Yoshimasa Igarashi

Microstructures and mechanical properties of Co-29Cr-6Mo alloy fabricated by selective laser melting process for dental applications

The selective laser melting (SLM) process was applied to a Co-29Cr-6Mo alloy, and its microstructure, mechanical properties, and metal elution were investigated to determine whether the fabrication process is suitable for dental applications. The microstructure was evaluated using scanning electron microscopy with energy-dispersed X-ray spectroscopy (SEM-EDS), X-ray diffractometry (XRD), and electron back-scattered diffraction pattern analysis. The mechanical properties were evaluated using a tensile test. Dense builds were obtained when the input energy of the laser scan was higher than 400 J mm⁻³, whereas porous builds were formed when the input energy was lower than 150 J mm⁻³. The microstructure obtained was unique with fine cellular dendrites in the elongated grains parallel to the building direction. The γ phase was dominant in the build and its preferential <001> orientation was confirmed along the building direction, which was clearly observed for the builds fabricated at lower input energy. Although the mechanical anisotropy was confirmed in the SLM builds due to the unique microstructure, the yield strength, UTS, and elongation were higher than those of the as-cast alloy and satisfied the type 5 criteria in ISO22764. Metal elution from the SLM build was smaller than that of the as-cast alloy, and thus, the SLM process for the Co-29Cr-6Mo alloy is a promising candidate for fabricating dental devices.

Nonlinear finite element analyses: Advances and challenges in dental applications

OBJECTIVES To discuss the development and current status of application of nonlinear finite element method (FEM) in dentistry. DATA AND SOURCES The literature was searched for original research articles with keywords such as nonlinear, finite element analysis, and tooth/dental/implant. References were selected manually or searched from the PUBMED and MEDLINE databases through November 2007. STUDY SELECTION The nonlinear problems analyzed in FEM studies were reviewed and categorized into: (A) nonlinear simulations of the periodontal ligament (PDL), (B) plastic and viscoelastic behaviors of dental materials, (C) contact phenomena in tooth-to-tooth contact, (D) contact phenomena within prosthodontic structures, and (E) interfacial mechanics between the tooth and the restoration. CONCLUSIONS The FEM in dentistry recently focused on simulation of realistic intra-oral conditions such as the nonlinear stress-strain relationship in the periodontal tissues and the contact phenomena in teeth, which could hardly be solved by the linear static model. The definition of contact area critically affects the reliability of the contact analyses, especially for implant-abutment complexes. To predict the failure risk of a bonded tooth-restoration interface, it is essential to assess the normal and shear stresses relative to the interface. The inclusion of viscoelasticity and plastic deformation to the program to account for the time-dependent, thermal sensitive, and largely deformable nature of dental materials would enhance its application. Further improvement of the nonlinear FEM solutions should be encouraged to widen the range of applications in dental and oral health science.

Does Removable Partial Denture Quality Affect Individuals’ Oral Health?:

The impact of oral disorders and interventions on individuals’ perceived oral health and oral-health-related quality of life (OHRQoL) is being increasingly recognized as an important health component. This study examined the association between denture quality and OHRQoL in individuals wearing removable partial dentures (RPDs). The study participants were 245 consecutive patients (mean age: 63.3 ± 8.7 yrs) at a university-based prosthodontic clinic who wore RPDs for more than one month. RPD quality and OHRQoL were determined by means of a 100-mm visual analog scale (VAS) and the 49-item Oral Health Impact Profile-Japanese version (OHIP-J49), respectively. Linear regression analysis between RPD quality and OHRQoL revealed that a 10-mm VAS increase in RPD quality rating was related to −2.8 OHIP-J49 units (95% confidence interval: −4.5 to −1.1, p = 0.001), which represents an improvement in OHRQoL. The results suggest that RPD quality influences individuals’ OHRQoL to a clinically significant extent.

Effects of chromium and nitrogen content on the microstructures and mechanical properties of as-cast Co-Cr-Mo alloys for dental applications.

The microstructure and mechanical properties of as-cast Co-(20-33)Cr-5Mo-N alloys were investigated to develop ductile Co-Cr-Mo alloys without Ni addition for dental applications that satisfy the requirements of the type 5 criteria in ISO 22674. The effects of the Cr and N contents on the microstructure and mechanical properties are discussed. The microstructures were evaluated using scanning electron microscopy with energy-dispersive X-ray spectroscopy (EDS), X-ray diffractometry (XRD), and electron back-scattered diffraction pattern analysis. The mechanical properties were evaluated using tensile testing. The proof strength and elongation of N-containing 33Cr satisfied the type 5 criteria in ISO 22674. ε-phase with striations was formed in the N-free (20-29)Cr alloys, while there was slight formation of ε-phase in the N-containing (20-29)Cr alloys, which disappeared in N-containing 33Cr. The lattice parameter of the γ-phase increased with increasing Cr content (i.e. N content) in the N-containing alloys, although the lattice parameter remained almost the same in the N-free alloys because of the small atomic radius difference between Co and Cr. Compositional analyses by EDS and XRD revealed that in the N-containing alloys Cr and Mo were concentrated in the cell boundary, which became enriched in N, stabilizing the γ-phase. The mechanical properties of the N-free alloys were independent of the Cr content and showed low strength and limited elongation. Strain-induced martensite was formed in all the N-free alloys after tensile testing. On the other hand, the proof strength, ultimate tensile strength, and elongation of the N-containing alloys increased with increasing Cr content (i.e. N content). Since formation of ε-phase after tensile testing was confirmed in the N-containing alloys the deformation mechanism may change from strain-induced martensite transformation to another form, such as twinning or dislocation slip, as the N content increases. Thus the N-containing 33Cr alloy with large elongation is promising for use in dentures with adjustable clasps through one piece casting.

