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[Clinical analysis of the fracture of nickel-titanium instruments during root canal therapy].

OBJECTIVE: To analyze the clinical fracture of nickel-titanium instruments and its causes. METHODS: 68 Profile and NiTiflex files broken during the clinical root canal instrumentations in two years were collected. The analysis was carried out regarding the relation between the broken files and the distribution in the teeth, canal, degree of curvature of canals, and the relation between amount of the broken files and the period. RESULTS: The majority of the clinical fracture of nickel-titanium instruments were flexural fatigue which frequently occurred in molar, the midpoint of the curvature, canal with curves > 30 degrees and very complex canals. Amount of the broken nickel-titanium instruments in the first year was twice than that in second year. CONCLUSION: The fracture of nickel-titanium instruments is closely related to the anatomy of the root canal, the operator's experience and the usage of instrument and so on.

Dental Instruments↗

Titanium dental copings prepared by a powder metallurgy method: a preliminary report.

PURPOSE: The purpose of this study was to determine if the Procera pressed-powder method can be used to fabricate titanium copings. MATERIALS AND METHODS: Commercially pure titanium powder was used to prepare the copings. The powder was pressed onto an enlarged tooth preparation die of aluminum using cold isostatic pressing. The outer shape of the coping was formed using a Procera milling machine, and the copings were vacuum sintered. RESULTS: Titanium copings could be prepared using this method. The density of the sintered copings reached 97% to 99%+ of theoretic density, and the copings showed ductile behavior after sintering. Enlarging the tooth preparation die to compensate for the sintering shrinkage could optimize the final size of the copings. CONCLUSION: Ductile and dense titanium dental copings can be produced with powder-metal processing using cold isostatic pressing, followed by milling and sintering to final shape. The forming technique has, if properly optimized, a potential of becoming a more cost-efficient production method than spark erosion.

Cold Temperature↗

A comparison of the torsional performance of stainless steel and titanium alloy tibial intramedullary nails: a clinically relevant approach.

In recent years there has been a tendency to design and manufacture intramedullary nails from titanium alloy rather than from stainless steel. The aim of this project was to compare the torsional performance of one manufacturers standard stainless steel and titanium alloy tibial intramedullary nails, using their distal locking screw holes and dedicated cross screws to secure each nail distally. A custom built test rig and materials testing machine were used to determine the torsional rigidity of the nails. Theory was used to calculate the torsional rigidity of the central parts of each nail. From the mechanical testing, the mean torsional rigidity of the titanium alloy nail system was 40.9 N m2 while that of the stainless steel nail system was 34.6 N m2, for all distal interlocking screw positions tested. Based on theoretical calculations the torsional rigidity of the central part of the nail was 83 N m2 for the stainless steel nail and 66 N m2 for the titanium alloy nail. This study shows the importance of using the distal locking screw holes and dedicated cross screws to secure intramedullary nails during mechanical testing so that clinically relevant results are obtained about the whole nail system and not just the nail.

Alloys↗

[The experimental study on sol-gel technique of coating titanium].

OBJECTIVE: The aim of this study was to establish sol-gel technique of coating titanium on the surface of Ni-Cr alloy (PFM) in order to enhance corrosion resistance and reduce corrosive rate in oral cavity. METHODS: The sol-gel technique included four steps: (1) pre-treatment; (2) preparation of sol; (3) coating; (4) heat treatment. Elements on the surface of Ni-Cr alloy were analyzed with X-ray photoelectron spectroscopy. RESULTS: After coating Ti, the surface of Ni-Cr alloy looked light golden without particles, blisters and fragments. Besides Ni and Cr, titanium was found on surface of Ni-Cr alloy after coating. With Ar(+) ion carving-corrosion figure, the thickness of titanium was about 20 - 80 microm. CONCLUSION: With sol-gel technique, titanium could be coated on the surface of Ni-Cr alloy.

Chromium Alloys↗

Effect of calcium and phosphorus ion implantation on the corrosion resistance and biocompatibility of titanium.

This paper is concerned with the corrosion resistance and biocompatibility of titanium after surface modification by the ion implantation of calcium or phosphorus or calcium + phosphorus. Calcium and phosphorus ions were implanted in a dose of 10(17) ions/cm(2). The ion beam energy was 25 keV. The microstructure of the implanted layers was examined by TEM. The chemical composition of the surface layers was determined by XPS and SIMS. The corrosion resistance was examined by electrochemical methods in a simulated body fluid (SBF) at a temperature of 37 degrees C. The biocompatibility was evaluated in vitro. As shown by TEM results, the surface layers formed during calcium, phosphorus and calcium + phosphorus implantation were amorphous. The results of the electrochemical examinations (Stern's method) indicate that the calcium, phosphorus and calcium + phosphorus implantation into the surface of titanium increases its corrosion resistance in stationary conditions after short- and long-term exposures in SBF. Potentiodynamic tests show that the calcium-implanted samples undergo pitting corrosion during anodic polarisation. The breakdown potentials measured are high (2.5 to 3 V). The good biocompatibility of all the investigated materials was confirmed under the specific conditions of the applied examination, although, in the case of calcium implanted titanium it was not as good as that of non-implanted titanium.

