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2008 J. Phys. D: Appl. Phys. 41 113001

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IOP PUBLISHING JOURNAL OF PHYSICS D: APPLIED PHYSICS
J. Phys. D: Appl. Phys. 41 (2008) 113001 (22pp) doi:10.1088/0022-3727/41/11/113001

TOPICAL REVIEW

Tribology of dental materials: a review

Z R Zhou1 and J Zheng
Tribology Research Institute, Key Laboratory for Advanced Technology of Materials of Ministry of
Education, Southwest Jiaotong University, Chengdu 610031, Peoples Republic of China
E-mail: zrzhou@home.swjtu.edu.cn (Z R Zhou)

Received 1 October 2007, in final form 19 November 2007

Published 13 May 2008
Online at stacks.iop.org/JPhysD/41/113001

Abstract
The application of tribology in dentistry is a growing and rapidly expanding field. Intensive
research has been conducted to develop an understanding of dental tribology for successful
design and selection of artificial dental materials. In this paper, the anatomy and function of
human teeth is presented in brief, three types of current artificial dental materials are
summarized, and their advantages and disadvantages, as well as typical clinical applications,
are compared based on the literature. Possible tribological damage of tooth structure, which is
induced by complex interfacial motion, and friction-wear test methods are reported. According
to results obtained by the authors and from the literature, the main progress in the area of
dental tribology on both natural teeth and artificial dental materials is reviewed. Problems and
challenges are discussed and future research directions for dental tribology are recommended.
(Some figures in this article are in colour only in the electronic version)

1. Introduction
Human teeth are not only an important masticatory organ
but are also closely associated with both pronunciation and
the facial aesthetics of human beings. Beyond all doubt,
teeth play an extremely significant role in our daily life.
With ageing, various pathological factors and traumas, tooth
lesions such as caries, partial or overall tooth tissue loss will
occur unavoidably. As a result, artificial dental materials
have gradually been developed and used to restore and treat
the lesions of human teeth. Nowadays, metals and alloys,
ceramics and composite materials are most widely used for
dental restorations and implants.
Tribology is the science of the mechanisms of friction,
lubrication and wear of interacting surfaces that are in relative
motion. By definition, friction is the rubbing of one object
or surface against another, whilst wear is a process that
occurs whenever a surface is exposed to another surface
or to chemically active substances [1], which can result
in a progressive removal of material from surfaces through
mechanical or chemical action. In general, oral biomechanical
functions can result in some tribological movement of teeth,
restorations and implants occurring in the mouth [25]. For
1 Author to whom any correspondence should be addressed.
example, during chewing food, the teeth, together with any
restorations, have to move in contact with one another, and
then friction and wear occur generally with the lubrication of
saliva or food slurry [5]. It has been accepted that tooth wear
is a clinical problem that is becoming increasingly important
in ageing populations. Understanding of dental friction and
wear behaviour would help the clinical management of tooth
wear, which involves the replacement of missing tooth tissue
with dental materials, together with an attempt to minimize
the causal factors and develop new dental materials [5].
In addition, tooth wear proceeds in a regular progressive
manner, particularly in the molar teeth, endowing it with
potential as a method of estimating the evolution, age, diet
and health changes of ancient humans in archaeology [69].
Therefore tribology of dental materials has developed and is
paid increasing attention by various researchers.
Attention to the issue of dental friction and wear paid
by clinicians can be traced back hundreds of years [10]. In
1778, Hunter wrote one of the first textbooks of dentistry [10],
in which he explained that there are three modes of tooth
wear in the mouth: attrition, abrasion and erosion. With the
rapid development of material science, more and more dental
practitioners and engineering researchers have focused on the
tribological behaviour of human teeth and artificial dental

0022-3727/08/113001+22$30.00 1 2008 IOP Publishing Ltd Printed in the UK

J. Phys. D: Appl. Phys. 41 (2008) 113001 Topical Review

Table 1. Statistics of papers concerning tribology of dental materials.

Papers on human teeth Papers on dental materials
Period Attrition Abrasion Erosion Abfraction Composites Ceramics Metals
19601969 5 8 11 1 2
19701979 17 38 22 1 12 2 3
19801989 40 19 40 4 62 18 6
19901999 31 61 127 16 107 63 11
2000present 54 38 101 8 70 41 6

materials since the 1960s. Howden (1971) first reported a Table 2. The number of research papers versus time and dental
special pattern of surface loss caused by the movement of acid materials.
gastric juice in patients with gastroesophageal reflux disease Papers on Papers on
(GERD) [11]. Cvar and Ryge (1971) devised a scoring system Period Paper sum human teeth artificial materials
to assess the wear of dental materials, which is known as 19601969 27
25 (92.6%)
2 (7.4%)
the United States Public Health Services (USPHS) system 19701979 95
78 (82.1%)
17 (17.9%)
[12]. Subsequently Smith and Knight (1984) described a 19801989 189
103 (54.5%)
86 (45.5%)
19901999 416
235 (56.5%)
181 (43.5%)
categorization index which is most commonly used for the
2000present 318
201 (63.2%)
117 (36.8%)
wear assessment of human teeth [13]. Based on replica
laboratory models, Leinfelder (1986) developed a popular
indirect method for measuring wear in dentistry [14]. More
recently, Grippo coined a relatively new term abfraction
to define the loss of dental tissues caused by stress-induced
noncarious lesions [15]. In addition, in order to simulate
and investigate the tribological behaviour of dental materials
systematically, several research centres developed wear testing
devices and methods of different degrees of complexity, which
improved dental tribology to a considerable degree. Notable
are the relative dentine abrasion (RDA) method (Hefferren
1976) [16], the artificial mouth conception (Delong and
Douglas 1983) [17] and the Oregon Health Science University
Oral Wear Simulator (Condon and Ferracane 1996) [18]. In
1999 the International Standard Organization (ISO) published
a technical specification on Wear by tooth brushing, followed
in 2001 by another technical specification called Wear by two-
and/or three-body contact [19].
Based on published papers since 1960, a wide ranging Figure 1. Human tooth structure. (Reprinted with permission
literature search for key words (human teeth, dental materials, from [6]. Copyright 2006, Professional Engineering Publishing.)
friction and wear, attrition, abrasion, erosion and abfraction)
was examined and some useful information on dental tribology 2. Dental materials
was estimated, as shown in tables 1 and 2. It can be seen that
increasing attention is paid to tribological behaviour of dental Normally dental materials can be classified as natural
materials. In addition, with increased life expectancy and the materials, namely human teeth, and artificial materials which
increased consumption of soft drinks, tribological problems of are mainly used for dental restorations and implants.
human teeth, especially chemical effects, have been frequently
investigated since the 1990s.
2.1. Anatomy and function of human teeth
In this paper, concepts of dental wear and relevant
factors including microstructural, physical, chemical and Human teeth possess a unique structure [20] composed of
clinical factors are presented based on research published enamel, dentineenamel junction, dentine and pulp (shown in
in English. The main investigations and progress of dental figure 1), and each zone is anisotropic. The two most important
tribology obtained by the authors and from the literature elements of a tooth from the tribological perspective are the
are reported. The main aim of the overview is to achieve outer enamel and the inner dentine, whose properties [21] are
better understanding of the associated mechanisms, to conduct given in table 3.
successful design and suitable selection for dental materials Enamel is the hardest tissue in the human body, while
and to recommend and identify major activities of dental dentine is usually considered to be elastic and soft. Initially
tribology based on current trends in research activities and the enamel of a thickness of 23 mm is exposed to the occlusal
technological opportunities and needs. surface and chemical environment within the mouth. Enamel

2
J. Phys. D: Appl. Phys. 41 (2008) 113001
Table 3. Mechanical properties of enamel and dentine.
Property Dentine Enamel
Youngs modulus (GPa) 10.215.6 20.084.2
Shear modulus (GPa) 6.49.7 29
Bulk modulus (GPa) 3.114.38 45.65
Poissons ratio 0.110.07 0.230.30
Compressive strength (GPa) 0.2490.315 0.0950.386
Tensile strength (GPa) 0.0400.276 0.0300.035
Shear strength (GPa) 0.0120.138 0.06
Knoop hardness 5771 250500
Density (kg m3 ) 2900 2500
is composed of 9296% inorganic substances, 12% organic
materials and 34% water by weight [22]. Most of the
inorganic substances are hydroxyapatite that is contained in
the basic structural unit of enamel, the rod or prism. These
prisms align and run approximately perpendicular from the
dentineenamel junction towards the tooth surface [2325].
The high hardness of enamel is attributed to its high mineral
content, while its brittle property is due to its high elastic
modulus and low tensile strength. Investigations have shown
that mechanical properties of enamel vary with location on a
tooth, local chemistry and prism orientation [2527]. Finite
element stress analysis results showed that the enamel absorbs
most of the applied chewing load during mastication due to
its greater stiffness as compared with dentine, and therefore
masticatory forces tend to flow around the enamel cap to the
root dentine [28].
Dentine is a hydrated biological composite composed
of 70% inorganic material, 18% organic matrix and 12%
water by weight, and its properties and structural components
vary with location [29]. The structural composition of
dentine includes oriented tubules surrounded by a highly
mineralized cuff of peritubular dentine and an intertubular
matrix consisting of type I collagen fibrils reinforced with
apatite [30]. Between enamel and dentine, the dentine
enamel junction, a biological interface, may dissipate stresses
inhibiting further crack propagation [30, 31]. The dentine
enamel junction has high fracture toughness and, along with
the more resilient underlying dentine, supports the integrity
of enamel by preventing its fracture during function [25, 26].
Another possible mechanical function of the soft dentine
beneath the dentineenamel junction may be related to the
ability of a whole tooth to resist impact forces which often
occur when the tooth is working [32].
The major functions of teeth, together with any
restorations and implants, are associated with speech,
breathing, taste, chewing and supporting bone, soft tissues
and the muscles of mastication. Initially a human has 20
primary (or baby) teeth [33]. These are eventually replaced,
during childhood, with 32 permanent (or adult) teeth. To allow
chewing, teeth are arranged into two opposing arches in the
mouth. Within each arch are different types of teeth (figure 2),
each of which has a different function. Incisor teeth are used
for shearing, the canines evolved for holding prey and molars
are used for chewing. In general molars have complex surfaces
and cusps that fit together in a dynamic way during the chewing
process. Figure 2 also illustrates the different surfaces of teeth.
The buccal side is the side nearest the lips or cheek; the lingual
3
Topical Review
Central
(or Incisors)
Lateral
1st Molar
2nd Molar
1st Bicuspid
Cuspuid
(or Canine)
2nd Bicuspid
Figure 2. Human tooth orientation. (Reprinted with permission
from [33]. Copyright 2005, Professional Engineering Publishing.)
side is that closest to the tongue. The occlusal surface, the main
site of toothwear processes, is the side which meets a tooth
or restoration in the opposite jaw during chewing or biting.
In addition, the side of one tooth in proximal contact with
another is defined as an approximal surface, and each tooth
has two approximal surfaces.
2.2. Artificial materials
Due to various pathological factors and trauma, some
patients have always had to suffer tooth lesions. Therefore,
various artificial materials have been developed and used
in dentistry to replace missing teeth or tooth tissue and
unaesthetic, but otherwise healthy, tooth enamel. Recreating
function and aesthetics are the two practical goals of such
treatments. Although the field of dental materials is highly
catholic in nature [34], for selecting a material for dental
application, it is necessary to remember that the choice of
material depends on a number of factors such as corrosion
behaviour, mechanical properties including strength and wear
resistance, cost, availability, biocompatibility and aesthetic
values. Normally dental materials may be grouped into three
categories: metals and their alloys, ceramics, polymers and
composites [3440]. Different forming/processing methods
and main clinical applications are shown in table 4.
2.2.1. Metals and alloys. Metals have been used as dental
materials for over a century [34]. Generally, most metals are
strong enough to withstand the maximum possible oral forces
and have been found to be competitive among dental materials.
Therefore, metallic restorations and particularly those made
from precious metal alloys retain a particular role in managing
the dental needs of patients. A general classification of dental
metallic materials, their class and broad application areas are
listed in table 4.
Currently the clinical use of metals and their alloys
in dentistry has been significantly confined by two major
problems: (1) the colour being very different from that of
tooth tissue and (2) the irritability or cytotoxicity of a metal
to cells. For example, as one of the most popular direct
restorative materials, amalgam has been successfully used by
the dental profession for approximately 100 years [41]. The
major attraction of this material is the proven longevity in
clinical service and ease of clinical use. However, the potential
toxicity of mercury in amalgam has increasingly aroused safety
concerns for both patients and dental personnel. Furthermore,
J. Phys. D: Appl. Phys. 41 (2008) 113001 Topical Review

