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

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

Table 3. Mechanical properties of enamel and dentine. Central


(or Incisors)
Property Dentine Enamel Lateral

1st Molar
Youngs modulus (GPa) 10.215.6 20.084.2
2nd Molar
Shear modulus (GPa) 6.49.7 29
Bulk modulus (GPa) 3.114.38 45.65 1st Bicuspid
Poissons ratio 0.110.07 0.230.30
Compressive strength (GPa) 0.2490.315 0.0950.386 Cuspuid
Tensile strength (GPa) 0.0400.276 0.0300.035 (or Canine)
2nd Bicuspid
Shear strength (GPa) 0.0120.138 0.06
Knoop hardness 5771 250500 Figure 2. Human tooth orientation. (Reprinted with permission
Density (kg m3 ) 2900 2500 from [33]. Copyright 2005, Professional Engineering Publishing.)

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

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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 in 1774 [4547], and many efforts were made therefore to
demands and it requires a more complex cavity preparation improve their aesthetics over the next 190 years. In the early
to compensate for its lack of adhesion to tooth tissues [42]. 1960s [45], dental ceramics were first formulated for routine
Therefore, amalgam has been gradually replaced by resin- fusion onto metal substructures, significantly broadening the
based composites which have excellent aesthetic appearance use of ceramics and then increasing the demand for dental
and can be bonded to the tooth structure easily. ceramic materials. Subsequently, with the employment of
Given these drawbacks, together with the material and dispersion strengthening, aluminous porcelain, a ceramic
labour costs associated with metal substrate fabrication, material suitable for all-ceramic substructures, was created and
metals and their alloys have increasingly been limited to used [44, 45]. A wide variety of dental ceramics is currently
orthodontic appliances and dental implants. However, the available [35].
dental literature indicates that among direct and indirect Aesthetics is an obvious attribute of ceramics and, along
restorations, gold-based casting alloys are considered the most with biocompatibility, durability and etchability (ability to
ideal dental material especially for posterior teeth because be bonded), is the primary reason why dentists often choose
they are wear resistant and cause minimal wear of opposing ceramics over other materials. However, two major problems
enamel [34, 43, 44]. arise in their dental usage: (1) the potential for catastrophic
brittle fracture and (2) the potential to abrade the opposing
2.2.2. Ceramics. Ceramics are used as an alternative to natural teeth or restorations [47]. Many studies have shown
gold-based casting alloys because of their greater aesthetic that enamel wear against dental ceramics is substantially
potential. Ceramics were first used successfully in dentistry greater than against gold [43, 44, 48, 49]. In addition, dental

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

ceramics with high strength and toughness are not generally of in vitro wear tests, carried out by the authors [59], have
aesthetic [35]. shown that artificial saliva, a simulation of real saliva, can
have both cooling and lubricant effects during the toothwear
2.2.3. Composites. Resin-based composite materials are process, and the risk of tooth texture burn may be significantly
widely used in restorative dentistry nowadays (table 4). reduced under the artificial saliva condition compared with
Being introduced in the mid-1960s [40], the first composite the dry condition. The lubricating mechanism of saliva is
restoratives were mainly unfilled resins (called polymers) presumably based on a full separation of the sliding surfaces by
and their use was confined to dental adhesives and direct salivary films [58], which can be maintained within the clinical
restorative materials in anterior teeth due to insufficient occlusal forces in the mouth. In addition, the presence of the
material properties [5, 34, 37]. In order to improve strength, lubricant influences how much kinetic energy is absorbed by
hardness and wear resistance and to reduce polymerization the shearing of the inter-molecular bonds in salivary films and
shrinkage, tooth coloured resin matrix composites containing how much is transferred to the teeth [60].
filler particles were developed and then used for restoring In general saliva is pH 7 (neutral); however, corrosive
posterior stress-bearing cavities as a viable alternative to agents such as acids can be introduced into the mouth [33].
amalgam approximately 30 years ago [34, 5052]. Composite The mouth of a person with a particularly acidic diet could be
resin denture teeth were developed in the 1980s [51]. Due to at pH 3, and regurgitated gastric acid is pH 1.2. Acidic drinks
the major influence of the fillers on their physical properties contain a range of different acids, which can range from pH 1
[53, 54], the classification of dental filling composites is to pH 6. Increased acidity in the mouth has been clearly shown
based on the type of filler used and the particle size thereof to initially decrease both the hardness and the elastic modulus
[36]. In general two types of composites are in the market, of enamel [61, 62] and then result in pathological wear of
i.e. microfill and hybrid composite filler materials. Polyacid- teeth [63,64]. Therefore, the role of saliva in the mouth is also
modified composite resins, known trivially as composers, were thought to involve both the protection of the enamel surface
also introduced to the dental profession in the early 1990s against acid attack because it is a buffer to acids produced
and were used for restoring teeth damaged by dental caries in plaque and the provision of a matrix for remineralization
[39]. With biocompatible fibres and matrix systems, fibrous [65, 66] because it supplies calcium and phosphate ions to
composites found application as biomaterials, and a number of remineralize enamel. There has been a worldwide monumental
fibrous composite materials for dental applications have been increase in the consumption of soft drinks, fruit juices and
developed [38]. sport drinks, and signs suggest a similar increase in the future,
The use of resin-based composites in restorative dentistry rather than slowing down [67]. This implies that exposure
has increased significantly in recent years. These materials of teeth to an acid environment is increasing. The presence
feature the advantage of good aesthetics for dental restorations of even a minute film of salivary pellicle (thickness of 100
and are able to bond to tooth structures easily by the acid-etch 500 nm) can protect the exposed materials surface from the
technique. However, excessive wear of composite restorations acid, thereby preventing its removal during the next friction
is still a major problem encountered in their use in stress- phase. So, the protective properties of saliva are extremely
bearing applications although significant improvements have significant for minimizing the corrosive effects of acids on
been made [42,55,56]. Higher wear rates than either metals or teeth and restorations.
ceramics have limited clinical longevity of dental composites.
3.2. Biomechanics
3. Tribology related to human teeth Mastication is the most important function of teeth. It has been
widely accepted that wear of dental materials in the mouth
3.1. Oral environment
results mainly from chewing cycles. Therefore, it is important
The oral environment plays an extremely important role in to understand the biomechanics of mastication.
the tribological behaviour of both human teeth and artificial Mastication is the action of chewing food, which is a
teeth. Saliva is the most important component of the chemistry complex and compound process [68]. Mastication involves
of the human mouth. All solid substrata as well as mucosa two stages: open phase and closed phase [3]. During the first
membranes exposed to the oral environment are covered by a stage the teeth are brought by the jaw from the open position to
layer of absorbed salivary proteins, the acquired pellicle [57], a position of contacting the food bolus. Normally, no occlusal
whose formation starts within seconds on any solid surface forces are involved in this phase (sticky foods represent an
exposed to the oral environment. The physiological role of exception), and the abrasive particles are suspended and free
saliva in the oral cavity is manifold. to move in the food slurry. The second stage starts when
An important function of saliva is to form a boundary the teeth first contact the food bolus and continues until the
lubrication system and serve as a lubricant between hard jaw begins to open. During this phase occlusal loads are
(enamel) and soft (mucosal) tissues [58] to help decrease applied and distributed through the food bolus so that the food
the wear of teeth and reduce the friction of oral mucosa and particles are trapped between the opposing surfaces of the teeth
tongue surfaces to prevent lesions and make swallowing easier, (especially upper and lower molars) and dragged across them.
which is of crucial importance to maintain functions such as Therefore, the food bolus is compressed and crushed, and then
mastication, deglutition and the faculty of speech. Results grinding occurs either with toothfoodtooth (or indirect) or