Calcium↗

[Microcosmic analysis of TCP/HA coating with micro-pores on titanium by IBAD method.].

PURPOSE: In order to improve the biocompatibility of dental implants, the physical structure and the chemical composites of tricalcium phosphate/hydroxyapatite(TCP/HA) coating on titanium were studied. METHODS: Coatings of TCP/HA and hydroxyapatite (HA) on titanium were formed by ion beam assisted deposition (IBAD) method. The scanning electron microscope (SEM) and atomic force microscope (AFM) were used to study the morphology of the coating surfaces. The chemical components and structure of the modified surfaces were characterized using energy dispersive X-ray analysis (EDX) and X-ray diffraction (XRD). RESULTS: The results showed that there were many micro-pores in the TCP/HA coating by SEM and AFM. The chemical components analysis showed that the Ca/P ratio of TCP/HA coating was lower than that of HA coating. The XRD showed that the TCP/HA coating was composed of TCP and HA. CONCLUSION: The results indicated that the TCP/HA coating with micro-pores was formed on titanium by IBAD method successfully. With higher binding strength between TCP/HA and titanium, this coating will be a potential coating material for dental implant, especially for the biological seal at the cervical level of the implant.

Calcium Phosphates↗

Observation of titanium pretreatment effects using a scanning electron microscope and study of titanium/ceramic and titanium/resin adhesive interface.

AIM: A morphological analysis is made of the titanium surface sandblasted using different sized microparticles, as well as an analysis of the adhesive interface after having layered the ceramic and resin on the same prepared surface. METHODS: A total of 14 titanium samples were prepared and randomly divided into 4 groups according to their different preparation methods. Group 1: control, no surface treatment. Group 2: 50 microm aluminium dioxide treatment. Group 3: 150 microm aluminium dioxide treatment. Group 4: Rocatec Plus system treatment. Samples of groups 2, 3, and 4 were subdivided into 2 groups: A) only sandblasted, B) sandblasted and ceramic (2B and 3B) or resin (4B) layered on top. The treated surface and the interface were then observed by scanning electrom microscope. RESULTS: Group 2 surface appeared irregular and rough; the interface with ceramic appeared discontinuous. Group 3 surface presented larger and deeper cavities where ceramic penetrated completely. Group 4 samples presented a rough surface covered by silicate particles and the interface between titanium and resin appeared regular and continuous. CONCLUSION: In order to guarantee an adequate interface, the 150 microm pretreated titanium surface seemed more suitable than the 50 microm one. The Rocatec Plus system was successful in obtaining an optimal layering with the resin due to its excellent quality.

Adhesives↗

[Repair of maxillary defects by free forearm flap and titanium mesh].

OBJECTIVE: To investigate the clinical effect of free forearm flap and titanium mesh in repairing maxillary defects. METHODS: From January 2002 to November 2002, partial maxillectomy or maxillectomy were performed in 3 patients with maxillary gingival carcinoma, in 1 patient with palatine mucoepicermoid carcinoma and in 1 patient with maxillary sinus carcinoma. Maxillary defects were reconstructed with free forearm flaps ranging from 4 cm x 5 cm to 6 cm x 7 cm and titanium mesh. The effect was estimated by clinical examination, CT and nasopharyngoscope. RESULTS: Five cases were followed up 5-15 months. All the flaps were alive. Facial, alveolar process and palatal contours were restored well. Epithelium was found on the nostril surface of the titanium mesh. The functions of speech and chew were restored well. CONCLUSION: A combination of the free forearm flap and titanium mesh is an ideal method in reconstruction of maxillary defects.

Adult↗

[Surface modifications of titanium implant material with excimer laser for more effective osseointegration].

