During the 20th century, metal alloys have assumed an important role as restorative materials. Among existing examples, cobalt–chromium (Co–Cr) alloys increasingly began to be used in medicine and ...especially in dentistry. Their success is mainly due to their mechanical properties such as stiffness, strength and corrosion resistance, thus allowing a high biocompatibility. There are quite meaningful data on the corrosion and toxicity of Co–Cr alloys for their use in restorative materials such as dental prostheses. Toxicological studies following Co and Cr exposures in the oral cavity are more difficult to conduct because there are many different situations leading to the release of metal ions and wear particles. Furthermore, the links between exposure and the appearance of local or systemic toxicity are not automatic. Since 2017, the European Union (EU) regulatory framework for Co–Cr alloys has been undergoing profound changes. A new EU Medical Devices Regulation (MDR) (2017/745) will be applied in May 2021 with the need to consider that Co metal is a new carcinogenic, mutagenic and toxic to reproduction (CMR) substance. On 18 February 2020, the 14th Adaptation to Technical Progress (ATP14) to the Classification, Labelling and Packaging (CLP) regulation was published, including the harmonised classification for Co metal as a CMR 1B substance. In this context, the use of Co might be forbidden if the medical devices are invasive and as soon as they include more than 0.1% (m/m) Co. This review provides a specific overview on Co–Cr dental alloys in terms of metal ions and wear particles release, toxicological risks, and the actual and new EU regulatory framework.
Abstract Objectives To give an overview of aspects of silane coupling agents and surface conditioning in dentistry. Methods Currently, silane coupling agents are used as adhesion promoters. Silanes ...are effective in enhancing adhesion between resin composite and silica-based ceramics. They do not bond effectively to non-silica based dental restorative materials. Surface conditioning of non-silica based ceramics with silica coating improves the bonding. This current overview will focus on the silane coupling agents: their properties, limitations in adhesion promotion and the clinical problems with the use of silanes. It will also focus on the current surface conditioning methods as well as new surface conditioning techniques to enhance the bonding through conventional silanization approaches. Results Several surface conditioning methods are being used clinically to enhance the adhesion of resin composites to non-silica based restorative materials. Other approaches are under investigation. The clinical problem of using silanes in adhesion promotion is the bond degradation over time in oral environment. Significance The current silane coupling agents are not ideal. The current silane coupling agents can fulfill the minimum requirements in clinical practice to enhance the bonding of resin composite to dental restorative materials. Developments of novel surface conditioning methods and silane coupling agents are required to address the bond durability problem.
This narrative review will focus on the evolution, present and future of engine‐driven root canal preparation. Root canal preparation changed drastically when Walia in 1988 introduced the use of ...nickel‐titanium (NiTi) alloys in Endodontics. In 2013, five generations of NiTi endodontic instruments had been established based on their metallurgical, mechanical properties and design features. Since then, manufacturers have been introducing further major changes in instrument design and characteristics that have not been translated in new recognized generations of instruments. In general, those changes have demonstrated enhanced instrument properties, but it is not clear yet if all those improvements are directly translated to an improvement in clinical success. This narrative review attempts to address the present status of engine‐driven instruments in terms of both evidence from laboratory‐based studies and clinical data, to identify potential further generations of instruments, and last to anticipate future directions for research and development.
The introduction of automated instrumentation in endodontics represented a major advance in progress for this specialty, with improvements in the quality and predictability of root canal preparation ...and a significant reduction in procedural errors. In recent years, endodontic instruments have undergone a series of changes brought about by modifications in design, surface treatments, and thermal treatments. In addition, new movements have also been incorporated to offer greater safety and efficiency, optimizing the properties of the NiTi alloy, especially through eccentric rotary motion. An understanding of the mechanical properties of these new NiTi instruments and their effect on the clinical performance of root canal preparation is essential if dental practitioners are to select the instruments that provide optimal clinical outcomes, especially in curved or flattened canals. The objective of this literature review is to present and discuss the characteristics of the NiTi alloys used in the major instrumentation systems available in the market, as well as the influence of the metallurgical and mechanical properties of NiTi instruments and the movements that drive them, to enable more accurate and predictable planning of root canal preparation.
