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Effect of luting cement on dental biofilm composition and secondary caries around metallic restorations in situ.

Since the importance of luting cement on secondary caries in enamel and dentin is unknown, an in situ crossover study was conducted in three phases over 21 days using a fluoride-containing toothpaste. One hundred and twenty-six metallic restorations were cemented into the dentinoenamel junction of slabs of human teeth with zinc phosphate (ZP), resin-modified glass ionomer (GI) or resinous cement (RC). The slabs were inserted onto flanges of the removable partial acrylic dentures of 14 volunteers and covered with gauze to enhance dental plaque accumulation. The volunteers used fluoride toothpaste (1.100 microg F/g, w/w). After 21 days, the biofilm that formed on the slabs was collected for biochemical and microbiological analyses, and the demineralization in enamel-dentin around the restorations was evaluated. The fluoride concentration of biofilm in the GI group was higher (p<0.05) than the ZP and RC groups. Also, the concentration of Zinc in biofilm formed on the slabs cemented with ZP was higher (p<0.05) than the other groups. However, the effect of the luting material on enamel or dentin demineralization was not statistically significant (p>0.05). The data suggest that when fluoride toothpaste is used, the anticariogenic property of the luting cement may not be relevant to the reduction of secondary caries.

Adult↗

[Contribution of vibration supported cementation on reconstructions].

A laboratory study was undertaken to investigate the influence of different types of cement and cementation techniques on the enlargement of the marginal gap of crowns. The crowns and preparations in the study were standardized; preparation forms were shoulder, chamfer and shoulderless. The cement brands were Harvard, Durelon and AquaCem. The enlargement of the marginal gap was measured for two different cementation methods: 1. Crowns were manually seated onto metal dies and subsequently loaded with 50 N constantly for 10 minutes 2. Crowns were manually seated on the dies and exposed to mechanical vibration from a Bergendal amalgam-condenser, subsequently loaded with 50 N constantly for 10 minutes. The comparison of both methods showed a 12-31% smaller vertical cementation gap enlargement of the samples that were treated with vibration. We recommend the clinical use of this method. Best results were achieved with AquaCem; Harvard showed the greatest difference when changing between the methods.

Crowns↗

[PH changes of different cements].

Some properties are required in dental cements used in fixed restorations. One of them is the acidic characteristic of the material since (OH)- ions released during the setting phase may have undesirable effects on the pulp. In this study three different luting cements were tested regarding to their PH values during setting reaction and was found that cements used caused PH changes. Acidity of cements had changed considerably depending upon time and it was determined that PH values of three cements decreased in the period of 24 hours.

Dental Cements↗

[Bond strength of dental luting cements to titanium castings].

This study compared the tensile bond strength of dental luting cements to the titanium castings with gold alloy (Type IV), 12% Au-Ag-Pd alloy and Ni-Cr alloy in dental clinical practice. In this experimental condition, the zinc phosphate cement did not adhere to any dental casting alloy tested. The tensile bond strength of polycarboxylate cement to the titanium castings was 96 kg/cm2, about two times as high as that gold alloy (Type IV). The tensile bond strength of the glass ionomer cement to titanium castings was 32 kg/cm2, about two times as high as that of dental precious alloys. The tensile bond strength of the adhesive resin cement to titanium castings was 220 kg/cm2, about three times as high as that of dental precious alloys.

Dental Alloys↗

The effect of weight loss of liquid on the diametral tensile strengths of various kinds of luting cements.

The role of water evaporation from the liquids of the cements were tested, and the effect of this loss on their strength was evaluated for 0, 10, 20 and 30 minute, intervals. After 30 minutes the evaporation of liquid from the cements was so high that they lost their luting consistency. The data suggests that the highest weight loss was with polycarboxylate cement liquids, with glass-ionomer and zinc phosphate cement liquids following respectively. However, when diametral tensile strength test values were evaluated it was determined that glass-ionomer exhibited the highest resistance to fracturing and zinc phosphate the lowest. Upon examination of samples which were fractured, while polycarboxylate and glass-ionomer cracked and split into large fragments, zinc phosphate cements fractured into a multitude of small pieces. On the basis of this study, it appears that the manufacturers' recommendations about the powder-to-liquid ratio and the mixing procedures is confirmed particularly and should be adhered to for optimal results.

Analysis of Variance↗

Adhesive improvement of the mechanical properties of a dense HA-cemented Ti dental implant.