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J. Phys. D: Appl. Phys. 41 (2008) 113001 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.
Figure 3. Schematic drawing of inter-oral movements of teeth. It is worth noting that during mastication, thegosis
(a) Open phase mastication, (b) closed phase mastication,
and bruxism there exists relative motion between the
(c) thegosis/bruxism and (d) toothbrushing. (Reprinted with
permission from [33], copyright 2005, Elsevier, and from [68], proximal teeth, which can cause friction at proximal contacts
copyright 2007, Elsevier.) 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
Figure 4. Relation between sine curve and masticatory loading direct contact between teeth and from any abrasive particles
patterns. (Reprinted with permission from [71]. Copyright 1999,
Elsevier.) or devices sandwiched between them during mastication,
thegosis, bruxism, toothbrushing and other functions. Tooth
direct toothtooth (complete penetration of the food bolus, if surface loss caused by wear is a common clinical problem, with
present) contacting of the opposing teeth surfaces [69]. A various epidemiologic studies suggesting prevalence estimates
simplified drawing of the chewing cycle is displayed in figure 3. of up to 97%, with around 7% of the population showing
The literature shows that the shape of the occlusal force pathological wear requiring treatment [78].
curve is similar to the positive half of a sine curve but The main categories of wear that contribute to
asymmetric mainly because of the irregularity of some foods the destruction of natural teeth and artificial materials
[70, 71], as shown in figure 4. During normal chewing the are classified as follows [2]: physiological wear (vital
load applied to the teeth is in the range 1020 N at initial life functions), pathological wear (disease and abnormal
contact [17, 72], and is heightened within the range 50150 N conditions), prophylactic wear (preventive conditions) and
at the end of the chewing cycle [73, 74]. The magnitude of the finishing procedure wear. An overview is provided in table 6.
force depends mainly upon the physical properties of food. As Physiological wear, inevitable due to the mastication
there is a great variety of foods, various forces can be expected. function [35, 79], is surface degradation that results in
In addition, the maximum biting forces vary according to sex, progressive but very slow loss of the convexity of tooth cusps,
age and muscle build. Typically, the maximum biting load which manifests as a flattening of both cusp tips on the posterior
at the incisors is 100 N, gradually increasing as one moves teeth and incisal edges on the anterior teeth for mammalians.
posteriorly to reach around 500 N at the molars. Compared with physiological wear, some pathological
General chewing parameters [33, 68, 75] are listed in factors can cause excessive wear of teeth and restorations [2,3].
table 5. The total duration of a chewing cycle has been Clinical reports show that wear usually becomes significantly
shown to be about 0.70 s, whilst the mean duration of the severe due to erosion, bruxism, xerostomia, and so on.
occlusion is about 0.10 s [68], and these periods add up to Pathological wear also can be caused by detrimental oral habits
1530 min of actual contact loading each day [33]. The speed [3, 80], which generally include chewing tobacco, biting on
of teeth sliding ranges from 0.25 to 0.50 mm s1 . Tooth-on- hard objects such as pens, pencils or pipe stems, opening hair
tooth sliding distances are around 0.91.2 mm [33]. These pins with teeth and biting fingernails. In addition, occupational

