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BIODENTAL ENGINEERING IV
PROCEEDINGS OF THE IV INTERNATIONAL CONFERENCE ON BIODENTAL ENGINEERING,
PORTO, PORTUGAL, 21–23 JUNE 2016

Biodental Engineering IV

Editors
R.M. Natal Jorge, J.C. Reis Campos, Mário A.P. Vaz,
Sónia M. Santos & João Manuel R.S. Tavares
Universidade do Porto, Porto, Portugal
CRC Press/Balkema is an imprint of the Taylor & Francis Group, an informa business

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Published by: CRC Press/Balkema

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ISBN: 978-1-138-05737-1 (Hbk)

ISBN: 978-1-315-16489-2 (eBook)
 Biodental Engineering IV – Natal Jorge et al. (Eds)
© 2018 Taylor & Francis Group, London, ISBN 978-1-138-05737-1

Table of contents

Preface vii
Acknowledgements ix
Scientific committee xi

Fixed prosthodontics—clinical vs pre-clinical practice 1

C.F. Almeida, R. Machado, O.F. Lino, C. Silva & J.C. Sampaio-Fernandes
Degradation of dental implant systems after immersion in therapeutic gels 5
G.M.P. Juanito, M.S. Araujo, R.S. Magini, J.C.M. Souza, M.E.R. Dotto, F.S. Silva & B. Henriques
Novel strategies for the enhancement of zirconia behavior 11
R.S.F. Pereira, B. Henriques, M.C. Fredel & F.S. Silva
Surface finishing in tooth preparation for fixed prosthodontics—comparative study 15
E. Correia, P. Rocha-Almeida, M.A. Sampaio-Fernandes, P. Vaz, C. Silva & J.C. Sampaio-Fernandes
Virtual die-spacing—Everest® (Kavo®) system evaluation 17
P. Rocha-Almeida, J.C. Reis Campos, T. Coutinho Almeida, P. Vaz, C. Silva & J.C. Sampaio-Fernandes
Implant Stability Quotient (ISQ) from surgery to prosthetic rehabilitation 21
M.A. Sampaio-Fernandes, L. Guilherme Pimentel, N. Mesquita Marques, P. Ferras Fernandes,
P. Júlio Almeida & J.C. Sampaio-Fernandes
A 2D stress analysis of zirconia dental implants: A comparison study 25
L.G. Piqueiro, J. Belinha, A.M.R. Correia, L.M.J.S. Dinis & R.M. Natal Jorge
Meshless methods in oral biomechanics 29
J. Belinha, L.M.J.S. Dinis & R.M. Natal Jorge
Stress analysis of 3D trabecular patches: A computational study 35
C.I.R.A. Maia dos Santos, M.C. Marques, J. Belinha, R.M. Natal Jorge,
M.C. Manzanares Céspedes & C. Chaussain
Micro-CT images for mechanical simulation geometrical models using advanced
discretisation techniques 45
M. Marques, J. Belinha, R.M. Natal Jorge, M.C. Manzanares Céspedes & C. Chaussain
Development of a computational framework to predict bone tissue remodelling
using distinct discretization techniques 53
M. Peyroteo, J. Belinha, S. Vinga, L.M.J.S. Dinis & R.M. Natal Jorge
Endodontic-periodontal lesions: A 2D computational study 59
P.F.O. Lopes, J. Belinha, L.M.J.S. Dinis & R.M. Natal Jorge
The numerical analysis of angled abutments using advanced discretization techniques 65
R.O.S.S. Costa, J. Belinha, L.M.J.S. Dinis & R.M. Natal Jorge
Surface roughness of stainless steel orthodontic loops in artificial saliva 71
S. Castro, R. Martins, R. Campos, P. Teles & M. Pollmann
Surface changes (scanning electron microscope) induced by artificial saliva in stainless
steel orthodontic loops 73
S. Castro, E. Martins, M. Ponces, M. Vasconcelos & M. Pollmann

v
Convergence angle of prepared teeth for full crowns 75
I. Meireles Silva, A. Matos Oliveira, P. Vaz, P. Rocha-Almeida, C. Silva & J.C. Sampaio-Fernandes
Dermal zygomatic peri-implant reaction—gene expression? 79
M.A. Sampaio-Fernandes, L. Tovim, L. Rau, C. Silva, J.C. Sampaio-Fernandes & P. Vaz
Palatal obturators for cleft palate patients 81
M. António Silva, A. Correia, H. Figueiral, V. Campos, T. Pereira Leite, T. Tavares & R. Campos
Linkage between denture’s conditions and oral lesions 87
J. Carvalho, L. Vitorino, S. Félix & R. Campos
Influence of selective etching on marginal filtration of self-etching adhesives 93
S. Arroyo Bote, J. Martínez Arroyo, C. Bucchi & M.C. Manzanares Céspedes
Mandible anomalies—how can two-dimensional ultrasound help? 97
I. Côrte-Real, A. Felino, P. Vaz, R. Nogueira, A.C. Braga, V. Campos & F. Valente
Influence of porosity and cell density on tissue engineering of mandibular condylar cartilage 101
S. Cortez, J.L. Alves & A. Completo
Effects of dynamic compression on cells in tissue engineering of mandibular condylar cartilage 107
S. Cortez, J.L. Alves & A. Completo
Three-dimensional scaffold in bone regeneration 111
M.B. Sordi, I.C. Encarnação, A. Aragones, C.A.M. Benfatti & R.S. Magini
Experimental study of a new biomembrane (MES) for guided bone regeneration 117
R.Z. Gomes, I. Guerra, A. Afonso, M. Helena Fernandes, M. Vasconcelos, A. Felino & J. Cavalheiro
Image processing techniques and orthodontic related apical root resorption prediction models 123
S. Alves, H. Silva, L. Mesquita, N. Lavado & M. Lopez
Effect of drill speed on bone damage during drilling 129
M.G.A. Fernandes, R. Natal, E.M.M. Fonseca, J.E.P.C. Ribeiro & L. Azevedo
Determination of optimal parameters in drilling composite materials to minimize
the machining temperature using the Taguchi method 135
A.C. Lopes, M.G.A. Fernandes, J.E.P.C. Ribeiro & E.M.M. Fonseca

Author index 141

vi
 Biodental Engineering IV – Natal Jorge et al. (Eds)
© 2018 Taylor & Francis Group, London, ISBN 978-1-138-05737-1

Preface

Dentistry is a branch of medicine with peculiarities and diverse areas of action, being commonly consid-
ered as a very interdisciplinary area. The development, validation and clinical use of more competently
techniques and technologies have been of great demand and interest.
The purpose of these BIODENTAL Conferences on Biodental Engineering, initiated in 2009, is to
solidify knowledge in the field of bioengineering applied to dentistry promoting a comprehensive forum
for discussion on the recent advances in the related fields in order to identify potential collaboration
between researchers and end-users from different sciences.
This book contains the full papers presented at the 4th International Conference on Biodental Engi-
neering (BIODENTAL 2016), which was held in Vila Nova de Famalicão, Porto, Portugal, in June 21–23.
The conference had 1 Invited Lectures, and 50 contributed presentations, which were selected by the
conference scientific committee.
During BIODENTAL 2016, several topics and applications were addressed, including biomechanical
disorders, numerical simulation, orthodontics, implantology, aesthetics, dental medicine, medical devices
and medical imaging.
The conference co-chairs would like to take this opportunity to express their gratitude to the confer-
ence sponsors, all members of the conference scientific committee, invited lecturers, session-chairs and to
all authors for submitting and sharing their knowledge.

R.M. Natal Jorge

J.C. Reis Campos
Mário A.P. Vaz
Sónia M. Santos
João Manuel R.S. Tavares
(Conference co-chairs)

vii
 Biodental Engineering IV – Natal Jorge et al. (Eds)
© 2018 Taylor & Francis Group, London, ISBN 978-1-138-05737-1

Acknowledgements

The editors and the Conference co-chairs acknowledge the support towards the organization of the 4th
International Conference on Biodental Engineering BIODENTAL 2016 and the publishing of this Book
of Proceedings to the following organizations:
– Universidade do Porto (UP)
– Faculdade de Engenharia da Universidade do Porto (FEUP)
– Faculdade de Medicina Dentária da Universidade do Porto (FMDUP)
– Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial (INEGI)
– Laboratório de Biomecânica do Porto (LABIOMEP)
– Fundação para a Ciência e a Tecnologia (FCT)
– Project NORTE-01-0145-FEDER-000022 – SciTech – Science and Technology for Competitive and
Sustainable Industries, cofinanced by Programa Operacional Regional do Norte (NORTE2020),
through Fundo Europeu de Desenvolvimento Regional (FEDER)
– Associação Portuguesa de Mecânica Teórica Aplicada e Computacional (APMTAC)
– Câmara Municipal da Vila Nova de Famalicão
– Casa das Artes de Vila Nova de Famalicão
– Centros auditivos Widex

ix
 Biodental Engineering IV – Natal Jorge et al. (Eds)
© 2018 Taylor & Francis Group, London, ISBN 978-1-138-05737-1

Scientific committee

All works submitted to BIODENTAL 2016 were evaluated by an International Scientific Committee
composed by 69 expert researchers from recognized institutions:

Afonso Pinhão Ferreira Josep Torrent

Amaya Pérez Kazem Alemzadeh
António Completo Leopoldo Forner Navarro
André Correia Luis Geraldo Vaz
António Ramos Luís Pires Lopes
António Torres Marques Luís Roseiro
Augusta Neto Marco Parente
Carla Roque Margarida Sampaio Fernandes
Cláudia Barros Machado Mª Jesús Mora
Cornelia Kober Mª Manzanares Céspedes
Daniela Iacoviello Maria João Ponces
Edson Capello Mário Forjaz Secca
Luis Vieira Pinto Mário Vasconcelos
Elza Maria Morais Fonseca Mário Vaz
Estevam Las Casas Miguel Pinto
Fernanda Gentil Mildred Ballin Hecke
Fernando Guerra Pablo Rodríguez Cervantes
Filipe Silva Patrícia Fonseca
Gerhard A. Holzapfel Paula Vaz
Maria Helena Figueiral Paulo Gonçalves Piloto
Henrique Almeida Paulo Melo
Hernani Miguel Reis Lopes Paulo Rui Fernandes
Ioannis Misirlis Pedro Martins
Iracema Braga Pedro Mesquita
João Batista Novaes Júnior Pedro Gomes Nicolau
João Carlos Pinho Reis Campos
João Eduardo Ribeiro Renato Natal Jorge
João Manuel Tavares Sampaio Fernandes
João Paulo Flores Fernandes Sílvia Barbeiro
Joaquim Gabriel Teresa Pereira Leite
John Middleton Urbano Santana-Mora
Jorge Belinha Urbano Santana-Penin
João Leite-Moreira Vicente Campos
Jorge Marinho Yongjie (Jessica) Zhang
José Mário Rocha

xi
 Biodental Engineering IV – Natal Jorge et al. (Eds)
© 2018 Taylor & Francis Group, London, ISBN 978-1-138-05737-1

Fixed prosthodontics—clinical vs pre-clinical practice

Carlos Ferreira Almeida

Master of Oral Rehabilitation, Faculty of Dental Medicine, University of Porto, Portugal

Rui Machado, Orlando F. Lino, César Silva & João Carlos Sampaio-Fernandes
Department of Prosthodontics, Faculty of Dental Medicine, University of Porto, Portugal

ABSTRACT: The aim of this study was to quantify and compare the most frequently type of teeth
required fixed rehabilitation by undergraduate students in Fixed Prosthodontics’ clinical appointments at
the Faculty of Dental Medicine of the University of Porto, in two periods (1990–1994 and 2010–2014),
defining new goals for pre-clinical practice. This study was based on a retrospective review of two-hundred
patient reports, divided into two equal samples. A total of 357 teeth had been prepared, and the major-
ity involved fixed bridge rehabilitation. No significant differences were found between quadrants. The
maxillary teeth were the most frequently prepared and remained constant or increased between peri-
ods. Regarding the lower jaw, a significant difference was observed: the most frequently prepared teeth
in 1990–1994 were molars, whereas in 2010–2014 were the canines and premolars. Pre-clinical practical
teaching should thus focus on all the upper teeth and on lower premolars.

1 INTRODUCTION The orientation of pre-clinical practice to the

The parameters for clinical education of future den-
tists should be developed with efficiency and care,
both in terms of clinical aspects and didactics. Fur-
thermore, undergraduate dental education should
be able to create dental practitioners that work
based on an ethical, generally competent dentistry,
bearing in mind real society needs (Scott, 2003).
Tooth preparation is a basic technique used
in fixed prosthesis treatment, and is therefore of
crucial importance to pre-clinical students. In the
Faculty of Dental Medicine of the University of
Porto (FMDUP), Portugal, the teaching of Fixed
Prosthodontics is carried out for three years (15
ECTS). The first year focuses primarily on the
basic knowledge of this area, which is covered by
lectures, commented videos and simple procedure
demonstrations in a pre-clinical class (3 ECTS).
The second year involves practical demonstra-
tions and pre-clinical practice in simulators (phan-
toms) of multiple teeth and dental preparations
(upper arch: two central incisors, one canine, two
premolars, one first molar; lower arch: one premo-
lar and one molar), as well as the development
of post and core restorations, impressions and
cementing techniques (6 ECTS).
In the final year, classes are exclusively clinical.
Students practice simple fixed rehabilitations in
patients, under the guidance of teachers (6 ECTS).
Internal surveys on students’ satisfaction often
stated a lack of correlation between pre-clinical
and clinical practice.
current clinical reality may allow students to be
better prepared for improving the most requested
dental preparations. Taking into account the time
available for the learning process, the adaptation
of the pre-clinical program is of the utmost impor-
tance. On the other hand, the introduction of new
areas of knowledge, such as implant rehabilitation,
in the undergraduate curriculum, has led to less
frequent tooth preparation requirements (Barrero
et al., 2015).
Although it is common notion amongst den-
tal professionals that some types of teeth require
rehabilitation more frequently than others, there is
no actual study on different types of teeth involved
in clinical rehabilitations with fixed prosthesis.
A study of this kind would help to clarify which
teeth require rehabilitation most often. Literature
on this subject, namely on identifying the involved
teeth, is limited.
The majority of the available literature defends
that the most common region for fixed prostheses is
the upper arch. Fejérdy et al. reported that canines
of both jaws were the teeth most frequently used
for placing abutments. Valderhaug et al. stated that
there is no significant difference between the left
and the right side of the upper and lower arches
(Fejérdy et al., 2007; Valderhaug et al., 1976).
Accounting all these studies, we can conclude
that one of the most usually replaced teeth is the
premolar, in both the upper and the lower jaw.
However, neither of these studies had the goal of
improving the educational curriculum.

1
 The aim of this study is to quantify and com- Table 1. Types of fixed prosthetic restorations by
pare the types of teeth that most frequently require period of years.
rehabilitation with crowns and fixed bridges per-
formed by undergraduate students in Fixed Pros- Prepared Total of
Prepared bridge prepared
thodontics’ clinical appointments at FMDUP, in crowns abutments teeth
two different decades (1990–1994 and 2010–2014), Period (N) (N) (N)
and define new goals for the pre-clinical practice.
1990–1994 83 86 169
2010–2014 91 97 188
2 MATERIAL AND METHODS Total 174 183 357

This study is based on the reports of clinical treat-

ments performed within the subject “Fixed Pros- Table 2. Prepared teeth by arch, quadrant and year.
thodontics” by final-year undergraduate students
in FMDUP, that describe in detail the treatments Molars Premolars Canines Incisors
given to the patients. These treatments were in due
Upper arch R L ST R L ST R L ST R L ST T
time assessed by teaching staff.
We conducted a retrospective review of two- 1990–1994 8 8 16 13 16 29 8 9 17 32 31 63 125
hundred patient reports, equally divided into two 2010–2014 10 11 21 25 21 46 11 16 27 30 32 62 156
samples from two distinct periods: the reports Sub-Total 37 75 44 125
of the first sample were collected from FMDUP
files of the subject “Fixed Prosthodontics” from Molars Premolars Canines Incisors
the period between 1990 and 1994, in alphabeti- Lower arch R L ST R L ST R L ST R L ST T
cal order, and the reports of the second sample
were the last hundred cases of the current subject 1990–1994 13 12 25 8 8 16 1 1 2 0 1 1 44
“Fixed Prosthodontics” from FMDUP, covering 2010–2014 5 4 9 5 7 12 3 4 7 2 2 4 32
the period between 2010 and 2014. In both peri- Sub-Total 34 28 9 5
ods of time the patients’ gender was taken into
Total 71 103 53 130 357
account, considering the total number of patients
treated within the subject “Fixed Prosthodontics”. R – Right; L – Left; St – Subtotal; T – Total.
The analyzed data was recorded on a Microsoft
Excel database. Then, comparative analysis was
conducted, taking into consideration the following type of fixed prosthesis was bridge abutments in
parameters: age, type of fixed prosthodontics reha- both periods. Between the two periods (1990–1994
bilitation, and prepared teeth. All cases whose data and 2010–2014), no significant (p < 0.05) varia-
was incomplete or that involved implant support tion was found between the number of crowns and
were excluded. abutments prepared.
Statistical analyses included the Chi-Square test
and Fisher’s exact test, at a significance level of 3.2 Prepared teeth
95%, using the Software Statistical Package for the
Social Sciences (SPSS), version 22.0 (IBM SPSSS, Table 2 presents the number of prepared teeth by
Chicago, Illinois, USA). arch, quadrant, and period. Most of the 357 pre-
pared teeth were from the upper jaw (N = 281,
79%). The most frequently prepared upper teeth
3 RESULTS were incisors (N = 125, 44%), followed by premolars
(N = 75, 27%), canines (N = 44, 16%), and molars
The study focused on 100 patients with fixed pros- (N = 37, 13%). Regarding the lower jaw, the most
thesis rehabilitations performed between 1990 and frequently prepared teeth were molars (N = 34,
1994, and on 100 patients with the same treatment 44%), followed by premolars (N = 28, 37%), canines
between 2010 and 2014. In both periods, 40% (N = 9, 12%), and incisors (N = 5, 7%).
of the patients were male (n = 40) and 60% were A comparison between the two studied periods
female (n = 60). shows that there was an increase in the number of
prepared upper molars, premolars and canines. Con-
cerning lower teeth, a decrease in the preparation
3.1 Type of fixed rehabilitation of molars and premolars was observed. The great-
The 357 rehabilitations (169 in 1990–1994 and est increase was found in the number of prepared
188 in 2010–2014) were divided into two groups: premolars and canines, and the greatest decrease was
crowns and abutments (Table 1). The most common registered in the number of prepared molars.