Table 4. Current artificial dental materials.

Material type Forming/processing method Typical application
Metals and Amalgam Low copper Posterior restoration
their alloys High copper Posterior restoration
Noble alloys Gold (non-heat-treatable) Restoration of single teeth
Gold (heat-treatable) Fixed bridges
Palladiumsilver Restoration of single teeth
Base alloys Nickel Restoration of single and missing
teeth, partial denture frameworks
Cobalt Partial Denture framework and implants
Iron Orthodontic appliances and
endodontic instruments
Titanium Implants
Ceramics Feldspathic porcelain Condensed and sintered Veneers, inlays, anterior crowns
Leucite-reinforced porcelain Pressure moulded Veneers, inlays, anterior
and posterior crowns
Silicate-reinforced porcelain Pressure moulded Anterior and posterior crowns,
anterior bridges
Al2 O3 -reinforced porcelain Condensed and sintered Anterior crowns
Alumina core ceramic Dry pressed and sintered Anterior and posterior crowns,
anterior bridges
Glass-infiltrated core ceramic Slip cast, sintered and Anterior and posterior crowns,
infiltrated with glass anterior bridges
Machinable ceramic Milled or ground Veneers, inlays, anterior
and posterior crowns
Zirconia core ceramic Dry pressed and sintered Posterior crowns and bridges
Unfilled Lightly filled or unfilled Adhesives
polymers and composite
composite Macrofill composite
Microfill composite Homogeneous microfill Restorations and crowns of anterior
and posterior teeth, inlays,
onlays, veneer
Heterogeneous microfill
Hybrid composite Composed 7080% glass fillers Obturation materials for dental caries
and 2030% nanofillers polyacid-modified
Compomers fibrous composite Carbon fibres for the core and glass fibres Dental post, orthodontic archwires
for sheathing and brackets

Glass ionomer Resin-modified Adhesives, obturation materials

for dental caries
Metal-reinforced Adhesives, obturation materials
for dental caries

its metal-like appearance does not meet current aesthetic
demands and it requires a more complex cavity preparation
to compensate for its lack of adhesion to tooth tissues [42].
Therefore, amalgam has been gradually replaced by resin-
based composites which have excellent aesthetic appearance
and can be bonded to the tooth structure easily.
Given these drawbacks, together with the material and
labour costs associated with metal substrate fabrication,
metals and their alloys have increasingly been limited to
orthodontic appliances and dental implants. However, the
dental literature indicates that among direct and indirect
restorations, gold-based casting alloys are considered the most
ideal dental material especially for posterior teeth because
they are wear resistant and cause minimal wear of opposing
enamel [34, 43, 44].
2.2.2. Ceramics. Ceramics are used as an alternative to
gold-based casting alloys because of their greater aesthetic
potential. Ceramics were first used successfully in dentistry
in 1774 [4547], and many efforts were made therefore to
improve their aesthetics over the next 190 years. In the early
1960s [45], dental ceramics were first formulated for routine
fusion onto metal substructures, significantly broadening the
use of ceramics and then increasing the demand for dental
ceramic materials. Subsequently, with the employment of
dispersion strengthening, aluminous porcelain, a ceramic
material suitable for all-ceramic substructures, was created and
used [44, 45]. A wide variety of dental ceramics is currently
available [35].
Aesthetics is an obvious attribute of ceramics and, along
with biocompatibility, durability and etchability (ability to
be bonded), is the primary reason why dentists often choose
ceramics over other materials. However, two major problems
arise in their dental usage: (1) the potential for catastrophic
brittle fracture and (2) the potential to abrade the opposing
natural teeth or restorations [47]. Many studies have shown
that enamel wear against dental ceramics is substantially
greater than against gold [43, 44, 48, 49]. In addition, dental