Patterns of missing occlusal units and oral health-related quality of life in SDA patients

The aim of this study was to explore the relationship between patterns of missing occlusal units (OUs) and oral health-related quality of life (OHRQoL) in subjects with the shortened dental arches (SDAs). Subjects with SDAs were recruited consecutively for 1 month from six university-based prosthodontic clinics. In total, 115 SDA subjects participated (mean age, 58.5 +/- 10.0 years; 71% female). The location and number of missing teeth were examined and the number of missing OUs was calculated. To evaluate OHRQoL, the Japanese version of the Oral Health Impact Profile (OHIP-J) was administered and the summary score of OHIP-J was calculated. The SDA subjects were categorized depending upon the anterior-posterior lengths of the missing or remaining OUs. Regression analyses were performed to investigate the OHIP-J differences between groups of subjects with various anterior-posterior SDA lengths. The analyses revealed that subjects who only lost the second molar contact exhibited significantly better OHRQoL than those who lost more teeth [coefficient: 11.1, 95% confidence interval (CI): 2.8-19.2, P = 0.02]. Furthermore a statistically significant group difference was observed between the groups with and without the first molar occlusal contact (coefficient: 12.8, 95% CI: 1.4 to 24.1, P = 0.03). In conclusion, although our results are of exploratory nature and need validation, patterns of missing OUs are likely to be related to the OHRQoL impairment in SDA subjects with the presence of first molar contact having a particularly important role.

Comparisons between a mixing ability test and masticatory performance tests using a brittle or an elastic test food.

A variety of chewing tests and test items have been utilized to evaluate masticatory function. The purpose of this study was to compare a mixing ability test with masticatory performance tests using peanuts or gummy jelly as test foods. Thirty-two completely dentate subjects (Dentate group, mean age: 25.1 years) and 40 removable partial denture wearers (RPD group, mean age: 65.5 years) participated in this study. The subjects were asked to chew a two-coloured paraffin wax cube as a test item for 10 strokes. Mixing Ability Index (MAI) was determined from the colour mixture and shape of the chewed cube. Subjects were asked to chew 3 g portions of peanuts and a piece of gummy jelly for 20 strokes, respectively. Median particle size of chewed peanuts was determined using a multiple-sieving method. Concentration of dissolved glucose from the surface of the chewed gummy jelly was measured using a blood glucose meter. Pearsons correlation coefficient was used to test the relationships between the MAI, median particle size and the concentration of dissolved glucose. Mixing Ability Index was significantly related to median particle size (Dentate group: r = -0.56, P < 0.001, RPD group: r = -0.70, P < 0.001), but not significantly related to glucose concentration (Dentate group: r = 0.12, RPD group: r = 0.21, P > 0.05). It seems that ability of mixing the bolus is more strongly related to the ability of comminuting brittle food than elastic food.

Association of genetic, psychological and behavioral factors with sleep bruxism in a Japanese population.

Sleep bruxism is a sleep‐related movement disorder that can be responsible for various pains and dysfunctions in the orofacial region. The aim of the current case–control association study was to investigate the association of genetic, psychological and behavioral factors with sleep bruxism in a Japanese population. Non‐related participants were recruited and divided into either a sleep bruxism group (n = 66) or control group (n = 48) by clinical diagnoses and 3‐night masseter electromyographic recordings by means of a portable miniature device. The Epworth Sleepiness Scale, Temperament and Character Inventory, NEO‐Five Factor Inventory and custom‐made questionnaires that asked about familial aggregation, alcohol intake, caffeine intake, cigarette smoking, past stressful life events, daytime tooth‐contacting habit, temporomandibular disorder, daily headache, snoring, apnea/hypopnea symptoms, leg‐restlessness symptoms and nocturnal‐myoclonus symptoms were administered. In addition, 13 polymorphisms in four genes related to serotonergic neurotransmission (SLC6A4, HTR1A, HTR2A and HTR2C) were genotyped. These factors were compared between case (sleep bruxism) and control groups in order to select potential predictors of sleep‐bruxism status. The statistical procedure selected five predictors: Epworth Sleepiness Scale, leg‐restlessness symptoms, rs6313 genotypes, rs2770304 genotypes and rs4941573 genotypes. A multivariate stepwise logistic regression analysis between the selected predictors and sleep‐bruxism status was then conducted. This analysis revealed that only the C allele carrier of HTR2A single nucleotide polymorphism rs6313 (102C>T) was associated significantly with an increased risk of sleep bruxism (odds ratio = 4.250, 95% confidence interval: 1.599–11.297, P = 0.004).This finding suggests a possible genetic contribution to the etiology of sleep bruxism.