2
 A statistically significant correlation was found
between each period and type of prepared teeth in
the lower jaw (p<0.0005). In the period between
1990 and 1994 the most frequently prepared teeth
were molars, while in the 2010–2014 period were
incisors, canines and premolars (p = 0.011). No
significant variation was observed amongst quad-
rants (p = 0.894).
4 DISCUSSION
In a review article about oral rehabilitation across
thirteen European countries published in 2007,
Zitzmann et al. concluded that half of the Euro-
pean population had some type of oral rehabili-
tation (fixed or removable), which is less common
in countries where the GDP (Gross Domestic
Product) is lower, despite the need of rehabilita-
tion being higher. They also found that, at younger
ages, and if the number of missing teeth was
smaller, the likelihood of rehabilitation with fixed
prosthesis was greater. Furthermore, the frequency
of rehabilitation with implants had increased, but
it was still low. These results are consistent with
those obtained in the study by Battistuzzi et al. in
1987, where they also referred that molars were the
first teeth to be lost in all socio-economical classes
(Zitzmann et al., 2007; Battistuzzi et al., 1987).
Valderhaug et al. reported that fixed prosthe-
sis rehabilitation in the maxilla represented 74%
of all, with no difference between right and left
sides. They also indicated that upper incisors and
premolars represented almost 70% of all abutment
crowns. Moreover, they found that upper first
premolars were the teeth most frequently replaced
with bridges. The canines were the teeth most
commonly replaced with abutments in both jaws
(Valderhaug et al., 1976).
In our study, the most frequently prepared
upper teeth were the anterior ones in both periods,
since about half of the rehabilitations involved the
incisors and nearly 87% (N = 109 in 1990–1994
and N = 135 in 2010–2014) of the total number of
fixed prosthesis placed in the upper arch involved
incisors, canines, and premolars. These teeth are
more exposed in the smile, having great aesthetic
and social importance, and thus this region has
highly aesthetical and functional requirements.
Our results are consistent with those obtained by
Valderhaug (Valderhaug et al., 1976).
The results of our study show no significant dif-
ference between quadrants, which is in agreement
with the results of Fejérdy et al.
We also did not find significant differences
between periods, with the exception of the lower
jaw. In the lower arch, the teeth most frequently
involved in rehabilitations were premolars and
3
molars. These results are close to those published in
by other authors (Fejérdy et al., 2007; Näpänkan-
gas et al., 2001; Al-Rafee et al., 1996; Barrero
et al., 2015).
However, this finding was not as significant in
the period of 2010–2014, having the number of
prepared molars and premolars decreased between
the two periods (twenty-five to nine molars and
sixteen to twelve premolars). These statistically
significant results may be related to the decreas-
ing early loss of first molars due to decay, possibly
explained by the increasing rates of oral hygiene in
the Portuguese population. Another explanation
may be the introduction of implantology in prac-
tice classes of master degrees in FMDUP, which is
now the first choice for replacing molars.
In the 2010–2014 period, the most frequently
prepared mandibular teeth were canines. This can
be explained by the fact that canines are commonly
used for abutments in fixed rehabilitations due to
being strong teeth that have a long root with a very
powerful bone implantation.
Bridges abutments preparations were more
frequent although we did not find a significant
difference between them and single crown prepa-
ration. This finding could be unexpected due to
the introduction of implantology in the university
clinical practice. Many factors can be pointed out
like the exclusivity clinical learning of implantol-
ogy in postgraduate education or some published
evidence on the survival rates between implants vs
bridges pointing out that bridges could give a bet-
ter longevity (Müller et al., 2008; Holm-Pedersen
et al., 2008).
Fejérdy et al. reported that, in Hungary, the
teeth that were most often used as abutments for
fixed prosthesis were canines in both jaws. They
also referred that the most often replaced teeth
in the maxilla were premolars, and in the mandi-
ble were first molars and second premolars. They
found no significant differences between the right
and the left side (Fejérdy et al., 2007).
Näpänkangas et al., regarding metal-ceramic
bridges in the Finnish population, concluded
that more fixed prosthesis had been prepared in
the upper arch than in the lower arch. The most
often replaced teeth were first premolars, followed
by upper lateral incisors and lower first molars
(Näpänkangas et al., 2001).
Al-Rafee et al. and Leempoel et al., in stud-
ies regarding bridges conducted in Saud Arabia
and The Netherlands, respectively, reported that
more bridges were placed in the maxilla, and that
lower first molars were the teeth that needed to be
replaced most often. The most common places for
abutments were the maxillary second premolars
and the mandibular second premolars and second
molars (Al-Rafee et al., 1996; Leempoel et al., 1989).
 Our study on prepared teeth cannot be easily
compared to other studies, since we included all
preparations and not only abutments of bridges.
Our primary objective was to understand which
teeth required a more intensive training of under-
graduate students. However, the results seem to
be close to those obtained by Valderhaug et al.,
regarding the maxilla, and to those obtained by
Al-Rafee et al. or Müller et al. concerning the
mandible (Valderhaug et al., 1976; Al-Rafee et al.,
1996; Müller et al., 2008).
In this study, it was also clear that fixed pros-
theses performed in FMDUP involved mainly the
upper teeth. This trend has slightly increased, since
the use of upper teeth surpassed 82% in the 2010–
2014 period. These results are consistent with
those obtained by Barrero et al. It seems clear that
the predominant use of upper teeth, and, amongst
these, the anterior ones, is related to the higher
aesthetic demands of this region (Holm-Pedersen
et al., 2008; Barrero et al., 2015).
Another interesting point is the fact that the
number of preparations involving every type of teeth
of the upper jaw remained constant or increased in
the 20-year period between the two samples.
Thus, it seems that pre-clinical teaching of the
dental preparation technique in the upper arch
should focus on all teeth. Regarding the lower jaw,
currently, premolars are the teeth whose prepa-
ration technique should have a more intensive
training.
5 CONCLUSION
The study on the rehabilitation of fixed prosthesis
on teeth performed by undergraduate students in
FMDUP patients in the periods of 1990–1994 and
2010–2014 lead us to conclude that:
− Tooth preparations for fixed bridge rehabilita-
tion were slightly more common than for single
crowns;
− No difference was observed between right and
left quadrants;
− The most frequently prepared teeth were the
maxillary ones, and between periods (1990–1994
4
and 2010–2014) the number of prepared maxil-
lary teeth remained constant or increased;
− In the lower jaw, we observed a significant dif-
ference between the two periods. The most fre-
quently prepared teeth in the 1990–1994 period
were the molars, while during the 2010–2014
period were the canines and premolars;
− Pre-clinical practical teaching should focus on
all of the upper teeth and on lower canines and
premolars.
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Al-Rafee MA, Fayyad MA. Failure of dental bridges.
Age and sex of patients and distribution of replaced
and abutment teeth. J Oral Rehabil 1996; 23: 280–282.
Barrero C, Duqum I, Petrola F. Dental students’ per-
ceived preparedness to treat patients in clinic after a
fixed prosthodontics course: survey results of a case
study. J Dent Educ 2015: 79(4) p 409–16.
Battistuzzi P, Kayser A, Peer P. Tooth loss and remaining
occlusion in a Dutch population. J Oral Rehabil 1987;
14: 541–547.
Brand HS, Kamell H, Kharbanda AK, et al. Students’
perceptions of materials and techniques used at Euro-
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dontics. J Dent Educ 2013; 77(9): 1140–6.
Fejérdy P, Tollas OL, Fejérdy L, et al. Monitoring trends
in fixed partial denture design based on national sur-
veys. Fogorv Sz 2007; 100(6): 279–88.
Holm-Pedersen P, Lang NP, Müller F. What are the lon-
gevities of teeth and oral implants? Clin Oral Implants
Res. 2008;19(3): 326–8.
Müller F, Naharro M, Carlsson GE. What are the preva-
lence and incidence of tooth loss in the adult and eld-
erly population in Europe? Clin Oral Implants Res.
2008; 19(3): 326–8.
Näpänkangas R, Salonen MA, Raustia AM. Treat-
ment need for fixed metal ceramic bridge prostheses
in patients treated by dental students in 1984–1996.
J Oral Rehabil. 2001; 28(12): 1101–5.
Scott J. Dental education in Europe: the challenges of
variety. J Dent Educ 2003; 67(1): 69–78.
Valderhaug J, Karlsen K. Frequency and location of arti-
ficial crowns and fixed partial dentures constructed at
a dental school. J Oral Rehabil 1976: 3(1): 75–81.
Zitzmann NU, Hagmann E, Weiger R. What is the preva-
lence of various types of prosthetic dental restorations
in Europe? Clin Oral Impl Res 2007; 18: 20–33.
 Biodental Engineering IV – Natal Jorge et al. (Eds)
© 2018 Taylor & Francis Group, London, ISBN 978-1-138-05737-1

Degradation of dental implant systems after immersion in therapeutic gels

G.M.P. Juanito, M.S. Araujo, R.S. Magini & J.C.M. Souza

Post-graduate Program in Dentistry (PPGO), Center for Research on Dental Implants (CEPID),
Federal University of Santa Catarina (UFSC), Florianópolis/SC, Brazil

M.E.R. Dotto
Department of Physics, Federal University of Santa Catarina (UFSC), Florianópolis/SC, Brazil

F.S. Silva & B. Henriques

Department of Mechanical Engineering (DEM), Center for MicroElectromechanical Systems (CMEMS),
University of Minho, Guimarães, Portugal

ABSTRACT: The aim of this study was to evaluate the changes on implant-abutment surfaces after
immersion systems in 2% chlorhexidine or 1% citric acid. Implant-abutment systems were embedded in
epoxy resin and cross-sectioned at delimited areas to be immersed in 2% Chlorhexidine (CG) or 1% Citric
Acid (CAG) Gel for 4 and 2 min, respectively. The surfaces were analyzed by profilometry and Scanning
Electron Microscopy (SEM). SEM analysis revealed changes on the test surfaces after immersion in chlo-
rhexidine or citric acid. Signs of corrosion were more evident for CAG. Before immersion, Ra roughness
mean values were at 0.035 μm for GC implant and at 0.022 μm for GC abutment; while Ra mean values
were at 0.038 μm for CAG implant and 0.016 μm for CAG abutment. After immersion, Ra roughness
mean values were at 0.041 μm for GC implant and 0.033 μm for GC abutment; while Ra mean values were
at 0.49 μm for CAG implant and 0.031 μm for CAG abutment. All groups showed statistically significant
differences when compared (p < 0.05). It was concluded that both gels applied caused change on dental
implant systems being more intense when immersed in 1% citric acid.