4
J. Phys. D: Appl. Phys. 41 (2008) 113001
ceramics with high strength and toughness are not generally
aesthetic [35].
2.2.3. Composites. Resin-based composite materials are
widely used in restorative dentistry nowadays (table 4).
Being introduced in the mid-1960s [40], the first composite
restoratives were mainly unfilled resins (called polymers)
and their use was confined to dental adhesives and direct
restorative materials in anterior teeth due to insufficient
material properties [5, 34, 37]. In order to improve strength,
hardness and wear resistance and to reduce polymerization
shrinkage, tooth coloured resin matrix composites containing
filler particles were developed and then used for restoring
posterior stress-bearing cavities as a viable alternative to
amalgam approximately 30 years ago [34, 5052]. Composite
resin denture teeth were developed in the 1980s [51]. Due to
the major influence of the fillers on their physical properties
[53, 54], the classification of dental filling composites is
based on the type of filler used and the particle size thereof
[36]. In general two types of composites are in the market,
i.e. microfill and hybrid composite filler materials. Polyacid-
modified composite resins, known trivially as composers, were
also introduced to the dental profession in the early 1990s
and were used for restoring teeth damaged by dental caries
[39]. With biocompatible fibres and matrix systems, fibrous
composites found application as biomaterials, and a number of
fibrous composite materials for dental applications have been
developed [38].
The use of resin-based composites in restorative dentistry
has increased significantly in recent years. These materials
feature the advantage of good aesthetics for dental restorations
and are able to bond to tooth structures easily by the acid-etch
technique. However, excessive wear of composite restorations
is still a major problem encountered in their use in stress-
bearing applications although significant improvements have
been made [42,55,56]. Higher wear rates than either metals or
ceramics have limited clinical longevity of dental composites.
3. Tribology related to human teeth
3.1. Oral environment
The oral environment plays an extremely important role in
the tribological behaviour of both human teeth and artificial
teeth. Saliva is the most important component of the chemistry
of the human mouth. All solid substrata as well as mucosa
membranes exposed to the oral environment are covered by a
layer of absorbed salivary proteins, the acquired pellicle [57],
whose formation starts within seconds on any solid surface
exposed to the oral environment. The physiological role of
saliva in the oral cavity is manifold.
An important function of saliva is to form a boundary
lubrication system and serve as a lubricant between hard
(enamel) and soft (mucosal) tissues [58] to help decrease
the wear of teeth and reduce the friction of oral mucosa and
tongue surfaces to prevent lesions and make swallowing easier,
which is of crucial importance to maintain functions such as
mastication, deglutition and the faculty of speech. Results
5
Topical Review
of in vitro wear tests, carried out by the authors [59], have
shown that artificial saliva, a simulation of real saliva, can
have both cooling and lubricant effects during the toothwear
process, and the risk of tooth texture burn may be significantly
reduced under the artificial saliva condition compared with
the dry condition. The lubricating mechanism of saliva is
presumably based on a full separation of the sliding surfaces by
salivary films [58], which can be maintained within the clinical
occlusal forces in the mouth. In addition, the presence of the
lubricant influences how much kinetic energy is absorbed by
the shearing of the inter-molecular bonds in salivary films and
how much is transferred to the teeth [60].
In general saliva is pH 7 (neutral); however, corrosive
agents such as acids can be introduced into the mouth [33].
The mouth of a person with a particularly acidic diet could be
at pH 3, and regurgitated gastric acid is pH 1.2. Acidic drinks
contain a range of different acids, which can range from pH 1
to pH 6. Increased acidity in the mouth has been clearly shown
to initially decrease both the hardness and the elastic modulus
of enamel [61, 62] and then result in pathological wear of
teeth [63,64]. Therefore, the role of saliva in the mouth is also
thought to involve both the protection of the enamel surface
against acid attack because it is a buffer to acids produced
in plaque and the provision of a matrix for remineralization
[65, 66] because it supplies calcium and phosphate ions to
remineralize enamel. There has been a worldwide monumental
increase in the consumption of soft drinks, fruit juices and
sport drinks, and signs suggest a similar increase in the future,
rather than slowing down [67]. This implies that exposure
of teeth to an acid environment is increasing. The presence
of even a minute film of salivary pellicle (thickness of 100
500 nm) can protect the exposed materials surface from the
acid, thereby preventing its removal during the next friction
phase. So, the protective properties of saliva are extremely
significant for minimizing the corrosive effects of acids on
teeth and restorations.
3.2. Biomechanics
Mastication is the most important function of teeth. It has been
widely accepted that wear of dental materials in the mouth
results mainly from chewing cycles. Therefore, it is important
to understand the biomechanics of mastication.
Mastication is the action of chewing food, which is a
complex and compound process [68]. Mastication involves
two stages: open phase and closed phase [3]. During the first
stage the teeth are brought by the jaw from the open position to
a position of contacting the food bolus. Normally, no occlusal
forces are involved in this phase (sticky foods represent an
exception), and the abrasive particles are suspended and free
to move in the food slurry. The second stage starts when
the teeth first contact the food bolus and continues until the
jaw begins to open. During this phase occlusal loads are
applied and distributed through the food bolus so that the food
particles are trapped between the opposing surfaces of the teeth
(especially upper and lower molars) and dragged across them.
Therefore, the food bolus is compressed and crushed, and then
grinding occurs either with toothfoodtooth (or indirect) or
J. Phys. D: Appl. Phys. 41 (2008) 113001
Figure 3. Schematic drawing of inter-oral movements of teeth.
(a) Open phase mastication, (b) closed phase mastication,
(c) thegosis/bruxism and (d) toothbrushing. (Reprinted with
permission from [33], copyright 2005, Elsevier, and from [68],
copyright 2007, Elsevier.)
Figure 4. Relation between sine curve and masticatory loading
patterns. (Reprinted with permission from [71]. Copyright 1999,
Elsevier.)
direct toothtooth (complete penetration of the food bolus, if
present) contacting of the opposing teeth surfaces [69]. A
simplified drawing of the chewing cycle is displayed in figure 3.
The literature shows that the shape of the occlusal force
curve is similar to the positive half of a sine curve but
asymmetric mainly because of the irregularity of some foods
[70, 71], as shown in figure 4. During normal chewing the
load applied to the teeth is in the range 1020 N at initial
contact [17, 72], and is heightened within the range 50150 N
at the end of the chewing cycle [73, 74]. The magnitude of the
force depends mainly upon the physical properties of food. As
there is a great variety of foods, various forces can be expected.
In addition, the maximum biting forces vary according to sex,
age and muscle build. Typically, the maximum biting load
at the incisors is 100 N, gradually increasing as one moves
posteriorly to reach around 500 N at the molars.
General chewing parameters [33, 68, 75] are listed in
table 5. The total duration of a chewing cycle has been
shown to be about 0.70 s, whilst the mean duration of the
occlusion is about 0.10 s [68], and these periods add up to
1530 min of actual contact loading each day [33]. The speed
of teeth sliding ranges from 0.25 to 0.50 mm s1 . Tooth-on-
tooth sliding distances are around 0.91.2 mm [33]. These
6
Topical Review
parameters vary widely and depend on the kind of food, the
size of food bolus, chemical and physical action of saliva and
psychological factors [68].
Except for mastication, other functions, such as thegosis
and bruxism (figure 3), can also result in friction and wear of
dental materials [3]. Thegosis is the action of sliding teeth into
lateral positions. This has been suggested to be a genetically
determined habit originally established to sharpen teeth [76].
Bruxism is the action of grinding of teeth without the presence
of food, which is regarded as a response to stress and treated
clinically as pathological behaviour [3]. During thegosis and
bruxism there are occlusal forces, which guide the movement
of the lower jaw relative to the upper jaw and thereby cause
friction and wear of teeth and restorations in direct contact
(toothtooth or toothrestoration or restorationrestoration).
In addition, tooth cleaning (for instance, toothbrushing) and
habits such as pipe-smoking and pencil chewing can also
cause friction and wear of teeth and restorations [3, 77]. The
relationship of the movement and wear of dental materials is
shown in figure 5.
It is worth noting that during mastication, thegosis
and bruxism there exists relative motion between the
proximal teeth, which can cause friction at proximal contacts
and then result in interproximal wear of dentition [6].
Under the physiological loads, the biological thresholds for
micromovements at the proximal contacts are arguably in the
range of less than 100 m. As a result, tooth motion of this
type is usually undetected and neglected.
3.3. Wear mode
As mentioned above, friction and wear can result from
direct contact between teeth and from any abrasive particles
or devices sandwiched between them during mastication,
thegosis, bruxism, toothbrushing and other functions. Tooth
surface loss caused by wear is a common clinical problem, with
various epidemiologic studies suggesting prevalence estimates
of up to 97%, with around 7% of the population showing
pathological wear requiring treatment [78].
The main categories of wear that contribute to
the destruction of natural teeth and artificial materials
are classified as follows [2]: physiological wear (vital
life functions), pathological wear (disease and abnormal
conditions), prophylactic wear (preventive conditions) and
finishing procedure wear. An overview is provided in table 6.
Physiological wear, inevitable due to the mastication
function [35, 79], is surface degradation that results in
progressive but very slow loss of the convexity of tooth cusps,
which manifests as a flattening of both cusp tips on the posterior
teeth and incisal edges on the anterior teeth for mammalians.
Compared with physiological wear, some pathological
factors can cause excessive wear of teeth and restorations [2,3].
Clinical reports show that wear usually becomes significantly
severe due to erosion, bruxism, xerostomia, and so on.
Pathological wear also can be caused by detrimental oral habits
[3, 80], which generally include chewing tobacco, biting on
hard objects such as pens, pencils or pipe stems, opening hair
pins with teeth and biting fingernails. In addition, occupational
J. Phys. D: Appl. Phys. 41 (2008) 113001 Topical Review

Table 5. Inter-oral chewing parameters.

Duration (s)
Chewing Chewing Sliding Sliding
load (N) frequency (Hz) speed (mm/s) distances (mm) Total Occlusion
2150, Max 450 12 0.250.50 0.91.2 0.70 0.10

Thegosis buccal showed the least, respectively [83]. It is notable that

Direct
tooth
contact
Bruxism Wear at
Indirect
sites of
Mastication occlusal
Contact
(closed phase) contact
(trapped
particles) Chemical
effects
Habits Wear at
(pipe smoking etc) contact
Slurry free sites
Mastication effects
(opened phase) (suspended
particles)
Toothbrushing
Figure 5. Relation between movement and wear of teeth.
(Reprinted with permission from [3]. Copyright 1996, Elsevier.)
habits may result in the wear of teeth and restorations. For
instance, tailors or seamstresses sever thread with their teeth,
shoemakers and upholsterers hold nails between their teeth,
glassblowers and musicians play wind instruments, and so on.
It has been pointed out that in normal use the benefits
of toothbrushing far outweigh the potential harm; however,
wear can occur as a result of overzealous toothbrushing and
improper use of dental floss and toothpicks [10, 77]. Scaling
and cleaning can result in minor wear of teeth [2].
Dental treatments usually involve processes such as
cutting, finishing and polishing and these cause the wear of
teeth and restorations to some extent [2].
The actual wear situation in the mouth may vary
considerably because of different substrates, opposing
wear surfaces, lubrication systems involved and third-party
abrasives [81]. The mouth provides an extremely complex
tribological system. Therefore, wear of teeth and restorations
tooth wear is multifactorial in the mouth and physical and
chemical processes interact [82]. It has long been recognized
that it is difficult to ascribe many individual cases to any one
category [3].
3.4. Wear location
Wear of teeth and restorations occurs mainly at sites of occlusal
surfaces and incisal surfaces during mastication, thegosis and
bruxism. Masticatory wear can also occur on the lingual and
buccal aspects of teeth as coarse food is forced against these
surfaces by the tongue, lips and cheeks during mastication.
Prophylactic wear, which is caused by toothbrushing, scaling,
cleaning, etc, can occur on the buccal, lingual, occlusal and
approximal aspects of teeth. It was reported that the occlusal
surface showed the greatest wear and the cervical, lingual and
the approximal wear at sites of proximal contacts is often
forgotten [84, 85]. Regarding the tooth position, the first
molar showed the greatest degree of wear, while the canine
and premolar showed the least, respectively. As for the tooth
location, mandibular occlusal surfaces showed greater wear
than maxillary occlusal surfaces in all age groups [78].
There is a vast amount of literature concerning the occlusal
wear of dental materials. Most studies made a distinction
between occlusal contact area (OCA) and contact-free occlusal
area (CFOA) wear [69]. The occlusal contact area is the
region where opposing materials contact directly (including
toothtooth, toothrestoration and restorationrestoration). It
usually represents the region where two-body wear can occur.
The contact-free occlusal area is the region where only three-
body wear occurs caused by food particles, toothpaste and
other physical objects. Figure 6 illustrates contact and contact-
free areas.
It is pointed out that for dental implants, fretting can occur
at the interface between the implant and the alveolar bone
during occlusal movements [86, 87]. It has been regarded as
one of the causes of dental implant failure, which could result
in the implants loosening.
3.5. Dental terminology
Three terms attrition, abrasion and erosion have been
widely used in dentistry to describe the wear of natural
teeth and artificial materials since 1778 [36, 10, 33, 69, 80].
Recently, abfraction has also been used by some researchers.
Most of the terms are peculiar to dentistry and have either little
or no meaning in engineering tribology.
Attrition. The wear caused by tooth-to-tooth or tooth-
to-restoration or restoration-to-restoration friction is called
attrition, which is often regarded as a result of two-body
interactions.
Abrasion. Friction between a tooth or restoration and an
exogenous agent (such as food bolus, toothpaste, toothpick and
dental floss) causes the form of wear called abrasion, which
is usually regarded as a result of three-body interactions. If
teeth are worn by friction from the food bolus, this wear is
termed masticatory abrasion [80].
Erosion. Surface loss of either teeth or restorations caused by
chemical or electrochemical action is widely called erosion
in the dental literature.
It is worth noting that the term erosion has a remarkably
different meaning between dentistry and engineering tribology.
Normally, in dentistry, erosion is used to describe surface
loss of dental materials resulting from the solution by acids

