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Antibacterial properties of aged dental cements evaluated by direct-contact and agar diffusion tests.

STATEMENT OF PROBLEM: Since failure of fixed partial dentures is most frequently caused by caries, it would be advantageous if cements possessed antibacterial properties. PURPOSE: The purpose of this study was to evaluate the antibacterial properties of 3 dental cements using the direct-contact test and agar diffusion test. MATERIAL AND METHODS: For the direct-contact test, wells (n = 4) of microtiter plates were coated with the tested cements (Harvard cement, Duralon, and Ketac-Cem) while Streptococcus mutans suspension was placed directly on the cements. Bacterial growth was evaluated by a temperature-controlled microplate spectrophotometer. Eight wells of bacteria without the tested cements served as the positive control. Six wells of the tested cement without bacteria served as the negative control. For the agar diffusion test, triplicate specimens of freshly mixed cements were poured into uniform wells (5 mm in diameter) punched in the agar plates inoculated with Streptococcus mutans . After incubation at 37 degrees C for 24 hours, the agar plates were examined for bacterial growth and the diameter of the halo formed in the bacterial lawn was measured. In both tests, each cement was mixed in 2 different powder/liquid ratios. For the direct-contact test, data were initially recorded after 1 hour of incubation. Additional experiments were performed on specimens that were aged for 24 hours, 1 week, 1 month, and 3 months before assessment by either direct-contact test or agar diffusion test. The data were subjected to 1-way ANOVA with the Tukey post hoc test (alpha=.05). RESULTS: Compared with the control group, Duralon and Harvard cements demonstrated antibacterial properties even after 3 months with the direct-contact test (P <.002), while Ketac-Cem exhibited no antibacterial properties. In the agar diffusion test, no antibacterial activity was observed for any of the tested cements. The different powder/liquid ratios had a negligible effect on the antibacterial properties of the tested cements. CONCLUSIONS: Within the limitations of this study, Duralon and Harvard cements possessed prolonged antibacterial properties, while Ketac-Cem exhibited no antibacterial activity. The direct-contact test may be a more suitable test than the agar diffusion test to evaluate antibacterial properties of definitive cements.

Agar↗

The retention of complete crowns prepared with three different tapers and luted with four different cements.

STATEMENT OF PROBLEM: The role of adhesive properties of cements on the retentive strength of crowns with different degrees of taper is not clear. PURPOSE: This study evaluated the retention of full crowns prepared with 3 different tapers and cemented with 2 conventional and 2 adhesive resin cements. MATERIAL AND METHODS: One hundred twenty sound human molar teeth were assigned randomly to 1 of 12 groups, (n=10). The groups represented the 4 cements: zinc phosphate (Fleck's), a conventional glass ionomer (Ketac-Cem); 2 adhesive resin cements (C&B Metabond and Panavia); and 3 tapers of 6-degrees, 12-degrees, and 24-degrees within each cement. Crowns were cast with a high noble alloy. The 6-degree taper was considered the control within each cement group. Retention was measured (MPa) by separating the metal crowns from the prepared teeth under tension on a universal testing machine. Analysis of variance was used to test the main effects on the retentive strength of full crowns, namely cements, tapers, and failure modes. The Fisher's multiple comparison test was used to evaluate the source of the differences. The chi(2) analyses were used to examine the relationships between failure types, cements, and tapers. All statistical tests were conducted at alpha=.05. RESULTS: There was a significant difference in the main effect cement (P<.0001) and taper (P=.0002). The mean retentive strength values of both Fleck's and Ketac-Cem were significantly lower than the mean retentive strength values of both C&B Metabond and Panavia (P<.0001). The retention of crowns prepared with 6-degree taper was not significant from the 12-degree taper (P=.0666). The difference in retention was significant between the 6-degree taper and the 24-degree taper (P<.0001) and between 12-degree taper and 24-degree taper (P=.0178). The types of failure were adhesive in the cement (65%), cohesive in the tooth (31%), and assembly failure (fracture of embedding resin) (4%). The type of failure was dependent on the degree of taper (P<.0001) and on the type of cement (P<.0042). CONCLUSION: Within the limitations of this study, the retentive values of the adhesive resins at 24-degree taper were 20% higher than the retentive values of the conventional cements at 6-degree taper. The use of resin luting agents yielded retention values that were double the values of zinc phosphate or conventional glass ionomer cement.