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


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

and measurement, in vitro laboratory simulation and in situ With replica models there are a number of measurement
testing. In vivo observation and measurement is generally used systems, the majority of which compare the replicas of
by clinicians to observe and evaluate clinical manifestations restorations with standard reference models or calibrated
of the wear of teeth and restorations in the mouth, whilst reference steps [3]. Advantages of this method are that it is
in vitro laboratory simulation is usually used by materials fast and inexpensive [69]; however, the major disadvantages
and tribology researchers to explore wear mechanisms of are that it assesses only the wear at the restoration margin
natural teeth and artificial materials. More recently, the in and, therefore, gives no indication of wear occurring at other
situ method has been introduced and developed to investigate sites [3]. In addition, it tends to underestimate wear [69].
dental tribology [82]. Recently, it has been pointed out that the best method for
measuring wear is by comparing sequential 3D images of the
4.1. In vivo observation and measurement materials of interest [3, 33, 69], which is quantitative, accurate
and providing storable 3D databases that can be compared with
In vivo methods are widely used in clinics. Clinical observation other 3D databases. However, considering that it needs to use
of the loss of dental hard tissue caused by wear can be traced expensive equipment [69, 33], few clinical studies have used
back hundreds of years [10]. 3D scanning technology to measure wear although it has been
As mentioned above, both oral environment and available since the mid-1980s.
biomechanics are very complex; tooth wear is therefore
multifactorial in the mouth and physical and chemical 4.2. In vitro laboratory simulation
processes interact. So, it has been accepted that the main
advantage of in vivo methods is to obtain and examine Due to the mentioned disadvantages of in vivo methods,
tribological behaviour of teeth and restorations resulting from the quest for a wear machine which would predict clinical
a real oral environment and biomechanics [3, 33, 52, 68, 69, performance has been the dream of many material scientists
84]. However, in vivo methods have some disadvantages with the ever increasing number of artificial dental materials
which limit their contribution to the tribology of dental available. Therefore, laboratory simulation methods were
materials. Firstly, it is impossible for in vivo methods to widely developed to mimic wear conditions in the mouth
isolate and study individual wear processes, including attrition, such as clinical masticatory cycle and oral environment and
abrasion and erosion. Although some measures can be then used for in vitro evaluation of dental materials after the
taken to unify the testing conditions among the subjects to 1940s [40].
some extent, it is still evident that subjectivity is indeed a The wear testing devices used in in vitro studies were
variable, which leads to problems in interpreting results [3,84]. various, which include simplest pin-on-disc devices and a more
Secondly, the lack of control over important variables that complex artificial mouth [17, 33, 92]. Several liquids are
may influence tribological behaviour (such as chewing force, incorporated in these wear machines such as water, alcohol,
dietary intake or environment factors) significantly limits their acids, olive-oil, olive-oil/CaF slurry, artificial saliva, with or
contribution to tribology of dental materials, especially wear without the inclusion of bacteria [84]. A summary of the
mechanisms [91]. In addition, wear processes clearly cannot different test geometries used in dental tribology is shown in
be accelerated in vivo and research work is dependent on figure 7.
volunteer compliance [69]; as a result, in vivo studies are both Generally three main mechanical approaches can be
time-consuming and expensive. considered with different wear simulation techniques:
It is noted that sufficiently sensitive methods of wear toothbrushing machines, two-body wear machines and three-
measurement are also a problem for most in vivo studies. body wear machines. For toothbrushing machines, in general
In general, the systems for wear measurement in dentistry a toothbrush/dentifrice abrasion concept is used consisting
use either clinical categorization systems or indirect methods of the following elements [84]: toothbrush, programmable
which measure wear on replica laboratory models [3]. For brushing techniques and paths and medium (such as dry, wet
toothwear the most commonly used categorization index is and dentifrice abrasive slurry). A relative dentine abrasion
that described by Smith and Knight which separately scores (RDA) method developed by Hefferren is perhaps the most
the wear of the tooth surfaces according to the amount of well-known in vitro method to study toothpaste abrasion and
exposed dentine [13]. For restorative materials probably the is widely used by manufacturers [16]. The literature survey
most universally used scoring system is the one devised by shows that several two-body wear simulators were designed
Cvar and Ryge for the United States Public Health Service and used with varying degrees of success to imitate clinical
(USPHS), in which the wear of restorations was categorized wear [84], such as two-body abrasion single-pass sliding,
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 body machine sliding wear, pin-on-disc tribometer, abrasive
still clinically acceptable, and Charlie means excessive wear disc, oscillatory wear test, modified polisher and fretting
and the restoration must be replaced. The advantages of the test. In addition, a number of three-body wear simulators
chairside method of wear assessment are that it is readily have been developed to simulate masticatory abrasion, which
available and does not require special equipment, whilst the include abrasive slurry that acts simultaneously with the
disadvantages are that it is subjective and insensitive and takes surface contact. Examples of these devices [84] are ACTA
a long time to get significant results [3, 69]. wear machine, Oregon Health Sciences University Oral

9
J. Phys. D: Appl. Phys. 41 (2008) 113001 Topical Review

W
W W W+X

Pin
Pin Abrasive
slurry

Disc
(a) (b) (c)

Spring
Abrasive
Material action Abrasive
slurry
samples slurry

Ball

Stirrer Antagonist disc


(d) (e) (Stainless steel)

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 methods to study the tribology of dental materials. As a result,
device, Zurich computer-controlled masticator, Minnesota in situ methods were developed by West et al in 1998 [93]. Dur-
MTS wear simulator (also called artificial mouth), BIOMAT ing in situ testing, specimens are mounted in devices worn in
wear simulator and Willytec Munich and Muc3. the mouth and finally removed for ex vivo measurements [33].
It has been accepted that in vitro testing offers researchers Therefore, specimens can be exposed to the real oral environ-
much more control over experimental variables and the ment. In a word, in situ testing provides a partial compromise
opportunity to take far more accurate measurements than between the in vivo and in vitro conditions [6].
in vivo testing and therefore shows many advantages in the For most in situ methods the conditions of any experiment
study of wear mechanism of natural teeth and artificial dental can be carefully controlled so that the effects noted can be
materials [33] Moreover, in vitro evaluation of dental materials ascribed to the agent under test [82]. In situ studies can use
can be examined over relatively short periods of time in sensitive equipment such as profilometer and scanning force
comparison with clinical trials. However, the oral environment microscopy, to measure the loss of materials surface due to
is very complex and has many variables; therefore all in various factors so that experiments could be conducted over
vitro models cannot replicate the oral environment with all comparatively short time periods. Initially in situ methods
its biological variations [82]. And extrapolation to the oral were used mainly to measure the erosion of dentine and enamel
environment is impossible to calculate. As a result, only trends by soft drinks and were then gradually used to study a variety of
and indications as to the true extent of wear can be obtained phenomena in the mouth including abrasion of dental materials
by in vitro methods [3]. In addition, the results of in vitro by toothpastes [33, 82].
studies would be credible provided that the most influencing
parameters have been identified and can be used and controlled 5. Tribological behaviour of natural teeth
in the test rigs [33]. To be of value, wear simulation must
produce clinically relevant results [69]. It should be noted As mentioned above, friction occurs during normal oral
that nowadays most of the in vitro studies have been carried functions; therefore, toothwear, a cumulative multifactorial
out on different test rigs with differing contact geometries, lifetime process, is irreversible to a large extent [9496]. It has
loads, sliding speeds, lubricants, etc, which make it difficult to been shown that the rate of toothwear may be associated with
compare wear results obtained by different machines. factors such as age, gender, occlusal conditions, parafunction,
gastrointestinal disturbances, excessive intake of citrus fruits
4.3. In situ testing or beverages with a low pH, environmental factors, salivary
factors and congenital anomalies of dental tissues [97].
Whatever in vitro method is employed, it is difficult to extrap-
olate findings into a clinical meaning, particularly since the
5.1. Effect of tooth microstructure
wear of teeth is multifactorial and physical and chemical pro-
cesses interact [82]. Indeed, it is this multifactorial aetiology Tooth enamel is one of those unique natural substances which
of toothwear which has hampered the development of in vivo 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