7
J. Phys. D: Appl. Phys. 41 (2008) 113001 Topical Review

Table 6. Classification of wear situations in dentistry. (Reprinted from [2] with permission of ASM International, copyright 1988.)
Inter-oral wear event Type of wear Lubricant Substrate Opponent Abrasive
Physiological causes of wear
Non-contact wear Three-body Saliva/food Tooth/restoration Food
Direct contact wear Two-body Saliva Tooth/restoration Tooth/restoration
Sliding contact Two-body Saliva Tooth/restoration Tooth/restoration
Pathological causes of wear
Bruxism Two-body Saliva Tooth/restoration Tooth/restoration
Xerostomia Two-body Tooth/restoration Tooth/restoration
Erosion Saliva Tooth/restoration
Unusual habits Two-body Saliva Tooth/restoration Foreign body
Prophylactic causes of wear
Toothbrush and dentifrice Three-body Water Tooth/restoration Toothbrush Dentifrice
Prophylactic pastes Three-body Water Tooth/restoration Polishing cup Pumice
Scaling and cleaning Two-body Water Tooth/restoration Instrument
Cutting, finishing, polishing
Cutting burs/diamonds Two-body Water Tooth/restoration Bur
Finishing burs Two-body Water Tooth/restoration Bur
Polishing pastes Three-body Water Tooth/restoration Polishing cup Abrasive slurry

3.6. Clinical significance

Figure 6. Contact and contact-free areas. (Reprinted with
permission from [69]. Copyright 2006, Elsevier.)
which are not of bacterial origin [5]. However, in engineering,
erosion, as defined by the American Society for Testing and
Materials Committee on Standards [88], is the progressive loss
of a material from a solid surface due to mechanical interaction
between that surface and a fluid, a multicomponent fluid,
impinging liquid or solid particles, whilst the wear caused
by the interaction of chemical degradation and movement of
the surfaces is termed corrosion [5]. By definition, erosion
can be observed as a shoreline being eroded by the pounding
surf or bridge supports being eroded by the rush of river waters
around them, while no such powerful flow of fluids occurs in
the human mouth to affect teeth. Therefore, more recently
Grippo et al [80] pointed out that the term erosion should
be deleted from the dental lexicon and supplanted by the term
corrosion to denote chemical dissolution of teeth. It should
be noted that the term erosion in this paper only has its
meaning in dentistry, that is, it refers to the surface loss of
teeth or restorations caused by chemical dissolution rather than
mechanical attack.
Friction between the surfaces of teeth has been implicated to
be necessary for oral functions, especially mastication [69].
Moreover, tooth wear may be regarded as having significant
clinical consequences both aesthetically and functionally
[3, 69, 79], the presence of which can improve masticatory
efficiency and reduce the susceptibility of dentition to disease
and malocclusion. As teeth wear, they continue to erupt, which
led to the concept of wearing into occlusion [69]. In dentistry,
occlusion is known as the alignment of the teeth of the upper
and lower jaws when brought together.
However, if wear is not controlled, the enamel will
eventually be breached, causing superficial dentine to be
exposed in the mouth [69]. Once breached, both the enamel
and the exposed dentine wear at accelerated rates. Excessive
wear of teeth can result in disastrous consequences such as
unacceptable damage to the occluding surfaces, alteration
of the functional path of masticatory movement, dentine
hypersensitivity and even pulpal pathology. It may also
destroy the anterior tooth structure that is essential to the
acceptable anterior guidance function or aesthetics, causing
increased horizontal stresses on the masticatory system and
associated temporomandibular joint remodelling [4, 89, 90].
Moreover, the wear of proximal surfaces may lead to loss of
the proximal contact area and thereby result in food impaction
and subsequent loss of bone and periodontal attachment.
In addition, excessive wear has been shown to be a
major problem encountered in the use of artificial dental
materials, especially composite restorations, in stress-bearing
applications. It may lead to premature failure and replacement
of the restoration and implant [19, 87].
4. Testing methods

Abfraction. Abfraction is used to term stress-induced dental The literature survey shows that nowadays three kinds
hard tissue loss, which occurs most commonly in the cervical of methods have been used by various workers to study
region of teeth. tribological behaviour of dental materials: in vivo observation

8
J. Phys. D: Appl. Phys. 41 (2008) 113001
and measurement, in vitro laboratory simulation and in situ
testing. In vivo observation and measurement is generally used
by clinicians to observe and evaluate clinical manifestations
of the wear of teeth and restorations in the mouth, whilst
in vitro laboratory simulation is usually used by materials
and tribology researchers to explore wear mechanisms of
natural teeth and artificial materials. More recently, the in
situ method has been introduced and developed to investigate
dental tribology [82].
4.1. In vivo observation and measurement
In vivo methods are widely used in clinics. Clinical observation
of the loss of dental hard tissue caused by wear can be traced
back hundreds of years [10].
As mentioned above, both oral environment and
biomechanics are very complex; tooth wear is therefore
multifactorial in the mouth and physical and chemical
processes interact. So, it has been accepted that the main
advantage of in vivo methods is to obtain and examine
tribological behaviour of teeth and restorations resulting from
a real oral environment and biomechanics [3, 33, 52, 68, 69,
84]. However, in vivo methods have some disadvantages
which limit their contribution to the tribology of dental
materials. Firstly, it is impossible for in vivo methods to
isolate and study individual wear processes, including attrition,
abrasion and erosion. Although some measures can be
taken to unify the testing conditions among the subjects to
some extent, it is still evident that subjectivity is indeed a
variable, which leads to problems in interpreting results [3,84].
Secondly, the lack of control over important variables that
may influence tribological behaviour (such as chewing force,
dietary intake or environment factors) significantly limits their
contribution to tribology of dental materials, especially wear
mechanisms [91]. In addition, wear processes clearly cannot
be accelerated in vivo and research work is dependent on
volunteer compliance [69]; as a result, in vivo studies are both
time-consuming and expensive.
It is noted that sufficiently sensitive methods of wear
measurement are also a problem for most in vivo studies.
In general, the systems for wear measurement in dentistry
use either clinical categorization systems or indirect methods
which measure wear on replica laboratory models [3]. For
toothwear the most commonly used categorization index is
that described by Smith and Knight which separately scores
the wear of the tooth surfaces according to the amount of
exposed dentine [13]. For restorative materials probably the
most universally used scoring system is the one devised by
Cvar and Ryge for the United States Public Health Service
(USPHS), in which the wear of restorations was categorized
as alpha, bravo and Charlie [12]. An alpha score means two-body wear rotating countersample, Taber abraser, two-
there is no wear, bravo means visible wear; however, it is
still clinically acceptable, and Charlie means excessive wear
and the restoration must be replaced. The advantages of the
chairside method of wear assessment are that it is readily
available and does not require special equipment, whilst the
disadvantages are that it is subjective and insensitive and takes
a long time to get significant results [3, 69].
9
Topical Review
With replica models there are a number of measurement
systems, the majority of which compare the replicas of
restorations with standard reference models or calibrated
reference steps [3]. Advantages of this method are that it is
fast and inexpensive [69]; however, the major disadvantages
are that it assesses only the wear at the restoration margin
and, therefore, gives no indication of wear occurring at other
sites [3]. In addition, it tends to underestimate wear [69].
Recently, it has been pointed out that the best method for
measuring wear is by comparing sequential 3D images of the
materials of interest [3, 33, 69], which is quantitative, accurate
and providing storable 3D databases that can be compared with
other 3D databases. However, considering that it needs to use
expensive equipment [69, 33], few clinical studies have used
3D scanning technology to measure wear although it has been
available since the mid-1980s.
4.2. In vitro laboratory simulation
Due to the mentioned disadvantages of in vivo methods,
the quest for a wear machine which would predict clinical
performance has been the dream of many material scientists
with the ever increasing number of artificial dental materials
available. Therefore, laboratory simulation methods were
widely developed to mimic wear conditions in the mouth
such as clinical masticatory cycle and oral environment and
then used for in vitro evaluation of dental materials after the
1940s [40].
The wear testing devices used in in vitro studies were
various, which include simplest pin-on-disc devices and a more
complex artificial mouth [17, 33, 92]. Several liquids are
incorporated in these wear machines such as water, alcohol,
acids, olive-oil, olive-oil/CaF slurry, artificial saliva, with or
without the inclusion of bacteria [84]. A summary of the
different test geometries used in dental tribology is shown in
figure 7.
Generally three main mechanical approaches can be
considered with different wear simulation techniques:
toothbrushing machines, two-body wear machines and three-
body wear machines. For toothbrushing machines, in general
a toothbrush/dentifrice abrasion concept is used consisting
of the following elements [84]: toothbrush, programmable
brushing techniques and paths and medium (such as dry, wet
and dentifrice abrasive slurry). A relative dentine abrasion
(RDA) method developed by Hefferren is perhaps the most
well-known in vitro method to study toothpaste abrasion and
is widely used by manufacturers [16]. The literature survey
shows that several two-body wear simulators were designed
and used with varying degrees of success to imitate clinical
wear [84], such as two-body abrasion single-pass sliding,
body machine sliding wear, pin-on-disc tribometer, abrasive
disc, oscillatory wear test, modified polisher and fretting
test. In addition, a number of three-body wear simulators
have been developed to simulate masticatory abrasion, which
include abrasive slurry that acts simultaneously with the
surface contact. Examples of these devices [84] are ACTA
wear machine, Oregon Health Sciences University Oral
J. Phys. D: Appl. Phys. 41 (2008) 113001
W
W W
Pin
Pin
Disc
(a)
Abrasive
slurry
Ball
(d)
Figure 7. Dental wear test configurations. (a) Pin-on-disc, (b) reciprocating, (c) one-way slide and static end load, (d) ball and crater and
(e) two disc. (Reprinted with permission from [33]. Copyright 2005, Professional Engineering Publishing.)
Wear Simulator, four-station Leinfelder-type three-body wear
device, Zurich computer-controlled masticator, Minnesota
MTS wear simulator (also called artificial mouth), BIOMAT
wear simulator and Willytec Munich and Muc3.
It has been accepted that in vitro testing offers researchers
much more control over experimental variables and the
opportunity to take far more accurate measurements than
in vivo testing and therefore shows many advantages in the
study of wear mechanism of natural teeth and artificial dental
materials [33] Moreover, in vitro evaluation of dental materials
can be examined over relatively short periods of time in
comparison with clinical trials. However, the oral environment
is very complex and has many variables; therefore all in
vitro models cannot replicate the oral environment with all
its biological variations [82]. And extrapolation to the oral
environment is impossible to calculate. As a result, only trends
and indications as to the true extent of wear can be obtained
by in vitro methods [3]. In addition, the results of in vitro
studies would be credible provided that the most influencing
parameters have been identified and can be used and controlled
in the test rigs [33]. To be of value, wear simulation must
produce clinically relevant results [69]. It should be noted
that nowadays most of the in vitro studies have been carried
out on different test rigs with differing contact geometries,
loads, sliding speeds, lubricants, etc, which make it difficult to
compare wear results obtained by different machines.
4.3. In situ testing
Whatever in vitro method is employed, it is difficult to extrap-
olate findings into a clinical meaning, particularly since the
wear of teeth is multifactorial and physical and chemical pro-
cesses interact [82]. Indeed, it is this multifactorial aetiology
of toothwear which has hampered the development of in vivo
Topical Review
W+X
Abrasive
slurry
(b) (c)
Spring
Material action Abrasive
samples slurry
Stirrer Antagonist disc
(e) (Stainless steel)
methods to study the tribology of dental materials. As a result,
in situ methods were developed by West et al in 1998 [93]. Dur-
ing in situ testing, specimens are mounted in devices worn in
the mouth and finally removed for ex vivo measurements [33].
Therefore, specimens can be exposed to the real oral environ-
ment. In a word, in situ testing provides a partial compromise
between the in vivo and in vitro conditions [6].
For most in situ methods the conditions of any experiment
can be carefully controlled so that the effects noted can be
ascribed to the agent under test [82]. In situ studies can use
sensitive equipment such as profilometer and scanning force
microscopy, to measure the loss of materials surface due to
various factors so that experiments could be conducted over
comparatively short time periods. Initially in situ methods
were used mainly to measure the erosion of dentine and enamel
by soft drinks and were then gradually used to study a variety of
phenomena in the mouth including abrasion of dental materials
by toothpastes [33, 82].
5. Tribological behaviour of natural teeth
As mentioned above, friction occurs during normal oral
functions; therefore, toothwear, a cumulative multifactorial
lifetime process, is irreversible to a large extent [9496]. It has
been shown that the rate of toothwear may be associated with
factors such as age, gender, occlusal conditions, parafunction,
gastrointestinal disturbances, excessive intake of citrus fruits
or beverages with a low pH, environmental factors, salivary
factors and congenital anomalies of dental tissues [97].
5.1. Effect of tooth microstructure
Tooth enamel is one of those unique natural substances which
still cannot be substituted effectively by artificial restorative
10
J. Phys. D: Appl. Phys. 41 (2008) 113001 Topical Review