Compositions of stainless steel, nickel-titanium, cobalt-chromium and β-titanium orthodontic alloys were simulated with mixtures of Fe, Ni, Cr, Co, Ti and Mo metal ions as potential oxidative ...stress-triggering agents. Wild-type yeast
and two mutants ΔSod1 and ΔCtt1 were used as model organisms to assess the cytotoxicity and oxidative stress occurrence. Metal mixtures at concentrations of 1, 10, 100 and 1000 µM were prepared out of metal chlorides and used to treat yeast cells for 24 h. Every simulated orthodontic alloy at 1000 µM was cytotoxic, and, in the case of cobalt-chromium alloy, even 100 µM was cytotoxic. Reactive oxygen species and oxidative damage were detected for stainless steel and both cobalt-chromium alloys at 1000 µM in wild-type yeast and 100 µM in the ΔSod1 and ΔCtt1 mutants. Simulated nickel-titanium and β-titanium alloy did not induce oxidative stress in any of the tested strains.
Cobalt-chromium (Co-Cr) alloys are widely utilized in dentistry. The salivary pH is a significant factor, which affects the characteristics and the behavior of dental alloys through corrosion. This ...study aimed to evaluate the corrosion behavior in artificial saliva with different pH values (3, 5.7, and 7.6) of two commercial Co-Cr dental alloys manufactured by casting and by milling. Corrosion resistance was determined by the polarization resistance technique, and the tests were carried out at 37 ± 1 °C, in Carter Brugirard artificial saliva. After the electrochemical parameters, it can be stated that the cast Co-Cr alloy has the lowest corrosion current density, the highest polarization resistance, and the lowest speed of corrosion in artificial saliva with pH = 7.6. In the case of milled Co-Cr alloy, the same behavior was observed, but in artificial saliva with pH = 5.7, it recorded the most electropositive values of open circuit potential and corrosion potential. Although both cast and milled Co-Cr alloys presented a poorer corrosion resistance in artificial saliva with a more acidic pH value, the milled Co-Cr alloy had better corrosion behavior, making this alloy a better option for the prosthetic treatment of patients suffering from GERD.
Summary
Background
The role of palladium and nickel sensitization in oral disease and dermatitis is not fully understood.
Objectives
To investigate whether sensitization to these metals was ...associated with exposure to dental alloys and oral and skin complaints/symptoms in a European multicentre study.
Methods
In six dermatology clinics, patch tests with palladium (3% Na2PdCl4; Pd = 102.0 µmol/g) and nickel (5% NiSO4.6H2O; Ni = 190.2 µmol/g) were performed in consecutive patients, and patients' characteristics were collected with a questionnaire and a clinical investigation.
Results
In total, 906 patients were included, of whom 24.3% reacted to palladium and 25.2% to nickel. The rate of monosensitization was 6–7% for both metals. Palladium sensitization (as opposed to no sensitization to both metals) was associated with exposure to dental crowns odds ratio (OR) 2.0, skin reactivity to metals (OR 2.8), oral lichenoid lesions (OR 4.7), xerostomia (OR 7.3), and metal taste (OR 20.7), but not with eczema, stomatitis, or oral burning sensation. Additionally, xerostomia (OR 8.7) and metal taste (OR 4.6) were associated with sensitization to both metals.
Conclusions
Clinically, it is important for palladium‐sensitized patients to undergo an oral examination, with particular attention to the presence of/exposure to dental crowns. In the case of metal contact allergy, exposure to dental crowns could play a role.