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

11
J. Phys. D: Appl. Phys. 41 (2008) 113001 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

(a) 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
(b) are the prime determinants of the wear rates of teeth and
Figure 10. Two types of human tooth wear scars observation restorations [110]. It has been implicated that the very
parallel to the occlusal section (versus titanium ball): (a) at the common high toothwear rates of ancient human beings mainly
enamel zone and (b) at the dentine zone. (Reprinted with permission resulted from the fact that their diet was very coarse and
from [99]. Copyright 2003, Elsevier.) abrasive because hard particles were often incorporated in
120
their food. These particles may be intrinsic components
such as bone fragments or collagenous material of fish or
Parallel to the occlusal surface
100 Perpendicular to the occlusal surface
meat, cellulose or phytoliths of plant foods and those which
Depth of wear scar/m

were inadvertently introduced as contaminants during food


80 preparation or processing, for example, mineral grit was
introduced during the grinding of cereal grains. In contrast,
60 reliance on factory-processed foods, so-called delicate foods,
has resulted in very low rates of toothwear in contemporary
40
populations. In addition, results of in vitro compression tests
[108] showed that larger particles produced fewer, larger wear
20
features on the surfaces of teeth than smaller ones, and total
0 wear increased with the particle size.
Enamel DEJ Dentin

Figure 11. A comparison of tooth wear depth between different 5.3. Pathological factors
contact zones for two different orientations (versus titanium ball).
(Reprinted with permission from [99]. Copyright 2003, Elsevier.) Clinical reports show that pathological factors such as erosion,
bruxism, xerostomia and tetracycline can result in excessive
ground, which can cause abrasion to the occlusal surfaces. toothwear, which sometimes needs necessary intervention for
The entrapment of particles is clearly influenced by the nature cosmetic or functional purposes. Erosion is probably the most
of the contacting surfaces. Rough surfaces may trap more significant factor because various surveys have shown a high
particles than smooth ones. It was indicated that scratches in prevalence of erosion all over the world, which is likely to
the occlusal surfaces resulting from thegosis may act as particle increase with the increasing consumption of acidic drinks.
traps during mastication [71].
The effect of occlusal load on mastication abrasion has 5.3.1. Chemical effects. As stated above, tooth erosion
also been investigated. In vitro compression tests, which is defined as an irreversible loss of dental hard tissues
were conducted by Mass to examine the microscopic wear due to a chemical process without the involvement of

12
J. Phys. D: Appl. Phys. 41 (2008) 113001 Topical Review

microorganisms [63], which can be caused by either extrinsic issue and theories have invoked occlusal, physiological,
or intrinsic agents [3, 33, 80]. Extrinsic agents include acidic genetic and stress factors [120].
substances, beverages, snacks or environmental exposure to In general bruxism can cause abnormal attrition at sites of
acidic agents. Intrinsic causes of erosion include recurrent occlusal contact (OCA) and then result in excessive toothwear.
vomiting as part of anorexia or bulimia or the regurgitation of It was reported that patients with bruxing habits can apply
gastric contents. The pattern and distribution of erosion lesions occlusal loads of approximately 1000 N [75], while for normal
differ according to the acid sources [111]. Dietary erosion people, as discussed above, the maximum biting load at
affects the labial and palatal surfaces of the upper anterior the incisors is 100 N, gradually increasing as one moves
teeth, while regurgitation erosion typical affects the palatal posteriorly to reach around 500 N at the molars. In addition to
surfaces of the upper anterior teeth as the tongue directs the these increased loads, bruxists have a total tooth contact time
vomit forwards during vomiting. Airborne acid affects the of 30 min to 3 h in a 24 h period. For a nonbruxist, the tooth
upper and lower anterior teeth. contact time is about 10 min. As a result, wear due to extensive
Erosive substance loss of enamel is a dynamic process bruxism could be very severe. The vertical loss of dental hard
with demineralization and remineralization periods [112]. In tissues in patients with bruxism habits has been reported to be
the initial stage, the softening of enamel occurs due to partial 3 to 4 times higher than that in normal people [119].
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 5.3.3. Other factors. Clinical reports have shown that a
tissue could act as a scaffold [113]. At a more advanced stage large number of people suffer from impaired salivary functions
the mineral of the outer enamel is totally lost and repair is [121, 122], displaying symptoms such as dry mouth (also
not possible, while the remaining softened enamel beneath called xerostomia). Xerostomia is a condition characterized
the lost hard tissue is probably remineralizable. A substantial by a reduction or loss in salivary flow, often with a concurrent
loss of dental hard tissue must be expected when softening change in the composition of the saliva, resulting in dryness of
is followed by friction processes such as mastication and the oral cavity and then difficulties in speaking, masticating,
toothbrushing [33, 89], and there is evidence that the acid-
swallowing, etc [121]. As mentioned above, saliva plays an
eroded enamel is more susceptible to abrasion and attrition than
extremely significant role in decreasing the friction and wear
the intact enamel [114]. It was reported that the type of acid,
of teeth to prevent those lesions; therefore, if not treated,
pH value, acid concentration and temperature are all relevant
people could suffer excessive toothwear from xerostomia. The
to the wear of teeth [89, 115]. Toothwear caused by erosion
most common option for xerostomia treatment is the use of an
observed clinically is the combined effect of demineralization
artificial saliva or saliva substitute (oral lubricants).
of the tooth surface by an erosive agent and abrasion of the
demineralized surface by the surrounding oral soft tissues, food Recently authors investigated the tribological behaviour
mastication and toothbrushing [90]. Patients with clinically of human teeth at different tetracycline stained extents against
evident palatal erosion showed a ten-fold greater wear rate titanium alloy by using a reciprocating sliding wear test
(median 6 m/month) than those without any evidence of machine. The results showed that the friction and wear
abnormal wear (median 0.6 m/month) [112]. behaviour of lightly tetracycline stained teeth were similar to
For most people, avoidance of erosive foods will those of normal teeth, and the worn surface is characterized by
well prevent toothwear caused by erosion. Studies also scratch and slight plough. However, for heavily tetracycline
proposed that immediately following an acidic challenge, a stained teeth, significant plough and delamination were
remineralizing agent, such as fluoride mouthrinses, fluoride dominant accompanied with strong discontinuities in the
tablets, fluoride lozenges or dairy milk, should be administered evolution of the coefficient of friction and the rather high
to enhance rapid remineralization of the softened tooth surface stable friction coefficient, and their tribological property was
as well as to serve as a mouth refresher or as an alternative, a obviously inferior to normal teeth. It was suggested that
neutralizing solution should be used [64]. In addition, it has the wear resistance of human teeth decreases with increasing
been increasingly emphasized that modifying the composition tetracycline stained extent due to the variation of the tooth
of soft drinks is an important concept in the prevention of microstructure (figure 13).
toothwear due to erosion and should be further developed Gil et al [123] reported that the accumulation of lead in
[115, 116]. teeth was associated with dental health factors, such as dental
plaque, salivalis lactobacilli number, dental colour, dental
5.3.2. Bruxism. Bruxism, a very common parafunction of abrasion and toothbrushing frequency. Coloured teeth and
the masticatory system, may be defined as rhythmic, habitual teeth subject to abrasion showed the highest lead content. Teeth
tooth clenching or grinding movements that would occur obtained from irregular brushers presented higher tooth lead
either when awake or during sleep [117119]. Examples of content than subjects with regular toothbrushing frequency.
the consequences of bruxism often mentioned in the dental In addition, a clinical survey conducted by Judith et al
literature are toothwear, muscular pain, toothache, mobile showed that to a lesser extent, difficulty in relaxation, pain and
teeth, various problems with removal and fixed prostheses, and distress and avoidance of going out are associated with tooth
so on. The aetiology of bruxism has long been a controversial loss and/or denture wearing [124].