materials. The most important feature of enamel is its excellent (A)

wear resistance. Mass [98] pointed out that the variation in the
crystallite orientation of prismatic enamels may contribute to
optimal dental function through the property of differential
wear in functionally distinct regions of teeth.
Zheng and Zhou studied the friction and wear behaviour
of enamel and dentine against titanium balls by using a
(a) (b) (c) (d) (e)
reciprocating wear test apparatus with the lubricant of artificial
saliva [99]. Results showed that the enamel zone exhibited 1.0

Coefficient of friction
a lower friction coefficient and better wear resistance in 0.8
comparison with the dentine zone in the same tooth, and the
0.6
hardness and wear depth decreased as the test locations move
through the outer enamel to the inner dentine, as shown in 0.4
figures 8 and 9. The wear of enamel resulted mainly from the e
0.2 d c b a
microfracture process and is characterized by delamination,
whilst dentine wear as a result of ductile chip formation 0.0
1 10 100 1000 10000
and plenty of strong ploughs appeared on the worn surface (B) Number of cycles
(figure 10). In addition, the depth of wear scar varied with
test orientations (figure 11). Therefore, they concluded that Figure 8. Friction behaviour of human tooth parallel to the occlusal
section (versus titanium ball), (A) contact position for different wear
the excellent tribological property of enamel was closely tests; (B) variations of the friction coefficient at different contact
associated with its high hardness and the presence of prisms, positions. (Reprinted with permission from [99]. Copyright 2003,
and the tribological behaviour of natural tooth may interact Elsevier.)
strongly with microstructure orientation.
Some researchers pointed out [100, 101] that due to 400 100
Hardness
different microstructures and mechanical properties, wear rates Depth
of enamel and dentine showed different increasing tendencies 300
Hardness (HV50 )

75

as the load increased. High mineral content and corresponding
hardness result in relatively low wear rates of enamel at lower
loads; however, the brittle nature of enamel contributes to a
high wear rate at higher loads. In contrast, dentine has higher
organic content and relative softness, which makes it less prone
to fracture under oral conditions; as a result, it shows a high
wear rate at lower loads but a low wear rate at higher loads.
It was reported that the differential wear rate between dentine
and enamel occurring in areas of exposed dentine may be a
cofactor in the formation of some Class VI lesions [102].
It was reported that sound enamel under friction by
mastication and biting lost only a 1040 m thick layer per
year [103]. Two stages of the wear of enamel have been
observed by several researchers with different wear apparatus
[100, 104, 105], which is also consistent with the results of
clinical traits [106]. Clinical studies described the primary and
the secondary phases as running-in wear and steady-state wear,
respectively. The initial stage appeared to last for a period
of 2 years before the transition to a slower second stage. In
addition, the wear of enamel was reported to be controlled by
the mechanical removal of materials without obvious changes
in the composition and crystal structure of enamel [105].
Considering that the gradual wear of human teeth with
age is an inevitable and irreversible process, the structure and
property of the tooth surface exposed in the mouth could vary
with ageing. Zheng and Zhou [107] found that there existed
differences in both the evolution of the friction coefficient and
the wear behaviour between teeth at different ages against
the titanium alloy. Although delamination and ploughing
mechanisms were dominant for the wear of human teeth, more
severe wear was observed for primary teeth and permanent
teeth in old age accompanied by remarkable fluctuation in the
Depth (m)
200 50
100 25
0 0
0 1 2 3 4 5 6
Distance (mm)
Figure 9. Variations of wear depth and hardness as a function of the
distance from the enamel to the dentine zone in the occlusal section
(versus titanium ball). (Reprinted with permission from [99].
Copyright 2003, Elsevier.)
friction coefficient. Figure 12 shows the relationship between
the hardnessdepth of wear scar and tooth ages. Permanent
teeth throughout their life exhibited higher hardness and lower
wear depth than primary teeth. Moreover, the hardness and
wear depth of permanent teeth varied with ageing, and the
permanent teeth in old age showed obviously higher wear depth
than the permanent teeth in young and middle ages. It was
suggested that the permanent teeth in young and middle ages
have better wear resistance in comparison with primary teeth
and permanent teeth in old age.
5.2. Chewing effect
Toothwear resulting from mastication has been reported to be
closely associated with occlusal conditions (such as occlusal
surface roughness and load) and the properties of food particles
(such as texture and size) [6, 33].
During the closed phase of mastication, food particles are
trapped between opposing tooth surfaces and then crushed and