We have been using dense, pure hydroxyapatite (HA) dental implants for the last 15 years and results have shown that dense HA is a chemically stable material with acceptable mechanical properties. However, due to HA's physical characteristics, particularly its brittleness, there is the risk that the implant will fail if the subsequent bone binding comprises less than one half of the root portion. To ensure greater implant success, a new cementing method has been developed that uses methacrylates for the bonding of the dense HA outer shell to the titanium (Ti) inner cylinder in a two-piece HA-cemented Ti implant. Mechanical property tests were conducted to compare the HA-cemented Ti implant bonded with this new acrylic cement with existing commercially available HA-cemented Ti implants bonded with a triethyleneglycol dimethacrylate (TEGDMA)-bisphenol-A diglycidyl ether (BisGMA compound). The vertical and horizontal compressive strength of this improved implant was respectively 3.4 and 6.1 times greater than the commercial implants. This increased strength of new acrylic cement is due to its ability to compensate for shrinkage that affects adhesion during curing, thereby providing stronger bonding.

Adhesiveness↗

Is there any difference between vacuum mixing systems in reducing bone cement porosity?

Six vacuum mixing systems, Cemvac, Merck, Mitvac, Optivac, Osteobond, and Stryker, were tested using prechilled Palacos R bone cement to investigate the reduction of porosity compared to mixing at atmospheric pressure. In addition the Optivac, Osteobond, and Stryker were tested using Simplex P bone cement to find out if they were effective in reducing the porosity of a middle viscosity bone cement. All vacuum mixing systems reduced the number of macropores (> 1 mm) and micropores (0.1 mm < voids < 1 mm) and increased the density of both Palacos R and Simplex P. But only the Optivac, Stryker, and Merck systems reduced the area percentage of macropores with more than 50% compared to the control. When using Simplex P bone cement, all three mixing systems tested reduced the numbers and the area percentage of macropores compared to the control. The results show that vacuum mixing is effective in reducing the porosity in both a high viscosity cement such as Palacos R and a middle viscosity cement such as Simplex P. Not all systems tested were effective in reducing the number and size of large voids.

Absorptiometry, Photon↗

Ex vivo degradation of a poly(propylene glycol-fumarate) biodegradable particulate composite bone cement.

We have developed a biodegradable particulate composite bone cement consisting of a poly(propylene glycolfumarate)-(methylmethacrylate) matrix mixed with calcium carbonate and tricalcium phosphate particulates. Previous ex vivo studies suggest that this system provides sufficient strength for a number of potential clinical applications including structural reinforcement of osseous defects, internal fixation devices for age-related fractures, and delivery of antibiotics to treat osteomyelitis. As a first step toward investigating in vivo responses to this material, we studied the influence of varied concentrations of crosslinker, accelerator, and free radical on the mechanical properties of the cement. We then developed an ex vivo degradation assay and correlated the mechanical properties of degrading cement with the temporal changes in chemical properties of both the cement and the bathing medium. The optimal cement formulation was composed of one-third poly(propylene glycolfumarate)-(methylmethacrylate), one-third calcium carbonate, and one-third tricalcium phosphate, and provided initial compressive strengths of up to 30 MPa and compressive moduli of up to 300 MPa. Degradation rates, measured by a decline in mechanical properties, dissolution of calcium from the cement, and change in pH of the bathing medium, could be controlled by changing the concentration of reactants in the matrix. Specifically, an increase in methylmeth-acrylate or increase in both methylmethacrylate and benzoyl peroxide was inversely proportional to the rate of degradation and directly proportional to the initial mechanical properties. The degradation products and environmental changes appear to be compatible with physiologic remodeling and therefore justify examination of the in vivo response to implantation of this material.

Analysis of Variance↗

Influence of delayed injection time on the creep behavior of acrylic bone cement.

It has been proposed that creep of acrylic bone cement may contribute to loosening of cemented total joint replacements. If true, it is important that factors affecting creep of bone cement are identified. The objective of this study was to evaluate the effect of an operator-controlled variable, injection time, on the creep behavior of acrylic bone cement. Results from this investigation showed that injection time significantly (p < 0.0001) influenced creep behavior of bone cement. "Delayed" injection time of acrylic bone cement increased creep by approximately 5 times in 24 h compared to specimens prepared according to standard injection procedures.

Acrylates↗

Characterization of acrylic bone cement using dynamic mechanical analysis.

Dynamic mechanical analysis (DMA) was used to characterize the properties of acrylic bone cement with the addition of tricalcium phosphate (TCP), hydroxyethyl methacrylate (HEMA), and ethylene glycol dimethacrylate (EGDMA). The glass transition temperature of acrylic bone cement is >100 degrees C; the cement has a flat modulus response near human body temperature. The height of the damping peak decreases and becomes broader with increasing TCP content. Thus, TCP is incompatibile with acrylic bone cement. When the frequency is changed from high to low, the damping peak shifts to low temperature. The shift in damping peak with frequency indicates that this relaxation is time-dependent. When acrylic bone cement contains TCP with HEMA and EGDMA, the incompatibility between acrylic bone cement and TCP can be ameliorated.

