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Biomedical subjects

M Braem

Publications and source records attributed to M Braem.

At least 37 records · Page 2Linked to original sources
PubMed1994

Clinical relevance of laboratory fatigue studies.

From a clinical point of view, fatigue in dental restorative resins is discussed by the way that fatigue expresses itself in different forms in these materials. In vitro testing of the fatigue sensitivity of dental composites is far from conclusive: there is a need for standardized testing methodology. Some findings obtained with a recently developed fatigue machine, and interpreted as a function of masticatory stresses, indicate that the generalized form of fatigue will probably be limited to microfilled based composites.

Bisphenol A-Glycidyl Methacrylate↗
PubMed1994

Morphological characterization of the interface between resin and sclerotic dentine.

Since dentine exposed to the oral environment undergoes important compositional and morphological transformations, bonding to it differs significantly from bonding to unaffected normal dentine. In this investigation, the interface between resin and sclerotic dentine, the dentine type clinically exhibited by cervical abrasive or erosive lesions, was morphologically characterized by scanning electron microscopy after an argon-ion-beam etching procedure. The microstructure of the resin-sclerotic dentine interface was compared with that produced to normal unaffected dentine in an attempt to find reasons for the reported less reliable bonding of adhesive resins to sclerotic dentine. A resin-dentine interdiffusion zone or hybrid layer with only a limited width was formed at the hypermineralized intertubular dentine. No or only short resin tags were developed in most dentinal tubules, since their orifices were obliterated due to increased peritubular dentine apposition, intratubular deposition of irregular minerals and formation of so-called sclerotic casts. Consequently, it is reasonable to predict that dentine adhesives with an adhesion strategy, which mainly involves micromechanical interlocking by the formations of a resin-dentine interdiffusion zone combined with resin-tag development into the dentinal tubules, will be less effective when applied to sclerotic dentine than to unaffected normal dentine. An adapted adhesive treatment may be necessary to make sclerotic dentine more receptive to bonding. Further research should be directed to develop adhesive systems that bond equally well to various kinds of dentine.

Acid Etching, Dental↗
PubMed1994

Dual cure luting composites--Part II: Clinically related properties.

Thirteen dual cure luting composites were compared in function of film thickness, consistency, and working time by using the American National Standard/American Dental Association (ANS/ADA) specifications for zinc phosphate cement and direct filling resins. The effect of temperature and setting reaction on the film thickness was also evaluated for some representative products. All three clinically related properties varied widely among the products investigated. A strong linear correlation was found between film thickness and consistency. This relation is supported by the temperature dependence of film thickness of dual cure luting composites. Cooling of the material increased the consistency, resulting in a larger film thickness, while heating reduced the film thickness because of the lower consistency. However, one product with a rather short working time at room temperature occasionally exhibited a dramatically enlarged film thickness after heating, probably caused by accelerated chemical polymerization. No correlation emerged between film thickness and maximum filler size or between consistency and filler weight content. Maximum filler size and filler weight content had been measured previously in Part I of this study. Scanning electron microscope (SEM) analysis of the cured film thickness samples revealed that the largest filler particles had been crushed under the heavy load pressure during film thickness measurement. The lack of correlation between consistency and filler weight content can be explained by the multifactorial determination of the consistency. It is concluded that the great diversity in the currently available luting composites makes clear specifications with regard to the optimum composition of luting composites urgently needed. Furthermore, more adequate methods for testing the film thickness of luting composites are also required.

American Dental Association↗
PubMed1994

Clinical status of ten dentin adhesive systems.

Laboratory testing of dentin adhesive systems still requires corroboration by long-term clinical trials for their ultimate clinical effectiveness to be validated. The objective of this clinical investigation was to evaluate, retrospectively, the clinical effectiveness of earlier-investigated dentin adhesive systems (Scotchbond, Gluma, Clearfil New Bond, Scotchbond 2, Tenure, and Tripton), and to compare their clinical results with those obtained with four modern total-etch adhesive systems (Bayer exp. 1 and 2, Clearfil Liner Bond System, and Scotchbond Multi-Purpose). In total, 1177 Class V cervical lesions in the teeth of 346 patients were restored following two cavity designs: In Group A, enamel was neither beveled nor intentionally etched, as per ADA guidelines; in Group B, adjacent enamel was beveled and conditioned. Clinical retention rates definitely indicated the improved clinical efficacy of the newest dentin adhesives over the earlier systems. With regard to adhesion strategy, adhesive systems that removed the smear layer and concurrently demineralized the dentin surface layer performed clinically better than systems that modified the disorderly layer of smear debris without complete removal. Hybridization by resin interdiffusion into the exposed dentinal collagen layer, combined with attachment of resin tags into the opened dentin tubules, appeared to be essential for reliable dentin bonding but might be insufficient by itself. The additional formation of an elastic bonding area as a polymerization shrinkage absorber and the use of a microfine restorative composite apparently guaranteed an efficient clinical result. The perfect one-year retention recorded for Clearfil Liner Bond System and Scotchbond Multi-Purpose must be confirmed at later recalls.