13
J. Phys. D: Appl. Phys. 41 (2008) 113001 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,
(a) 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
(b)
of the type of toothbrush and the composition, especially
Figure 13. Microstructure observation of the occlusal surface: the abrasivity of the toothpaste on toothwear caused by
(a) normal human teeth and (b) heavily tetracycline stained teeth. toothbrushing. Traditionally studies on toothbrushing were
conducted in vitro by using various wear simulators, whilst
5.4. Effect of tooth flexure more recently, in situ methods have been frequently used [82].
Although toothbrushes alone or combined with toothpaste have
During mastication or bruxism, occlusal loading can cause been proposed to both cause tooth wear, abrasion of gingival
tooth flexure [15, 75, 80] and generally result in shear stress in tissues and gingival recession, and be involved in the aetiology
the cervical region of a tooth where the enamel has been found of dentine hypersensitivity [77], toothbrushing alone appears
to be less resilient. Once the shear stresses resulting from to have no obvious effect on the wear of enamel and very
tooth flexure exceed the failure stresses of enamel, cracking little on dentine [33]. Most, but not all, toothpastes have low
and subsequent enamel loss can occur in the cervical region
relative enamel abrasivity values and are implicated to have a
(around the cementoenamel junction), which is clinically
minimal effect on enamel and in normal use would not cause
called noncarious cervical lesions (NCCL) by abfraction.
significant wear of dentine in a lifetime of use [77]. However, it
Fracture of the cervical enamel by abfraction is most likely
should be noted that dentine is considerably more susceptible
to occur along the boundaries of the hydroxyapatite crystals.
than enamel to abrasion caused by toothpaste abrasive, and
Levitch et al reported that the number, size and depth
dentine loss appears to correlate with toothpaste abrasivity
of cervical lesions increased with age [75]. Cervical lesions
[127]. Overuse or abuse of toothbrushing with toothpaste
by abfraction were seen more commonly on maxillary (upper
would only be relevant to dentine and not enamel wear unless
jaw) incisors in clinics, possibly because these small teeth
high relative enamel abrasivity toothpastes were in use and as
were less able to withstand the applied occlusal load. A
stated these are unusual [77]. Therefore, toothpaste with lower
finite element study conducted by Rees et al suggested that
abrasivity might be advisable for daily oral hygiene practice
stresses in maxillary incisors were several times larger than
those in canines and molars [125], which explained these of patients with excessive toothwear.
clinical observations. Clinical studies have also shown that Wear of enamel and dentine can be dramatically increased
abfraction lesions are common in people with parafunctional if toothbrushing follows an erosive challenge [77], which
habits, especially bruxists [75], as mentioned above, who apply may result in noncarious cervical lesions [128]. Attin et al
large eccentric occlusal loads. 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
5.5. Effect of toothbrushing
carried out by Hooper et al showed that toothbrushing with
Teeth are usually cleaned using a filament-based toothbrush fluoride toothpaste containing sodium hexametaphosphate
and a toothpaste. Toothbrush and toothpaste can be traced before meals could provide significant erosive protection in
back 1000 years [77], and toothbrushing with toothpaste is susceptible individuals [67].