1 INTRODUCTION peri-implant tissue and continuing with decon-

Currently, titanium and its alloys have been the
most biomaterial used in the production of den-
tal implants systems. (Ungvári et al., 2010). The
corrosion resistance of titanium depends on
the composition and environmental conditions,
including temperature, pH and concentration
of reactive ions. (Nakagawa et al., 1999; Naka-
gawa, Matsuya, Udoh, 2001; Souza et al., 2012;
Faverani et al., 2014). However, changes can occur
on titanium surfaces leading to ions release to
peri-implants tissues. That can stimulate migra-
tion of immune cells and induce peri-implant
inflammatory reactions. (Sjögren, Sletten, 2000;
Brogginni et al., 2006, Juanito GMP, et al. 2015).
These inflammatory reactions induce the devel-
opment of mucositis and perimplatitis. Perim-
plantitis is characterized by inflammation and
continued loss of integrated bone around the
implant associated a biofilm. Clinician proce-
dures are used commonly for mechanical and
chemical treatment for those pathologies concern-
ing the surgical procedure is a complex process,
starting with surgical debridement of devitalized
tamination of the exposed implant surface. The
implant surface can be cleaned by mechani-
cal (an air-powder abrasive) or chemical (citric
acid, H2O2, chlorhexidine digluconate (CHX) or
EDTA) procedures or with laser irradiation (CO2,
diode, Er:YAG or Nd:YAG). Chemical, mechani-
cal, and laser treatments can be used to remove
the biofilms adhered to the implant surface (Sub-
ramani and Wismeijer; 2012; Kamel et al. 2013).
Chemical treatments typically applied for debri-
dement of contaminated surfaces include citric
acid, tetracycline, saline, chlorhexidine, hydrogen
peroxide, tetracycline, and doxycycline (Finnegan
et al. 2010; Gosau et al. 2010; Valderrama et al.
2014). Solutions with a low pH and/or high
fluoride concentrations can modify the titanium
surface by destroying the titanium oxide layer,
resulting in release of ions and debris into the sur-
rounding medium (Huang 2002; Rodrigues et al.
2009; Sartori et al. 2009; Bhola et al. 2011, Souza
et al. 2012). These acidic treatments can inhibit
repassivation of the oxide layer, which can result
in progressive corrosion, (Rodrigues et al. 2013;
Schwarz et al. 2013; Souza et al., 2012).

5
 However, the titanium surface behavior in con- Different areas within the critical zone were
tact with some substances used in the treatment of inspected at magnification ranging from 1000 to
perimplantitis is not entirely understood in the lit- 2000 X at 10 kV.
erature. Therefore, such potential titanium degra-
dation risk should be clarified, revealing the effects 2.3 Topographic analysis by optical profilometry
of these common therapeutic procedures in dental
clinical practice for patients with oral rehabilita- The roughness of the abutment and the dental
tions implant supported. implant was analyzed using optical profilometry
The aim of this study was to evaluate the changes (DektakXT Profilometer, Germany) at three six
on implant-abutment surfaces after immersion in different areas within the critical zone in all sam-
two therapeutic gels, namely 2% chlorhexidine or ples (n = 18). For optical profilometry, the following
1% citric acid. parameters were considered: length measurement
at 2 mm, cut off at 0.25 mm and speed of 30s
before and after immersion in both gels.
2 MATERIALS AND METHODS The roughness values were obtained regard-
ing Ra roughness parameter that consists in the
2.1 Sample preparation arithmetic mean value between the peak and valley
height values in the effective roughness profile.
Dental implant systems (Titamax, Neodent®,
Curitiba, Brazil) were used in this study. Abut-
ments were torqued at 15 Ncm on their respec- 2.4 Statistical analysis
tive implants using a Lutron digital torquemeter Results were statistically analyzed by analysis t-stu-
(Lutron TQ8800, Taiwan). Then, the abutment- dent test, at a significance level of p < 0.05 by using
implant assemblies were embedded in acrylic resin the SPSS 17.0 software.
(Technovit 7200 VLC. Kulzer, Wehrheim, Ger-
many) and cross-sectioned along the vertical axis
of the implant using a precise cutting machine 3 RESULTS
(Isomet 1000, Germany).
The cross-sectioned samples were wet ground 3.1 Morphological analysis of cross-sectioned
down to 2400 Mesh using silicon carbide sandpa- areas
pers followed by polishing with alumina particles
Micrographs of cross-sectioned areas obtained by
(1 and 0.03 μm at diameter). After that, the samples
SEM revealed scratches from sample preparation
were ultrasonically cleaned in isopropyl alcohol for
by grinding and polishing (Fig. 1).
10 min, and then in distilled water for 5 min.
The micrographs obtained after immersion
The cross-section method allowed the analysis
in chlorhexidine did not show clear signs of the
along the implant-abutment connection by micros-
abutment implant system degradation, although a
copy and profilometry.
slight change was noted on the surfaces (Fig. 2).
After preparation, samples were divided into
Samples immersed in a 1% citric acid revealed
two groups, for all samples, an area has been
significantly greater changes when compared with
selected (0.8 × 0.8) mm at the level of critical
abutment region and implant considering the
interaction of substances. The delimited area was
analyzed after contact with the solutions accord-
ing to the specifications suggested in the literature
(Ungvári et al., 2010) for chemical disinfection.
A group of samples was immersed in 2% chlo-
rhexidine gel for 4 min (group CG) and another
one (group CAG) was immersed in 1% citric acid
for 2 min. After ultrasonic cleaning, the surfaces
were analyzed again by profilometry and scanning
electron microscopy (SEM).

2.2 Topographic analysis by Scanning Electron

Microscopy (SEM)
Before and after immersion in chlorhexidine and
citric acid gels, the samples were analyzed by scan-
ning electron microscopy (JEOL-JSM, model
T-330 A).
Figure 1. SEM images of implant and abutment sur-
faces before immersion in chlorhexidine (left column)
and citric acid (right column) gels.

6
the results obtained after immersion in chlorhexi- Chlorexidine Group Ra roughness h1m)
dine. Morphological aspects resultant from degra- (Jlm)
dation by corrosion were noticed on the surfaces ,041
,045
immersed in 1% citric acid, mainly on the implant
region (Fig. 3). ,040

,035

,030
3.2 Roughness analysis by optical profilometry
,025
The mean values of Ra roughness for implant and ,020
abutment before and after immersion in 2% chlorhex- ,015
idine and 1% citric acid are shown in Figures 4 and 5. ,010
Before immersion in chlorhexidine, the mean ,005 Before
values of Ra roughness for implant and abut- ,000 • After
Abutment
ment surfaces were different due to the grinding Implant

and polishing on abutment and implant structural

materials.
In fact, abutment is composed of Ti6Al4V while
implant is composed of commercially pure tita-
nium that reveals different hardness values.
Figure 4. Ra roughness (μm) mean values for implant
and abutment, before and after immersion in 2%
chlorhexidine.
Citric Acid Group Ra roughness (J.lm)

(Jlm)
,050

,045

,040

,035

,030

,025

,020

,015

,010

,005 • Before

•After
,000 Implant Abutment

Figure 5. Ra roughness (μm) mean values for implant

Figure 2. SEM images of implant and abutment sur-
faces after immersion in 2% chlorhexidine.
Figure 3. SEM images of implant and abutment sur-
faces after immersion in 1% citric acid.
and abutment, before and after immersion in 2%
chlorhexidine.
However, the results revealed an increase in Ra
roughness for both implant and abutment (Table 1
and Fig. 4) after immersion in 2% chlorhexidine.
The mean values of Ra roughness recorded
before and after immersion in 1% citric acid (CAG)
are shown in Figure 5. These Ra values were higher
when compared with those on chlorhexidine group
(CG), corroborating with morphological aspects
noticed on SEM images (Table 2).
In this study, changes on titanium implant and
abutment surfaces were noticed by SEM and pro-
filometry analyses after immersion in therapeutic
gels.
Such findings were corroborated by the results
shown in a previous study (Faverani et al., 2014),
which tested 0.12% chlorhexidine for longer peri-
ods of time (from 7 up to 14 days) simulating
the post-operative daily prescription with chlo-
rhexidine rinses after surgery implant placement.
Faverani et al. (2014) also observed a statistically