The biointegration of dental and orthopaedic implants depends mainly on the morphology and physical-chemical properties of their surfaces. Accordingly, the development of the desired microstructure is a relevant requirement in the bulk manufacture. Besides the widely used sandblasting plus acid etching and plasma-spray coating techniques, the laser surface modification method offers a plausible alternative. In order to analyze the influence of the laser treatment, the surfaces of titanium samples were exposed to excimer laser irradiation. The aim of this study was to develop surfaces that provide optimal conditions for bone-implant contact, bone growth, formation and maintenance of gingival attachment. For this purpose, holes were ablated on the surface of samples by nanosecond (18 ns, ArF) and also sub-picosecond (0,5 ps, KrF) laser pulses. Using pulses of ns length, due to melt ejection, crown-like protrusions were formed at the border of the holes, which made them sensitive to mechanical effects. To avoid these undesirable crown-like structures ultrashort KrF excimer laser pulses were successfully applied. On the other hand, titanium samples were laser-polished in favour of formation and connection of healthy soft tissues. Irradiation by a series of nanosecond laser pulses resulted in an effective smoothening as detected by atomic force microscopy (AFM). By inhibiting plaque accumulation this favours formation of gingival attachment. X-ray photoelectron spectroscopy (XPS) studies showed that laser treatment, in addition to micro-structural and morphological modification, results in decreasing of surface contamination and thickening of the oxide layer. X-ray diffraction (XRD) analysis revealed that the original alpha-titanium crystalline structure of the laser-polished titanium surface was not altered by the irradiation.

Dental Implants↗

[Treatment of condylar fracture by external pterygoid muscle-condyle anatomical reduction and internal rigid fixation with mini titanium plates].

PURPOSE: To investigate the surgical indications, procedures and treatment outcomes of condylar fracture by external pterygoid muscle-condyle anatomical reduction and internal rigid fixation with mini titanium plates. METHODS: Patients with dislocation of the condylar head, fracture of the condylar neck and subcondylar neck (the degree of displacement greater than 30 to 45) and decreased vertical height of the ramus (greater than 4 to 5mm) were included in the study. Modified aural-temporal stick-shaped incision or retromandibular approach was adopted in 23 cases with 28 condylar fractures. The fractures were treated by external pterygoid muscle-condyle anatomical reduction and internal rigid fixation with mini tension band titanium plates. All the patients were re-examined and evaluated 3 to 6 months after surgery in respects of facial symmetry, mouth opening, types of mouth opening, occlusion and mastication. RESULTS: All the patients had symmetrical face, mouth opening increased from 26.7+/-7.2 (before surgery) to 38.4+/-5.6 (3 months after surgery) and 37.2+/-4.5 mm(6 months after surgery). 2 patients with postoperative malocclusion had intermaxillary distraction for 1 week and their occlusion returned to normal. Radiographic check-up showed the condyle and titanium plates without displacement. No absorption was noted on the condylar surface. The patients had normal mastication. 2 patients with temporal facial paralysis recovered 3 months after conservative therapy. CONCLUSION: Treatment of condylar fracture by external pterygoid muscle-condyle anatomical reduction and internal rigid fixation with mini titanium plates in selected patients is an effective procedure for recovery of anatomical positions and masticatory function. Supported by Research Fund from Science and Technology Bureau of Jining city.

Bone Plates↗

[Clinical applications of devitalized autogenous calvarial bone flaps fixed with titanium clamps (CranioFix) for cranioplasty].

OBJECTIVE: To evaluate reimplantation of devitalized autogenous calvarial bone flaps and the fixation of titanium clamps (CranioFix) for cranioplasty. METHODS: From March 2000 to December 2003, 21 patients underwent (1) delayed reimplantation of preserved autogenous bone flaps, which were removed during the initial operations for increased intracranial pressure and stored in a freezer and autoclaved before use, or (2) immediate reimplantation of tumor invaded bone flaps that were devitalized by boiling. All of these flaps were fixed with titanium clamps (CranioFix). Resorption of the bone flaps was monitored by skull roentgenograms and computed tomography (CT). The clinical and aesthetic results were evaluated. RESULTS: During the follow-up period of 6 to 30 months, no complications were found. There was slight resorption of the bone flaps in all cases, but the edge of the bone flaps was within the range of the titanium clamps according to skull roentgenograms and CT. Clinical and aesthetic results were highly satisfactory. CONCLUSIONS: It is simple and practical using devitalized autogenous calvarial bone flaps for cranioplasty. The firmness decreasing of the reimplanted bone flap due to resorption can be prevented greatly by titanium clamps (CranioFix).

Adolescent↗

[Experimental study of fast formation of biomimetic apatite coatings on pure titanium surface].