11
J. Phys. D: Appl. Phys. 41 (2008) 113001
(a)
(b)
Figure 10. Two types of human tooth wear scars observation
parallel to the occlusal section (versus titanium ball): (a) at the
enamel zone and (b) at the dentine zone. (Reprinted with permission
from [99]. Copyright 2003, Elsevier.)
120
Parallel to the occlusal surface
100 Perpendicular to the occlusal surface
Depth of wear scar/m
80
60
40
20
0 wear increased with the particle size.
Enamel DEJ
Figure 11. A comparison of tooth wear depth between different
contact zones for two different orientations (versus titanium ball).
(Reprinted with permission from [99]. Copyright 2003, Elsevier.)
ground, which can cause abrasion to the occlusal surfaces.
The entrapment of particles is clearly influenced by the nature
of the contacting surfaces. Rough surfaces may trap more
particles than smooth ones. It was indicated that scratches in
the occlusal surfaces resulting from thegosis may act as particle
traps during mastication [71].
The effect of occlusal load on mastication abrasion has
also been investigated. In vitro compression tests, which
were conducted by Mass to examine the microscopic wear
Topical Review
400 40
300 30
Hardness /HV50g
Depth /m
200 20
100 Hardness 10
Depth
0 0
Primary tooth Permanent tooth Permanent tooth Permanent tooth
at young age at middle age at old age
Figure 12. Variations of wear depth and hardness for human teeth at
four ages. (Reprinted with permission from [107]. Copyright 2006,
Elsevier.)
features on the occlusal surfaces as a result of abrasion by food
particles [108], indicated that wear seemed to be independent
of load. The results were quite different from a study conducted
by Zheng et al [109]. Zheng and Zhou used a reciprocating
wear test apparatus to study the friction and wear behaviour of
enamel under different wear conditions, which should simulate
more what actually occurs during chewing [109]. They found
that the wear volume of enamel resulting from abrasion by food
particles increased progressively with normal load, which was
consistent with other studies [99].
At the population level, the abrasive properties of foods
are the prime determinants of the wear rates of teeth and
restorations [110]. It has been implicated that the very
common high toothwear rates of ancient human beings mainly
resulted from the fact that their diet was very coarse and
abrasive because hard particles were often incorporated in
their food. These particles may be intrinsic components
such as bone fragments or collagenous material of fish or
meat, cellulose or phytoliths of plant foods and those which
were inadvertently introduced as contaminants during food
preparation or processing, for example, mineral grit was
introduced during the grinding of cereal grains. In contrast,
reliance on factory-processed foods, so-called delicate foods,
has resulted in very low rates of toothwear in contemporary
populations. In addition, results of in vitro compression tests
[108] showed that larger particles produced fewer, larger wear
features on the surfaces of teeth than smaller ones, and total
Dentin
5.3. Pathological factors
Clinical reports show that pathological factors such as erosion,
bruxism, xerostomia and tetracycline can result in excessive
toothwear, which sometimes needs necessary intervention for
cosmetic or functional purposes. Erosion is probably the most
significant factor because various surveys have shown a high
prevalence of erosion all over the world, which is likely to
increase with the increasing consumption of acidic drinks.
5.3.1. Chemical effects. As stated above, tooth erosion
is defined as an irreversible loss of dental hard tissues
due to a chemical process without the involvement of
12
J. Phys. D: Appl. Phys. 41 (2008) 113001
microorganisms [63], which can be caused by either extrinsic
or intrinsic agents [3, 33, 80]. Extrinsic agents include acidic
substances, beverages, snacks or environmental exposure to
acidic agents. Intrinsic causes of erosion include recurrent
vomiting as part of anorexia or bulimia or the regurgitation of
gastric contents. The pattern and distribution of erosion lesions
differ according to the acid sources [111]. Dietary erosion
affects the labial and palatal surfaces of the upper anterior
teeth, while regurgitation erosion typical affects the palatal
surfaces of the upper anterior teeth as the tongue directs the
vomit forwards during vomiting. Airborne acid affects the
upper and lower anterior teeth.
Erosive substance loss of enamel is a dynamic process
with demineralization and remineralization periods [112]. In
the initial stage, the softening of enamel occurs due to partial
demineralization of the surface. At this very early stage
of the process, when the pH of saliva returns to neutrality,
remineralization is in theory still possible as the remaining
tissue could act as a scaffold [113]. At a more advanced stage
the mineral of the outer enamel is totally lost and repair is
not possible, while the remaining softened enamel beneath
the lost hard tissue is probably remineralizable. A substantial
loss of dental hard tissue must be expected when softening
is followed by friction processes such as mastication and
toothbrushing [33, 89], and there is evidence that the acid-
eroded enamel is more susceptible to abrasion and attrition than
the intact enamel [114]. It was reported that the type of acid,
pH value, acid concentration and temperature are all relevant
to the wear of teeth [89, 115]. Toothwear caused by erosion
observed clinically is the combined effect of demineralization
of the tooth surface by an erosive agent and abrasion of the
demineralized surface by the surrounding oral soft tissues, food
mastication and toothbrushing [90]. Patients with clinically
evident palatal erosion showed a ten-fold greater wear rate
(median 6 m/month) than those without any evidence of
abnormal wear (median 0.6 m/month) [112].
For most people, avoidance of erosive foods will
well prevent toothwear caused by erosion. Studies also
proposed that immediately following an acidic challenge, a
remineralizing agent, such as fluoride mouthrinses, fluoride
tablets, fluoride lozenges or dairy milk, should be administered
to enhance rapid remineralization of the softened tooth surface
as well as to serve as a mouth refresher or as an alternative, a
neutralizing solution should be used [64]. In addition, it has
been increasingly emphasized that modifying the composition
of soft drinks is an important concept in the prevention of
toothwear due to erosion and should be further developed
[115, 116].
5.3.2. Bruxism. Bruxism, a very common parafunction of
the masticatory system, may be defined as rhythmic, habitual
tooth clenching or grinding movements that would occur
either when awake or during sleep [117119]. Examples of
the consequences of bruxism often mentioned in the dental
literature are toothwear, muscular pain, toothache, mobile
teeth, various problems with removal and fixed prostheses, and
so on. The aetiology of bruxism has long been a controversial
13
Topical Review
issue and theories have invoked occlusal, physiological,
genetic and stress factors [120].
In general bruxism can cause abnormal attrition at sites of
occlusal contact (OCA) and then result in excessive toothwear.
It was reported that patients with bruxing habits can apply
occlusal loads of approximately 1000 N [75], while for normal
people, as discussed above, the maximum biting load at
the incisors is 100 N, gradually increasing as one moves
posteriorly to reach around 500 N at the molars. In addition to
these increased loads, bruxists have a total tooth contact time
of 30 min to 3 h in a 24 h period. For a nonbruxist, the tooth
contact time is about 10 min. As a result, wear due to extensive
bruxism could be very severe. The vertical loss of dental hard
tissues in patients with bruxism habits has been reported to be
3 to 4 times higher than that in normal people [119].
5.3.3. Other factors. Clinical reports have shown that a
large number of people suffer from impaired salivary functions
[121, 122], displaying symptoms such as dry mouth (also
called xerostomia). Xerostomia is a condition characterized
by a reduction or loss in salivary flow, often with a concurrent
change in the composition of the saliva, resulting in dryness of
the oral cavity and then difficulties in speaking, masticating,
swallowing, etc [121]. As mentioned above, saliva plays an
extremely significant role in decreasing the friction and wear
of teeth to prevent those lesions; therefore, if not treated,
people could suffer excessive toothwear from xerostomia. The
most common option for xerostomia treatment is the use of an
artificial saliva or saliva substitute (oral lubricants).
Recently authors investigated the tribological behaviour
of human teeth at different tetracycline stained extents against
titanium alloy by using a reciprocating sliding wear test
machine. The results showed that the friction and wear
behaviour of lightly tetracycline stained teeth were similar to
those of normal teeth, and the worn surface is characterized by
scratch and slight plough. However, for heavily tetracycline
stained teeth, significant plough and delamination were
dominant accompanied with strong discontinuities in the
evolution of the coefficient of friction and the rather high
stable friction coefficient, and their tribological property was
obviously inferior to normal teeth. It was suggested that
the wear resistance of human teeth decreases with increasing
tetracycline stained extent due to the variation of the tooth
microstructure (figure 13).
Gil et al [123] reported that the accumulation of lead in
teeth was associated with dental health factors, such as dental
plaque, salivalis lactobacilli number, dental colour, dental
abrasion and toothbrushing frequency. Coloured teeth and
teeth subject to abrasion showed the highest lead content. Teeth
obtained from irregular brushers presented higher tooth lead
content than subjects with regular toothbrushing frequency.
In addition, a clinical survey conducted by Judith et al
showed that to a lesser extent, difficulty in relaxation, pain and
distress and avoidance of going out are associated with tooth
loss and/or denture wearing [124].
J. Phys. D: Appl. Phys. 41 (2008) 113001
(a)
(b)
Figure 13. Microstructure observation of the occlusal surface:
(a) normal human teeth and (b) heavily tetracycline stained teeth.
5.4. Effect of tooth flexure
During mastication or bruxism, occlusal loading can cause
tooth flexure [15, 75, 80] and generally result in shear stress in
the cervical region of a tooth where the enamel has been found
to be less resilient. Once the shear stresses resulting from
tooth flexure exceed the failure stresses of enamel, cracking
and subsequent enamel loss can occur in the cervical region
(around the cementoenamel junction), which is clinically
called noncarious cervical lesions (NCCL) by abfraction.
Fracture of the cervical enamel by abfraction is most likely
to occur along the boundaries of the hydroxyapatite crystals.
Levitch et al reported that the number, size and depth
of cervical lesions increased with age [75]. Cervical lesions
by abfraction were seen more commonly on maxillary (upper
jaw) incisors in clinics, possibly because these small teeth
were less able to withstand the applied occlusal load. A
finite element study conducted by Rees et al suggested that
stresses in maxillary incisors were several times larger than
those in canines and molars [125], which explained these
clinical observations. Clinical studies have also shown that
abfraction lesions are common in people with parafunctional
habits, especially bruxists [75], as mentioned above, who apply
large eccentric occlusal loads.
5.5. Effect of toothbrushing
Teeth are usually cleaned using a filament-based toothbrush
and a toothpaste. Toothbrush and toothpaste can be traced
back 1000 years [77], and toothbrushing with toothpaste is
14
Topical Review
arguably the most common oral hygiene habit in developed
countries. The oral dental health benefits of toothbrushing
with toothpaste are recognized and reviewed in a large number
of publications: plaque removal, the control of extrinsic stain
and the delivery of preventive and therapeutic agents for dental
and gingival diseases or conditions [82].
The chemical composition of a typical toothpaste is as fol-
lows [126]: abrasive particles, peroxides, enzyme systems and
absorbents, saccharin and peppermint flavouring and water.
Toothpaste abrasive particles are made from materials such
as calcium carbonate, sodium bicarbonate, precipitated silica,
pumice and perlite, which are used to obtain optimum stain
removal during toothbrushing. Peroxides can either dissolve
or bleach the particle stain. Enzyme systems and absorbents
are used to soften the pellicle easing the removal process. In
addition, generally fluorides are added to toothpastes to prevent
caries and tooth erosion. Due to different geometries, nature
and contents of abrasive particles, toothpastes can manifest dif-
ferent abrasivities [126, 127], which is normally described by
the relative dentine abrasivity value (RDA value). Although
optimum stain removal is desired from a toothpaste abrasive
it is important that during the cleaning process the enamel or
dentine or soft gum tissue is not damaged.
Various studies have been carried out to study the effects
of the type of toothbrush and the composition, especially
the abrasivity of the toothpaste on toothwear caused by
toothbrushing. Traditionally studies on toothbrushing were
conducted in vitro by using various wear simulators, whilst
more recently, in situ methods have been frequently used [82].