7
Table 1. Statistical analysis of the results on Ra rough- citric acid or 2% chlorhexidine. We can conclude
ness (μm) before and after immersion in 2% chlorhexi- that there were changes on the surface of the den-
dine (CG). tal implant systems after both gels; although, signs
of corrosion were clearly detected after immersion
Mean (μm) Std. deviation p
in 1% citric acid.
CG Abutment 0.022 0.0013 <0.05 Roughness slightly increased on the implant
before surface after immersion in 2% chlorhexidine for
CG Abutment 0.033 0.0078 5 min. However, chlorhexidine gel can adhere to
after the surface of the titanium; leading to changes in
CG Implant 0.035 0.0087 <0.05 the roughness.
before Considering the changes observed on the sur-
CG Implant 0.041 0.012 face of the samples, the clinician should be aware
after on the application timer of chlorhexidine or citric
acid in contact with titanium-based dental implant
systems.
Table 2. Statistical analysis of the results of Ra rough-
ness (μm) before and after immersion in 1% citric acid.
REFERENCES
Mean (μm) Std. deviation p
Bhola, R., Bhola, S.M., Mishra, B. & Olson, D.L. (2011)
CAG Implant 0.038 0.0087 <0.05
Corrosion in titanium dental implants/prostheses
before
—a review. Trends in Biomaterials and Artificial
CAG Implant 0.05 0.012 Organs 25: 34–46.
after Broggini N, McManus LM, Hermann JS, Medina R,
CAG Abutment 0.016 0.011 <0.05 Schenk RK, Buser D, Cochran DL. (2006). Peri-
before implant Inflammation Defined by the Implant-
CAG Abutment 0.031 0.0178 Abutment Interface. J Dent Res, 85: 473–478.
after Faverani, Leonardo Perez et al. Corrosion kinetics and
topography analysis of Ti-6Al-4V alloy subjected
to different mouthwash solutions. Materials Science
and Engineering C, Filadélfia, v. 43, n. 1, p. 1–10,
significant increase in the roughness values of the jul. 2014.
samples after immersion in such solution. Finnegan, M., Linley, E., Stenyer, S.P., Mcdonnell, G.,
It should be highlighted that our study tested Simons, C. & Maillard, J.Y. (2010) Mode of action
the effect of a commercial chlorhexidine gel form of hydrogen peroxide and other oxidizing agents:
which is more viscous and difficult to remove differences between liquid and gas forms. Journal of
after rising or ultra-sonic bath concerning a clini- Antimicrobial Chemotherapy 65: 2108–2115.
Gosau, M., Hahnel, S., Schwarz, F., Gerlach, T., Reichert,
cal procedure. The roughness values found for the T.E. & Burger, R. (2010) Effect of six different peri-
GC samples can thus be assigned to a substance implantitis disinfection methods on in vivo human
impregnating the surface of the samples. There are oral biofilm. Clinical Oral Implants Research 21:
previous reports that the chlorhexidine, has the 866–872.
capability to adhere to the titanium oxide layer, Huang, H. (2002) Effects of fluoride concentration and
thereby changing the surface of the implant (Meyle, elastic tensile strain on the corrosion resistance of
2012). Other authors reported the same difficulty commercially pure titanium. Biomaterials 23: 59–63.
in detaching the solution, and also believe that Kamel, M.S., Khosa, A., Tawse-Smith, A. & Leichter, J.
small changes found in samples immersed in the (2013) The use of laser therapy for dental implant sur-
face decontamination: a narrative review of in vitro
solution can be attributed to incomplete removal studies. Lasers in Medical Science 29: 1977–1985.
from the titanium surface (Faverani et al., 2014). Meyle, Joerg. Mechanical, chemical and laser treatments
Another previous study used the form and timer of the implant surface in the presence of marginal
for chlorhexidine application similar to that in the bone loss around implants. Eur J Oral Implantol,
present study (gel, applied for 5 min) and found no Londres, v. 5, n. 5, p. 71–81, 2012.
statistically significant difference in roughness of Nakagawa M, Matsuya S, Shiraishi T, Ohta M. Effect of
the samples before and after contact with the gel fluoride concentration and pH on corrosion behav-
tested (Ungvari et al., 2010). ior of titanium for dental use. J Dent Res 1999; 78:
1568–72.
Nakagawa M, Matsuya S, Udoh K. Corrosion behavior
of pure titanium and titanium alloys in fluoride-
4 CONCLUSIONS containing solutions. Dent Mater J 2001; 20: 30514.
Rodrigues, D.B., Urban, R.M., Jacobs, J.J. & Gilbert,
This study evaluated the surface modification of J.L. (2009) In vivo severe corrosion and hydrogen
implant-abutment systems in contact with 1% embrittlement of retrieved modular body titanium

8
 alloy hip-implants. Journal of Biomedical Materials
Research Part B 88: 206–219.
Rodrigues, D.B., Valderrama, P., Wilson, T.G., Palmer,
K., Thomas, A., Sridhar, S., Adapalli, A., Burbano,
M. & Wadhwani, C. (2013) Titanium corrosion
mechanisms in the oral environment: a retrieval
study. Materials (Basel) 6: 5258–5274.
Sartori, R., Correa, C.B., Marcantonio, E. & Vaz, L.G.
(2009) Influence of a fluoridated medium with dif-
ferent pHs on commercially pure titanium-based
implants. Journal of Prosthodontics 18: 130–134.
Schwarz, F., Hegewald, A., John, G., Sahm, N. & Becker,
J.L. (2013) Four-year follow-up of combined surgi-
cal therapy of advanced peri-implantitis evaluating
two methods of surface decontamination. Journal
of Clinical Periodontology 40: 962–967.
Sjögren, LDS, Sletten, Jon E. Cytotoxicity of dental
alloys, metals, and ceramics assessed by Millipore fil-
ter, agar overlay, and MTT tests. Scandinavian Insti-
tute of Dental Materials, Haslum, Norway, 2000.
Souza JCM, Barbosa SL, Ariza E, Celis J-P, Rocha LA.
Simultaneous degradation by corrosion and wear
9
of titanium in artificial saliva containing fluorides.
Wear. 2012 292: 82–88.
Souza JCM, Henriques M, Oliveira R, Teughels W, Celis
JP, Rocha LA. Do oral biofilms influence the wear
and corrosion behavior of titanium? Biofouling.
2010; 26(4): 471–478.
Subramani, K. & Wismeijer, D. (2012) Decontamination
of titanium implant surface and re-osseointegration
to treat peri-implantitis: a literature review. Inter-
national Journal of Oral Maxillofacial Implants 27:
1043–1054.
Ungvári K, Pelsöczi IK, Kormos B, Oszkó A, Rakonczay
Z, Kemény L et al. Effects on titanium implant sur-
faces of chemical agents used for the treatment of
peri-implantitis. J Biomed Mater Res B Appl Bio-
mater. 2010; 94(1): 222–9.
Valderrama, P., Blansett, J., Gonzalez, M.G., Cantu,
M.G. & Wilson, T.G. (2014) Detoxification of
implant surfaces affected by peri-implant disease:
an overview of non-surgical methods. Open Dental
Journal 8: 77–84.
 Biodental Engineering IV – Natal Jorge et al. (Eds)
© 2018 Taylor & Francis Group, London, ISBN 978-1-138-05737-1

Novel strategies for the enhancement of zirconia behavior

R.S.F. Pereira, B. Henriques & M.C. Fredel

CERMAT, Universidade Federal de Santa Catarina, Florianópolis, Brazil

F.S. Silva
MEMS, Universidade do Minho, Guimarães, Portugal

ABSTRACT: Zirconia is widely used as ceramic material, mainly because of its high mechanical prop-
erties, accounted by a martensitic phase transformation. However, a combination of events can affect
zirconia properties, reducing and making hard to predict its lifetime under wet environments. To prevent
this behavior some strategies have been developed, including using new materials and new processing
techniques. This document will give a brief explanation about zirconia-based materials and the future of
this oxide ceramic as material for dental applications.

1 INTRODUCTION Because of the danger related to LTD of zirco-

The need for metals substitution in human body
has lead to an increase in zirconia interest, encour-
aging new strategies to develop products using this
material.
As well described in literature, zirconia based
biomaterials have some advantages when com-
pared with titanium alloys, such as: high tensile
strength (up to 1500 MPa), whiteness and high
biocompatibility. Even compared with other bioce-
ramics, like alumina, its relatively low Young’s
modulus (∼200 GPa) and high fracture toughness
(up to 15 MPa√m), make zirconia a good choice
to human body applications (Basu 2005; Miyazaki
et al. 2013; Palmero et al. 2016; Chevalier 2006).
Fracture toughness and tensile strength are
both related to the same toughening mechanism,
which is responsible to inhibit crack propagation,
called transformation toughening. In this phenom-
enon, a metastable phase (tetragonal) is exposed
to a mechanical stress concentration. This stress
is enough to causes a phase change from tetrago-
nal to monoclinic, leading to a volume expansion,
about 4%, which causes compression stress on the
tip of the crack, stopping it.
However, even exhibiting great mechanical
properties, in-service catastrophic failure events of
zirconia hip prostheses have been reported in late
1990’s (Chevalier 2006; Chevalier et al. 1999). This
event was addressed to an unexpected behavior
for low temperatures, able to decrease mechanical
properties of the material (Chevalier et al. 1999).
For this reason, the phenomenon is known as Low
Thermal Degradation (LTD) or also referred as
aging.
nia based ceramics, a lot of studies were performed
showing that the key for this phenomenon is water,
which causes oxygen diffusion into the material
(Chevalier et al. 2007; Chevalier et al. 2009; Schu-
bert & Frey 2005). This oxygen causes stresses in
the zirconia lattice, promoting a phase transforma-
tion without an external mechanical load.
However, notwithstanding the concern with
failures in orthopedic applications, the use of these
materials is substantially growing in the dentistry
field (Fornabaio et al. 2015), mainly in the pro-
duction of all ceramic restorations using yttria
stabilized tetragonal zirconia policrystals (Y-TZP)
(Denry & Kelly 2014).
2 STRATEGIES TO AVOID AGING
Yttrium is a trivalent metal when bonded with
oxygen while zirconium is tetravalent. When the
oxide of the former is used to stabilize the tetrago-
nal phase of zirconia, an oxygen unbalancing is
caused, and vacancies are generated. This dif-
ference in valences allied to the metastability of
tetragonal phase, makes only yttria stabilized zir-
conia to show significant aging behavior (Forna-
baio et al. 2015; Palmero et al. 2016).
However, other oxides such as magnesia, calcia
and ceria, can also be used to stabilize tetragonal
phase with the advantage of not generating signifi-
cant amount of oxygen vacancies thus, showing
almost no aging (Fornabaio et al. 2015; Chevalier
2006).
Nevertheless, the mechanical strength exhibited
by zirconia stabilized by higher contents of yttria