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

6. Tribological behaviour of artificial dental stainless bracketwire combinations during sliding processes,
materials carried out by Willems et al [132], indicated the significant
role of the centred positioning method on the friction value. In
In dentistry, as discussed above, metals and alloys, ceramics addition, the slot-filling, bracketwire combination resulted
and composites are generally applied to restorations and in an increased coefficient of friction and therefore is not
implants. Considering the inter-oral complex environment and recommended for sliding systems. It is also notable that pain
biomechanics, wear processes of artificial dental materials are and discomfort of the oral mucosa can often be experienced
very complicated, which normally include abrasion, attrition, as a result of trauma from the metallic appliance caused by
corrosion, fretting wear and fatigue [3, 5]. These processes increased friction between mucosa tissue and the surface of
occur in various combinations to cause surface loss of materials the brackets [134], on which few research works have however
in the mouth. Excessive wear may lead to premature failure been conducted.
and replacement of dental restorations and implants. Fretting wear has been frequently mentioned by clinicians
Wear resistance of artificial dental materials is clinically as a possible failure cause of dental implants [86, 87]. Yu
important for clinical longevity, aesthetics and resistance et al investigated tangential fretting behaviour of pure titanium
to dental plaque [3, 5, 80]; therefore, a large number of (TA2) and its alloy (TC4) against the human thighbone cortical
studies have been carried out on their tribological properties. bone [87]. Results showed that friction logs transformed from
Commonly their research interests are as follows [6]: (1) a partial slip directly to a gross slip without a mixed regime,
the wear resistance of artificial dental materials and (2) the and the friction coefficients in each fretting regime went up
predisposition of restorative materials to create wear on the with the displacement. The wear depths on the Ti ball were
opposing structures, especially the opposing enamel. only to the extent of several to tens of micrometres, which
were much less than those of the bone. In addition, the friction
6.1. Metals and alloys coefficient of the boneTC4 pair was higher than that of the
boneTA2 pair, and the maximum wear depth on the bone
Corrosion has been considered the most important factor in against TA2 was about 40% the value of that on the bone against
the selection of metallic materials in dentistry because poor TC4. Therefore the wear adaptability of boneTA2 pairs was
biocompatibility and cytotoxicity of their corrosion or wear better than that of boneTC4 pairs. Abrasive wear features
products may make the materials worse for either restoration and various microfractures were observed on the worn cortical
or implantation purposes in the mouth [34, 130]. It has been bone surfaces. It was suggested that some surface modification
reported that the presence of a metal restoration is the most techniques of titanium be adopted to reduce the fretting damage
commonly cited reason for an adverse reaction [130]. There is to bone.
a vast amount of literature concerning the corrosion of dental It should also be noted that commercially pure (CP)
alloys, and from the proffered information it emerges that titanium and its alloys have been increasingly applied to dental
leaching of metallic ions and food habits are the main causes restorations, especially implants, in place of other metals
of corrosion of metallic restorations and implants [34]. The due to their excellent biocompatibility, corrosion resistance
purity, casting and melting techniques also affect the corrosion and light weight [135139]. One of the disadvantages of
behaviour of metal alloys. In general the nature of metal titanium for structural applications is its poor tribological
alloys plays a major role in the initiation and propagation characteristics [135]. Clinical trials [136] showed that cast CP-
of corrosion. Recently Liu et al reported that the wear Ti dental restorations underwent the greatest amount of wear in
and corrosion resistance of nickel-based and chromium-based comparison with conventional dental alloys. Alloying may be a
dental alloys could be improved with the presence of titanium possible method to improve the wear resistance of CP-Ti [137
aluminum nitride films [131]. 139]. Ohkubo et al [137] indicated that among the different
Generally, most metals are strong enough to withstand types of titanium alloys, + alloys exhibited the best wear
maximum possible oral forces. However, with the life quality resistance due to increased resistance to plastic deformation
increasing significantly, the appearance of dental materials resulting from the existence of needles in the retained
may be the most important factor to be considered for many matrix, which was consistent with that given by Khan et al
patients. As a result, nowadays, metals and alloys have [136]. It was also found that alloying with copper [138], which
increasingly been applied to orthodontic appliances and dental introduced the Ti/Ti2 Cu eutectoid, seemed to improve the
implants. wear resistance of titanium alloys. Iijima et al reported that
Friction in fixed orthodontic appliance systems is Ti6Al7Nb alloys can be used for dental restorations because
recognized by most clinicians to be very harmful to tooth they exhibited lower wear loss and a much smoother worn
movement [132, 133]. Various factors affect the friction surface than CP-Ti [139].
resistance process of orthodontic metallic bracketwire
combinations, such as archwire and bracket materials, their 6.2. Ceramics
size and shape, width and slot dimensions and the surface
composition, roughness and cleanliness. Other important The advantages of ceramics in dentistry are their natural
parameters are the bracket-to-wire positioning in a three- appearance and their durable chemical and optical properties.
dimensional space, the ligature force and type of ligation, Normally ceramics possess relatively high resistance against
the interbracket distances and lubrication. Fretting tests of wear. However, clinical trials show that there may exist