Clinical Trials as Topic↗
PubMed1993

Hardness and Young's modulus determined by nanoindentation technique of filler particles of dental restorative materials compared with human enamel.

The recently developed nanoindentation technique was used to measure hardness and Young's modulus of small filler particles in resin composites and other dental restoratives. This technique eliminates the need to visualize indentations. Load and displacement are continuously monitored during a loading-unloading sequence, and hardness as well as Young's modulus are then calculated from the load-displacement curves taking into account the geometry of the indenter. Thirteen posterior composites, 3 dental ceramics for CAD/CAM restorations, 1 sintered porcelain, and 1 amalgam were investigated in this study. The results were compared to the hardness and Young's modulus determined by nanoindentation of human enamel. Of the dental materials tested, only five materials contain inorganic filler particles with a nanohardness not statistically different from that of enamel. The predominant fillers in all other materials, except amalgam and the prepolymerized resin fillers in Bell Firm PX, were found to be significantly harder. The dental restorative materials, except the alloy phase in amalgam, were composed of particles with a Young's modulus significantly lower than that of human enamel. The alloy phase in amalgam had a Young's modulus value comparable to that of enamel.

Dental Amalgam↗
PubMed1993

Evaluation of two dentin adhesives in cervical lesions.

The clinical effectiveness of two dentin adhesives, Clearfil New Bond and Scotchbond 2, was evaluated in two different cavity designs. Group A was without enamel bevel or acid etch and with a butt-joint cavity; and group B had enamel bevel, acid etch, and feather-edged cavities. The retentive rate and marginal adaptation were monitored for 2 years. In the Clearfil system, 21% of group A restorations failed after 2 years, whereas virtually all the group B restorations (99%) were retained. In addition, after 2 years, the total of debonded group A restorations in the Scotchbond 2 system expanded to 13%, whereas no restorations from group B were lost. There was clearly marginal deterioration in time irrespective of the bonding system. Nevertheless, the marginal adaptation of cervical lesions restored with Clearfil New Bond adhesive in combination with Clearfil Ray composite resin revealed fewer defects compared with the Scotchbond 2 adhesive with Silux Plus composite resin restorations. SEM evaluation disclosed composite resin remnants on the dentin surface in cavities with lost fillings, which indicates partial cohesive failure of the adhesive joint.

Composite Resins↗
PubMed1993

Two-year clinical evaluation of two dentine-adhesive systems in cervical lesions.

Two commercially available dentine-adhesive systems, Tenure and Tripton, were tested in two different cavity designs by placing 132 Class V composite restorations in cervical lesions of 35 patients. In Group A, the cervical restorations were placed totally in dentine without any intentional enamel involvement. In Group B, they were placed in dentine with adjacent enamel margins bevelled and acid etched. The retention rate, the evidence of clinical microleakage, and the marginal integrity were monitored over a 2-year period. The results of this clinical investigation indicate a high failure rate when only dentinal bonding was involved. A loss rate of 30% for Tenure and 55% for Tripton was noted in Group A after 2 years of clinical service. However, both adhesive systems used in combination with micromechanical retention on the enamel border (Group B) performed extremely well with only one restoration each having debonded over the 2-year period. Identically, marginal integrity and evidence of clinical microleakage more severely deteriorated with time for the Group A restorations in comparison with their Group B counterparts. In summary, the overall results were more positive for Tenure than for Tripton. It is concluded that micromechanical retention by acid etching of the enamel margin is still indispensable for the clinical success of cervical Class V composite restorations, primarily for retention and clinical microleakage and also, but to a lesser degree, for marginal adaptation.

Acid Etching, Dental↗
PubMed1993

Three-year follow-up of five posterior composites: in vivo wear.