Analysis of Variance↗

Effect of bioactive filler content on mechanical properties and osteoconductivity of bioactive bone cement.

We took three types of bioactive bone cement (designated AWC, HAC, and TCPC), each with a different bioactive filler, and evaluated the influence of each filler on the mechanical properties and osteoconductivity of the cement. The cements consisted of bisphenol-a-glycidyl methacrylate-based (Bis-GMA based) monomers as an organic matrix, with a bioactive filler of apatite/wollastonite containing glass-ceramic (AW-GC) or sintered hydroxyapatite (HA) or beta-tricalcium phosphate (beta-TCP) powder. Each filler was mixed with the monomers in proportions of 50, 70, and 80% (w/w), giving a total of nine cement subgroups. The nine subgroups were designated AWC50, AWC70, AWC80, HAC50, HAC70, HAC80, TCPC50, TCPC70, and TCPC80. The compressive and bending strengths of AWC were found to be higher than those of HAC and TCPC for all bioactive filler contents. We also evaluated the cements in vivo by packing them into the intramedullary canals of rat tibiae. To compare the osteoconductivity of the cements, an affinity index was calculated for each cement; it equaled the length of bone in direct apposition to the cement, expressed as a percentage of the total length of the cement surface. Microradiographic examination up to 26 weeks after implantation revealed that AWC showed a higher affinity index than HAC and TCPC for each filler content although the affinity indices of all nine subgroups (especially the AWC and HAC subgroups) increased with time. New bone had formed along the AWC surface within 4 weeks, even in the cement containing AW-GC filler at only 50% (w/w); observation of the cement-bone interfaces using a scanning electron microscope showed that all the cements had directly contacted the bone. At 4 weeks the AWC had bonded to the bone via a 10 micron-thick reactive layer; the width of the layer, in which partly degraded AW-GC particles were seen, became slightly thicker with time. On the other hand, in the HAC- and TCPC-implanted tibiae, some particles on the cement surface were surrounded by new bone and partly absorbed or degraded. The results suggest that the stronger bonding between the inorganic filler and the organic matrix in the AWC cements gave them better mechanical properties. The results also indicate that the higher osteoconductivity of AWC was caused by the higher reactivity of the AW-GC powder on the cement surface.

Animals↗

Bioactive bone cement: effects of phosphoric ester monomer on mechanical properties and osteoconductivity.

A new bioactive bone cement, designated GBC, has been developed. It consists of polymethyl methacrylate (PMMA) as an organic matrix and bioactive glass beads as an inorganic filler. The bioactive beads, consisting of MgO--CaO--SiO(2)--P(2)O(5)--CaF(2) glass, have been newly designed, and a novel PMMA powder was selected. The purpose of the present study was to evaluate the effects on mechanical properties and osteoconductivity of adding a phosphoric ester (PE) monomer to the cement as an adhesion-promoting agent. Four kinds of cements were prepared: GBC, GBC with PE (designated GBC/PE), a cement consisting of the same PMMA used in GBC with apatite- and wollastonite-containing glass-ceramic (AW-GC) powder (designated AWC), and AWC with PE (designated AWC/PE). Each filler was added to the cement at 70 wt %. Adding PE to either GBC or AWC resulted in increases in the bending strength and decreases in the Young's modulus compared with the unmodified cements. Cements were packed into the intramedullar canals of rat tibiae to evaluate osteoconductivity as determined by an affinity index. Rats were sacrificed at 4 and 8 weeks after operation. The affinity index (length of bone in direct contact with the cement expressed as a percentage of the total length of the cement surface) was calculated for each cement. Adding PE to either GBC or AWC resulted in significant increases in the affinity index compared with the unmodified cements. The affinity index for GBC was significantly higher than that of AWC, and that for GBC/PE was also significantly higher than that of AWC/PE. The affinity indices for each cement increased significantly with time up to 8 weeks. Our study revealed that the higher osteoconductivity of GBC/PE was due to the large alkyl group in the PE monomer, to the hydrophilicity of the phosphoric acid in the PE monomer, and to the higher bioactivity of the bioactive glass beads at the cement surface. GBC/PE shows promise as an alternative bone cement with improved properties compared with conventional PMMA bone cement.

Animals↗

Strontium-containing hydroxyapatite (Sr-HA) bioactive cement for primary hip replacement: an in vivo study.

