental activities. Interestingly, 22% of the ischemic events occurred at high levels of mental stress, but low physical activity. Ten percent of episodes occurred during sleep. Although the majority of events occurred during usual daily activities, when duration of ischemia was normalized for time spent in each category, increasing physical or mental activity was associated with an increasing duration of ischemia per unit (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Flexural strength of an infused ceramic, glass ceramic, and feldspathic porcelain

In-Ceram material is a relatively new all-ceramic restorative material with improved properties that require research. The clinical selection of restorative materials is based on a number of parameters such as esthetics, fit, and strength. This study determined the flexural strength of In-Ceram system components and compared the core material with conventional feldspathic ceramics and with Dicor all-ceramic restorative material. Four-point flexural strength values of bend bars of each ceramic were 18.39 +/- 5.00 MPa for In-Ceram sintered alumina, 76.53 +/- 15.23 MPa for In-Ceram infusion glass, and 236.15 +/- 21.94 MPa for In-Ceram infused alumina core. Flexural strength of self-glazed feldspathic porcelain was 69.74 +/- 5.47 MPa, as-cast Dicor ceramic 71.48 +/- 7.17 MPa, and polished Dicor ceramic was 107.78 +/- 8.45 MPa.

A comparative strength study of metal ceramic and all-ceramic esthetic materials: Modulus of rupture

The modulus of rupture for three metal ceramics and five all-ceramic substructures with and without veneer porcelain was compared. Support of the veneer porcelain was directly related to the modulus of elasticity and not to the strength of the substructure material. The higher the modulus of elasticity, the greater was the strength of the veneered restoration. For each 1 x 10(6) increase in the modulus there was a corresponding 1040 psi increase in strength. The veneered all-ceramics had 45% to 70% of the strength of the metal ceramic restorations. The veneered nonprecious and gold-palladium metal ceramic test bars were significantly stronger than any veneered all-ceramic material.

Evaluation of the fit and strength of an all-ceramic fixed partial denture

A laboratory investigation of the fit and strength of three-unit all-ceramic FPDs was performed with a metal-ceramic FPD control. The conclusions were: 1. No difference was found between the marginal seal of the metal-ceramic and all-ceramic FPDs. 2. The all-ceramic FPDs had a more uniform cement space and their occlusal seat was significantly (99.9%) better than the metal-ceramic restorations. 3. The metal-ceramic FPDs were significantly stronger than the all-ceramic FPDs. 4. Load calculations suggest that short-span all-ceramic FPDs may be strong enough to resist normal masticatory forces for selected patients. However, generalized usage will probably result in an unacceptable failure rate.

Thermal cycling distortion of metal ceramics: Part I—Metal collar width

The complex three-dimensional geometry of conventional full crown restorations severely complicates the study of thermal cycling distortion in metal ceramic castings. A simplified experimental geometry was developed to (1) maximize the measuring sensitivity, (2) eliminate the casting variables, (3) allow the direct measurement of casting distortion, and (4) evaluate the thermal cycling distortion of a wide range of metal collar widths. It was found that all of the one-walled castings distorted during the initial thermal cycling (oxidation) of the alloy. There was no significant distortion associated with porcelain application or glazing. The castings with an 0.8 mm metal collar had significantly less distortion than those with 0.1 and 0.4 mm collars at 2 of the 10 sites measured (inferior or facial margins).

Use of an elastomeric material to improve the occlusal seat and marginal seal of cast restorations

A method to improve the fit of castings by the use of a light-bodied condensation silicone impression material was tested. Eighteen-full coverage castings were made on individual resin dies and divided into two groups. The experimental group was adjusted internally to a uniform precementation space by using the silicone impression material as a disclosing agent for binding of the castings on the axial or occlusal walls. Measurements of marginal fit were made with a light microscope using a filar eyepiece both externally and internally by sectioning after cementation with a zinc phosphate cement. Results demonstrated a significant improvement in marginal seal and occlusal seating in the experimental group compared with the control group. The condensation silicone material proved to be an appropriate research tool for nondestructive, three-dimensional evaluation of the postcementation space and offers a new method of evaluation of cement thickness because seating was found to be not significantly different from that with zinc phosphate cement.

Thermal cycling distortion of metal ceramics: Part II-Etiology

The three-dimensional geometry of conventional fixed prostheses complicates the study of the thermal cycling distortion in metal ceramic alloys. Any explanation of the etiology of thermal cycling distortion in metal ceramic restorations must account for the observed magnitude, timing, and direction of the deformation. The simplified experimental geometry developed in Part I was applied to elucidate the etiologic factors involved in metal ceramic deformation. Techniques to minimize the thermal cycling distortion were also studied. It was found that all of the significant distortion occurred during the first thermal cycling of the alloy (oxidation) and that no distortion resulted from the application of body porcelain. The specimens that were cold worked and then oxidized had significantly more distortion than any other group. A significant reduction in distortion was observed when the initial thermal cycling was completed before the specimens were cold worked. It was determined that the release of casting- and cold working-induced stresses had a synergistic effect.

Comparison of conventional paint-on die spacers and those used with the all-ceramic restorations

The study compared the thickness of conventional (Tru-Fit and Belle de St. Claire) and all-ceramic (Dicor and Cerestore) die spacers. Three coats of Tru-Fit, two coats of Belle de St. Claire, and two coats of Cerestore die spacers provided a 25 microns thickness. A single coat of the Dicor spacer resulted in a 37 microns layer. A significantly thinner layer occurred at the convex occlusal line angles for all of the materials tested. This could impede the flow of the luting agent at the time of cementation.