The wear of five posterior composites at occlusal contact areas (OCA) and contact free occlusal areas (CFOA) was evaluated in Class II cavities over a 3-year period with an accurate 3D-measuring technique. A clinical evaluation was also performed. The ultrafine compact-filled composites (Willems et al., 1992) showed acceptable OCA-wear rates ranging from 110 to 149 microns after 3 years. This is very similar to the OCA-wear rate of human enamel on molars, which is about 122 microns after 3 years. The fine compact-filled composite had an unacceptable OCA-wear value of 242 microns after 3 years. The ultrafine midway-filled composite showed an exceptionally high CFOA-wear value of 151 microns after 3 years, which gave the impression of it being gradually washed out of the cavity. Clinically, 70% of the restorations made with the ultrafine midway-filled composite showed excellent colour match after 3 years. For most of the compact-filled composites slightly opaque fillings were noted and 63% of the restorations made with one of these materials were clearly opaque. It can be concluded that the investigated ultrafine compact-filled composites can be considered as amalgam alternatives as far as their wear resistance is concerned.

Adult↗
PubMed1993

Three-year follow-up of five posterior composites: SEM study of differential wear.

Assessing the wear of both enamel and composite at a shared occlusal contact area offers the opportunity to determine the differential wear between enamel and composite on the same tooth. Differential wear measurements were carried out on five posterior composite materials with an accurate 3D-measuring technique. The distinct wear step between enamel and composite was visualized by means of scanning electron photomicrographs. Both investigated ultrafine midway-filled and fine compact-filled composites (Willems et al., 1992a) have a considerably higher differential wear value and are, therefore, less suitable for rehabilitation of posterior teeth than are the ultrafine compact-filled composites, which have, in this study, a very satisfactory differential wear rate and appear to be highly wear resistant materials suitable for use in stress-bearing areas.

Adult↗
PubMed1993

Dual-cure luting composites: Part I: Filler particle distribution.

Fourteen dual-cure luting composites were analyzed for their filler particle shape, predominant and maximum filler size, and filler weight in function of their clinical use. Polished surfaces were etched with an argon ion beam and studied by means of scanning electron microscopy. The type of filler particles, either inorganic or prepolymerized, could clearly be recognized. Their shapes were angular, rounded or spherical, depending on the product. The maximum filler size varied extremely from less than 1 micron to 250 microns. A particle-size distribution analyser disclosed a bell-shaped filler-size distribution. The predominant filler size for all the products was much smaller than the maximum filler size. The filler weight varied from 36 to 77%. After ion etching, some products showed small areas with a low degree of filler loading. A classification of the luting composites based on the maximum filler size is proposed. Since the particle size varies widely within the group of products analyzed, a standard specification for luting composites is urgently needed.

Adhesives↗
PubMed1993

Comparative SEM and TEM examination of the ultrastructure of the resin-dentin interdiffusion zone.

The resin-dentin interdiffusion zone produced by a dentin-adhesive system that removes the smear layer and concurrently decalcifies superficial dentin was morphologically examined by both scanning and transmission electron microscopy. Cross-sectioned resin-bonded dentin discs were etched with an argon-ion beam to make the resin-dentin interface observable by SEM. For the TEM examination, the sections were partly decalcified by an aqueous EDTA solution to facilitate ultramicrotomy and to disclose the ultrastructure of the interdiffusion zone. Both SEM and TEM confirmed the presence of the resin-dentin interdiffusion zone as the junction between the deep unaltered dentin structure and the restorative resin. Within the interdiffusion zone, three sublayers with characteristic ultrastructure and staining were identified by TEM. An upper diffuse black layer contained few structural features. Underneath, partially-altered collagen fibrils were closely packed, mostly running parallel with the interface and perpendicular to the dentinal tubules. Their outline was electron-dense, forming tunnel-like structures. At the base of the upper layer, several stained projections were found to bulge out into the underlying collagen network and appeared to be confined by obstructive, parallel-running collagen fibrils. Finally, the third dense layer, containing hydroxyapatite crystals, demarcated the superficially demineralized dentin layer from the deeper unaltered dentin. Resin diffusion into the decalcified dentin surface layer was evident, but diminished with depth, presumably reducing deeper resin impregnation into the interfibrillar spaces. The citric acid dentin-pretreatment probably caused denaturation of the superficial collagen fibrils. Its decalcifying effect gradually weakened with depth, leaving behind hydroxyapatite crystals at the base of the interdiffusion zone.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid Etching, Dental↗
PubMed1993

Chemical characterization of the resin-dentin interface by micro-Raman spectroscopy.