This study presents the correct processing of Co-Cr alloys as a method of preserving the properties of the materials as-cast, and therefore they can be safely placed in contact with the oral cavity ...tissues as resistance frameworks. The basic materials analyzed in this study were five commercial Co-Cr dental alloys with different components obtained in three processing steps. The analysis of the electrochemical behavior at the surface of the Co-Cr alloys was performed by electrochemical measurements: impedance spectroscopy (EIS), open circuit electrical potential (OCP), and linear polarization (LP). In terms of validation, all five alloys had a tendency to generate a stable oxide layer at the surface. After the measurements and the graphical representation, the alloy that had a higher percentage of tungsten (W) and iron (Fe) in composition showed a higher tendency of anodizing. After the application of the heat treatment, the disappearance of the hexagonal phase was observed, with the appearance of new phases of type (A,B)
O
corresponding to some oxide compounds, such as Fe
O
, Cr
O
, (Cr,Fe)
O
, and CoMnO
. In conclusion, the processing of Co-Cr alloys by melting and casting in refractory molds remains a viable method that can support innovation, in the context of technology advance in recent years towards digitalization of the manufacturing process, i.e., the construction of prosthetic frameworks conducted by additive methods using Co-Cr powder alloy.
Abstract Objective Selective laser melting (SLM) is increasingly used for the fabrication of customized dental components made of metal alloys such as CoCrMo. The main aim of the present study is to ...elucidate the influence of the non-equilibrium microstructure obtained by SLM on corrosion susceptibility and extent of metal release (measure of biocompatibility). Methods A multi-analytical approach has been employed by combining microscopic and bulk compositional tools with electrochemical techniques and chemical analyses of metals in biologically relevant fluids for three differently SLM fabricated CoCrMo alloys and one cast CoCrMo alloy used for comparison. Results Rapid cooling and strong temperature gradients during laser melting resulted in the formation of a fine cellular structure with cell boundaries enriched in Mo (Co depleted), and suppression of carbide precipitation and formation of a martensitic ɛ (hcp) phase at the surface. These features were shown to decrease the corrosion and metal release susceptibility of the SLM alloys compared with the cast alloy. Unique textures formed in the pattern of the melting pools of the three different laser melted CoCrMo alloys predominantly explain observed small, though significant, differences. The susceptibility for corrosion and metal release increased with an increased number (area) of laser melt pool boundaries. Significance This study shows that integrative and interdisciplinary studies of microstructural characteristics, corrosion, and metal release are essential to assess and consider during the design and fabrication of CoCrMo dental components of optimal biocompatibility. The reason is that the extent of metal release from CoCrMo is dependent on fabrication procedures.
Abstract Introduction The purpose of this study was to evaluate the effect of 2 different temperatures (20°C and 37°C) on the cyclic fatigue life of rotary instruments and correlate the results with ...martensitic transformation temperatures. Methods Contemporary nickel-titanium rotary instruments ( n = 20 each and tip size #25, including Hyflex CM Coltene, Cuyahoga Falls, OH, TRUShape Dentsply Tulsa Dental Specialties, Tulsa, OK, Vortex Blue Dentsply Tulsa Dental Specialties, and ProTaper Universal Dentsply Tulsa Dental Specialties) were tested for cyclic fatigue at room temperature (20°C ± 1°C) and at body temperature (37°C ± 1°C). Instruments were rotated until fracture occurred in a simulated canal with an angle curvature of about 60° and a radius curvature of 3 mm; the center of the curvature was 4.5 mm from the instrument tip. The number of cycles to fracture was measured. Phase transformation temperatures for 2 instruments of each brand were analyzed by differential scanning calorimetry. Data were analyzed using the t test and 1-way analysis of variance with the significance level set at 0.05. Results For the tested size and at 20°C, Hyflex CM showed the highest resistance to fracture; no significant difference was found between TRUShape and Vortex Blue, whereas ProTaper Universal showed the lowest resistance to fracture. At 37°C, resistance to fatigue fracture was significantly reduced, up to 85%, for the tested instruments ( P < .001); at that temperature, Hyflex CM and Vortex Blue had similar and higher fatigue resistance compared with TRUShape and ProTaper Universal. Conclusions Under the conditions of this study, using a novel testing design, immersion in water at simulated body temperature was associated with a marked decrease in the fatigue life of all rotary instruments tested.
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