Biocompatible Materials↗

Water absorption characteristics and cytotoxic and biological evaluation of bone cements formulated with a novel activator.

A novel activator, N,N,Dimethylamino 4-benzyl laurate (DML) was used in the curing of acrylic bone cements, based on poly(methylmethacrylate). The water absorption characteristics were studied, and the behavior was found to be similar to commercial bone cements. The net amount of solubles were also in the same range as obtained for commercial cements cured with conventional activators. Biocompatibility tests were conducted on the neat activator (DML) and cured cements. The present study indicated that there were no toxic effects; furthermore, osteoblast-like cells were seen to proliferate and differentiate more readily on DML containing cements. The analysis of the effect of leachables from cements into the media showed continued cell proliferation and cell viability.

Bone Cements↗

Bone-bonding ability of bioactive bone cement under mechanical stress.

Bioactive bone cement (BABC) is able to bond to bone through a Ca-P rich layer. It was evaluated so far in a rat tibial model, where no mechanical stresses are supposed to take place. The objective is to investigate the behavior of BABC in the environment of posterolateral spinal fixation model, in which the bone cement interface is exposed to continuous mechanical stress. Japanese white rabbits were used. Fixation of L5-L6 segment was done by wiring the spinous and transverse processes of L5 and L6 vertebrae. Then BABC was applied over the transverse processes and the intertransverse process membrane on both sides. Polymethylmethacrylate (PMMA) bone cement was used similarly in the control group. Animals were sacrificed after 1 day, 4, 8, and 16 weeks postoperatively. Bone cement interface was examined using Giemsa surface staining and SEM, and affinity index was measured. Biomechanical testing was done nondestructively in right and left torsion. BABC bonded to bone directly with no intervening soft tissue at 4, 8, and 16 weeks, while soft tissue was consistently seen between PMMA bone cement and bone. BABC-spine constructs were stiffer than PMMA-spine constructs at all time intervals. BABC bonded directly to bone under mechanical stress and afforded stiffer fixation than PMMA bone cement.

Animals↗

Influence of filler content on static properties of glass-reinforced bone cement.

A commercial acrylic bone cement was modified by the incorporation of different weight fractions of glass spheres. The influence of the filler proportion on the mechanical behavior was assessed. Composite cements were prepared by replacing part of the powder phase of the cement by an equivalent weight of glass particles, which resulted in an increase in the liquid-to-powder (L/P) ratio of the polymeric matrix. Dynamic mechanical analysis revealed an increase in residual monomer content with increasing filler proportion as a consequence of the increase in L/P. Flexural, compressive, and fracture properties of the cement with varying amounts of glass particles were measured. It was found that up to 50 wt% glass particles could be added with significant increases in flexural modulus and fracture toughness. The mechanical behavior was explained in terms of both the reinforcing effect of the filler and the plasticizing effect of the monomer. Glass-filled bone cements displayed superior workability compared with the standard cement, which was attributed to a decrease in the viscosity of the initial mix and the surface characteristics of the glass particles. The observed increase in fracture toughness could be rationalized through the application of proposed mechanisms for toughening of particle-reinforced polymers.

Acrylic Resins↗

PMMA-based composite materials with reactive ceramic fillers: IV. Radiopacifying particles embedded in PMMA beads for acrylic bone cements.

New acrylic bone cements were prepared from alumina particles previously treated by 3-(trimethoxysilyl)propylmethacrylate (gamma-MPS) and embedded in poly(methylmethacrylate-co-ethylacrylate) beads with about 7 mol% of ethyl acrylate repeating units. The encapsulation was performed through a conventional suspension polymerization process. The influence of (i) the concentration of the dispersion stabilizer and (ii) the alumina content upon the shape, size, and size distribution of the acrylic beads was studied. Cements were prepared from each batch by hand-mixing alumina-filled acrylic beads with a liquid monomer mixture containing methyl methacrylate, n-butyl methacrylate, and N,N-dimethyl-p-toluidine. Benzoyl peroxide was previously added to the solid part. The powder-to-liquid ratio was equal to 2 for each formulation. Compressive strength of cured cement decreases with alumina content, whereas compressive modulus remains roughly constant. These results are in contradiction to those obtained for cements based on a mixture of gamma-MPS-treated alumina and unfilled acrylic beads. Nevertheless, they are interpreted in terms of alumina arrangement in the cement. In the first case, alumina particles contribute to the reinforcement of the dispersed acrylic phase, with poor benefits for the whole materials. In the second case, they allow the reinforcement of the continuous acrylic phase and, therefore, the cement's one.

Acrylates↗

Creep properties of three low temperature-curing bone cements: a preclinical assessment.