OBJECTIVE: To investigate calcium-phosphate coating on commercial pure titanium substrate using a fast biomimetic procedure. METHODS: The titanium specimens were divided into two groups, group A and group B. The specimens of group A were only treated with the mixture of H2SO4/HCl for 30 min. The specimens of group B were treated with the mixture of H2SO4/HCl for 30 min, immersed into 5 mol/L NaOH solution at 60 degrees C for 24 h, and then heated to 600 degrees C and maintained for 1 h. All specimens were soaked into simulated body fluid-A (SBF) and SBF-B for each day. The surface morphology was observed by field scanning electron microscopy. RESULTS: Dense calcium-phosphate coating deposited on all the titanium surfaces of two groups. The calcium-phosphate coating consisted of spheric structure with a diameter of 1 approximately 3 microm, which was proved to be hydroxycarbonate apatite with the analysis of X-ray diffraction. CONCLUSIONS: Thin hydroxycarbonate apatite coating can deposited on pure titanium using a fast biomimetic procedure.

Apatites↗

Effect of titanium ion and resistance encoding plasmid of Pseudomonas aeruginosa ATCC 10145.

Titanium and its alloys are technically superior and cost-effective materials, with a wide variety of aerospace, industrial, marine, and commercial applications. In this study, the effects of titanium ions on bacterial growth were evaluated. Six strains of bacteria known to be resistant to both metal ions and antibiotics were used in this study. Two strains, Escherichia coli ATCC 15489, and Pseudomonas aeruginosa ATCC 10145, proved to be resistant to titanium ions. Plasmid-cured P. aeruginosa resulted in the loss of one or more resistance markers, indicating plasmid-encoded resistance. The plasmid profile of P. aeruginosa revealed the presence of a 23-kb plasmid. The plasmid was isolated and transformed into DH5alpha. Interestingly, the untransformed DH5alpha did not grow in 300 mg/l titanium ions, but the transformed DH5alpha grew quite well under such conditions. The survival rate of the transformed DH5alpha also increased more than 3-fold compared to that of untransformed DH5alpha.

Culture Media↗

[Using of titanium mesh for the reconstruction of skull base defect].

OBJECTIVE: The purpose of this study is to evaluate the possibility and surgical principle of titanium mesh used for the reconstruction of skull base bone defect. METHODS: The clinical data of 11 patients with defect of skull base bone repaired with titanium mesh were retrospectively analysed. RESULTS: Among 11 patients, there were 6 patients with skull base tumor, 3 patients with fibrosis hyperplasia, 2 patients with encephalomeningocele. The surgical approach included craniofacial approach in 7 patients, transfrontal and extended transfrontal approach in 3 patients, trans-midface approach in 1 patient. The anterior and lateral skull base was repaired in 2 patients, anterior and middle skull base and sellar repaired in 6 patients, anterior skull base and orbital floor repaired in 3 patients. In early postoperative period, there were 3 patients with intracranial pneumatosis, but without symptom, and 1 patient with transient cerebrospinal leakage. Following-up for average 14.4 months, there was no titanium mesh displacement and intracranial infection in all patients. CONCLUSIONS: The titanium mesh used for the repair of skull base bone defect was both possible and safe.

Adolescent↗

[Biomechanical evaluation of titanium mesh with anterior plate fixation or ilium autograft in anterior cervical decompression].

OBJECTIVE: To evaluate the biomechanical characteristics of titanium mesh with anterior plate fixation or ilium autograft in anterior cervical decompression. METHODS: Six fresh cervical spine specimens (C3-7) of young cadaver were used in the biomechanical test. After C5, C5,6 and C4-6 were given vertebrectomy, ilium autograft and titanium mesh with anterior plate fixation were performed. Their stabilities of flexion, bilateral axial rotation, the lateral bending and the extension were tested. Intact cervical spine specimens served as control group. RESULTS: Ilium autograft improved the stability of the unstable cervical vertebrae and decreased the flexion, the lateral bending or the extension, showing a significant difference when compared with control group (P<0.05). Whereas, axial rotational motion was decreased insignificantly (P>0.05). Titanium mesh with anterior plate fixation improved the stability of the unstable spine and decreased the flexion,the bilateral axial rotation,the lateral bending or the extension, showing a significant difference when compared with control group (P<0.05). CONCLUSION: The vertebrectomy and anterior cervical fusion by ilium autograft was the least stable construct of all modes tested,and the titanium mesh implantation is stable than the intact cervical sample.

Biomechanical Phenomena↗

Experimental studies in rats on the effects of asbestos inhalation coupled with the inhalation of titanium dioxide or quartz.