Although toothbrushes alone or combined with toothpaste have
been proposed to both cause tooth wear, abrasion of gingival
tissues and gingival recession, and be involved in the aetiology
of dentine hypersensitivity [77], toothbrushing alone appears
to have no obvious effect on the wear of enamel and very
little on dentine [33]. Most, but not all, toothpastes have low
relative enamel abrasivity values and are implicated to have a
minimal effect on enamel and in normal use would not cause
significant wear of dentine in a lifetime of use [77]. However, it
should be noted that dentine is considerably more susceptible
than enamel to abrasion caused by toothpaste abrasive, and
dentine loss appears to correlate with toothpaste abrasivity
[127]. Overuse or abuse of toothbrushing with toothpaste
would only be relevant to dentine and not enamel wear unless
high relative enamel abrasivity toothpastes were in use and as
stated these are unusual [77]. Therefore, toothpaste with lower
abrasivity might be advisable for daily oral hygiene practice
of patients with excessive toothwear.
Wear of enamel and dentine can be dramatically increased
if toothbrushing follows an erosive challenge [77], which
may result in noncarious cervical lesions [128]. Attin et al
suggested that for protection of dentine surfaces at least
30 min should elapse before toothbrushing after an erosive
attack [129]. It is interesting to note that a recent study
carried out by Hooper et al showed that toothbrushing with
fluoride toothpaste containing sodium hexametaphosphate
before meals could provide significant erosive protection in
susceptible individuals [67].
J. Phys. D: Appl. Phys. 41 (2008) 113001
6. Tribological behaviour of artificial dental
materials
In dentistry, as discussed above, metals and alloys, ceramics
and composites are generally applied to restorations and
implants. Considering the inter-oral complex environment and
biomechanics, wear processes of artificial dental materials are
very complicated, which normally include abrasion, attrition,
corrosion, fretting wear and fatigue [3, 5]. These processes
occur in various combinations to cause surface loss of materials
in the mouth. Excessive wear may lead to premature failure
and replacement of dental restorations and implants.
Wear resistance of artificial dental materials is clinically
important for clinical longevity, aesthetics and resistance
to dental plaque [3, 5, 80]; therefore, a large number of
studies have been carried out on their tribological properties.
Commonly their research interests are as follows [6]: (1)
the wear resistance of artificial dental materials and (2) the
predisposition of restorative materials to create wear on the
opposing structures, especially the opposing enamel.
6.1. Metals and alloys
Corrosion has been considered the most important factor in
the selection of metallic materials in dentistry because poor
biocompatibility and cytotoxicity of their corrosion or wear
products may make the materials worse for either restoration
or implantation purposes in the mouth [34, 130]. It has been
reported that the presence of a metal restoration is the most
commonly cited reason for an adverse reaction [130]. There is
a vast amount of literature concerning the corrosion of dental
alloys, and from the proffered information it emerges that
leaching of metallic ions and food habits are the main causes
of corrosion of metallic restorations and implants [34]. The
purity, casting and melting techniques also affect the corrosion
behaviour of metal alloys. In general the nature of metal
alloys plays a major role in the initiation and propagation
of corrosion. Recently Liu et al reported that the wear
and corrosion resistance of nickel-based and chromium-based
dental alloys could be improved with the presence of titanium
aluminum nitride films [131].
Generally, most metals are strong enough to withstand
maximum possible oral forces. However, with the life quality
increasing significantly, the appearance of dental materials
may be the most important factor to be considered for many
patients. As a result, nowadays, metals and alloys have
increasingly been applied to orthodontic appliances and dental
implants.
Friction in fixed orthodontic appliance systems is
recognized by most clinicians to be very harmful to tooth
movement [132, 133]. Various factors affect the friction
resistance process of orthodontic metallic bracketwire
combinations, such as archwire and bracket materials, their
size and shape, width and slot dimensions and the surface
composition, roughness and cleanliness. Other important
parameters are the bracket-to-wire positioning in a three-
dimensional space, the ligature force and type of ligation,
the interbracket distances and lubrication. Fretting tests of
15
Topical Review
stainless bracketwire combinations during sliding processes,
carried out by Willems et al [132], indicated the significant
role of the centred positioning method on the friction value. In
addition, the slot-filling, bracketwire combination resulted
in an increased coefficient of friction and therefore is not
recommended for sliding systems. It is also notable that pain
and discomfort of the oral mucosa can often be experienced
as a result of trauma from the metallic appliance caused by
increased friction between mucosa tissue and the surface of
the brackets [134], on which few research works have however
been conducted.
Fretting wear has been frequently mentioned by clinicians
as a possible failure cause of dental implants [86, 87]. Yu
et al investigated tangential fretting behaviour of pure titanium
(TA2) and its alloy (TC4) against the human thighbone cortical
bone [87]. Results showed that friction logs transformed from
a partial slip directly to a gross slip without a mixed regime,
and the friction coefficients in each fretting regime went up
with the displacement. The wear depths on the Ti ball were
only to the extent of several to tens of micrometres, which
were much less than those of the bone. In addition, the friction
coefficient of the boneTC4 pair was higher than that of the
boneTA2 pair, and the maximum wear depth on the bone
against TA2 was about 40% the value of that on the bone against
TC4. Therefore the wear adaptability of boneTA2 pairs was
better than that of boneTC4 pairs. Abrasive wear features
and various microfractures were observed on the worn cortical
bone surfaces. It was suggested that some surface modification
techniques of titanium be adopted to reduce the fretting damage
to bone.
It should also be noted that commercially pure (CP)
titanium and its alloys have been increasingly applied to dental
restorations, especially implants, in place of other metals
due to their excellent biocompatibility, corrosion resistance
and light weight [135139]. One of the disadvantages of
titanium for structural applications is its poor tribological
characteristics [135]. Clinical trials [136] showed that cast CP-
Ti dental restorations underwent the greatest amount of wear in
comparison with conventional dental alloys. Alloying may be a
possible method to improve the wear resistance of CP-Ti [137
139]. Ohkubo et al [137] indicated that among the different
types of titanium alloys, + alloys exhibited the best wear
resistance due to increased resistance to plastic deformation
resulting from the existence of needles in the retained
matrix, which was consistent with that given by Khan et al
[136]. It was also found that alloying with copper [138], which
introduced the Ti/Ti2 Cu eutectoid, seemed to improve the
wear resistance of titanium alloys. Iijima et al reported that
Ti6Al7Nb alloys can be used for dental restorations because
they exhibited lower wear loss and a much smoother worn
surface than CP-Ti [139].
6.2. Ceramics
The advantages of ceramics in dentistry are their natural
appearance and their durable chemical and optical properties.
Normally ceramics possess relatively high resistance against
wear. However, clinical trials show that there may exist
J. Phys. D: Appl. Phys. 41 (2008) 113001
two major problems encountered in their dental use [46]:
(1) most ceramic restorations may be abrasive and potentially
destructive to the opposing natural teeth or restorations and
(2) brittle fracture plays a major role in the wear of some
ceramics during the friction process in the mouth, which
could cause disastrous results clinically. Therefore, the use of
less abrasive ceramics would offer excellent aesthetics whilst
minimizing the wear of opposing natural teeth and would be a
valuable addition to the dentists selection of materials [6].
Many researchers have focused on investigating the
abrasive potential of various dental ceramics to opposing
dentition, especially opposing enamel. Literature survey
shows that the wear of enamel and ceramic appears
to be closely related to the ceramic microstructure,
surface characteristics (such as smoothness or glaze) and
environmental influences [4, 140, 141].
Internal porosity and other surface defects, which are
produced by an inadequate firing technique, act as stress
concentrators and result in greater wear [4]. Glazing and/or
polishing can lower wear at the early stage of contact, but the
positive effect of a glazed/polished ceramic surface is quickly
lost when the material is placed in function. The internal
characterization of ceramics is recommended because shading
materials contain abrasive metal oxides. The application of
external stains should be limited to the noncontacting surfaces
of aesthetic restorations. Moreover, etching the inner side
of the porcelain veneer, which is often needed clinically,
can cause microcracks which may slightly weaken the wear
resistance of the porcelain.
An acidic and/or alkalic chemical attack caused by dietary
habits and intrinsic diseases may result in the degradation of
ceramic surfaces in the mouth [4]. Load has a significant
effect on the friction coefficient and wear loss of dental
porcelains [141]. Thus, if a degraded ceramic surface is
further subjected to dysfunctional occlusion or parafunctional
habits such as bruxism, the wear process may be accelerated.
More recently, Akihiko et al reported that porcelain showed
significantly less wear loss and was less abrasive to opposing
enamel or composite resins in three-body conditions compared
with two-body conditions, regardless of its surface conditions
[140]. In addition, abrasion of toothbrushing is a possible
cause of the wear of dental porcelains. Anil et al reported that
significant material loss and decrease in roughness occurred
in the surface of porcelains as a result of the equivalent of
8.5 years of toothbrushing [142].
In order to minimize the damage by brittle fracture,
many efforts have been made to develop high-toughness
dental ceramics in the past decades. Recently, yttria-
stabilized tetragonal zirconia polycrystal (Y-TZP), a high-
toughness zirconia ceramic, has been developed as an
alternative to porcelains or glass-ceramics in posterior
restorations [143, 144].
6.3. Composites
The main problem involved in the dental application of
composites is their inadequate resistance against wear when
used as posterior composite restorations, resulting in a loss
16
Topical Review
of anatomic form under masticatory abrasion and attrition.
Many efforts have been made continuously to optimize the
composites in order to have better wear resistance since they
were widely used in dentistry. Nowadays, many dental
composites do not show excessive wear anymore, and wear is
more likely to occur at occlusal contact areas than on contact-
free areas [19, 145].
Wear mechanisms of dental composites were associated
with wear conditions [6]. Abrasion and chemical degradation
appeared to be dominant in the contact-free areas clinically,
while fatigue and adhesive wear were generally associated
with occlusal contact wear [3]. Nagarajan et al [50, 146]
investigated the two-body wear of three medium filled
composites and one highly filled one. Wear was found to
occur by simultaneous processes consisting of tribochemical
reactions between filler particles and water, dissolution of
hydrated products, formation of surface films containing
a mixture of filler fragments and reaction products and
mechanical detachment of the surface films.
Generally, the wear process of composites is associated
with both material and oral factors [145]. Material factors
normally relate to the characteristics, content and distribution
of filler, the degree of conversion, the nature of the matrix and
the interfacial bond strength between filler and matrix.
Filler characteristics, such as size, shape, hardness and
brittleness, play an important role in the wear process of
dental composites. The wear resistance of composites is better
with higher filler loading but smaller particle size [145, 147].
Hard filler particles could protect the soft matrix and enhance
the materials overall resistance to abrasion [145]; however,
the hardness of filler particles must not be higher than that
of hydroxyapatite crystals of human enamel. An ultra-
fine filler size will reduce the impact of the filler hardness.
Compared with composites containing large filler particles
(>1 m) [2,36,145,148], microfilled and small-particle hybrid
composites were frequently mentioned to have a tendency to
display better abrasion resistance because of their smoother
surface, decreased inter-particle spacing and decreased friction
to food particles. In contrast to sharp and pointed particles,
the presence of spherical and irregular particles could benefit
both the composite wear and the opposing enamel wear [149].
An additional aspect to be considered is filler brittleness
[145]. Under high stress, brittle filler particles will easily