Oral health-related quality of life in patients treated by implant-supported fixed dentures and removable partial dentures.

OBJECTIVES This study investigated the association between denture status [implant-supported fixed dentures (IDs) and removable partial dentures (RPDs)] and oral health-related quality of life (OHRQoL). MATERIALS AND METHODS Consecutive patients with IDs and RPDs were recruited from the Prosthodontics Departments at Showa University and Tokyo Medical and Dental University. The Japanese version of the Oral Health Impact Profile (OHIP-J-49) was administered to each subject. For each OHIP-J-49 question, the subjects were asked to indicate the frequency with which they had experienced a dental problem during the last month. Responses were recorded on a 5 point Likert rating scale, with 0 being never and 4, very often. Summary scores were calculated and regression analyses conducted to investigate the association between denture status and OHIP-J-49 summary score. RESULTS In total 79 ID subjects (mean age±SD of 51.7±12.4 years, 44.3% men) and 109 RPD subjects (mean age of 66.5±8.6 years, 30% men) participated after giving informed consent. The regression analysis between the type of treatment and the OHIP-J-49 summary score revealed a significant association with a coefficient of 17.0 (Confidence interval, CI: 10.9-23.1). When age and duration of denture usage, which had significant associations with OHIP-J-49, were included in this model, the regression coefficient remained virtually unchanged at 17.4 (CI: 9.75-25.0), thus indicating little potential confounding by them. CONCLUSIONS OHRQoL in patients with implant-supported fixed dentures is generally less impaired than it is in those patients with RPDs.

N-acetyl cysteine protects osteoblastic function from oxidative stress†

We tested the protective potential of an antioxidant amino acid derivative, N-acetyl cysteine (NAC), in controlling oxidative stress against osteoblasts. Osteoblastic cells extracted from rat bone marrow were cultured. Oxidative stress was induced by adding 100 μM H₂O₂ into the culture media. Then, some H₂O₂-treated cultures were cotreated with 2.5 or 5 mM NAC. Addition of H₂O₂ decreased the number of cells to 50% of untreated cultures at days 2. Addition of 5 mM NAC into H₂O₂ cultures resulted in a dose-dependent increase in the number of cells, with the cell number being 50% greater than that in the 100 μM H₂O₂ culture. The gene expression levels of type I collagen, osteopontin, and osteocalcin were downregulated threefold by H₂O₂ on day 7. The H₂O₂-suppressed gene expression was fully recovered by NAC cotreatment. The mineralizing capability, assessed by Von Kossa staining on day 15, were approximately 1.8 times greater in the NAC + H₂O₂ cotreated group than in the culture with H₂O₂ alone. These NAC-mediated restorations were associated with an NAC dose-dependent increase of intracellular glutathione and a NAC dose-dependent decrease of intracellular reactive oxygen species. In conclusion, oxidative stress induced by H₂O₂ substantially impairs the proliferation, differentiation, and mineralization of osteoblasts. More importantly, the addition of NAC into the culture was found to restore these damages to a near normal level due to the improved redox balance, warranting further in vivo studies to test its therapeutic potential as a local antioxidative stress drug.

Comparison of food mixing ability among mandibulectomy patients

Many papers have been published on surgical mandibulectomy and reconstruction. However, only a few reports refer to masticatory function after prosthodontic treatment in mandibulectomy patients. The aim of this study was to investigate the masticatory function of mandibulectomy patients. Twenty-three subjects (10 males and 13 females, with an average age of 63 years) participated in this study: 11 subjects who had undergone unilateral marginal mandibulectomy, six subjects with unilateral segmental mandibulectomy with reconstruction and six subjects with hemimandibulectomy without reconstruction. Mixing Ability Index (MAI) was used to measure masticatory function on the non-defect side and on the defect side with a prosthesis installed. Comparisons were carried out among the marginal, segmental and hemimandibular groups and between the non-defect side and the defect side. Consequently, our study indicates these results. On the non-defect side, a significant difference was found between the marginal and the segmental groups, and between the marginal and the hemimandibular groups. In the marginal and the segmental groups, a significant difference was found between the non-defect and the defect sides. In conclusion, our study suggests that MAI is an adequate tool to study the masticatory function in mandibulectomy patients, the masticatory function of the mandibulectomy patients is more impaired than that of the ordinary removable partial denture patients, and that surgical intervention affects the masticatory function on not only the defect side but also the non-defect side in mandibulectomy patients.