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Calcium aluminate cement as dental restorative: Mechanical properties and clinical durability
Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In 1995, the Swedish government recommended the discontinuation of amalgam as restorative in paediatric dentistry. Because the mercury content in amalgam constitutes an environmental hazard, its use has declined. The use of resin composites is increasing, but the polymerisation shrinkage of the material is still undesirably high, and the handling of uncured resin can cause contact dermatitis. A new restorative material has recently been developed in Sweden as an alternative to amalgam and resin composite: a calcium aluminate cement (CAC). CAC has been marketed as a ceramic direct restorative for posterior restorations (class I, II) and for class V restorations. This thesis evaluates mechanical properties and clinical durability of the calcium aluminate cement when used for class II restorations. Hardness, in vitro wear, flexural strength, flexural modulus, and surface roughness were evaluated. A scanning electron replica method was used for evaluation of the interfacial adaptation to tooth structures in vivo. The durability was studied in a 2-year intra-individually clinical follow-up of class II restorations.

Major results and conclusions from the studies are as follows:

• The CAC was a relatively hard material, harder than resin-modified glass ionomer cement but within the range of resin composites. The CAC wore less than resin-modified glass ionomer cement but more than resin composite.

• Flexural strength of CAC was in the same range as that of zinc phosphate cement and far below that of both resin composite and resin-modified glass ionomer cement. Flexural modulus of CAC was higher than both resin composite and resin-modified glass ionomer cement. The low flexural strength of CAC precludes its use in stress-bearing areas.

• Surface roughness of CAC could be decreased by several polishing techniques.

• For CAC restorations, interfacial adaptation was higher to dentin but lower to enamel compared with resin composite restorations. Fractures were found perpendicular to the boarders of all CAC restorations and may indicate expansion of the material.

• After 2 years of clinical service, the class II CAC restorations showed an unacceptably high failure rate. Material fractures and tooth fractures were the main reasons for failure.

Place, publisher, year, edition, pages
Umeå: Umeå universitet. Institutionen för odontologi , 2004. , 67 p.
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 84
Keyword [en]
mechanical properties, clinical, restorations, ceramic, cement, resin composite, adaptation, SEM
Research subject
Odontology
Identifiers
URN: urn:nbn:se:umu:diva-270ISBN: 91-7305-589-1 (print)OAI: oai:DiVA.org:umu-270DiVA: diva2:142894
Public defence
2004-06-03, Tandläkarhögskolan 9 tr, Sal D, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2004-05-12 Created: 2004-05-12 Last updated: 2010-08-24Bibliographically approved
List of papers
1. Hardness and in vitro wear of a novel ceramic restorative cement
Open this publication in new window or tab >>Hardness and in vitro wear of a novel ceramic restorative cement
2002 (English)In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 110, no 2, 175-178 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the present work was to compare a new ceramic restorative cement for posterior restorations, DoxaDent, with other types of tooth-colored materials for direct use as regards hardness and in vitro wear. Four hybrid resin composites, one polyacid-modified resin composite, one resin-modified glass ionomer cement, one conventional glass ionomer cement, one zinc phosphate cement, an experimental version as well as the marketed version of the ceramic restorative cement, were investigated. Hardness of the materials was tested with the Wallace indentation tester and wear was tested with the ACTA wear machine. All tests were carried out on 2-wk-old specimens. DoxaDent was as hard as the zinc phosphate cement and the hardest resin composite. The ceramic restorative cement wore significantly more than the resin composites, the same as the zinc phosphate cement, and less than the glass ionomer cements. No correlation between hardness and wear was found. It can be concluded that the ceramic restorative cement is a rather hard material but with a relatively low wear resistance.

Place, publisher, year, edition, pages
John Wiley & Sons, Inc, 2002
Keyword
physical properties, posterior restorations, composite, glass ionomer cement, zinc phosphate cement
Identifiers
urn:nbn:se:umu:diva-3966 (URN)10.1034/j.1600-0722.2002.11226.x (DOI)
Available from: 2004-05-12 Created: 2004-05-12 Last updated: 2010-08-24Bibliographically approved
2. Flexural strength and modulus of a novel ceramic restorative cement intended for posterior restorations as determined by a three-point bending test
Open this publication in new window or tab >>Flexural strength and modulus of a novel ceramic restorative cement intended for posterior restorations as determined by a three-point bending test
2003 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, Vol. 61, no 2, 87-92 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to compare a new restorative cement intended for posterior restorations, Doxadent, with other types of tooth-colored materials as regards flexural strength and flexural modulus. The new restorative material consists mainly of calcium aluminate. Four hybrid resin composites, one polyacid-modified resin composite, one resin-modified glass ionomer cement, one conventional glass ionomer cement, one zinc phosphate cement, and an experimental version as well as the marketed version of Doxadent were investigated. Flexural strength and flexural modulus were tested according to ISO standard 4049 and determined after 1 d, 1 week, and 2 weeks. Together with the zinc phosphate cement, Doxadent had the lowest flexural strengths (13-22 MPa). The strongest materials were the resin composites and the polyacid-modified resin composite (83-136 MPa). The highest flexural modulus was found for Doxadent (17-19 GPa). The flexural strength of Doxadent decreased significantly from 1 week to 2 weeks, while flexural modulus remained unchanged. The other materials reacted in different ways to prolonged water storage. It can be concluded that the restorative cement Doxadent had significantly lower flexural strength and significantly higher flexural modulus than today's materials used for direct posterior restorations.