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

two major problems encountered in their dental use [46]: of anatomic form under masticatory abrasion and attrition.
(1) most ceramic restorations may be abrasive and potentially Many efforts have been made continuously to optimize the
destructive to the opposing natural teeth or restorations and composites in order to have better wear resistance since they
(2) brittle fracture plays a major role in the wear of some were widely used in dentistry. Nowadays, many dental
ceramics during the friction process in the mouth, which composites do not show excessive wear anymore, and wear is
could cause disastrous results clinically. Therefore, the use of more likely to occur at occlusal contact areas than on contact-
less abrasive ceramics would offer excellent aesthetics whilst free areas [19, 145].
minimizing the wear of opposing natural teeth and would be a Wear mechanisms of dental composites were associated
valuable addition to the dentists selection of materials [6]. with wear conditions [6]. Abrasion and chemical degradation
Many researchers have focused on investigating the appeared to be dominant in the contact-free areas clinically,
abrasive potential of various dental ceramics to opposing while fatigue and adhesive wear were generally associated
dentition, especially opposing enamel. Literature survey with occlusal contact wear [3]. Nagarajan et al [50, 146]
shows that the wear of enamel and ceramic appears investigated the two-body wear of three medium filled
to be closely related to the ceramic microstructure, composites and one highly filled one. Wear was found to
surface characteristics (such as smoothness or glaze) and occur by simultaneous processes consisting of tribochemical
environmental influences [4, 140, 141]. reactions between filler particles and water, dissolution of
Internal porosity and other surface defects, which are hydrated products, formation of surface films containing
produced by an inadequate firing technique, act as stress a mixture of filler fragments and reaction products and
concentrators and result in greater wear [4]. Glazing and/or mechanical detachment of the surface films.
polishing can lower wear at the early stage of contact, but the Generally, the wear process of composites is associated
positive effect of a glazed/polished ceramic surface is quickly with both material and oral factors [145]. Material factors
lost when the material is placed in function. The internal normally relate to the characteristics, content and distribution
characterization of ceramics is recommended because shading of filler, the degree of conversion, the nature of the matrix and
materials contain abrasive metal oxides. The application of the interfacial bond strength between filler and matrix.
external stains should be limited to the noncontacting surfaces Filler characteristics, such as size, shape, hardness and
of aesthetic restorations. Moreover, etching the inner side brittleness, play an important role in the wear process of
of the porcelain veneer, which is often needed clinically, dental composites. The wear resistance of composites is better
can cause microcracks which may slightly weaken the wear with higher filler loading but smaller particle size [145, 147].
resistance of the porcelain. Hard filler particles could protect the soft matrix and enhance
An acidic and/or alkalic chemical attack caused by dietary the materials overall resistance to abrasion [145]; however,
habits and intrinsic diseases may result in the degradation of the hardness of filler particles must not be higher than that
ceramic surfaces in the mouth [4]. Load has a significant of hydroxyapatite crystals of human enamel. An ultra-
effect on the friction coefficient and wear loss of dental fine filler size will reduce the impact of the filler hardness.
porcelains [141]. Thus, if a degraded ceramic surface is Compared with composites containing large filler particles
further subjected to dysfunctional occlusion or parafunctional (>1 m) [2,36,145,148], microfilled and small-particle hybrid
habits such as bruxism, the wear process may be accelerated. composites were frequently mentioned to have a tendency to
More recently, Akihiko et al reported that porcelain showed display better abrasion resistance because of their smoother
significantly less wear loss and was less abrasive to opposing surface, decreased inter-particle spacing and decreased friction
enamel or composite resins in three-body conditions compared to food particles. In contrast to sharp and pointed particles,
with two-body conditions, regardless of its surface conditions the presence of spherical and irregular particles could benefit
[140]. In addition, abrasion of toothbrushing is a possible both the composite wear and the opposing enamel wear [149].
cause of the wear of dental porcelains. Anil et al reported that An additional aspect to be considered is filler brittleness
significant material loss and decrease in roughness occurred [145]. Under high stress, brittle filler particles will easily
in the surface of porcelains as a result of the equivalent of fracture and cause rapid abrasion of the material itself, but
8.5 years of toothbrushing [142]. a less antagonistic engagement. It is well accepted that a
In order to minimize the damage by brittle fracture, smooth surface provides reduced frictional wear at the occlusal
many efforts have been made to develop high-toughness contact area, which will lessen the wear of both composite and
dental ceramics in the past decades. Recently, yttria- antagonistic enamels. Whenever filler particles protrude and
stabilized tetragonal zirconia polycrystal (Y-TZP), a high- are big and extremely hard, there can be high antagonistic wear
toughness zirconia ceramic, has been developed as an rates that could cause catastrophic loss of the tooth substance
alternative to porcelains or glass-ceramics in posterior in time [145, 150].
restorations [143, 144]. Obviously, the ability of a resin composite to
resist abrasive action depends on fillermatrix interactions.
6.3. Composites Therefore, the filler content and distribution and inter-particle
spacing significantly influence the physical properties and
The main problem involved in the dental application of then the wear resistance of dental composites [145]. As the
composites is their inadequate resistance against wear when filler volume increased, wear was reduced regardless of the
used as posterior composite restorations, resulting in a loss filler treatment [145, 151]. Wear resistance of microfilled

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

Table 7. Dental materials and their tribological problems in clinics.

Materials Main tribological problems Influencing factors


Metals and their alloys Wearcorrosion, friction in fixed orthodontic The nature of metal, alloying, oral factors
appliance systems, fretting wear
Ceramics Abrasive potential to the opposing enamel, brittle fracture Ceramic microstructure and surface characteristics,
oral factors
Composites Excessive wear in posterior composite restorations 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

composites was remarkably enhanced by the filler volume with In summary, normally different dental materials encounter
an increase from 25 to 30 vol%. Filler particles situated very different tribological problems in their clinical uses, as shown
close can protect the softer resin matrix from abrasives, thus in table 7. It can be seen that both material property and
reducing wear. It was reported that the use of finer particles oral factors can significantly influence the friction and wear
for a fixed-volume-fraction of filler resulted in decreased inter- process of restorations in the mouth. An additional aspect
particle spacing and reduced wear [145]. Moreover, even at a to be considered is the clinical operation technique. Wear
low microfiller level, well-distributed fillers can achieve good resistance of restorative materials tends to increase as the
wear resistance for small-particle hybrid composites. cavity size decreases. The restorations placed should be
Clearly a weak, incoherent matrix can invoke phenomena as small as possible in order to benefit from the strong
such as plucking out of filler particles and excessive wear of support of, and full protection by, the surrounding natural
the matrix and thus reduce the abrasive capacity of composites. tooth structure [4, 140, 145]. Ideally, the wear of a dental
As a result, wear can be reduced significantly as the degree material should be similar to that of human enamel because
of cure, strength and toughness of the resin matrix increases. enamel has extremely excellent wear resistance despite fairly
In general the degree of cure, strength and toughness of the bad working conditions in the mouth, such as widely ranging
matrix is associated with its composition and cure conditions. load, reciprocating movements, temperature shocks or possible
High-intensity curing units and postcuring can result in a high acid attacks. To date, however, this property may only be
degree of conversion and then enhance the fracture toughness found in ceramic materials and particular metal alloys [19].
and strength [152, 153]. The wear of amalgam is higher than that of enamel but
Another key factor in the wear of composites is a good lower than that of composite resins. Although significant
interfacial bond between the filler and the matrix. Good improvements have been achieved, many resin composites still
filler/matrix adhesion was indicated to enhance stress-transfer exhibit considerable in vivo wear in the long run [6, 155].
ability, protect the matrix and interfere with crack propagation
at higher filler levels and accordingly reduce wear [145, 154]. 7. Concluding remarks
Silane coupling agents are thought to play a major role in
enhancing the adhesion of the interface between the inorganic In dentistry, the tribological behaviour, in particular the wear of
filler and the organic resin. It is important that the microfillers teeth and restorative materials, is a particular clinical problem.
need to be kept well dispersed to achieve the full effect of Wear is an important consequence of occlusal interaction.
protection. In addition, contamination of the filler might However, if not controlled, wear could lead to poor masticatory
disturb silanization and reduce fillermatrix coupling. Another function and various treatment problems with a concomitant
advantage of the use of a coupling agent in dental composites reduction in the quality of life and possible deterioration of
is that it, at least to some extent, protects the filler against systematic health. As a result, tribology of dental materials,
hydrolytic degradation. which concerns the understanding of the mechanisms and
Oral factors, in particular oral chemical environment, have controlling factors in dental wear, is critically important. As
a significant effect on the wear process and in vivo degradation discussed above, inter-oral friction and wear of dental materials
of composite restorations. The resin matrix can be softened are extremely complex; therefore, there appear some problems
and fillers can be leached out when composites are exposed in current research, some of which should be focused on in
to certain chemicals/food simulating liquids [52, 145], thus future work.
reducing the resistance against wear to a considerable extent. The literature survey shows that for the wear of human
A high degree of cure of the composite matrix could decrease teeth more clinical observations have been reported than in
its degradation in long-term exposure to water. It should vitro studies. In other words, many studies have focused on
be noted that there is a rising failure rate of posterior resin the aetiology of toothwear but the wear mechanism is far less
composite restorations due to interproximal wear [145, 154]. understood. Take tooth erosion for instance. Toothwear by
Furthermore, wear of crowns and bridges made of composites erosion is paid increasing attention and accordingly a great
is generally greater than that of fillings if they are analysed number of papers on the chemical effect has become available
after longer periods of service [19]. recently (table 1). However, most studies focused on the