Rats were exposed for 1 year, with a 2-year follow-up, to dust clouds consisting of a mixture of amosite or chrysotile asbestos with either titanium dioxide or quartz. The addition of titanium dioxide to asbestos did not increase levels of pulmonary fibrosis above the amounts produced by chrysotile or amosite alone. Quartz, however, greatly increased fibrosis above that produced by the asbestos types alone. Both particulate dusts caused an increase in the numbers of pulmonary tumours and mesotheliomas compared to asbestos alone but while tumours in animals treated with asbestos and quartz tended to occur earlier than tumours with asbestos alone, in animals treated with dusts containing titanium dioxide, tumour production occurred later than with asbestos alone. In animals treated with mixtures of asbestos and quartz, there was evidence of increased transport of fibres across the visceral pleural surface and this may be associated with the finding of a higher proportion of pleural mesotheliomas than previously reported in experimental inhalation studies from any laboratory using the main asbestos varieties. The presence of particulate dusts made little difference to the amounts of amosite fibre retained in the lung tissue but, with chrysotile, titanium dioxide appeared to increase retention while quartz reduced it.

Animals↗

New platinum, titanium, and ruthenium complexes with different patterns of DNA damage in rat ovarian tumor cells.

DNA protein cross-links (DPC), DNA interstrand cross-links (ISCL), and DNA single strand breaks following treatment of experimental ovarian tumor cells (O-342) with five new metal complexes (three platinum, one titanium, one ruthenium compounds) were investigated at 6, 24, and 48 h after drug exposure and compared with their in vitro growth inhibitory potential. cis-Diamminedichloroplatinum(II) (cisplatin, DDP) served as reference drug. The following new compounds were tested: 18-crown-6-tetracarboxybis-diammineplatinum(II) (CTDP), cis-aminotrismethylenephosphonato-diammineplatinum(II) (AMDP), cis-diamminecyclohexano-aminotrismethylenephosphonato-platin um(II) (DAMP), diethoxybis-(1-phenylbutane-1,3-dionato)-titanium(IV) (budotitane), and trans-indazolium-tetrachlorobisindazole-ruthenate(III) (IndCR). At equimolar concentrations DNA cross-linking activity of the platinum agents decreased in the order cisplatin, CTDP, AMDP, DAMP; this was paralleled by growth inhibition in a cell proliferation assay. CTDP-induced interstrand cross-linking occurred more slowly compared to cisplatin (DDP) (6 h: CTDP, 73 +/- 15 versus DDP, 365 +/- 72 rad equivalents), but reached a peak similar to cisplatin 24 h after exposure (CTDP, 317 +/- 68 versus DDP, 392 +/- 116 rad equivalents). At this time point in contrast to DDP no DNA protein cross-links were observed for CTDP (total cross-links: CTDP 310 +/- 71, DDP 1987 +/- 436 rad equivalents). Thus, at 24 h, CTDP was found to be distinctly less reactive to proteins than DDP, and it is suggested that CTDP might be similar in its toxicity pattern to the structurally related compound carboplatin which was also reported to be less reactive to protein than DDP. By 48 h, CTDP- and DDP-induced interstrand cross-links were 65 +/- 21 and 180 +/- 33 rad equivalents, respectively. Although at a lower level, by 24 h, AMDP showed a ratio of ISCL to total cross-links (179 +/- 39 versus 213 +/- 31 rad equivalents), which was comparable to CTDP. The second biphosphonate complex DAMP was the least active platinum compound in terms of DNA damage, effecting only 16 +/- 7 rad equivalents ISCL and 63 +/- 28 rad equivalents total cross-links; similar to DDP, DAMP displayed a higher DPC fraction at 24 h. The titanium complex diethoxybis-(1-phenylbutane-1,3-dionato)-tita-++ +nium(IV) showed dose-dependent inhibition of cell proliferation, while no significant DNA damage could be detected with the alkaline elution technique. These results, together with observations from other authors, indicating that space-filling planar aromatic ring systems are important for its antitumor activity, suggest as possible mechanism of action of diethoxybis-(1-phenylbutane-1,3-dionato)-titanium(IV) intercalation into the DNA.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Histologic comparison of ceramic and titanium implants in cats.

This study compared the reparative processes around cylindrical glass-ceramic-coated and pure titanium implants placed in feline femurs. Six weeks after implant placement, bone specimens with inserted implants were prepared for histologic examination including histomorphometric quantification of the relative implant surface areas that were in contact with bone. The glass-ceramic implants were surrounded by a 0.2- to 0.5-mm envelope of fibrous connective tissue [corrected]. By contrast, the major part of the titanium implants (81% +/- 5%) was in direct contact with living lamellar or woven bone. Thus, titanium and glass ceramic evoked different reparative processes when implanted in bone, and only the titanium implants appeared to become osseointegrated.

Animals↗