The chemical nature of the interface between dentin and adhesive resin materials was characterized by micro-Raman spectroscopy. The resulting chemical profiles were correlated with photomicrographs obtained by SEM after an argon-ion-beam etching treatment of the sample surface. Two commercially available dentin adhesive systems, of which one was also applied with a different conditioning agent, were investigated. Raman spectra, which were recorded along line scans across the interface with a step increment of 1 micron, revealed that resin effectively penetrated 4 to 6 microns deep into the superficially decalcified dentin zone. Across the interface, a gradual transition from resin to dentin over the interdiffusion zone with a mixed contribution of both substances was noticed. Finally, resin appeared to penetrate to the entire decalcification depth of dentin regardless of the aggressiveness of the conditioning procedure.

Boron Compounds↗
PubMed1993

Assessment by nano-indentation of the hardness and elasticity of the resin-dentin bonding area.

The hardness and Young's modulus of the successive layers across a resin-dentin bonding area were determined by nano-indentation for four commercially-available dentin adhesive systems, of which two were also applied with a different conditioning agent. With a computer-controlled nano-indentation technique, minute triangular indentations were made within a small area of a few micrometers' diameter at a load of a few milli-Newtons. The load and displacement of the indenter were continuously monitored during the loading-unloading sequence, so hardness and Young's modulus could be computed as a function of the indenter geometry and the applied load. The hardness of the resin-dentin interdiffusion zone was significantly lower than that of unaltered dentin. A gradient of moduli of elasticity was observed from the rather stiff dentin over a more elastic resin-dentin interdiffusion zone and adhesive resin layer to the restorative composite. That gradient was more substantial in those systems that produced relatively thick adhesive resin layers or supplementally provided a filled low-viscosity resin as an intermediate layer between the adhesive resin and the bulk restorative composite. Such an elastic bonding area might have a strain capacity sufficient to relieve stresses between the shrinking composite restoration and the rigid dentin substrate, thereby improving the conservation of the dentin bond and, as a consequence, the marginal integrity and retention of the restoration.

Composite Resins↗
PubMed1993

[Adhesion of composite to dentin. Mechanical and clinical results].

Although an efficient bond of resin composites to enamel can be realized since quite a long time, reliable dentine bonding is nowadays still a clinical problem. After the failure of the dentine-etch technique, followed by the misfortunes of the chemical dentine adhesion technique, modern dentine adhesive systems are believed to function by a micromechanical attachment mechanism. Based on a morphological study of the resin-dentine interface, a broad selection of dentine adhesive systems was classified following their adhesion-strategy. In a second part, eight dentine adhesive systems were clinically tested in terms of retention.

Acrylic Resins↗
PubMed1993

Composite resins in the 21st century.

Human enamel and dentin should be used as the physiologic standards with which to compare composite resins, especially in the posterior region. The intrinsic surface roughness of composite resins must be equal to or lower than the surface roughness of human enamel on enamel-to-enamel occlusal contact areas (Ra = 0.64 microns). Roughness determines the biologic strength of composite resins. The nanoindentation hardness value of the filler particles (2.91 to 8.84 GPa) must not be higher than that of the hydroxyapatite crystals of human enamel (3.39 GPa). Composite resins intended for posterior use should have a Young's modulus at least equal to, and preferably higher than, that of dentin (18.500 MPa). The compressive strength of enamel (384 MPa) and dentin (297 MPa) and the fracture strength of a natural tooth (molar = 305 MPa; premolar = 248 MPa) offer excellent mechanical standards to select the optimal strength for posterior composite resins. The in vivo occlusal contact area wear rate of composite resins must be comparable to the attritional enamel wear rate (about 39 microns/y) in molars. Differential wear between enamel and composite resin on the same tooth is a new criterion for visualizing and quantifying the wear resistance of composite resins in a biologic way. Posterior resins must have a radiographic opacity that is slightly in excess of that of human enamel (198% Al). Based on these standard criteria, it can be concluded that in the 21st century the ultrafine compact-filled composite resins may be the materials of choice for restoring posterior cavities.

Analysis of Variance↗
PubMed1992

Stress-induced cervical lesions.

The increasing occurrence of dental lesions at the cervical surfaces requires more knowledge of the causes of the process. Acidic and abrasive mechanisms have clearly been documented as causes but the stress theory by Lee and Eakle is still controversial. This report describes several incidences of possible stress-induced lesions according to the characteristics described by Lee and Eakle. The occurrences of subgingival lesions lend credence to the stress-induction theory by exclusion of other superimposing etiologic factors. With the current concepts, a perceptive approach to the treatment of cervical lesions can be executed.

Bite Force↗