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

aetiology and prevention of dental erosion, while almost no testing is to analyse the fundamental mechanisms, which may
studies have been carried out on its mechanism in detail. lead to a better understanding of in vivo failure patterns. Many
It is also found that few research works have focused on in vitro methods have been developed since the 1990s, on
the effect of bioactivity and biomechanics of human teeth which Roulet commented that there were almost as many
on their tribological behaviour. Nevertheless, the lack of wear testing devices as there were scientists who are interested
these aspects may be one of the main obstacles hindering the in wear [158]. So the question has arisen whether these
development of dental materials because, as discussed above, devices and methods fulfil the standards for qualification and
the tribological properties of ideal restorations and implants validation that are already in place in other fields of medical
should not only be similar to human teeth but also exhibit product testing [19]. Some researchers have observed that,
individual differences such as age and sex. For artificial dental firstly, comparison of the results obtained by different devices
materials the same situation is encountered. Most studies was difficult; secondly, the experimental results were best
have focused on providing comparative ranking of various characterized as inconclusive; thirdly, some laboratory studies
dental materials using wear test machines simulating the oral lack correlation with clinical trials [3, 19, 33]. An important
conditions [146], whilst only a few in vitro studies have been point to be kept in mind with future in vitro testing is that
carried out on their wear mechanisms. Future in vitro wear wear test machines need to simulate the oral condition and
testing should be aimed at an understanding of the fundamental biomechanics as closely as possible, otherwise, the lack of
underlying wear mechanisms involved, which will lead to a correlation between the results of in vitro and in vivo studies
better understanding of in vivo failure patterns. will be inevitable. And an efficient and universally accepted
Little is known about the systemic effects of artificial in vitro tribological test would undoubtedly promote and assist
material components, such as the clearance of the worn tribology of dental materials.
material, adverse effects, chemical reactions or a possible There exists a state of confusion in assessing the wear
incorporation of worn material into body cells or tissues [19]. of dental materials. Three parameters, wear volume, wear
depth and wear area, have been used by various researchers,
With composites there is a certain amount of concern that,
respectively. Generally there are significant differences
besides the leaching of monomer components, micro- and
between the wear assessments of the same sample measured
nanosized inorganic filler particles of composite resins that
by different parameters [69, 155]. Volume was reported to be
are worn, swallowed or inhaled and accumulated into tissues
the preferred parameter because wear is defined as the volume
could be linked to diseases of the liver, kidney and intestine.
of the material removed [69]. The disadvantages of the other
It is also found that the role of interproximal wear in the
two parameters are that they represent indirect wear measures,
loss of dental tissues and restorative materials has attracted less
depend on occlusal factors and vary with time. Moreover,
attention. Moreover, less attention has been paid to fretting depth is not a good parameter for comparing wear because its
wear of dental implants which can cause the loosening of magnitude depends on where the depth is measured and the
metallic implants and subsequently result in these failures. direction from which it is measured. In addition, evaluating
In addition, few studies have focused on the effect of tooth the wear of dental materials requires that both the material
location on its tribological behaviour. of interest and the opposing material be considered because
It is worth noting that much emphasis has been placed materials may be worn by the antagonist or they may cause
on the wear of dental materials, but efforts to explain and aggressive wear of the antagonist [69]. Clinically, it is the
understand their friction behaviour in the mouth remain much combined wear or total wear that is important; especially if the
fewer [3, 6]. This indicates that in the past the importance opposing material is enamel.
of friction as a factor in the wear of brittle dental materials In addition, modelling dental tribology is proposed to be
may not have been fully appreciated. Friction forces play started [33]. Almost no attempt has been made at modelling
a major role in the oral wear process of dental materials. any dental tribological behaviour. This is probably because
Stolarski [3] noted that when friction is present the critical of the complexity of the oral environment and biomechanical
load can fall to 10% of the friction-free value. Future in functions. However, sometimes simple models, while they
vitro studies should pay attention not only to measure the may not give a completely accurate representation, can be
friction force but also to explore the friction process and factors useful in comparing and contrasting the situations of oral
in detail. Recently some researchers have pointed out that lubrication, friction and wear.
considering how the energy from friction is dissipated at the Due to the fact that tribology of dental materials is involved
material surface would provide a greater insight into the wear in many subjects such as dentistry, materials and engineering,
mechanism of dental materials [155157]. In addition, the there is still a poor understanding of tribology behaviour of
composition and viscosity of the lubricant should be carefully dental materials. Even through a lot of progress has been
considered in in vitro testing because solvent penetration to made, much remains to be done. It is evident that collaboration
a depth of just a few micrometres is sufficient to alter friction among clinical dentists, materials researchers and tribologists
which will therefore affect the wear [3]. Clearly works devoted will help to advance this research area of strong current interest.
to this field will promote tribology of dental materials.
As mentioned above, in vivo studies have some advantages Acknowledgment
in observing clinical manifestation and predicting risk factors
for oral tribological behaviour, rather than investigating their This work was supported by the National Natural Science
mechanisms. In contrast, the marked advantage of in vitro Foundation of China (No 50535050).

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