11
(>3 mol.%) or by other stabilizers might be signifi-
cantly reduced. Ceria, for instance, can stabilize
the tetragonal phase of zirconia with still appreci-
ated fracture toughness and without aging sensitiv-
ity, Figure 1 (Palmero et al. 2016; Fornabaio et al.
2015; Chevalier 2006).
Hence, there are nowadays three main ways to
avoid zirconia aging:
Yttria fully stabilized microstructure modifi-
cation, using precipitates as alumina, to obtain
small microstructural grains and, as a conse-
quence, ceramic-ceramic composite materi-
als. This approach was mainly used to improve
mechanical properties of hip implants, with the
drawback, for oral applications, of increasing the
Young’s Modulus of the composite (Tebaldo &
Gautier 2013; Perrichon et al. 2016; Nevarez-
Rascon et al. 2009).
Dopant changing, where the mainly challenge
is to obtain good mechanical properties with- Figure 2. Composite of 3 mol.% yttria stabilized zirco-
nia and alumina [13].
out using yttrium oxide (yttria). Here two oxides
have been shown good potential: Cerium oxide
(ceria), with studies coming from hip materials
designs; and magnesium oxide (magnesia), where
a partially stabilized microstructure gives inter-
esting aesthetics along with suitable mechanical
properties to use as crowns (Palmero et al. 2016;
Fornabaio et al. 2015).
Avoid the Y-TZP contact with water, or mois-
ture, by a surface protection layer, using glass
or a codopant, for example, in the surface of
the piece (Marro et al. 2011; Camposilvan et al.
2015). The challenge in this approach is to cre-
ate a homogeneous layer with good mechani-
cal properties, considering that cracks start to
propagate from the surface and that it may dra-
matically impact the mechanical strength of the
materials.

Figure 3. Ceria stabilized zirconia composite [3].

LTD
1400

'
NO LTD
1200

m-
a.
~ 1000
.c
c;,
c:
~ 800
u;

600

400
5 9 10 11 12 13 16
Toughness (MPa" m)

Figure 1. Different ceria stabilized zirconia materials in

comparison with classical 3 mol.% yttria stabilized zirco- Figure 4. Layer of ceria-stabilized zirconia upon a
nia (Adapted from [3]). 3 mol.% yttria stabilized zirconia framework.

12
3 FUTURE TRENDS
As zirconia is still being one of the most reliable
ceramics, in terms of fracture toughness (KIC), and
its properties are also really appreciated, one may
foresee further improvements based on the strate-
gies previously described, with more studies being
conducted.
Thinking about dental applications, is possible
to split the material requirements in two different
categories: the ones with aesthetical demands and
the others that do not.
In the first one, where dental prosthesis is the
main example, the challenge is how to obtain a
translucent zirconia without losing in mechanical
properties and aging resistance. Moreover, because
of such aesthetical requirements, is not possible
to use ceria as stabilizer, once it has a yellowish
color.
In these aesthetical applications (dental resto-
rations) is also usual to apply a porcelain veneer,
which masks the white color of zirconia. The
future in this application is go for monolithic zir-
conia restorations without a surface layer of glass
or feldspathic porcelain, once most of failures in
this prosthesis are regarded to fracture and exfo-
liation of the veneering material (Denry & Kelly
2014). Monolithic zirconia restorations, exhibiting
a gradient in translucency given by the presence of
different stabilizers over the volume of the zirconia
part is also being attempted.
The second category gives more freedom to
work with different zirconia based materials, once
no teeth—like color or translucency are required.
In this way, ceria stabilized zirconia is one of the
most promising materials, especially as a ceramic-
ceramic compound. Nevertheless, yttria stabilized
zirconia will be continuously investigated, espe-
cially to produce ceramic-ceramic composites,
which can have the highest strength for ceramic
materials.
As a component with higher mechanical
requirements than dental crowns, and also because
of their traumatic replacement, dental implants
need to be tested under compatible in-service con-
ditions, namely those where zirconia have shown
special problems: the LTD and subcritical crack
growth, which is like stress corrosion for some
oxides ceramics.
For both applications (aesthetical and mechani-
cal), it is likely that zirconia will be, in few years,
the gold standard material, replacing titanium
alloys and disilicates. However, to make it possi-
ble, researchers and scientists have to handle some
of the challenges previously reported, using new
materials and processing techniques.
13
REFERENCES
Basu, B., 2005. Toughening of yttria-stabilised tetrago-
nal zirconia ceramics. International Materials Reviews,
50(4): 239–256.
Camposilvan, E. et al., 2015. Acta Biomaterialia
Enhanced reliability of yttria-stabilized zirconia for
dental applications. Acta Biomaterialia, 17: 36–46.
Chevalier, J. et al., 2009. The tetragonal-monoclinic
transformation in zirconia: Lessons learned and
future trends. Journal of the American Ceramic Soci-
ety, 92(9): 1901–1920.
Chevalier, J., 2006. What future for zirconia as a biomate-
rial? Biomaterials, 27(4): 535–543.
Chevalier, J., Gremillard, L. & Deville, S., 2007. Low-
Temperature Degradation of Zirconia and Impli-
cations for Biomedical Implants. Annual Review of
Materials Research, 37(1): 1–32.
Chevalier, J., Olagnon, C. & Fantozzi, G., 1999. Subcriti-
cal crack propagation in 3Y-TZP ceramics: static and
cyclic fatigue. Journal of American Ceramic Society,
82(11): 3129–3138.
Denry, I. & Kelly, J.R., 2014. Emerging Ceramic-based
Materials for Dentistry. Journal of Dental Research,
93(12): 1235–42.
Fornabaio, M. et al., 2015. Zirconia-based composites
for biomedical applications: Role of second phases
on composition, microstructure and zirconia trans-
formability. Journal of the European Ceramic Society,
35(0): 4039–4049.
Marro, F.G. et al., 2011. Surface modification of 3Y-TZP
with cerium oxide. Journal of the European Ceramic
Society, 31(3): 331–338.
Miyazaki, T. et al., 2013. Current status of zirconia res-
toration. Journal of Prosthodontic Research, 57(4):
236–261.
Nevarez-Rascon, A. et al., 2009. On the wide range of
mechanical properties of ZTA and ATZ based dental
ceramic composites by varying the Al2O3 and ZrO2
content. International Journal of Refractory Metals
and Hard Materials, 27(6): 962–970.
Palmero, P. et al., 2015. Towards long lasting zirconia-
based composites for dental implants. Part I : Innova-
tive synthesis, microstructural characterization and in
vitro stability. Biomaterials, 50: 38–46.
Perrichon, A. et al., 2016. A testing protocol combining
shocks, hydrothermal ageing and friction, applied to
Zirconia Toughened Alumina (ZTA) hip implants.
Journal of the Mechanical Behavior of Biomedical
Materials, 65(July 2016): 600–608.
Schubert, H. & Frey, F., 2005. Stability of Y-TZP dur-
ing hydrothermal treatment: Neutron experiments
and stability considerations. Journal of the European
Ceramic Society, 25(9): 1597–1602.
Tebaldo, V. & Gautier, G., 2013. Influences of evalua-
tion methods and testing load on microhardness and
Young’s modulus of ZTA and ATZ ceramics. Ceram-
ics International, 39(3): 2683–2693.
 Biodental Engineering IV – Natal Jorge et al. (Eds)
© 2018 Taylor & Francis Group, London, ISBN 978-1-138-05737-1

Surface finishing in tooth preparation for fixed prosthodontics—

comparative study

E. Correia
DDS, Faculty of Dental Medicine of the University of Porto (FMDUP), Portugal

P. Rocha-Almeida & M.A. Sampaio-Fernandes

Fixed Prosthodontics, FMDUP, Portugal

P. Vaz
Fixed Prosthodontics, Medical and Orofacial Genetics, FMDUP, Portugal

C. Silva & J.C. Sampaio-Fernandes

Fixed Prosthodontics, FMDUP, Portugal

ABSTRACT: Tooth preparation for fixed prosthesis should take into account some principles in order
to obtain regular surfaces and smooth textures on the cervical surface. This way it will be possible to
achieve uniform prosthesis seating on the tooth structure and the best marginal adaptation, contribut-
ing to the fixed prosthesis durability. The surface regularization (that allows the surface finishing) may
be performed by different methods and instruments, which may show different results. Eleven teeth were
embedded in epoxy resin and finished with different instruments: ultrasonic tip, fine grain diamond burs
assembled to turbineand to a multiplier handpiece. The samples were analyzed with SEM and the results
subjected to Mann-Whitney test to determine statistical significance. The best results for this surface
preparation were obtained using fine grain diamond burs assembled to a multiplier handpiece or through
an ultrasonic tip.