fracture and cause rapid abrasion of the material itself, but
a less antagonistic engagement. It is well accepted that a
smooth surface provides reduced frictional wear at the occlusal
contact area, which will lessen the wear of both composite and
antagonistic enamels. Whenever filler particles protrude and
are big and extremely hard, there can be high antagonistic wear
rates that could cause catastrophic loss of the tooth substance
in time [145, 150].
Obviously, the ability of a resin composite to
resist abrasive action depends on fillermatrix interactions.
Therefore, the filler content and distribution and inter-particle
spacing significantly influence the physical properties and
then the wear resistance of dental composites [145]. As the
filler volume increased, wear was reduced regardless of the
filler treatment [145, 151]. Wear resistance of microfilled
J. Phys. D: Appl. Phys. 41 (2008) 113001
Table 7. Dental materials and their tribological problems in clinics.
Materials Main tribological problems
Metals and their alloys Wearcorrosion, friction in fixed orthodontic
appliance systems, fretting wear
Ceramics Abrasive potential to the opposing enamel, brittle fracture
Composites Excessive wear in posterior composite restorations
composites was remarkably enhanced by the filler volume with
an increase from 25 to 30 vol%. Filler particles situated very
close can protect the softer resin matrix from abrasives, thus
reducing wear. It was reported that the use of finer particles
for a fixed-volume-fraction of filler resulted in decreased inter-
particle spacing and reduced wear [145]. Moreover, even at a
low microfiller level, well-distributed fillers can achieve good
wear resistance for small-particle hybrid composites.
Clearly a weak, incoherent matrix can invoke phenomena
such as plucking out of filler particles and excessive wear of
the matrix and thus reduce the abrasive capacity of composites.
As a result, wear can be reduced significantly as the degree
of cure, strength and toughness of the resin matrix increases.
In general the degree of cure, strength and toughness of the
matrix is associated with its composition and cure conditions.
High-intensity curing units and postcuring can result in a high
degree of conversion and then enhance the fracture toughness
and strength [152, 153].
Another key factor in the wear of composites is a good
interfacial bond between the filler and the matrix. Good
filler/matrix adhesion was indicated to enhance stress-transfer
ability, protect the matrix and interfere with crack propagation
at higher filler levels and accordingly reduce wear [145, 154].
Silane coupling agents are thought to play a major role in
enhancing the adhesion of the interface between the inorganic
filler and the organic resin. It is important that the microfillers
need to be kept well dispersed to achieve the full effect of
protection. In addition, contamination of the filler might
disturb silanization and reduce fillermatrix coupling. Another
advantage of the use of a coupling agent in dental composites
is that it, at least to some extent, protects the filler against
hydrolytic degradation.
Oral factors, in particular oral chemical environment, have
a significant effect on the wear process and in vivo degradation
of composite restorations. The resin matrix can be softened
and fillers can be leached out when composites are exposed
to certain chemicals/food simulating liquids [52, 145], thus
reducing the resistance against wear to a considerable extent.
A high degree of cure of the composite matrix could decrease
its degradation in long-term exposure to water. It should
be noted that there is a rising failure rate of posterior resin
composite restorations due to interproximal wear [145, 154].
Furthermore, wear of crowns and bridges made of composites
is generally greater than that of fillings if they are analysed
after longer periods of service [19].
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Topical Review
Influencing factors
The nature of metal, alloying, oral factors
Ceramic microstructure and surface characteristics,
oral factors
Characteristics, content and distribution of filler,
the degree of conversion and the nature
of matrix, the interfacial bond strength between
filler and matrix, oral factors
In summary, normally different dental materials encounter
different tribological problems in their clinical uses, as shown
in table 7. It can be seen that both material property and
oral factors can significantly influence the friction and wear
process of restorations in the mouth. An additional aspect
to be considered is the clinical operation technique. Wear
resistance of restorative materials tends to increase as the
cavity size decreases. The restorations placed should be
as small as possible in order to benefit from the strong
support of, and full protection by, the surrounding natural
tooth structure [4, 140, 145]. Ideally, the wear of a dental
material should be similar to that of human enamel because
enamel has extremely excellent wear resistance despite fairly
bad working conditions in the mouth, such as widely ranging
load, reciprocating movements, temperature shocks or possible
acid attacks. To date, however, this property may only be
found in ceramic materials and particular metal alloys [19].
The wear of amalgam is higher than that of enamel but
lower than that of composite resins. Although significant
improvements have been achieved, many resin composites still
exhibit considerable in vivo wear in the long run [6, 155].
7. Concluding remarks
In dentistry, the tribological behaviour, in particular the wear of
teeth and restorative materials, is a particular clinical problem.
Wear is an important consequence of occlusal interaction.
However, if not controlled, wear could lead to poor masticatory
function and various treatment problems with a concomitant
reduction in the quality of life and possible deterioration of
systematic health. As a result, tribology of dental materials,
which concerns the understanding of the mechanisms and
controlling factors in dental wear, is critically important. As
discussed above, inter-oral friction and wear of dental materials
are extremely complex; therefore, there appear some problems
in current research, some of which should be focused on in
future work.
The literature survey shows that for the wear of human
teeth more clinical observations have been reported than in
vitro studies. In other words, many studies have focused on
the aetiology of toothwear but the wear mechanism is far less
understood. Take tooth erosion for instance. Toothwear by
erosion is paid increasing attention and accordingly a great
number of papers on the chemical effect has become available
recently (table 1). However, most studies focused on the
J. Phys. D: Appl. Phys. 41 (2008) 113001
aetiology and prevention of dental erosion, while almost no
studies have been carried out on its mechanism in detail.
It is also found that few research works have focused on
the effect of bioactivity and biomechanics of human teeth
on their tribological behaviour. Nevertheless, the lack of
these aspects may be one of the main obstacles hindering the
development of dental materials because, as discussed above,
the tribological properties of ideal restorations and implants
should not only be similar to human teeth but also exhibit
individual differences such as age and sex. For artificial dental
materials the same situation is encountered. Most studies
have focused on providing comparative ranking of various
dental materials using wear test machines simulating the oral
conditions [146], whilst only a few in vitro studies have been
carried out on their wear mechanisms. Future in vitro wear
testing should be aimed at an understanding of the fundamental
underlying wear mechanisms involved, which will lead to a
better understanding of in vivo failure patterns.
Little is known about the systemic effects of artificial
material components, such as the clearance of the worn
material, adverse effects, chemical reactions or a possible
incorporation of worn material into body cells or tissues [19].
With composites there is a certain amount of concern that,
besides the leaching of monomer components, micro- and
nanosized inorganic filler particles of composite resins that
are worn, swallowed or inhaled and accumulated into tissues
could be linked to diseases of the liver, kidney and intestine.
It is also found that the role of interproximal wear in the
loss of dental tissues and restorative materials has attracted less
attention. Moreover, less attention has been paid to fretting
wear of dental implants which can cause the loosening of
metallic implants and subsequently result in these failures.
In addition, few studies have focused on the effect of tooth
location on its tribological behaviour.
It is worth noting that much emphasis has been placed
on the wear of dental materials, but efforts to explain and
understand their friction behaviour in the mouth remain much
fewer [3, 6]. This indicates that in the past the importance
of friction as a factor in the wear of brittle dental materials
may not have been fully appreciated. Friction forces play
a major role in the oral wear process of dental materials.
Stolarski [3] noted that when friction is present the critical
load can fall to 10% of the friction-free value. Future in
vitro studies should pay attention not only to measure the
friction force but also to explore the friction process and factors
in detail. Recently some researchers have pointed out that
considering how the energy from friction is dissipated at the
material surface would provide a greater insight into the wear
mechanism of dental materials [155157]. In addition, the
composition and viscosity of the lubricant should be carefully
considered in in vitro testing because solvent penetration to
a depth of just a few micrometres is sufficient to alter friction
which will therefore affect the wear [3]. Clearly works devoted
to this field will promote tribology of dental materials.
As mentioned above, in vivo studies have some advantages
in observing clinical manifestation and predicting risk factors
for oral tribological behaviour, rather than investigating their
mechanisms. In contrast, the marked advantage of in vitro
18
Topical Review
testing is to analyse the fundamental mechanisms, which may
lead to a better understanding of in vivo failure patterns. Many
in vitro methods have been developed since the 1990s, on
which Roulet commented that there were almost as many
wear testing devices as there were scientists who are interested
in wear [158]. So the question has arisen whether these
devices and methods fulfil the standards for qualification and
validation that are already in place in other fields of medical
product testing [19]. Some researchers have observed that,
firstly, comparison of the results obtained by different devices
was difficult; secondly, the experimental results were best
characterized as inconclusive; thirdly, some laboratory studies
lack correlation with clinical trials [3, 19, 33]. An important
point to be kept in mind with future in vitro testing is that
wear test machines need to simulate the oral condition and
biomechanics as closely as possible, otherwise, the lack of
correlation between the results of in vitro and in vivo studies
will be inevitable. And an efficient and universally accepted
in vitro tribological test would undoubtedly promote and assist
tribology of dental materials.
There exists a state of confusion in assessing the wear
of dental materials. Three parameters, wear volume, wear
depth and wear area, have been used by various researchers,
respectively. Generally there are significant differences
between the wear assessments of the same sample measured
by different parameters [69, 155]. Volume was reported to be
the preferred parameter because wear is defined as the volume
of the material removed [69]. The disadvantages of the other
two parameters are that they represent indirect wear measures,
depend on occlusal factors and vary with time. Moreover,
depth is not a good parameter for comparing wear because its
magnitude depends on where the depth is measured and the
direction from which it is measured. In addition, evaluating
the wear of dental materials requires that both the material
of interest and the opposing material be considered because
materials may be worn by the antagonist or they may cause
aggressive wear of the antagonist [69]. Clinically, it is the
combined wear or total wear that is important; especially if the
opposing material is enamel.
In addition, modelling dental tribology is proposed to be
started [33]. Almost no attempt has been made at modelling
any dental tribological behaviour. This is probably because
of the complexity of the oral environment and biomechanical
functions. However, sometimes simple models, while they
may not give a completely accurate representation, can be
useful in comparing and contrasting the situations of oral
lubrication, friction and wear.
Due to the fact that tribology of dental materials is involved
in many subjects such as dentistry, materials and engineering,
there is still a poor understanding of tribology behaviour of
dental materials. Even through a lot of progress has been
made, much remains to be done. It is evident that collaboration
among clinical dentists, materials researchers and tribologists
will help to advance this research area of strong current interest.
Acknowledgment
This work was supported by the National Natural Science
Foundation of China (No 50535050).
J. Phys. D: Appl. Phys. 41 (2008) 113001
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