The purpose of this study was to evaluate the strontium-containing hydroxyapatite (Sr-HA) cement in primary hip replacement, using a rabbit model, and to investigate the histological findings at the cement-implant and bone-cement interfaces under weight-bearing conditions. Unilateral hip replacement was performed with Sr-HA cement or polymethylmethacrylate (PMMA) cement in rabbits and observations were made after 6 months. Good fixation between the Sr-HA cement and implant was observed. Osseointegration of the Sr-HA cement with cancellous bone was widespread. Many multinucleus cells covered the surface of the cement, and resorbed the superficial layer of the cement. By scanning electron microscopy (SEM) and energy-dispersive X-ray (EDX) analysis, high calcium and phosphorus levels were detected at the interface with a thickness of about 10 microm. Intimate contact was also observed between the Sr-HA cement and cortical bone without fibrous layer intervening. The overall affinity index of bone on Sr-HA cement was (85.06 +/- 5.40)%, which is significantly higher than that on PMMA cement (2.77%+/- 0.49%). On the contrary, a fibrous layer was consistently observed between PMMA cement and bone, and PMMA cement evoked an inflammatory response and foreign body reaction in the surrounding bony tissues. Results suggested good bioactivity and bone-bonding ability of the Sr-HA cement under weight-bearing conditions.

Animals↗

Dye incorporation to enhance the laser ablation of standard and reduced-modulus bone cements.

Laser ablation of acrylic bone cement is an alternative method of cement removal that can be used during revision arthroplasty of cemented implants. This study investigated the feasibility of using a continuous-wave Argon ion laser (wavelength = 514 nm) with the addition of methylene blue or red dye no. 13 to enhance the ablation of two types of bone cements: polymethylmethacrylate and polybutylmethylmethacrylate. Six cement/dye combinations were studied while power (0.5, 0.75, and 1.0 W) and exposure times (30, 45, 60, and 90 seconds) were varied. The Argon laser was unable to ablate undyed polymethylmethacrylate or polybutylmethylmethacrylate. However, ablation was shown for both cements with either dye. The red dye had a stronger absorption peak at 514 nm than did the blue dye. Statistically larger ablation areas were seen for red polymethylmethacrylate than for blue polymethylmethacrylate (p < 0.013) at all levels tested. Ablation areas were larger in red than in blue polybutylmethylmethacrylate cement. Blue polybutylmethylmethacrylate cement produced larger ablation areas than did blue polymethylmethacrylate cements at all energy levels tested, with smaller surrounding damage areas. Red polybutylmethylmethacrylate cement also produced larger ablation areas than did red polymethylmethacrylate cement (at 0.75 and 1.0 W), again with smaller damage areas. Damage zones were smallest in red polybutylmethylmethacrylate cements at all test levels. These results suggest that, by using dyes to selectively alter the absorption characteristics of bone cement, laser ablation can be an effective method for cement removal. Changes in the chemical structure of the cement can also influence the response to laser treatment. Furthermore, the absorption spectra of the bone cement can be altered to maximize energy absorption at a wavelength that is not absorbed by bone tissue; this potentially minimizes damage to bone during revision surgery.

Arthroplasty↗

Comparative study of four glass ionomer luting cements during post pull-out tests.

OBJECTIVES: The aim of this study was to compare the maximum loads and modes of failure of four glass ionomer luting cements during post pull-out tests. METHODS: The cements studied included two based on conventional glass ionomer cement chemistry, i.e., a hand-mixed cement and an encapsulated cement, and two based on the newer light-cured chemistry, i.e., a restorative cement used at a low powder:liquid ratio and an experimental luting cement. One hundred and forty bovine incisors were cut 13 mm from the apex and prepared with post channels, 1.75 mm in diameter and 9 mm long. Ni-Cr-Mb bonding alloy posts were cast and sandblasted prior to cementation into the roots with each of the cements. Twenty-four hours later, pull-out tests were carried out at a strain rate of 0.5 mm/min. The maximum loads and modes of failure were noted. The data obtained were analyzed using a Kruskal-Wallis test followed by comparison of groups using Mann-Whitney tests. RESULTS: Comparison of the maximum loads revealed a significant difference between the conventional encapsulated cement and all other cements. Weibull analysis of the results gave values for the Weibull moduli and probabilities of survival for a post under a given load for each cement and indicated that the newer cements performed better than the conventional cements. SIGNIFICANCE: Further research into the in vitro and in vivo behavior of the resin-modified glass ionomer cements in clinical situations where light-curing is not possible is justified.