1 INTRODUCTION buccal (I), lingual/palatal (III), mesial (IV) and

distal (II) faces (Fig. 1). The lingual/palatal (III)
Tooth preparation for fixed prosthesis should were left without finishing. The buccal (I) have
take into account some principles in order to been finished with an ultrasonic tip for veneer
obtain regular surfaces and smooth textures on preparation with fine grit, while the mesial (IV)
the cervical surface. This way it will be possible were finished with fine grain diamond burs assem-
to achieve uniform prosthesis seating on the bled to turbine. The distal (II) faces were finished
tooth structure and the best marginal adapta- with fine grain diamond burs assembled to a mul-
tion, contributing to the fixed prosthesis durabil- tiplier handpiece (1:5) (Fig. 2).
ity (Goodacre et al. 2001, Horne et al. 2001). The
surface regularization (that allows the surface
finishing) may be performed by different meth-
ods and instruments, which may show different
results (Horne et al. 2012, Ayad 2009, Ram et al.
2015).
This study aimed to compare the cervical finish-
ing lines of dental preparations according to differ-
ent motorized instruments.

2 MATERIAL AND METHODS

Eleven teeth were embedded in epoxy resin and

prepared with diamond coarse grain burs on the Figure 1. Teeth embedded in epoxy resin.

15

Figure 2. Surface finishing performed by different
instruments: A—multiplier handpiece, B—turbine, C—
ultrasonic tip.
Figure 3. Images of SEM of finishing surfaces with
three different methods: A—fine grain diamond bur
assembled to turbine (CEMUP SE x150 15kV WD = 15
mm), B—ultrasonic tip (CEMUP SE x150 15kV WD =
15 mm), C—fine grain diamond bur assembled to a mul-
tiplier handpiece (CEMUP SE x150 15kV WD = 15 mm)
and control group (D) (CEMUP SE x150 15kV WD =
15 mm).
Subsequently, the samples were coated with a
thin film of Au/Pd by sputtering, and images were
obtained by Scanning Electronic Microscope of
high-resolution X-Ray Microanalysis (JEOL JSM
6301F/Oxford INCA Energy 350), with magni-
fications of 150x. The images were evaluated by
five examiners and the results subjected to Mann-
Whitney test to determine statistical significance.
16
3 RESULTS AND DISCUSSION
Through the images obtained by scanning elec-
tron microscopy (SEM) was observed the cervical
surface morphology and performed an evaluation.
The obtained averages for each group were: group
I (Ultrasonic) = 6.89, group II (Multiplier Hand-
piece w/fine grain bur) = 6.90, group III (Control
Group) = 5.03 and group IV (Turbine w/fine grain
bur) = 6.07.
The obtained differences indicated that finish-
ing methods are all useful, however the multiplier
handpiece and ultrasound tip have more regu-
lar finishing then the turbine (Fig. 3), which is in
accordance with others investigations (Horne et al.
2012, Ellis et al. 2012). Between the multiplier
handpiece and ultrasound tip there were no statis-
tically significant differences (p = 0.939) regarding
the evaluation of cervical surfaces finishing.
4 CONCLUSIONS
The ideal tooth preparation requires a finishing
that renders an extremely regular cervical surface.
The best results for this surface preparation were
obtained using fine grain diamond burs assembled to
a multiplier handpiece or through an ultrasonic tip.
REFERENCES
Ayad, M.F. 2009. Effects of tooth preparation burs and
luting cement types on the marginal fit of extracoronal
restorations. Journal of Prosthodontics 18(2): 145–51.
Ellis, R., Bennani, V., Purton, D., Chandler, N. & Lowe, B.
2012. The effect of ultrasonic instruments on the qual-
ity of preparation margins and bonding to dentin. Jour-
nal of Esthetic and Restorative Dentistry 24(4): 278–85.
Goodacre JC, Campagni WV, Aquilino, SA. 2001. Tooth
preparations for complete crowns: An art form based
on scientific principles. J Prosthet Dent 85, 273–274.
Horne, P., Bennani, V., Chandler, N. & Purton, D. 2001.
Tooth preparations for complete crowns: an art form
based on scientific principles. The Journal of Pros-
thetic Dentistry 85(4): 363–76.
Horne, P., Bennani, V., Chandler, N. & Purton, D. 2012.
Ultrasonic margin preparation for fixed prosthodon-
tics: a pilot study. Journal of Esthetic and Restorative
Dentistry 24(3): 201–9.
Ram, H.K., Shah, R.J. & Agrawal, H.S. 2015. Evalua-
tion of three different tooth preparation techniques
for metal ceramic crowns by comparing preparation
depths: An in vitro study. Journal of Indian Prostho-
dontic Society 15(2): 162–7.
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The Project Gutenberg eBook of Knights and
their days
 This ebook is for the use of anyone anywhere in the United
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Title: Knights and their days

Author: Dr. Doran

Release date: November 16, 2023 [eBook #72142]

Language: English

Original publication: New York: Redfield, 1856

Credits: Alan, Susan Skinner and the Online Distributed

Proofreading Team at https://www.pgdp.net (This file
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*** START OF THE PROJECT GUTENBERG EBOOK KNIGHTS

AND THEIR DAYS ***
WIT AND WISDOM
OF THE
REV. SYDNEY SMITH:
BEING
SELECTIONS FROM HIS WRITINGS,
AND PASSAGES OF HIS
LETTERS AND TABLE TALK.
With Notes, and a Biographical Memoir,
By EVERT A. DUYCKINCK.
A Portrait, after G. Stewart Newton,
AND AN AUTOGRAPH LETTER.
In One Volume, 12mo, Cloth, Price $1.25.
Advertisement.
The chief writings of the Rev. Sydney Smith are included in the
original English editions in eight octavo volumes. These are his
“Two Volumes of Sermons,” 1809; the Collection of his “Works,”
(embracing articles from the Edinburgh Review, the Plymley
Letters, and other Papers) 4 vols., 1839-40; a posthumous
volume, “Sermons preached at St. Paul’s,” &c., 1846; “Elementary
Sketches of Moral Philosophy, delivered at the Royal Institution,”
published in 1850. To these are to be added, “Letters on American
Debts,” 1843; “A Fragment on the Irish Roman Catholic Church,”
1845; Letters on Railway Management and other topics to the
Morning Chronicle; Articles in the Edinburgh Review not collected
in his “Works”; numerous Sketches and Essays printed in the
“Memoirs,” by his daughter, Lady Holland; and the extensive
series of “Letters,” edited by Mrs. Austin. These have mainly
furnished the material of the present volume. In the preparation of
the Table Talk, Memoir, and Notes, many collateral sources have
been drawn upon.
The most important of Sydney Smith’s Writings will here be found
given entire; while the selection generally presents the most
characteristic passages of his “Wit and Wisdom” from the whole.
Numerous Miscellanies, of much interest, are included which are
not to be met with in any previous collection of the author’s works.
Contents.
Biographical Memoir, by the Editor.
Articles from the Edinburgh Review, (including the Papers
on Female Education, Professional Education, Notices of
America, &c., &c.)
Sketches of Moral Philosophy, (including the Essays on the
Conduct of the Understanding; on Wit and Humor, &c., &c.)
The Peter Plymley Letters.
Passages from Sermons.
Speeches on the Reform-Bill. The Ballot.
Letters on American Debts.
Passages from Letters on the Ecclesiastical Commission.
A Fragment on the Irish Roman Catholic Church.
Letters on Railway Management.
Character of Sir James Mackintosh and of Francis
Horner.
Practical Essays, &c.
Passages from Letters.
Table Talk. Personal, &c., &c.
DR. DORAN’S WORKS.
Table Traits, with Something on them. By Dr. Doran, Author of
“Habits and Men,” &c., &c. 12mo., cloth. Price $1 25. Half calf, or
mor. ex., $2 25.
BILL OF FARE.
The Legend of Amphitryon—A Prologue.
Diet and Digestion.—Water—Breakfast,
Corn, Bread, &c.—Tea—Coffee—Chocolate.
The Old Coffee House.—The French Cafés.
The Ancient Cook and his Art.
The Modern Cook and his Science.
Pen and Ink Sketches of Careme.
Dinner Traits.—The Materials for Dining.
A Light Dinner for Two.—Sauces.
The Parasite.
Table Traits of Utopia and the Golden Age.
Table Traits of England in the Early Times.
Table Traits of the Last Century.
Wine and Water.
The Birth of the Vine, and what has come of it.
The Making and Marring of Wine.
Imperial Drinkers, and Incidents in Germany.—An
Incident of Travel.
A few odd Glasses of Wine. [Egyptian]
The Tables of the Ancient and Modern
The Diet of the Saints of Old.
The Bridal and Banquet of Ferques.
The Support of Modern Saints.
The Cæsars at Table.
Their Majesties at Meat.
English Kings at their Tables.
Strange Banquets—The Castellan Von Coucy.
Authors and their Dietetics.
The Liquor-loving Laureates.
Supper.
Nearly every page contains something amusing, and you may
shut the book in the middle, and open it again after a
twelvemonth’s interval, without at all compromising its power of
affording enjoyment.—The London Times.
Habits and Men, with Remnants of Record touching the Makers of
both. By Dr. Doran, author of “Table Traits,” &c., &c. 12mo.,
cloth, $1. Half calf, or mor. extra, $2 00.
CONTENTS.
Between You and Me.
Man Manners, and a Story with a Moral to it.
Adonis at Home and Abroad—Pt. I.—Pt. II.
Remnants of Stage Dresses.
Three Acts and an Epilogue.
The Tiring-Bowers of Queens “La Mode
in her Birth-place.”
Hats, Wigs and their Wearers.
Beards and their Bearers.—Swords.
Gloves, B—s, and Buttons.—Stockings.
“Masks and Faces.”
Puppets for Grown Gentlemen.
Touching Tailors.
The Tailors Measured by the Poets.
Sir John Hawkwood, the Heroic Tailor.
Why did the Tailors choose St. William for
their Patron?
George Dörfling, the Martial Tailor.
Admiral Hobson, the Naval Tailor.
John Stow, the Antiquarian Tailor.
John Speed, the Antiquarian Tailor.
Samuel Pepys, the Official Tailor.
Richard Ryan, the Theatrical Tailor.
Paul Whitehead, the Poet Tailor.
Mems. of “Merchant Tailors.”
Chapters on Beaux.
The Beaux of the Olden Time.
Beau Fielding—Beau Nash.
The Prince de Ligne—Beau Brummel.
Doctors Ready Dressed—Odd Fashions.
This is one of the most amusing and erudite books of the day,
abounding in anecdote and queer stories of the dress of different
ages, of kings and queens, poets, statesmen, tailors, &c. The
sketches of the “tiring-bowers” of queens, of Paul Whitehead, the
poet tailor; of Beau Nash, and Beau Fielding, are rich in lore, and
are produced in sparkling style.—Boston Courier.
The Lives of the Queens of England of the House of Hanover. By
Dr. Doran. 2 vols., 12mo., cloth, $2. Half calf, or mor. extra, $4
00.
CONTENTS.
Sophia Dorothea, Wife of George I.
Caroline Wilhelmina Dorothea, Wife of George II.
Charlotte, Wife of George III.
Caroline of Brunswick, Wife of George IV.
Dr. Doran has availed himself of the ample material scattered
through personal memoirs, pamphlets, periodicals, and other
fugitive literature of the time, with the thoroughness, quick eye for
humor, and appreciation of the picturesque, which characterize
his other amusing works.
KNIGHTS AND THEIR DAYS.
 KNIGHTS