Place, publisher, year, edition, pages
Taylor & Francis, 2003
Keyword
Composite, glass ionomer cement, mechanical properties, posterior restorations, zinc phosphate cement
Identifiers
urn:nbn:se:umu:diva-17666 (URN)10.1080/00016350310001424 (DOI)12790505 (PubMedID)
Available from: 2007-11-15 Created: 2007-11-15 Last updated: 2010-08-24Bibliographically approved
3. Surface roughness of a novel "ceramic restorative cement" after treatment with different polishing techniques in vitro
Open this publication in new window or tab >>Surface roughness of a novel "ceramic restorative cement" after treatment with different polishing techniques in vitro
2003 (English)In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 7, no 1, 27-31 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to determine the surface roughness of a novel calcium aluminate cement (CAC) intended for posterior restorations after treatment with different polishing devices in vitro. Forty-eight CAC specimens were polished with diamond burs at 15,550 rpm or 27,000 rpm, Sof-Lex discs, Jiffy points, Shofu silicone points, and Aaba universal polisher. Amalgam specimens were polished with Shofu silicone points and used as reference. Roughness was measured using a profilometer. The smoothest CAC surface was observed after use of the fine Sof-Lex disc (roughness average [Ra] 0.26 mm). Diamond burs at higher speed, points, and polisher gave rather similar results (Ra 0.58–0.72 mm). An increase in surface roughness could be seen from using diamond burs at lower speed (Ra 2.3 mm). Extra fine Shofu points and Sof-Lex discs as a final step reincreased surface roughness. Polished amalgam showed the smoothest surface in the study (Ra 0.17). It can be concluded that the smoothest CAC surfaces were obtained with the fine Sof-Lex discs. Different polishing points and diamond burs at higher speed, which are suitable polishing devices for posterior restorations, also gave relatively smooth surfaces.

Place, publisher, year, edition, pages
Springer-Verlag, 2003
Keyword
surface properties, dental polishing, ceramics
Identifiers
urn:nbn:se:umu:diva-3968 (URN)10.1007/s00784-002-0193-0 (DOI)
Available from: 2004-05-12 Created: 2004-05-12 Last updated: 2010-08-25Bibliographically approved
4. Interfacial adaptation of a calcium aluminate cement used in class II cavities, in vivo
Open this publication in new window or tab >>Interfacial adaptation of a calcium aluminate cement used in class II cavities, in vivo
2004 (English)In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 8, no 2, 75-80 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this in vivo study was to evaluate the interfacial marginal adaptation of a calcium aluminate cement, Doxadent (DD), and to compare it intra-individually with a resin composite, Tetric Ceram/Syntac Single-Component (TC/SS), in Class II cavities. Sixteen Class II box-shaped, enamel-bordered cavities were prepared in eight premolars scheduled to be extracted after 1 month's service for orthodontic reasons. The interfacial marginal adaptation (internal surfaces) of the restorations was evaluated by a quantitative scanning electron microscope analysis using a replica method. DD showed a statistically significant, lower degree of gap-free adaptation to enamel compared with TC/SS: 84% vs. 93%. To dentin, DD showed a significantly better adaptation than TC/SS: 72% vs. 49%. A high frequency of enamel fractures perpendicular to the margins was observed for the DD restorations, which may be explained by an expansion of the calcium-aluminate cement. It can be concluded that DD showed a better adaptation to dentin while TC/SS showed a better adaptation to enamel. The dimensional changes of DD have to be investigated before clinical use can be recommended.

Place, publisher, year, edition, pages
Springer-Verlag, 2004
Keyword
Clinical, Dental restoration, Dental cement, Interfacial adaptation
Identifiers
urn:nbn:se:umu:diva-17140 (URN)10.1007/s00784-003-0242-3 (DOI)14661081 (PubMedID)
Available from: 2007-11-02 Created: 2007-11-02 Last updated: 2010-08-25Bibliographically approved
5. A two-year clinical evaluation of a new calcium aluminate cement in Class II cavities
Open this publication in new window or tab >>A two-year clinical evaluation of a new calcium aluminate cement in Class II cavities
2003 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, Vol. 61, no 4, 235-40 p.Article in journal (Refereed) Published
Abstract [en]

A calcium aluminate cement (Doxa Certex, Uppsala, Sweden) has recently been developed intended for use as direct restorative filling material for posterior restorations. The material is inorganic and non-metallic and the main components are CaO, Al2O3, SiO2, and water. The aim of this study was to evaluate intra-individually the experimental calcium aluminate cement (CAC) and a resin composite (RC) in Class II restorations. Each of 57 participants received at least one pair of restorations of the same size, one CAC and one RC (Tetric Ceram). Sixty-one pairs were performed. The restorations were evaluated clinically, according to slightly modified USPHS criteria, at baseline, after 6 months, 1, and 2 years. One-hundred-and-twenty restorations were evaluated at 2 years. Postoperative sensitivity was reported for 5 restorations (2 RC, 3 CAC). Significantly better clinical durability was shown for RC. Five non-acceptable CAC restorations (8.2%) were observed at 6 months, 10 CAC (16.7%) and 2 RC (3.3%) at 12 months, and 11 CAC (18.3%) at 24 months. This resulted in a cumulative failure frequency of 43.3% for the CAC material and 3.3% for the RC material. Main reasons for failure for the CAC were partial material fracture (7), cusp fracture (5), and proximal chip fracture (6). The CAC showed a non-acceptable clinical failure rate for Class II restorations, probably caused by its difficult handling and low mechanical properties.

Place, publisher, year, edition, pages
Taylor & Francis, 2003
Keyword
Cement, ceramic, clinical, composite resin, dental restorations
Identifiers
urn:nbn:se:umu:diva-17138 (URN)10.1080/00016350310004575 (DOI)14582592 (PubMedID)
Available from: 2007-11-02 Created: 2007-11-02 Last updated: 2010-08-25Bibliographically approved

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