Acrylic Resins↗

Development of bioactive bone cement and its clinical applications.

This paper is a summary of already published papers on the bioactive bone cement (BA cement) which consists of CaO-SiO2-P2O5-MgO-CaF2 (AW glass-ceramic) powder and bisphenol-a-glycidyl methacrylate (Bis-GMA) resin. Two types of BA cement, dough and injection type, were prepared by changing their chemical compositions slightly. They harden in a few minutes exhibiting much lower curing temperature than PMMA cement. They have significantly higher compressive, bending, and tensile strengths than PMMA cement and have a character of bonding directly with bone in 4-8 weeks in vivo. Intercalary prosthetic replacement of the femur and total prosthetic replacement of the hip were performed in dogs using either PMMA cement or BA cement. Mechanical tests demonstrated that fixation strengths of these prostheses with BA cement increased with time and were significantly greater than those with PMMA cement tested at any time. Results of histological examinations showed direct bonding between BA cement and bone, and that the bone trabeculae around BA cement mantle grew with time, while with PMMA cement an intervening soft tissue layer was always observed at the cement-bone interface. BA cement was used in a few aged patients to install a hip prosthesis either in cases of revision or femoral neck fracture. The longest follow-up period of the patient is 4 yrs. The patients have been doing well with no adverse effect of the cement to date.

Animals↗

Effect of monovalent ions in glass ionomer cements on their interaction with sodium fluoride solution.

The effects on surface morphology of glass ionomer cements following exposure to 0.2% NaF solution were studied. The effect of cement on the solution was also evaluated. The four cements were chosen to contain Na and F, Na alone, F alone and neither Na nor F to show any interactions produced by having the same ion in both the cement and solution. Four glass ionomer cements were formulated so that they differed only in respect of the glass component. AH2 (a glass used in dental restorative cement) contained both Na and F, MP4 (a glass used in orthopaedic cement) contained Na only, LG26 (a glass used in surgical cement) contained F only and LG30 (an experimental control glass) contained neither F nor Na. Discs of cement were set in moulds at 37 degrees C for 1 h, then matured in water for 3 d. Each test disc was then immersed in 10 ml 0.2% NaF for 24 h at 37 degrees C whereas control discs remained in water. The test and control disc surfaces were assessed qualitatively using electron microscopy and quantitatively by linear profilometry generating roughness values (Ra). Test solution pH was measured before and after cement immersion. Inspection of the electron micrographs showed considerable disruption of AH2 and LG26 test surfaces compared to their controls whereas MP4 and LG30 showed similar surfaces for test and control. Statistical analysis of the Ra values showed that AH2 and LG26 test surfaces were significantly rougher than their controls as well as LG30 and MP4 test surfaces, which were not significantly different from their controls. All NaF solutions show pH increases; those for AH2 and MP4 were significantly higher than those for LG26 and LG30. The F-containing cements were subject to surface disruption whereas F-free cements were not. The Ra values of test surfaces correlated strongly (r = 0.998) with the F uptake of the cements (data from a previous study) but it was not possible to ascribe the causality to this association. The pH changes appear to be influenced by whether or not Na is present in the cement. The resultant pH values are too near to neutral for pH alone to explain the surface disruption observed. In addition, it is concluded that the changes in OH ion concentration are too low to permit F-/OH- interchange as a possible explanation for F uptake by these cements.

Anions↗

Production of TNF-alpha and bone resorbing activity by macrophages in response to different types of bone cement particles.

We have compared the capacity of clinically relevant wear debris from seven different cement types to activate macrophages to produce TNF-alpha, IL-1beta, IL-6 and bone resorbing activity in vitro. The bone cements were: CMW 1 original (PMMA only); CMW 1RO (1 microm BaSO4; 9.2%); CMW copolymer bone cement 1 (10 microm BaSO4; 10%); CMW copolymer bone cement 2 (1 microm BaSO4; 10%); Palacos R (10 microm ZrO2; 15.6%); CMW Calcium phosphate cement 20% (10 microm tri-calcium phosphate; 20%) and CMW calcium phosphate cement 30% (10 microm tri-calcium phosphate; 30%). Cement debris was produced aseptically using a simple configuration wear test. The majority of particles were in the size range 0.1-0.5 microm for each cement type. The cement particles were co-cultured with the U937 macrophage cell line at ratios of 10 and 100 microm3 particle volumes to macrophage cell numbers for 24 h. At the 10:1 ratio the particles had no effect on the cells. At the 100:1 ratio, the major cytokine produced was TNF-alpha and there were no statistical differences between the different types of cement debris. The bone resorption activity of the co-culture supernatants was significantly greater than the control (U937 cells without particles) for particles of CMW 1RO, CMW copolymer bone cement 1, CMW copolymer bone cement 2 and Palacos R (P < 0.05, ANOVA). However there were no statistical differences between the levels of bone resoprtion evoked by these four cement types. The CMW1 original and CMW calcium phosphate containing cements failed to induce the macrophages to elaborate bone resorption activity at the 100:1 ratio. These data suggest that the addition of radio-opaque additives to bone cement may increase the capacity of the debris to induce osteolysis.