The mechanical characteristics of new bone cements should be assessed before these cements are released on the orthopedic market in great quantities. In this study, we present the deformational response of 3 relatively new, low-curing temperature bone cements (Cemex RX, Cemex System, and Cemex Isoplastic) to a dynamic compressive force in comparison to Simplex P bone cement. For this purpose, dynamic compressive creep tests were performed on cylindrical shaped specimens at a maximal load level of 20 MPa for a period of 250,000 cycles. The results showed that Cemex System and Cemex RX produced creep rates that were higher (20% and 30%, respectively) as compared to Simplex P bone cement. The creep behavior of Cemex Isoplastic was very similar to that of Simplex P. It was concluded that although Cemex RX and Cemex System produced higher creep rates than Simplex P, these differences were not considered excessive. Hence, although other tests are required to assess the safety and efficacy of these new cements, the dynamic creep properties under compression can be considered adequate for clinical use.

Biocompatible Materials↗

Attenuation of acoustic emission body waves in acrylic bone cement and synthetic bone using wavelet time-scale analysis.

This article addresses acoustic emission (AE) wave attenuation in acrylic bone cement and wave attenuation due to the existence of material interface between acrylic bone cement and sawbone. In this article, a series of tests were performed using standard pencil lead break sources. The attenuation features inside acrylic bone cement and sawbone materials and the attenuation due to the existence of material interfaces such as cement-cement and cement-sawbone were studied. In addition, the discrete wavelet-based signal energy decomposition method was introduced to examine detail breakdown of signal energy distribution of attenuation. From the tests, it was observed that the attenuation of AE signal was linear with respect to the wave travel distance for both energy and amplitude. Furthermore, AE energy attenuation was more sensitive than AE amplitude attenuation. In the analysis of attenuation due to material interfaces, the couplant plays a major role in reducing the attenuation at the interfaces. The attenuation at an interface composed by different material is less compared with an interface composed by the same material.

Acoustics↗

Cytotoxic effect of bone cements in HL-60 cells: distinction between apoptosis and necrosis.

Ten PMMA-based bone cements used in prosthetic surgery have been studied with respect to the induction of programmed cell death (i.e., apoptosis) in HL-60 cells, which are remarkably sensitive to various apoptotic stimuli. Annexin V binding and propidium iodide (PI) exclusion were the methods for detection of early apoptotic changes, while PI entry was considered as a marker of necrosis. Hoechst 33342 staining was used to detect DNA fragmentation and Alamar blue was applied to measure oxide-reduction activity of cells. The production of reactive oxygen species (ROS) related to cell damage was verified using dichlorofluorescein-diacetate (DCFH-DA) oxidation to DCF. Under our experimental conditions, the cements tested, for the most part, were not toxic to leukemic cells at 4 and 24 h. After 24 h, three cements were able to induce cell death, with two eliciting both apoptosis and necrosis, and one cement acting mainly via apoptosis. Both processes of cell death are likely to be mediated by the production of oxygen-free radicals. These findings provide potential leads for investigation into the molecular mechanisms of cell death, which are responsible for tissue damage by cements and intolerance of cemented prostheses.

Apoptosis↗

A new bioactive bone cement: effect of glass bead filler content on mechanical and biological properties.

A new bioactive bone cement (designated GBC), consisting of bioactive glass beads as an inorganic filler and polymethylmethacrylate (PMMA) as an organic matrix, has been developed. The purpose of the present study was to examine the effect of the amount of glass bead filler added to GBC on its mechanical and biological properties, and to decide the most suitable content of filler. Serial changes in GBC with time were also examined. The newly designed bioactive beads, consisting of MgO-CaO-SiO2-P2O5-CaF2 glass, were added to the cement in the proportions 30, 40, 50, 60, and 70 wt %. These cements were designated GBC30, GBC40, GBC50, GBC60, and GBC70, respectively. The compressive strength and the elastic modulus of bending of GBC increased as the glass bead content increased. The various types of GBC were packed into the intramedullar canals of rat tibiae to evaluate osteoconductivity, as determined by an affinity index calculated as the length of bone in direct contact with the cement expressed as a percentage of the total length of the cement surface. Rats were killed at 4 and 8 weeks after the operation and the affinity index was calculated for each type of GBC. Histologically, new bone had formed along the surface of all types of GBC within 4 weeks, even in GBC30 containing only 30 wt % of glass beads. At each time interval studied, there was a trend for the affinity index of GBC to increase as the glass bead filler content increased. There was no significant increase of affinity index between GBC60 and GBC70. The affinity indices for all types of GBC increased significantly with time up to 8 weeks. The handling properties of GBC were comparable to those of conventional PMMA bone cement. We conclude that when mechanical properties and osteoconductivity are both taken into consideration, GBC60 is the most suitable formulation; it shows excellent osteoconductivity and sufficient mechanical strength for clinical use.

Animals↗