A N D T H E I R D AY S

BY DR. DORAN
AUTHOR OF “LIVES OF THE QUEENS OF ENGLAND OF THE HOUSE OF HANOVER,”
“TABLE TRAITS,” “HABITS AND MEN,” ETC.

“Oh, ’tis a brave profession, and rewards

All loss we meet, with double weight of glory.”
Shirley (The Gentleman of Venice.)

REDFIELD
3 4 B E E K M A N S T R E E T, N E W Y O R K
1856
 TO

PHILIPPE WATIER, ESQ.

IN MEMORY OF MERRY NIGHTS AND DAYS NEAR METZ AND THE
MOSELLE,
THIS LITTLE VOLUME

Is inscribed
BY HIS VERY SINCERE FRIEND,
THE AUTHOR.
 CONTENTS.

PAGE
A FRAGMENTARY PROLOGUE
9
THE TRAINING OF PAGES 30
KNIGHTS AT HOME 36
LOVE IN CHEVALIERS, AND CHEVALIERS IN LOVE 51
DUELLING, DEATH, AND BURIAL 65
THE KNIGHTS WHO “GREW TIRED OF IT” 78
FEMALE KNIGHTS AND JEANNE DARC 104
THE CHAMPIONS OF CHRISTENDOM 113
SIR GUY OF WARWICK, AND WHAT BEFELL HIM 133
GARTERIANA 148
FOREIGN KNIGHTS OF THE GARTER 170
THE POOR KNIGHTS OF WINDSOR, AND THEIR DOINGS 184
THE KNIGHTS OF THE SAINTE AMPOULE 194
THE ORDER OF THE HOLY GHOST 200
JACQUES DE LELAING 208
THE FORTUNES OF A KNIGHTLY FAMILY 228
THE RECORD OF RAMBOUILLET 263
SIR JOHN FALSTAFF 276
STAGE KNIGHTS 295
STAGE LADIES, AND THE ROMANCE OF HISTORY 312
THE KINGS OF ENGLAND AS KNIGHTS; FROM THE NORMANS TO
THE
STUARTS 329
“THE INSTITUTION OF A GENTLEMAN” 351
THE KINGS OF ENGLAND AS KNIGHTS; THE STUARTS 358
THE SPANISH MATCH 364
THE KINGS OF ENGLAND AS KNIGHTS; FROM STUART TO
375
BRUNSWICK
RECIPIENTS OF KNIGHTHOOD 388
RICHARD CARR, PAGE, AND GUY FAUX, ESQUIRE 410
ULRICH VON HUTTEN 420
SHAM KNIGHTS 439
PIECES OF ARMOR 455
 THE

KNIGHTS AND THEIR DAYS.

 A FRAGMENTARY PROLOGUE.
“La bravoure est une qualité innée, on ne se la donne pas.”
Napoleon I.

Dr. Lingard, when adverting to the sons of Henry II., and their
knightly practices, remarks that although chivalry was considered the
school of honor and probity, there was not overmuch of those or of
any other virtues to be found among the members of the chivalrous
orders. He names the vices that were more common, as he thinks,
and probably with some justice. Hallam, on the other hand, looks on
the institution of chivalry as the best school of moral discipline in the
Middle Ages: and as the great and influential source of human
improvement. “It preserved,” he says, “an exquisite sense of honor,
which in its results worked as great effects as either of the powerful
spirits of liberty and religion, which have given a predominant
impulse to the moral sentiments and energies of mankind.”
The custom of receiving arms at the age of manhood is supposed,
by the same author, to have been established among the nations
that overthrew the Roman Empire; and he cites the familiar passage
from Tacitus, descriptive of this custom among the Germans. At first,
little but bodily strength seems to have been required on the part of
the candidate. The qualifications and the forms of investiture
changed or improved with the times.
In a general sense, chivalry, according to Hallam, may be referred to
the age of Charlemagne, when the Caballarii, or horsemen, became
the distinctive appellation of those feudal tenants and allodial
proprietors who were bound to serve on horseback. When these
were equipped and formally appointed to their martial duties, they
were, in point of fact, knights, with so far more incentives to
distinction than modern soldiers, that each man depended on
himself, and not on the general body. Except in certain cases, the
individual has now but few chances of distinction; and knighthood, in
its solitary aspect, may be said to have been blown up by
gunpowder.
As examples of the true knightly spirit in ancient times, Mr. Hallam
cites Achilles, who had a supreme indifference for the question of
what side he fought upon, had a strong affection for a friend, and
looked at death calmly. I think Mr. Hallam over-rates the bully Greek
considerably. His instance of the Cid Ruy Diaz, as a perfect
specimen of what the modern knight ought to have been, is less to
be gainsaid.
In old times, as in later days, there were knights who acquired the
appellation by favor rather than service; or by a compelled rather
than a voluntary service. The old landholders, the Caballarii, or
Milites, as they came to be called, were landholders who followed
their lord to the field, by feudal obligation: paying their rent, or part of
it, by such service. The voluntary knights were those “younger
brothers,” perhaps, who sought to amend their indifferent fortunes by
joining the banner of some lord. These were not legally knights, but
they might win the honor by their prowess; and thus in arms, dress,
and title, the younger brother became the equal of the wealthy
landholders. He became even their superior, in one sense, for as Mr.
Hallam adds:—“The territorial knights became by degrees ashamed
of assuming a title which the others had won by merit, till they
themselves could challenge it by real desert.”
The connection of knighthood with feudal tenure was much
loosened, if it did not altogether disappear, by the Crusades. There
the knights were chiefly volunteers who served for pay: all feudal
service there was out of the question. Its connection with religion
was, on the other hand, much increased, particularly among the
Norman knights who had not hitherto, like the Anglo-Saxons, looked
upon chivalric investiture as necessarily a religious ceremony. The
crusaders made religious professors, at least, of all knights, and
never was one of these present at the reading of the gospel, without
holding the point of his sword toward the book, in testimony of his
desire to uphold what it taught by force of arms. From this time the
passage into knighthood was a solemn ceremony; the candidate was
belted, white-robed, and absolved after due confession, when his
sword was blessed, and Heaven was supposed to be its director.
With the love of God was combined love for the ladies. What was
implied was that the knight should display courtesy, gallantry, and
readiness to defend, wherever those services were required by
defenceless women. Where such was bounden duty—but many
knights did not so understand it—there was an increase of
refinement in society; and probably there is nothing overcharged in
the old ballad which tells us of a feast at Perceforest, where eight
hundred knights sat at a feast, each of them with a lady at his side,
eating off the same plate; the then fashionable sign of a refined
friendship, mingled with a spirit of gallantry. That the husbands
occasionally looked with uneasiness upon this arrangement, is
illustrated in the unreasonably jealous husband in the romance of
“Lancelot du Lac;” but, as the lady tells him, he had little right to cavil
at all, for it was an age since any knight had eaten with her off the
same plate.
Among the Romans the word virtue implied both virtue and valor—as
if bravery in a man were the same thing as virtue in a woman. It
certainly did not signify among Roman knights that a brave man was
necessarily virtuous. In more recent times the word gallantry has
been made also to take a double meaning, implying not only courage
in man, but his courtesy toward woman. Both in ancient and modern
times, however, the words, or their meanings, have been much
abused. At a more recent period, perhaps, gallantry was never better
illustrated than when in an encounter by hostile squadrons near
Cherbourg, the adverse factions stood still, on a knight, wearing the
colors of his mistress, advancing from the ranks of one party, and
challenging to single combat the cavalier in the opposite ranks who
was the most deeply in love with his mistress. There was no lack of
adversaries, and the amorous knights fell on one another with a fury
little akin to love.
A knight thus slain for his love was duly honored by his lady and
contemporaries. Thus we read in the history of Gyron le Courtois,
that the chivalric king so named, with his royal cousin Melyadus, a
knight, by way of equerry, and a maiden, went together in search of
the body of a chevalier who had fallen pour les beaux yeux of that