Acrylic Resins↗

[Significance of jet lavage for in vitro and in vivo cement penetration].

AIM: The purpose of this study was to determine the efficacy of pulsatile jet lavage and manual syringe lavage with regard to their cleansing capabilities as measured by cement penetration into cancellous bone both in vivo and in vitro. METHODS: Three separate experiments were performed. Study A: In a cadaver study 36 left human cadaver femora were used for implantation of cemented femoral components. Conventional broaches were used for femoral preparation. Bone lavage was carried out either using jet lavage or manual syringe lavage of equal volume. The allocation to two different lavage groups was randomised. In both groups high-pressurising cementing techniques were implemented with the use of a proximal seal and additional finger packing. Study B: To guarantee standardised cement pressurisation and equal bone quality, the influence of jet lavage (1000 ml) versus syringe lavage (1000 ml) was studied in 11 paired human cadaver femora in an additional study without prosthesis implantation. The specimens were imbedded in specially designed pots. Bone cement was applied in a retrograde manner and subjected to a standard pressure protocol with a constant force of 3000 N. Study C: To directly compare the effectiveness of both pulsatile jet and syringe lavage with regard to cement penetration in vivo, a new sheep model allowing for standardised bilateral, simultaneous cement pressurisation was used. After femoral neck osteotomies both femoral cavities of 10 sheep were prepared for retrograde cement application. After randomisation one side was lavaged with 250 ml irrigation using a bladder syringe, the contralateral femur with the identical volume but using a pulsatile lavage. A specially designed apparatus was used to allow for bilateral simultaneous cement pressurisation. ANALYSIS: In all studies horizontal sections were obtained from the femoral specimens at predefined levels using a diamond saw. Microradiographs were taken and analysed using image analysis to assess cement penetration into cancellous bone. RESULTS: Study A: Compared with syringe lavage the use of jet lavage significantly improved the penetration of cement into cancellous bone (p = 0.027). In the presence of strong, dense cancellous bone the findings were more pronounced. Study B: Our results show that in equal quality bone, the use of jet lavage yields significantly (p < 0.001) improved cement penetration compared to syringe lavage specimens. Study C: The results of the in vivo study confirmed the superiority of jet lavage bone surface preparation (p = 0.002). CONCLUSIONS: The use of jet lavage yields significantly improved interdigitation between cancellous bone and cement both in vitro and in vivo and should be regarded as mandatory in cemented total hip arthroplasty. High pressurising techniques are effective means to improve cement penetration, but should only be administered with jet lavage to reduce the risk of fat embolism.

Animals↗

Use of a polyglycolide lactide cement plug restrictor in total hip arthroplasty.

The use of a polyglycolide lactide cement plug restrictor in cemented femoral fixation during total hip arthroplasty was evaluated. Femoral cement pressurization was evaluated in vitro in a cadaveric model and the host response to polymer degradation was evaluated in vivo in a canine total hip arthroplasty model. Sixteen embalmed anatomic specimen femurs were prepared for cement femoral fixation. The intramedullary canal was plugged with either an ultrahigh molecular weight polyethylene cement plug restrictor or a polyglycolide lactide cement plug restrictor. Peak pressures in the proximal, mid, and distal portions of the cement mantle were recorded during cement insertion, cement pressurization, and implant insertion. There was no difference between the two plug groups in peak pressures throughout the cement mantle during cement insertion, pressurization, or implant insertion. Total hip arthroplasty using a cementless acetabular component and a cemented femoral stem was performed in 24 dogs. The femoral intramedullary canal was plugged with a polyethylene or a biodegradable cement plug restrictor. The dogs were sacrificed at 7 weeks, 10 months, or 15 months. Radiographically, no osteolytic lesions were seen around either plug type. Histomorphometrically, the polyglycolide lactide plugs appeared intact at 7 weeks and partially degraded by 10 and 15 months. In both plug groups, a mild fibrohistiocytic reaction with infiltration of fibrocytes, histocytes, and endothelial cells was seen. No osteolysis was observed. The results of the current study show that femoral cement pressurization can be attained in vitro using a biodegradable cement plug restrictor and that for as long as 15 months in the in vivo canine model there were no adverse reactions associated with use of these plugs compared with conventional ultrahigh molecular weight polyethylene plugs.

Animals↗

The Frank Stinchfield Award. Influence of cement technique on the interface strength of femoral components.

The optimal surface finish for polymethylmethacrylate cemented femoral components remains controversial. Concerns about early debonding of the prosthesis-cement interface have led surgeons to use roughened surfaces to enhance the cement-prosthesis bond. However, loosening of roughened stems is associated with the generation of excessive wear debris. The purpose of the current study was to determine whether the time to cementation influenced the cement-prosthesis bond of four roughened cobalt chrome surfaces (60 grit-blasted, 10 grit-blasted, 10 grit-blasted with polymethylmethacrylate precoating, glass bead-blasted) and one polished cobalt chrome surface. Fixation strength was assessed using mechanical pushout and tensile testing. Roughened and polymethylmethacrylate precoated surfaces had significantly greater tensile and shear strengths at early cementation times compared with polished surfaces. However, roughened components had significant decreases in tensile and shear strengths as cementation time increased from 2 to 4 minutes and 2 to 6 minutes. In contrast, tensile and shear strengths for the polished surface were significantly lower than for the roughened surfaces and did not change with longer cementation times. When using a roughened or precoated cemented femoral component, the surgeon should consider cementing earlier with wetter cement to maximize the cement-prosthesis bond. When implanting a polished femoral component, it is preferable that the cement is doughy, because the cement-prosthesis bond is not influenced by the wetness of the cement and it is easier to maintain the orientation of the femoral component.

Arthroplasty, Replacement, Hip↗

Capsulated versus hand-mixed glass-ionomer luting cements for post retention.

OBJECTIVES: Glass-ionomer luting cements are supplied in two forms, as loose powder and liquid to be hand-mixed (HM) or pre-proportioned in a capsule to be mechanically mixed (MM). This study was to determine if post retention in pull-out tests was affected by the method of mixing the cement. METHODS: Two hundred stainless steel posts of diameter 1.75 mm were cemented within post-channels prepared in stainless steel cylinders using two hand-mixed cements FJL and KCL (Fuji I Luting Cement and Ketac-Cem Luting Cement) and two capsulated cements FJC and KCM (Fuji Cap I and Ketac-Cem Maxicap). Three groups of test specimens were prepared. In Group I each cement was mixed as recommended by the manufacturer, Group II cements were placed within a capsule and mechanically mixed and in Group III cements were removed from the capsule and mixed by hand. Specimens were stored for 1 h at 37 degrees C and 100% humidity prior to post pull-out tests at a crosshead speed of 10 mm min-1. The maximum loads at failure were subjected to Weibull analysis and Mann-Whitney tests to determine probabilities of survival and significant differences between the groups. RESULTS: Significant differences (P < 0.05) were found between all pairs of cements tested except KCM(MM) vs FJL(HM), FJL(MM) vs KCL(HM), KCL(MM), vs KCL(HM), FJC(HM) vs FJC(MM), KCL(MM) vs FJL(MM). CONCLUSIONS: The capsulated cements as supplied by the manufacturers are preferable to the equivalent hand-mixed formulations, as they give higher probabilities of survival when subjected to a given load. Both capsulated and hand-mixed formulations of Fuji had higher probabilities of survival compared to the corresponding Ketac cements. The probability of post survival can be altered by the method of mixing the cement.

Capsules↗

Tensile bond strength of gold and porcelain inlays to extracted teeth using three cements.

This in vitro study compared the tensile bond strength of gold and porcelain inlays to extracted molars in standardized cavities. Three cements were used: zinc phosphate, glass-ionomer, and a resin composite cement. The gold inlays were cemented using zinc phosphate or glass-ionomer cement, and the porcelain inlays were luted using resin composite or glass-ionomer cement. Surface treatments included, for gold inlays, either no treatment (zinc phosphate cement) or airborne particle abraded and tinplated (glass-ionomer cement); and for porcelain inlays, either no treatment (glass-ionomer cement) or etched and silane-treated (resin composite cement). Statistical analysis was performed using the Weibull distribution. Results showed no significant differences between gold inlays cemented using zinc phosphate or glass-ionomer cements and porcelain inlays luted using glass-ionomer cements. The bonded porcelain inlays (resin composite cement) showed tensile bond strengths two to three times higher than those obtained for cemented gold inlays.

Composite Resins↗

Comparison of luting cements for minimally retentive crown preparations.

OBJECTIVE: The purpose of this study was to compare the retentive strengths of resin, glass-ionomer, and zinc phosphate cements under adverse conditions. METHOD AND MATERIALS: Thirty extracted teeth were mounted and prepared in their long axis. The axial wall height was 3 mm and the convergence angle was 28 degrees. These conditions increased the role of the cement and decreased the role of the preparation in providing retention of the casting. The axial surface area was determined. Copings were fabricated with a ring aligned in the long axis to facilitate removal of the crown. They were cemented with a resin cement, a glass-ionomer cement, or a zinc phosphate cement. A block randomization scheme was used to assign cements so that the mean surface areas of the teeth were equivalent in all groups. The copings were loaded in tension, and the amount of force required to remove the coping was recorded. The stress required to remove the coping was calculated. RESULTS: The mean stress required to remove the copings was 9.4, 5.0, and 3.1 MPa for the resin, glass-ionomer, and zinc phosphate cements, respectively. CONCLUSION: The resin cement group was significantly stronger than both the glass-ionomer cement and the zinc phosphate cement groups. The glass-ionomer cement was significantly stronger than the zinc phosphate cement.

Analysis of Variance↗

Partially cemented AncaDualFit hip stems do not fail in simulated active patients.

BACKGROUND: Partially cemented hip stems have been introduced to offer the advantages of cemented stems on the short-term, and of cementless ones on the long-term. One such device, the AncaDualFit, has been thoroughly validated pre-clinically under average loading conditions. Concerns recently arose concerning the long-term endurance of such implants in active patients. In fact, it was suspected that cyclic loads applied by demanding patients could lead to fixation failure. METHODS: The long-term performance of the AncaDualFit partially cemented stem was studied in vitro, using a validated protocol that simulated the loads of 24 years of an active patient. Inducible and permanent micromotions were measured in five specimens and compared against two well-established cemented stems, and a cementless stem (the original design from which was derived). Cement damage (fatigue cracks) due to cyclic loading was quantified and compared against the cemented stems. FINDINGS: Inducible and permanent micromotions of the AncaDualFit partially cemented stem were slightly larger that the cemented stems, but much smaller than the cementless one. The migration, however, indicated a clear trend towards stabilization. Cement damage was minimal, even if compared to the most successful cemented stems. Short cracks were observed only near the cement inlet, but did not propagate in the two cement pockets. INTERPRETATION: The partially cemented AncaDualFit stem can safely withstand very severe loading without significant damage, thanks to the design of the two anterior and posterior cement pockets. Results are reassuring also in comparison with other successful designs. Thus, it can be safely used, even in active patients.

Arthroplasty, Replacement, Hip↗

The effect of cement restrictors on the occlusion of the humeral canal: an in vitro comparative study of 2 devices.

An in vitro study investigated the efficacy of cement restrictor devices on cement containment and penetration within the humerus. Eight pairs of preserved humeri were prepared using advanced cementing technique followed by insertion of 1 of 2 cement restrictors. Low-viscosity cement was injected followed by sham humeral stem insertion. Each specimen was sectioned into transverse 10-mm slices. Slices were photographed and digitized to quantify the cement/stem and canal cross-sectional area. Cement penetration was determined from the ratio of cement area to canal area. A significant increase in cement penetration was observed among slices from distal to proximal for both restrictors (P = .02). There was no significant difference in cement penetration, leakage, or migration between restrictors. Five of the 8 specimens migrated, with means of 21.5 +/- 25.0 mm and 24.0 +/- 36.0 mm for the polyethylene and silicone restrictors. Leakage or migration resulted in a significant decrease in cement penetration with the polyethylene restrictors (P = .001). In the silicone restrictor group, migration resulted in decreased cement penetration (P = .04). When using advanced cementing techniques, intramedullary restrictors allow improved cement penetration; however, they do not ensure cement containment.

Arthroplasty, Replacement↗